TY - JOUR T1 - Dyadic profiles of couples' self-perceptions of aging: Implications for mental health. JF - Psychology and Aging Y1 - 2024 A1 - Huo, Meng A1 - Kim, Kyungmin KW - Aged KW - Aging KW - Humans KW - Mental Health KW - Resilience, Psychological KW - Retirement KW - Self Concept AB -

The way older adults perceive their own aging processes influences their mental health, but we know little about how this occurs in a dyadic context, where spouses' perceptions and health are often intertwined. The present study sought to identify dyadic profiles of self-perceptions of aging (SPAs) in couples and examine how certain profiles are associated with each partner's mental health over time. A pooled sample of 3,850 heterosexual couples aged 50+ in the Health and Retirement Study (2012/2014) rated positive and negative SPAs and provided data on demographic characteristics, couple relationships, and health. We tracked these couples' depressive symptoms over 2 years (2014/2016). Latent profile analysis revealed five profiles of couples' SPAs: similarly positive (20%), similarly negative (6%), similarly average (38%), husband negative (20%), and wife negative (17%). Physical health and marital quality consistently differentiated couples in profile membership. Couples with similarly positive and similarly average SPAs reported the smallest increases in depressive symptoms over time, and couples with similarly negative SPAs fared worst in mental health. We observed interesting gender differences across profiles; husbands in the husband negative profile reported significantly greater increases in depressive symptoms than those in the wife negative profile. Yet, wives in these two profiles did not differ in their depressive symptoms over time, and they reported worse mental health than wives in the similarly positive and similarly average profiles. This study adds to the emerging literature that advocates for an interpersonal approach to SPAs and reveals risk and resilience in couples as they age together. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

VL - 39 IS - 2 ER - TY - JOUR T1 - Food Insecurity, Race and Ethnicity, and Cognitive Function Among United States Older Adults. JF - The Journal of Nutrition Y1 - 2024 A1 - Wang, Haowei A1 - El-Abbadi, Naglaa KW - Aged KW - Cognition KW - Cognitive Dysfunction KW - ethnicity KW - Food insecurity KW - Food Supply KW - Humans KW - Middle Aged KW - Minority Groups KW - Racial Groups KW - United States AB -

BACKGROUND: Cognitive impairment and dementia are severe public health issues in aging populations, which can be exacerbated by insufficient or unhealthy dietary intake. Food (in)security status is linked to cognitive function among older adults, but the relationship is complex and can vary by sociodemographic characteristics.

OBJECTIVE: This article aimed to investigate the association between food insecurity and cognitive function among United States older adults and explore potential variations by race and ethnicity groups.

METHODS: We prospectively examined changes in cognitive function and incidence of cognitive impairment alongside the presence of self-reported food insecurity among older adults of different racial and ethnic groups. Data were from the 2012-2018 Health and Retirement Study (HRS) and the 2013 Health Care and Nutrition Study (HCNS), including N = 6,638 United States adults aged 50 years and older. Food insecurity was measured by a self-reported United States Household Food Security Survey Module, and cognitive function was assessed by the modified version of the Telephone Interview for Cognitive Status.

RESULTS: Results showed that 17% of United States older adults reported food insecurity in the 2013 HCNS. Compared with food secure older adults, those reporting food insecurity experienced worsened cognitive functioning over time (B = -0.63, p < .001), and they were more likely to have onset of cognitive impairment (OR= 1.46, p < .001) in the 6-y observation. Compared with non-Hispanic White older adults, being non-Hispanic Black, non-Hispanic Other, or Hispanic was associated with 2.96, 2.09, or 1.26 odds (p < .001) of cognitive impairment (2012-2018), respectively. Older adults of racial and ethnic minority groups also had higher risks of experiencing the double burden of cognitive impairment alongside food insecurity compared with non-Hispanic White older adults.

CONCLUSION: Findings underscore racial and ethnic structural disparities in food security and cognitive health in the United States aging population.

VL - 154 IS - 1 ER - TY - JOUR T1 - Food Security and Health Outcomes following Gray Divorce. JF - Nutrients Y1 - 2024 A1 - Zhao, Hang A1 - Andreyeva, Tatiana A1 - Sun, Xiaohan KW - Adult KW - Aged KW - Divorce KW - Female KW - Food security KW - Food Supply KW - Humans KW - Marriage KW - Outcome Assessment, Health Care KW - Retirement KW - United States AB -

The study evaluates the immediate and long-term consequences of gray divorce (i.e., marital dissolution after age 50) for the food security, depression, and disability of older Americans. Staggered Difference-in-Difference models were fitted to a nationally representative longitudinal sample of adults aged ≥ 50 years from the Health and Retirement Study, 1998-2018. Food insecurity and disability increase in the year of gray divorce and remain significantly elevated for up to six years or more following the event, consistent with the chronic strain model of gray divorce. Gray divorce has particularly adverse consequences for the food security of older women, while no gender differences were observed for disability. Increasing trends in gray divorce have important negative implications for food security and health of older Americans, particularly women, who appear to be less prepared to financially withstand a marital collapse in older age. Targeted policies to provide nutrition assistance and support in reemployment might be necessary to reduce the burden of food insecurity in the wake of gray divorce among women.

VL - 16 IS - 5 ER - TY - JOUR T1 - The long and the short of it: Salivary telomere length as a candidate biomarker for hypertension and age-related changes in blood pressure. JF - Physiological Reports Y1 - 2024 A1 - Speer, Hollie A1 - McKune, Andrew J A1 - Woodward, Andrew P KW - Aged KW - Bayes Theorem KW - Biomarkers KW - Blood pressure KW - Female KW - Humans KW - Hypertension KW - Telomere KW - Telomere Shortening AB -

Hypertension becomes more prevalent with increasing age. Telomere length (TL) has been proposed as a candidate biomarker and can be accessibly extracted from saliva. However, clarity is needed to evaluate the suitability of using TL as a predictor in such instances. This study investigated salivary TL in a cohort of older adults from the 2008 Health and Retirement Study (n = 3329; F: 58%, mean age: 69.4, SD: 10.3 years) to examine any associations with blood pressure (BP). A Bayesian robust regression model was fit using weakly informative priors to predict the effects of TL with age, sex, systolic BP (SBP), diastolic BP (DBP), and treatment status. There were small effects of treatment (β: -0.07, 95% CrI [-0.33, 0.19], pd: 71.91%) and sex (β: -0.10, 95% CrI [-0.27, 0.07], pd: >86.78%). Population effects showed a reduction of 0.01 log units in TL with each year of advancing age (95% CrI [-0.01, -0.00]). Conditional posterior predictions suggest that females, and treated individuals, experience greater change in TL with increasing age. Bayes R was ~2%. TL declines with increasing age, differs between sexes, and appears to be influenced by antihypertensive drugs. Overall, all effects were weak. The data do not currently support the suitability of salivary TL as a biomarker to predict or understand any age-related changes in BP.

VL - 12 IS - 1 ER - TY - JOUR T1 - Neighborhood Social Environment and Dementia: The Mediating Role of Social Isolation. JF - Journal of Applied Gerontology, Series B, Psychological Sciences and social sciences Y1 - 2024 A1 - Choi, Eun Young A1 - Cho, Gawon A1 - Chang, Virginia W KW - Aged KW - Dementia KW - Humans KW - Prospective Studies KW - Residence Characteristics KW - Social Environment KW - social isolation AB -

OBJECTIVES: Despite the potential importance of the neighborhood social environment for cognitive health, the connection between neighborhood characteristics and dementia remains unclear. This study investigated the association between the prospective risk of dementia and three distinct aspects of neighborhood social environment: socioeconomic deprivation, disorder, and social cohesion. We also examined whether objective and subjective aspects of individual-level social isolation may function as mediators.

METHODS: Leveraging data from the Health and Retirement Study (2006-2018; N = 9,251), we used Cox proportional hazards models to examine the association between time-to-dementia incidence and each neighborhood characteristic, adjusting for covariates and the propensity to self-select into disadvantaged neighborhoods. We used inverse odds weighting to decompose significant total effects of neighborhood characteristics into mediational effects of objective and subjective social isolation.

RESULTS: The risk of dementia was associated with deprivation and disorder but not low cohesion. In deprived neighborhoods, individuals had an 18% increased risk of developing dementia (cause-specific hazard ratio [CHR] = 1.18, 95% CI: 1.02 to 1.38), and those in disordered areas had a 27% higher risk (CHR = 1.27, 95% CI: 1.03 to 1.59). 20% of the disorder's effects were mediated by subjective social isolation, while the mediational effects of objective isolation were nonsignificant. Deprivation's total effects were not partitioned into mediational effects given its nonsignificant associations with the mediators.

DISCUSSION: Neighborhood deprivation and disorder may increase middle to older adults' risks of dementia. The disorder may adversely affect cognitive health through increasing loneliness. Our results suggest a clear need for dementia prevention targeting upstream neighborhood contexts, including the improvement of neighborhood conditions to foster social integration among residents.

VL - 79 IS - 4 ER - TY - JOUR T1 - Perceived neighborhood disorder and type 2 diabetes disparities in Hispanic, Black, and White Americans. JF - Frontiers in Public Health Y1 - 2024 A1 - Yu, Min Ying A1 - Velasquez, Alfredo J A1 - Campos, Belinda A1 - Robinette, Jennifer W KW - Adult KW - Aged KW - Diabetes Mellitus, Type 2 KW - ethnicity KW - Hispanic or Latino KW - Humans KW - Middle Aged KW - United States KW - White KW - White People AB -

INTRODUCTION: Approximately 32 million Americans have type 2 diabetes, and that number continues to grow. Higher prevalence rates are observed among certain subgroups, including members of marginalized racial/ethnic groups as well as residents of disordered neighborhoods (i.e., those with more trash and vandalism). Institutionalized discriminatory practices have resulted in disproportionate representation of marginalized racial/ethnic groups in disordered neighborhoods compared to non-Hispanic Whites. These neighborhood disparities may partially contribute to health disparities, given that signs of neighborhood disorder often relate to a general withdrawal from the neighborhood, minimizing opportunities for both physical and social engagement. Yet, research suggests variability across racial/ethnic groups both in reporting rates of neighborhood disorder and in the extent to which neighborhood disorder is interpreted as posing a threat to health and well-being.

METHODS: Using 2016-2018 Health and Retirement Study data (n = 10,419, mean age = 67 years), a representative sample of older US adults, this study examined the possibility of racial/ethnic differences in associations between perceived neighborhood disorder and type 2 diabetes risk. Participants reported their perceptions of neighborhood disorder and type 2 diabetes status. Weighted logistic regression models predicted type 2 diabetes risk by perceived neighborhood disorder, race/ethnicity, and their interaction.

RESULTS: Non-Hispanic Blacks and Hispanics had higher type 2 diabetes risk; these two groups also reported more disorder in their neighborhoods compared to non-Hispanic Whites. Perceiving more neighborhood disorder was associated with increased type 2 diabetes risk, but the interaction between race/ethnicity and disorder was not significant.

DISCUSSION: Findings from the current study suggest that the negative effects of perceiving neighborhood disorder, a neighborhood-level stressor, extend to increased type 2 diabetes risk.

VL - 12 ER - TY - JOUR T1 - The Potential of Informal Care for Self-Perceptions of Aging Among Older Community-Dwelling Adults: Longitudinal Findings From the Health and Retirement Study. JF - Journal of Applied Gerontology, Series B, Psychological Sciences and social sciences Y1 - 2024 A1 - Zwar, Larissa A1 - König, Hans-Helmut A1 - Hajek, André KW - Activities of Daily Living KW - Aged KW - Humans KW - Independent Living KW - Longitudinal Studies KW - Patient Care KW - Retirement KW - Self Concept KW - United States AB -

OBJECTIVES: This is the first study to analyze, whether receipt of (informal) care with (instrumental) activities of daily living (IADL/ADL) is associated with (positive and negative) self-perceptions of aging among community-dwelling older adults; and whether chronological age moderates these associations, using a longitudinal design.

METHODS: Longitudinal data of the Health and Retirement Study in the United States was used. The sample was composed of up to 9,198 observations of community-dwelling adults aged ≥50 years pooled over 6 waves (2008-2018). Receiving care at all and the amount of care received with (I)ADL were analyzed in association with positive and negative attitudes towards own aging (ATOA; 8-item modified Philadelphia Geriatric Center Morale Scale, positive and negative subscore). Adjusted fixed effects regression analyses with robust standard errors were calculated.

RESULTS: Transitioning into receipt of care with any (I)ADL was associated with lower positive ATOA but not with any change in negative ATOA. Chronological age moderated the association between receipt of informal care, primarily with IADL, and negative ATOA. More negative ATOA was found among care recipients between 50 and 64 years but less among care recipients aged ≥80 years.

DISCUSSION: Receiving any form of informal care was associated with an increase in internalized ageism, in particular among adults aged 50 to 64 years, but a decrease among those aged ≥80 years. Psycho-educative measures are recommended for adults with care needs to prevent a loss of positive self-perceptions of aging, and reduce the danger to their healthy aging, with the receipt of care.

VL - 79 IS - 3 ER - TY - JOUR T1 - The Prevalence of Cognitive Impairment Among Medicare Beneficiaries Who Use Outpatient Physical Therapy. JF - Physical Therapy Y1 - 2024 A1 - Miller, Matthew J A1 - Cenzer, Irena A1 - Barnes, Deborah E A1 - Kelley, Amy S A1 - Covinsky, Kenneth E KW - Aged KW - Cognitive Dysfunction KW - Cross-Sectional Studies KW - Dementia KW - Female KW - Humans KW - Male KW - Medicare KW - Mobility Limitation KW - Outpatients KW - pain KW - Physical Therapy Modalities KW - Prevalence KW - United States AB -

OBJECTIVE: The objective of this study was to estimate the prevalence of cognitive impairment (including cognitive impairment no dementia [CIND] and dementia) among Medicare fee-for-service beneficiaries who used outpatient physical therapy and to estimate the prevalence of cognitive impairment by measures that are relevant to rehabilitation practice.

METHODS: This cross-sectional analysis included 730 Medicare fee-for-service beneficiaries in the 2016 wave of the Health and Retirement Study with claims for outpatient physical therapy. Cognitive status, our primary variable of interest, was categorized as normal, CIND, or dementia using a validated approach, and population prevalence of cognitive impairment (CIND and dementia) was estimated by sociodemographic variables and Charlson comorbidity index score. Age-, gender- (man/woman), race-/ethnicity-adjusted population prevalence of CIND and dementia were also calculated for walking difficulty severity, presence of significant pain, self-reported fall history, moderate-vigorous physical activity (MVPA) ≤1×/week, and sleep disturbance frequency using multinomial logistic regression.

RESULTS: Among Medicare beneficiaries with outpatient physical therapist claims, the prevalence of any cognitive impairment was 20.3% (CIND:15.2%, dementia:5.1%). Cognitive impairment was more prevalent among those who were older, Black, had lower education attainment, or higher Charlson comorbidity index scores. The adjusted population prevalence of cognitive impairment among those who reported difficulty walking across the room was 29.8%, difficulty walking 1 block was 25.9%, difficulty walking several blocks was 20.8%, and no difficulty walking was 16.3%. Additionally, prevalence of cognitive impairment among those with MVPA ≤1×/week was 27.1% and MVPA >1×/week was 14.1%. Cognitive impairment prevalence did not vary by significant pain, self-reported fall history, or sleep disturbance.

CONCLUSION: One in 5 older adults who use outpatient physical therapist services have cognitive impairment. Furthermore, cognitive impairment is more common in older physical therapist patients who report worse physical function and less physical activity.

IMPACT: Physical therapists should consider cognitive screening for vulnerable older adults to inform tailoring of clinical practice toward a patient's ability to remember and process rehabilitation recommendations.

VL - 104 IS - 1 ER - TY - JOUR T1 - Purposeful and purposeless aging: Structural issues for sense of purpose and their implications for predicting life outcomes. JF - Developmental Psychology Y1 - 2024 A1 - Pfund, Gabrielle N A1 - Olaru, Gabriel A1 - Allemand, Mathias A1 - Hill, Patrick L KW - Aged KW - Aging KW - Humans KW - Longevity KW - Retirement KW - United States AB -

Despite the value of sense of purpose during older adulthood, this construct often declines with age. With some older adults reconsidering the relevance of purpose later in life, the measurement of purpose may suffer from variance issues with age. The current study investigated whether sense of purpose functions similarly across ages and evaluated if the predictive power of purpose on mental, physical, cognitive, and financial outcomes changes when accounting for a less age-affected measurement structure. Utilizing data from two nationwide panel studies (Health and Retirement Study: = 14,481; Midlife in the United States: = 4,030), the current study conducted local structural equation modeling and found two factors for the positively and negatively valenced purpose items in the Purpose in Life subscale (Ryff, 1989), deemed the purposeful and purposeless factor. These factors become less associated with each other at higher ages. When reproducing past findings with this two-factor structure, the current study found that the purposeful and purposeless factors predicted these outcomes in the same direction as would be suggested by past research, but the magnitude of these effects differed for some outcomes. The discussion focuses on the implications of what this means for our understanding of sense of purpose across the lifespan. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

VL - 60 IS - 1 ER - TY - JOUR T1 - Residential greenspace and major depression among older adults living in urban and suburban areas with different climates across the United States. JF - Environmental Research Y1 - 2024 A1 - Fossa, Alan J A1 - D'Souza, Jennifer A1 - Bergmans, Rachel A1 - Zivin, Kara A1 - Adar, Sara D KW - Aged KW - depression KW - Depressive Disorder, Major KW - Environmental Exposure KW - Female KW - Humans KW - Male KW - Mental Health KW - Middle Aged KW - Parks, Recreational KW - United States AB -

BACKGROUND AND AIM: Residential greenspace could alleviate depression - a leading cause of disability. Fewer studies of depression and greenspace have considered major depression, and, to our knowledge, none have considered how climate, which determines vegetation abundance and type, may change the impacts of greenspace. Our aim was to investigate whether residential greenspace is associated with major depression among older adults and explore effect modification by climate.

METHODS: We used biennial interviews between 2008 and 2016 from the Health and Retirement Study. We calculated greenness within walking distance of home addresses as the maximum NDVI for the year of each participant interview averaged within a 1 km buffer. Reflecting clinical criteria, a score of ≥5 on the CIDI-SF indicated major depression in the preceding 12-months. We characterized climate using Köppen-Geiger classifications. To estimate prevalence ratios, we used Poisson regression. Our models adjusted for sociodemographic characteristics, geography, annual sunshine, and bluespace.

RESULTS: The 21,611 eligible participants were 65 ± 10 years old on average, 55% female, 81% White, 12% Black, 10% Hispanic/Latino, and 31% had at least a 4-year college degree. The 12-month prevalence of a major depression was 8%. In adjusted models, more residential greenspace was associated with a lower prevalence of major depression (prevalence ratio per IQR, 0.91; 95% CI, 0.84 to 0.98). There was evidence of effect modification by climate (P forinteraction, 0.062). We observed stronger associations in tropical (prevalence ratio per IQR 0.69; 95% CI, 0.47 to 1.01) and cold (prevalence ratio per IQR, 0.83; 95% CI, 0.74 to 0.93) climates compared to arid (prevalence ratio per IQR 0.99; 95% CI, 0.90 to 1.09) and temperate (prevalence ratio per IQR 0.98; 95% CI, 0.86 to 1.11) climates.

CONCLUSIONS: Residential greenspace may help reduce major depression. However, climate may influence how people benefit from greenspace.

VL - 243 ER - TY - JOUR T1 - Variation in Home Healthcare Use by Dementia Status Among a National Cohort of Older Adults. JF - Journals of Gerontology. Series A Biological Sciences and Medical Sciences Y1 - 2024 A1 - Burgdorf, Julia G A1 - Ornstein, Katherine A A1 - Liu, Bian A1 - Leff, Bruce A1 - Brody, Abraham A A1 - McDonough, Catherine A1 - Ritchie, Christine S KW - Aged KW - Delivery of Health Care KW - Dementia KW - Home Care Services KW - Hospitalization KW - Humans KW - Medicare KW - United States AB -

BACKGROUND: Medicare-funded home healthcare (HHC) delivers skilled nursing, therapy, and related services through visits to the patient's home. Nearly one-third (31%) of HHC patients have diagnosed dementia, but little is currently known regarding how HHC utilization and care delivery differ for persons living with dementia (PLwD).

METHODS: We drew on linked 2012-2018 Health and Retirement Study and Medicare claims for a national cohort of 1 940 community-living older adults. We described differences in HHC admission, length of stay, and referral source by patient dementia status and used weighted, multivariable logistic and negative binomial models to estimate the relationship between dementia and HHC visit type and intensity while adjusting for sociodemographic characteristics, health and functional status, and geographic/community factors.

RESULTS: PLwD had twice the odds of using HHC during a 2-year observation period, compared to those without dementia (odds ratio [OR]: 2.03; p < .001). They were more likely to be referred to HHC without a preceding hospitalization (49.4% vs 32.1%; p < .001) and incurred a greater number of HHC episodes (1.4 vs 1.0; p < .001) and a longer median HHC length of stay (55.8 days vs 40.0 days; p < .001). Among post-acute HHC patients, PLwD had twice the odds of receiving social work services (unadjusted odds ratio [aOR]: 2.15; p = .008) and 3 times the odds of receiving speech-language pathology services (aOR: 2.92; p = .002).

CONCLUSIONS: Findings highlight HHC's importance as a care setting for community-living PLwD and indicate the need to identify care delivery patterns associated with positive outcomes for PLwD and design tailored HHC clinical pathways for this patient subpopulation.

VL - 79 IS - 3 ER - TY - JOUR T1 - ADHD genetic burden associates with older epigenetic age: mediating roles of education, behavioral and sociodemographic factors among older adults. JF - Clin Epigenetics Y1 - 2023 A1 - Arpawong, Thalida E A1 - Klopack, Eric T A1 - Jung K Kim A1 - Crimmins, Eileen M KW - Aged KW - Aging KW - Attention Deficit Disorder with Hyperactivity KW - Biomarkers KW - DNA Methylation KW - Educational Status KW - Epigenesis, Genetic KW - Humans KW - Middle Aged KW - sociodemographic factors AB -

BACKGROUND: Shortened lifespans are associated with having Attention Deficit Hyperactivity Disorder (ADHD), which is likely mediated by related behavioral and sociodemographic factors that are also associated with accelerated physiological aging. Such factors include exhibiting more depressive symptoms, more cigarette smoking, higher body mass index, lower educational attainment, lower income in adulthood, and more challenges with cognitive processes compared to the general population. A higher polygenic score for ADHD (ADHD-PGS) is associated with having more characteristic features of ADHD. The degree to which (1) the ADHD-PGS associates with an epigenetic biomarker developed to predict accelerated aging and earlier mortality is unknown, as are whether (2) an association would be mediated by behavioral and sociodemographic correlates of ADHD, or (3) an association would be mediated first by educational attainment, then by behavioral and sociodemographic correlates. We evaluated these relationships in a population-based sample from the US Health and Retirement Study, among N = 2311 adults age 50 and older, of European-ancestry, with blood-based epigenetic and genetic data. The ADHD-PGS was calculated from a prior genomewide meta-analysis. Epigenome-wide DNA methylation levels that index biological aging and earlier age of mortality were quantified by a blood-based biomarker called GrimAge. We used a structural equation modeling approach to test associations with single and multi-mediation effects of behavioral and contextual indicators on GrimAge, adjusted for covariates.

RESULTS: The ADHD-PGS was significantly and directly associated with GrimAge when adjusting for covariates. In single mediation models, the effect of the ADHD-PGS on GrimAge was partially mediated via smoking, depressive symptoms, and education. In multi-mediation models, the effect of the ADHD-PGS on GrimAge was mediated first through education, then smoking, depressive symptoms, BMI, and income.

CONCLUSIONS: Findings have implications for geroscience research in elucidating lifecourse pathways through which ADHD genetic burden and symptoms can alter risks for accelerated aging and shortened lifespans, when indexed by an epigenetic biomarker. More education appears to play a central role in attenuating negative effects on epigenetic aging from behavioral and sociodemographic risk factors related to ADHD. We discuss implications for the potential behavioral and sociodemographic mediators that may attenuate negative biological system effects.

VL - 15 IS - 1 ER - TY - JOUR T1 - [Analysis of healthy life expectancy and related socioeconomic influencing factors among the middle-aged and elderly in China, the United States, and the European Union]. JF - Zhonghua Liu Xing Bing Xue Za Zhi Y1 - 2023 A1 - Hou, X D A1 - Luo, Y N A1 - Jin, Y Z A1 - Zheng, Z J KW - Activities of Daily Living KW - Aged KW - China KW - European Union KW - Female KW - Healthy life expectancy KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Socioeconomic factors KW - United States AB -

To calculate and compare the healthy life expectancy (HLE) of the middle-aged and elderly in China, the United States, and developing and developed countries in the European Union(EU) and analyze the impact of socioeconomic factors on HLE in different countries or regions. Four surveys from 2010 to 2019 were brought into the research. The data were collected from the China Health and Retirement Longitudinal Study, Health and Retirement Study, and the Survey of Health, Ageing and Retirement in Europe. Developed and developing countries in the EU were divided into two groups for calculation. Education level, total family wealth, and work retirement status were selected to measure socioeconomic status, and activities of daily living were used as health status indicators. We used the multi-state life cycle table method to calculate the transition probability between different health states and estimate life expectancy and HLE. A total of 69 544 samples were included in the study. In terms of age, the middle-aged and elderly in the United States and developed countries of the EU have higher HLE in all age groups. In terms of gender, only Chinese women have lower HLE than men. Regarding socioeconomic factors, the middle-aged and elderly with higher education levels and total family wealth level have higher HLE. In China, working seniors have higher HLE, while for USA women and developed countries of the EU, retired or unemployed seniors have higher HLE. Demographic and socioeconomic factors impact HLE in different countries or regions. China should pay more attention to the health of women and the middle-aged and elderly retired with lower education and less total family wealth.

VL - 44 IS - 6 ER - TY - JOUR T1 - Apolipoprotein E (APOE) genotype, dementia, and memory performance among Caribbean Hispanic versus US populations. JF - Alzheimers Dement Y1 - 2023 A1 - Llibre-Guerra, Jorge J A1 - Li, Jing A1 - Qian, Yuting A1 - Llibre-Rodriguez, Juan de Jesús A1 - Jiménez-Velázquez, Ivonne Z A1 - Acosta, Daisy A1 - Salas, Aquiles A1 - Llibre-Guerra, Juan Carlos A1 - Valvuerdi, Adolfo A1 - Harrati, Amal A1 - Weiss, Jordan A1 - Liu, Mao-Mei A1 - Dow, William H KW - Aged KW - Alleles KW - Alzheimer disease KW - Apolipoprotein E4 KW - Apolipoproteins E KW - Caribbean Region KW - Female KW - Genotype KW - Hispanic or Latino KW - Humans KW - Male AB -

INTRODUCTION: Apolipoprotein E (APOE) is considered the major susceptibility gene for developing Alzheimer's disease. However, the strength of this risk factor is not well established across diverse Hispanic populations.

METHODS: We investigated the associations among APOE genotype, dementia prevalence, and memory performance (immediate and delayed recall scores) in Caribbean Hispanics (CH), African Americans (AA), Hispanic Americans (HA) and non-Hispanic White Americans (NHW). Multivariable logistic regressions and negative binomial regressions were used to examine these associations by subsample.

RESULTS: Our final dataset included 13,516 participants (5198 men, 8318 women) across all subsamples, with a mean age of 74.8 years. Prevalence of APOE ε4 allele was similar in CHs, HAs, and NHWs (21.8%-25.4%), but was substantially higher in AAs (33.6%; P < 0.001). APOE ε4 carriers had higher dementia prevalence across all groups.

DISCUSSION: APOE ε4 was similarly associated with increased relative risk of dementia and lower memory performance in all subsamples.

VL - 19 IS - 2 ER - TY - JOUR T1 - Association between BMI trajectories in late-middle age and subsequent dementia risk in older age: a 26-year population-based cohort study. JF - BMC Geriatrics Y1 - 2023 A1 - Qin, Zijian A1 - Liu, Zheran A1 - Li, Ruidan A1 - Luo, Yaxin A1 - Wei, Zhigong A1 - He, Ling A1 - Pei, Yiyan A1 - Su, Yonglin A1 - Hu, Xiaolin A1 - Peng, Xingchen KW - Aged KW - Body Mass Index KW - Cognition KW - Cohort Studies KW - Dementia KW - Humans KW - Risk Factors AB -

BACKGROUND: The association between body mass index (BMI) and dementia risk differs depending on follow-up time and age at BMI measurement. The relationship between BMI trajectories in late-middle age (50-65 years old) and the risk of dementia in older age (> 65 years old) has not been revealed.

METHODS: In the present study, participants from the Health and Retirement Study were included. BMI trajectories were constructed by combining BMI trend and variation information. The association between BMI trajectories at the age of 50-65 years and dementia risk after the age of 65 years was investigated. Participants with European ancestry and information on polygenic scores for cognitive performance were pooled to examine whether genetic predisposition could modify the association.

RESULTS: A total of 10,847 participants were included in the main analyses. A declining BMI trend and high variation in late-middle age were associated with the highest subsequent dementia risk in older age compared with an ascending BMI trend and low variation (RR = 1.76, 95% CI = 1.45-2.13). Specifically, in stratified analyses on BMI trajectories and dementia risk based on each individual's mean BMI, the strongest association between a declining BMI trend with high variation and elevated dementia risk was observed in normal BMI group (RR = 2.66, 95% CI = 1.72-4.1). Similar associations were found when participants were stratified by their genetic performance for cognition function without interaction.

CONCLUSIONS: A declining BMI trend and high variation in late-middle age were associated with a higher risk of dementia. Early monitoring of these individuals is needed to prevent dementia in older individuals.

VL - 23 IS - 1 ER - TY - JOUR T1 - Associations Between Longitudinal Loneliness, DNA Methylation Age Acceleration, and Cognitive Functioning. JF - The Journals of Gerontology, Series B, Psychological Sciences and Social Sciences Y1 - 2023 A1 - Lynch, Morgan A1 - Em Arpawong, Thalida A1 - Beam, Christopher R KW - Aged KW - Aging KW - Biomarkers KW - Cognition KW - DNA Methylation KW - Humans KW - Loneliness KW - Longitudinal Studies AB -

OBJECTIVES: Loneliness may influence aging biomarkers related to cognitive functioning, for example, through accelerated DNA methylation (DNAm) aging.

METHODS: In the present study, we tested whether six common DNAm age acceleration measures mediated the effects of baseline loneliness and five different longitudinal loneliness trajectories on general cognitive ability, immediate memory recall, delayed memory recall, and processing speed in 1,814 older adults in the Health and Retirement Study.

RESULTS: We found that baseline loneliness and individuals who belong to the highest loneliness trajectories had poorer general cognitive ability and memory scores. Only DNAm age acceleration measures that index physiological comorbidities, unhealthy lifestyle factors (e.g., smoking), and mortality risk-mediated effects of baseline loneliness on general cognitive ability and memory functioning but not processing speed. These same DNAm measures mediated effects of the moderate-but-declining loneliness trajectory on cognitive functioning. Additionally, immediate and delayed memory scores were mediated by GrimAge Accel in the lowest and two highest loneliness trajectory groups. Total and mediated effects of loneliness on cognitive functioning outcomes were mainly accounted for by demographic, social, psychological, and physiological covariates, most notably self-rated health, depressive symptomatology, objective social isolation, and body mass index.

DISCUSSION: Current findings suggest that DNAm biomarkers of aging, particularly GrimAge Accel, have promise for explaining the prospective association between loneliness and cognitive functioning outcomes.

VL - 78 IS - 12 ER - TY - JOUR T1 - Associations of Food Insecurity and Memory Function Among Middle to Older-Aged Adults in the Health and Retirement Study. JF - JAMA Netw Open Y1 - 2023 A1 - Lu, Peiyi A1 - Kezios, Katrina A1 - Jawadekar, Neal A1 - Swift, Samuel A1 - Vable, Anusha A1 - Zeki Al Hazzouri, Adina KW - Adult KW - Aged KW - Cohort Studies KW - Cross-Sectional Studies KW - Female KW - Food insecurity KW - Food Supply KW - Humans KW - Male KW - Memory Disorders KW - Middle Aged KW - Retirement AB -

IMPORTANCE: Food insecurity is a leading public health issue in the US. Research on food insecurity and cognitive aging is scarce, and is mostly cross-sectional. Food insecurity status and cognition both can change over the life course, but their longitudinal relationship remains unexplored.

OBJECTIVE: To examine the longitudinal association between food insecurity and changes in memory function during a period of 18 years among middle to older-aged adults in the US.

DESIGN, SETTING, AND PARTICIPANTS: The Health and Retirement Study is an ongoing population-based cohort study of individuals aged 50 years or older. Participants with nonmissing information on their food insecurity in 1998 who contributed information on memory function at least once over the study period (1998-2016) were included. To account for time-varying confounding and censoring, marginal structural models were created, using inverse probability weighting. Data analyses were conducted between May 9 and November 30, 2022.

MAIN OUTCOMES AND MEASURES: In each biennial interview, food insecurity status (yes/no) was assessed by asking respondents whether they had enough money to buy food or ate less than they felt they should. Memory function was a composite score based on self-completed immediate and delayed word recall task of a 10-word list and proxy-assessed validated instruments.

RESULTS: The analytic sample included 12 609 respondents (mean [SD] age, 67.7 [11.0] years, 8146 [64.60%] women, 10 277 [81.51%] non-Hispanic White), including 11 951 food-secure and 658 food-insecure individuals in 1998. Over time, the memory function of the food-secure respondents decreased by 0.045 SD units annually (β for time, -0.045; 95% CI, -0.046 to -0.045 SD units). The memory decline rate was faster among food-insecure respondents than food-secure respondents, although the magnitude of the coefficient was small (β for food insecurity × time, -0.0030; 95% CI, -0.0062 to -0.00018 SD units), which translates to an estimated 0.67 additional (ie, excess) years of memory aging over a 10-year period for food-insecure respondents compared with food-secure respondents.

CONCLUSIONS AND RELEVANCE: In this cohort study of middle to older-aged individuals, food insecurity was associated with slightly faster memory decline, suggesting possible long-term negative cognitive function outcomes associated with exposure to food insecurity in older age.

VL - 6 IS - 7 ER - TY - JOUR T1 - Associations of Social, Cultural, and Community Engagement With Health Care Utilization in the US Health and Retirement Study. JF - JAMA Netw Open Y1 - 2023 A1 - Gao, Qian A1 - Bone, Jessica K A1 - Bu, Feifei A1 - Paul, Elise A1 - Sonke, Jill K A1 - Fancourt, Daisy KW - Aged KW - Cohort Studies KW - Delivery of Health Care KW - Female KW - Hospitalization KW - Humans KW - Male KW - Middle Aged KW - Patient Acceptance of Health Care KW - Retirement AB -

IMPORTANCE: There is growing evidence for the health benefits associated with social, cultural, and community engagement (SCCE), including for supporting healthy behaviors. However, health care utilization is an important health behavior that has not been investigated in association with SCCE.

OBJECTIVE: To examine the associations between SCCE and health care utilization.

DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study used data from the 2008 to 2016 waves of the Health and Retirement Study (HRS), a longitudinal panel study using a nationally representative sample of the US population aged 50 years and older. Participants were eligible if they reported SCCE and health care utilization in the relevant HRS waves. Data were analyzed from July to September 2022.

EXPOSURES: SCCE was measured with a 15-item Social Engagement scale (including community, cognitive, creative, or physical activities) at baseline (frequency) and longitudinally over 4 years (no, consistent, increased, or decreased engagement).

MAIN OUTCOMES AND MEASURES: Health care utilization was assessed in association with SCCE within 4 overarching categories: inpatient care (ie, hospital stays, hospital readmissions, length of hospital stays), outpatient care (ie, outpatient surgery, physician visits, number of physician visits), dental care (including dentures), and community health care (ie, home health care, nursing home stays, nights in a nursing home).

RESULTS: A total of 12 412 older adults (mean [SE] age, 65.0 [0.1] years; 6740 [54.3%] women) were included in short-term analyses with 2 years of follow-up. Independent of confounders, more SCCE was associated with shorter hospital stays (incidence rate ratio [IRR], 0.75; 95% CI, 0.58-0.98), greater odds of outpatient surgery (odds ratio [OR], 1.34; 95% CI, 1.12-1.60) and dental care (OR, 1.73; 95% CI, 1.46-2.05), and lower odds of home health care (OR, 0.75; 95% CI, 0.57-0.99) and nursing home stays (OR, 0.46; 95% CI, 0.29-0.71). Longitudinal analysis included 8635 older adults (mean [SE] age, 63.7 [0.1] years; 4784 [55.4%] women) with data on health care utilization 6 years after baseline. Compared with consistent SCCE, reduced SCCE or consistent nonparticipation in SCCE was associated with more inpatient care utilization, such as hospital stays (decreased SCCE: IRR, 1.29; 95% CI, 1.00-1.67; consistent nonparticipation: IRR, 1.32; 95% CI, 1.04-1.68) but lower levels of subsequent outpatient care, such as physician visits (decreased SCCE: OR, 0.68; 95% CI, 0.50-0.93; consistent nonparticipation: OR, 0.62; 95% CI, 0.46-0.82) and dental care utilization (decreased SCCE: OR, 0.68; 95% CI, 0.57-0.81; consistent nonparticipation: OR, 0.51; 95% CI, 0.44-0.60).

CONCLUSIONS AND RELEVANCE: These findings suggest that more SCCE was associated with more dental and outpatient care utilization and reduced inpatient and community health care utilization. SCCE might be associated with shaping beneficial early and preventive health-seeking behaviors, facilitating health care decentralization and alleviating financial burden by optimizing health care utilization.

VL - 6 IS - 4 ER - TY - JOUR T1 - Biological expressions of early life trauma in the immune system of older adults. JF - PLoS One Y1 - 2023 A1 - Noppert, Grace A A1 - Duchowny, Kate A A1 - Stebbins, Rebecca A1 - Aiello, Allison E A1 - Dowd, Jennifer B A1 - Clarke, Philippa KW - Adolescent KW - Aged KW - Cytomegalovirus Infections KW - Humans KW - Immune System KW - Immunoglobulin G KW - Interleukin-6 KW - United States KW - White AB -

BACKGROUND: Poor immune function is associated with increased risk for a number of age-related diseases, however, little is known about the impact of early life trauma on immune function in late-life.

METHODS: Using nationally representative data from the Health and Retirement Study (n = 5,823), we examined the association between experiencing parental/caregiver death or separation before age 16 and four indicators of immune function in late-life: C-reactive Protein (CRP), Interleukin-6 (IL-6), soluble Tumor Necrosis Factor (sTNFR), and Immunoglobulin G (IgG) response to cytomegalovirus (CMV). We also examined racial/ethnic differences.

FINDINGS: Individuals that identified as racial/ethnic minorities were more likely to experience parental/caregiver loss and parental separation in early life compared to Non-Hispanic Whites, and had poorer immune function in late-life. We found consistent associations between experiencing parental/caregiver loss and separation and poor immune function measured by CMV IgG levels and IL-6 across all racial/ethnic subgroups. For example, among Non-Hispanic Blacks, those that experienced parental/caregiver death before age 16 had a 26% increase in CMV IgG antibodies in late-life (β = 1.26; 95% CI: 1.17, 1.34) compared to a 3% increase in CMV antibodies among Non-Hispanic Whites (β = 1.03; 95% CI: 0.99, 1.07) controlling for age, gender, and parental education.

INTERPRETATION: Our results suggest a durable association between experiencing early life trauma and immune health in late-life, and that structural forces may shape the ways in which these relationships unfold over the life course.

VL - 18 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/37343002?dopt=Abstract ER - TY - JOUR T1 - Breast and prostate cancer screening rates by cognitive status in US older adults. JF - J Am Geriatr Soc Y1 - 2023 A1 - Schoenborn, Nancy L A1 - Cidav, Tom A1 - Boyd, Cynthia M A1 - Pollack, Craig E A1 - Sekhon, Vishaldeep Kaur A1 - Yasar, Sevil KW - Aged KW - Breast Neoplasms KW - Cognition KW - Dementia KW - Early Detection of Cancer KW - Humans KW - Male KW - Mass Screening KW - Medicare KW - Prostate-Specific Antigen KW - Prostatic Neoplasms KW - United States AB -

INTRODUCTION: For most older adults with dementia, the short-term harms and burdens of routine cancer screening likely outweigh the delayed benefits. We aimed to provide a more updated assessment of the extent that US older adults with dementia receive breast and prostate cancer screenings.

METHODS: Using the Health and Retirement Study (HRS) Wave 12 (2014-2015) linked to Medicare, we examine rates of breast and prostate cancer screenings in adults 65+ years by cognitive status. We used claims data to identify eligibility for screening and receipt of screening. We used a validated method using HRS data to define cognitive status.

RESULTS: The analytic sample included 2439 women in the breast cancer screening cohort and 1846 men in the prostate cancer screening cohort. Average ages were 76.8 years for women and 75.6 years for men, with 9.0% and 7.6% with dementia in each cohort, respectively. Among women with dementia, 12.3% were screened for breast cancer. When stratified by age, 10.6% of those 75+ and have dementia were screened for breast cancer. When stratified by predicted life expectancy, 10.4% of those with predicted life expectancy of <10 years and have dementia were screened for breast cancer. Among men with dementia, 33.9% were screened for prostate cancer. When stratified by age, 30.9% of those 75+ and have dementia were screened for prostate cancer. When stratified by predicted life expectancy, 34.4% of those with predicted life expectancy of <10 years and have dementia were screened for prostate cancer. Using multivariable logistic regression, dementia was associated with lower odds of receiving breast cancer screening (OR 0.36, 95% CI 0.23-0.57) and prostate cancer screening (OR 0.58, 95% CI 0.36-0.96).

DISCUSSION: Our results suggest potential over-screening in older adults with dementia. Better supporting dementia patients and caregivers to make informed cancer screening decisions is critical.

VL - 71 IS - 5 ER - TY - JOUR T1 - Centrally Acting ACE Inhibitor Use and Physical Performance in Older Adults. JF - J Frailty Aging Y1 - 2023 A1 - George, C J A1 - Hall, C B A1 - Weiss, E F A1 - Verghese, J A1 - Neptune, E A1 - Abadir, P KW - Aged KW - Angiotensin-Converting Enzyme Inhibitors KW - Cross-Sectional Studies KW - Hand Strength KW - Humans KW - Muscle Strength KW - Physical Functional Performance AB -

BACKGROUND: There is conflicting evidence regarding the role of angiotensin-converting enzyme inhibitors and physical function. While some studies show improvements in muscle strength and physical function, others show no significant difference or decreased performance. This ambiguity could be due to differential effects of angiotensin-converting enzyme inhibitor subtypes which can be categorized as centrally or peripherally-acting based upon their ability to cross the blood-brain barrier.

OBJECTIVE: The objective of this study is to compare physical performance measures among angiotensin-converting enzyme inhibitor subtype users.

METHODS: Design: Cross-sectional Setting: Ambulatory Participants: Performed in 364 participants in the Health and Retirement Study cohort who were ≥ 65 years (median age (IQR) 74.00 (69-80) years.

MEASUREMENTS: Average difference in hand grip (kg), gait speed(m/s) and peak expiratory flow (L/min).

RESULTS: Compared to participants on a peripherally-acting angiotensin-converting enzyme inhibitor (113 (31%)), those on a centrally-acting agent (251(69%)) had stronger grip strength 28.9 ±1.0 vs 26.3±1.0, p=.011 and higher peak expiratory flow rates 316.8±130.4 vs. 280.0±118.5, p= .011 in unadjusted analysis. After multiple adjustments the difference in PEF remained statistically significant (Estimate(CI) 26.5, 95% CI 2.24, 50.5, p = 0.032).

CONCLUSION: Our results suggest that in older adults the use of centrally-acting angiotensin-converting enzyme inhibitors compared to a peripherally acting angiotensin-converting enzyme inhibitors was associated with better lung function in older individuals.

VL - 12 IS - 2 ER - TY - JOUR T1 - Change in Purpose in Life Before and After Onset of Cognitive Impairment. JF - JAMA Network Open Y1 - 2023 A1 - Sutin, Angelina R A1 - Luchetti, Martina A1 - Stephan, Yannick A1 - Terracciano, Antonio KW - Aged KW - Aging KW - Awareness KW - Cognitive Dysfunction KW - Cohort Studies KW - Female KW - Humans KW - Male KW - Middle Aged KW - Retirement AB -

IMPORTANCE: Purpose in life is a critical aspect of psychological well-being that is associated with better cognitive outcomes across the continuum of dementia. To our knowledge, the natural history of purpose with onset of cognitive impairment has yet to be evaluated.

OBJECTIVE: To evaluate changes in purpose in life prior to and after onset of cognitive impairment.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used assessments of purpose in life and cognitive status from March 2006 to May 2021 in the Health and Retirement Study (HRS) and from May 2011 to November 2021 in the National Health and Aging Trends Study (NHATS).

EXPOSURE: Cognitive impairment at each wave based on established thresholds in HRS and NHATS.

MAIN OUTCOMES AND MEASURES: The main outcome was purpose in life, measured with the Ryff Measures of Psychological Well-Being in HRS and a validated item in NHATS.

RESULTS: In HRS, 22 668 participants provided 50 985 assessments of purpose across all waves. In NHATS, 10 786 participants provided 53 880 assessments of purpose across all waves. In HRS, 58.3% of participants were female, with mean (SD) age of 64.76 (10.41) years at baseline; in NHATS, 57.4% were female, with mean (SD) age of 76.82 (7.71) years at baseline. Across waves, 6794 HRS participants (30%) and 4446 NHATS participants (41.2%) were in the cognitive impairment range. Accounting for demographic covariates and normative change in purpose, multilevel modeling indicated that standardized purpose in life declined significantly prior to onset of cognitive impairment (estimate for 10 years) in both HRS (b = -0.12; 95% CI, -0.17 to -0.07; P < .001) and NHATS (b = -0.10; 95% CI, -0.20 to -0.01; P = .03). Purpose declined significantly more rapidly following onset of cognitive impairment, with a standardized decline nearly 3 times larger compared with prior to impairment in HRS (b = -0.35; 95% CI, -0.41 to -0.29; P < .001) and 4 times larger in NHATS (b = -0.44; 95% CI, -0.53 to -0.34; P < .001).

CONCLUSIONS AND RELEVANCE: In this cohort study, purpose in life declined with emergence of cognitive impairment. The decline before onset was too small to be useful to detect impending impairment in clinical settings. The steeper decline following impairment suggests that individuals are aware that their purpose is declining. Purpose may be an intervention target following cognitive impairment to maintain well-being and to reduce or slow emergence of behavioral symptoms associated with low purpose.

VL - 6 IS - 9 ER - TY - JOUR T1 - Changes in Self-Perceptions of Aging Among Black and White Older Adults: The Role of Volunteering. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2023 A1 - Huo, Meng A1 - Kim, Kyungmin A1 - Haghighat, Misha D KW - Aged KW - Aging KW - Black People KW - Humans KW - Racial Groups KW - Self Concept KW - United States KW - White AB -

OBJECTIVES: Given the health consequences of self-perceptions of aging (SPA), understanding how SPA change among Black and White older adults may shed light on racial disparities in late-life health. The current study is the first to assess whether Black older adults exhibit less favorable patterns of change in SPA than White older adults. We also tested whether the salubrious effect of volunteering on SPA would be particularly salient among Black older adults.

METHODS: A pooled sample of adults aged 50+ (N = 10,183; Black: n = 1,672, White: n = 8,511) from the Health and Retirement Study rated positive and negative SPA once every 4 years across 3 waves (2008/2010, 2012/2014, and 2016/2018). We assessed participants' reports on volunteering status in each wave.

RESULTS: Growth curve models revealed that positive SPA decreased over time whereas negative SPA increased. Black older adults reported more positive and less negative SPA at baseline and flatter time-related changes than their White counterparts. We found that volunteering was significantly associated with more positive and less negative SPA across waves, but this effect was only evident in White older adults.

DISCUSSION: Findings revealed vulnerabilities in White older adults as they experience and perceive age-related changes but also identified volunteering as a way to uniquely protect them. More research is needed to refine our understanding of racial disparities in the United States and help tailor interventions intended to maximize benefits to older adults from diverse backgrounds.

VL - 78 IS - 5 ER - TY - JOUR T1 - CogDrisk, ANU-ADRI, CAIDE, and LIBRA Risk Scores for Estimating Dementia Risk. JF - JAMA Netw Open Y1 - 2023 A1 - Huque, Md Hamidul A1 - Kootar, Scherazad A1 - Eramudugolla, Ranmalee A1 - Han, S Duke A1 - Carlson, Michelle C A1 - Lopez, Oscar L A1 - Bennett, David A A1 - Peters, Ruth A1 - Anstey, Kaarin J KW - Aged KW - Aged, 80 and over KW - Alzheimer disease KW - Australia KW - Cohort Studies KW - Female KW - Heart Disease Risk Factors KW - Humans KW - Male KW - Risk Factors AB -

IMPORTANCE: While the Australian National University-Alzheimer Disease Risk Index (ANU-ADRI), Cardiovascular Risk Factors, Aging, and Dementia (CAIDE), and Lifestyle for Brain Health (LIBRA) dementia risk tools have been widely used, a large body of new evidence has emerged since their publication. Recently, Cognitive Health and Dementia Risk Index (CogDrisk) and CogDrisk for Alzheimer disease (CogDrisk-AD) risk tools have been developed for the assessment of dementia and AD risk, respectively, using contemporary evidence; comparison of the relative performance of these risk tools is limited.

OBJECTIVE: To evaluate the performance of CogDrisk, ANU-ADRI, CAIDE, LIBRA, and modified LIBRA (LIBRA with age and sex estimates from ANU-ADRI) in estimating dementia and AD risks (with CogDrisk-AD and ANU-ADRI).

DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study obtained data from the Rush Memory and Aging Project (MAP), the Cardiovascular Health Study Cognition Study (CHS-CS), and the Health and Retirement Study-Aging, Demographics and Memory Study (HRS-ADAMS). Participants who were free of dementia at baseline were included. The factors were component variables in the risk tools that included self-reported baseline demographics, medical risk factors, and lifestyle habits. The study was conducted between November 2021 and March 2023, and statistical analysis was performed from January to June 2023.

MAIN OUTCOMES AND MEASURES: Risk scores were calculated based on available factors in each of these cohorts. Area under the receiver operating characteristic curve (AUC) was calculated to measure the performance of each risk score. Multiple imputation was used to assess whether missing data may have affected estimates for dementia risk.

RESULTS: Among the 6107 participants in 3 validation cohorts included for this study, 2184 participants without dementia at baseline were available from MAP (mean [SD] age, 80.0 [7.6] years; 1606 [73.5%] female), 548 participants without dementia at baseline were available from HRS-ADAMS (mean [SD] age, 79.5 [6.3] years; 288 [52.5%] female), and 3375 participants without dementia at baseline were available from CHS-CS (mean [SD] age, 74.8 [4.9] years; 1994 [59.1%] female). In all 3 cohorts, a similar AUC for dementia was obtained using CogDrisk, ANU-ADRI, and modified LIBRA (MAP cohort: CogDrisk AUC, 0.65 [95% CI, 0.61-0.69]; ANU-ADRI AUC, 0.65 [95% CI, 0.61-0.69]; modified LIBRA AUC, 0.65 [95% CI, 0.61-0.69]; HRS-ADAMS cohort: CogDrisk AUC, 0.75 [95% CI, 0.71-0.79]; ANU-ADRI AUC, 0.74 [95% CI, 0.70-0.78]; modified LIBRA AUC, 0.75 [95% CI, 0.71-0.79]; CHS-CS cohort: CogDrisk AUC, 0.70 [95% CI, 0.67-0.72]; ANU-ADRI AUC, 0.69 [95% CI, 0.66-0.72]; modified LIBRA AUC, 0.70 [95% CI, 0.68-0.73]). The CAIDE and LIBRA also provided similar but lower AUCs than the 3 aforementioned tools (eg, MAP cohort: CAIDE AUC, 0.50 [95% CI, 0.46-0.54]; LIBRA AUC, 0.53 [95% CI, 0.48-0.57]). The performance of CogDrisk-AD and ANU-ADRI in estimating AD risks was also similar.

CONCLUSIONS AND RELEVANCE: CogDrisk and CogDrisk-AD performed similarly to ANU-ADRI in estimating dementia and AD risks. These results suggest that CogDrisk and CogDrisk-AD, with a greater range of modifiable risk factors compared with other risk tools in this study, may be more informative for risk reduction.

VL - 6 IS - 8 ER - TY - JOUR T1 - Comparison of sex differences in cognitive function in older adults between high- and middle-income countries and the role of education: a population-based multicohort study. JF - Age Ageing Y1 - 2023 A1 - Bloomberg, Mikaela A1 - Dugravot, Aline A1 - Sommerlad, Andrew A1 - Kivimäki, Mika A1 - Singh-Manoux, Archana A1 - Sabia, Séverine KW - Aged KW - Cognition KW - Developing Countries KW - Educational Status KW - Female KW - Humans KW - Income KW - Male KW - Middle Aged KW - Sex Characteristics KW - United States AB -

BACKGROUND: The extent to which education explains variations in sex differences in cognitive function between countries at different levels of economic development is unknown. We examined the role of education in sex differences in four cognitive domains in high- and middle-income countries.

METHODS: Analyses were based on 70,846 participants, aged 60 years and older, in cohort studies from a high-income (United States) and four middle-income countries (Mexico, Brazil, China, and India). We used weighted linear models to allow nationally-representative comparisons of sex differences in orientation, memory, attention, and fluency using the United States as the reference, before and after adjustment for education, and after stratification by education.

RESULTS: Females had lower levels of education than males in all countries, particularly in India. Before adjustment for education, sex differences in orientation and attention in all middle-income countries, memory in Brazil, China, and India, and fluency in India were less favourable to females than in the United States (P < 0.010). For example, females outperformed males in memory in the United States (mean difference [male-female scores] = -0.26 standard deviations [95% CI -0.30, -0.22]) but not in China (0.15 [0.09, 0.21]) or India (0.16 [0.13, 0.19]). Adjustment for education attenuated these sex differences. In analyses stratified by education, there were minimal sex differences in the high education group in all countries.

CONCLUSION: Education contributes to larger female disadvantages in cognitive function at older ages in middle-income countries compared with the United States. Gender equity in education is an important target to reduce sex disparities in cognitive function globally.

VL - 52 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/36821646?dopt=Abstract ER - TY - JOUR T1 - Contributions of neighborhood social environment and air pollution exposure to Black-White disparities in epigenetic aging. JF - PLoS One Y1 - 2023 A1 - Yannatos, Isabel A1 - Stites, Shana A1 - Brown, Rebecca T A1 - McMillan, Corey T KW - Aged KW - Aging KW - Air Pollution KW - Black or African American KW - Cross-Sectional Studies KW - Epigenesis, Genetic KW - Humans KW - Particulate Matter KW - Retrospective Studies KW - Social Environment KW - United States KW - White AB -

Racial disparities in many aging-related health outcomes are persistent and pervasive among older Americans, reflecting accelerated biological aging for Black Americans compared to White, known as weathering. Environmental determinants that contribute to weathering are poorly understood. Having a higher biological age, measured by DNA methylation (DNAm), than chronological age is robustly associated with worse age-related outcomes and higher social adversity. We hypothesize that individual socioeconomic status (SES), neighborhood social environment, and air pollution exposures contribute to racial disparities in DNAm aging according to GrimAge and Dunedin Pace of Aging methylation (DPoAm). We perform retrospective cross-sectional analyses among 2,960 non-Hispanic participants (82% White, 18% Black) in the Health and Retirement Study whose 2016 DNAm age is linked to survey responses and geographic data. DNAm aging is defined as the residual after regressing DNAm age on chronological age. We observe Black individuals have significantly accelerated DNAm aging on average compared to White individuals according to GrimAge (239%) and DPoAm (238%). We implement multivariable linear regression models and threefold decomposition to identify exposures that contribute to this disparity. Exposure measures include individual-level SES, census-tract-level socioeconomic deprivation and air pollution (fine particulate matter, nitrogen dioxide, and ozone), and perceived neighborhood social and physical disorder. Race and gender are included as covariates. Regression and decomposition results show that individual-level SES is strongly associated with and accounts for a large portion of the disparity in both GrimAge and DPoAm aging. Higher neighborhood deprivation for Black participants significantly contributes to the disparity in GrimAge aging. Black participants are more vulnerable to fine particulate matter exposure for DPoAm, perhaps due to individual- and neighborhood-level SES, which may contribute to the disparity in DPoAm aging. DNAm aging may play a role in the environment "getting under the skin", contributing to age-related health disparities between older Black and White Americans.

VL - 18 IS - 7 ER - TY - JOUR T1 - Cross-Lagged Associations Between Physical Activity, Self-Rated Health, and Psychological Resilience Among Older American Adults: A 3-Wave Study. JF - J Phys Act Health Y1 - 2023 A1 - Lee, Sunwoo KW - Aged KW - Aged, 80 and over KW - Exercise KW - Humans KW - Middle Aged KW - Prospective Studies KW - Resilience, Psychological AB -

The current study examined the reciprocal association between psychological resilience, physical activity, and self-rated health in older America adults. A 3-wave cross-lagged panel design was employed using data sampled from the Health and Retirement Study 2010, 2014, and 2018. In total, 8380 older adults, age ranged between 56 and 95 years at the baseline (mean age = 68.06, SD = 7.77), were analyzed. Using structural equation modeling, standardized path coefficients were estimated to determine the relationship between physical activity, self-rated health, and psychological resilience across 2 follow-up points. Cross-lagged analysis revealed that higher levels of physical activity at T1 and T2 were significantly associated with higher levels of self-rated health at T2 and T3, respectively. Self-rated health at T1 and T2 were significantly associated with physical activity at T2 and T3, respectively. Self-rated health and psychological resilience were positively related to one another at each time point. However, relationship between physical activity and psychological resilience was complex across time. Study findings support reciprocal prospective relationship between physical activity and self-rated health and the relationship between self-rated health and psychological resilience.

VL - 20 IS - 7 ER - TY - JOUR T1 - Dementia Attributable Healthcare Utilizations in the Caribbean versus United States. JF - Journal of Alzheimers Disease: JAD Y1 - 2023 A1 - Li, Jing A1 - Weiss, Jordan A1 - Rajadhyaksha, Ashish A1 - Acosta, Daisy A1 - Harrati, Amal A1 - Jiménez Velázquez, Ivonne Z A1 - Liu, Mao-Mei A1 - Guerra, Jorge J Llibre A1 - Rodriguez, Juan de Jesús Llibre A1 - Dow, William H KW - Aged KW - Alzheimer disease KW - Delivery of Health Care KW - ethnicity KW - Humans KW - Patient Acceptance of Health Care KW - Puerto Rico KW - United States AB -

BACKGROUND: Despite the high burden of Alzheimer's disease and other dementias among the Hispanic population worldwide, little is known about how dementia affects healthcare utilizations among this population outside of the US, in particular among those in the Caribbean region.

OBJECTIVE: This study examines healthcare utilization associated with Alzheimer's disease and other dementias among older adults in the Caribbean as compared to the US.

METHODS: We conducted harmonized analyses of two population-based surveys, the 10/66 Dementia Group Research data collected in Dominican Republic, Cuba, and Puerto Rico, and the US-based Health and Retirement Study. We examined changes in hospital nights and physician visits in response to incident and ongoing dementias.

RESULTS: Incident dementia significantly increased the risk of hospitalization and number of hospital nights in both populations. Ongoing dementia increased the risk of hospitalization and hospital nights in the US, with imprecise estimates for the Caribbean. The number of physician visits was elevated in the US but not in the Caribbean.

CONCLUSIONS: The concentration of increased healthcare utilization on hospital care and among patients with incident dementia suggests an opportunity for improved outpatient management of new and existing dementia patients in the Caribbean.

VL - 96 IS - 2 ER - TY - JOUR T1 - Dementia Attributable Healthcare Utilizations in the Caribbean versus United States. JF - Journal of Alzheimers Disease: JAD Y1 - 2023 A1 - Li, Jing A1 - Weiss, Jordan A1 - Rajadhyaksha, Ashish A1 - Acosta, Daisy KW - Aged KW - Alzheimer disease KW - Delivery of Health Care KW - ethnicity KW - Humans KW - Patient Acceptance of Health Care KW - Puerto Rico KW - United States AB -

BACKGROUND: Despite the high burden of Alzheimer's disease and other dementias among the Hispanic population worldwide, little is known about how dementia affects healthcare utilizations among this population outside of the US, in particular among those in the Caribbean region.

OBJECTIVE: This study examines healthcare utilization associated with Alzheimer's disease and other dementias among older adults in the Caribbean as compared to the US.

METHODS: We conducted harmonized analyses of two population-based surveys, the 10/66 Dementia Group Research data collected in Dominican Republic, Cuba, and Puerto Rico, and the US-based Health and Retirement Study. We examined changes in hospital nights and physician visits in response to incident and ongoing dementias.

RESULTS: Incident dementia significantly increased the risk of hospitalization and number of hospital nights in both populations. Ongoing dementia increased the risk of hospitalization and hospital nights in the US, with imprecise estimates for the Caribbean. The number of physician visits was elevated in the US but not in the Caribbean.

CONCLUSIONS: The concentration of increased healthcare utilization on hospital care and among patients with incident dementia suggests an opportunity for improved outpatient management of new and existing dementia patients in the Caribbean.

VL - 96 IS - 2 ER - TY - JOUR T1 - Dietary Intake Levels of Iron, Copper, Zinc, and Manganese in Relation to Cognitive Function: A Cross-Sectional Study. JF - Nutrients Y1 - 2023 A1 - Zhao, Dong A1 - Huang, Yilun A1 - Wang, Binghan A1 - Chen, Hui A1 - Pan, Wenfei A1 - Yang, Min A1 - Xia, Zhidan A1 - Zhang, Ronghua A1 - Yuan, Changzheng KW - Aged KW - Cognition KW - Copper KW - Cross-Sectional Studies KW - Eating KW - Humans KW - Iron KW - Manganese KW - Trace Elements KW - Zinc AB -

: Previous studies have related circulating levels of trace metal elements, of which dietary intake is the major source, to cognitive outcomes. However, there are still relatively few studies evaluating the associations of dietary intake levels of iron, copper, zinc, and manganese with cognitive function (CF). : We leveraged the data of 6863 participants (mean [standard deviation] age = 66.7 [10.5] years) in the Health and Retirement Study (2013/2014). Dietary intake levels of iron, copper, zinc, and manganese were calculated from a semi-quantitative food frequency questionnaire. CF was assessed using the 27-point modified Telephone Interview for Cognitive Status (TICS). We used linear regression models to calculate the mean differences in global CF scores by quintiles of dietary intake levels of trace metal elements. : Among the study participants, the mean (SD) values of daily dietary intake were 13.3 (6.3) mg for iron, 1.4 (0.7) mg for copper, 10.7 (4.6) mg for zinc, and 3.3 (1.6) mg for manganese. Compared with the lowest quintile of dietary iron intake (<8.1 mg), the highest quintile (≥17.7 mg) was associated with a lower cognitive score (-0.50, -0.94 to -0.06, P-trend = 0.007). Higher dietary copper was significantly associated with poorer CF (P-trend = 0.002), and the mean difference in cognitive score between extreme quintiles (≥1.8 vs. <0.8 mg) was -0.52 (95% confidence interval: -0.94 to -0.10) points. We did not observe significant associations for dietary intake of zinc (P-trend = 0.785) and manganese (P-trend = 0.368). : In this cross-sectional study, higher dietary intake of iron and copper was related to worse CF, but zinc and manganese intake levels were not significantly associated with CF.

VL - 15 IS - 3 ER - TY - JOUR T1 - Does personality always matter for health? Examining the moderating effect of age on the personality-health link from life span developmental and aging perspectives. JF - Journal of personality and social psychology Y1 - 2023 A1 - Luo, Jing A1 - Zhang, Bo A1 - Graham, Eileen K A1 - Mroczek, Daniel K KW - Adolescent KW - Adult KW - Aged KW - Aged, 80 and over KW - Aging KW - Humans KW - Longevity KW - Longitudinal Studies KW - Middle Aged KW - Personality KW - Personality Disorders KW - Young Adult AB -

Extensive evidence has been found for the associations between personality traits and health. However, it remains unknown whether the relationships between personality and health show differential patterns across different life stages. The current research examined how the associations between the levels of and changes in the Big Five personality traits and different types of health outcomes (self-rated, physical, and physiological health outcomes) differ across ages over the life span (Sample 1, age range: 15-100) and during the aging process (Sample 2, age range: 50-109) in particular. Using data from the two large longitudinal studies-the Household, Income, and Labor Dynamics in Australia Survey and the Health and Retirement Study, we observed three important patterns. First, levels of and changes in personality traits were significantly associated with health across different life phases, and these effects were observed even in very old ages. Second, overall, the prospective relations between personality traits/changes in personality traits and health outcomes increased in strength in middle adulthood and/or early stages of late adulthood; however, the strength of their connections diminished in very old ages. Finally, there were some trait-specific and health outcome-specific patterns in the age-differential associations between personality and health. Findings from the present study contribute to enhancing our understanding of the personality-health link from a developmental perspective and provide critical information for the design and implementation of screening and interventions targeting health promotion. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

VL - 125 IS - 5 ER - TY - JOUR T1 - Education, incident cancer, and rate of memory decline in a national sample of US adults in mid-to-later-life. JF - J Geriatr Oncol Y1 - 2023 A1 - Ospina-Romero, Monica A1 - Brenowitz, Willa D A1 - Glymour, M Maria A1 - Westrick, Ashly A1 - Graff, Rebecca E A1 - Hayes-Larson, Eleanor A1 - Mayeda, Elizabeth Rose A1 - Ackley, Sarah F A1 - Lindsay C Kobayashi KW - Aged KW - Aging KW - Cancer Survivors KW - Educational Status KW - Humans KW - Longitudinal Studies KW - Memory Disorders KW - Middle Aged KW - Neoplasms AB -

INTRODUCTION: Middle-aged and older adults who develop cancer experience memory loss following diagnosis, but memory decline in the years before and after cancer diagnosis is slower compared to their cancer-free counterparts. Educational attainment strongly predicts memory function during aging, but it is unclear whether education protects against memory loss related to cancer incidence or modifies long-term memory trajectories in middle-aged and older cancer survivors.

MATERIALS AND METHODS: Data were from 14,449 adults (3,248 with incident cancer, excluding non-melanoma skin cancer) aged 50+ in the population-based US Health and Retirement Study from 1998 to 2016. Memory was assessed every two years as a composite of immediate and delayed word recall tests and proxy assessments for impaired individuals. Memory scores all time points were standardized at to the baseline distribution. Using multivariate-adjusted linear mixed-effects models, we estimated rates of memory decline in the years before cancer diagnosis, shortly after diagnosis, and in the years after diagnosis. We compared rates of memory decline between incident cancer cases and age-matched cancer-free adults, overall and according to level of education (<12 years, "low"; 12 to <16 years, "intermediate"; ≥16 years, "high").

RESULTS: Incident cancer diagnoses were followed by short-term declines in memory averaging 0.06 standard deviation (SD) units (95% confidence interval [CI]: -0.084, -0.036). Those with low education experienced the strongest magnitude of short-term decline in memory after diagnosis (-0.10 SD units, 95% CI: -0.15, -0.05), but this estimate was not statistically significantly different from the short-term decline in memory experienced by those with high education (-0.04 SD units, 95% CI: -0.08, 0.01; p-value for education as an effect modifier = 0.15). In the years prior to and following an incident cancer diagnosis, higher educational attainment was associated with better memory, but it did not modify the difference in rate of long-term memory decline between cancer survivors and those who remained cancer-free.

DISCUSSION: Education was associated with better memory function over time among both cancer survivors and cancer-free adults aged 50 and over. Low education may be associated with a stronger short-term decline in memory after a cancer diagnosis.

VL - 14 IS - 5 ER - TY - JOUR T1 - The effect of housing wealth on older adults' health care utilization: Evidence from fluctuations in the U.S. housing market. JF - J Health Econ Y1 - 2023 A1 - Tran, My A1 - Gannon, Brenda A1 - Rose, Christiern KW - Aged KW - Housing KW - Humans KW - Patient Acceptance of Health Care KW - prescription drugs KW - Retirement AB -

Do wealthier individuals use more health care services than those less affluent? Our paper addresses this question by examining the relationship between housing wealth and health care utilization. Exploiting fluctuations in the U.S. housing market, we estimate the effect of unanticipated wealth shocks on older adults' health care utilization, using county-year variation in house prices to construct an instrumental variable. Using data from the 1996-2016 Health and Retirement Study, we find that an increase in wealth significantly increases numbers of doctor visits, prescription drugs, outpatient surgery, and dental services. Notably, an economic downturn like that in the Great Recession, when housing wealth declined by 16 percent on average, could reduce the utilization of prescription drugs by 0.4 percent, outpatient services by 0.5 percent, dental care by 0.6 percent, and numbers of doctor visits by 0.5 visits annually.

VL - 88 ER - TY - JOUR T1 - Estimating the Prevalence of Dementia in India Using a Semi-Supervised Machine Learning Approach. JF - Neuroepidemiology Y1 - 2023 A1 - Jin, Haomiao A1 - Crimmins, Eileen A1 - Kenneth M. Langa A1 - Dey, A B A1 - Lee, Jinkook KW - Aged KW - Aging KW - Dementia KW - Female KW - Humans KW - India KW - Male KW - Middle Aged KW - Prevalence KW - supervised machine learning AB -

INTRODUCTION: Accurate estimation of dementia prevalence is essential for making effective public and social care policy to support individuals and families suffering from the disease. The purpose of this paper is to estimate the prevalence of dementia in India using a semi-supervised machine learning approach based on a large nationally representative sample.

METHODS: The sample of this study is adults 60 years or older in the wave 1 (2017-2019) of the Longitudinal Aging Study in India (LASI). A subsample in LASI received extensive cognitive assessment and clinical consensus ratings and therefore has diagnoses of dementia. A semi-supervised machine learning model was developed to predict the status of dementia for LASI participants without diagnoses. After obtaining the predictions, sampling weights and age standardization to the World Health Organization (WHO) standard population were applied to generate the estimate for prevalence of dementia in India.

RESULTS: The prevalence of dementia for those aged 60 years and older in India was 8.44% (95% CI: 7.89%-9.01%). The age-standardized prevalence was estimated to be 8.94% (95% CI: 8.36%-9.55%). The prevalence of dementia was greater for those who were older, were females, received no education, and lived in rural areas.

DISCUSSION: The prevalence of dementia in India may be higher than prior estimates derived from local studies. These prevalence estimates provide the information necessary for making long-term planning of public and social care policy. The semi-supervised machine learning approach adopted in this paper may also be useful for other large population aging studies that have a similar data structure.

VL - 57 IS - 1 ER - TY - JOUR T1 - Everyday Discrimination, Neighborhood Perceptions, and Incidence of Activity Limitations Among Middle-Aged and Older African Americans. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2023 A1 - Qin, Weidi A1 - Nguyen, Ann W A1 - Wang, Yi A1 - Hamler, Tyrone C A1 - Wang, Fei KW - Activities of Daily Living KW - Aged KW - Black or African American KW - Humans KW - Incidence KW - Middle Aged KW - Residence Characteristics KW - Retirement AB -

OBJECTIVES: This study aims to examine the relationship between everyday discrimination, neighborhood perceptions, and the incidence of daily activity limitations (i.e., activities of daily living [ADL] and instrumental activities of daily living [IADL]) among middle-aged and older African Americans. This study also examines whether neighborhood perceptions moderate the association between discrimination and the incidence of daily activity limitations.

METHODS: Data were from the 2006 to 2016 waves of the Health and Retirement Study. African Americans aged 50 or older free of ADL limitations (N = 1,934) and IADL limitations (N = 2,007) at baseline were selected. Cox proportional hazards regression models were performed to test the study aims. Multiple imputations were applied to handle missing data.

RESULTS: One-unit increase in everyday discrimination was associated with a 25% (p < .05) higher risk of ADL limitation onset. Perceived neighborhood social cohesion and physical disadvantage moderated the association between discrimination and IADL limitation onset.

DISCUSSION: Everyday discrimination represents a significant stressor that negatively affects older African Americans' performance of daily activities. Community-level efforts that improve neighborhood perceptions are needed to alleviate the negative effects of discrimination on the incidence of activity limitations.

VL - 78 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/36661210?dopt=Abstract ER - TY - JOUR T1 - Examining racial and ethnic differences in disability among older adults: A polysocial score approach. JF - Maturitas Y1 - 2023 A1 - Tang, Junhan A1 - Chen, Ying A1 - Liu, Hua A1 - Wu, Chenkai KW - Activities of Daily Living KW - Aged KW - Cohort Studies KW - Disabled Persons KW - ethnicity KW - Health Status Disparities KW - Humans KW - Racial Groups KW - United States AB -

OBJECTIVES: Racial and ethnic disparities in disability in activities of daily living (ADL) continue to be a public concern. We evaluated whether the polysocial score approach could provide a more comprehensive method for modifying racial and ethnic differences in such disability.

STUDY DESIGN: Cohort study.

MAIN OUTCOME MEASURES: We included 5833 participants from the Health and Retirement Study, who were aged 65 years or more and were initially free of ADL disability. We considered six ADLs: bathing, eating, using the toilet, dressing, walking across a room, and getting in/out of bed. We included 20 social factors spanning economic stability, neighborhood and physical environment, education, community and social context, and health system. We used forward stepwise logistic regression to derive a polysocial score for ADL disability. We created a polysocial score using 12 social factors and categorized the score as low (0-19), intermediate (20-30), and high (31+). We used multivariable logistic regression to estimate the incident risk of ADL disability and examine additive interactions between race/ethnicity and polysocial score.

RESULTS: A higher polysocial score is associated with a lower incidence of ADL disability among older adults in the United States. We found additive interactions between race/ethnicity and polysocial score categories. In the low polysocial score category, White and Black/Hispanic participants had a 18.5 % and 24.4 % risk of ADL disability, respectively. Among White participants, the risk of ADL disability decreased to 14.1 % and 12.1 % in the intermediate and high polysocial score categories, respectively; among Black/Hispanic participants, those in the intermediate and high categories had a 11.9 % and 8.7 % risk of ADL disability, respectively.

CONCLUSIONS: The polysocial score approach provides a new opportunity for explaining racial/ethnic disparities in functional capacity among older adults.

VL - 172 ER - TY - JOUR T1 - Female APOE ɛ4 Carriers with Slow Rates of Biological Aging Have Better Memory Performances Compared to Female ɛ4 Carriers with Accelerated Aging. JF - J Alzheimers Dis Y1 - 2023 A1 - O'Shea, Deirdre M A1 - Galvin, James E KW - Aged KW - Aging KW - Apolipoprotein E4 KW - Cognition KW - Dementia KW - Female KW - Humans KW - Longitudinal Studies KW - Male KW - Memory Disorders AB -

BACKGROUND: Evidence suggests that APOE ɛ4 carriers have worse memory performances compared to APOE ɛ4 non-carriers and effects may vary by sex and age. Estimates of biological age, using DNA methylation may enhance understanding of the associations between sex and APOE ɛ4 on cognition.

OBJECTIVE: To investigate whether associations between APOE ɛ4 status and memory vary according to rates of biological aging, using a DNA methylation age biomarker, in older men and women without dementia.

METHODS: Data were obtained from 1,771 adults enrolled in the 2016 wave of the Health and Retirement Study. A series of ANCOVAs were used to test the interaction effects of APOE ɛ4 status and aging rates (defined as 1 standard deviation below (i.e., slow rate), or above (i.e., fast rate) their sex-specific mean rate of aging on a composite measure of verbal learning and memory.

RESULTS: APOE ɛ4 female carriers with slow rates of GrimAge had significantly better memory performances compared to fast and average aging APOE ɛ4 female carriers. There was no effect of aging group rate on memory in the female non-carriers and no significant differences in memory according to age rate in either male APOE ɛ4 carriers or non-carriers.

CONCLUSION: Slower rates of aging in female APOE ɛ4 carriers may buffer against the negative effects of the ɛ4 allele on memory. However, longitudinal studies with larger sample sizes are needed to evaluate risk of dementia/memory impairment based on rates of aging in female APOE ɛ4 carriers.

VL - 92 IS - 4 ER - TY - JOUR T1 - Gender differences in the association of polygenic risk and divergent depression trajectories from mid to late life: a national longitudinal study. JF - Biodemography Soc Biol Y1 - 2023 A1 - Chen, Ping A1 - Li, Yi A1 - Wu, Fang KW - Adult KW - Aged KW - Aged, 80 and over KW - depression KW - Depressive Disorder, Major KW - Female KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Risk Factors KW - Sex Factors AB -

Our research fills a critical gap in the depression literature by utilizing a life course perspective to examine gender-gene interactions in association with depression trajectories over time. Using data from the Health and Retirement Study, we estimated multi-level negative binomial and logistic mixed models to analyze gender-specific trajectories of depressive symptoms (CESD-8) and potential clinical depression risk from middle to late adulthood in relation to gender-by-polygenic-risk (PRS) interactions. We found increasingly greater female-male gaps in the CESD-8 scale and a higher probability of clinical depression risk with increasing polygenic risk scores. Furthermore, females' higher genetic vulnerabilities to depressive conditions than males vary from ages 51 to 90 years, (e.g. 0.28 higher CESD-8 scale for females at ages 76-85 years than for similar-aged males; higher 3.44% probability of depression risk for females at ages 81-85 compared to similar-aged males) (e.g. about 2.40% higher probability of depression risk for females at ages 61-70 years than for similar-aged males) . This study contributes to new knowledge of how gender-by-polygenic-risk interactions are associated with depression trajectories across the life course.

VL - 68 IS - 1 ER - TY - JOUR T1 - Handgrip strength is associated with risks of new-onset stroke and heart disease: results from 3 prospective cohorts. JF - BMC Geriatr Y1 - 2023 A1 - Li, Guochen A1 - Lu, Yanqiang A1 - Shao, Liping A1 - Wu, Luying A1 - Qiao, Yanan A1 - Ding, Yi A1 - Ke, Chaofu KW - Aged KW - Hand Strength KW - Heart Diseases KW - Humans KW - Longitudinal Studies KW - Middle Aged KW - Prospective Studies KW - Stroke AB -

BACKGROUND: Stroke and heart disease are two major contributors to the global disease burden. We aimed to evaluate and compare the roles of different handgrip strength (HGS) expressions in predicting stroke and heart disease in three nationally representative cohorts.

METHODS: This longitudinal study used data from the Health and Retirement Study (HRS), the Survey of Health, Ageing, and Retirement in Europe (SHARE), and the China Health and Retirement Longitudinal Study (CHARLS). The Cox proportional hazard model was applied to analyze the relationship between HGS and stroke and heart disease, and Harrell's C index was used to assess the predictive abilities of different HGS expressions.

RESULTS: A total of 4,407 participants suffered from stroke and 9,509 from heart disease during follow-up. Compared with the highest quartile, participants in the lowest quartile of dominant HGS, absolute HGS and relative HGS possessed a significantly higher risk of new-onset stroke in Europe, America, and China (all P < 0.05). After adding HGS to office-based risk factors, there were minimal or no differences in the increases of Harrell's C indexes among three HGS expressions. In contrast, the modest association between HGS and heart disease was only seen in SHARE and HRS, but not in CHARLS.

CONCLUSION: Our findings support that HGS can be used as an independent predictor of stroke in middle-aged and older European, American and Chinese populations, and the predictive ability of HGS may not depend on how it is expressed. The relationship between HGS and heart disease calls for further validation.

VL - 23 IS - 1 ER - TY - JOUR T1 - How to construct a frailty index from an existing dataset in 10 steps. JF - Age and Ageing Y1 - 2023 A1 - Theou, Olga A1 - Haviva, Clove A1 - Wallace, Lindsay A1 - Searle, Samuel D A1 - Rockwood, Kenneth KW - Aged KW - Aging KW - Frail Elderly KW - Frailty KW - Geriatric Assessment KW - Humans KW - Retrospective Studies AB -

BACKGROUND: The frailty index is commonly used in research and clinical practice to quantify health. Using a health deficit accumulation model, a frailty index can be calculated retrospectively from data collected via survey, interview, performance test, laboratory report, clinical or administrative medical record, or any combination of these. Here, we offer a detailed 10-step approach to frailty index creation, with a worked example.

METHODS: We identified 10 steps to guide the creation of a valid and reliable frailty index. We then used data from waves 5 to 12 of the Health and Retirement Study (HRS) to illustrate the steps.

RESULTS: The 10 steps are as follows: (1) select every variable that measures a health problem; (2) exclude variables with more than 5% missing values; (3) recode the responses to 0 (no deficit) through 1 (deficit); (4) exclude variables when coded deficits are too rare (< 1%) or too common (> 80%); (5) screen the variables for association with age; (6) screen the variables for correlation with each other; (7) count the variables retained; (8) calculate the frailty index scores; (9) test the characteristics of the frailty index; (10) use the frailty index in analyses. In our worked example, we created a 61-item frailty index following these 10 steps.

CONCLUSIONS: This 10-step procedure can be used as a template to create one continuous health variable. The resulting high-information variable is suitable for use as an exposure, predictor or control variable, or an outcome measure of overall health and ageing.

VL - 52 IS - 12 ER - TY - JOUR T1 - Immigrant Wealth Stratification and Return Migration: The Case of Mexican Immigrants in the United States During the Twentieth Century. JF - Demography Y1 - 2023 A1 - Sheftel, Mara Getz KW - Aged KW - Aging KW - Emigrants and Immigrants KW - Emigration and Immigration KW - Humans KW - Income KW - Independent Living KW - Mexican Americans KW - Mexico KW - Middle Aged KW - United States AB -

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

VL - 60 IS - 3 ER - TY - JOUR T1 - The impact of hearing loss on trajectories of depressive symptoms in married couples. JF - Soc Sci Med Y1 - 2023 A1 - West, Jessica S A1 - Smith, Sherri L A1 - Dupre, Matthew E KW - Aged KW - depression KW - Female KW - Hearing loss KW - Humans KW - Male KW - Marriage KW - Retirement KW - Spouses AB -

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

VL - 321 ER - TY - JOUR T1 - Inequalities in Retirement Life Span in the United States. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2023 A1 - Shi, Jiaxin A1 - Dudel, Christian A1 - Monden, Christiaan A1 - van Raalte, Alyson KW - Aged KW - Educational Status KW - Employment KW - Female KW - Humans KW - Life Expectancy KW - Life Tables KW - Longevity KW - Male KW - Middle Aged KW - Retirement KW - United States AB -

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

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

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

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

VL - 78 IS - 5 ER - TY - JOUR T1 - Life course engagement in enriching activities: When and how does it matter for cognitive aging? JF - Psychol Aging Y1 - 2023 A1 - Frank, Colleen C A1 - Mundy, Lindsey M A1 - Jacqui Smith KW - Aged KW - Aging KW - Cognition KW - cognitive aging KW - Cognitive Dysfunction KW - Humans KW - Life Change Events KW - Longitudinal Studies KW - Retrospective Studies AB -

Growing evidence suggests that participation in enriching activities (physical, social, and mental) across the life course is beneficial for cognitive functioning in older age. However, few studies have examined the effects of enrichment across the entire life course within the same participants. Using 2,931 participants in the Health and Retirement Study, we linked self-report data from later life and retrospective self-report data from early life and midlife to cognitive performance after Age 65. We categorized participants as having either high (top ∼25%) or average to low (bottom ∼75%) level of enrichment during each life period. Thus, eight groups were identified that reflected unique patterns of enrichment during early, mid, and later life (e.g., high-high-high). Using growth curve modeling, we found that life course enrichment patterns predicted both cognitive functioning and the rate of cognitive decline across five time points spanning 8 years (Aim 1). Groups with high enrichment during at least one life period had higher performance and slower decline in older age, compared to those who had average to low levels of enrichment throughout all three life periods. We also found that high enrichment during each life period independently predicted better cognitive performance and that high enrichment during early and later life also predicted slower cognitive decline (Aim 2). These findings support the idea that high enrichment is beneficial for cognition in later life and that the effects are long-lasting, even when individuals are inconsistent in enrichment engagement throughout the entire life course. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

VL - 38 IS - 4 ER - TY - JOUR T1 - Life-Sustaining Treatments Among Medicare Beneficiaries with and without Dementia at the End of Life. JF - Journal of Alzheimer's Disease : JAD Y1 - 2023 A1 - Zhu, Yingying A1 - Olchanski, Natalia A1 - Cohen, Joshua T A1 - Freund, Karen M A1 - Jessica Faul A1 - Fillit, Howard M A1 - Neumann, Peter J A1 - Lin, Pei-Jung KW - Aged KW - Alzheimer disease KW - Cohort Studies KW - Death KW - Humans KW - Medicare KW - Terminal Care KW - United States AB -

BACKGROUND: Older adults with dementia including Alzheimer's disease may have difficulty communicating their treatment preferences and thus may receive intensive end-of-life (EOL) care that confers limited benefits.

OBJECTIVE: This study compared the use of life-sustaining interventions during the last 90 days of life among Medicare beneficiaries with and without dementia.

METHODS: This cohort study utilized population-based national survey data from the 2000-2016 Health and Retirement Study linked with Medicare and Medicaid claims. Our sample included Medicare fee-for-service beneficiaries aged 65 years or older deceased between 2000 and 2016. The main outcome was receipt of any life-sustaining interventions during the last 90 days of life, including mechanical ventilation, tracheostomy, tube feeding, and cardiopulmonary resuscitation. We used logistic regression, stratified by nursing home use, to examine dementia status (no dementia, non-advanced dementia, advanced dementia) and patient characteristics associated with receiving those interventions.

RESULTS: Community dwellers with dementia were more likely than those without dementia to receive life-sustaining treatments in their last 90 days of life (advanced dementia: OR = 1.83 [1.42-2.35]; non-advanced dementia: OR = 1.16 [1.01-1.32]). Advance care planning was associated with lower odds of receiving life-sustaining treatments in the community (OR = 0.84 [0.74-0.96]) and in nursing homes (OR = 0.68 [0.53-0.86]). More beneficiaries with advanced dementia received interventions discordant with their EOL treatment preferences.

CONCLUSIONS: Community dwellers with advanced dementia were more likely to receive life-sustaining treatments at the end of life and such treatments may be discordant with their EOL wishes. Enhancing advance care planning and patient-physician communication may improve EOL care quality for persons with dementia.

VL - 96 IS - 3 ER - TY - JOUR T1 - Longitudinal body weight dynamics in relation to cognitive decline over two decades: A prospective cohort study. JF - Obesity (Silver Spring) Y1 - 2023 A1 - Zhou, Tianjing A1 - Chen, Hui A1 - Huang, Yuhui A1 - Wang, Binghan A1 - Zheng, Yan A1 - Wang, Liang A1 - Rong, Shuang A1 - Ma, Yuan A1 - Yuan, Changzheng KW - Aged KW - Body Weight KW - Cognitive Dysfunction KW - Humans KW - Longitudinal Studies KW - Middle Aged KW - Prospective Studies KW - Weight Gain KW - Weight Loss AB -

OBJECTIVE: The aim of this study was to investigate the associations of body weight change (BWC) and body weight variability (BWV) with changes in cognitive function.

METHODS: In 10,340 Health and Retirement Study participants (mean age: 68.0 years), body weight was reported biennially from 1993/1994 to 2016, and cognitive function was measured biennially from 1998 to 2016. We calculated BWC and BWV as the slope and root-mean-square error by regressing body weight on time for each individual. BWC was categorized by quintiles (Q): stable weight (Q2 to Q4), weight loss (Q1), and weight gain (Q5). BWV was categorized by tertiles. We used linear mixed regression models to assess associations with cognitive change.

RESULTS: Compared with stable weight (median: 0 kg/y), weight loss (median: -1.3 kg/y) predicted faster cognitive decline as demonstrated by mean difference of -0.023 (95% CI: -0.027 to -0.019) in cognitive change z score per year, whereas weight gain (median: 1 kg/y) was related to slower cognitive decline (β = 0.006; 95% CI: 0.003 to 0.009). Larger BWV was also associated with faster cognitive decline (β comparing the top with bottom tertile = -0.003; 95% CI: -0.006 to -0.0002). Similar associations were observed for episodic and working memory.

CONCLUSIONS: Weight loss and large BWV over a long time independently predicted faster cognitive decline in middle-aged and older adults, underscoring the importance of long-term dynamic body weight monitoring.

VL - 31 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/36782381?dopt=Abstract ER - TY - JOUR T1 - A longitudinal study of polygenic score and cognitive function decline considering baseline cognitive function, lifestyle behaviors, and diabetes among middle-aged and older US adults. JF - Alzheimer's research & therapy Y1 - 2023 A1 - Liu, Tingting A1 - Li, Changwei A1 - Zhang, Ruiyuan A1 - Millender, Eugenia Flores A1 - Miao, Hongyu A1 - Ormsbee, Michael A1 - Guo, Jinzhen A1 - Westbrook, Adrianna A1 - Pan, Yang A1 - Wang, Jing A1 - Kelly, Tanika N KW - Adult KW - Aged KW - Apolipoproteins E KW - Cognition KW - Cognitive Dysfunction KW - Diabetes Mellitus KW - Humans KW - Life Style KW - Longitudinal Studies KW - Middle Aged AB -

BACKGROUND: Genomic study of cognition decline while considering baseline cognition and lifestyle behaviors is scarce. We aimed to evaluate the impact of a polygenic score for general cognition on cognition decline rate, while considering baseline cognition and lifestyle behaviors, among the general population and people with diabetes, a patient group commonly affected by cognition impairment.

METHODS: We tested associations of the polygenic score for general cognition with annual changing rates of cognition measures in 8 years of follow-up among 12,090 White and 3100 Black participants of the Health and Retirement Study (HRS), a nationally representative sample of adults aged 50 years and older in the USA. Cognition measures including word recall, mental status, and total cognitive score were measured biannually. To maximize sample size and length of follow-up, we treated the 2010 wave of survey as baseline, and follow-up data until 2018 were analyzed. Baseline lifestyle behaviors, APOE status, and measured cognition were sequentially adjusted. Given racial differences in polygenic score, all analyses were conducted by race.

RESULTS: The polygenic score was significantly associated with annual changing rates of all cognition measures independent of lifestyle behaviors and APOE status. Together with age and sex, the polygenic score explained 29.9%, 15.9%, and 26.5% variances of annual changing rates of word recall, mental status, and total cognitive scores among Whites and explained 17.2%, 13.9%, and 18.7% variance of the three traits among Blacks. Among both White and Black participants, those in the top quartile of polygenic score had the three cognition measures increased annually, while those in the bottom quartile had the three cognition measures decreased annually. After further adjusting for the average cognition assessed in 3 visits around baseline, the polygenic score was still positively associated with annual changing rates of all cognition measures for White (P ≤ 2.89E - 19) but not for Black (P ≥ 0.07) participants. In addition, among participants with diabetes, physical activity offset the genetic susceptibility to decline of mental status (interaction P ≤ 0.01) and total cognitive scores (interaction P = 0.03).

CONCLUSIONS: Polygenic score predicted cognition changes in addition to measured cognition. Physical activity offset genetic risk for cognition decline among diabetes patients.

VL - 15 IS - 1 ER - TY - JOUR T1 - Measurement differences in the assessment of functional limitations for cognitive impairment classification across geographic locations. JF - Alzheimers Dement Y1 - 2023 A1 - Nichols, Emma A1 - Ng, Derek K A1 - Hayat, Shabina A1 - Kenneth M. Langa A1 - Lee, Jinkook A1 - Steptoe, Andrew A1 - Deal, Jennifer A A1 - Gross, Alden L KW - Activities of Daily Living KW - Aged KW - Cognitive Dysfunction KW - Dementia KW - England KW - Humans KW - Surveys and Questionnaires KW - United States AB -

INTRODUCTION: The measurement of dementia in cross-national contexts relies on the assessment of functional limitations. We aimed to evaluate the performance of survey items on functional limitations across culturally diverse geographic settings.

METHODS: We used data from the Harmonized Cognitive Assessment Protocol Surveys (HCAP) in five countries (total N = 11,250) to quantify associations between items on functional limitations and cognitive impairment.

RESULTS: Many items performed better in the United States and England compared to South Africa, India, and Mexico. Items on the Community Screening Instrument for Dementia (CSID) had the least variability across countries (SD = 0.73 vs. 0.92 [Blessed] and 0.98 [Jorm IQCODE]), but also the weakest associations with cognitive impairment (median odds ratio [OR] = 2.23 vs. 3.01 [Blessed] and 2.75 [Jorm IQCODE]).

DISCUSSION: Differences in cultural norms for reporting functional limitations likely influences performance of items on functional limitations and may affect the interpretation of results from substantive studies.

HIGHLIGHTS: There was substantial cross-country variation in item performance. Items from the Community Screening Instrument for Dementia (CSID) had less cross-country variability but lower performance. There was more variability in performance of instrumental activities of daily living (IADL) compared to activities of daily living (ADL) items. Variability in cultural expectations of older adults should be taken into account. Results highlight the need for novel approaches to assessing functional limitations.

VL - 19 IS - 5 ER - TY - JOUR T1 - Measures of Aging Biology in Saliva and Blood as Novel Biomarkers for Stroke and Heart Disease in Older Adults. JF - Neurology Y1 - 2023 A1 - Waziry, Reem A1 - Gu, Yian A1 - Boehme, Amelia K A1 - Williams, Olajide A KW - Aged KW - Aging KW - Biology KW - Biomarkers KW - DNA Methylation KW - Heart Diseases KW - Humans KW - Middle Aged KW - Saliva KW - Stroke KW - United States AB -

BACKGROUND AND OBJECTIVES: The role of aging biology as a novel risk factor and biomarker for vascular outcomes in different accessible body tissues such as saliva and blood remain unclear. We aimed to (1) assess the role of aging biology as a risk factor of stroke and heart disease among individuals of same chronologic age and sex and (2) compare aging biology biomarkers measured in different accessible body tissues as novel biomarkers for stroke and heart disease in older adults.

METHODS: This study included individuals who consented for blood and saliva draw in the Venous Blood Substudy and Telomere Length Study of the Health and Retirement Study (HRS). The HRS is a population-based, nationally representative longitudinal survey of individuals aged 50 years and older in the United States. Saliva-based measures included telomere length. Blood-based measures included DNA methylation and physiology biomarkers. Propensity scores-matched analyses and Cox regression models were conducted.

RESULTS: This study included individuals aged 50 years and older, who consented for blood (N = 9,934) and saliva (N = 5,808) draw in the HRS. Blood-based biomarkers of aging biology showed strong associations with incident stroke as follows: compared with the lowest tertile of blood-based biomarkers of aging, biologically older individuals had significantly higher risk of stroke based on DNA methylation Grim Age clock (adjusted hazard ratio [aHR] = 2.64, 95% CI 1.90-3.66, < 0.001) and Physiology-based Phenotypic Age clock (aHR = 1.75, 95% CI 1.27-2.42, < 0.001). In secondary analysis, biologically older individuals had increased risk of heart disease as follows: DNA methylation Grim Age clock (aHR = 1.77, 95% CI 1.49-2.11, < 0.001) and Physiology-based Phenotypic Age clock (aHR = 1.61, 95% CI 1.36-1.90, < 0.001).

DISCUSSION: Compared with saliva-based telomere length, blood-based aging physiology and some DNA methylation biomarkers are strongly associated with vascular disorders including stroke and are more precise and sensitive biomarkers of aging. Saliva-based telomere length and blood-based DNA methylation and physiology biomarkers likely represent different aspects of biological aging and accordingly vary in their precision as novel biomarkers for optimal vascular health.

VL - 101 IS - 23 ER - TY - JOUR T1 - Multimorbidity and Functional Disability among Older Adults: The Role of Inflammation and Glycemic Status - An Observational Longitudinal Study. JF - Gerontology Y1 - 2023 A1 - Botoseneanu, Anda A1 - Markwardt, Sheila A1 - Quiñones, Ana R KW - Activities of Daily Living KW - Aged KW - Arthritis KW - C-reactive protein KW - Diabetes Mellitus KW - Disabled Persons KW - Female KW - Glycated Hemoglobin KW - Heart Diseases KW - Humans KW - Hypertension KW - Inflammation KW - Longitudinal Studies KW - Male KW - multimorbidity KW - Prospective Studies KW - Stroke AB -

INTRODUCTION: Specific multimorbidity combinations, in particular those including arthritis, stroke, and cognitive impairment, have been associated with high burden of activities of daily living (ADL)-instrumental activities of daily living (IADL) disability in older adults. The biologic underpinnings of these associations are still unclear.

METHODS: Observational longitudinal study using data from the Health and Retirement Study (N = 8,618, mean age = 74 years, 58% female, 25% non-white) and negative binomial regression models stratified by sex to evaluate the role of inflammatory and glycemic biomarkers (high-sensitivity C-reactive protein (hs-CRP) and HbA1c) in the association between specific multimorbidity combinations (grouped around one of eight index diseases: arthritis, cancer, cognitive impairment, diabetes, heart disease, hypertension, lung disease, and stroke; assessed between 2006 and 2014) and prospective ADL-IADL disability (2 years later, 2008-2016). Results were adjusted for sociodemographic characteristics, body mass index, number of coexisting diseases, and baseline ADL-IADL score.

RESULTS: Multimorbidity combinations indexed by arthritis (IRR = 1.1, 95% CI = 1.01-1.20), diabetes (IRR = 1.19, 95% CI = 1.09-1.30), and cognitive impairment (IRR = 1.11, 95% CI = 1.01-1.23) among men and diabetes-indexed multimorbidity combinations (IRR = 1.07, 95% CI = 1.01-1.14) among women were associated with higher ADL-IADL scores at increasing levels of HbA1c. Across higher levels of hs-CRP, multimorbidity combinations indexed by arthritis (IRR = 1.06, 95% CI = 1.02-1.11), hypertension (IRR = 1.06, 95% CI = 1.02-1.11), heart disease (IRR = 1.06, 95% CI = 1.01-1.12), and lung disease (IRR = 1.14, 95% CI = 1.07-1.23) were associated with higher ADL-IADL scores among women, while there were no significant associations among men.

CONCLUSION: The findings suggest potential for anti-inflammatory management among older women and optimal glycemic control among older men with these particular multimorbidity combinations as focus for therapeutic/preventive options for maintaining functional health.

VL - 69 IS - 7 ER - TY - JOUR T1 - Neighborhood Characteristics and Elevated Blood Pressure in Older Adults. JF - JAMA Network Open Y1 - 2023 A1 - Sims, Kendra D A1 - Willis, Mary D A1 - Hystad, Perry W A1 - Batty, G David A1 - Bibbins-Domingo, Kirsten A1 - Smit, Ellen A1 - Odden, Michelle C KW - Aged KW - Blood pressure KW - Cohort Studies KW - ethnicity KW - Female KW - Humans KW - Hypertension KW - Male KW - Neighborhood characteristics AB -

IMPORTANCE: The local environment remains an understudied contributor to elevated blood pressure among older adults. Untargeted approaches can identify neighborhood conditions interrelated with racial segregation that drive hypertension disparities.

OBJECTIVE: To evaluate independent associations of sociodemographic, economic, and housing neighborhood factors with elevated blood pressure.

DESIGN, SETTING, AND PARTICIPANTS: In this cohort study, the sample included Health and Retirement Study participants who had between 1 and 3 sets of biennial sphygmomanometer readings from 2006 to 2014 or 2008 to 2016. Statistical analyses were conducted from February 5 to November 30, 2021.

EXPOSURES: Fifty-one standardized American Community Survey census tract variables (2005-2009).

MAIN OUTCOMES AND MEASURES: Elevated sphygmomanometer readings over the study period (6-year period prevalence): a value of at least 140 mm Hg for systolic blood pressure and/or at least 90 mm Hg for diastolic blood pressure. Participants were divided 50:50 into training and test data sets. Generalized estimating equations were used to summarize multivariable associations between each neighborhood variable and the period prevalence of elevated blood pressure, adjusting for individual-level covariates. Any neighborhood factor associated (Simes-adjusted for multiple comparisons P ≤ .05) with elevated blood pressure in the training data set was rerun in the test data set to gauge model performance. Lastly, in the full cohort, race- and ethnicity-stratified associations were evaluated for each identified neighborhood factor on the likelihood of elevated blood pressure.

RESULTS: Of 12 946 participants, 4565 (35%) had elevated sphygmomanometer readings (median [IQR] age, 68 [63-73] years; 2283 [50%] male; 228 [5%] Hispanic or Latino, 502 [11%] non-Hispanic Black, and 3761 [82%] non-Hispanic White). Between 2006 and 2016, a lower likelihood of elevated blood pressure was observed (relative risk for highest vs lowest tertile, 0.91; 95% CI, 0.86-0.96) among participants residing in a neighborhood with recent (post-1999) in-migration of homeowners. This association was precise among participants with non-Hispanic White and other race and ethnicity (relative risk, 0.91; 95% CI, 0.85-0.97) but not non-Hispanic Black participants (relative risk, 0.97; 95% CI, 0.85-1.11; P = .48 for interaction) or Hispanic or Latino participants (relative risk, 0.84; 95% CI, 0.65-1.09; P = .78 for interaction).

CONCLUSIONS AND RELEVANCE: In this cohort study of older adults, recent relocation of homeowners to a neighborhood was robustly associated with reduced likelihood of elevated blood pressure among White participants but not their racially and ethnically marginalized counterparts. Our findings indicate that gentrification may influence later-life blood pressure control.

IS - 9 ER - TY - JOUR T1 - Occupational characteristics and epigenetic aging among older adults in the United States. JF - Epigenetics Y1 - 2023 A1 - Andrasfay, Theresa A1 - Crimmins, Eileen KW - Aged KW - Aging KW - DNA Methylation KW - Epigenesis, Genetic KW - ethnicity KW - Humans KW - United States AB -

Occupational characteristics have been studied as risk factors for several age-related diseases and are thought to impact the ageing process, although there has been limited empirical work demonstrating an association between adverse occupational characteristics and accelerated ageing and this prior work has yielded mixed results. We used the 2010 and 2016 waves of the Health and Retirement Study ( = 1,251) to examine the association between occupation categories and self-reported working conditions of American adults at midlife and their subsequent epigenetic ageing as measured through five epigenetic clocks: PCHorvath, PCHannum, PCPhenoAge, PCGrimAge, and DunedinPACE. We found that individuals working in sales/clerical, service, and manual work show evidence of epigenetic age acceleration compared to those working in managerial/professional jobs and that the associations were stronger with second- and third-generation clocks. Individuals reporting high stress and high physical effort at work showed evidence of epigenetic age acceleration only on PCGrimAge and DunedinPACE. Most of these associations were attenuated after adjustment for race/ethnicity, educational attainment, and lifestyle-related risk factors. Sales/clerical work remained significantly associated with PCHorvath and PCHannum, while service work remained significantly associated with PCGrimAge. The results suggest that manual work and occupational physical activity may appear to be risk factors for epigenetic age acceleration through their associations with socioeconomic status, while stress at work may be a risk factor for epigenetic age acceleration through its associations with health behaviours outside of work. Additional work is needed to understand when in the life course and the specific mechanisms through which these associations occur.

VL - 18 IS - 1 ER - TY - JOUR T1 - Out-of-Pocket Health Care Spending at Older Ages: Do Caregiving Arrangements Matter? JF - J Appl Gerontol Y1 - 2023 A1 - Friedman, Esther M A1 - Beach, Scott R A1 - Schulz, Richard KW - Aged KW - Delivery of Health Care KW - Health Expenditures KW - Humans KW - Medicare KW - Middle Aged KW - United States AB -

Identifying the correlates of out-of-pocket (OOP) health care spending is an important step for ensuring the financial security of older adults. Whether or not someone has a family member providing assistance is one such factor that could be associated with OOP spending. If family caregivers facilitate better health, health care spending could be reduced. On the other hand, costs would be higher if family members facilitate more (or more costly) care for loved ones. This paper explores the relationship between caregiving arrangements and OOP spending using data from 5045 individuals in the 2000-2016 Health and Retirement Study with Medicare coverage and caregiving needs. We do not find a relationship between family caregiving and OOP health care costs, overall. However, among those with Medicare HMO insurance, having a family caregiver is associated with more spending than having no helper. This is mainly due to differences in spending on prescription medications.

VL - 42 IS - 5 ER - TY - JOUR T1 - Personality and Risk of Incident Stroke in 6 Prospective Studies. JF - Stroke Y1 - 2023 A1 - Stephan, Yannick A1 - Sutin, Angelina R A1 - Luchetti, Martina A1 - Aschwanden, Damaris A1 - Terracciano, Antonio KW - Adolescent KW - Adult KW - Aged KW - Aged, 80 and over KW - Humans KW - Longitudinal Studies KW - Middle Aged KW - Neuroticism KW - Personality KW - Prospective Studies KW - Stroke KW - United States KW - Young Adult AB -

BACKGROUND: A large literature has examined a broad range of factors associated with increased risk of stroke. Few studies, however, have examined the association between personality and stroke. The present study adopted a systematic approach using a multi-cohort design to examine the associations between 5-Factor Model personality traits (neuroticism, extraversion, openness, agreeableness, and conscientiousness) and incident stroke using data from 6 large longitudinal samples of adults.

METHODS: Participants (age range: 16-104 years old, N=58 105) were from the MIDUS (Midlife in the United States) Study, the HRS (Health and Retirement Study), The US (Understanding Society) study, the WLS (Wisconsin Longitudinal Study), the NHATS (National Health and Aging Trends Study), and the LISS (Longitudinal Internet Studies for the Social Sciences). Personality traits, demographic factors, clinical and behavioral risk factors were assessed at baseline; stroke incidence was tracked over 7 to 20 years follow-up.

RESULTS: Meta-analyses indicated that higher neuroticism was related to a higher risk of incident stroke (hazard ratio, 1.15 [95% CI, 1.10-1.20]; <0.001), whereas higher conscientiousness was protective (HR, 0.89 [95% CI, 0.85-0.93]; <0.001). Additional meta-analyses indicated that BMI, diabetes, blood pressure, physical inactivity, and smoking as additional covariates partially accounted for these associations. Extraversion, openness, and agreeableness were unrelated to stroke incidence.

CONCLUSIONS: Similar to other cardiovascular and neurological conditions, higher neuroticism is a risk factor for stroke incidence, whereas higher conscientiousness is a protective factor.

VL - 54 IS - 8 ER - TY - JOUR T1 - Predictive Models of Life Satisfaction in Older People: A Machine Learning Approach. JF - Int J Environ Res Public Health Y1 - 2023 A1 - Shen, Xiaofang A1 - Yin, Fei A1 - Jiao, Can KW - Aged KW - Humans KW - Linear Models KW - Machine learning KW - Middle Aged KW - Personal Satisfaction AB -

Studies of life satisfaction in older adults have been conducted extensively through empirical research, questionnaires, and theoretical analysis, with the majority of these studies basing their analyses on simple linear relationships between variables. However, most real-life relationships are complex and cannot be approximated with simple correlations. Here, we first investigate predictors correlated with life satisfaction in older adults. Then, machine learning is used to generate several predictive models based on a large sample of older adults (age ≥ 50 years; = 34,630) from the RAND Health and Retirement Study. Results show that subjective social status, positive emotions, and negative emotions are the most critical predictors of life satisfaction. The Support Vector Regression (SVR) model exhibited the highest prediction accuracy for life satisfaction in older individuals among several models, including Multiple Linear Regression (MLR), Ridge Regression (RR), Least Absolute Shrinkage and Selection Operator Regression (LASSO), K Nearest Neighbors (KNN), and Decision Tree Regression (DT) models. Although the KNN and DT models exhibited better model fitting than MLR, RR, and LASSO, their performances were poor in terms of model validation and model generalization. These results indicate that machine learning is superior to simple correlations for understanding life satisfaction among older adults.

VL - 20 IS - 3 ER - TY - JOUR T1 - Predictors of food insecurity among older adults before and during COVID-19 in the United States. JF - Front Public Health Y1 - 2023 A1 - Nicklett, Emily Joy A1 - Cheng, Greta Jianjia A1 - Morris, Zachary A KW - Aged KW - COVID-19 KW - diet KW - Food insecurity KW - Food Supply KW - Humans KW - Middle Aged KW - Pandemics KW - United States AB -

BACKGROUND: The COVID-19 pandemic has strained the health and wellbeing of older adult populations through increased morbidity, mortality, and social exclusion. However, the impact of COVID-19 on the health of older adults through food security has received relatively little attention, despite the strong impact of diet quality on the health and longevity of older adults.

OBJECTIVE: The objective of this study was to identify sociodemographic and socioeconomic predictors of self-reported food insecurity before and early in the COVID-19 pandemic among community-dwelling older adults in the United States.

METHODS: Using longitudinal data from the Health and Retirement Study, a nationally representative sample of middle-aged and older adults in the United States, we examined the associations between sociodemographic and socioeconomic predictors of self-reported food insecurity between 2018 ( = 2,413) and June 2020 ( = 2,216) using population-weighted multivariate logistic regression models.

RESULTS: The prevalence of food insecurity doubled among participants from 2018 (4.83%) to June 2020 (9.54%). In 2018, non-Hispanic Black and rural residents were more likely to report food insecurity, while individuals with higher education and greater wealth were less likely to report food insecurity in adjusted models. In June 2020, those who were relatively younger, not working due to a disability, and renting were more likely to report food insecurity. Those with an increased number of functional limitations, a recent onset of a work-limiting disability, and those who were no longer homeowners experienced an elevated longitudinal risk for food insecurity.

CONCLUSION: Future research should examine effective policies and interventions to address the disproportionate impacts of COVID-19 on populations at a heightened risk of experiencing food insecurity.

VL - 11 ER - TY - JOUR T1 - Preoperative Factors Predict Memory Decline After Coronary Artery Bypass Grafting or Percutaneous Coronary Intervention in an Epidemiological Cohort of Older Adults. JF - J Am Heart Assoc Y1 - 2023 A1 - Tang, Angelina B A1 - Diaz-Ramirez, L Grisell A1 - Smith, Alexander K A1 - Lee, Sei J A1 - Whitlock, Elizabeth L KW - Aged KW - Aged, 80 and over KW - Coronary Artery Bypass KW - Coronary Artery Bypass, Off-Pump KW - Coronary Artery Disease KW - Female KW - Humans KW - Male KW - Memory Disorders KW - Percutaneous Coronary Intervention KW - Treatment Outcome AB -

Background Durable memory decline may occur in older adults after surgical (coronary artery bypass grafting [CABG]) or nonsurgical (percutaneous coronary intervention) coronary revascularization. However, it is unknown whether individual memory risk can be predicted. We reanalyzed an epidemiological cohort of older adults to predict memory decline at ≈1 year after revascularization. Methods and Results We studied Health and Retirement Study participants who underwent CABG or percutaneous coronary intervention at age ≥65 years between 1998 and 2015 and participated in ≥1 biennial postprocedure assessment. Using a memory score based on direct and proxy cognitive tests, we identified participants whose actual postprocedure memory score was 1-2 ("mild") or >2 ("major") SDs below expected postprocedure performance. We modeled probability of memory decline using logistic regression on preoperatively known factors and evaluated model discrimination and calibration. A total of 1390 participants (551 CABG, 839 percutaneous coronary intervention) underwent CABG/percutaneous coronary intervention at 75±6 years old; 40% were women. The cohort was 83% non-Hispanic White, 8.4% non-Hispanic Black, 6.4% Hispanic ethnicity, and 1.7% from other groups masked by the HRS (Health and Retirement Study) to preserve participant confidentiality. At a median of 1.1 (interquartile range, 0.6-1.6) years after procedure, 267 (19%) had mild memory decline and 88 (6.3%) had major memory decline. Factors predicting memory decline included older age, frailty, and off-pump CABG; obesity was protective. The optimism-corrected area under the receiver operator characteristic curve was 0.73 (95% CI, 0.71-0.77). A cutoff of 50% probability of memory decline identified 14% of the cohort as high risk, and was 94% specific and 30% sensitive for late memory decline. Conclusions Preoperative factors can be used to predict late memory decline after coronary revascularization in an epidemiological cohort with high specificity.

VL - 12 IS - 1 ER - TY - JOUR T1 - Prevalence and Trends of Weakness Among Middle-Aged and Older Adults in the United States. JF - Journal of strength and conditioning research Y1 - 2023 A1 - McGrath, Ryan A1 - FitzSimmons, Samantha A1 - Andrew, Sarah A1 - Black, Kennedy A1 - Bradley, Adam A1 - Christensen, Bryan K A1 - Collins, Kyle A1 - Klawitter, Lukus A1 - Kieser, Jacob A1 - Langford, Matthew A1 - Orr, Megan A1 - Hackney, Kyle J KW - Aged KW - Body Mass Index KW - Female KW - Hand Strength KW - Humans KW - Male KW - Middle Aged KW - Muscle Weakness KW - Prevalence KW - Retirement KW - United States AB -

McGrath, R, FitzSimmons, S, Andrew, S, Black, K, Bradley, A, Christensen, BK, Collins, K, Klawitter, L, Kieser, J, Langford, M, Orr, M, and Hackney, KJ. Prevalence and trends of weakness among middle-aged and older adults in the United States. J Strength Cond Res 37(12): 2484-2490, 2023-Muscle weakness, which is often determined with low handgrip strength (HGS), is associated with several adverse health conditions; however, the prevalence and trends of weakness in the United States is not well-understood. We sought to estimate the prevalence and trends of weakness in Americans aged at least 50 years. The total unweighted analytic sample included 22,895 Americans from the 2006-2016 waves of the Health and Retirement Study. Handgrip strength was measured with a handgrip dynamometer. Men with weakness were below at least one of the absolute or normalized (body mass, body mass index) cut points: <35.5 kg, <0.45 kg/kg, <1.05 kg/kg/m 2 . The presence of any weakness in women was also identified as being below one of the absolute or normalized HGS cut points: <20.0 kg, <0.34 kg/kg, or <0.79 kg/kg/m 2 . There was an increasing trend in the prevalence of any weakness over time ( p < 0.001). The prevalence of weakness was 45.1% (95% confidence interval [CI]: 44.0-46.0) in the 2006-2008 waves and 52.6% (CI: 51.5-53.7) in the 2014-2016 waves. Weakness prevalence was higher for older (≥65 years) Americans (64.2%; CI: 62.8-65.5) compared with middle-aged (50-64 years) Americans (42.2%; CI: 40.6-43.8) in the 2014-2016 waves. Moreover, the prevalence of weakness in the 2014-2016 waves was generally higher in women (54.5%; CI: 53.1-55.9) than in men (50.4%; CI: 48.7-52.0). Differences existed in weakness prevalence across races and ethnicities. The findings from our investigation suggest that the prevalence of weakness is overall pronounced and increasing in Americans. Efforts for mitigating and better operationalizing weakness will elevate in importance as our older American population grows.

VL - 37 IS - 12 ER - TY - JOUR T1 - Prevalence and Trends of Weakness Among Middle-Aged and Older Adults in the United States. JF - Journal of strength and conditioning research Y1 - 2023 A1 - McGrath, Ryan A1 - FitzSimmons, Samantha A1 - Andrew, Sarah A1 - Black, Kennedy KW - Aged KW - Body Mass Index KW - Female KW - Hand Strength KW - Humans KW - Male KW - Middle Aged KW - Muscle Weakness KW - Prevalence KW - Retirement KW - United States AB -

McGrath, R, FitzSimmons, S, Andrew, S, Black, K, Bradley, A, Christensen, BK, Collins, K, Klawitter, L, Kieser, J, Langford, M, Orr, M, and Hackney, KJ. Prevalence and trends of weakness among middle-aged and older adults in the United States. J Strength Cond Res 37(12): 2484-2490, 2023-Muscle weakness, which is often determined with low handgrip strength (HGS), is associated with several adverse health conditions; however, the prevalence and trends of weakness in the United States is not well-understood. We sought to estimate the prevalence and trends of weakness in Americans aged at least 50 years. The total unweighted analytic sample included 22,895 Americans from the 2006-2016 waves of the Health and Retirement Study. Handgrip strength was measured with a handgrip dynamometer. Men with weakness were below at least one of the absolute or normalized (body mass, body mass index) cut points: <35.5 kg, <0.45 kg/kg, <1.05 kg/kg/m 2 . The presence of any weakness in women was also identified as being below one of the absolute or normalized HGS cut points: <20.0 kg, <0.34 kg/kg, or <0.79 kg/kg/m 2 . There was an increasing trend in the prevalence of any weakness over time ( p < 0.001). The prevalence of weakness was 45.1% (95% confidence interval [CI]: 44.0-46.0) in the 2006-2008 waves and 52.6% (CI: 51.5-53.7) in the 2014-2016 waves. Weakness prevalence was higher for older (≥65 years) Americans (64.2%; CI: 62.8-65.5) compared with middle-aged (50-64 years) Americans (42.2%; CI: 40.6-43.8) in the 2014-2016 waves. Moreover, the prevalence of weakness in the 2014-2016 waves was generally higher in women (54.5%; CI: 53.1-55.9) than in men (50.4%; CI: 48.7-52.0). Differences existed in weakness prevalence across races and ethnicities. The findings from our investigation suggest that the prevalence of weakness is overall pronounced and increasing in Americans. Efforts for mitigating and better operationalizing weakness will elevate in importance as our older American population grows.

VL - 37 IS - 12 ER - TY - JOUR T1 - Psychological pathways explaining the prospective association between obesity and physiological dysregulation. JF - Health Psychol Y1 - 2023 A1 - Putra, I Gusti Ngurah Edi A1 - Daly, Michael A1 - Sutin, Angelina A1 - Steptoe, Andrew A1 - Robinson, Eric KW - Aged KW - Body Mass Index KW - Body Weight KW - Humans KW - Longitudinal Studies KW - Obesity KW - Social Stigma KW - Weight Gain AB -

OBJECTIVE: Obesity is associated with a range of negative psychological conditions that may also affect physiological health. Across two studies, we tested whether a range of psychological measures explain why obesity is prospectively associated with physiological dysregulation, measured via clinical indicators of cardiovascular, immune system, and metabolic function.

METHOD: We used comparable 4-year follow-up representative longitudinal data of U.K. and U.S. older adults (≥50 years) from the English Longitudinal Study of Ageing (2008/2009-2012/2013; Study 1; n = 6,250) and the Health and Retirement Study (2008/2010-2012/2014; Study 2; n = 9,664). A diverse range of psychological measures (e.g., depressive symptoms, life satisfaction, weight stigma, positive affect) were tested as candidate mediators in Studies 1 (n = 14) and 2 (n = 21).

RESULTS: Obesity predicted physiological dysregulation at follow-up across both studies. In Study 1, only weight stigma (measured between baseline and follow-up) explained 37% of the association between obesity and physiological dysregulation. In Study 2, only changes in weight stigma from baseline to follow-up (not baseline weight stigma) explained 13% of the effect of obesity on future physiological dysregulation. Mediation by weight stigma in both studies was partially attenuated when changes in body mass index from baseline to follow-up were controlled for. No other psychological measures explained the association between obesity and physiological dysregulation in either study.

CONCLUSIONS: The prospective association between obesity and physiological dysregulation was largely not explained by psychological factors. However, experiencing weight stigma is associated with increased weight gain and this process may explain obesity-related declines in physiological health. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

VL - 42 IS - 7 ER - TY - JOUR T1 - Racial and Ethnic Disparities in Health Care Use and Access Associated With Loss of Medicaid Supplemental Insurance Eligibility Above the Federal Poverty Level. JF - JAMA Intern Med Y1 - 2023 A1 - Roberts, Eric T A1 - Kwon, Youngmin A1 - Hames, Alexandra G A1 - McWilliams, J Michael A1 - Ayanian, John Z A1 - Tipirneni, Renuka KW - Aged KW - Cross-Sectional Studies KW - Female KW - Healthcare Disparities KW - Humans KW - Male KW - Medicaid KW - Medicare KW - Middle Aged KW - Poverty KW - United States AB -

IMPORTANCE: Medicaid supplemental insurance covers most cost sharing in Medicare. Among low-income Medicare beneficiaries, the loss of Medicaid eligibility above this program's income eligibility threshold (100% of federal poverty level [FPL]) may exacerbate racial and ethnic disparities in Medicare beneficiaries' ability to afford care.

OBJECTIVE: To examine whether exceeding the income threshold for Medicaid, which results in an abrupt loss of Medicaid eligibility, is associated with greater racial and ethnic disparities in access to and use of care.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used a regression discontinuity design to assess differences in access to and use of care associated with exceeding the income threshold for Medicaid eligibility. We analyzed Medicare beneficiaries with incomes 0% to 200% of FPL from the 2008 to 2018 biennial waves of the Health and Retirement Study linked to Medicare administrative data. To identify racial and ethnic disparities associated with the loss of Medicaid eligibility, we compared discontinuities in outcomes among Black and Hispanic beneficiaries (n = 2885) and White beneficiaries (n = 5259). Analyses were conducted between January 1, 2022, and October 1, 2022.

MAIN OUTCOME MEASURES: Patient-reported difficulty accessing care due to cost and outpatient service use, medication fills, and hospitalizations measured from Medicare administrative data.

RESULTS: This cross-sectional study included 8144 participants (38 805 person-years), who when weighted represented 151 282 957 person-years in the community-dwelling population of Medicare beneficiaries aged 50 years and older and incomes less than 200% FPL. In the weighted sample, the mean (SD) age was 75.4 (9.4) years, 66.1% of beneficiaries were women, 14.8% were non-Hispanic Black, 13.6% were Hispanic, and 71.6% were White. Findings suggest that exceeding the Medicaid eligibility threshold was associated with a 43.8 percentage point (pp) (95% CI, 37.8-49.8) lower probability of Medicaid enrollment among Black and Hispanic Medicare beneficiaries and a 31.0 pp (95% CI, 25.4-36.6) lower probability of Medicaid enrollment among White beneficiaries. Among Black and Hispanic beneficiaries, exceeding the threshold was associated with increased cost-related barriers to care (discontinuity: 5.7 pp; 95% CI, 2.0-9.4), lower outpatient use (-6.3 services per person-year; 95% CI, -10.4 to -2.2), and fewer medication fills (-6.9 fills per person-year; 95% CI, -11.4 to -2.5), but it was not associated with a statistically significant discontinuity in hospitalizations. Discontinuities in these outcomes were smaller or nonsignificant among White beneficiaries. Consequently, exceeding the threshold was associated with widened disparities, including greater reductions in outpatient service use (disparity: -6.2 services per person-year; 95% CI, -11.7 to -0.6; P = .03) and medication fills (disparity: -7.2 fills per person-year; 95% CI, -13.4 to -1.0; P = .02) among Black and Hispanic vs White beneficiaries.

CONCLUSIONS AND RELEVANCE: This cross-sectional study found that loss of eligibility for Medicaid supplemental insurance above the federal poverty level, which increases cost sharing in Medicare, was associated with increased racial and ethnic health care disparities among low-income Medicare beneficiaries. Expanding eligibility for Medicaid supplemental insurance may narrow these disparities.

VL - 183 IS - 6 ER - TY - JOUR T1 - Racial Differences in Employment and Poverty Histories and Health in Older Age. JF - Am J Prev Med Y1 - 2023 A1 - Lu, Peiyi A1 - Kezios, Katrina A1 - Milazzo, Floriana A1 - Jawadekar, Neal A1 - Shelley, Mack A1 - Zeki Al Hazzouri, Adina KW - Aged KW - Black or African American KW - Employment KW - Humans KW - Middle Aged KW - Poverty KW - Race Factors KW - White AB -

INTRODUCTION: Black Americans encounter more barriers in the job market and earn less than White Americans. However, the extent to which racial disparities in employment and poverty histories impact health is not fully understood. This study characterized employment‒poverty histories for Black and White middle-aged adults and examined their association with health.

METHODS: Respondents born in 1948-1953 and enrolled in the 2004 Health and Retirement Study (N=555, N=2,209) were included. Sequence analysis grouped respondents with similar employment‒poverty trajectories from 2004 to 2016, and confounder-adjusted regression analyses estimated the associations between these trajectories and health in 2018. Analyses were conducted in 2021-2022.

RESULTS: More than 23% of Black respondents experienced both employment and poverty fluctuations, including bouts of extreme poverty (<50% of the federal poverty threshold), whereas no trajectory for White respondents included extreme poverty. Adversities in employment‒poverty were associated with worse health. For example, among Black respondents, those who experienced both employment and poverty fluctuations had worse cognition than those employed and not poor (β= -0.55 standardized units, 95% CI= -0.81, -0.30). Similarly, among White respondents, those who experienced employment fluctuations had worse cognition than those employed (β= -0.35, 95% CI= -0.46, -0.24). Notably, the employed and not poor trajectory was associated with worse survival among Black respondents than among White respondents.

CONCLUSIONS: Employment fluctuations were associated with worse health, especially cognitive function, where the association was stronger among Black Americans who experienced both employment fluctuations and poverty. Findings highlight the importance of enhancing employment stability and of antipoverty programs, especially for Black Americans.

VL - 64 IS - 4 ER - 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 - Relationships between Interpersonal Goals and Loneliness in Older Adults: A Cross-Sectional Study. JF - Int J Environ Res Public Health Y1 - 2023 A1 - Ezeokonkwo, Francesca C A1 - Sekula, Kathleen L A1 - Stokes, Jeffrey E A1 - Theeke, Laurie A A1 - Zoucha, Rick A1 - Troutman-Jordan, Meredith A1 - Sharma, Dinesh KW - Aged KW - Cross-Sectional Studies KW - Ecosystem KW - Female KW - Goals KW - Humans KW - Interpersonal Relations KW - Loneliness AB -

Loneliness is linked to many physiological and psychological issues and disproportionately affects older adults. Interpersonal goals (compassion and self-image) are essential to interpersonal relationships; however, how they relate to loneliness in older adults is unknown. We investigated the impact of interpersonal goals on loneliness using the Ecosystem-Egosystem Theory of Social Motivation. This study, adopting a descriptive cross-sectional correlational design, used data from the 2016 Health and Retirement Study. Participants ( = 3212) included people aged >65 years (mean age: 75; female: 60.1%). We performed exploratory factor analysis with principal axis factoring and varimax rotation to examine the suitability of compassionate and self-image goals as separate factors. The complex samples general linear model was used to assess the relationship between loneliness and interpersonal goals. Interpersonal goals were significantly negatively associated with loneliness. Respondents with higher compassion and self-image goals reported lower loneliness levels. Our results contribute to understanding how interpersonal goals relate to loneliness in older adults. These initial findings warrant further investigation.

VL - 20 IS - 3 ER - TY - JOUR T1 - Relationships Between Types of Leisure Activities and Mental Health among Older Adults With Diabetes During the COVID-19 Pandemic. JF - Am J Health Behav Y1 - 2023 A1 - Lee, Jungjoo A1 - Han, Areum A1 - Kim, Junhyoung A1 - Park, Se-Hyuk KW - Aged KW - COVID-19 KW - Diabetes Mellitus KW - Humans KW - Leisure activities KW - Mental Health KW - Pandemics AB -

Three types of leisure activities such as sedentary, social, and leisure-time physical activity (LTPA) have been identified as essential factors that influence mental health outcomes among older adults with diabetes. In this study, we aimed to investigate what types of leisure activities are associated with mental health outcomes among older adults with diabetes during the COVID-19 pandemic. We used 2020 Health and Retirement Study (HRS) data. We extracted 310 records from 3266 individuals diagnosed with diabetes and conducted a hierarchical regression analysis to investigate the research question. LTPA was the strongest predictor of reduced loneliness and stress and increased happiness and life satisfaction among older adults with diabetes. Our findings highlight the relationship between different types of leisure activities and mental health for older adults with diabetes during the COVID-19 pandemic. Data suggest that LTPA, social leisure, and sedentary leisure reduce loneliness and stress and improve happiness and life satisfaction.

VL - 47 IS - 2 ER - TY - JOUR T1 - The Role of Different Weakness Cut-Points for Future Cognitive Impairment in Older Americans. JF - Journal of the American Directors Association Y1 - 2023 A1 - McGrath, Ryan A1 - Tomkinson, Grant R A1 - Hamm, Jeremy M A1 - Juhl, Kirsten A1 - Knoll, Kelly A1 - Parker, Kelly A1 - Smith, Ashleigh E A1 - Rhee, Yeong KW - Aged KW - Body Mass Index KW - Cognition KW - Cognitive Dysfunction KW - Female KW - Geriatric Assessment KW - Hand Strength KW - Humans KW - Male AB -

OBJECTIVES: New absolute and normalized handgrip strength (HGS) cut-points may not yield similar predictive value for cognitive performance. We sought to determine the associations of (1) each absolute and normalized weakness cut-point, and (2) compounding weakness on future cognitive impairment in older Americans.

DESIGN: Longitudinal panel.

SETTING AND PARTICIPANTS: The analytic sample included 11,116 participants aged ≥65 years from the 2006 to 2018 waves of the Health and Retirement Study. Participants from the Health and Retirement Study completed detailed interviews that included physical measures and core interviews.

METHODS: The modified Telephone Interview of Cognitive Status assessed cognitive function and persons scoring <11 were classified as having a cognitive impairment. A handgrip dynamometer measured HGS. Men were considered weak if their HGS was <35.5 kg (absolute), <0.45 kg/kg (body mass normalized), or <1.05 kg (body mass index normalized), whereas women were classified as weak if their HGS was <20.0 kg, <0.337 kg/kg, or <0.79 kg. Compounding weakness included those below 1, 2, or all 3 cut-points. Generalized estimating equations quantified the associations.

RESULTS: Persons considered weak under the absolute cut-point had 1.62 (95% CI 1.34-1.96) greater odds for future cognitive impairment, but no significant associations were observed for those classified as weak under the body mass [odds ratio (OR) 1.12, CI 0.91-1.36] and body mass index normalized (OR 1.17, CI 0.95-1.43) cut-points. Older Americans below all 3 weakness cut-points had 1.47 (CI 1.15-1.88) greater odds for future cognitive impairment, but no significant associations were found for persons classified as weak under 1 (OR 1.08, CI 0.83-1.42) or 2 (OR 1.19, CI 0.91-1.55) cut-points.

CONCLUSIONS AND IMPLICATIONS: Our findings suggest that each weakness cut-point has differential prognostic value for future cognitive impairment, and aggregating weakness cut-points may improve their predictive utility. Consideration should be given to how weakness categories are uniquely linked to cognitive function.

VL - 24 IS - 12 ER - TY - JOUR T1 - Social Frailty Index: Development and validation of an index of social attributes predictive of mortality in older adults. JF - Proc Natl Acad Sci U S A Y1 - 2023 A1 - Shah, Sachin J A1 - Oreper, Sandra A1 - Jeon, Sun Young A1 - Boscardin, W John A1 - Fang, Margaret C A1 - Covinsky, Kenneth E KW - Aged KW - Child KW - Frailty KW - Humans KW - Longitudinal Studies KW - Retirement KW - Sociological Factors AB -

While social characteristics are well-known predictors of mortality, prediction models rely almost exclusively on demographics, medical comorbidities, and function. Lacking an efficient way to summarize the prognostic impact of social factor, many studies exclude social factors altogether. Our objective was to develop and validate a summary measure of social risk and determine its ability to risk-stratify beyond traditional risk models. We examined participants in the Health and Retirement Study, a longitudinal, survey of US older adults. We developed the model from a comprehensive inventory of 183 social characteristics using least absolute shrinkage and selection operator, a penalized regression approach. Then, we assessed the predictive capacity of the model and its ability to improve on traditional prediction models. We studied 8,250 adults aged ≥65 y. Within 4 y of the baseline interview, 22% had died. Drawn from 183 possible predictors, the Social Frailty Index included age, gender, and eight social predictors: neighborhood cleanliness, perceived control over financial situation, meeting with children less than yearly, not working for pay, active with children, volunteering, feeling isolated, and being treated with less courtesy or respect. In the validation cohort, predicted and observed mortality were strongly correlated. Additionally, the Social Frailty Index meaningfully risk-stratified participants beyond the Charlson score (medical comorbidity index) and the Lee Index (comorbidity and function model). The Social Frailty Index includes age, gender, and eight social characteristics and accurately risk-stratifies older adults. The model improves upon commonly used risk prediction tools and has application in clinical, population health, and research settings.

VL - 120 IS - 7 ER - TY - JOUR T1 - Structural equation model of coping and life satisfaction of community-dwelling older people during the COVID-19 pandemic. JF - J Patient Rep Outcomes Y1 - 2023 A1 - Lalani, Nasreen A1 - Dongjuan, Xu A1 - Cai, Yun A1 - Arling, Greg W KW - Activities of Daily Living KW - Adaptation, Psychological KW - Aged KW - Child KW - COVID-19 KW - Female KW - Frailty KW - Humans KW - Independent Living KW - Male KW - Pandemics KW - Personal Satisfaction AB -

BACKGROUND: COVID-19 put older individuals at high risk for morbidity and mortality, isolation, reduced coping, and lower satisfaction with life. Many older adults experienced social isolation, fear, and anxiety. We hypothesized that successful coping with these stressors would maintain or improve satisfaction with life, a crucial psychological outcome during the pandemic. Our study investigated relationships between older people's coping and life satisfaction during the pandemic and their optimism, sense of mastery, closeness with spouse, family, and friends, and vulnerabilities from frailty, comorbid diseases, memory problems, and dependencies in instrumental activities of daily living (IADL).

METHODS: The study was based on a special COVID-19 sample of 1351 community-dwelling older adults who participated in the 2020 Health and Retirement Survey. A comprehensive structural equation modeling was used to test direct and indirect effects, with life satisfaction as the main outcome and coping as a mediator between the other variables and coping.

RESULTS: Most survey respondents were female and between the ages of 65-74 years. They averaged 1.7 chronic conditions, one in seven was frail, about one-third rated their memory as fair or poor, and about one in seven reported one or more difficulties in IADL. As hypothesized-older people with increased sense of mastery and optimism were better able to cope and had greater life satisfaction. In addition, close relationships with friends and with other family members besides the spouse/partner or children contributed to more successful coping, while the interpersonal closeness of all types contributed directly to greater life satisfaction. Finally, older people with more IADL limitations reported greater difficulty coping and lower life satisfaction, and those older people who were frail or had multiple comorbid diseases reported lower life satisfaction.

CONCLUSIONS: Optimism, sense of mastery and closeness with family/friends promotes coping and life satisfaction, whereas frailty and comorbidities make coping more challenging and lead to lower life satisfaction particularly during a pandemic. Our study improves on prior research because of its nationally representative sample and formal specification and testing of a comprehensive theoretical framework.

VL - 7 IS - 1 ER - TY - JOUR T1 - Structural Inequity and Socioeconomic Status Link to Osteoporosis Diagnosis in a Population-Based Cohort of Middle-Older-Age Americans. JF - Inquiry Y1 - 2023 A1 - Gough Courtney, Margaret A1 - Roberts, Josephine A1 - Godde, Kanya KW - Adult KW - Aged KW - Aged, 80 and over KW - Black or African American KW - Humans KW - Income KW - Logistic Models KW - Middle Aged KW - Osteoporosis KW - Social Class KW - Socioeconomic factors AB -

Socioeconomic status (SES) is an important social determinant of health inequities that has been linked to chronic conditions, including osteoporosis, but research tends to focus on socioeconomic disadvantage rather than how socioeconomic advantage may facilitate these inequities. This study accounts for structural inequities and assesses the relationship between early-life and later-life SES, and risk of osteoporosis diagnosis. Data come from the nationally representative, population-based cohort Health and Retirement Study and include individuals ages 50 to 90. The outcome variable is osteoporosis diagnosis. Logistic regression models of the relationship between SES and osteoporosis diagnosis are estimated, accounting for demographic, health, and childhood variables. Higher levels of childhood and adult SES link to lower odds of osteoporosis diagnosis. Structural inequities in income and underdiagnosis of osteoporosis among persons identifying as Black/African American were detected. Accounting for bone density scan access, inequities in osteoporosis diagnosis appear to stem from barriers to accessing health care due to financial constraints. The important role of SES and evidence of structural inequities leading to underdiagnosis suggest the critical importance of clinicians receiving Diversity, Equity, and Inclusion training to reduce health inequities.

VL - 60 ER - TY - JOUR T1 - Subjective Memory Complaints Predict Decline in Memory, Instrumental Activities of Daily Living, and Social Participation in Older Adults: A Fixed-Effects Model. JF - Am J Occup Ther Y1 - 2023 A1 - Lee, Chang Dae A1 - Foster, Erin R KW - Activities of Daily Living KW - Aged KW - Aging KW - Female KW - Humans KW - Independent Living KW - Longitudinal Studies KW - Male KW - Memory Disorders KW - Social participation AB -

IMPORTANCE: Although subjective memory complaints (SMCs) have been suggested to be associated with future memory impairment, limitations in instrumental activities of daily living (IADLs), and social participation restriction, these associations are still inconclusive.

OBJECTIVE: To determine whether changes in SMCs over time predict decline in memory, IADLs, and social participation in older adults.

DESIGN: Longitudinal study.

SETTING: Community.

PARTICIPANTS: Sample 1 included 2,493 community-dwelling older adults drawn from the Health and Retirement Study (HRS) data collected between 2004 and 2018. Sample 2 included 1,644 community-dwelling older adults drawn from the HRS data collected between 2008 and 2018.

OUTCOMES AND MEASURES: Self-reported SMCs, memory function, self-reported IADL performance, and self-reported social participation.

RESULTS: The mean age of Sample 1 at baseline was 70.16 yr; 1,468 (58.88%) were female. In Sample 1, immediate and delayed memory (all ps < .001) and IADL performance (p < .01) declined over time. Increases in SMCs over time significantly predicted future immediate and delayed memory declines (p < .01 and p < .001, respectively) and future IADL performance decline (p < .001), after controlling for depressive symptoms. The mean age of Sample 2 at baseline was 71.52 yr; 928 (56.45%) were female. In Sample 2, social participation declined over time (all ps < .001). Increases in SMCs over time significantly predicted future social participation decline (p < .05), after controlling for depressive symptoms.

CONCLUSIONS AND RELEVANCE: Increases in SMCs predict future decline in memory, IADL performance, and social participation after accounting for depressive symptoms. What This Article Adds: SMCs can be used as an early indicator of future memory impairment, IADL limitations, and social participation restrictions in older adults. Furthermore, interventions that minimize SMCs may help older adults achieve successful aging.

VL - 77 IS - 4 ER - TY - JOUR T1 - Understanding Alzheimer's disease in the context of aging: Findings from applications of stochastic process models to the Health and Retirement Study. JF - Mech Ageing Dev Y1 - 2023 A1 - Arbeev, Konstantin G A1 - Bagley, Olivia A1 - Yashkin, Arseniy P A1 - Duan, Hongzhe A1 - Akushevich, Igor A1 - Ukraintseva, Svetlana V A1 - Yashin, Anatoliy I KW - Aged KW - Aging KW - Alzheimer disease KW - Apolipoproteins E KW - Humans KW - Medicare KW - Retirement KW - United States AB -

There is growing literature on applications of biodemographic models, including stochastic process models (SPM), to studying regularities of age dynamics of biological variables in relation to aging and disease development. Alzheimer's disease (AD) is especially good candidate for SPM applications because age is a major risk factor for this heterogeneous complex trait. However, such applications are largely lacking. This paper starts filling this gap and applies SPM to data on onset of AD and longitudinal trajectories of body mass index (BMI) constructed from the Health and Retirement Study surveys and Medicare-linked data. We found that APOE e4 carriers are less robust to deviations of trajectories of BMI from the optimal levels compared to non-carriers. We also observed age-related decline in adaptive response (resilience) related to deviations of BMI from optimal levels as well as APOE- and age-dependence in other components related to variability of BMI around the mean allostatic values and accumulation of allostatic load. SPM applications thus allow revealing novel connections between age, genetic factors and longitudinal trajectories of risk factors in the context of AD and aging creating new opportunities for understanding AD development, forecasting trends in AD incidence and prevalence in populations, and studying disparities in those.

VL - 211 ER - TY - JOUR T1 - United we thrive: friendship and subsequent physical, behavioural and psychosocial health in older adults (an outcome-wide longitudinal approach). JF - Epidemiology and Psychiatric Sciences Y1 - 2023 A1 - Kim, E S A1 - Chopik, W J A1 - Chen, Y A1 - Wilkinson, R A1 - VanderWeele, T J KW - Aged KW - Aging KW - Friends KW - Humans KW - Interpersonal Relations KW - Prospective Studies AB -

AIMS: Three factors converge to underscore the heightened importance of evaluating the potential health/well-being effects of friendships in older adulthood. First, policymakers, scientists, and the public alike are recognizing the importance of social relationships for health/well-being and creating national policies to promote social connection. Second, many populations are rapidly aging throughout the world. Third, we currently face what some call a 'friendship recession'. Although, growing research documents associations between friendship with better health and well-being, friendship can also have a 'dark side' and can potentially promote negative outcomes. To better capture friendship's potential heterogeneous effects, we took an outcome-wide analytic approach.

METHODS: We analysed data from 12,998 participants in the Health and Retirement Study (HRS) - a prospective and nationally representative cohort of U.S. adults aged >50, and, evaluated if increases in friendship strength (between ; 2006/2008 and ; 2010/2012) were associated with better health/well-being across 35 outcomes (in ; 2014/2016). To assess friendship strength, we leveraged all available friendship items in HRS and created a composite 'friendship score' that assessed the following three domains: (1) friendship network size, (2) friendship network contact frequency and (3) friendship network quality.

RESULTS: Stronger friendships were associated with better outcomes on some indicators of physical health (e.g. reduced risk of mortality), health behaviours (e.g. increased physical activity) and nearly all psychosocial indicators (e.g. higher positive affect and mastery, as well as lower negative affect and risk of depression). Friendship was also associated with increased likelihood of smoking and heavy drinking (although the latter association with heavy drinking did not reach conventional levels of statistical significance).

CONCLUSIONS: Our findings indicate that stronger friendships can have a dual impact on health and well-being. While stronger friendships appear to mainly promote a range of health and well-being outcomes, stronger friendships might also promote negative outcomes. Additional research is needed, and any future friendship interventions and policies that aim to enhance outcomes should focus on how to amplify positive outcomes while mitigating harmful ones.

VL - 32 ER - TY - JOUR T1 - Working, Low Income, and Cancer Caregiving: Financial and Mental Health Impacts. JF - J Clin Oncol Y1 - 2023 A1 - Bradley, Cathy J A1 - Kitchen, Sara A1 - Owsley, Kelsey M KW - Aged KW - Caregivers KW - Employment KW - Humans KW - Income KW - Insurance, Health KW - Mental Health KW - Neoplasms AB -

PURPOSE: Approximately 6 million people provide caregiving to people diagnosed with cancer. Many must remain employed to support their household and to have access to health insurance. It is unknown if caregiving for a spouse diagnosed with cancer is associated with greater financial and mental stress relative to providing care for a spouse with different conditions.

METHODS: Health and Retirement Study (2002-2020) data were used to compare employed caregivers, younger than age 65 years, caring for a spouse diagnosed with cancer (n = 103) and a matched control group caring for a spouse with other conditions (n = 515). We used logistic regression to examine a decrease in household income, increase in household debt, stopping work, and a new report of a mental health condition over a 4-year period, adjusting for socioeconomic and demographic characteristics, and health insurance status. Subanalyses stratified estimations by median household income.

RESULTS: Around a third of cancer caregivers reported they stopped working (35%) and had an increase in household debt (30%). Cancer caregivers in households below the median household income were more likely to report decreased income (13.4 percentage points [pp]; < .10), increased household debt (14.5 pp; < .10), and stopping work (18.8 pp; < .05) than similar noncancer caregivers. Mixed results were found for a change in mental health domains. The results were robust to multiple sensitivity analyses.

CONCLUSION: Cancer caregivers from low-income households were more likely to increase debt and incur work loss compared with noncancer caregivers in similar households. Policies such as paid sick leave and family leave are needed for this strained and important population who have financial and employment responsibilities in addition to caregiving.

VL - 41 IS - 16 ER - TY - JOUR T1 - Association of Cumulative Blood Pressure With Cognitive Decline, Dementia, and Mortality. JF - Journal of the American College of Cardiology Y1 - 2022 A1 - Li, Chenglong A1 - Zhu, Yidan A1 - Ma, Yanjun A1 - Hua, Rong A1 - Zhong, Baoliang A1 - Xie, Wuxiang KW - Aged KW - Blood pressure KW - Cognition KW - Cognitive Dysfunction KW - Dementia KW - Female KW - Male AB -

BACKGROUND: Elevated blood pressure (BP) has been linked to impaired cognition and dementia in older adults. However, few studies have accounted for long-term cumulative BP exposure.

OBJECTIVES: The aim of this study was to test whether long-term cumulative BP was independently associated with subsequent cognitive decline, incident dementia, and all-cause mortality among cognitively healthy adults.

METHODS: This study used data from the HRS (Health and Retirement Study) and ELSA (English Longitudinal Study of Ageing). Cumulative BP was calculated as the area under the curve using measurements from wave 0 (1998-1999) to wave 4 (2008-2009) in ELSA and wave 8 (2006-2007) to wave 10 (2010-2011) in the HRS. Outcomes included cognitive decline, incident dementia, and all-cause mortality.

RESULTS: A total of 7,566 and 9,294 participants from ELSA and the HRS were included (44.8% and 40.2% men and median age 62.0 years [IQR: 55.0-70.0 years] and 65.0 years [IQR: 58.0-72.0 years], respectively). The median follow-up duration was 8.0 years (IQR: 4.0-8.0 years) and 8.0 years (IQR: 6.0-8.0 years), respectively. Elevated cumulative systolic BP and pulse pressure were independently associated with accelerated cognitive decline (P < 0.001 for both), elevated dementia risk (P < 0.001 for both), and all-cause mortality (P < 0.001 for both), while a significant inverse association was observed for diastolic BP. Strong dose-response relationships were identified, with similar results for the 2 cohorts.

CONCLUSIONS: Long-term cumulative BP was associated with subsequent cognitive decline, dementia risk, and all-cause mortality in cognitively healthy adults aged ≥50 years. Efforts are required to control long-term systolic BP and pulse pressure and to maintain adequate diastolic BP.

VL - 79 IS - 14 ER - TY - JOUR T1 - Association of Playing College American Football With Long-term Health Outcomes and Mortality. JF - JAMA Network Open Y1 - 2022 A1 - Phelps, Alyssa A1 - Alosco, Michael L A1 - Baucom, Zachary A1 - Hartlage, Kaitlin A1 - Palmisano, Joseph N A1 - Weuve, Jennifer A1 - Mez, Jesse A1 - Tripodis, Yorghos A1 - Stern, Robert A KW - Aged KW - Brain Concussion KW - Cohort Studies KW - Female KW - Football KW - Health Care KW - Humans KW - Male KW - Neurodegenerative Diseases KW - Outcome Assessment AB -

Importance: Exposure to repetitive head impacts from playing American football (including impacts resulting in symptomatic concussions and subconcussive trauma) is associated with increased risk for later-life health problems, including cognitive and neuropsychiatric decline and neurodegenerative disease. Most research on long-term health consequences of playing football has focused on former professional athletes, with limited studies of former college players.

Objectives: To estimate the prevalence of self-reported health conditions among former college football players compared with a sample of men in the general population as well as standardized mortality ratios (SMRs) among former college football players.

Design, Setting, and Participants: This cohort study included data from 447 former University of Notre Dame (ND) football players aged 59 to 75 years who were seniors on the rosters from 1964 to 1980. A health outcomes survey was distributed to living players and next of kin of deceased players for whom contact information was available. The survey was completed from December 2018 to May 2019.

Exposure: Participation in football at ND.

Main Outcomes and Measures: Prevalence of health outcomes was compared between living former players who completed the survey and propensity score-matched participants in the Health and Retirement Study (HRS). Standardized mortality ratios of all causes and specific causes of death among all former players were compared with those among men in the general US population.

Results: A total of 216 living players completed the health survey (median age, 67 years; IQR, 63-70 years) and were compared with 638 participants in the HRS (median age, 66 years; IQR, 63-70 years). Former players reported a higher prevalence of cognitive impairment (10 [5%] vs 8 [1%]; P = .02), headaches (22 [10%] vs 22 [4%]; P = .001), cardiovascular disease (70 [33%] vs 128 [20%]; P = .001), hypercholesterolemia (111 [52%] vs 182 [29%]; P = .001), and alcohol use (185 [86%] vs 489 [77%]; P = .02) and a lower prevalence of diabetes (24 [11%] vs 146 [23%]; P = .001). All-cause mortality (SMR, 0.54; 95% CI, 0.42-0.67) and mortality from heart (SMR, 0.64; 95% CI, 0.39-0.99), circulatory (SMR, 0.23; 95% CI, 0.03-0.83), respiratory (SMR, 0.13; 95% CI, 0.00-0.70), and digestive system (SMR, 0.13; 95% CI, 0.00-0.74) disorders; lung cancer (SMR, 0.26; 95% CI, 0.05-0.77); and violence (SMR, 0.10; 95% CI, 0.00-0.58) were significantly lower in the ND cohort than in the general population. Mortality from brain and other nervous system cancers was significantly higher in the ND cohort (SMR, 3.82; 95% CI, 1.04-9.77). Whereas point estimates were greater for all neurodegenerative causes (SMR, 1.42; 95% CI, 0.29-4.18), amyotrophic lateral sclerosis (SMR, 2.93; 95% CI, 0.36-10.59), and Parkinson disease (SMR, 2.07; 95% CI, 0.05-11.55), the difference did not reach statistical significance.

Conclusions and Relevance: In this cohort study of former college football players, both positive and negative health outcomes were observed. With more than 800 000 former college players living in the US, additional research appears to be needed to provide stakeholders with guidance to maximize factors that improve health outcomes and minimize factors that may increase risk for later-life morbidity and mortality.

VL - 5 IS - 4 ER - TY - JOUR T1 - Associations Between Satisfaction With Aging and Health and Well-being Outcomes Among Older US Adults. JF - JAMA Network Open Y1 - 2022 A1 - Julia S Nakamura A1 - Hong, Joanna H A1 - Jacqui Smith A1 - William J. Chopik A1 - Chen, Ying A1 - Tyler J VanderWeele A1 - Eric S Kim KW - Aged KW - Aging KW - Female KW - Health Behavior KW - Humans KW - Male KW - Middle Aged KW - Personal Satisfaction KW - United States AB -

Importance: Researchers and policy makers are expanding the focus from risk factors of disease to seek potentially modifiable health factors that enhance people's health and well-being. Understanding if and to what degree aging satisfaction (one's beliefs about their own aging) is associated with a range of health and well-being outcomes aligns with the interests of older adults, researchers, health systems, and politicians.

Objectives: To evaluate associations between changes in aging satisfaction and 35 subsequent health and well-being outcomes.

Design, Setting, and Participants: This cohort study used data from the Health and Retirement Study, a national, diverse, and longitudinal sample of 13 752 US adults older than 50 years, to evaluate if changes in aging satisfaction (between combined cohorts from 2008 and 2010 and 4 years later, in 2012 and 2014) were subsequently associated with 35 indicators of physical, behavioral, and psychosocial health and well-being in 2016 and 2018. Statistical analysis was conducted from July 24, 2020, to November 6, 2021.

Exposure: Aging satisfaction.

Main Outcomes and Measures: A total of 35 physical (eg, stroke), behavioral (eg, sleep problems), and psychosocial (eg, depression) outcomes were evaluated using multiple linear and generalized linear regression models. Data from all participants, irrespective of how their levels of aging satisfaction changed from the prebaseline to baseline waves, were incorporated into the overall estimate, which was conditional on prior satisfaction.

Results: During the 4-year follow-up period, participants (N = 13 752; 8120 women [59%]; mean [SD] age, 65 [10] years; median age, 64 years [IQR, 56-72 years]; 7507 of 11 824 married [64%]) in the highest (vs lowest) quartile of aging satisfaction had improved physical health (eg, 43% reduced risk of mortality [risk ratio, 0.57; 95% CI, 0.46-0.71]), better health behaviors (eg, 23% increased likelihood of frequent physical activity [risk ratio, 1.23; 95% CI, 1.12-1.34]), and improved psychosocial well-being (eg, higher positive affect [β = 0.51; 95% CI, 0.44-0.58] and lower loneliness [β = -0.41; 95% CI, -0.48 to -0.33]), conditional on prebaseline aging satisfaction.

Conclusions and Relevance: This study suggests that higher aging satisfaction is associated with improved subsequent health and well-being. These findings highlight potential outcomes if scalable aging satisfaction interventions were developed and deployed at scale; they also inform the efforts of policy makers and interventionists who aim to enhance specific health and well-being outcomes. Aging satisfaction may be an important target for future interventions aiming to improve later-life health and well-being.

VL - 5 IS - 2 ER - TY - JOUR T1 - Defining Childlessness Among Middle-Aged and Older Americans: A Research Note. JF - Demography Y1 - 2022 A1 - Xu, Xiao A1 - Liang, Jersey A1 - Raymo, James M A1 - Kim, BoRin A1 - Ofstedal, Mary Beth KW - Aged KW - Child KW - Family Characteristics KW - Gender Identity KW - Marital Status KW - Middle Aged KW - Residence Characteristics AB -

Measuring childlessness is complicated by the increasing complexity of family structure. Using data from the 2014 Health and Retirement Study, in this research note we compared three definitions of childlessness: (1) respondent never fathered/gave birth to a child, (2) respondent had no children who were living and in contact, and (3) respondent and spouse/partner had no children or stepchildren who were living and in contact. Results showed that the prevalence of childlessness among Americans aged 55 or older ranged from 9.2% to 13.6% depending on which definition was used. The association between select individual characteristics (gender and marital status) and the likelihood of childlessness, as well as the association between childlessness and loneliness and living arrangements, also varied depending on how childlessness was defined. Therefore, how we define childlessness can affect our understanding of its prevalence, correlates, and relationships with well-being. Future research on childlessness should carefully consider the choice of definition and its implications for research and policy discussions.

VL - 59 IS - 3 ER - TY - JOUR T1 - Diet Quality and Health in Older Americans. JF - Nutrients Y1 - 2022 A1 - Zhao, Hang A1 - Andreyeva, Tatiana KW - Activities of Daily Living KW - Aged KW - diet KW - Eating KW - Healthy KW - Nutritional Status AB -

Adequate nutrition is an essential component of healthy ageing. This study documents the quality of diets among older Americans and implications of healthy eating for their physical and mental health. Using a nationally representative longitudinal sample of adults aged ≥50 years, from the Health and Retirement Study (HRS) 2010-2016 and food intake data from the 2013 Health Care and Nutrition Study (HCNS), the study evaluates the onset of health problems along the spectrum of diet quality measured by the Healthy Eating Index (HEI)-2015. Older adults adhering to healthier diets, in the high HEI group, have a significantly lower risk of developing limitations in activities of daily living (15.2% vs. 19.6%, < 0.01) and depression (11.8% vs. 14.9%, < 0.01), as compared to participants with low HEI scores. Consuming healthier diets also predicts more favorable health outcomes, as measured by blood-based biomarkers, including C-reactive protein (3.3 vs. 3.8, < 0.05), cystatin C (1.1 vs. 1.2, < 0.1), total cholesterol (192.1 vs. 196.4, < 0.1), and high-density lipoprotein (57.2 vs. 53.8, < 0.01). Most older Americans can benefit from improving diet to reduce their risk of disability, chronic disease, and depression.

VL - 14 IS - 6 ER - TY - JOUR T1 - Geriatric Conditions Among Middle-aged and Older Adults on Methadone Maintenance Treatment: A Pilot Study. JF - Journal of Addiction Medicine Y1 - 2022 A1 - Benjamin H Han A1 - Cotton, Brandi Parker A1 - Polydorou, Soteri A1 - Sherman, Scott E A1 - Rosie Ferris A1 - Arcila-Mesa, Mauricio A1 - Qian, Yingzhi A1 - McNeely, Jennifer KW - Aged KW - Analgesics, Opioid KW - Female KW - Humans KW - Methadone KW - Middle Aged KW - Opiate Substitution Treatment KW - Opioid-Related Disorders KW - Pilot Projects AB -

OBJECTIVES: The number of older adults on methadone maintenance treatment (MMT) for opioid use disorder is increasing, but little is known about the characteristics and healthcare needs of this aging treatment population. This population may experience accelerated aging due to comorbidities and health behaviors. The aim of this study was to compare the prevalence of geriatric conditions among adults age ≥50 on MMT to a nationally representative sample of community-dwelling older adults.

METHODS: We performed a geriatric assessment on 47 adults age ≥50 currently on MMT enrolled in 2 opioid treatment programs, in New York City and in East Providence, Rhode Island. We collected data on self-reported geriatric conditions, healthcare utilization, chronic medical conditions, physical function, and substance use. The results were compared to 470 age, sex, and race/ethnicity-matched adults in the national Health and Retirement Study.

RESULTS: The mean age of the study sample was 58.8 years and 23.4% were female. The most common chronic diseases were hypertension (59.6%) and arthritis (55.3%) with 66% reporting ≥2 diseases. For geriatric conditions, adults on MMT had a significantly higher prevalence of mobility, hearing, and visual impairments as well as falls, urinary incontinence, chronic pain, and insomnia than the Health and Retirement Study sample.

CONCLUSIONS: Older adults on MMT in 2 large opioid treatment programs have a high prevalence of geriatric conditions. An interdisciplinary, geriatric-based approach to care that focuses on function and addresses geriatric conditions is needed to improve the health of this growing population.

VL - 16 IS - 1 ER - TY - JOUR T1 - The importance of chronic conditions for potentially avoidable hospitalizations among non-Hispanic Black and non-Hispanic White older adults in the US: a cross-sectional observational study. JF - BMC Health Services Research Y1 - 2022 A1 - Jørgensen, Terese Sara Høj A1 - Allore, Heather A1 - Elman, Miriam R A1 - Nagel, Corey A1 - Quiñones, Ana R KW - Aged KW - Asthma KW - chronic KW - Chronic Obstructive KW - Heart Failure KW - Hospitalization KW - Humans KW - Medicare KW - Pulmonary Disease KW - Renal Insufficiency AB -

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

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

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

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

VL - 22 IS - 1 ER - TY - JOUR T1 - Lonely older adults are more likely to delay or avoid medical care during the coronavirus disease 2019 pandemic. JF - International Journal of Geriatric Psychiatry Y1 - 2022 A1 - Li, Yue A1 - Cheng, Zijing A1 - Cai, Xueya A1 - Holloway, Melissa A1 - Maeng, Daniel A1 - Simning, Adam KW - Aged KW - COVID-19 KW - Humans KW - Independent Living KW - Loneliness KW - Pandemics KW - SARS-CoV-2 AB -

OBJECTIVES: To examine the relationship between loneliness and self-reported delay or avoidance of medical care among community-dwelling older adults during the coronavirus disease 2019 (COVID-19) pandemic.

METHODS: Analyses of data from a nationally representative survey administered in June of 2020, in COVID-19 module of the Health and Retirement Study. Bivariate and multivariable analyses determined associations of loneliness with the likelihood of, reasons for, and types of care delay or avoidance.

RESULTS: The rate of care delay or avoidance since March of 2020 was 29.1% among all respondents (n = 1997), and 10.1% higher for lonely (n = 1,150%, 57.6%) versus non-lonely respondents (33.5% vs. 23.4%; odds ratio = 1.59, p = 0.003 after covariate adjustment). The differences were considerably larger among several subgroups such as those with emotional/psychiatric problems. Lonely older adults were more likely to cite "Decided it could wait," "Was afraid to go," and "Couldn't afford it" as reasons for delayed or avoided care. Both groups reported dental care and doctor's visit as the two most common care delayed or avoided.

CONCLUSIONS: Loneliness is associated with a higher likelihood of delaying or avoiding medical care among older adults during the pandemic.

VL - 37 IS - 3 ER - TY - JOUR T1 - The positive impact of informal spousal caregiving on the physical activity of older adults. JF - Front Public Health Y1 - 2022 A1 - Zan, Hua A1 - Shin, Su Hyun KW - Aged KW - Caregivers KW - Female KW - Humans KW - Retirement KW - Spouses KW - United States AB -

INTRODUCTION: Although physical activity (PA) is crucial for health, the literature is mixed about how individuals' PA decisions are affected by their spouses. To fill this gap, we examined the extent to which providing care for one spouse affects the PA of the other spouse among those aged 50 or older in the United States.

METHODS: We analyzed 9,173 older adults living with their spouses or partners from the 2004 to 2016 waves of the Health and Retirement Study. To identify the causal effect of spousal caregiving on the PA of older adults, we estimated individual-fixed effects models using a two-stage least squared instrumental variable approach with spousal falls as our instrument. We also estimated the models by splitting the sample by gender and race/ethnicity to identify heterogeneous impacts of spousal caregiving on PA decisions among subgroups.

RESULTS: We found that a one percentage point increase in the probability of providing care to spouses led to an increase in the probability of initiating moderate or vigorous PA (MVPA) by 0.34-0.52 percentage points. This effect was salient, especially among female and non-Hispanic white older adults.

DISCUSSION: Caregiving experience might provide opportunities to learn about caregiving burdens and trigger an emotional response about the salience of an event (i.e., they need care in the future). Older caregivers might start MVPA in an effort to improve or maintain their health and avoid burdening their families for caregiving in the future. This study demonstrated spousal influence on PA. Instead of delivering PA-promotion information (e.g., the harm of sedentary lifestyle and benefits of regular PA) to individuals, risk communication and education efforts on PA promotion might be more effective considering the family context. Family events such as health shocks or the emergence of caregiving needs from family members provide windows of opportunities for intervening. Subgroup differences should also be considered in targeted interventions.

VL - 10 ER - TY - JOUR T1 - Projecting the chronic disease burden among the adult population in the United States using a multi-state population model. JF - Front Public Health Y1 - 2022 A1 - Ansah, John P A1 - Chiu, Chi-Tsun KW - Adult KW - Aged KW - Chronic disease KW - Cross-Sectional Studies KW - ethnicity KW - Hispanic or Latino KW - Humans KW - Middle Aged KW - United States KW - White People AB -

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

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

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

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

VL - 10 ER - TY - JOUR T1 - Rural-urban differences in food insecurity and associated cognitive impairment among older adults: findings from a nationally representative survey. JF - BMC Geriatrics Y1 - 2022 A1 - Srivastava, Shobhit A1 - Muhammad, T KW - Aged KW - Cognitive Dysfunction KW - COVID-19 KW - Cross-Sectional Studies KW - Food insecurity KW - Food Supply KW - Humans KW - Pandemics AB -

INTRODUCTION: Due to rapid urbanization, Covid-19 pandemic and increasing food prices, a higher rate of food insecurity has been observed in recent years in India. Thus, we aim to study the prevalence of food insecurity among older Indian adults and the association of food insecurity as a modifiable risk factor with late-life cognitive impairment.

METHOD: Data for this study were obtained from the recent release of the Longitudinal Ageing Study in India (2017-18). The total sample size for the study was 31,464 older adults aged 60 years and above. Cognitive functioning was measured through five broad domains (memory, orientation, arithmetic function, executive function, and object naming) adapted from the cognitive module of the US Health and Retirement Study (HRS). Descriptive statistics along with cross-tabulation were presented in the study. Additionally, multivariable logistic regression analysis was used to fulfil the objectives of the study.

RESULTS: It was found that 7.7% of older adults in rural areas reduced their size of meals due to unavailability (urban, 3.2%), 41.2% of them did not eat enough food of their choice (urban, 38.3%), 6.9% were hungry but did not eat food (urban, 2.6%), 5.0% did not eat for whole day (urban, 2.2%), and 6.9% lost weight due to lack of food in their household (urban, 2.9%). It was found that older adults who did not have enough food of their choice had significantly higher odds [AOR: 1.24; CI: 1.14, 1.35] of suffering from cognitive impairment in reference to their counterparts. Similarly, the older adults who were hungry but did not eat were 30% [AOR: 1.30; CI: 1.02, 1.73] more likely to suffer from cognitive impairment in reference to their counterparts. Interaction model revealed that older adults who had food insecurity in rural areas had higher odds of cognitive impairment than older adults who had food insecurity in urban areas.

CONCLUSION: The findings of the study highlight that the food security status in older adults may bring about greater challenges due to their limited economic resources. Interventions focusing on food security may have unintended positive impacts on late-life mental wellbeing as the older age is associated with higher cognitive deficits.

VL - 22 IS - 1 ER - TY - JOUR T1 - Trends in prevalence, health disparities, and early detection of dementia: A 10-year nationally representative serial cross-sectional and cohort study. JF - Front Public Health Y1 - 2022 A1 - Lu, Kevin A1 - Xiong, Xiaomo A1 - Li, Minghui A1 - Yuan, Jing A1 - Luo, Ye A1 - Friedman, Daniela B KW - Aged KW - Cognitive Dysfunction KW - Cohort Studies KW - Cross-Sectional Studies KW - Dementia KW - Female KW - Humans KW - Male KW - Middle Aged KW - Prevalence AB -

OBJECTIVE: To identify trends in the prevalence of mild cognitive impairment (MCI) and dementia, and to determine risk factors associated with the early detection of dementia among U.S. middle-aged and older adults.

METHODS: We used 10-year nationally representative longitudinal data from the Health and Retirement Study (HRS) (2006-2016). Adults aged 55 years or older were included to examine the trend. To identify the associated factors, adults aged 55 years or older in 2006 who developed MCI or dementia in subsequent waves until the 2016 wave were included. Early and late detection of dementia were identified using the Langa-Weir classification of cognitive function. Multivariate logistic regression models were used to identify factors associated with the early detection of dementia.

RESULTS: The sample size for the analysis of the prevalence of MCI and dementia ranged from 14,935 to 16,115 in the six survey years, and 3,729 individuals were identified to determine associated factors of the early detection of dementia. Among them, participants aged 65 years or older accounted for 77.9%, and male participants accounted for 37.2%. The 10-year prevalence of MCI and dementia was 14.5 and 6.6%, respectively. We also found decreasing prevalence trends in MCI (from 14.9 to 13.6%) and dementia (from 7.4 to 6.0%) overall in the past decade. Using logistic regression controlling for the year, non-Hispanic black (MCI: OR = 2.83, < 0.001; dementia: OR = 2.53, < 0.001) and Hispanic (MCI: OR = 2.52, < 0.001; dementia: OR = 2.62, < 0.001) had a higher prevalence of both MCI and dementia than non-Hispanic white participants. In addition, men had a lower prevalence of MCI (OR = 0.94, = 0.035) and dementia (OR = 0.84, < 0.001) compared to women. Associated factors of the early detection of dementia include age, gender, race, educational attainment, stroke, arthritis diseases, heart problems, and pensions.

CONCLUSION: This study found a decreasing trend in the prevalence of MCI and dementia in the past decade and associated racial/ethnic and gender disparities among U.S. middle-aged and older adults. Healthcare policies and strategies may be needed to address health disparities in the prevalence and take the associated factors of the early detection of dementia into account in clinical settings.

VL - 10 ER - TY - JOUR T1 - Trends in the Use of Residential Settings Among Older Adults. JF - The Journals of Gerontology: Series B Y1 - 2022 A1 - Toth, Matt A1 - Palmer, Lauren A1 - Lawren E. Bercaw A1 - Voltmer, Helena A1 - Sarita Karon KW - Activities of Daily Living KW - Aged KW - Comorbidity KW - Cross-Sectional Studies KW - Dementia KW - Female KW - Health Status Disparities KW - Health Transition KW - Homes for the Aged KW - Humans KW - Independent Living KW - Male KW - Medicare KW - Nursing homes KW - United States AB -

OBJECTIVES: As the U.S. population ages, the prevalence of disability and functional limitations, and demand for long-term services and supports (LTSS), will increase. This study identified the distribution of older adults across different residential settings, and how their health characteristics have changed over time.

METHODS: A cross-sectional analysis of older adults residing in traditional housing, community-based residential facilities (CBRFs), and nursing facilities using 3 data sources: the Medicare Current Beneficiary Survey (MCBS), 2008 and 2013; the Health and Retirement Study (HRS), 2008 and 2014; and the National Health and Aging Trends Study, 2011 and 2015. We calculated the age-standardized prevalence of older adults by setting, functional limitations, and comorbidities and tested for health characteristics changes relative to the baseline year (2002).

RESULTS: The proportion of older adults in traditional housing increased over time, relative to baseline (p < .05), while the proportion of older adults in CBRFs was unchanged. The proportion of nursing facility residents declined from 2002 to 2013 in the MCBS (p < .05). The prevalence of dementia and functional limitations among traditional housing residents increased, relative to the baseline year in the HRS and MCBS (p < .05).

DISCUSSION: The proportion of older adults residing in traditional housing is increasing, while the nursing facility population is decreasing. This change may not be due to better health; rather, older adults may be relying on noninstitutional LTSS.

VL - 77 IS - 2 ER - TY - JOUR T1 - Acceleration of health deficit accumulation in late-life: Evidence of terminal decline in frailty index three years before death in the US Health and Retirement Study JF - Annals of Epidemiology Y1 - 2021 A1 - Stolz, Erwin A1 - Mayerl, Hannes A1 - Emiel O Hoogendijk A1 - Armstrong, Joshua J. A1 - Roller-Wirnsberger, Regina A1 - Wolfgang Freidl KW - Aged KW - aged 80 and over KW - Death KW - Frailty KW - Geriatrics KW - repeated rounds of survey AB - BackgroundLittle is known about within-person frailty index (FI) changes during the last years of life. In this study, we assess whether there is a phase of accelerated health deficit accumulation (terminal health decline) in late-life.Material and methods23,393 observations from up to the last 21 years of life of 5,713 deceased participants of the AHEAD cohort in the Health and Retirement Study were assessed. A FI with 32 health deficits was calculated for up to 10 successive biannual, self- and proxy-reported assessments (1995-2014), and FI changes according to time-to-death were analyzed with a piecewise linear mixed model with random change points.ResultsThe average normal (pre-terminal) health deficit accumulation rate was 0.01 per year, which increased to 0.05 per year at approximately 3 years before death. Terminal decline began earlier in women and was steeper among men. The accelerated (terminal) rate of health deficit accumulation began at a FI-value of 0.29 in the total sample, 0.27 for men, and 0.30 for women.ConclusionWe found evidence for an observable terminal health decline in the FI following declining physiological reserves and failing repair mechanisms. Our results suggest a conceptually meaningful cut-off value for the continuous FI around 0.30. VL - 58 SN - 1047-2797 ER - TY - JOUR T1 - Brief interventions for older adults (BIO) delivered by non-specialist community health workers to reduce at-risk drinking in primary care: a study protocol for a randomised controlled trial. JF - BMJ Open Y1 - 2021 A1 - Paula, Tassiane Cristine Santos A1 - Chagas, Camila A1 - Noto, Ana Regina A1 - Formigoni, Maria Lucia Oliveira Souza A1 - Pereira, Tiago Veiga A1 - Ferri, Cleusa Pinheiro KW - Aged KW - Alcohol Drinking KW - Alcoholism KW - Brazil KW - Community Health Workers KW - Cost-Benefit Analysis KW - Crisis Intervention KW - Humans KW - Primary Health Care KW - Quality of Life KW - Randomized Controlled Trials as Topic AB -

INTRODUCTION: Evidence suggests that brief interventions are effective in reducing alcohol consumption among older adults. However, the effectiveness of these interventions when delivered by community health workers (non-specialists) in a primary healthcare setting is unknown. To our knowledge, this will be the first randomised trial to examine this.

METHODS AND ANALYSIS: Two hundred and forty-two individuals considered at-risk drinkers (Alcohol Use Disorders Identification Test-Consumption, AUDIT-C score ≥4) will be recruited and randomly allocated to usual care (waiting-list) or usual care plus an intervention delivered by trained community health workers (non-specialists). Seven primary care units (PCUs) in Sao José dos Campos, Brazil. PCUs are part of the Brazilian public healthcare system (Sistema Único de Saúde).6 months.The primary outcome will be the proportion of participants considered at-risk drinkers (AUDIT-C score ≥4). Secondary outcomes will include alcohol consumption in a typical week in the last 30 days (in units per week) assessed by the AUDIT, service use questionnaire, cognitive performance-assessed by The Health and Retirement Study Harmonised Cognitive Assessment, physical activity-assessed by the International Physical Activity Questionnaire, depression-assessed by the Geriatric Depression Scale and quality of life-assessed by the Control, Autonomy, Self-realisation and Pleasure-16 instrument. The analysis will be based on intention-to-treat principle.

ETHICS AND DISSEMINATION: This study has been approved by the Ethics Committee of the Universidade Federal de São Paulo, CEP/UNIFESP Project n: 0690/2018; CAAE: 91648618.0.0000.5505. All eligible participants will provide informed consent prior to randomisation. The results of this study will be published in relevant peer-reviewed journals and in conference presentations.

TRIAL REGISTRATION NUMBER: RBR-8rcxkk.

VL - 11 IS - 5 ER - TY - JOUR T1 - Peripheral edema: A common and persistent health problem for older Americans. JF - PLoS One Y1 - 2021 A1 - Besharat, Soroush A1 - Grol-Prokopczyk, Hanna A1 - Gao, Shan A1 - Feng, Changyong A1 - Akwaa, Frank A1 - Gewandter, Jennifer S KW - Aged KW - Aged, 80 and over KW - Cross-Sectional Studies KW - Edema KW - ethnicity KW - Female KW - Follow-Up Studies KW - Humans KW - Longitudinal Studies KW - Lower Extremity KW - Male KW - Middle Aged KW - Mobility Limitation KW - Prognosis KW - Surveys and Questionnaires KW - United States AB -

Peripheral edema (i.e., lower limb swelling) can cause pain, weakness, and limited range of motion. However, few studies have examined its prevalence in the U.S. or its association with demographics, comorbidities, activity, or mobility. This study used data from the Health and Retirement Study, a nationally representative longitudinal survey of U.S. adults (age 51+/ N = 19,988 for 2016), to evaluate time trends and correlates of peripheral edema using weighted descriptive statistics and logistic regressions, respectively. Peripheral edema was assessed with the question "Have you had… // Persistent swelling in your feet or ankles?" The weighted prevalence of edema among older U.S. adults was 19% to 20% between 2000 and 2016. Peripheral edema was associated with older age, female sex, non-white race, low wealth, obesity, diabetes, hypertension, pain, low activity levels, and mobility limitations (odds ratios ranging from 1.2-5.6; p-values ≤0.001). This study provides the first estimates of national prevalence and correlates of peripheral edema among older Americans. Peripheral edema is common and strongly associated with comorbidities, pain, low activity levels, and mobility limitations, and disproportionately affects poorer and minority groups. Peripheral edema should be a focus of future research in order to develop novel and cost-effective interventions.

VL - 16 IS - 12 ER - TY - JOUR T1 - Personal Mastery and All-Cause Mortality among Older Americans Living with Diabetes JF - Elderly Health Journal Y1 - 2021 A1 - TUNG, HO-JUI A1 - Yeh, Ming-Chin A1 - Ford, Randall A1 - Shah, Gulzar KW - Aged KW - Diabetes KW - Immigrants KW - Mortality KW - personal mastery AB - Introduction: Higher personal mastery is associated with better physical functioning, wellbeing, and longevity among older populations. However, few studies have focused on whether personal mastery is protective against mortality among older adults living with diabetes over time. Methods: A total of 1,779 participants were identified from an off-year survey of the Health and Retirement Study. Proportional Hazard Models were used to evaluate the significance of selected variables in predicting the survival of participants over a 13-year period. Results: A substantial proportion (46.7%) of the diabetic patients had survived by the end of 2016. Adults with lower mastery scores were more likely to die (Hazard Ratio = .94, p < .001). Gender differences in the association patterns between personal mastery and survival were identified. Personal mastery had an independent health-protective effect on the survival of diabetes patients over the study period. With lower educational attainment, the foreign-born female diabetics scored higher in personal mastery measure when compared to their male counterparts. In the face of more severe diabetes comorbidity, foreign-born female diabetics also outlived their male counterparts over the study period. Conclusion: As a crucial psychological resource and a modifiable factor, personal mastery holds a potential for improving the health status among lower SES groups of older adults. Further investigations into the identified gender difference could be applied to break the cycle of poor health among lower Socio-Economic Status groups of older adults. VL - 7 IS - 1 ER - TY - JOUR T1 - Relationships among types of activity engagement and insomnia symptoms among older adults. JF - BMC Geriatrics Y1 - 2021 A1 - Kim, Da Eun A1 - Roberts, Tonya J A1 - Moon, Chooza KW - Aged KW - Exercise KW - Leisure activities KW - Sleep AB -

BACKGROUND: An increasing awareness exists that lack of activity engagement is associated with insomnia symptoms. However, the majority of studies have focused on the association between a single type of activity engagement and insomnia symptoms.

METHODS: This is a cross-sectional study using secondary data from the Health and Retirement Study examining the relationships among different types of activity engagement and insomnia symptoms among older adults. The sample for this study included 3321 older adults who responded to survey modules on activity engagement and insomnia symptoms in 2016. Activity engagement was measured using items for three types of activities (i.e., social, cognitive, and physical) validated in this study. Insomnia symptoms were measured using four items (i.e., difficulty of falling asleep, waking up during the night, waking up too early, and feeling rested). Independent t-tests were conducted to identify the differences in insomnia symptoms according to activity engagement level. Regressions were conducted to examine the associations among three types of activity engagement and insomnia symptoms after adjusting for covariates such as demographics, chronic disease, activities of daily living difficulty, cognitive function, sleep disorder, loneliness, and caregiving.

RESULTS: The respondents in the high-level social, cognitive, and physical activity engagement groups were found to show fewer insomnia symptoms. Furthermore, higher social (β = - 0.04, p = 0.040) and cognitive (β = - 0.06, p = 0.007) activity engagements were associated with fewer insomnia symptoms even after adjusting for other types of activity engagement and all covariates.

CONCLUSIONS: This study suggests that older adults with higher social and cognitive activity engagements may be likely to have fewer insomnia symptoms. Based on these results, future research is needed to develop multi-component intervention programs that can encourage older adults to engage in these activities.

VL - 21 IS - 1 ER - TY - JOUR T1 - Association between telomere length and neighborhood characteristics by race and region in US midlife and older adults JF - Health and Place Y1 - 2020 A1 - Amy D Thierry KW - Adult KW - Aged KW - Aging KW - Article KW - Black person KW - Caucasian KW - controlled study KW - Health Disparities KW - health disparity KW - human KW - neglect KW - neighborhood KW - Neighborhood characteristics KW - race KW - race difference KW - Retirement KW - Telomere length AB - Disadvantaged neighborhoods are correlated with worse health outcomes, particularly among US Blacks. However, less is known about the link between neighborhood characteristics and biomarkers of cellular age, such as telomere length (TL), which may be implicated in racial health inequities. Moreover, this relationship may vary across US region given patterns of racial segregation across the US. Therefore, this study analyzed 2008 Health and Retirement Study data on 3,869 US-born white and Black adults >50 years old to examine race differences in the relationship between salivary TL and (1) neighborhood safety, cleanliness, and social cohesion and (2) interactions between neighborhood characteristics and US region. Neighborhood characteristics were not associated with TL in whites. However, significant associations were found among Blacks with variation by region. Blacks living in less clean neighborhoods in the Northeast (b = −0.03, SE = 0.01, p < 0.05), Midwest (b = −0.04, SE = 0.01, p < 0.01), and South (b = −0.05, SE = 0.01, p < 0.01) as well as those reporting less neighborhood safety and social cohesion in the Midwest (b = −0.03, SE = 0.02, p < 0.05 and b = −0.03, SE = 0.01, p < 0.05) and South (b = −0.03, SE = 0.01, p < 0.05 for both characteristics) had shorter TL than Blacks in the West. Therefore, exposure to neighborhood level historical discrimination and neglect may be detrimental to TL in Blacks. Future research should further examine how neighborhoods contribute to aging disparities. © 2019 Elsevier Ltd VL - 62 SN - 13538292 (ISSN) UR - https://www.sciencedirect.com/science/article/pii/S1353829219303752 JO - Health Place ER - TY - JOUR T1 - Disparities in patient-centered communication for Black and Latino men in the U.S.: Cross-sectional results from the 2010 health and retirement study. JF - PLoS One Y1 - 2020 A1 - Mitchell, Jamie A A1 - Perry, Ramona KW - Adult KW - African Americans KW - Aged KW - Aged, 80 and over KW - Chronic disease KW - Communication KW - Cross-Sectional Studies KW - Follow-Up Studies KW - Healthcare Disparities KW - Hispanic Americans KW - Humans KW - Insurance Coverage KW - Male KW - Middle Aged KW - Patient Education as Topic KW - Patient-Centered Care KW - Physician-Patient Relations KW - Prognosis KW - Racism AB -

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

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

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

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

VL - 15 IS - 9 ER - TY - JOUR T1 - Episodic Memory in Later Life: Benefits of Prayer and Meditation JF - Journal of Holistic Nursing Y1 - 2020 A1 - Lekhak, N. A1 - Bhatta, T.R. A1 - Zauszniewski, J.A. KW - Aged KW - Article KW - drawing KW - Episodic Memory KW - Female KW - human KW - human experiment KW - major clinical study KW - Male KW - meditation KW - mindfulness KW - Religion KW - Retirement KW - secondary analysis AB - {Purpose: To examine the effects of prayer and meditation on the episodic memory of older adults. Design: Secondary analysis of Health and Retirement Study (HRS). Method: Drawing from a subsample of HRS (n = 1,135), this study utilized generalized estimating equation regression models to examine the effects of meditation and prayer on changes in episodic memory of older adults over time. Findings: Findings show a statistically significant positive effect of the use of prayer (0.50, p <.05) on episodic memory score at baseline. We also observed a slight gain in episodic memory over time for older adults who used prayer (0.04, p =.05). Meditation was not found to have a statistically significant effect on changes in memory in later life. Conclusion: This study illustrates the benefits of prayer in preserving memory and provides much needed empirical basis for community-level interventions to enhance memory in later life. N1 - cited By 0 ER - TY - JOUR T1 - Genome-wide association study of cognitive function in diverse Hispanics/Latinos: results from the Hispanic Community Health Study/Study of Latinos. JF - Translational Psychiatry Y1 - 2020 A1 - Jian, Xueqiu A1 - Sofer, Tamar A1 - Wassim Tarraf A1 - Bressler, Jan A1 - Jessica Faul A1 - Zhao, Wei A1 - Scott M Ratliff A1 - Lamar, Melissa A1 - Lenore J Launer A1 - Laurie, Cathy C A1 - Schneiderman, Neil A1 - David R Weir A1 - Wright, Clinton B A1 - Kristine Yaffe A1 - Zeng, Donglin A1 - DeCarli, Charles A1 - Thomas H Mosley A1 - Smith, Jennifer A A1 - Hector M González A1 - Myriam Fornage KW - Aged KW - Cognition KW - Genome-Wide Association Study KW - Hispanic or Latino KW - Humans KW - Middle Aged KW - Neuropsychological tests KW - Public Health KW - Ubiquitin-Conjugating Enzymes AB -

Cognitive function such as reasoning, attention, memory, and language is strongly correlated with brain aging. Compared to non-Hispanic whites, Hispanics/Latinos have a higher risk of cognitive impairment and dementia. The genetic determinants of cognitive function have not been widely explored in this diverse and admixed population. We conducted a genome-wide association analysis of cognitive function in up to 7600 middle aged and older Hispanics/Latinos (mean = 55 years) from the Hispanic Community Health Study / Study of Latinos (HCHS/SOL). Four cognitive measures were examined: the Brief Spanish English Verbal Learning Test (B-SEVLT), the Word Fluency Test (WFT), the Digit Symbol Substitution Test (DSST), the Six-Item Screener (SIS). Four novel loci were identified: one for B-SEVLT at 4p14, two for WFT at 3p14.1 and 6p21.32, and one for DSST at 10p13. These loci implicate genes highly expressed in brain and previously connected to neurological diseases (UBE2K, FRMD4B, the HLA gene complex). By applying tissue-specific gene expression prediction models to our genotype data, additional genes highly expressed in brain showed suggestive associations with cognitive measures possibly indicating novel biological mechanisms, including IFT122 in the hippocampus for SIS, SNX31 in the basal ganglia for B-SEVLT, RPS6KB2 in the frontal cortex for WFT, and CSPG5 in the hypothalamus for DSST. These findings provide new information about the genetic determinants of cognitive function in this unique population. In addition, we derived a measure of general cognitive function based on these cognitive tests and generated genome-wide association summary results, providing a resource to the research community for comparison, replication, and meta-analysis in future genetic studies in Hispanics/Latinos.

VL - 10 IS - 1 ER - TY - JOUR T1 - Longitudinal and Reciprocal Relationships Between Psychological Well-Being and Smoking JF - Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco Y1 - 2020 A1 - Lappan, S. A1 - Thorne, C.B. A1 - Long, D. A1 - Hendricks, P.S. KW - Adult KW - Aged KW - Article KW - Education KW - Female KW - human KW - Life Satisfaction KW - Male KW - Middle Aged KW - Optimism KW - people by smoking status KW - psychological well-being KW - Retirement KW - Smoking cessation KW - structural equation modeling AB - INTRODUCTION: Smoking cessation treatments currently succeed at a rate of approximately 20%-30%, underscoring the importance of exploring factors that might increase intervention effectiveness. Although negative affect has been studied extensively in relation to smoking cessation, psychological well-being (PWB; eg, life satisfaction, optimism, positive affect, purpose in life) has received little attention. This study tested longitudinal and reciprocal relationships between PWB and smoking status in older adults. METHODS: Panel data were obtained from the biennial, longitudinal Health and Retirement Study. Using structural equation modeling, we developed cross-lagged models to examine the relationships of PWB in 2006 with smoking status in 2010 and of smoking status in 2006 with PWB in 2010 while controlling for covariates (Ns = 2939-4230, 55% women, 89% white, mean age = 64 years, mean years of education = 13, 25% smokers in 2006 and 21% smokers in 2010). Separate cross-lagged models were developed for each of the PWB variables: life satisfaction, optimism, positive affect, and purpose in life. RESULTS: Greater life satisfaction (standardized path coefficient = -0.04), optimism (standardized path coefficient = -0.07), and positive affect (standardized path coefficient = -0.08) in 2006 predicted a reduced likelihood of smoking in 2010. Being a smoker in 2006 predicted lower life satisfaction (standardized path coefficient = -0.25), optimism (standardized path coefficient = -0.10), positive affect (standardized path coefficient = -0.10), and purpose in life (standardized path coefficient = -0.13) in 2010. CONCLUSIONS: Findings warrant further exploration of the relationships between PWB and smoking, and support the incorporation of PWB-boosting components into existing treatments. IMPLICATIONS: Given the relatively low success rate of current smoking cessation treatments, the present results suggest that increasing PWB might promote abstinence and therefore warrant consideration as a focus of future cessation treatment research. Moreover, these results suggest that smoking might inhibit PWB, illuminating a negative consequence of smoking not previously identified. Helping smokers increase their PWB may benefit them beyond promoting cessation and contribute to a flourishing society. These results warrant further investigation of PWB and smoking, and support the continued evaluation of PWB-boosting components in smoking cessation treatments. © The Author(s) 2018. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. VL - 22 N1 - cited By 1 ER - TY - JOUR T1 - Relationship between smoking status and muscle strength in the United States older adults. JF - Epidemiology and Health Y1 - 2020 A1 - Wiener, R Constance A1 - Findley, Patricia A A1 - Shen, Chan A1 - Dwibedi, Nilanjana A1 - Sambamoorthi, Usha KW - Aged KW - Aged, 80 and over KW - Female KW - Hand Strength KW - Humans KW - Male KW - Middle Aged KW - Muscle Strength KW - Smoking KW - United States AB -

OBJECTIVES: Muscle strength in older adults is associated with greater physical ability. Identifying interventions to maintain muscle strength can therefore improve quality of life. The purpose of this study was to evaluate whether current or former smoking status is associated with a decrease in muscle strength in older adults.

METHODS: Data from the Health and Retirement Study from 2012-2014 were analyzed with regard to maximum dominant hand grip strength, maximum overall hand grip strength, and smoking status (current, former, or never). Unadjusted linear regression was conducted. Other factors known to be related to strength were included in the adjusted linear regression analyses.

RESULTS: For maximum grip strength, the regression coefficient was 4.91 for current smoking (standard error [SE], 0.58; p<0.001), 3.58 for former smoking (SE, 0.43; p<0.001), and 28.12 for never smoking (SE, 0.34). Fully adjusted linear regression on the relationship between dominant hand grip strength and smoking did not yield a significant result. The factors significantly associated with dominant hand grip strength were male sex, younger age, a race/ethnicity of non-Hispanic White or non-Hispanic Black, higher income, morbidity of ≤1 condition, no pain, and moderate or vigorous exercise more than once a week.

CONCLUSIONS: Muscle strength in older adults was not associated with smoking status in the adjusted analysis.

VL - 42 ER - TY - JOUR T1 - The World Health Organization (WHO) approach to healthy ageing. JF - Maturitas Y1 - 2020 A1 - Rudnicka, Ewa A1 - Napierała, Paulina A1 - Podfigurna, Agnieszka A1 - Męczekalski, Błażej A1 - Smolarczyk, Roman A1 - Grymowicz, Monika KW - Aged KW - Aging KW - Global Health KW - healthy aging KW - Humans KW - World Health Organization AB -

The ageing of the global population is the most important medical and social demographic problem worldwide. The World Health Organization (WHO) has defined healthy ageing as a process of maintaining functional ability to enable wellbeing in older age. The WHO, Member States and Partners for Sustainable Development Goals have created a Global Strategy and Action Plan for Ageing and Health for 2016-2020 and its continuation with the WHO programme The Decade of Healthy Ageing 2020-2030. The WHO has established main priorities such as supporting country planning and action, collecting better global data and promoting research on healthy ageing, aligning health systems to the needs of older people, laying the foundations and ensuring the human resources necessary for long-term integrated care, undertaking a global campaign to combat ageism, and enhancing the global network for age-friendly cities and communities. There are several reports of coordinated preventive health and social health initiatives in well developed countries. However, there is little evidence on the application of the active ageing frameworks in developing countries. Greater national capacities and closer monitoring of the progress through age-disaggregated data is needed to effectively implement the intended programmes on healthy ageing.

VL - 139 ER - TY - JOUR T1 - Are younger cohorts in the USA and England ageing better? JF - International journal of epidemiology Y1 - 2019 A1 - de la Fuente, J. A1 - Francisco Félix Caballero A1 - Verdes, E. A1 - Rodríguez-Artalejo, F. A1 - Cabello, M. A1 - de la Torre-Luque, A. A1 - Albert Sánchez-Niubó A1 - María Haro, J. A1 - Ayuso-Mateos, J.L. A1 - Chatterji, S. KW - Aged KW - Aging KW - Article KW - Cohort Analysis KW - cultural factor KW - Education KW - England KW - Englishman KW - Female KW - Health Status KW - Household KW - human KW - human experiment KW - human tissue KW - longitudinal study KW - major clinical study KW - Male KW - mental capacity KW - Retirement KW - theoretical study AB - BACKGROUND: Whether worldwide increases in life expectancy are accompanied by a better health status is still a debate. People age differently, and there is a need to disentangle whether healthy-ageing pathways can be shaped by cohort effects. This study aims to analyse trends in health status in two large nationally representative samples of older adults from England and the USA. METHODS: The sample comprised 55 684 participants from the first seven waves of the English Longitudinal Study of Ageing (ELSA), and the first 11 waves of the Health and Retirement Study (HRS). A common latent health score based on Bayesian multilevel item response theory was used. Two Bayesian mixed-effects multilevel models were used to assess cohort effects on health in ELSA and HRS separately, controlling for the effect of household wealth and educational attainment. RESULTS: Similar ageing trends were found in ELSA (β = -0.311; p < 0.001) and HRS (β = -0.393; p < 0.001). The level of education moderated the life-course effect on health in both ELSA (β = -0.082; p < 0.05) and HRS (β = -0.084; p < 0.05). A birth-year effect was found for those belonging to the highest quintiles of household wealth in both ELSA (β = 0.125; p < 0.001) and HRS (β = 0.170; p < 0.001). CONCLUSIONS: Health inequalities have increased in recent cohorts, with the wealthiest participants presenting a better health status in both the USA and English populations. Actions to promote health in the ageing population should consider the increasing inequality scenario, not only by applying highly effective interventions, but also by making them accessible to all members of society. © The Author(s) 2019; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association. VL - 48 N1 - cited By 0 ER - TY - JOUR T1 - Childhood Misfortune and Handgrip Strength Among Black, White, and Hispanic Americans. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2019 A1 - Natalie R Smith A1 - Kenneth F Ferraro A1 - Blakelee R Kemp A1 - Patricia M Morton A1 - Sarah A Mustillo A1 - Jacqueline L. Angel KW - Adult KW - Adult Survivors of Child Abuse KW - African Americans KW - Aged KW - European Continental Ancestry Group KW - Female KW - Hand Strength KW - Health Status KW - Hispanic Americans KW - Humans KW - Male KW - Risk Factors KW - Sex Factors AB -

OBJECTIVE: Although early-life insults may affect health, few studies use objective physical measures of adult health. This study investigated whether experiencing misfortune during childhood is associated with handgrip strength (HGS) in later life.

METHOD: Data on childhood misfortune and adult characteristics from the Health and Retirement Study were used to predict baseline and longitudinal change in HGS among White, Black, and Hispanic American men and women.

RESULTS: Regression analyses revealed that multiple indicators of childhood misfortune were related to HGS at baseline, but the relationships were distinct for men and women. Over the study, having one childhood impairment predicted steeper declines in HGS for men, but childhood misfortune was unrelated to HGS change among women. Hispanic Americans had lower baseline HGS than their non-Hispanic counterparts and manifested steeper declines in HGS.

DISCUSSION: The relationship between childhood exposures and adult HGS varied by the type of misfortune, but there was no evidence that the relationship varied by race/ethnicity. The significant and enduring Hispanic disadvantage in HGS warrants greater attention in gerontology.

VL - 74 UR - http://psychsocgerontology.oxfordjournals.org/lookup/doi/10.1093/geronb/gbw147https://academic.oup.com/psychsocgerontology/article/2645640/Childhood-Misfortune-and-Handgrip-Strength-Among IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27927743?dopt=Abstract JO - GERONB ER - TY - JOUR T1 - Closing down the shop: Optimal health and wealth dynamics near the end of life JF - Health Economics (United Kingdom) Y1 - 2019 A1 - Hugonnier, J. A1 - Pelgrin, F. A1 - St-Amour, P. KW - Aged KW - Aging KW - Article KW - dis-savings KW - end of life KW - endogenous mortality risk KW - human KW - life cycle KW - long term care KW - Medically Uninsured KW - mortality risk KW - Retirement AB - Near the end of life, health declines, mortality risk increases, and curative care is replaced by uninsured long-term care, accelerating the fall in wealth. Whereas standard explanations emphasize inevitable aging processes, we propose a complementary closing down the shop justification where agents' decisions affect their health and the timing of death. Despite preferring to live, individuals optimally deplete their health and wealth towards levels associated with high death risk and gradual indifference between life and death. Reinstating exogenous aging processes reinforces the relevance of closing down. Using Health and Retirement Study–Consumption and Activities Mail Survey data for elders, a structural estimation of the closed-form decisions identifies, tests, and confirms the relevance of closing down. © 2019 John Wiley & Sons, Ltd. SN - 10579230 (ISSN) UR - https://onlinelibrary.wiley.com/doi/full/10.1002/hec.3960 N1 - Export Date: 13 January 2020CODEN: HEECECorrespondence Address: Pelgrin, F.; Department of Data Science, Economics and Finance, EDHEC Business SchoolFrance; email: Florian.PELGRIN@edhec.edu JO - Health Econ. ER - TY - JOUR T1 - Effects of long-term care setting on spousal health outcomes. JF - Health Serv Res Y1 - 2019 A1 - Dong, Jing A1 - Pollack, Harold A1 - R. Tamara Konetzka KW - Adaptation, Psychological KW - Aged KW - Caregivers KW - Community Health Services KW - Female KW - Humans KW - Long-term Care KW - Male KW - Patient Preference KW - social isolation KW - Spouses AB -

OBJECTIVE: To provide empirical evidence on the effects of home and community-based services (HCBS) (vs nursing home) use on spousal health.

DATA SOURCES: Merged data from the 1996 to 2012 Health and Retirement Study (HRS) and the Area Health Resource File (AHRF).

STUDY DESIGN: We assess the impact of HCBS use on spousal health. We use an instrumental variable (IV) approach to account for the potential endogeneity of the choice of care setting and reverse causality. Our instrument is the supply of skilled nursing home beds per 1000 people older than 65 years.

DATA EXTRACTION METHODS: Our sample includes spouses of HCBS or nursing home users, resulting in 8608 observations.

PRINCIPAL FINDINGS: We find that HCBS use leads to harmful effects on spousal physical health, which may be caused by increased informal care responsibilities. We also find improved spousal mental health, especially in depression symptoms, which may be caused by increased satisfaction.

CONCLUSIONS: We find evidence of both beneficial (mental health) and harmful (physical health) consequences for spouses of individuals receiving LTC at home relative to in an institution. Our results are important in estimating the potential cost and effectiveness of HCBS expansion.

VL - 54 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/30246337?dopt=Abstract ER - TY - JOUR T1 - Genetic heterogeneity of Alzheimer's disease in subjects with and without hypertension. JF - Geroscience Y1 - 2019 A1 - Nazarian, Alireza A1 - Konstantin G Arbeev A1 - Arseniy P Yashkin A1 - Alexander M Kulminski KW - Aged KW - Aged, 80 and over KW - Aging KW - Alzheimer disease KW - Cohort Studies KW - disease progression KW - Female KW - Genetic Heterogeneity KW - Genetic Predisposition to Disease KW - Genome-Wide Association Study KW - Humans KW - Hypertension KW - Male KW - Polymorphism, Single Nucleotide KW - Prognosis KW - Prospective Studies KW - Risk Assessment AB -

Alzheimer's disease (AD) is a progressive neurodegenerative disorder caused by the interplay of multiple genetic and non-genetic factors. Hypertension is one of the AD risk factors that has been linked to underlying pathological changes like senile plaques and neurofibrillary tangles formation as well as hippocampal atrophy. In this study, we investigated the differences in the genetic architecture of AD between hypertensive and non-hypertensive subjects in four independent cohorts. Our genome-wide association analyses revealed significant associations of 15 novel potentially AD-associated polymorphisms (P < 5E-06) that were located outside the chromosome 19q13 region and were significant either in hypertensive or non-hypertensive groups. The closest genes to 14 polymorphisms were not associated with AD at P < 5E-06 in previous genome-wide association studies (GWAS). Also, four of them were located within two chromosomal regions (i.e., 3q13.11 and 17q21.2) that were not associated with AD at P < 5E-06 before. In addition, 30 genes demonstrated evidence of group-specific associations with AD at the false discovery rates (FDR) < 0.05 in our gene-based and transcriptome-wide association analyses. The chromosomal regions corresponding to four genes (i.e., 2p13.1, 9p13.3, 17q12, and 18q21.1) were not associated with AD at P < 5E-06 in previous GWAS. These genes may serve as a list of prioritized candidates for future functional studies. Our pathway-enrichment analyses revealed the associations of 11 non-group-specific and four group-specific pathways with AD at FDR < 0.05. These findings provided novel insights into the potential genetic heterogeneity of AD among subjects with and without hypertension.

VL - 41 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/31055733?dopt=Abstract 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 - Having a Happy Spouse Is Associated With Lowered Risk of Mortality. JF - Psychological Science Y1 - 2019 A1 - Stavrova, Olga KW - Aged KW - Aged, 80 and over KW - Exercise KW - Female KW - Happiness KW - Humans KW - Interpersonal Relations KW - Longevity KW - Male KW - Middle Aged KW - Mortality KW - Personal Satisfaction KW - Risk Reduction Behavior KW - Self Report KW - Sexual Partners KW - Socioeconomic factors KW - Spouses KW - Survival Analysis AB -

Studies have shown that individuals' choice of a life partner predicts their life outcomes, from their relationship satisfaction to their career success. The present study examined whether the reach of one's spouse extends even further, to the ultimate life outcome: mortality. A dyadic survival analysis using a representative sample of elderly couples ( N = 4,374) followed for up to 8 years showed that a 1-standard-deviation-higher level of spousal life satisfaction was associated with a 13% lower mortality risk. This effect was robust to controlling for couples' socioeconomic situation (e.g., household income), both partners' sociodemographic characteristics, and baseline health. Exploratory mediation analyses pointed toward partner and actor physical activity as sequential mediators. These findings suggest that life satisfaction has not only intrapersonal but also interpersonal associations with longevity and contribute to the fields of epidemiology, positive psychology, and relationship research.

VL - 30 IS - 5 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 - Multi-ancestry study of blood lipid levels identifies four loci interacting with physical activity. JF - Nature Communications Y1 - 2019 A1 - Kilpeläinen, Tuomas O A1 - Bentley, Amy R A1 - Noordam, Raymond A1 - Yun Ju Sung A1 - Schwander, Karen A1 - Thomas W Winkler A1 - Jakupović, Hermina A1 - Daniel I Chasman A1 - Alisa Manning A1 - Ntalla, Ioanna A1 - Aschard, Hugues A1 - Brown, Michael R A1 - de Las Fuentes, Lisa A1 - Franceschini, Nora A1 - Guo, Xiuqing A1 - Vojinovic, Dina A1 - Aslibekyan, Stella A1 - Feitosa, Mary F A1 - Kho, Minjung A1 - Musani, Solomon K A1 - Melissa Richard A1 - Wang, Heming A1 - Wang, Zhe A1 - Traci M Bartz A1 - Bielak, Lawrence F A1 - Campbell, Archie A1 - Dorajoo, Rajkumar A1 - Fisher, Virginia A1 - Hartwig, Fernando P A1 - Horimoto, Andrea R V R A1 - Li, Changwei A1 - Kurt Lohman A1 - Marten, Jonathan A1 - Sim, Xueling A1 - Smith, Albert V A1 - Tajuddin, Salman M A1 - Alver, Maris A1 - Amini, Marzyeh A1 - Boissel, Mathilde A1 - Jin-Fang Chai A1 - Chen, Xu A1 - Divers, Jasmin A1 - Evangelou, Evangelos A1 - Gao, Chuan A1 - Graff, Mariaelisa A1 - Sarah E Harris A1 - He, Meian A1 - Hsu, Fang-Chi A1 - Jackson, Anne U A1 - Jing Hua Zhao A1 - Kraja, Aldi T A1 - Kühnel, Brigitte A1 - Laguzzi, Federica A1 - Lyytikäinen, Leo-Pekka A1 - Ilja M Nolte A1 - Rauramaa, Rainer A1 - Riaz, Muhammad A1 - Robino, Antonietta A1 - Rueedi, Rico A1 - Heather M Stringham A1 - Takeuchi, Fumihiko A1 - van der Most, Peter J A1 - Varga, Tibor V A1 - Verweij, Niek A1 - Erin B Ware A1 - Wen, Wanqing A1 - Li, Xiaoyin A1 - Yanek, Lisa R A1 - Amin, Najaf A1 - Donna K Arnett A1 - Boerwinkle, Eric A1 - Brumat, Marco A1 - Brian E Cade A1 - Canouil, Mickaël A1 - Chen, Yii-Der Ida A1 - Concas, Maria Pina A1 - Connell, John A1 - de Mutsert, Renée A1 - de Silva, H Janaka A1 - de Vries, Paul S A1 - Demirkan, Ayse A1 - Ding, Jingzhong A1 - Charles B Eaton A1 - Jessica Faul A1 - Friedlander, Yechiel A1 - Gabriel, Kelley P A1 - Ghanbari, Mohsen A1 - Giulianini, Franco A1 - Gu, Chi Charles A1 - Gu, Dongfeng A1 - Tamara B Harris A1 - He, Jiang A1 - Heikkinen, Sami A1 - Heng, Chew-Kiat A1 - Hunt, Steven C A1 - Ikram, M Arfan A1 - Jost Bruno Jonas A1 - Koh, Woon-Puay A1 - Komulainen, Pirjo A1 - Krieger, Jose E A1 - Stephen B Kritchevsky A1 - Kutalik, Zoltán A1 - Kuusisto, Johanna A1 - Langefeld, Carl D A1 - Langenberg, Claudia A1 - Lenore J Launer A1 - Leander, Karin A1 - Lemaitre, Rozenn N A1 - Lewis, Cora E A1 - Liang, Jingjing A1 - Liu, Jianjun A1 - Mägi, Reedik A1 - Manichaikul, Ani A1 - Meitinger, Thomas A1 - Andres Metspalu A1 - Milaneschi, Yuri A1 - Mohlke, Karen L A1 - Thomas H Mosley A1 - Murray, Alison D A1 - Michael A Nalls A1 - Nang, Ei-Ei Khaing A1 - Nelson, Christopher P A1 - Nona, Sotoodehnia A1 - Norris, Jill M A1 - Nwuba, Chiamaka Vivian A1 - Jeff O'Connell A1 - Palmer, Nicholette D A1 - Papanicolau, George J A1 - Pazoki, Raha A1 - Nancy L Pedersen A1 - Peters, Annette A1 - Peyser, Patricia A A1 - Polasek, Ozren A1 - David J Porteous A1 - Poveda, Alaitz A1 - Olli T Raitakari A1 - Rich, Stephen S A1 - Neil Risch A1 - Robinson, Jennifer G A1 - Rose, Lynda M A1 - Rudan, Igor A1 - Schreiner, Pamela J A1 - Scott, Robert A A1 - Stephen Sidney A1 - Sims, Mario A1 - Smith, Jennifer A A1 - Snieder, Harold A1 - Sofer, Tamar A1 - John M Starr A1 - Sternfeld, Barbara A1 - Strauch, Konstantin A1 - Tang, Hua A1 - Kent D Taylor A1 - Tsai, Michael Y A1 - Tuomilehto, Jaakko A1 - André G Uitterlinden A1 - van der Ende, M Yldau A1 - van Heemst, Diana A1 - Voortman, Trudy A1 - Waldenberger, Melanie A1 - Wennberg, Patrik A1 - Wilson, Gregory A1 - Xiang, Yong-Bing A1 - Yao, Jie A1 - Yu, Caizheng A1 - Yuan, Jian-Min A1 - Zhao, Wei A1 - Alan B Zonderman A1 - Becker, Diane M A1 - Boehnke, Michael A1 - Bowden, Donald W A1 - de Faire, Ulf A1 - Ian J Deary A1 - Elliott, Paul A1 - Tõnu Esko A1 - Freedman, Barry I A1 - Froguel, Philippe A1 - Paolo P. Gasparini A1 - Gieger, Christian A1 - Kato, Norihiro A1 - Laakso, Markku A1 - Lakka, Timo A A1 - Lehtimäki, Terho A1 - Patrik K E Magnusson A1 - Oldehinkel, Albertine J A1 - Brenda W J H Penninx A1 - Nilesh J Samani A1 - Shu, Xiao-Ou A1 - van der Harst, Pim A1 - Jana V. van Vliet-Ostaptchouk A1 - Vollenweider, Peter A1 - Wagenknecht, Lynne E A1 - Wang, Ya X A1 - Wareham, Nicholas J A1 - David R Weir A1 - Wu, Tangchun A1 - Zheng, Wei A1 - Zhu, Xiaofeng A1 - Michele K Evans A1 - Franks, Paul W A1 - Gudnason, Vilmundur A1 - Caroline Hayward A1 - Horta, Bernardo L A1 - Tanika N Kelly A1 - Liu, Yongmei A1 - Kari E North A1 - Pereira, Alexandre C A1 - Ridker, Paul M A1 - Tai, E Shyong A1 - van Dam, Rob M A1 - Fox, Ervin R A1 - Sharon L R Kardia A1 - Liu, Ching-Ti A1 - Dennis O Mook-Kanamori A1 - Province, Michael A A1 - Redline, Susan A1 - Cornelia M van Duijn A1 - Rotter, Jerome I A1 - Charles Kooperberg A1 - Gauderman, W James A1 - Psaty, Bruce M A1 - Kenneth Rice A1 - Munroe, Patricia B A1 - Myriam Fornage A1 - Cupples, L Adrienne A1 - Charles N Rotimi A1 - Alanna C Morrison A1 - Rao, Dabeeru C A1 - Ruth J F Loos KW - Adolescent KW - Adult KW - Aged KW - Aged, 80 and over KW - Asians KW - Blacks KW - Brazil KW - Calcium-Binding Proteins KW - Cholesterol KW - Cholesterol, HDL KW - Cholesterol, LDL KW - Exercise KW - Female KW - Genetic Loci KW - Genome-Wide Association Study KW - Genotype KW - Hispanic or Latino KW - Humans KW - LIM-Homeodomain Proteins KW - Lipid Metabolism KW - Lipids KW - Male KW - Membrane Proteins KW - Microtubule-Associated Proteins KW - Middle Aged KW - Muscle Proteins KW - Nerve Tissue Proteins KW - Transcription Factors KW - Triglycerides KW - Whites KW - Young Adult AB -

Many genetic loci affect circulating lipid levels, but it remains unknown whether lifestyle factors, such as physical activity, modify these genetic effects. To identify lipid loci interacting with physical activity, we performed genome-wide analyses of circulating HDL cholesterol, LDL cholesterol, and triglyceride levels in up to 120,979 individuals of European, African, Asian, Hispanic, and Brazilian ancestry, with follow-up of suggestive associations in an additional 131,012 individuals. We find four loci, in/near CLASP1, LHX1, SNTA1, and CNTNAP2, that are associated with circulating lipid levels through interaction with physical activity; higher levels of physical activity enhance the HDL cholesterol-increasing effects of the CLASP1, LHX1, and SNTA1 loci and attenuate the LDL cholesterol-increasing effect of the CNTNAP2 locus. The CLASP1, LHX1, and SNTA1 regions harbor genes linked to muscle function and lipid metabolism. Our results elucidate the role of physical activity interactions in the genetic contribution to blood lipid levels.

VL - 10 IS - 1 ER - TY - JOUR T1 - New alcohol-related genes suggest shared genetic mechanisms with neuropsychiatric disorders. JF - Nature Human Behaviour Y1 - 2019 A1 - Evangelou, Evangelos A1 - Gao, He A1 - Chu, Congying A1 - Ntritsos, Georgios A1 - Blakeley, Paul A1 - Butts, Andrew R A1 - Pazoki, Raha A1 - Suzuki, Hideaki A1 - Koskeridis, Fotios A1 - Yiorkas, Andrianos M A1 - Karaman, Ibrahim A1 - Elliott, Joshua A1 - Luo, Qiang A1 - Aeschbacher, Stefanie A1 - Traci M Bartz A1 - Baumeister, Sebastian E A1 - Braund, Peter S A1 - Brown, Michael R A1 - Brody, Jennifer A A1 - Clarke, Toni-Kim A1 - Dimou, Niki A1 - Jessica Faul A1 - Homuth, Georg A1 - Jackson, Anne U A1 - Kentistou, Katherine A A1 - Joshi, Peter K A1 - Lemaitre, Rozenn N A1 - Penelope A Lind A1 - Lyytikäinen, Leo-Pekka A1 - Mangino, Massimo A1 - Milaneschi, Yuri A1 - Nelson, Christopher P A1 - Ilja M Nolte A1 - Perälä, Mia-Maria A1 - Polasek, Ozren A1 - David J Porteous A1 - Scott M Ratliff A1 - Smith, Jennifer A A1 - Stančáková, Alena A1 - Teumer, Alexander A1 - Tuominen, Samuli A1 - Thériault, Sébastien A1 - Vangipurapu, Jagadish A1 - Whitfield, John B A1 - Wood, Alexis A1 - Yao, Jie A1 - Yu, Bing A1 - Zhao, Wei A1 - Dan E Arking A1 - Auvinen, Juha A1 - Liu, Chunyu A1 - Männikkö, Minna A1 - Risch, Lorenz A1 - Rotter, Jerome I A1 - Snieder, Harold A1 - Veijola, Juha A1 - Alexandra I Blakemore A1 - Boehnke, Michael A1 - Campbell, Harry A1 - Conen, David A1 - Johan G Eriksson A1 - Hans-Jörgen Grabe A1 - Guo, Xiuqing A1 - van der Harst, Pim A1 - Catharina A Hartman A1 - Caroline Hayward A1 - Andrew C Heath A1 - Järvelin, Marjo-Riitta A1 - Kähönen, Mika A1 - Sharon L R Kardia A1 - Kühne, Michael A1 - Kuusisto, Johanna A1 - Laakso, Markku A1 - Lahti, Jari A1 - Lehtimäki, Terho A1 - McIntosh, Andrew M A1 - Mohlke, Karen L A1 - Alanna C Morrison A1 - Nicholas G Martin A1 - Oldehinkel, Albertine J A1 - Brenda W J H Penninx A1 - Psaty, Bruce M A1 - Olli T Raitakari A1 - Rudan, Igor A1 - Nilesh J Samani A1 - Scott, Laura J A1 - Timothy Spector A1 - Verweij, Niek A1 - David R Weir A1 - James F Wilson A1 - Levy, Daniel A1 - Tzoulaki, Ioanna A1 - Bell, Jimmy D A1 - Matthews, Paul M A1 - Rothenfluh, Adrian A1 - Desrivières, Sylvane A1 - Schumann, Gunter A1 - Elliott, Paul KW - Adult KW - Aged KW - Alcohol Drinking KW - Alcoholism KW - Brain KW - Female KW - genes KW - Genetic Predisposition to Disease KW - Genome-Wide Association Study KW - Humans KW - Magnetic Resonance Imaging KW - Male KW - Mental Disorders KW - Middle Aged KW - Neuroimaging KW - Polymorphism, Single Nucleotide KW - Quantitative Trait Loci KW - Schizophrenia KW - Whites AB -

Excessive alcohol consumption is one of the main causes of death and disability worldwide. Alcohol consumption is a heritable complex trait. Here we conducted a meta-analysis of genome-wide association studies of alcohol consumption (g d) from the UK Biobank, the Alcohol Genome-Wide Consortium and the Cohorts for Heart and Aging Research in Genomic Epidemiology Plus consortia, collecting data from 480,842 people of European descent to decipher the genetic architecture of alcohol intake. We identified 46 new common loci and investigated their potential functional importance using magnetic resonance imaging data and gene expression studies. We identify genetic pathways associated with alcohol consumption and suggest genetic mechanisms that are shared with neuropsychiatric disorders such as schizophrenia.

VL - 3 IS - 9 ER - TY - JOUR T1 - One-Year Mortality After Dialysis Initiation Among Older Adults. JF - JAMA Intern Med Y1 - 2019 A1 - Melissa W Wachterman A1 - O'Hare, Ann M A1 - Rahman, Omari-Khalid A1 - Karl A Lorenz A1 - Edward R Marcantonio A1 - Alicante, Gabrielle K A1 - Amy Kelley KW - Aged KW - Aged, 80 and over KW - Female KW - Humans KW - Male KW - Renal Dialysis KW - United States AB - This cohort study examines the incidence of mortality 1 year after the start of hemodialysis in patients 65 years and older. VL - 179 IS - 7 U1 - http://www.ncbi.nlm.nih.gov/pubmed/31009039?dopt=Abstract ER - TY - JOUR T1 - Racial disparities and temporal trends in dementia misdiagnosis risk in the United States JF - Alzheimer's and Dementia: Translational Research and Clinical Interventions Y1 - 2019 A1 - Kan Z Gianattasio A1 - Prather, C. A1 - M. Maria Glymour A1 - Ciarleglio, A. A1 - Melinda C Power KW - Aged KW - algorithm KW - ancestry group KW - Article KW - Black person KW - Caucasian KW - Dementia KW - diagnostic error KW - ethnic group KW - Female KW - health disparity KW - human KW - ICD-9-CM KW - major clinical study KW - Male KW - Medicare KW - priority journal KW - Retirement KW - risk factor KW - sensitivity analysis KW - Sensitivity and Specificity KW - United States AB - Introduction: Systematic disparities in misdiagnosis of dementia across racial/ethnic groups have implications for health disparities. We compared the risk of dementia under- and overdiagnosis in clinical settings across racial/ethnic groups from 2000 to 2010. Methods: We linked fee-for-service Medicare claims to participants aged ≥70 from the nationally representative Health and Retirement Study. We classified dementia status using an algorithm with similar sensitivity and specificity across racial/ethnic groups and assigned clinical dementia diagnosis status using ICD-9-CM codes from Medicare claims. Multinomial logit models were used to estimate relative risks of clinical under- and overdiagnosis between groups and over time. Results: Non-Hispanic blacks had roughly double the risk of underdiagnosis as non-Hispanic whites. While primary analyses suggested a shrinking disparity over time, this was not robust to sensitivity analyses or adjustment for covariates. Risk of overdiagnosis increased over time in both groups. Discussion: Our results suggest that efforts to reduce racial disparities in underdiagnosis are warranted. © 2019 The Authors VL - 5 ER - TY - JOUR T1 - Self-Reported Personality Traits and Informant-Rated Cognition: A 10-Year Prospective Study JF - Journal of Alzheimer's Disease Y1 - 2019 A1 - Angelina R Sutin A1 - Yannick Stephan A1 - Antonio Terracciano KW - Aged KW - agreeableness KW - Article KW - Cognition KW - Conscientiousness KW - extraversion KW - Female KW - follow up KW - human KW - major clinical study KW - Male KW - neurosis KW - openness KW - Personality KW - priority journal KW - prospective study KW - Self Report AB - Personality traits, such as higher Neuroticism and lower Conscientiousness, are associated with risk of Alzheimer's disease and other dementias. A diagnosis of dementia relies, in part, on informant ratings of the individual's cognitive status. Here we examine whether self-reported personality traits are associated with four measures of informant-rated cognition up to a decade later. Participants from the Health and Retirement Study (N = 2,536) completed a five-factor model measure of personality in 2006 or 2008. Informants completed the 2016 Harmonized Cognitive Assessment Protocol (HCAP), which included ratings of the participant's current cognitive functioning and change in cognitive function over the last decade assessed with the IQCODE, Blessed, 1066, and CSID. Controlling for characteristics of the participant, informant, and their relationship, higher Neuroticism and lower Conscientiousness were associated consistently with worse informant-rated cognition. The association between Openness and better informant-rated cognition was due primarily to higher baseline cognitive function. Extraversion and Agreeableness were associated with better informant-rated cognition only among participants who were cognitively intact at follow-up. The present research suggests that knowledgeable informants are able to detect cognitive deficits associated with personality. © 2019 - IOS Press and the authors. All rights reserved. VL - 72 UR - https://www.ncbi.nlm.nih.gov/pubmed/31561364 N1 - cited By 0 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 - Are coresidence and nursing homes substitutes? Evidence from Medicaid spend-down provisions. JF - J Health Econ Y1 - 2018 A1 - Corina D Mommaerts KW - Adult children KW - Aged KW - Aged, 80 and over KW - Female KW - Health Expenditures KW - Homes for the Aged KW - Humans KW - Long-term Care KW - Male KW - Medicaid KW - Nursing homes KW - Residence Characteristics KW - United States AB -

This paper measures the extent to which the price of nursing home care affects a potential substitute living arrangement: coresidence with adult children. Exploiting variation in state Medicaid income "spend-down" provisions over time, I find that living in a state with a spend-down provision decreases the prevalence of coresidence with adult children by 1-4 percentage points for single elderly individuals, with a corresponding increase in the use of nursing home care. These findings suggest that changes in Medicaid eligibility for long-term care benefits could have large impacts on living arrangements, care utilization patterns, and Medicaid expenditures.

VL - 59 U1 - http://www.ncbi.nlm.nih.gov/pubmed/29709710?dopt=Abstract ER - TY - JOUR T1 - Arthritis, Depression, and Falls Among Community-Dwelling Older Adults: Evidence From the Health and Retirement Study. JF - J Appl Gerontol Y1 - 2018 A1 - Lien Quach A1 - Jeffrey A Burr KW - Accidental Falls KW - Aged KW - Aged, 80 and over KW - Arthritis, Rheumatoid KW - Comorbidity KW - depression KW - Female KW - Health Surveys KW - Humans KW - Independent Living KW - Male KW - Osteoarthritis KW - United States AB -

The aims of this study were to examine the association between different types of arthritis and falls and to investigate whether clinically significant depression symptoms (CSDS) moderate these relationships. The study used nationally representative data from the 2008 Health and Retirement Study ( n = 7,715, M age = 75, 62% female, and 90% White). Among the respondents, 42% experienced at least one fall during the previous 2 years. About one third had some form of arthritis: 22% osteoarthritis (OA), 4.8% rheumatoid arthritis (RA), 2.3% both OA and RA, and 7.9% with other arthritis types. About one fifth of respondents had CSDS. OA and CSDS are associated with the odds of falling (17% and 29%, respectively), adjusting for socio-demographic characteristics, lifestyle, health conditions, and psychiatric medications. There was no statistically significant interaction between types of arthritis and CSDS. Health care providers should pay attention to managing arthritis, especially OA, and CSDS to prevent falls among older adults.

VL - 37 UR - http://www.ncbi.nlm.nih.gov/pubmed/27178205 IS - 9 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27178205?dopt=Abstract 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 - Drinking Patterns Among Older Couples: Longitudinal Associations With Negative Marital Quality. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2018 A1 - Kira S. Birditt A1 - James A. Cranford A1 - Jasmine A Manalel A1 - Toni C Antonucci KW - Aged KW - Aged, 80 and over KW - Alcohol Drinking KW - Family Conflict KW - Female KW - Humans KW - Longitudinal Studies KW - Male KW - Marriage KW - Middle Aged KW - Sex Factors KW - Spouses AB -

Objectives: Research with younger couples indicates that alcohol use has powerful effects on marital quality, but less work has examined the effects of drinking among older couples. This study examined whether dyadic patterns of drinking status among older couples are associated with negative marital quality over time.

Method: Married participants (N = 4864) from the Health and Retirement Study reported on alcohol consumption (whether they drink alcohol and average amount consumed per week) and negative marital quality (e.g., criticism and demands) across two waves (Wave 1 2006/2008 and Wave 2 2010/2012).

Results: Concordant drinking couples reported decreased negative marital quality over time, and these links were significantly greater among wives. Wives who reported drinking alcohol reported decreased negative marital quality over time when husbands also reported drinking and increased negative marital quality over time when husbands reported not drinking.

Discussion: The present findings stress the importance of considering the drinking status rather than the amount of alcohol consumed of both members of the couple when attempting to understand drinking and marital quality among older couples. These findings are particularly salient given the increased drinking among baby boomers and the importance of marital quality for health among older couples.

VL - 73 UR - http://www.ncbi.nlm.nih.gov/pubmed/27353031 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27353031?dopt=Abstract ER - TY - JOUR T1 - Early Origins of Adult Cancer Risk Among Men and Women: Influence of Childhood Misfortune? JF - J Aging Health Y1 - 2018 A1 - Blakelee R Kemp A1 - Kenneth F Ferraro A1 - Patricia M Morton A1 - Sarah A Mustillo KW - African Americans KW - Aged KW - Child KW - Female KW - Hispanic Americans KW - Humans KW - Incidence KW - Male KW - Middle Aged KW - Neoplasms KW - Parents KW - Prevalence KW - Risk Assessment KW - Risk Factors KW - Social Class KW - Social Conditions KW - Socioeconomic factors KW - United States AB -

OBJECTIVE: To examine the effect of five childhood misfortune domains-parental behavior, socioeconomic status, infectious diseases, chronic diseases, and impairments-on all-site and selected site-specific cancer prevalence and all-site cancer incidence.

METHOD: Panel data from the Health and Retirement Study (2004-2012) were used to investigate cancer risk among adults above the age of 50.

RESULTS: Risky parental behavior and impairment in childhood were associated with higher odds of all-site cancer prevalence, and childhood chronic disease was associated with prostate cancer, even after adjusting for adult health and socioeconomic factors. Moreover, having one infectious disease in childhood lowered the odds of colon cancer. Cancer trends varied by race and ethnicity, most notably, higher prostate cancer prevalence among Black men and lower all-site cancer among Hispanic adults.

DISCUSSION: These findings underscore the importance of examining multiple domains of misfortune because the type and amount of misfortune influence cancer risk in different ways.

VL - 30 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27683354?dopt=Abstract ER - TY - JOUR T1 - Education and Psychosocial Functioning Among Older Adults: 4-Year Change in Sense of Control and Hopelessness. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2018 A1 - Uchechi A Mitchell A1 - Jennifer A Ailshire A1 - Lauren L Brown A1 - Morgan E. Levine A1 - Eileen M. Crimmins KW - Activities of Daily Living KW - Aged KW - Educational Status KW - Female KW - Humans KW - Internal-External Control KW - Male KW - Middle Aged KW - Psychology KW - Sadness KW - Social participation KW - Social Support AB -

OBJECTIVES: This study investigates education differences in levels and change in sense of control and hopelessness among older adults.

METHOD: We used data from the Health and Retirement Study, an ongoing biennial survey of a nationally representative sample of older Americans, to examine education differences in sense of control (e.g., mastery and perceived constraints) and hopelessness. Our sample included 8,495 adults aged 52 and older who were interviewed in 2006/2008 and 2010/2012. We assessed separate models for change in sense of control and hopelessness, accounting for recent changes in social circumstances and health status.

RESULTS: Low mastery, perceived constraints, and hopelessness were highest among individuals with less than a high school education. Over a 4-year period, this group experienced the greatest declines in psychosocial functioning, as indicated by greater increases in low mastery, perceived constraints, and hopelessness. Education differences existed net of recent negative experiences, specifically the loss of intimate social relationships and social support and increases in disease and disability.

DISCUSSION: These findings highlight the importance of education for sense of control and hopelessness in older adulthood and demonstrate the cumulative advantage of higher levels of education for psychosocial functioning.

VL - 73 UR - http://psychsocgerontology.oxfordjournals.org/content/early/2016/03/23/geronb.gbw031.abstract IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27013537?dopt=Abstract U4 - Health and Retirement Study/Longitudinal analysis/Mastery/Perceived constraints ER - TY - JOUR T1 - Educational and Gender Differences in Health Behavior Changes After a Gateway Diagnosis. JF - J Aging Health Y1 - 2018 A1 - Elaine M Hernandez A1 - Rachel Margolis A1 - Robert A Hummer KW - Aged KW - Attitude to Health KW - Educational Status KW - Exercise KW - Female KW - Health Behavior KW - Humans KW - Hypertension KW - Male KW - Middle Aged KW - Retirement KW - Sex Factors KW - Smoking cessation KW - United States AB -

OBJECTIVE: Hypertension represents a gateway diagnosis to more serious health problems that occur as people age. We examine educational differences in three health behavior changes people often make after receiving this diagnosis in middle or older age, and test whether these educational differences depend on (a) the complexity of the health behavior change and (b) gender.

METHOD: We use data from the Health and Retirement Study and conduct logistic regression analysis to examine the likelihood of modifying health behaviors post diagnosis.

RESULTS: We find educational differences in three behavior changes-antihypertensive medication use, smoking cessation, and physical activity initiation-after a hypertension diagnosis. These educational differences in health behaviors were stronger among women compared with men.

DISCUSSION: Upon receiving a hypertension diagnosis, education is a more important predictor of behavior changes for women compared with men, which may help explain gender differences in the socioeconomic gradient in health in the United States.

VL - 30 UR - http://jah.sagepub.com/cgi/doi/10.1177/0898264316678756 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27940641?dopt=Abstract JO - Journal of Aging and Health ER - TY - JOUR T1 - The Effects of Medicare Part D on Health Outcomes of Newly Covered Medicare Beneficiaries. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2018 A1 - Diebold, Jeffrey KW - Aged KW - Female KW - Health Status KW - Humans KW - Hypertension KW - Male KW - Medicare Part D KW - Medication Adherence KW - Models, Statistical KW - United States AB -

OBJECTIVES: To estimate the impact of Medicare Part D on cost-related prescription nonadherence and health outcomes among the newly covered medicare beneficiaries.

METHOD: Difference-in-differences analyses of data from a balanced panel of Medicare beneficiaries observed in each wave of the Health and Retirement Study from 2000 to 2010 were carried out. The differences in the pre- and post-Part D changes in these outcomes are calculated for previously uncovered Part D enrollees and a comparison group of previously covered Medicare beneficiaries.

RESULTS: The results from this analysis indicate that Part D reduced cost-related nonadherence rates among the newly covered by 7 percentage points and that this decline was sustained through 2010. Part D was also associated with a 5 percentage points increase in the likelihood that a newly covered enrollee reported to be in good or better health and a 4-percentage point decline in the likelihood of being diagnosed with high blood pressure. These improvements were also sustained through 2010 but were only evident among those newly covered beneficiaries who remained enrolled in a Part D plan through 2010. However, there is insufficient evidence to conclude that Part D improved the blood pressure of newly covered, hypertensive beneficiaries.

DISCUSSION: Part D has had a sustained impact on cost-related nonadherence rates and the health status of newly covered beneficiaries. However, the change in health status is conditional on remaining enrolled in a Part D plan over time.

VL - 73 UR - http://psychsocgerontology.oxfordjournals.org/content/early/2016/05/05/geronb.gbw030.abstract IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27154961?dopt=Abstract U4 - Cost-related nonadherence/Health care policy/Health outcomes/Medicare Part D ER - TY - JOUR T1 - Gene discovery and polygenic prediction from a genome-wide association study of educational attainment in 1.1 million individuals. JF - Nature Genetics Y1 - 2018 A1 - Lee, James J A1 - Wedow, Robbee A1 - Okbay, Aysu A1 - Kong, Edward A1 - Maghzian, Omeed A1 - Zacher, Meghan A1 - Nguyen-Viet, Tuan Anh A1 - Bowers, Peter A1 - Sidorenko, Julia A1 - Richard Karlsson Linnér A1 - Mark Alan Fontana A1 - Kundu, Tushar A1 - Lee, Chanwook A1 - Hui Liu A1 - Li, Ruoxi A1 - Royer, Rebecca A1 - Pascal N Timshel A1 - Walters, Raymond K A1 - Willoughby, Emily A A1 - Yengo, Loic A1 - Alver, Maris A1 - Bao, Yanchun A1 - Clark, David W A1 - Day, Felix R A1 - Furlotte, Nicholas A A1 - Joshi, Peter K A1 - Kathryn E Kemper A1 - Kleinman, Aaron A1 - Langenberg, Claudia A1 - Mägi, Reedik A1 - Joey W Trampush A1 - Verma, Shefali Setia A1 - Wu, Yang A1 - Lam, Max A1 - Jing Hua Zhao A1 - Zheng, Zhili A1 - Jason D Boardman A1 - Campbell, Harry A1 - Freese, Jeremy A1 - Kathleen Mullan Harris A1 - Caroline Hayward A1 - Herd, Pamela A1 - Kumari, Meena A1 - Lencz, Todd A1 - Luan, Jian'an A1 - Anil K. Malhotra A1 - Andres Metspalu A1 - Lili Milani A1 - Ong, Ken K A1 - Perry, John R B A1 - David J Porteous A1 - Ritchie, Marylyn D A1 - Smart, Melissa C A1 - Smith, Blair H A1 - Tung, Joyce Y A1 - Wareham, Nicholas J A1 - James F Wilson A1 - Jonathan P. Beauchamp A1 - Dalton C Conley A1 - Tõnu Esko A1 - Lehrer, Steven F A1 - Patrik K E Magnusson A1 - Oskarsson, Sven A1 - Pers, Tune H A1 - Matthew R Robinson A1 - Thom, Kevin A1 - Watson, Chelsea A1 - Chabris, Christopher F A1 - Meyer, Michelle N A1 - David I Laibson A1 - Yang, Jian A1 - Johannesson, Magnus A1 - Philipp D Koellinger A1 - Turley, Patrick A1 - Peter M Visscher A1 - Daniel J. Benjamin A1 - Cesarini, David KW - Adult KW - Aged KW - Aged, 80 and over KW - Cohort Studies KW - Educational Status KW - Female KW - Genome-Wide Association Study KW - Humans KW - Male KW - Middle Aged KW - Multifactorial Inheritance KW - Phenotype KW - Polymorphism, Single Nucleotide AB -

Here we conducted a large-scale genetic association analysis of educational attainment in a sample of approximately 1.1 million individuals and identify 1,271 independent genome-wide-significant SNPs. For the SNPs taken together, we found evidence of heterogeneous effects across environments. The SNPs implicate genes involved in brain-development processes and neuron-to-neuron communication. In a separate analysis of the X chromosome, we identify 10 independent genome-wide-significant SNPs and estimate a SNP heritability of around 0.3% in both men and women, consistent with partial dosage compensation. A joint (multi-phenotype) analysis of educational attainment and three related cognitive phenotypes generates polygenic scores that explain 11-13% of the variance in educational attainment and 7-10% of the variance in cognitive performance. This prediction accuracy substantially increases the utility of polygenic scores as tools in research.

VL - 50 IS - 8 U1 - http://www.ncbi.nlm.nih.gov/pubmed/30038396?dopt=Abstract ER - TY - JOUR T1 - Health Shocks and Initiation of Use of Preventive Services Among Older Adults. JF - J Appl Gerontol Y1 - 2018 A1 - Ng, Boon Peng A1 - Gail A Jensen KW - Aged KW - Cholesterol KW - Early Detection of Cancer KW - Female KW - Health Status KW - Health Surveys KW - Humans KW - Influenza, Human KW - Male KW - Mammography KW - Middle Aged KW - Papanicolaou Test KW - Prostatic Neoplasms KW - Vaccination KW - Vaginal Smears AB -

This article examines whether adverse changes to health or functioning serve as an impetus to begin using preventive services among older individuals with a history of non-use. Using data from the 1998-2008 Health and Retirement Study, the use of mammograms, pap smears, prostate cancer screenings, cholesterol checks, and flu shots is examined among 2,975 self-reported non-users of such services. Older women who experience a health shock are 1.86, 1.50, 1.79, and 1.46 times more likely to begin getting mammograms, pap smears, cholesterol checks, and flu shots, respectively. Older men who experience a health shock are 2.24, 2.72, and 1.64 times more likely to begin getting prostate cancer screenings, cholesterol checks, and flu shots, respectively. All of these results are statistically significant. Thus, older adults often improve their health behaviors after experiencing an adverse health event.

VL - 37 UR - http://jag.sagepub.com/cgi/doi/10.1177/0733464816657474 IS - 7 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27449258?dopt=Abstract JO - Journal of Applied Gerontology ER - TY - JOUR T1 - Inconsistency in the Self-report of Chronic Diseases in Panel Surveys: Developing an Adjudication Method for the Health and Retirement Study. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2018 A1 - Christine T Cigolle A1 - Corey L Nagel A1 - Caroline S Blaum A1 - Jersey Liang A1 - Ana R Quiñones KW - Aged KW - Chronic disease KW - Data Accuracy KW - Epidemiologic Methods KW - Female KW - Health Surveys KW - Humans KW - Interviews as Topic KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Self Report AB -

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

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

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

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

VL - 73 UR - https://www.ncbi.nlm.nih.gov/pubmed/27260670 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27260670?dopt=Abstract ER - TY - JOUR T1 - 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 - Linked Lives: Dyadic Associations of Mastery Beliefs With Health (Behavior) and Health (Behavior) Change Among Older Partners. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2018 A1 - Drewelies, Johanna A1 - William J. Chopik A1 - Christiane A Hoppmann A1 - Jacqui Smith A1 - Denis Gerstorf KW - Aged KW - Aged, 80 and over KW - Dominance-Subordination KW - Female KW - Health Behavior KW - Health Status KW - Humans KW - Male KW - Marriage KW - Middle Aged KW - Models, Theoretical KW - Psychological Tests KW - Risk Reduction Behavior KW - Surveys and Questionnaires AB -

Objectives: Mastery beliefs are known to contribute to healthy aging. However, it is an open question whether individual mastery-health associations impact the health of close long-term partners.

Method: We applied actor-partner interdependence models to 4-wave, 6-year longitudinal dyadic data from married and cohabitating partners in the Health and Retirement Study (N = 1,981 partners; age at baseline: M = 67 years, SD = 8.93, range 50-94 years).

Results: Higher individual mastery beliefs were associated with better individual physical health and health behaviors. Higher mastery beliefs were associated with subsequent increases in light physical activity. Having a partner with higher levels of mastery was uniquely associated with fewer functional limitations, better self-rated health, and more physical activity. Actor × Partner interaction effects for functional limitations indicated multiplicative associations of actor and partner mastery with health. Of note, mastery-health associations for individuals and their partners were invariant across age, gender, education, employment status, perceived stress over one's own and partner's health, and cognition.

Discussion: Findings suggest that partner mastery beliefs matter for the health (behaviors) of older adults. We discuss possible mechanisms underlying partner interrelations in mastery and health, their age invariance, and consider implications arising from our results.

VL - 73 UR - http://www.ncbi.nlm.nih.gov/pubmed/27229003 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27229003?dopt=Abstract ER - TY - JOUR T1 - Loneliness and depressive symptoms: the moderating role of the transition into retirement. JF - Aging Ment Health Y1 - 2018 A1 - Dikla Segel-Karpas A1 - Liat Ayalon A1 - Margie E Lachman KW - Aged KW - depression KW - Female KW - Humans KW - Loneliness KW - Male KW - Middle Aged KW - Retirement AB -

OBJECTIVES: The transition to retirement implies significant changes in daily routine and in the social environment. More specifically, it requires more self-directed efforts in order to stay socially engaged. Hence, for those who suffer from loneliness, the transition to retirement could result in increased depressive symptoms due to the lack of structured daily routine.

METHODS: We used two waves of the Health and Retirement Study, and tested whether the transition to retirement between the two waves moderates the effects of loneliness on depressive symptoms.

RESULTS: The transition to retirement moderated the effect of loneliness in wave 1 on depressive symptoms in wave 2, such that for those who retired, the effect was stronger in comparison to those who stayed employed.

CONCLUSIONS: Although many manage to easily transition into retirement, lonely older workers are at increased risk for maladjustment and the experience of depressive symptoms following retirement. This group could perhaps benefit from interventions aimed at increasing daily social interactions and establishing a socially satisfying routine.

VL - 22 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27624519?dopt=Abstract ER - TY - JOUR T1 - A Longitudinal Assessment of Perceived Discrimination and Maladaptive Expressions of Anger Among Older Adults: Does Subjective Social Power Buffer the Association? JF - The Journals of Gerontology: Series B Y1 - 2018 A1 - Lee, Yeonjung A1 - Bierman, Alex KW - African Americans KW - Aged KW - Anger KW - European Continental Ancestry Group KW - Female KW - Hispanic Americans KW - Humans KW - Longitudinal Studies KW - Male KW - Personality Inventory KW - Power, Psychological KW - Prejudice KW - Racism KW - United States AB -

Objectives: We examine whether perceived discrimination in older adults is associated with external conflict (anger-out) and internally directed anger (anger-in), as well as how subjective social power-as indicated by a sense of personal control and subjective social status-modifies these associations while holistically controlling for time-stable confounds and the five major dimensions of personality.

Method: The 2006 and 2008 psychosocial subsamples of the Health and Retirement Study were combined to create baseline observations, and the 2010 and 2012 waves were combined to create follow-up observations. Responses were analyzed with random-effects models that adjust for repeated observations and fixed-effects models that additionally control for all time-stable confounds.

Results: Discrimination was significantly associated with anger-in and anger-out. Fixed-effects models and controls for personality reduced these associations by more than 60%, although they remained significant. Measures of subjective social power weaken associations with anger-out but not anger-in.

Discussion: The mental health consequences of perceived discrimination for older adults may be over-estimated if time-stable confounds and personality are not taken into account. Subjective social power can protect victims of discrimination from reactions that may escalate conflict, but not from internalized anger that is likely to be wearing and cause further health problems.

VL - 73 IS - 8 ER - TY - JOUR T1 - Medicare Part D Implementation and Associated Health Impact Among Older Adults in the United States. JF - Int J Health Serv Y1 - 2018 A1 - Chen, Cheng-Chia A1 - Hsien-Chang Lin A1 - Seo, Dong-Chul KW - Aged KW - Health Services for the Aged KW - Humans KW - Medicare Part D KW - United States AB -

This study examined the effect of Medicare (Part D) implementation on health outcomes among U.S. older adults. Study participants were initially extracted from the 2004-2008 Health and Retirement Study (HRS). Data from respondents who further participated in the HRS 2005-2007 Prescription Drug Study were analyzed (N = 746). This was a retrospective pre-post design with a treatment and a control group. The difference-in-differences approach with panel ordered logistic regressions was used to examine the Part D effect on three patient health outcomes before and after the implementation, controlling for patient sociodemographic characteristics. People with continuous Part D enrollment from 2006-2008 were less likely to have a worse self-rated health than those who were not enrolled in Part D (odds ratio [OR] = 0.48; p < .05). A higher Charlson Comorbidity Index score was associated with a higher likelihood of having worse self-rated overall health, worse mental health, and worse activities of daily living impairment (ORs = 1.12, 1.17, and 1.36, respectively; all ps < .001). The Part D implementation appears to have a positive effect on older adults' overall health outcomes. A decrease in out-of-pocket cost for health care may encourage older adults to utilize more needed medications, which in turn helped maintain better health.

VL - 48 UR - http://joh.sagepub.com/lookup/doi/10.1177/0020731416676226 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27799594?dopt=Abstract JO - International Journal of Health Services 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 - Perceived Control Mediates Effects of Socioeconomic Status and Chronic Stress on Physical Frailty: Findings From the Health and Retirement Study. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2018 A1 - Christopher J Mooney A1 - Ari J. Elliot A1 - Kathryn Z. Douthit A1 - Marquis, Andre A1 - Christopher L Seplaki KW - Aged KW - Cross-Sectional Studies KW - Female KW - Frail Elderly KW - Frailty KW - Humans KW - Internal-External Control KW - Longitudinal Studies KW - Male KW - Models, Theoretical KW - Risk Factors KW - Socioeconomic factors KW - Stress, Psychological AB -

Objective: To investigate the psychosocial etiology of physical frailty by examining the influence of chronic stress and perceived control.

Method: Using population-based samples of older adults from the Health and Retirement Study, this study employed structural equation modeling in cross-sectional (N = 5,250) and longitudinal (N = 2,013) samples to estimate the effects of chronic stress and socioeconomic status (SES) on baseline frailty and change in frailty status over 4 years and the extent to which perceived control mediates or moderates effects of chronic stress.

Results: Perceived control fully mediated effects of chronic stress and partially mediated effects of SES on both baseline frailty and change in frailty. Multigroup analyses revealed that the mediating role of perceived control was consistent across age, gender, and racial/ethnic subgroups. There was no evidence to support a moderating role of perceived control in the chronic stress and frailty relationship.

Discussion: Findings provide novel evidence for a mediating role of perceived control in pathways linking SES and chronic stress to frailty, further underscoring the importance of psychosocial constructs to the development and progression of frailty in older adults.

VL - 73 UR - http://psychsocgerontology.oxfordjournals.org/content/early/2016/08/12/geronb.gbw096.long IS - 7 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27522087?dopt=Abstract ER - TY - JOUR T1 - The Potential Effects of Obesity on Social Security Claiming Behavior and Retirement Benefits. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2018 A1 - Michael D Hurd A1 - James P Smith A1 - Julie M Zissimopoulos KW - Aged KW - Female KW - Humans KW - Life Expectancy KW - Male KW - Obesity KW - Pensions KW - Poverty KW - Social Class KW - Social Security KW - United States AB -

OBJECTIVES: Obesity prevalence among Americans has increased for nearly three decades. We explore the relationship between the rise in obesity and Social Security retirement benefit claiming, a decision impacting nearly all aging Americans. Specifically, we investigate whether obesity can affect individuals' decision to claim benefits early, a choice that has important implications for financial security in retirement, particularly for those with lower socioeconomic status (SES).

METHOD: We use a microsimulation model called MINT6 (Modeling Income in the Near Term, version 6) to demonstrate the potential effects of obesity on subjective life expectancy and claiming behavior. We impute obesity status using data from the National Health and Nutrition Examination Survey (NHANES), which describes the distribution of obesity prevalence within the United States by gender, poverty status, and race/ethnicity.

RESULTS: We find that the rise in obesity and the consequent incidence of obesity-related diseases may lead some individuals to make claiming decisions that lead to lower monthly and lifetime Social Security retirement benefits. Further, we find that the potential economic impact of this decision is larger for those with lower SES.

DISCUSSION: We present a behavioral perspective by addressing the potential effects that obesity can have on individuals' retirement decisions and their resulting Social Security retirement benefits.

PB - 19 VL - 73 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27044665?dopt=Abstract U4 - Social Security benefit claiming/Subjective Probabilities of Survival ER - TY - JOUR T1 - Smoking Cessation and Changes in Body Mass Index Among Middle Aged and Older Adults. JF - J Appl Gerontol Y1 - 2018 A1 - Sharma, Andy KW - Aged KW - Aged, 80 and over KW - Body Mass Index KW - Female KW - Humans KW - Male KW - Middle Aged KW - Models, Statistical KW - Smoking cessation KW - Weight Gain AB -

OBJECTIVE: This study contributes to the body of literature examining smoking cessation and body mass index (BMI) for adults aged 50 and older.

METHOD: Utilizing the 2004 and 2010 waves of the RAND Health and Retirement Study, this analysis utilized Fixed Effects (FE) regression on a sample of 1,316 adults aged 50 and older.

RESULTS: Older adults undergo a small change in BMI after a transition from smoking to nonsmoking during a 6-year period, and this occurs after accounting for individual-level unobserved heterogeneity. More specifically, men experience a BMI gain of 1.24 ( p< .01) and women experience a BMI gain of 1.58 ( p< .01).

DISCUSSION: Gerontologists/health professionals can use these results to inform older adults about the potential for a small increase in BMI and, in the process, assuage any apprehensions about excessive weight gain. This insight may encourage a greater number of older adults to cease smoking.

VL - 37 UR - http://www.ncbi.nlm.nih.gov/pubmed/27353834 IS - 8 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27353834?dopt=Abstract ER - TY - JOUR T1 - Study of 300,486 individuals identifies 148 independent genetic loci influencing general cognitive function. JF - Nature Communications Y1 - 2018 A1 - Gail Davies A1 - Lam, Max A1 - Sarah E Harris A1 - Joey W Trampush A1 - Luciano, Michelle A1 - W David Hill A1 - Hagenaars, Saskia P A1 - Ritchie, Stuart J A1 - Riccardo E Marioni A1 - Fawns-Ritchie, Chloe A1 - David C Liewald A1 - Okely, Judith A A1 - Ahola-Olli, Ari V A1 - Barnes, Catriona L K A1 - Bertram, Lars A1 - Joshua C. Bis A1 - Katherine E Burdick A1 - Christoforou, Andrea A1 - DeRosse, Pamela A1 - Djurovic, Srdjan A1 - Espeseth, Thomas A1 - Giakoumaki, Stella A1 - Giddaluru, Sudheer A1 - Gustavson, Daniel E A1 - Caroline Hayward A1 - Edith Hofer A1 - Ikram, M Arfan A1 - Karlsson, Robert A1 - Knowles, Emma A1 - Lahti, Jari A1 - Leber, Markus A1 - Li, Shuo A1 - Mather, Karen A A1 - Melle, Ingrid A1 - Morris, Derek A1 - Christopher J Oldmeadow A1 - Palviainen, Teemu A1 - Payton, Antony A1 - Pazoki, Raha A1 - Katja E Petrovic A1 - Chandra A Reynolds A1 - Sargurupremraj, Muralidharan A1 - Scholz, Markus A1 - Smith, Jennifer A A1 - Smith, Albert V A1 - Terzikhan, Natalie A1 - Thalamuthu, Anbupalam A1 - Trompet, Stella A1 - Sven J van der Lee A1 - Erin B Ware A1 - Windham, B Gwen A1 - Margaret J Wright A1 - Yang, Jingyun A1 - Yu, Jin A1 - Ames, David A1 - Amin, Najaf A1 - Amouyel, Philippe A1 - Andreassen, Ole A A1 - Armstrong, Nicola J A1 - Assareh, Amelia A A1 - John R. Attia A1 - Attix, Deborah A1 - Avramopoulos, Dimitrios A1 - David A Bennett A1 - Böhmer, Anne C A1 - Patricia A. Boyle A1 - Brodaty, Henry A1 - Campbell, Harry A1 - Tyrone D. Cannon A1 - Elizabeth T. Cirulli A1 - Congdon, Eliza A1 - Conley, Emily Drabant A1 - Corley, Janie A1 - Cox, Simon R A1 - Dale, Anders M A1 - Dehghan, Abbas A1 - Danielle M. Dick A1 - Dickinson, Dwight A1 - Johan G Eriksson A1 - Evangelou, Evangelos A1 - Jessica Faul A1 - Ford, Ian A1 - Nelson A. Freimer A1 - Gao, He A1 - Giegling, Ina A1 - Gillespie, Nathan A A1 - Gordon, Scott D A1 - Gottesman, Rebecca F A1 - Michael E Griswold A1 - Gudnason, Vilmundur A1 - Tamara B Harris A1 - Hartmann, Annette M A1 - Hatzimanolis, Alex A1 - Gerardo Heiss A1 - Holliday, Elizabeth G A1 - Joshi, Peter K A1 - Kähönen, Mika A1 - Sharon L R Kardia A1 - Ida Karlsson A1 - Kleineidam, Luca A1 - David S Knopman A1 - Kochan, Nicole A A1 - Konte, Bettina A1 - Kwok, John B A1 - Stephanie Le Hellard A1 - Lee, Teresa A1 - Lehtimäki, Terho A1 - Li, Shu-Chen A1 - Lill, Christina M A1 - Liu, Tian A1 - Koini, Marisa A1 - London, Edythe A1 - Longstreth, Will T A1 - Lopez, Oscar L A1 - Loukola, Anu A1 - Luck, Tobias A1 - Astri J Lundervold A1 - Lundquist, Anders A1 - Lyytikäinen, Leo-Pekka A1 - Nicholas G Martin A1 - Grant W Montgomery A1 - Murray, Alison D A1 - Anna C Need A1 - Noordam, Raymond A1 - Nyberg, Lars A1 - William E R Ollier A1 - Papenberg, Goran A1 - Pattie, Alison A1 - Polasek, Ozren A1 - Russell A Poldrack A1 - Psaty, Bruce M A1 - Reppermund, Simone A1 - Steffi G Riedel-Heller A1 - Rose, Richard J A1 - Rotter, Jerome I A1 - Roussos, Panos A1 - Rovio, Suvi P A1 - Saba, Yasaman A1 - Fred W Sabb A1 - Sachdev, Perminder S A1 - Satizabal, Claudia L A1 - Schmid, Matthias A1 - Rodney J Scott A1 - Matthew A Scult A1 - Simino, Jeannette A1 - Slagboom, P Eline A1 - Smyrnis, Nikolaos A1 - Soumaré, Aïcha A1 - Nikos C Stefanis A1 - Stott, David J A1 - Richard E Straub A1 - Sundet, Kjetil A1 - Taylor, Adele M A1 - Kent D Taylor A1 - Tzoulaki, Ioanna A1 - Tzourio, Christophe A1 - André G Uitterlinden A1 - Vitart, Veronique A1 - Aristotle N Voineskos A1 - Kaprio, Jaakko A1 - Wagner, Michael A1 - Wagner, Holger A1 - Weinhold, Leonie A1 - Wen, K Hoyan A1 - Elisabeth Widen A1 - Yang, Qiong A1 - Zhao, Wei A1 - Hieab H Adams A1 - Dan E Arking A1 - Robert M Bilder A1 - Bitsios, Panos A1 - Boerwinkle, Eric A1 - Chiba-Falek, Ornit A1 - Corvin, Aiden A1 - Philip L de Jager A1 - Debette, Stéphanie A1 - Donohoe, Gary A1 - Elliott, Paul A1 - Fitzpatrick, Annette L A1 - Gill, Michael A1 - David C. Glahn A1 - Hägg, Sara A1 - Narelle K Hansell A1 - Ahmad R Hariri A1 - Ikram, M Kamran A1 - Jukema, J Wouter A1 - Vuoksimaa, Eero A1 - Matthew C Keller A1 - Kremen, William S A1 - Lenore J Launer A1 - Lindenberger, Ulman A1 - Aarno Palotie A1 - Nancy L Pedersen A1 - Pendleton, Neil A1 - David J Porteous A1 - Katri Räikkönen A1 - Olli T Raitakari A1 - Ramirez, Alfredo A1 - Reinvang, Ivar A1 - Rudan, Igor A1 - Schmidt, Reinhold A1 - Schmidt, Helena A1 - Peter W Schofield A1 - Peter R Schofield A1 - John M Starr A1 - Vidar M Steen A1 - Trollor, Julian N A1 - Turner, Steven T A1 - Cornelia M van Duijn A1 - Villringer, Arno A1 - Daniel R Weinberger A1 - David R Weir A1 - James F Wilson A1 - Anil K. Malhotra A1 - McIntosh, Andrew M A1 - Gale, Catharine R A1 - Seshadri, Sudha A1 - Thomas H Mosley A1 - Bressler, Jan A1 - Lencz, Todd A1 - Ian J Deary KW - Adolescent KW - Adult KW - Aged KW - Aged, 80 and over KW - Cognition KW - Genetic Loci KW - Genetic Predisposition to Disease KW - Humans KW - Mental Disorders KW - Middle Aged KW - Multifactorial Inheritance KW - Neurodegenerative Diseases KW - Neurodevelopmental Disorders KW - Polymorphism, Single Nucleotide KW - Reaction Time KW - Young Adult AB -

General cognitive function is a prominent and relatively stable human trait that is associated with many important life outcomes. We combine cognitive and genetic data from the CHARGE and COGENT consortia, and UK Biobank (total N = 300,486; age 16-102) and find 148 genome-wide significant independent loci (P < 5 × 10) associated with general cognitive function. Within the novel genetic loci are variants associated with neurodegenerative and neurodevelopmental disorders, physical and psychiatric illnesses, and brain structure. Gene-based analyses find 709 genes associated with general cognitive function. Expression levels across the cortex are associated with general cognitive function. Using polygenic scores, up to 4.3% of variance in general cognitive function is predicted in independent samples. We detect significant genetic overlap between general cognitive function, reaction time, and many health variables including eyesight, hypertension, and longevity. In conclusion we identify novel genetic loci and pathways contributing to the heritability of general cognitive function.

VL - 9 IS - 1 ER - TY - JOUR T1 - Survival Advantage Mechanism: Inflammation as a Mediator of Positive Self-Perceptions of Aging on Longevity. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2018 A1 - Becca R Levy A1 - Bavishi, Avni KW - Aged KW - Aged, 80 and over KW - Aging KW - Biomarkers KW - C-reactive protein KW - Female KW - Humans KW - Inflammation KW - Longevity KW - Male KW - Middle Aged KW - Self Concept KW - Surveys and Questionnaires KW - Survival Analysis AB -

OBJECTIVE: Previous studies have found that positive self-perceptions of aging (SPA) are associated with longer survival; however, a biological mechanism was unknown. We examined whether C-reactive protein (CRP), a marker of cumulative stress-related inflammation, mediates the relationship between SPA and survival.

METHOD: The SPA of participants aged 50 and older in the Health and Retirement Study (N = 4,149) were assessed at baseline. Inflammation was measured by the level of CRP 4 years later. Survival was followed for up to 6 years.

RESULTS: As hypothesized, CRP mediated the impact of SPA on survival. Following the steps of a mediation analysis, positive SPA at baseline predicted lower CRP after 4 years (β = -.29, p = .03) and longer survival in the 2 years following the CRP measurement (β = .20, p =.003); additionally, lower CRP predicted longer survival, after adjusting for positive SPA (β = -.02, p = .0001). All models adjusted for baseline age, CRP, health, sex, race, and education.

DISCUSSION: It was found that lower CRP partially mediates the relationship between positive SPA and longer survival. Hence, this study presents a novel pathway to explain the process by which positive SPA extend longevity.

VL - 73 UR - http://psychsocgerontology.oxfordjournals.org/content/early/2016/03/26/geronb.gbw035.abstractN2 - IS - 3 N1 - 10.1093/geronb/gbw035 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27032428?dopt=Abstract U4 - Aging/C-reactive protein/Inflammation/Longevity/Mechanism/Mortality/Self-perceptions of aging/Social cognition/Survival 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 - Aging perceptions and self-efficacy mediate the association between personality traits and depressive symptoms in older adults. JF - Int J Geriatr Psychiatry Y1 - 2017 A1 - O'Shea, Deirdre M A1 - Vonetta M Dotson A1 - Fieo, Robert A KW - Aged KW - Aged, 80 and over KW - Aging KW - Depressive Disorder KW - Female KW - Humans KW - Male KW - Middle Aged KW - Personality KW - Risk Factors KW - Self Concept KW - Self Efficacy AB -

OBJECTIVE: Personality traits have been shown to be predictors of depressive symptoms in late life. Thus, we examined whether other more modifiable sources of individual differences such as self-efficacy and self-perceptions of aging would mediate the association between personality traits and depressive symptoms in older adults.

METHOD: Data were obtained from 3,507 older adult participants who took part in the 2012 Health and Retirement Study. The "Big Five" personality traits, self-efficacy, aging perceptions, and depressive symptoms were assessed. Mediation analyses tested the hypothesis that self-efficacy and aging perceptions would mediate the relationship between personality traits and depressive symptoms.

RESULTS: All five personality traits were significant predictors of depressive symptoms. Neuroticism was positively associated with depressive symptoms and had the greatest effect compared with the other personality traits. There was a significant indirect effect of neuroticism, extraversion, and conscientiousness on depressive symptoms (including both mediators). The mediating effect of aging perceptions on the relationship between neuroticism and depressive symptoms was the strongest compared with self-efficacy, accounting for approximately 80% of the total indirect effect.

CONCLUSION: Our results provide support for interventions aimed at improving self-perceptions related to efficacy and aging in order to reduce depressive symptoms in older adults. Copyright © 2016 John Wiley & Sons, Ltd.

VL - 32 IS - 12 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27653811?dopt=Abstract ER - TY - JOUR T1 - Another Paradox? The Life Satisfaction of Older Hispanic Immigrants in the United States. JF - J Aging Health Y1 - 2017 A1 - Rocío Calvo A1 - Dawn C Carr A1 - Matz-Costa, Christina KW - Aged KW - Aged, 80 and over KW - Cross-Sectional Studies KW - Emigrants and Immigrants KW - Female KW - Health Status KW - Humans KW - Male KW - Middle Aged KW - Models, Theoretical KW - Personal Satisfaction KW - Surveys and Questionnaires AB -

OBJECTIVE: To investigate disparities in life satisfaction among older Hispanic immigrants in the United States relative to their native-born Hispanic and non-Hispanic White counterparts, and to identify factors associated with such disparities.

METHOD: Cross-sectional data from 9,798 individuals age 60 and above from the Health and Retirement Study (HRS) were used to estimate ordinary least squares (OLS) regression models.

RESULTS: Hispanic immigrants reported the highest levels of life satisfaction of all groups. Wealthier older adults, who were socially engaged, had social support, and experienced fewer functional limitations and lower exposure to discrimination, were more satisfied with their lives in the overall sample. Interaction effects revealed that although education was associated with greater life satisfaction only among non-Hispanic Whites, co-residing with children was associated with greater life satisfaction only among Hispanics.

DISCUSSION: Although older Hispanic immigrants had the least amount of socioeconomic resources of all groups in our study, they were the most satisfied with their lives. Possible explanations and directions for future research are discussed.

VL - 29 UR - http://jah.sagepub.com/content/early/2016/01/14/0898264315624901.abstract IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26772911?dopt=Abstract ER - TY - JOUR T1 - Are Changes in Self-Rated Health Associated With Memory Decline in Older Adults? JF - J Aging Health Y1 - 2017 A1 - Bendayan, Rebecca A1 - Andrea M Piccinin A1 - Scott M Hofer A1 - Muniz, Graciela KW - Aged KW - Cross-Sectional Studies KW - Diagnostic Self Evaluation KW - Female KW - Humans KW - Longitudinal Studies KW - Male KW - Memory Disorders KW - Self Report KW - United States AB -

OBJECTIVE: The association between patterns of change in self-rated health (SRH) and memory trajectories in older adults was examined using a systematic approach.

METHOD: Data from the Health and Retirement Study ( n = 6,016) and the English Longitudinal Study of Ageing ( n = 734) were analyzed. Individuals were grouped into five categories according to their pattern of change in SRH over 8 years: stable excellent/very good/good, stable fair/poor, improvement, decline, and fluctuating pattern without a trend. Memory was measured using immediate and delayed recall tests. Kruskal-Wallis, chi-squares tests, and linear mixed models were used to examine the association.

RESULTS: Different rates of decline in memory can be identified in the different patterns of change in SRH. Those who had a stable excellent/very good/good pattern had the slowest rate of decline.

DISCUSSION: Our findings suggest that SRH status and patterns of change could be used as a marker of cognitive decline in prevention screening programs.

VL - 29 UR - https://www.ncbi.nlm.nih.gov/pubmed/27481931 IS - 8 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27481931?dopt=Abstract ER - TY - JOUR T1 - The association between antidepressant use and hemoglobin A1C in older adults. JF - Geriatr Nurs Y1 - 2017 A1 - Kammer, Jamie A1 - Akiko S Hosler A1 - Leckman-Westin, Emily A1 - A. Gregory DiRienzo KW - Aged KW - Aged, 80 and over KW - Antidepressive Agents KW - Blood Glucose KW - Cross-Sectional Studies KW - depression KW - Diabetes Mellitus, Type 2 KW - Female KW - Glycated Hemoglobin A KW - Humans KW - Longitudinal Studies KW - Male KW - Risk Factors KW - Surveys and Questionnaires AB -

Depression is known to increase diabetes risk and worsen glycemic control in older adults, who already experience high rates of diabetes. The independent impact of antidepressants on glucose control is less clear. Data was drawn from the Health and Retirement Study, a large nationally-representative longitudinal study of retired individuals. Crude and adjusted linear models stratified by diabetes status were used to examine the cross-sectional associations between antidepressant use categorized by subclass and continuous hemoglobin A1C. The sample included 1,153 individuals, most over the age of 70. Antidepressant use was not associated with hemoglobin A1C in any model whether stratified or in the total combined sample. Antidepressants as a class were also not associated with hemoglobin A1C. These findings add to the literature suggesting that antidepressants are not associated with diabetes risk or glycemic control. Prospective studies with larger sample sizes are needed to confirm this finding.

VL - 38 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27742121?dopt=Abstract 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 - Associations between community-level disaster exposure and individual-level changes in disability and risk of death for older Americans. JF - Soc Sci Med Y1 - 2017 A1 - Samuel L. Brilleman A1 - Wolfe, Rory A1 - Moreno-Betancur, Margarita A1 - Anne E Sales A1 - Kenneth M. Langa A1 - Yun Li A1 - Elizabeth L. Daugher Biddison A1 - Rubinson, Lewis A1 - Theodore J Iwashyna KW - Aged KW - Aged, 80 and over KW - Cohort Studies KW - Community Participation KW - Continental Population Groups KW - Disabled Persons KW - Disaster Planning KW - Disasters KW - Female KW - Humans KW - Income KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Mortality KW - United States AB -

Disasters occur frequently in the United States (US) and their impact on acute morbidity, mortality and short-term increased health needs has been well described. However, barring mental health, little is known about the medium or longer-term health impacts of disasters. This study sought to determine if there is an association between community-level disaster exposure and individual-level changes in disability and/or the risk of death for older Americans. Using the US Federal Emergency Management Agency's database of disaster declarations, 602 disasters occurred between August 1998 and December 2010 and were characterized by their presence, intensity, duration and type. Repeated measurements of a disability score (based on activities of daily living) and dates of death were observed between January 2000 and November 2010 for 18,102 American individuals aged 50-89 years, who were participating in the national longitudinal Health and Retirement Study. Longitudinal (disability) and time-to-event (death) data were modelled simultaneously using a 'joint modelling' approach. There was no evidence of an association between community-level disaster exposure and individual-level changes in disability or the risk of death. Our results suggest that future research should focus on individual-level disaster exposures, moderate to severe disaster events, or higher-risk groups of individuals.

VL - 173 UR - https://www.sciencedirect.com/science/article/abs/pii/S0277953616306785?via%3Dihub U1 - http://www.ncbi.nlm.nih.gov/pubmed/27960126?dopt=Abstract JO - Social Science & Medicine ER - TY - JOUR T1 - Back to Work? Not Everyone. Examining the Longitudinal Relationships Between Informal Caregiving and Paid Work After Formal Retirement. JF - Journal of Gerontology, Series B Y1 - 2017 A1 - Gonzales, Ernest A1 - Lee, Yeonjung A1 - Brown, Celeste KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Caregivers KW - Employment KW - Family KW - Female KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Retirement KW - return to work AB -

Objectives: Research on unretirement (retirees who re-enter the workforce) is burgeoning. However, no longitudinal study has examined how informal care relates to unretirement. Utilizing role theory, this study aims to explore the heterogeneity of informal care responsibilities in retirement and to examine how informal care informs re-entering the workforce in later life.

Method: Data were drawn from the Health and Retirement Study of fully retired individuals aged 62 years and older in 1998 (n = 8,334) and followed to 2008. Informal care responsibilities included helping a spouse/partner with activities of daily living (ADLs) or instrumental activities of daily living (IADLs); helping parent(s) or parent-in-law(s) with ADLs or IADLs; and single or co-occurrence of care roles. Covariates included economic and social factors. Cox proportional hazard models were utilized.

Results: When compared with noncaregivers, helping a spouse with ADLs or IADLs reduced the odds of returning-to-work in the subsequent wave by 78% and 55%, respectively (hazard ratio [HR]: 0.22, confidence interval [CI]: 0.06-0.87; HR: 0.45, CI: 0.21-0.97). There was no statistical difference to returning-to-work between noncaregivers and helping parents with ADLs/IADLs or multiple caregiving responsibilities.

Discussion: Role theory provided a useful framework to understand the relationships of informal care and unretirement. Aspects of role strain emerged, where, spousal caregivers were less likely to come out of retirement. Spousal caregivers may face challenges to working longer, and subsequently, opportunities to bolster their retirement security are diminished. Research and policy implications are discussed.

VL - 72 IS - 3 ER - TY - JOUR T1 - Body weight status and telomere length in U.S. middle-aged and older adults. JF - Obes Res Clin Pract Y1 - 2017 A1 - An, Ruopeng A1 - Yan, Hai KW - Aged KW - Aging KW - Body Mass Index KW - Body Weight KW - ethnicity KW - Female KW - Humans KW - Linear Models KW - Male KW - Middle Aged KW - Obesity KW - Overweight KW - Racial Groups KW - Risk Factors KW - Sex Factors KW - Telomere KW - Telomere Shortening KW - United States KW - White People AB -

OBJECTIVE: Telomere length has been proposed as a biomarker of biological aging. This study examined the relationship between body weight status and telomere length in U.S. middle-aged and older adults.

METHODS: Nationally representative data (N=2749) came from the Health and Retirement Study. Linear regressions were performed to examine the relationship between baseline body weight status reported in 1992 and telomere length measured in 2008 in the overall sample and by sex and racial/ethnic groups, adjusted for individual characteristics.

RESULTS: Baseline overweight (25kg/m≤body mass index [BMI]<30kg/m) and obesity (BMI≥30kg/m) status positively predicted telomere length 17 years later. Compared with their normal weight counterparts, telomere length ratio was on average 0.062 (95% confidence interval=0.016, 0.109) and 0.125 (0.048, 0.202) larger among overweight and obese adults, respectively. In comparison to women and racial/ethnic minorities, the estimated positive associations between overweight and obesity status and telomere length were more salient among men and non-Hispanic whites, respectively.

CONCLUSIONS: The positive association between body weight status and telomere length found in this study was opposite to what existing biological model predicts, and could partially relate to the nonlinear relationship between body weight status and telomere length across age cohorts, and/or the lack of reliability of BMI as an indicator for adiposity in the older population. Large-scale longitudinal studies with baseline telomere length measures are warranted to replicate this study finding and explore the potential heterogeneous relationship between body weight status and telomere length.

VL - 11 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26895795?dopt=Abstract ER - TY - JOUR T1 - Caregiver stressors and depressive symptoms among older husbands and wives in the United States. JF - J Women Aging Y1 - 2017 A1 - Kim, Min Hee A1 - Ruth E Dunkle A1 - Amanda J Lehning A1 - Shen, Huei-Wern A1 - Sheila Feld A1 - Angela K Perone KW - Activities of Daily Living KW - Aged KW - Caregivers KW - depression KW - Female KW - Humans KW - Independent Living KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Multivariate Analysis KW - Prospective Studies KW - Regression Analysis KW - Sex Factors KW - Spouses KW - Stress, Psychological KW - United States AB -

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

VL - 29 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27673406?dopt=Abstract ER - TY - JOUR T1 - Is Childhood Socioeconomic Status Independently Associated with Adult BMI after Accounting for Adult and Neighborhood Socioeconomic Status? JF - PLoS One Y1 - 2017 A1 - Gregory Pavela KW - Adolescent KW - Adult KW - Aged KW - Aged, 80 and over KW - Alabama KW - Body Mass Index KW - Child KW - Female KW - Health Behavior KW - Humans KW - Male KW - Middle Aged KW - Obesity KW - Residence Characteristics KW - Risk Factors KW - Social Class KW - Socioeconomic factors KW - Young Adult AB -

Childhood socioeconomic status (SES) is inversely associated with adult weight in high income countries. Whether the influence of childhood SES on adult weight is best described using a critical period model or an accumulation of risk model is not yet settled. This research tests whether childhood SES is associated with adult BMI and likelihood of obesity independent of adult socioeconomic status and neighborhood characteristics. Data on individual childhood and adult characteristics come from the Health and Retirement Study (N = 13,545). Data on neighborhood characteristics come from the 2000 Decennial Census and American Community Survey (2005-2009). In the fully adjusted models, perceived financial hardship before the age of sixteen and having a father who was unemployed are associated with higher BMI among males and, among females, paternal education remains associated with adult BMI. However, childhood SES is not associated with likelihood of obesity after fully adjusting for adult SES and neighborhood characteristics, suggesting that the direct effects of early childhood SES on BMI are small relative to the other factors associated with obesity in adulthood.

VL - 12 UR - http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0168481 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/28095430?dopt=Abstract ER - TY - JOUR T1 - A Comparison of the Prevalence of Dementia in the United States in 2000 and 2012. JF - JAMA Intern Med Y1 - 2017 A1 - Kenneth M. Langa A1 - Eric B Larson A1 - Eileen M. Crimmins A1 - Jessica Faul A1 - Deborah A Levine A1 - Mohammed U Kabeto A1 - David R Weir KW - Aged KW - Dementia KW - Female KW - Humans KW - Male KW - Prevalence KW - Risk Factors KW - United States AB -

Importance: The aging of the US population is expected to lead to a large increase in the number of adults with dementia, but some recent studies in the United States and other high-income countries suggest that the age-specific risk of dementia may have declined over the past 25 years. Clarifying current and future population trends in dementia prevalence and risk has important implications for patients, families, and government programs.

Objective: To compare the prevalence of dementia in the United States in 2000 and 2012.

Design, Setting, and Participants: We used data from the Health and Retirement Study (HRS), a nationally representative, population-based longitudinal survey of individuals in the United States 65 years or older from the 2000 (n = 10 546) and 2012 (n = 10 511) waves of the HRS.

Main Outcomes and Measures: Dementia was identified in each year using HRS cognitive measures and validated methods for classifying self-respondents, as well as those represented by a proxy. Logistic regression was used to identify socioeconomic and health variables associated with change in dementia prevalence between 2000 and 2012.

Results: The study cohorts had an average age of 75.0 years (95% CI, 74.8-75.2 years) in 2000 and 74.8 years (95% CI, 74.5-75.1 years) in 2012 (P = .24); 58.4% (95% CI, 57.3%-59.4%) of the 2000 cohort was female compared with 56.3% (95% CI, 55.5%-57.0%) of the 2012 cohort (P < .001). Dementia prevalence among those 65 years or older decreased from 11.6% (95% CI, 10.7%-12.7%) in 2000 to 8.8% (95% CI, 8.2%-9.4%) (8.6% with age- and sex-standardization) in 2012 (P < .001). More years of education was associated with a lower risk for dementia, and average years of education increased significantly (from 11.8 years [95% CI, 11.6-11.9 years] to 12.7 years [95% CI, 12.6-12.9 years]; P < .001) between 2000 and 2012. The decline in dementia prevalence occurred even though there was a significant age- and sex-adjusted increase between years in the cardiovascular risk profile (eg, prevalence of hypertension, diabetes, and obesity) among older US adults.

Conclusions and Relevance: The prevalence of dementia in the United States declined significantly between 2000 and 2012. An increase in educational attainment was associated with some of the decline in dementia prevalence, but the full set of social, behavioral, and medical factors contributing to the decline is still uncertain. Continued monitoring of trends in dementia incidence and prevalence will be important for better gauging the full future societal impact of dementia as the number of older adults increases in the decades ahead.

VL - 177 UR - http://archinte.jamanetwork.com/article.aspx?doi=10.1001/jamainternmed.2016.6807http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2587084 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27893041?dopt=Abstract JO - JAMA Intern Med 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 - Coping With Chronic Stress by Unhealthy Behaviors: A Re-Evaluation Among Older Adults by Race/Ethnicity. JF - Journal of Aging and Health Y1 - 2017 A1 - Rodriquez, Erik J A1 - Gregorich, Steven E A1 - Livaudais-Toman, Jennifer A1 - Eliseo J Perez-Stable KW - Adaptation, Psychological KW - Aged KW - California KW - Chronic disease KW - Continental Population Groups KW - depression KW - Ethnic Groups KW - Female KW - Humans KW - Logistic Models KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Minority Groups KW - Risk-Taking KW - Stress, Psychological KW - Surveys and Questionnaires AB -

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

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

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

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

VL - 29 IS - 5 ER - TY - JOUR T1 - 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 - Death across the lifespan: Age differences in death-related thoughts and anxiety. JF - Death Stud Y1 - 2017 A1 - William J. Chopik KW - Adolescent KW - Adult KW - Aged KW - Aged, 80 and over KW - Aging KW - Anxiety KW - Attitude to Death KW - Cross-Sectional Studies KW - Female KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Thinking KW - Young Adult AB -

Many studies have found age-related declines in death-related anxiety. Why do death-related thoughts and anxiety decline across the lifespan when exposure to, and likelihood of, death increase over time? In Study 1, a cross-sectional survey of 2,363 adults, death-related thoughts declined across the lifespan. In Study 2, a longitudinal study of 9,815 adults followed over a 4-year period, death anxiety declined across the lifespan. Further, greater social support predicted lower levels of death anxiety over time, after controlling for self-rated health and chronic illnesses. Close relationships serve emotion regulation functions to decrease death anxiety and thoughts across the lifespan.

VL - 41 UR - https://www.tandfonline.com/doi/full/10.1080/07481187.2016.1206997 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27573253?dopt=Abstract JO - Death Studies ER - TY - JOUR T1 - Depressive Symptoms and Salivary Telomere Length in a Probability Sample of Middle-Aged and Older Adults. JF - Psychosom Med Y1 - 2017 A1 - Mark A Whisman A1 - Emily D Richardson KW - Aged KW - Anxiety Disorders KW - Body Mass Index KW - Chronic disease KW - depression KW - Female KW - Humans KW - Life Style KW - Male KW - Middle Aged KW - Neuroticism KW - Psychological Trauma KW - Saliva KW - Sex Factors KW - Smoking KW - Telomere Shortening AB -

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

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

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

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

VL - 79 UR - http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00006842-900000000-98910 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/28029664?dopt=Abstract JO - Psychosomatic Medicine ER - TY - JOUR T1 - Development and Validation of a 10-Year Mortality Prediction Model: Meta-Analysis of Individual Participant Data From Five Cohorts of Older Adults in Developed and Developing Countries. JF - J Gerontol A Biol Sci Med Sci Y1 - 2017 A1 - Suemoto, Claudia Kimie A1 - Ueda, Hiroshi A1 - Hiram Beltrán-Sánchez A1 - Lebrão, Maria Lucia A1 - Duarte, Yeda Aparecida A1 - Rebeca Wong A1 - Danaei, Goodarz KW - Aged KW - Aged, 80 and over KW - Developed Countries KW - Developing Countries KW - Female KW - Humans KW - Male KW - Meta-Analysis as Topic KW - Middle Aged KW - Models, Statistical KW - Mortality KW - Prognosis KW - Time Factors AB -

Background: Existing mortality prediction models for older adults have been each developed using a single study from the United States or Western Europe. We aimed to develop and validate a 10-year mortality prediction model for older adults using data from developed and developing countries.

Methods: We used data from five cohorts, including data from 16 developed and developing countries: ELSA (English Longitudinal Study of Aging), HRS (Health and Retirement Study), MHAS (Mexican Health and Aging Study), SABE-Sao Paulo (The Health, Well-being and Aging), and SHARE (Survey on Health, Ageing and Retirement in Europe). 35,367 older adults were split into training (two thirds) and test (one third) data sets. Baseline predictors included age, sex, comorbidities, and functional and cognitive measures. We performed an individual participant data meta-analysis using a sex-stratified Cox proportional hazards model, with time to death as the time scale. We validated the model using Harrell's C statistic (discrimination) and the estimated slope between observed and predicted 10-year mortality risk across deciles of risk (calibration).

Results: During a median of 8.6 years, 8,325 participants died. The final model included age, sex, diabetes, heart disease, lung disease, cancer, smoking, alcohol use, body mass index, physical activity, self-reported health, difficulty with bathing, walking several blocks, and reporting date correctly. The model showed good discrimination (Harrell's C = 0.76) and calibration (slope = 1.005). Models for developed versus developing country cohorts performed equally well when applied to data from developing countries.

Conclusion: A parsimonious mortality prediction model using data from multiple cohorts in developed and developing countries can be used to predict mortality in older adults in both settings.

VL - 72 UR - http://biomedgerontology.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=27522061 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27522061?dopt=Abstract ER - TY - JOUR T1 - Do Regular Cholesterol Screenings Lead to Lower Cholesterol Levels and Better Health Behaviors for All? Spotlight on Middle-Aged and Older Adults in the United States. JF - J Aging Health Y1 - 2017 A1 - Choi, Yool A1 - Lee, Hyo Jung KW - Aged KW - Aged, 80 and over KW - Cholesterol KW - Female KW - Health Behavior KW - Humans KW - Longitudinal Studies KW - Male KW - Mass Screening KW - Middle Aged KW - Preventive Health Services KW - United States AB -

OBJECTIVE: This study investigates how the causal effects of cholesterol screening differ by likelihood of using this preventive care service in terms of accessibility gaps and effects on health-related outcomes across groups with advantaged and disadvantaged backgrounds.

METHOD: We use propensity score matching to analyze a nationally representative sample using data from 2008, 2010, and 2012 waves of the Health and Retirement Study ( N = 3,907).

RESULTS: We find that respondents who are least likely to get their cholesterol tested benefit most from the use of cholesterol screening when they do use it, while its effects are smallest for those who are most likely to use this service.

DISCUSSION: Understanding the heterogeneous effects of preventive health service has important policy implications, particularly in terms of how to maximize the public health benefits of preventive care.

VL - 29 UR - http://europepmc.org/abstract/MED/26921271 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26921271?dopt=Abstract ER - TY - JOUR T1 - Dog Walking, the Human-Animal Bond and Older Adults' Physical Health. JF - Gerontologist Y1 - 2017 A1 - Angela L Curl A1 - Bibbo, Jessica A1 - Rebecca A Johnson KW - Aged KW - Animals KW - Dogs KW - Female KW - Health Status KW - Human-Animal Bond KW - Humans KW - Least-Squares Analysis KW - Linear Models KW - Logistic Models KW - Male KW - Middle Aged KW - Ownership KW - Walking AB -

PURPOSE OF THE STUDY: This study explored the associations between dog ownership and pet bonding with walking behavior and health outcomes in older adults.

DESIGN AND METHODS: We used data from the 12th wave (2012) of the Health and Retirement Study which included an experimental human-animal interaction module. Ordinary least squares regression and binary logistic regression models controlling for demographic variables were used to answer the research questions.

RESULTS: Dog walking was associated with lower body mass index, fewer activities of daily living limitations, fewer doctor visits, and more frequent moderate and vigorous exercise. People with higher degrees of pet bonding were more likely to walk their dog and to spend more time walking their dog each time, but they reported walking a shorter distance with their dog than those with weaker pet bonds. Dog ownership was not associated with better physical health or health behaviors.

IMPLICATIONS: This study provides evidence for the association between dog walking and physical health using a large, nationally representative sample. The relationship with one's dog may be a positive influence on physical activity for older adults.

VL - 57 UR - http://gerontologist.oxfordjournals.org/content/early/2016/03/18/geront.gnw051.abstract IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27002004?dopt=Abstract U4 - Exercise/physical activity/Recreational therapy/activities/Preventative medicine/care/services/Function/mobility/Dog walking ER - TY - JOUR T1 - The Effect of Widowhood on Mental Health - an Analysis of Anticipation Patterns Surrounding the Death of a Spouse. JF - Health Econ Y1 - 2017 A1 - Siflinger, Bettina KW - Adaptation, Psychological KW - Aged KW - Bereavement KW - Cause of Death KW - Female KW - Humans KW - Interviews as Topic KW - Male KW - Mental Health KW - Middle Aged KW - Models, Econometric KW - Qualitative Research KW - Spouses KW - Widowhood AB -

This study explores the effects of widowhood on mental health by taking into account the anticipation and adaptation to the partner's death. The empirical analysis uses representative panel data from the USA that are linked to administrative death records of the National Death Index. I estimate static and dynamic specifications of the panel probit model in which unobserved heterogeneity is modeled with correlated random effects. I find strong anticipation effects of the partner's death on the probability of depression, implying that the partner's death event cannot be assumed to be exogenous in econometric models. In the absence of any anticipation effects, the partner's death has long-lasting mental health consequences, leading to a significantly slower adaptation to widowhood. The results suggest that both anticipation effects and adaptation effects can be attributed to a caregiver burden and to the cause of death. The findings of this study have important implications for designing adequate social policies for the elderly US population that alleviate the negative consequences of bereavement. Copyright © 2016 John Wiley & Sons, Ltd.

VL - 26 UR - http://doi.wiley.com/10.1002/hec.3443http://api.wiley.com/onlinelibrary/tdm/v1/articles/10.1002%2Fhec.3443 IS - 12 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27747997?dopt=Abstract JO - Health Econ. ER - TY - JOUR T1 - Effects of receipt of Social Security retirement benefits on older women's employment. JF - J Women Aging Y1 - 2017 A1 - Gillen, Martie A1 - Claudia J Heath KW - Aged KW - Employment KW - Female KW - Humans KW - Middle Aged KW - Retirement KW - Social Security KW - United States KW - Women's Health KW - Women, Working AB -

Labor force participation of women has declined since 1999; however, labor force participation of women 62+ has increased. The 2000-2006 waves of Health and Retirement Study (HRS) data, the initial years of the continuing upward trajectory, were used to test the effects of receipt of Social Security retirement benefits on older women's employment. The models tested: (a) the effect of receipt of Social Security retirement benefits on whether employed; and (b) for women receiving Social Security retirement benefits, the effect of age elected receipt of benefits on whether employed. Both models included the effects of human capital characteristics and income sources. Receipt of Social Security benefits, pension income, and current age reduced the likelihood of employment; while educational level, good to excellent health, and nonmarried marital status increased the likelihood of employment. The older the woman was when she elected Social Security benefits, the more likely she was to be employed.

VL - 29 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27629359?dopt=Abstract ER - TY - JOUR T1 - Emergency Preparedness of Persons Over 50 Years Old: Further Results From the Health and Retirement Study. JF - Disaster Med Public Health Prep Y1 - 2017 A1 - Timothy S Killian A1 - Zola K Moon A1 - McNeill, Charleen A1 - Garrison, Betsy A1 - Moxley, Shari KW - Aged KW - Aged, 80 and over KW - Attitude to Health KW - Civil Defense KW - Equipment and Supplies KW - Female KW - Help-Seeking Behavior KW - Humans KW - Male KW - Middle Aged KW - Retirement KW - United States KW - Vulnerable Populations AB -

OBJECTIVE: This article conceptualized emergency preparedness as a complex, multidimensional construct and empirically examined an array of sociodemographic, motivation, and barrier variables as predictors of levels of emergency preparedness.

METHODS: The authors used the 2010 wave of the Health and Retirement Study's emergency preparedness module to focus on persons 50 years old and older in the United States by use of logistic regression models and reconsidered a previous analysis.

RESULTS: The models demonstrated 3 key findings: (1) a lack of preparedness is widespread across virtually all sociodemographic variables and regions of the country; (2) an authoritative voice, in the role of health care personnel, was a strong predictor of preparedness; and (3) previous experience in helping others in a disaster predisposes individuals to be better prepared. Analyses also suggest the need for caution in creating simple summative indexes and the need for further research into appropriate measures of preparedness.

CONCLUSION: This population of older persons was generally not well prepared for emergencies, and this lack of preparedness was widespread across social, demographic, and economic groups in the United States. Findings with implications for policy and outreach include the importance of health care providers discussing preparedness and the use of experienced peers for outreach. (Disaster Med Public Health Preparedness. 2017;11:80-89).

VL - 11 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/28065175?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 - Feeling Older and the Development of Cognitive Impairment and Dementia. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2017 A1 - Yannick Stephan A1 - Angelina R Sutin A1 - Martina Luchetti A1 - Antonio Terracciano KW - Aged KW - Aged, 80 and over KW - Aging KW - Alzheimer disease KW - Cognitive Dysfunction KW - depression KW - disease progression KW - Female KW - Health Behavior KW - Humans KW - Life Style KW - Likelihood Functions KW - Logistic Models KW - Longitudinal Studies KW - Male KW - Risk Factors KW - Self Concept AB -

Objective: Subjective age is a biopsychosocial marker of aging associated with a range of outcomes in old age. In the domain of cognition, feeling older than one's chronological age is related to lower cognitive performance and steeper cognitive decline among older adults. The present study examines whether an older subjective age is associated with the risk of incident cognitive impairment and dementia.

Method: Participants were 5,748 individuals aged 65 years and older drawn from the Health and Retirement Study. Measures of subjective age, cognition, and covariates were obtained at baseline, and follow-up cognition was assessed over a 2- to 4-year period. Only participants without cognitive impairment were included at baseline. At follow-up, participants were classified into one of the three categories: normal functioning, cognitive impairment without dementia (CIND), and dementia.

Results: An older subjective age at baseline was associated with higher likelihood of CIND (odds ratio [OR] = 1.18; 1.09-1.28) and dementia (OR = 1.29; 1.02-1.63) at follow-up, controlling for chronological age, other demographic factors, and baseline cognition. Physical inactivity and depressive symptoms partly accounted for these associations.

Conclusion: An older subjective age is a marker of individuals' risk of subsequent cognitive impairment and dementia.

VL - 72 UR - https://www.ncbi.nlm.nih.gov/pubmed/27436103 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27436103?dopt=Abstract ER - TY - JOUR T1 - Financial Care for Older Adults With Dementia. JF - Int J Aging Hum Dev Y1 - 2017 A1 - Pan, Xi A1 - Lee, Yeonjung A1 - Dye, Cheryl A1 - Laurie Theriot Roley KW - Adult children KW - Aged KW - Aged, 80 and over KW - Dementia KW - Female KW - Humans KW - Male KW - Middle Aged KW - United States AB -

This article describes an examination of the sociodemographic characteristics of adult children, particularly Baby Boomer caregivers, who provide financial care to older parents with dementia. The sample including 1,011adult children dementia caregivers aged 50 to 64 years is selected from a nationally representative sample in the 2010 Health and Retirement Study. Exact logistic regression revealed that race, provision of financial assistance to caregiver children, and the number of their children are significantly associated with financial caregiving of parents. Non-White caregivers are more likely to provide financial care to their parents or parents-in-law with dementia; those who have more children and provide financial assistance to their children are less likely to provide financial care to parents with dementia. The current findings present valuable new information on the sociodemographic characteristics of adult children who provide financial assistance to parents with dementia and inform research, programs, and services on dementia caregiving.

VL - 85 UR - http://journals.sagepub.com/doi/abs/10.1177/0091415016685327?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/28024418?dopt=Abstract 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 - From Noise to Signal: The Age and Social Patterning of Intra-Individual Variability in Late-Life Health. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2017 A1 - Lin, Jielu A1 - Jessica Kelley-Moore KW - Activities of Daily Living KW - Aged KW - cognitive aging KW - Cognitive Dysfunction KW - Disability Evaluation KW - Female KW - Health Behavior KW - Health Status Disparities KW - Humans KW - Individuality KW - Male KW - Middle Aged KW - Minority Groups KW - Models, Statistical KW - Multilevel Analysis KW - Reference Values KW - Sex Characteristics KW - Sex Factors KW - Socioeconomic factors AB -

OBJECTIVES: Despite a long tradition of attending to issues of intra-individual variability in the gerontological literature, large-scale panel studies on late-life health disparities have primarily relied on average health trajectories, relegating intra-individual variability over time to random error terms, or "noise." This article reintegrates the systematic study of intra-individual variability back into standard growth curve modeling and investigates the age and social patterning of intra-individual variability in health trajectories.

METHOD: Using panel data from the Health and Retirement Study, we estimate multilevel growth curves of functional limitations and cognitive impairment and examine whether intra-individual variability in these two health outcomes varies by age, gender, race/ethnicity, and socioeconomic status, using level-1 residuals extracted from the adjusted growth curve models.

RESULTS: For both outcomes, intra-individual variability increases with age. Racial/ethnic minorities and individuals with lower socioeconomic status tend to have greater intra-individual variability in health. Relying exclusively on average health trajectories may have masked important "signals" of life course health inequality.

DISCUSSION: The findings contribute to scientific understanding of the source of heterogeneity in late-life health and highlight the need to further investigate specific life course mechanisms that generate the social patterning of intra-individual variability in health status.

VL - 72 UR - http://psychsocgerontology.oxfordjournals.org/content/early/2015/08/26/geronb.gbv081.abstract IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26320123?dopt=Abstract U4 - Health disparities/Intra-individual variability/Multilevel growth curves/Residuals ER - TY - JOUR T1 - Gender Differences in Spousal Care Across the Later Life Course. JF - Res Aging Y1 - 2017 A1 - Glauber, Rebecca KW - Activities of Daily Living KW - Aged KW - Caregivers KW - Cross-Sectional Studies KW - Employment KW - Female KW - Home Care Services KW - Humans KW - Male KW - Marriage KW - Middle Aged KW - Sex Factors KW - Spouses AB -

Spouses often serve as the primary caregivers to their ill or disabled partners. Studies have shown that men receive more care from their wives than vice versa, but few studies have focused on how the gender gap in care varies across the later life course. Drawing on data from the Health and Retirement Study, this study examined the moderating effects of age, gender, and full-time employment on married women's and men's receipt of spousal care. This study found that among community-dwelling married adults, the gender gap in care was larger among those in middle age (50-65) than it was among those in older age. As women and men aged, the gender gap decreased primarily because men left full-time work and increased the amount of time that they spent caring for their wives. As gender differences in full-time employment narrowed, the gender gap in spousal care narrowed.

VL - 39 UR - http://www.ncbi.nlm.nih.gov/pubmed/27193046 IS - 8 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27193046?dopt=Abstract ER - TY - JOUR T1 - Genome-Wide Association Study of Loneliness Demonstrates a Role for Common Variation. JF - Neuropsychopharmacology Y1 - 2017 A1 - Gao, Jianjun A1 - Lea K. Davis A1 - Amy B. Hart A1 - Sanchez-Roige, Sandra A1 - Han, Lide A1 - John T. Cacioppo A1 - Abraham A Palmer KW - Aged KW - depression KW - Extraversion, Psychological KW - Female KW - Genome-Wide Association Study KW - Humans KW - Loneliness KW - Male KW - Mental Disorders KW - Middle Aged KW - Neuroticism KW - Phenotype AB -

Loneliness is a complex biological trait that has been associated with numerous negative health outcomes. The measurement and environmental determinants of loneliness are well understood, but its genetic basis is not. Previous studies have estimated the heritability of loneliness between 37 and 55% using twins and family-based approaches, and have explored the role of specific candidate genes. We used genotypic and phenotypic data from 10 760 individuals aged ⩾50 years that were collected by the Health and Retirement Study (HRS) to perform the first genome-wide association study of loneliness. No associations reached genome-wide significance (p>5 × 10). Furthermore, none of the previously published associations between variants within candidate genes (BDNF, OXTR, RORA, GRM8, CHRNA4, IL-1A, CRHR1, MTHFR, DRD2, APOE) and loneliness were replicated (p>0.05), despite our much larger sample size. We estimated the chip heritability of loneliness and examined coheritability between loneliness and several personality and psychiatric traits. Our estimates of chip heritability (14-27%) support a role for common genetic variation. We identified strong genetic correlations between loneliness, neuroticism, and a scale of 'depressive symptoms.' We also identified weaker evidence for coheritability with extraversion, schizophrenia, bipolar disorder, and major depressive disorder. We conclude that loneliness, as defined in this study, is a modestly heritable trait that has a highly polygenic genetic architecture. The coheritability between loneliness and neuroticism may reflect the role of negative affectivity that is common to both traits. Our results also reflect the value of studies that probe the common genetic basis of salutary social bonds and clinically defined psychiatric disorders.

VL - 42 UR - http://www.nature.com/doifinder/10.1038/npp.2016.197 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27629369?dopt=Abstract JO - Neuropsychopharmacology ER - TY - JOUR T1 - Genome-wide Association Study of Parental Life Span. JF - J Gerontol A Biol Sci Med Sci Y1 - 2017 A1 - Toshiko Tanaka A1 - Ambarish Dutta A1 - Luke C Pilling A1 - Xue, Luting A1 - Kathryn L Lunetta A1 - Joanne M Murabito A1 - Bandinelli, Stefania A1 - Robert B Wallace A1 - David Melzer A1 - Luigi Ferrucci KW - Aged KW - Aged, 80 and over KW - Chromosomes, Human, Pair 18 KW - Female KW - Genome-Wide Association Study KW - Humans KW - Longevity KW - Male KW - Middle Aged KW - Parents KW - Phenotype KW - Polymorphism, Single Nucleotide KW - Trans-Activators AB -

Background: Having longer lived parents has been shown to be an important predictor of health trajectories and life span. As such, parental life span is an important phenotype that may uncover genes that affect longevity.

Methods: A genome-wide association study of parental life span in participants of European and African ancestry from the Health and Retirement Study was conducted.

Results: A genome-wide significant association was observed for rs35715456 (log10BF = 6.3) on chromosome 18 for the dichotomous trait of having at least one long-lived parent versus not having any long-lived parent. This association was not replicated in an independent sample from the InCHIANTI and Framingham Heart Study. The most significant association among single nucleotide polymorphisms in longevity candidate genes (APOE, MINIPP1, FOXO3, EBF1, CAMKIV, and OTOL1) was observed in the EBF1 gene region (rs17056207, p = .0002).

Conclusions: A promising genetic signal for parental life span was identified but was not replicated in independent samples.

VL - 72 UR - http://biomedgerontology.oxfordjournals.org/lookup/doi/10.1093/gerona/glw206https://academic.oup.com/biomedgerontology/article/2422264/Genomewide-Association-Study-of-Parental-Life-Span IS - 10 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27816938?dopt=Abstract JO - GERONA ER - TY - JOUR T1 - Glycated haemoglobin (HbA1c), diabetes and trajectories of change in episodic memory performance. JF - J Epidemiol Community Health Y1 - 2017 A1 - Pappas, Colleen A1 - Andel, Ross A1 - Frank J Infurna A1 - Seetharaman, Shyam KW - Aged KW - cognitive aging KW - Demography KW - Diabetes Mellitus KW - Female KW - Glycated Hemoglobin A KW - Humans KW - Longitudinal Studies KW - Male KW - Memory, Episodic KW - Risk Factors KW - Sex Factors KW - United States AB -

BACKGROUND: As the ageing population grows, it is important to identify strategies to moderate cognitive ageing.

OBJECTIVE: We examined glycated haemoglobin (HbA1c) and diabetes in relation to level and change in episodic memory in older adults with and without diabetes.

METHODS: Data from 4419 older adults with (n=950) and without (n=3469) diabetes participating in a nationally representative longitudinal panel study (the Health and Retirement Study) were examined. Average baseline age was 72.66 years and 58% were women. HbA1c was measured in 2006 and episodic memory was measured using immediate and delayed list recall over 4 biennial waves between 2006 and 2012. Growth curve models were used to assess trajectories of episodic memory change.

RESULTS: In growth curve models adjusted for age, sex, education, race, depressive symptoms and waist circumference, higher HbA1c levels and having diabetes were associated with poorer baseline episodic memory (p=0.036 and <0.001, respectively) and greater episodic memory decline (p=0.006 and 0.004, respectively). The effect of HbA1c on episodic memory decline was smaller than the effect of age. The results were stronger for women than men and were not modified by age or race. When the main analyses were estimated for those with and without diabetes separately, HbA1c was significantly linked to change in episodic memory only among those with diabetes.

CONCLUSIONS: Higher HbA1c and diabetes were both associated with declines in episodic memory, with this relationship further exacerbated by having diabetes and elevated HbA1c. HbA1c appeared more important for episodic memory performance among women than men.

VL - 71 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27440936?dopt=Abstract ER - TY - JOUR T1 - Healthy Aging in the Context of Educational Disadvantage: The Role of "Ordinary Magic". JF - J Aging Health Y1 - 2017 A1 - Sara J McLaughlin KW - Aged KW - Aged, 80 and over KW - Educational Status KW - Female KW - Health Behavior KW - healthy aging KW - Humans KW - Logistic Models KW - Male KW - Middle Aged KW - Social Class KW - United States AB -

OBJECTIVE: The objective of this study is to examine the correlates of healthy aging in the context of educational disadvantage and the extent to which identified correlates are shared with the wider, more educationally advantaged population.

METHOD: Data are from the 2012 Health and Retirement Study. The analytic sample included 17,484 self-respondents ≥50 years of age. Educational disadvantage was defined as having less than a high school diploma. Using logistic regression, healthy aging was regressed on demographic, early-life, and health-related factors by educational status.

RESULTS: Among educationally disadvantaged adults, demographic characteristics (e.g., age), health practices (e.g., physical activity), and the presence of health conditions were independently correlated with healthy aging. With few exceptions, correlates of healthy aging were similar among educationally advantaged and disadvantaged adults.

DISCUSSION: Ordinary factors are associated with healthy aging among adults without a high school diploma, suggesting that healthy aging is possible for larger numbers of adults aging in the context of educational disadvantage.

VL - 29 UR - http://jah.sagepub.com/cgi/doi/10.1177/0898264316659994 IS - 7 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27444894?dopt=Abstract JO - Journal of Aging and Health ER - TY - JOUR T1 - Hierarchy and Speed of Loss in Physical Functioning: A Comparison Across Older U.S. and English Men and Women. JF - J Gerontol A Biol Sci Med Sci Y1 - 2017 A1 - Bendayan, Rebecca A1 - Cooper, Rachel A1 - Elizabeth G Wloch A1 - Scott M Hofer A1 - Andrea M Piccinin A1 - Graciela Muñiz Terrera KW - Activities of Daily Living KW - Aged KW - Aging KW - Cross-Cultural Comparison KW - Disability Evaluation KW - Female KW - Geriatric Assessment KW - Health Status Disparities KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Mobility Limitation KW - Self Report KW - Statistics, Nonparametric KW - United Kingdom KW - United States AB -

Background: We aimed to identify the hierarchy of rates of decline in 16 physical functioning measures in U.S. and English samples, using a systematic and integrative coordinated data analysis approach.

Methods: The U.S. sample consisted of 13,612 Health and Retirement Study participants, and the English sample consisted of 5,301 English Longitudinal Study of Ageing participants. Functional loss was ascertained using self-reported difficulties performing 6 activities of daily living and 10 mobility tasks. The variables were standardized, rates of decline were computed, and mean rates of decline were ranked. Mann-Whitney U tests were performed to compare rates of decline between studies.

Results: In both studies, the rates of decline followed a similar pattern; difficulty with eating was the activity that showed the slowest decline and climbing several flights of stairs and stooping, kneeling, or crouching the fastest declines. There were statistical differences in the speed of decline in all 16 measures between countries. American women had steeper declines in 10 of the measures than English women. Similar differences were found between American and English men.

Conclusions: Reporting difficulties climbing several flights of stairs without resting, and stooping, kneeling, or crouching are the first indicators of functional loss reported in both populations.

VL - 72 IS - 8 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27753610?dopt=Abstract ER - TY - JOUR T1 - Home and community-based service and other senior service use: Prevalence and characteristics in a national sample. JF - Home Health Care Serv Q Y1 - 2017 A1 - Amanda Sonnega A1 - Kristen N Robinson A1 - Helen G Levy KW - Aged KW - Aged, 80 and over KW - Community Health Services KW - Female KW - Home Care Services KW - Humans KW - Logistic Models KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Prevalence KW - Senior Centers KW - United States AB -

We report on the use of home and community-based services (HCBS) and other senior services and factors affecting utilization of both among Americans over age 60 in the Health and Retirement Study (HRS). Those using HCBS were more likely to be older, single, Black, lower income, receiving Medicaid, and in worse health. Past use of less traditional senior services, such as exercise classes and help with tax preparation, were found to be associated with current use of HCBS. These findings suggest use of less traditional senior services may serve as a "gateway" to HCBS that can help keep older adults living in the community.

VL - 36 UR - https://www.tandfonline.com/doi/full/10.1080/01621424.2016.1268552 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27925859?dopt=Abstract JO - Home Health Care Services Quarterly ER - TY - JOUR T1 - Honest Labor Bears a Lovely Face: Will Late-Life Unemployment Impact Health and Satisfaction in Retirement? JF - J Occup Environ Med Y1 - 2017 A1 - Maren W Voss A1 - Wendy Church Birmingham A1 - Lori Wadsworth A1 - Wei Chen A1 - Bounsanga, Jerry A1 - Gu, Yushan A1 - Hung, Man KW - Age Factors KW - Aged KW - Chronic disease KW - depression KW - Female KW - Health Status KW - Health Surveys KW - Humans KW - Male KW - Mental Health KW - Middle Aged KW - Personal Satisfaction KW - Retirement KW - Unemployment KW - United States KW - Work AB -

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

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

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

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

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

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

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

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

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

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

VL - 10 UR - https://linkinghub.elsevier.com/retrieve/pii/S1936-6574(16)30191-1 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/28082002?dopt=Abstract ER - TY - JOUR T1 - Identifying Older Adults with Serious Illness: A Critical Step toward Improving the Value of Health Care. JF - Health Serv Res Y1 - 2017 A1 - Amy Kelley A1 - Kenneth E Covinsky A1 - Rebecca Jean Gorges A1 - McKendrick, Karen A1 - Bollens-Lund, Evan A1 - R Sean Morrison A1 - Christine S Ritchie KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Critical Illness KW - Early Diagnosis KW - Female KW - Health Care Costs KW - Hospitalization KW - Humans KW - Male KW - Medicare KW - Nursing homes KW - Prospective Studies KW - Quality Improvement KW - United States AB -

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

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

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

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

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

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

VL - 52 UR - http://www.ncbi.nlm.nih.gov/pubmed/26990009 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26990009?dopt=Abstract U4 - Medicare; geriatrics; palliative medicine; population health 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 - The Impact of Medicare Part D on Emergency Department Visits. JF - Health Economics Y1 - 2017 A1 - Padmaja Ayyagari A1 - Dan M. Shane A1 - George L Wehby KW - Aged KW - Delivery of Health Care KW - Emergency Service, Hospital KW - Female KW - Humans KW - Insurance Coverage KW - Insurance, Health KW - Male KW - Medicare Part D KW - Middle Aged KW - prescription drugs KW - Surveys and Questionnaires KW - United States AB -

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

VL - 26 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26865471?dopt=Abstract ER - TY - JOUR T1 - Incorporating Persistent Pain in Phenotypic Frailty Measurement and Prediction of Adverse Health Outcomes. JF - J Gerontol A Biol Sci Med Sci Y1 - 2017 A1 - Matthew C. Lohman A1 - Karen L Whiteman A1 - Rebecca L. Greenberg A1 - Martha L. Bruce KW - Aged KW - Chronic pain KW - Female KW - Frail Elderly KW - Geriatric Assessment KW - Humans KW - Male KW - Phenotype KW - Prognosis AB -

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

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

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

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

VL - 72 UR - http://biomedgerontology.oxfordjournals.org/lookup/doi/10.1093/gerona/glw212 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/28087677?dopt=Abstract JO - GERONA ER - TY - JOUR T1 - The Influence of the Transportation Environment on Driving Reduction and Cessation. JF - Gerontologist Y1 - 2017 A1 - Jonathon M Vivoda A1 - Steven G Heeringa A1 - Amy J Schulz A1 - Grengs, Joe A1 - Cathleen M. Connell KW - Aged KW - Aging KW - Automobile Driving KW - environment KW - Family Characteristics KW - Female KW - Geographic Information Systems KW - Health Status KW - Humans KW - Longitudinal Studies KW - Male KW - Marital Status KW - Risk KW - Survival Analysis KW - Transportation KW - United States AB -

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

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

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

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

VL - 57 UR - http://www.ncbi.nlm.nih.gov/pubmed/27342439 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27342439?dopt=Abstract ER - TY - JOUR T1 - Loneliness, depression and cognitive function in older U.S. adults. JF - Int J Geriatr Psychiatry Y1 - 2017 A1 - Nancy J. Donovan A1 - Bei Wu A1 - Dorene M. Rentz A1 - Reisa A. Sperling A1 - Gad A. Marshall A1 - M. Maria Glymour KW - Aged KW - Aged, 80 and over KW - Cognitive Dysfunction KW - Demography KW - Depressive Disorder KW - Female KW - Humans KW - Loneliness KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Risk Factors AB -

OBJECTIVE: To examine reciprocal relations of loneliness and cognitive function in older adults.

METHODS: Data were analyzed from 8382 men and women, age 65 and older, participating in the US Health and Retirement Study from 1998 to 2010. Participants underwent biennial assessments of loneliness and depression (classified as no, low or high depression) determined by the Center for Epidemiologic Studies Depression scale (8-item version), cognition (a derived memory score based on a word list memory task and proxy-rated memory and global cognitive function), health status and social and demographic characteristics from 1998 to 2010. We used repeated measures analysis to examine the reciprocal relations of loneliness and cognitive function in separate models controlling sequentially and cumulatively for socio-demographic factors, social network, health conditions and depression.

RESULTS: Loneliness at baseline predicted accelerated cognitive decline over 12 years independent of baseline socio-demographic factors, social network, health conditions and depression (β = -0.2, p = 0.002). After adjustment for depression interacting with time, both low and high depression categories were related to faster cognitive decline and the estimated effect of loneliness became marginally significant. Reciprocally, poorer cognition at baseline was associated with greater odds of loneliness over time in adjusted analyses (OR 1.3, 95% CI (1.1-1.5) p = 0.005), but not when controlling for baseline depression. Furthermore, cognition did not predict change in loneliness over time.

CONCLUSION: Examining longitudinal data across a broad range of cognitive abilities, loneliness and depressive symptoms appear to be related risk factors for worsening cognition but low cognitive function does not lead to worsening loneliness over time. Copyright © 2016 John Wiley & Sons, Ltd.

VL - 32 UR - http://dx.doi.org/10.1002/gps.4495 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27162047?dopt=Abstract U4 - loneliness/depression/memory/cognitive function/aging/longitudinal ER - TY - JOUR T1 - A Longitudinal Analysis of Site of Death: The Effects of Continuous Enrollment in Medicare Advantage Versus Conventional Medicare. JF - Res Aging Y1 - 2017 A1 - Elizabeth Edmiston Chen A1 - Edward Alan Miller KW - Aged KW - Aged, 80 and over KW - Decision making KW - Fee-for-Service Plans KW - Female KW - health policy KW - Hospices KW - Hospital Mortality KW - Humans KW - Longitudinal Studies KW - Male KW - Medicare Part C KW - Terminal Care KW - United States AB -

This study assessed the odds of dying in hospital associated with enrollment in Medicare Advantage (M-A) versus conventional Medicare Fee-for-Service (M-FFS). Data were derived from the 2008 and 2010 waves of the Health and Retirement Study ( n = 1,030). The sample consisted of elderly Medicare beneficiaries who died in 2008-2010 (34% died in hospital, and 66% died at home, in long-term senior care, a hospice facility, or other setting). Logistic regression estimated the odds of dying in hospital for those continuously enrolled in M-A from 2008 until death compared to those continuously enrolled in M-FFS and those switching between the two plans. Results indicate that decedents continuously enrolled in M-A had 43% lower odds of dying in hospital compared to those continuously enrolled in M-FFS. Financial incentives in M-A contracts may reduce the odds of dying in hospital.

VL - 39 UR - http://www.ncbi.nlm.nih.gov/pubmed/27193048 IS - 8 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27193048?dopt=Abstract ER - TY - JOUR T1 - Mental health and breast cancer screening utilization among older Hispanic women. JF - J Women Aging Y1 - 2017 A1 - Tamara J. Cadet A1 - Berrett-Abebe, Julie A1 - Stewart, Kathleen KW - Affect KW - Aged KW - Anxiety KW - Breast Neoplasms KW - Early Detection of Cancer KW - Female KW - Hispanic Americans KW - Humans KW - Logistic Models KW - Middle Aged KW - Motivation KW - Patient Acceptance of Health Care KW - United States KW - Vulnerable Populations AB -

Considerable racial and ethnic differences exist in the way the burden of cancer is experienced in the United States for older Hispanic women. This study utilized data from the 2008 wave of the Health and Retirement Study to investigate the mental health factors associated with older Hispanic women's participation in breast cancer screening services. Logistic regression models were used. Findings indicated that anxiety and positive affect were associated with a greater likelihood of participating in breast cancer screening. Despite ongoing national conversations, evidence indicates there is agreement that underserved women need to be screened, particularly the older Hispanic population.

VL - 29 UR - https://www.ncbi.nlm.nih.gov/pubmed/27485158 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27485158?dopt=Abstract ER - TY - JOUR T1 - Neighborhood age structure and cognitive function in a nationally-representative sample of older adults in the U.S. JF - Soc Sci Med Y1 - 2017 A1 - Esther M Friedman A1 - Regina A Shih A1 - Mary E Slaughter A1 - Margaret M Weden A1 - Kathleen A. Cagney KW - Aged KW - Aged, 80 and over KW - Aging KW - Cognition KW - Female KW - Health Status KW - Humans KW - Interpersonal Relations KW - Male KW - Residence Characteristics KW - Social Support KW - Socioeconomic factors KW - United States AB -

Recent evidence suggests that living in a neighborhood with a greater percentage of older adults is associated with better individual health, including lower depression, better self-rated health, and a decreased risk of overall mortality. However, much of the work to date suffers from four limitations. First, none of the U.S.-based studies examine the association at the national level. Second, no studies have examined three important hypothesized mechanisms - neighborhood socioeconomic status and neighborhood social and physical characteristics - which are significantly correlated with both neighborhood age structure and health. Third, no U.S. study has longitudinally examined cognitive health trajectories. We build on this literature by examining nine years of nationally-representative data from the Health and Retirement Study (2002-2010) on men and women aged 51 and over linked with Census data to examine the relationship between the percentage of adults 65 and older in a neighborhood and individual cognitive health trajectories. Our results indicate that living in a neighborhood with a greater percentage of older adults is related to better individual cognition at baseline but we did not find any significant association with cognitive decline. We also explored potential mediators including neighborhood socioeconomic status, perceived neighborhood cohesion and perceived neighborhood physical disorder. We did not find evidence that neighborhood socioeconomic status explains this relationship; however, there is suggestive evidence that perceived cohesion and disorder may explain some of the association between age structure and cognition. Although more work is needed to identify the precise mechanisms, this work may suggest a potential contextual target for public health interventions to prevent cognitive impairment.

VL - 174 UR - http://linkinghub.elsevier.com/retrieve/pii/S0277953616306669http://api.elsevier.com/content/article/PII:S0277953616306669?httpAccept=text/plainhttp://api.elsevier.com/content/article/PII:S0277953616306669?httpAccept=text/xml U1 - http://www.ncbi.nlm.nih.gov/pubmed/28033564?dopt=Abstract JO - Social Science & Medicine ER - TY - JOUR T1 - Older Adults With Three Generations of Kin: Prevalence, Correlates, and Transfers. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2017 A1 - Rachel Margolis A1 - Wright, Laura KW - Aged KW - Black or African American KW - Family KW - Family Characteristics KW - Female KW - Hispanic or Latino KW - Humans KW - Intergenerational Relations KW - Male KW - Middle Aged KW - Resource Allocation KW - Social Support KW - Surveys and Questionnaires KW - United States KW - White People AB -

OBJECTIVES: We document the prevalence and sociodemographic correlates of older adults with three generations of living kin and examine the patterns of transfers among this group compared with those with fewer generations of kin available.

METHOD: We use the Health and Retirement Study (1998-2010) to estimate kin availability and intergenerational transfers among respondents in their 50s, 60s, and 70s.

RESULTS: It is far more common for older adults to have aging parents, children, and grandchildren than to have just two generations of kin (parents and children). Forty percent of adults in their 50s, 30% of those in their 60s, and 7.5% of those in their 70s have three generations of kin available. Hispanics and the least educated are more likely to have this generational configuration. The vast majority provides financial or in-kind transfers to at least one generation, and a large minority provides support to both older and younger generations.

DISCUSSION: Although there has been much concern about the strains among those sandwiched between parents and children, it is far more common among older adults to also have grandchildren, and many of these adults are transferring resources both upward and downward to multiple generations.

VL - 72 UR - http://psychsocgerontology.oxfordjournals.org/content/early/2016/01/26/geronb.gbv158.abstract IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26817631?dopt=Abstract U4 - Intergenerational exchange/Intergenerational support/Population aging/Sandwich generation ER - TY - JOUR T1 - Out-of-Pocket Spending and Financial Burden Among Medicare Beneficiaries With Cancer. JF - JAMA Oncol Y1 - 2017 A1 - Amol K Narang A1 - Lauren Hersch Nicholas KW - Aged KW - Cost of Illness KW - Female KW - Financing, Personal KW - Health Expenditures KW - Humans KW - Income KW - Insurance, Health KW - Male KW - Medicare KW - Neoplasms KW - Prospective Studies KW - Social Class KW - United States AB -

Importance: Medicare beneficiaries with cancer are at risk for financial hardship given increasingly expensive cancer care and significant cost sharing by beneficiaries.

Objectives: To measure out-of-pocket (OOP) costs incurred by Medicare beneficiaries with cancer and identify which factors and services contribute to high OOP costs.

Design, Setting, and Participants: We prospectively collected survey data from 18 166 community-dwelling Medicare beneficiaries, including 1409 individuals who were diagnosed with cancer during the study period, who participated in the January 1, 2002, to December 31, 2012, waves of the Health and Retirement Study, a nationally representative panel study of US residents older than 50 years. Data analysis was performed from July 1, 2014, to June 30, 2015.

Main Outcomes and Measures: Out-of-pocket medical spending and financial burden (OOP expenditures divided by total household income).

Results: Among the 1409 participants (median age, 73 years [interquartile range, 69-79 years]; 46.4% female and 53.6% male) diagnosed with cancer during the study period, the type of supplementary insurance was significantly associated with mean annual OOP costs incurred after a cancer diagnosis ($2116 among those insured by Medicaid, $2367 among those insured by the Veterans Health Administration, $5976 among those insured by a Medicare health maintenance organization, $5492 among those with employer-sponsored insurance, $5670 among those with Medigap insurance coverage, and $8115 among those insured by traditional fee-for-service Medicare but without supplemental insurance coverage). A new diagnosis of cancer or common chronic noncancer condition was associated with increased odds of incurring costs in the highest decile of OOP expenditures (cancer: adjusted odds ratio, 1.86; 95% CI, 1.55-2.23; P < .001; chronic noncancer condition: adjusted odds ratio, 1.82; 95% CI, 1.69-1.97; P < .001). Beneficiaries with a new cancer diagnosis and Medicare alone incurred OOP expenditures that were a mean of 23.7% of their household income; 10% of these beneficiaries incurred OOP expenditures that were 63.1% of their household income. Among the 10% of beneficiaries with cancer who incurred the highest OOP costs, hospitalization contributed to 41.6% of total OOP costs.

Conclusions and Relevance: Medicare beneficiaries without supplemental insurance incur significant OOP costs following a diagnosis of cancer. Costs associated with hospitalization may be a primary contributor to these high OOP costs. Medicare reform proposals that restructure the benefit design for hospital-based services and incorporate an OOP maximum may help alleviate financial burden, as can interventions that reduce hospitalization in this population.

VL - 3 UR - http://oncology.jamanetwork.com/article.aspx?doi=10.1001/jamaoncol.2016.4865 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27893028?dopt=Abstract JO - JAMA Oncol ER - TY - JOUR T1 - Perceived weight discrimination mediates the prospective relation between obesity and depressive symptoms in U.S. and U.K. adults. JF - Health Psychol Y1 - 2017 A1 - Robinson, Eric A1 - Angelina R Sutin A1 - Daly, Michael KW - Adult KW - Aged KW - Body Weight KW - depression KW - Female KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Obesity KW - Prejudice KW - Prospective Studies KW - United Kingdom KW - United States KW - Young Adult AB -

OBJECTIVE: Obesity has been shown to increase risk of depression. Persons with obesity experience discrimination because of their body weight. Across 3 studies, we tested for the first time whether experiencing (perceived) weight-based discrimination explains why obesity is prospectively associated with increases in depressive symptoms.

METHOD: Data from 3 studies, including the English Longitudinal Study of Ageing (2008/2009-2012/2013), the Health and Retirement Study (2006/2008-2010/2012), and Midlife in the United States (1995/1996-2004/2005), were used to examine associations between obesity, perceived weight discrimination, and depressive symptoms among 20,286 U.S. and U.K. adults.

RESULTS: Across all 3 studies, Class II and III obesity were reliably associated with increases in depressive symptoms from baseline to follow-up. Perceived weight-based discrimination predicted increases in depressive symptoms over time and mediated the prospective association between obesity and depressive symptoms in all 3 studies. Persons with Class II and III obesity were more likely to report experiencing weight-based discrimination, and this explained approximately 31% of the obesity-related increase in depressive symptoms on average across the 3 studies.

CONCLUSION: In U.S. and U.K. samples, the prospective association between obesity (defined using body mass index) and increases in depressive symptoms in adulthood may in part be explained by perceived weight discrimination. (PsycINFO Database Record

VL - 36 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27748611?dopt=Abstract ER - TY - JOUR T1 - Personality and Lung Function in Older Adults. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2017 A1 - Antonio Terracciano A1 - Yannick Stephan A1 - Martina Luchetti A1 - Gonzalez-Rothi, Ricardo A1 - Angelina R Sutin KW - Aged KW - Aged, 80 and over KW - Anxiety Disorders KW - Character KW - Disease Susceptibility KW - Dyspnea KW - Female KW - Follow-Up Studies KW - Health Behavior KW - Humans KW - Male KW - Medical History Taking KW - Middle Aged KW - Neuroticism KW - Peak Expiratory Flow Rate KW - Pulmonary Disease, Chronic Obstructive KW - Risk Factors AB -

OBJECTIVES: Lung disease is a leading cause of disability and death among older adults. We examine whether personality traits are associated with lung function and shortness of breath (dyspnea) in a national cohort with and without chronic obstructive pulmonary disease (COPD).

METHOD: Participants (N = 12,670) from the Health and Retirement Study were tested for peak expiratory flow (PEF) and completed measures of personality, health behaviors, and a medical history.

RESULTS: High neuroticism and low extraversion, openness, agreeableness, and conscientiousness were associated with lower PEF, and higher likelihood of COPD and dyspnea. Conscientiousness had the strongest and most consistent associations, including lower risk of PEF less than 80% of the predicted value (OR = 0.67; 0.62-0.73) and dyspnea (OR = 0.52; 0.47-0.57). Although attenuated, the associations remained significant when accounting for smoking, physical activity, and chronic diseases including cardiovascular and psychiatric disorders. The associations between personality and PEF or dyspnea were similar among those with or without COPD, suggesting that psychological links to lung function are not disease dependent. In longitudinal analyses, high neuroticism (β = -0.019) and low conscientiousness (β = 0.027) predicted steeper declines in PEF.

DISCUSSION: A vulnerable personality profile is common among individuals with limited lung function and COPD, predicts shortness of breath and worsening lung function.

VL - 72 UR - http://psychsocgerontology.oxfordjournals.org/content/early/2016/01/18/geronb.gbv161.abstract IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26786321?dopt=Abstract U4 - Chronic obstructive pulmonary disease/Conscientiousness/Conscientiousness/Lung function/Peak expiratory flow/Personality/Personality/Shortness of breath ER - TY - JOUR T1 - Positive Self-Perceptions of Aging and Lower Rate of Overnight Hospitalization in the US Population Over Age 50. JF - Psychosom Med Y1 - 2017 A1 - Jennifer K Sun A1 - Eric S Kim A1 - Jacqui Smith KW - Aged KW - Aging KW - Female KW - Follow-Up Studies KW - Hospitalization KW - Humans KW - Male KW - Middle Aged KW - Self Concept KW - United States AB -

OBJECTIVE: The aging of the baby boomer generation has led to an unprecedented rise in the number of US adults reaching old age, prompting an urgent call for innovative and cost-effective ways to address the increasing health care needs of the aging population. Studying the role of psychosocial factors on health care use could offer insight into how to minimize hospitalizations among older adults.

METHODS: We use prospective data from a subsample of 4735 participants (mean [standard deviation] age = 69 [8.79] years, 61% women) from the Health and Retirement Study, a nationally representative study of US adults over age 50, to examine the association between self-perceptions of aging (SPA) and self-reported overnight hospitalizations after adjusting for a comprehensive list of sociodemographic, health-related, and behavioral factors.

RESULTS: Over the 4-year follow-up period, there were a total of 5196 overnight hospitalizations, and 44% of the sample reported being hospitalized overnight at least once. After adjusting for sociodemographic factors, each standard deviation increase in positive SPA was associated with a lower rate of overnight hospitalization (incidence rate ratio = 0.75; 95% confidence interval = 0.71-0.80, p < .001). After dividing respondents into quartiles of SPA, we observed a dose-response relationship with individuals in higher quartiles showing increasingly lower rates of overnight hospitalization.

CONCLUSIONS: Positive self-perceptions of aging are associated with a lower rate of hospitalization among older adults over a 4-year period. Future research should examine the factors that contribute to older adults' SPA and explore the pathways through which attitudes toward aging influence the use of health care resources.

VL - 79 UR - http://www.ncbi.nlm.nih.gov/pubmed/27359184 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27359184?dopt=Abstract ER - TY - JOUR T1 - Psychosocial correlates of cervical cancer screening among older Hispanic women. JF - Soc Work Health Care Y1 - 2017 A1 - Tamara J. Cadet A1 - Stewart, Kathleen A1 - Howard, Tenial KW - Adult KW - Aged KW - Aged, 80 and over KW - Attitude to Health KW - Early Detection of Cancer KW - Female KW - Hispanic Americans KW - Humans KW - Logistic Models KW - Mass Screening KW - Middle Aged KW - Uterine Cervical Neoplasms AB -

Early detection through screening can reduce mortality rates of cervical cancer, and yet Hispanic women who have incidence rates higher than their non-Hispanic White counterparts are least likely to participate in cancer screening initiatives. This study utilized data from the 2008 wave of the Health and Retirement Study to investigate the psychosocial correlates associated with older Hispanic women's participation in cervical cancer screening services. Logistic regression models were used. Findings indicated that greater life satisfaction and religiosity were associated with a greater likelihood of participating in cervical cancer screening. Despite ongoing national conversations, evidence indicates there is agreement that underserved women need to be screened, particularly the older Hispanic population.

VL - 56 UR - https://www.tandfonline.com/doi/full/10.1080/00981389.2016.1263268 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27960632?dopt=Abstract JO - Social Work in Health Care ER - TY - JOUR T1 - Race Differences in Advance Directive Completion. JF - J Aging Health Y1 - 2017 A1 - Catheryn S Koss A1 - Tamara A. Baker KW - Advance directives KW - Aged KW - Aged, 80 and over KW - Black or African American KW - Female KW - Humans KW - Interviews as Topic KW - Logistic Models KW - Male KW - Qualitative Research KW - White People AB -

OBJECTIVE: Rates of advance directive completion have increased over the past decade, but significant race differences remain. This study examined how overall increases in advance directive completion have affected disparities between White and African American older adults.

METHOD: Data were taken from the Health and Retirement Study (HRS). Using logistic regression models, the odds of having an advance directive among a sample of older African Americans and Whites who died between 2001 and 2012 were compared ( N = 5,832).

RESULTS: Odds for African Americans were 16% of the odds for Whites, p < .001, 95% confidence interval (CI) = [0.11, 0.23]. There were no significant interactions between race and year of death before 2010. During 2010-2012, the increase in the odds for African Americans was greater than for Whites, odds ratio (OR) = 1.95, p = .02, 95% CI = [1.14, 3.35].

DISCUSSION: Although race disparities remain, the gap between Whites and African Americans has begun to narrow.

VL - 29 UR - http://jah.sagepub.com/content/early/2016/03/03/0898264316635568.abstract IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26944809?dopt=Abstract U4 - African Americans/end of life/advance directives/advance care planning/health disparities 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 - Receipt of Caregiving and Fall Risk in US Community-dwelling Older Adults. JF - Med Care Y1 - 2017 A1 - Geoffrey J Hoffman A1 - Hays, Ron D A1 - Steven P Wallace A1 - Martin F Shapiro A1 - Yakusheva, Olga A1 - Susan L Ettner KW - Accidental Falls KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Caregivers KW - Female KW - Geriatric Assessment KW - Humans KW - Independent Living KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Risk Assessment KW - Risk Factors KW - United States AB -

BACKGROUND: Falls and fall-related injuries (FRI) are common and costly occurrences among older adults living in the community, with increased risk for those with physical and cognitive limitations. Caregivers provide support for older adults with physical functioning limitations, which are associated with fall risk.

DESIGN: Using the 2004-2012 waves of the Health and Retirement Study, we examined whether receipt of low (0-13 weekly hours) and high levels (≥14 weekly hours) of informal care or any formal care is associated with lower risk of falls and FRIs among community-dwelling older adults. We additionally tested whether serious physical functioning (≥3 activities of daily living) or cognitive limitations moderated this relationship.

RESULTS: Caregiving receipt categories were jointly significant in predicting noninjurious falls (P=0.03) but not FRIs (P=0.30). High levels of informal care category (P=0.001) and formal care (P<0.001) had stronger associations with reduced fall risk relative to low levels of informal care. Among individuals with ≥3 activities of daily living, fall risks were reduced by 21% for those receiving high levels of informal care; additionally, FRIs were reduced by 42% and 58% for those receiving high levels of informal care and any formal care. High levels of informal care receipt were also associated with a 54% FRI risk reduction among the cognitively impaired.

CONCLUSIONS: Fall risk reductions among older adults occurred predominantly among those with significant physical and cognitive limitations. Accordingly, policy efforts involving fall prevention should target populations with increased physical functioning and cognitive limitations. They should also reduce financial barriers to informal and formal caregiving.

VL - 55 UR - http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00005650-900000000-98801 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27875481?dopt=Abstract JO - Medical Care ER - TY - JOUR T1 - The relationship between family support; pain and depression in elderly with arthritis. JF - Psychol Health Med Y1 - 2017 A1 - Hung, Man A1 - Bounsanga, Jerry A1 - Maren W Voss A1 - Anthony B. Crum A1 - Wei Chen A1 - Wendy Church Birmingham KW - Aged KW - Aged, 80 and over KW - Aging KW - Arthralgia KW - Arthritis KW - depression KW - Family KW - Female KW - Humans KW - Male KW - Middle Aged KW - Social Support KW - United States AB -

The prevalence and chronic nature of arthritis make it the most common cause of disability among U.S.A adults. Family support reduces the negative impact of chronic conditions generally but its role in pain and depression for arthritic conditions is not well understood. A total of 844 males (35.0%) and 1567 females (65.0%) with arthritic conditions (n = 2411) were drawn from the 2012 Health and Retirement Study to examine the effect of family support on pain and depressive symptoms. Using regression analysis and controlling for age, ethnicity, gender, marital/educational status and employment/income, physical function/disability status, pain and antidepressant medications, and other clinical indicators of chronic health conditions, we examined the effects of family support (spouse, children, other) on pain and depression levels. Results indicated that depressive symptoms decreased significantly with strong family and spousal support (p < .05). Pain decreased as support levels increased, but was non-statistically significant. This study provides new insights into the relationship between family support, pain, and depression for individuals with arthritis. Future longitudinal studies are needed to evaluate family support and relationships over a wider spectrum of demographics.

VL - 22 UR - https://www.ncbi.nlm.nih.gov/pubmed/27427504 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27427504?dopt=Abstract ER - TY - JOUR T1 - Retrospective Reports of Negative Early Life Events Over a 4-Year Period: A Test of Measurement Invariance and Response Consistency. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2017 A1 - Liat Ayalon KW - Aged KW - Child KW - Child, Preschool KW - Female KW - Humans KW - Life Change Events KW - Male KW - Memory, Episodic KW - Middle Aged KW - Models, Statistical KW - Psychometrics KW - Reproducibility of Results KW - Retrospective Studies KW - Surveys and Questionnaires AB -

OBJECTIVES: The present study examined measurement invariance (i.e., construct validity), response consistency (i.e., test-retest reliability), and potential predictors of response consistency to the Health and Retirement Study (HRS) negative early life events questionnaire over two time points.

METHOD: The study was based on the HRS psychosocial questionnaire, which is a U.S. nationally representative survey of individuals older than 50 years and their spouses of any age. Overall, 4,541 individuals older than 50 years were eligible to complete the questionnaire and responded to all four negative early life events items in 2008 and 2012.

RESULTS: Only partial invariance across the two time points was established (with three of the four loadings and two thresholds remaining constant over time). For 20% of the sample, at least one item was inconsistently reported across waves. A positive response to a negative early life event item in 2008 was the most consistent predictor of response inconsistency over time.

CONCLUSIONS: The measure of negative early life events has limited construct validity and test-retest reliability. Inconsistency is particularly high among those who had first endorsed an item. The use of this retrospective measure for the understanding of age and aging should be considered with caution. Panel surveys might consider probing about early life events repeatedly to better address inconsistencies over time.

VL - 72 UR - http://psychsocgerontology.oxfordjournals.org/content/early/2015/09/23/geronb.gbv087.abstract IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26405079?dopt=Abstract U4 - Confirmatory factor analysis/Epidemiology/Life events/Psychometrics/Recall/Reliability/Retrospective/Validity ER - TY - JOUR T1 - Social Activities, Incident Cardiovascular Disease, and Mortality. JF - J Aging Health Y1 - 2017 A1 - Sae Hwang Han A1 - Jane Tavares A1 - Evans, Molly A1 - Jane S Saczynski A1 - Jeffrey A Burr KW - Aged KW - Aged, 80 and over KW - Cardiovascular Diseases KW - Female KW - Humans KW - Incidence KW - Leisure activities KW - Logistic Models KW - Male KW - Middle Aged KW - Retirement KW - United States AB -

OBJECTIVE: This study examined the relationships between social activities, incident cardiovascular disease (CVD), and non-CVD mortality among older adults in the United States.

METHOD: Data from the Health and Retirement Study (2006-2010) were employed. Two measures of social engagement, volunteering and informal helping, along with two measures of social participation, attendance at religious services and social group meetings, were included. Mediation models for health behaviors were estimated.

RESULTS: Multinomial logistic regression models demonstrated that volunteering provided the most consistent results in terms of a lower risk of incident CVD and mortality. Furthermore, volunteering at higher time commitments is related to lower CVD incidence and death; informally helping others at a modest time commitment is related to lower risk of death only. Health behaviors mediated the relationships. Social participation was not related to either CVD or mortality.

DISCUSSION: Social activity is a modifiable behavior that may be considered a potential health intervention.

VL - 29 UR - http://jah.sagepub.com/content/early/2016/03/03/0898264316635565.abstract IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26944804?dopt=Abstract U4 - volunteering/heart disease/informal help/social groups/smoking/physical activity ER - TY - JOUR T1 - Social Capital and Unretirement: Exploring the Bonding, Bridging, and Linking Aspects of Social Relationships. JF - Res Aging Y1 - 2017 A1 - Guillermo Ernest Gonzales A1 - Nowell, William Benjamin KW - Aged KW - Aged, 80 and over KW - Analysis of Variance KW - Cross-Sectional Studies KW - Employment KW - Female KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Retirement KW - Social capital KW - United States AB -

Working longer is an important area of research given extended life expectancy, shortfalls of retirement income, desires to remain socially engaged, and solvency concerns of social insurance programs. The purpose of this longitudinal population-based study of older adults is to examine how different types of social resources (social bonding, bridging, and linking) relate to returning to work after retirement. Data were drawn from the Health and Retirement Study of fully retired older adults aged 62+ in 1998 ( N = 8,334) and followed to 2008. After controlling for a comprehensive set of fixed and time-varying covariates, findings suggest that social bridging (informal volunteering) and social linking (formal volunteering, partnered with an employed spouse) were strongly and positively related to returning to work (Hazard Ratio [HR]: 1.49, p < .001; HR: 1.58, p < .0001; and HR: 1.75, p < .0001, respectively). Social bonding resources were not significantly associated with returning to work. Implications for social policy are discussed.

VL - 39 UR - http://roa.sagepub.com/cgi/doi/10.1177/0164027516664569 IS - 10 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27555547?dopt=Abstract JO - Research on Aging 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 - Successful Aging as the Intersection of Individual Resources, Age, Environment, and Experiences of Well-being in Daily Activities. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2017 A1 - Shannon T. Mejia A1 - Lindsay H Ryan A1 - Gonzalez, Richard A1 - Jacqui Smith KW - Activities of Daily Living KW - Adult KW - Aged KW - Aged, 80 and over KW - Aging KW - environment KW - Female KW - Follow-Up Studies KW - Health Status KW - Humans KW - Male KW - Middle Aged KW - Personal Satisfaction KW - Social Support KW - United States AB -

Objective: We conceptualize successful aging as a cumulative index of individual resources (the absence of disease and disability, high cognitive and physical functioning, social embeddedness) in the service of successful aging outcomes (global well-being, experienced well-being, and vital status), and conditioned by age, social structure, and environment.

Method: The study used baseline and follow-up data from the 2008-2014 waves of the Health and Retirement Study (N = 17,230; age = 51-101). Linear, multilevel, and logistic models compared individual resources at baseline as independent, cumulative, and binary predictors of outcomes 4 years later.

Results: Individual resources were unequally distributed across age group and social structures (education, wealth, race, gender) and had a cumulative effect on all successful aging outcomes. For experienced well-being, individual resources were most important at midlife and for groups with lower education. Person-environment congruence (social cohesion, city satisfaction) was associated with all successful aging outcomes and conditioned the effect of individual resources on experienced well-being.

Discussion: A cumulative index allows for gradations in resources that can be compensated for by external factors such as person-environment congruence. This index could guide policy and interventions to enhance resources in vulnerable subgroups and diminish inequalities in successful aging outcomes.

VL - 72 UR - http://psychsocgerontology.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=28077430 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/28077430?dopt=Abstract ER - TY - JOUR T1 - Successful Aging in the Context of the Disablement Process: Working and Volunteering as Moderators on the Association Between Chronic Conditions and Subsequent Functional Limitations. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2017 A1 - Ben Lennox Kail A1 - Dawn C Carr KW - Aged KW - Aged, 80 and over KW - Aging KW - Disabled Persons KW - Employment KW - Female KW - Humans KW - Male KW - United States KW - Volunteers AB -

Objectives : This study evaluated the successful aging model by assessing the impact of two forms of productive engagement-working and volunteering-as potential interventions in the process of disablement.

Method : The Health and Retirement Study was used to (a) estimate two-stage selection equations of (i) currently working part time and full time and (ii) currently volunteering less than 100 hours and volunteering 100 hours or more per year (net of chronic health problems) and (b) assess whether, net of selection, working, and volunteering moderate the association between chronic conditions and subsequent functional limitations.

Results : Chronic conditions were associated with elevated levels of subsequent functional limitations, whereas both working and volunteering were associated with lower levels of subsequent functional limitations. Moreover, workers and volunteers of less than 100 hours per year experienced a reduction in the association of chronic conditions on subsequent functional limitations.

Discussion : This research highlights the role of productive engagement as a key element in successful aging. Not only do work and volunteering have direct associations with health outcomes themselves, but they also act as potential interventions in the process of disablement by attenuating the way in which chronic conditions are translated into subsequent functional limitations. This suggests that (a) future research should apply successful aging models to health processes as well as health outcomes and (b) policy makers should support social institutions that foster late-life productive engagement.

VL - 72 UR - http://www.ncbi.nlm.nih.gov/pubmed/27225973 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27225973?dopt=Abstract ER - TY - JOUR T1 - Telomere Length Among Older U.S. Adults: Differences by Race/Ethnicity, Gender, and Age. JF - J Aging Health Y1 - 2017 A1 - Lauren L Brown A1 - Belinda L Needham A1 - Jennifer A Ailshire KW - Aged KW - Aging KW - Biomarkers KW - Female KW - Health Status Disparities KW - Humans KW - Interviews as Topic KW - Male KW - Minority Groups KW - Qualitative Research KW - Telomere KW - United States AB -

OBJECTIVE: We examine race/ethnic, gender, and age differences in telomere length (TL) within a diverse, nationally representative sample of older adults.

METHOD: Data come from 5,228 White, Black, and Hispanic respondents aged 54+ in the 2008 Health and Retirement Study. TL was assayed from saliva using quantitative polymerase chain reaction (qPCR) by comparing telomere sequence copy number with a single gene copy number (T/S ratio). Linear regression was used to examine TL by race/ethnicity, gender, and age adjusting for social, economic, and health characteristics.

RESULTS: Women had longer TL than men (p < .05). Blacks ( p < .05) and Hispanics ( p < .10) had longer TL than Whites. Black women and men had the longest TL relative to other groups ( p < .05), while White men had the shortest TL ( p < .05). Black women and Hispanic men showed greater differences in TL with age.

DISCUSSION: Findings indicate social patterns in TL by race/ethnicity, gender, and age among older adults do not reflect differences observed in most population health outcomes.

VL - 29 UR - https://www.ncbi.nlm.nih.gov/pubmed/27469599 IS - 8 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27469599?dopt=Abstract ER - TY - JOUR T1 - Timing of Advance Directive Completion and Relationship to Care Preferences. JF - J Pain Symptom Manage Y1 - 2017 A1 - Enguidanos, Susan A1 - Jennifer A Ailshire KW - Advance care planning KW - Advance directives KW - Aged KW - Aged, 80 and over KW - Female KW - Humans KW - Male KW - Middle Aged KW - Patient Participation KW - Patient Preference KW - Retrospective Studies AB -

CONTEXT: Given recent Medicare rules reimbursing clinicians for engaging in advance care planning, there is heightened need to understand factors associated with the timing of advance directive (AD) completion before death and how the timing impacts care decisions.

OBJECTIVE: The purpose of this study was to investigate patterns in timing of AD completion and the relationship between timing and documented care preferences. We hypothesize that ADs completed late in the course of illness or very early in the disease trajectory will reflect higher preferences for aggressive care.

METHODS: We conducted a retrospective study using logistic regressions to analyze data from the Health and Retirement Study, a nationally representative longitudinal survey of older adults.

RESULTS: The analytic sample included exit interviews conducted from 2000 to 2012 among 2904 proxy reporters of deceased participants who had an AD. Nearly three-quarters (71%) of ADs were completed a year or more before death. Being younger or a racial/ethnic minority, and having lower education, a diagnosis of cancer or lung disease, and an expected death were associated with completing an AD within the three months before death, while having the lowest quartile of assets and memory problems were inversely associated with AD completion. Minorities, those with lower education, expected death, and timing of AD completion were associated with electing aggressive care.

CONCLUSION: Early documentation of care wishes may not be associated with an increased likelihood of electing aggressive care; however, ADs completed in the last months of life have higher rates of election of aggressive care.

VL - 53 UR - https://linkinghub.elsevier.com/retrieve/pii/S0885-3924(16)30336-0 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27720793?dopt=Abstract ER - TY - JOUR T1 - The Use of Life-Sustaining Procedures in the Last Month of Life Is Associated With More Depressive Symptoms in Surviving Spouses. JF - J Pain Symptom Manage Y1 - 2017 A1 - Katherine A Ornstein A1 - Melissa D. Aldridge A1 - Melissa M Garrido A1 - Rebecca Jean Gorges A1 - Bollens-Lund, Evan A1 - Albert L Siu A1 - Kenneth M. Langa A1 - Amy Kelley KW - Aged KW - Aged, 80 and over KW - Caregivers KW - depression KW - Female KW - Humans KW - Intubation KW - Longitudinal Studies KW - Male KW - Mental Health KW - Respiration, Artificial KW - Spouses KW - Survivors KW - Terminal Care AB -

CONTEXT: Family caregivers of individuals with serious illness who undergo intensive life-sustaining medical procedures at the end of life may be at risk of negative consequences including depression.

OBJECTIVES: The objective of this study was to determine the association between patients' use of life-sustaining procedures at the end of life and depressive symptoms in their surviving spouses.

METHODS: We used data from the Health and Retirement Study, a longitudinal survey of U.S. residents, linked to Medicare claims data. We included married Medicare beneficiaries aged 65 years and older who died between 2000 and 2011 (n = 1258) and their surviving spouses. The use of life-sustaining procedures (i.e., intubation/mechanical ventilation, tracheostomy, gastrostomy tube insertion, enteral/parenteral nutrition, and cardiopulmonary resuscitation) in the last month of life was measured via claims data. Using propensity score matching, we compared change in depressive symptoms of surviving spouses.

RESULTS: Eighteen percent of decedents underwent one or more life-sustaining procedures in the last month of life. Those whose spouses underwent life-sustaining procedures had a 0.32-point increase in depressive symptoms after death (scale range = 0-8) and a greater likelihood of clinically significant depression (odds ratio = 1.51) compared with a matched sample of spouses of those who did not have procedures (P < 0.05).

CONCLUSION: Surviving spouses of those who undergo intensive life-sustaining procedures at the end of life experience a greater magnitude of increase in depressive symptoms than those whose spouses do not undergo such procedures. Further study of the circumstances and decision making surrounding these procedures is needed to understand their relationship with survivors' negative mental health consequences and how best to provide appropriate support.

VL - 53 UR - http://linkinghub.elsevier.com/retrieve/pii/S0885392416307850http://api.elsevier.com/content/article/PII:S0885392416307850?httpAccept=text/plainhttp://api.elsevier.com/content/article/PII:S0885392416307850?httpAccept=text/xml IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27864126?dopt=Abstract JO - Journal of Pain and Symptom Management ER - TY - JOUR T1 - Accelerated increase and decrease in subjective age as a function of changes in loneliness and objective social indicators over a four-year period: results from the health and retirement study. JF - Aging Ment Health Y1 - 2016 A1 - Liat Ayalon A1 - Yuval Palgi A1 - Sharon Avidor A1 - Ehud Bodner KW - Aged KW - Aged, 80 and over KW - Aging KW - depression KW - Female KW - Humans KW - Loneliness KW - Male KW - Retirement KW - Social Change AB -

OBJECTIVES: The study examined the role of changes in loneliness and objective social indicators in the formation of changes in subjective age over a four-year period.

METHODS: The Health and Retirement Study is a US nationally representative study of older adults over 50 and their spouse of any age. We restricted the sample to individuals, 65 years of age and older (n = 2591). An accelerated increase in subjective age was defined as an increase in subjective age over the two waves greater than five years. An accelerated decrease in subjective age was defined as a difference that was lower than three years. These were examined against a change in subjective age in the range of three to five years (i.e., change consistent with the passage of time).

RESULTS: For 23.4% of the sample, changes in subjective age were consistent with the passage of time. A total of 38.3% had an accelerated decrease in subjective age, whereas 38.3% had an accelerated increase. A decrease in loneliness over the two waves resulted in an accelerated decrease in subjective age, whereas an increase in depressive symptoms resulted in an accelerated increase in subjective age. Changes in objective social indicators, physical difficulties or medical comorbidity did not predict changes in subjective age.

CONCLUSIONS: This is one of very few studies that examined changes in subjective age over time. Changes in subjective age represent an important construct that corresponding to other changes in subjective experiences.

PB - 20 VL - 20 UR - http://www.scopus.com/inward/record.url?eid=2-s2.0-84928654923andpartnerID=40andmd5=dc249d3a4a7b131281c68dbbc5ac5bb7 IS - 7 N1 - Export Date: 29 May 2015 Article in Press U1 - http://www.ncbi.nlm.nih.gov/pubmed/25925282?dopt=Abstract U4 - aloneness/epidemiology/loneliness/social relations/subjective ER - TY - JOUR T1 - African Ancestry, Social Factors, and Hypertension Among Non-Hispanic Blacks in the Health and Retirement Study. JF - Biodemography Soc Biol Y1 - 2016 A1 - Jessica R Marden A1 - Stefan Walter A1 - Jay S Kaufman A1 - M. Maria Glymour KW - African Americans KW - Aged KW - Female KW - Health Status Disparities KW - Humans KW - Hypertension KW - Life Style KW - Male KW - Middle Aged KW - Prevalence KW - Risk Factors KW - Socioeconomic factors KW - United States AB -

The biomedical literature contains much speculation about possible genetic explanations for the large and persistent black-white disparities in hypertension, but profound social inequalities are also hypothesized to contribute to this outcome. Our goal is to evaluate whether socioeconomic status (SES) differences provide a plausible mechanism for associations between African ancestry and hypertension in a U.S. cohort of older non-Hispanic blacks. We included only non-Hispanic black participants (N = 998) from the Health and Retirement Study who provided genetic data. We estimated percent African ancestry based on 84,075 independent single nucleotide polymorphisms using ADMIXTURE V1.23, imposing K = 4 ancestral populations, and categorized into quartiles. Hypertension status was self-reported in the year 2000. We used linear probability models (adjusted for age, sex, and southern birth) to predict prevalent hypertension with African ancestry quartile, before and after accounting for a small set of SES measures. Respondents with the highest quartile of African ancestry had 8 percentage points' (RD = 0.081; 95% CI: -0.001, 0.164) higher prevalence of hypertension compared to the lowest quartile. Adjustment for childhood disadvantage, education, income, and wealth explained over one-third (RD = 0.050; 95% CI: -0.034, 0.135) of the disparity. Explanations for the residual disparity remain unspecified and may include other indicators of SES or diet, lifestyle, and psychosocial mechanisms.

PB - 62 VL - 62 UR - http://www.tandfonline.com/doi/full/10.1080/19485565.2015.1108836 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27050031?dopt=Abstract 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 - Allostatic Load and Personality: A 4-Year Longitudinal Study. JF - Psychosom Med Y1 - 2016 A1 - Yannick Stephan A1 - Angelina R Sutin A1 - Martina Luchetti A1 - Antonio Terracciano KW - Aged KW - Aged, 80 and over KW - Aging KW - Allostasis KW - Anxiety Disorders KW - Biomarkers KW - Conscience KW - Extraversion, Psychological KW - Female KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Neuroticism KW - Personality AB -

OBJECTIVE: Dysregulation across multiple physiological systems, referred to as allostatic load, has pervasive consequences for an individual's health. The present study examined whether allostatic load is associated with personality and personality changes during a 4-year follow-up.

METHODS: A total of 5200 participants aged from 50 to 99 years (59.5% women, mean [standard deviation] age = 66.91 [8.88] years) from the Health and Retirement Study provided data on cardiovascular, metabolic, and immune markers at baseline and personality both at baseline and at 4 years later.

RESULTS: Higher allostatic load was related to higher neuroticism (β = 0.03, p = .042), lower extraversion (β = -0.06, p < .001), and lower conscientiousness (β = -0.06, p < .001) at baseline, and to declines in extraversion (β = -0.03, p = .007), conscientiousness (β = -0.04, p < .001), and agreeableness (β = -0.02, p = .020) over the 4-year period, controlling for demographic covariates. A significant quadratic relation between allostatic load and changes in openness (β = -0.03, p = .002) suggested that openness declines when individuals exceed a high level of cumulative physiological dysregulation. No association was found with changes in neuroticism.

CONCLUSIONS: Allostatic load is associated with personality change across adulthood and old age. The findings indicate that physiological dysregulation across multiple systems challenges personality stability and is associated with accelerated personality traits change.

PB - 78 VL - 78 UR - https://www.ncbi.nlm.nih.gov/pubmed/26716813 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26716813?dopt=Abstract ER - TY - JOUR T1 - Antidepressant use and functional limitations in U.S. older adults. JF - J Psychosom Res Y1 - 2016 A1 - An, Ruopeng A1 - Lu, Lingyun KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Antidepressive Agents KW - depression KW - Drug Utilization KW - Female KW - Health Surveys KW - Humans KW - Longitudinal Studies KW - Male KW - Mobility Limitation KW - Muscle, Skeletal KW - Prevalence KW - Risk Factors KW - Socioeconomic factors KW - United States AB -

OBJECTIVE: The upsurge in prevalence and long-term use of antidepressants among older adults might have profound health implications beyond depressive symptom management. This study examined the relationship between antidepressant use and functional limitation onset in U.S. older adults.

METHODS: Study sample came from 2006 and 2008 waves of the Health and Retirement Study, in combination with data from 2005 and 2007 Prescription Drug Study. Self-reported antidepressant use was identified based on the therapeutic classification of Cerner Multum's Lexicon. Functional limitations were classified into those pertaining to physical mobility, large muscle function, activities of daily living, gross motor function, fine motor function, and instrumental activities of daily living. Cox proportional hazard models were performed to assess the effects of antidepressant use on future functional limitation onset by limitation category, antidepressant type, and length of use, adjusted by depression status and other individual characteristics.

RESULTS: Antidepressant use for one year and longer was associated with an increase in the risk of functional limitation by 8% (95% confidence interval=4%-12%), whereas the relationship between antidepressant use less than a year and function limitation was statistically nonsignificant. Antidepressant use was associated with an increase in the risk of functional limitation by 8% (3%-13%) among currently nondepressed participants but not currently depressed participants.

CONCLUSION: Long-term antidepressant use in older adults should be prudently evaluated and regularly monitored to reduce the risk of functional limitation. Future research is warranted to examine the health consequences of extended and/or off-label antidepressant use in absence of depressive symptoms.

PB - 80 VL - 80 UR - http://www.sciencedirect.com/science/article/pii/S0022399915300167 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26721545?dopt=Abstract ER - TY - JOUR T1 - Are self-reported neighbourhood characteristics associated with onset of functional limitations in older adults with or without memory impairment? JF - J Epidemiol Community Health Y1 - 2016 A1 - Thu T Nguyen A1 - Rist, Pamela M A1 - M. Maria Glymour KW - Activities of Daily Living KW - Aged KW - Female KW - Humans KW - Independent Living KW - Interviews as Topic KW - Longitudinal Studies KW - Male KW - Memory Disorders KW - Middle Aged KW - Mobility Limitation KW - Residence Characteristics KW - Risk Factors KW - United States AB -

BACKGROUND: Neighbourhood resources may preserve functional independence in older adults, but little is known about whether benefits differ for individuals with normal and impaired memory. We evaluated the extent to which neighbourhood context was related to onset of instrumental and basic activities of daily living (I/ADL) limitations and whether relationships were modified by memory impairment.

METHODS: Health and Retirement Study participants 50+ years of age without baseline I/ADL limitations (n=8726 for IADL and n=8345 for ADL models) were interviewed biennially for up to 8 years. Self-reported neighbourhood characteristics were scaled from 0 (worst) to 1 (best). Memory, assessed by direct and proxy cognitive assessments, was dichotomised at the 20th centile. We used pooled logistic regression models, adjusted for demographics and individual characteristics.

RESULTS: Low neighbourhood physical disorder (OR=0.51 (95% CI: 0.37 to 0.69)), high social cohesion (OR=0.46 (0.34 to 0.62)), and high safety (OR=0.59 (0.46 to 0.76)) were associated with reduced incidence of IADL limitations. These neighbourhood characteristics were also associated with lower incidence of ADL limitations (disorder OR=0.59 (0.43 to 0.81)); social cohesion OR=0.60 (0.45 to 0.81)); safety OR=0.74 (0.58 to 0.93)). High social ties were not related to ADLs (OR=1.01(0.80 to 1.28)) or IADLs (OR=0.93(0.74 to 1.17)). The benefits of these neighbourhood characteristics for ADLs were similar among those with and without memory impairment but primarily observed among those without memory impairment for IADLs.

CONCLUSIONS: Older adults living in neighbourhoods with low physical disorder, high social cohesion and high safety experience lower incidence of IADL and ADL limitations. Memory status modified the estimated effects of neighbourhood characteristics on IADL but not ADL limitations.

VL - 70 UR - http://jech.bmj.com/content/early/2016/05/06/jech-2016-207241.abstract IS - 10 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27154180?dopt=Abstract ER - TY - JOUR T1 - Are There Spillover Effects from the GI Bill? The Mental Health of Wives of Korean War Veterans. JF - PLoS One Y1 - 2016 A1 - Anusha M Vable A1 - Ichiro Kawachi A1 - Canning, David A1 - M. Maria Glymour A1 - Marcia P Jimenez A1 - S. V. Subramanian KW - Adult KW - Aged KW - depression KW - Female KW - Humans KW - Korean War KW - Male KW - Mental Disorders KW - Mental Health KW - Middle Aged KW - Odds Ratio KW - Population Surveillance KW - Social Class KW - Spouses KW - Veterans KW - Veterans Health AB -

BACKGROUND: The Korean War GI Bill provided economic benefits for veterans, thereby potentially improving their health outcomes. However potential spillover effects on veteran wives have not been evaluated.

METHODS: Data from wives of veterans eligible for the Korean War GI Bill (N = 128) and wives of non-veterans (N = 224) from the Health and Retirement Study were matched on race and coarsened birth year and childhood health using coarsened exact matching. Number of depressive symptoms in 2010 (average age = 78) were assessed using a modified, validated Center for Epidemiologic Studies-Depression Scale. Regression analyses were stratified into low (mother < 8 years schooling / missing data, N = 95) or high (mother ≥ 8 years schooling, N = 257) childhood socio-economic status (cSES) groups, and were adjusted for birth year and childhood health, as well as respondent's educational attainment in a subset of analyses.

RESULTS: Husband's Korean War GI Bill eligibility did not predict depressive symptoms among veteran wives in pooled analysis or cSES stratified analyses; analyses in the low cSES subgroup were underpowered (N = 95, β = -0.50, 95% Confidence Interval: (-1.35, 0.35), p = 0.248, power = 0.28).

CONCLUSIONS: We found no evidence of a relationship between husband's Korean War GI Bill eligibility and wives' mental health in these data, however there may be a true effect that our analysis was underpowered to detect.

VL - 11 UR - https://www.ncbi.nlm.nih.gov/pubmed/27186983 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27186983?dopt=Abstract 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 - Association of Alcohol Use and Loneliness Frequency Among Middle-Aged and Older Adult Drinkers. JF - J Aging Health Y1 - 2016 A1 - Sarah L. Canham A1 - Pia M Mauro A1 - Christopher N Kaufmann A1 - Sixsmith, Andrew KW - Aged KW - Aged, 80 and over KW - Alcohol Drinking KW - Binge drinking KW - Cross-Sectional Studies KW - Female KW - Humans KW - Loneliness KW - Male KW - Middle Aged KW - Risk-Taking AB -

OBJECTIVES: We examined the association between alcohol use, at-risk drinking, and binge drinking, and loneliness in a sample of middle-aged and older adults.

METHOD: We studied participants aged 50+ years from the 2008 wave of the Health and Retirement Study who reported alcohol use. We ran separate multinomial logistic regressions to assess the association of three alcohol use outcomes (i.e., weekly alcohol consumption, at-risk drinking, and binge drinking) and loneliness.

RESULTS: After adjusting for covariates, being lonely was associated with reduced odds of weekly alcohol consumption 4 to 7 days per week, but not 1 to 3 days per week, compared with average alcohol consumption 0 days per week in the last 3 months. No association was found between at-risk drinking or binge drinking and loneliness.

DISCUSSION: Results suggest that among a sample of community-based adults aged 50+, loneliness was associated with reduced alcohol use frequency, but not with at-risk or binge drinking.

PB - 28 VL - 28 UR - http://jah.sagepub.com/content/early/2015/06/09/0898264315589579.abstract IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26082130?dopt=Abstract U2 - PMC4681688 ER - TY - JOUR T1 - Association of retirement age with mortality: a population-based longitudinal study among older adults in the USA. JF - J Epidemiol Community Health Y1 - 2016 A1 - Wu, Chenkai A1 - Michelle C Odden A1 - Gwenith G Fisher A1 - Stawski, Robert S KW - Adult KW - Aged KW - Female KW - Health Status KW - Humans KW - Life Expectancy KW - Life Style KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Mortality, Premature KW - Retirement KW - Risk Factors KW - United States AB -

BACKGROUND: Retirement is an important transitional process in later life. Despite a large body of research examining the impacts of health on retirement, questions still remain regarding the association of retirement age with survival. We aimed to examine the association between retirement age and mortality among healthy and unhealthy retirees and to investigate whether sociodemographic factors modified this association.

METHODS: On the basis of the Health and Retirement Study, 2956 participants who were working at baseline (1992) and completely retired during the follow-up period from 1992 to 2010 were included. Healthy retirees (n=1934) were defined as individuals who self-reported health was not an important reason to retire. The association of retirement age with all-cause mortality was analysed using the Cox model. Sociodemographic effect modifiers of the relation were examined.

RESULTS: Over the study period, 234 healthy and 262 unhealthy retirees died. Among healthy retirees, a 1-year older age at retirement was associated with an 11% lower risk of all-cause mortality (95% CI 8% to 15%), independent of a wide range of sociodemographic, lifestyle and health confounders. Similarly, unhealthy retirees (n=1022) had a lower all-cause mortality risk when retiring later (HR 0.91, 95% CI 0.88 to 0.94). None of the sociodemographic factors were found to modify the association of retirement age with all-cause mortality.

CONCLUSIONS: Early retirement may be a risk factor for mortality and prolonged working life may provide survival benefits among US adults.

VL - 70 UR - http://jech.bmj.com/content/early/2016/03/21/jech-2015-207097.abstract IS - 9 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27001669?dopt=Abstract ER - TY - JOUR T1 - Associations between health literacy and preventive health behaviors among older adults: findings from the health and retirement study. JF - BMC Public Health Y1 - 2016 A1 - Dena M. Fernandez A1 - Janet L. Larson A1 - Brian J Zikmund-Fisher KW - Aged KW - Aged, 80 and over KW - Female KW - Health Behavior KW - Health Knowledge, Attitudes, Practice KW - Health Literacy KW - Health Promotion KW - Humans KW - Logistic Models KW - Male KW - Middle Aged KW - Odds Ratio KW - Preventive Health Services KW - Regression Analysis KW - Retirement KW - United States AB -

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

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

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

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

VL - 16 UR - https://www.ncbi.nlm.nih.gov/pubmed/27430477 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27430477?dopt=Abstract ER - TY - JOUR T1 - Associations of childhood adversity and adulthood trauma with C-reactive protein: A cross-sectional population-based study. JF - Brain Behav Immun Y1 - 2016 A1 - Joy E. Lin A1 - Thomas C Neylan A1 - Elissa S Epel A1 - O Donovan, Aoife KW - Aged KW - Biomarkers KW - C-reactive protein KW - Cross-Sectional Studies KW - Female KW - Humans KW - Inflammation KW - Longitudinal Studies KW - Male KW - Mental Disorders KW - Middle Aged KW - Prevalence KW - Risk Factors KW - Socioeconomic factors KW - Stress, Psychological KW - Trauma and Stressor Related Disorders KW - United States AB -

Mounting evidence highlights specific forms of psychological stress as risk factors for ill health. Particularly strong evidence indicates that childhood adversity and adulthood trauma exposure increase risk for physical and psychiatric disorders, and there is emerging evidence that inflammation may play a key role in these relationships. In a population-based sample from the Health and Retirement Study (n=11,198, mean age 69 ± 10), we examine whether childhood adversity, adulthood trauma, and the interaction between them are associated with elevated levels of the systemic inflammatory marker high sensitivity C-reactive protein (hsCRP). All models were adjusted for age, gender, race, education, and year of data collection, as well as other possible confounds in follow-up sensitivity analyses. In our sample, 67% of individuals had experienced at least one traumatic event during adulthood, and those with childhood adversity were almost three times as likely to have experienced trauma as an adult. Childhood adversities and adulthood traumas were independently associated with elevated levels of hsCRP (β=0.03, p=0.01 and β=0.05, p<0.001, respectively). Those who had experienced both types of stress had higher levels of hsCRP than those with adulthood trauma alone, Estimate=-0.06, 95% CI [-0.003, -0.12], p=0.04, but not compared to those with childhood adversity alone, Estimate=-0.06, 95% CI [0.03, -0.16], p=0.19. There was no interaction between childhood and adulthood trauma exposure. To our knowledge, this is the first study to examine adulthood trauma exposure and inflammation in a large population-based sample, and the first to explore the interaction of childhood adversity and adulthood trauma with inflammation. Our study demonstrates the prevalence of trauma-related inflammation in the general population and suggests that childhood adversity and adulthood trauma are independently associated with elevated inflammation.

PB - 53 VL - 53 UR - http://www.sciencedirect.com/science/article/pii/S088915911530060X U1 - http://www.ncbi.nlm.nih.gov/pubmed/26616398?dopt=Abstract ER - TY - JOUR T1 - The Benefits of Social Technology Use Among Older Adults Are Mediated by Reduced Loneliness. JF - Cyberpsychol Behav Soc Netw Y1 - 2016 A1 - William J. Chopik KW - Aged KW - Aged, 80 and over KW - Attitude to Computers KW - depression KW - Female KW - Health Status KW - Humans KW - Interpersonal Relations KW - Loneliness KW - Male KW - Middle Aged KW - Personal Satisfaction KW - Social Networking KW - Telecommunications AB -

Technology has the ability to enhance and enrich the lives of older adults by facilitating better interpersonal relationships. However, few studies have directly examined associations between technology use for social reasons and physical and psychological health among older adults. The current study examines the benefits of technology use in 591 older adults from the 2012 wave of the Health and Retirement Study (Mage = 68.18, SD = 10.75; 55.5% female). Social technology use was assessed through five technology-based behaviors (i.e., using e-mail, social networking sites, online video/phone calls, online chatting/instant messaging, using a smartphone). Attitudes toward the usability and benefits of technology use were also assessed. Older adults had generally positive attitudes toward technology. Higher social technology use was associated with better self-rated health, fewer chronic illnesses, higher subjective well-being, and fewer depressive symptoms. Furthermore, each of the links between social technology use and physical and psychological health was mediated by reduced loneliness. Close relationships are a large determinant of physical health and well-being, and technology has the potential to cultivate successful relationships among older adults.

VL - 19 UR - http://online.liebertpub.com/doi/10.1089/cyber.2016.0151 IS - 9 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27541746?dopt=Abstract JO - Cyberpsychology, Behavior, and Social Networking ER - TY - JOUR T1 - Better Off Alone Than With a Smoker: The Influence of Partner's Smoking Behavior in Later Life. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2016 A1 - Rachel Margolis A1 - Wright, Laura KW - Aged KW - Female KW - Health Behavior KW - Humans KW - Logistic Models KW - Male KW - Marital Status KW - Middle Aged KW - Motivation KW - Single Person KW - Smoking KW - Smoking cessation KW - Spouses AB -

OBJECTIVES: We examine how the likelihood of smoking cessation among smokers and patterns of adherence to smoking cessation differ by partnership status, partnership changes, and partners' smoking behavior. The data are a nationally representative sample of smokers in middle and older age from the Health and Retirement Study (1992-2010).

METHOD: We use multivariate logistic regression models to analyze the likelihood of smoking cessation among smokers and then estimate adherence to smoking cessation using discrete-time event history models.

RESULTS: Those partnered with smokers and those whose partners relapse into smoking are much less likely than the unpartnered to quit smoking and adhere to smoking cessation. Respondents partnered with non-smokers and those whose partners quit smoking are more likely to quit smoking than the unpartnered. Those recently widowed, divorced, and repartnered have similar smoking changes to the consistently unpartnered.

DISCUSSION: Being partnered does not always mean healthier behavior changes. Rather, the association between partnership status and smoking changes depends greatly on the health behavior changes of the partner. The partnership context at the time of smoking cessation sets the stage for longer term patterns of adherence, shaping health in older age.

VL - 71 UR - http://psychsocgerontology.oxfordjournals.org/content/early/2015/02/17/geronb.gbu220.abstract IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25693998?dopt=Abstract ER - TY - JOUR T1 - Can social policy influence socioeconomic disparities? Korean War GI Bill eligibility and markers of depression. JF - Ann Epidemiol Y1 - 2016 A1 - Anusha M Vable A1 - Canning, David A1 - M. Maria Glymour A1 - Ichiro Kawachi A1 - Marcia P Jimenez A1 - S. V. Subramanian KW - Aged KW - Aged, 80 and over KW - depression KW - Health Status Disparities KW - Humans KW - Korean War KW - Male KW - Public Policy KW - Residence Characteristics KW - Risk Factors KW - Socioeconomic factors KW - Veterans AB -

PURPOSE: The Korean War GI Bill provided socioeconomic benefits to veterans; however, its association with health is unclear; we hypothesize GI Bill eligibility is associated with fewer depressive symptoms and smaller disparities.

METHODS: Data from 246 Korean War GI Bill eligible veterans and 240 nonveterans from the Health and Retirement Study were matched on birth year, southern birth, race, height, and childhood health using coarsened exact matching. Number of depressive symptoms in 2010 (average age = 78 years) was assessed using a modified, validated Center for Epidemiologic Studies-Depression Scale, dichotomized to reflect elevated depressive symptoms. Regression analyses were stratified into low (at least one parent < 8 years schooling/missing data, n = 167) or high (both parents ≥ 8 years schooling, n = 319) childhood socioeconomic status (cSES) groups.

RESULTS: Korean War GI Bill eligibility predicted fewer depressive symptoms among individuals from low cSES backgrounds [β = -0.64, 95% confidence interval (CI) = (-1.18, -0.09), P = .022]. Socioeconomic disparities were smaller among veterans than nonveterans for number of depressive symptoms [β = -0.76, 95% CI = (-1.33, -0.18), P = .010] and elevated depressive symptoms [β = -11.7, 95% CI = (-8.2, -22.6), P = .035].

CONCLUSIONS: Korean War GI Bill eligibility predicted smaller socioeconomic disparities in depression markers.

PB - 26 VL - 26 UR - http://www.sciencedirect.com/science/article/pii/S1047279715300107 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26778285?dopt=Abstract ER - TY - JOUR T1 - Changes in Depressive Symptoms among Older Adults with Multiple Chronic Conditions: Role of Positive and Negative Social Support. JF - Int J Environ Res Public Health Y1 - 2016 A1 - Ahn, SangNam A1 - Kim, Seonghoon A1 - Zhang, Hongmei KW - Aged KW - Aged, 80 and over KW - Aging KW - depression KW - Family KW - Female KW - Friends KW - Humans KW - Male KW - Multiple Chronic Conditions KW - Social Support KW - United States AB -

Depression severely affects older adults in the United States. As part of the social environment, significant social support was suggested to ameliorate depression among older adults. We investigate how varying forms of social support moderate depressive symptomatology among older adults with multiple chronic conditions (MCC). Data were analyzed using a sample of 11,400 adults, aged 65 years or older, from the 2006-2012 Health and Retirement Study. The current study investigated the moderating effects of positive or negative social support from spouse, children, other family, and friends on the association between MCC and depression. A linear mixed model with repeated measures was used to estimate the effect of MCC on depression and its interactions with positive and negative social support in explaining depression among older adults. Varying forms of social support played different moderating roles in depressive symptomatology among older adults with MCC. Positive spousal support significantly weakened the deleterious effect of MCC on depression. Conversely, all negative social support from spouse, children, other family, and friends significantly strengthened the deleterious effect of MCC on depression. Minimizing negative social support and maximizing positive spousal support can reduce depression caused by MCC and lead to successful aging among older adults.

VL - 14 UR - http://www.mdpi.com/1660-4601/14/1/16 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/28035968?dopt=Abstract JO - IJERPH 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 - A chapter a day: Association of book reading with longevity. JF - Soc Sci Med Y1 - 2016 A1 - Bavishi, Avni A1 - Martin D Slade A1 - Becca R Levy KW - Aged KW - Aged, 80 and over KW - Books KW - Chi-Square Distribution KW - Cohort Studies KW - Female KW - Humans KW - Longevity KW - Male KW - Michigan KW - Middle Aged KW - Reading KW - Survival Analysis AB -

Although books can expose people to new people and places, whether books also have health benefits beyond other types of reading materials is not known. This study examined whether those who read books have a survival advantage over those who do not read books and over those who read other types of materials, and if so, whether cognition mediates this book reading effect. The cohort consisted of 3635 participants in the nationally representative Health and Retirement Study who provided information about their reading patterns at baseline. Cox proportional hazards models were based on survival information up to 12 years after baseline. A dose-response survival advantage was found for book reading by tertile (HRT2 = 0.83, p < 0.001, HRT3 = 0.77, p < 0.001), after adjusting for relevant covariates including age, sex, race, education, comorbidities, self-rated health, wealth, marital status, and depression. Book reading contributed to a survival advantage that was significantly greater than that observed for reading newspapers or magazines (tT2 = 90.6, p < 0.001; tT3 = 67.9, p < 0.001). Compared to non-book readers, book readers had a 23-month survival advantage at the point of 80% survival in the unadjusted model. A survival advantage persisted after adjustment for all covariates (HR = .80, p < .01), indicating book readers experienced a 20% reduction in risk of mortality over the 12 years of follow up compared to non-book readers. Cognition mediated the book reading-survival advantage (p = 0.04). These findings suggest that the benefits of reading books include a longer life in which to read them.

VL - 164 UR - http://www.sciencedirect.com/science/article/pii/S0277953616303689 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27471129?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 - Claims-based Identification Methods and the Cost of Fall-related Injuries Among US Older Adults. JF - Med Care Y1 - 2016 A1 - Geoffrey J Hoffman A1 - Hays, Ron D A1 - Martin F Shapiro A1 - Steven P Wallace A1 - Susan L Ettner KW - Accidental Falls KW - Aged KW - Aged, 80 and over KW - Cross-Over Studies KW - Female KW - Humans KW - Insurance Claim Review KW - Male KW - Medicare KW - United States KW - Wounds and Injuries AB -

OBJECTIVES: Compare expenditures of fall-related injuries (FRIs) using several methods to identify FRIs in administrative claims data.

RESEARCH DESIGN: Using 2007-2009 Medicare claims and 2008 Health and Retirement Survey data, FRIs were identified using external-cause-of-injury (e-codes 880/881/882/884/885/888) only, e-codes plus a broad set of primary diagnosis codes, and a newer approach using e-codes and diagnostic and procedural codes. Linear regression models adjusted for sociodemographic, health, and geographic characteristics were used to estimate per-FRI, service component, patient cost share, expenditures by type of initial FRI treatment (inpatient, emergency department only, outpatient), and total annual FRI-related Medicare expenditures.

SUBJECTS: The analysis included 5497 community-dwelling adults ≥65 (228 FRI, 5269 non-FRI individuals) with continuous Medicare coverage and alive during the 24-month study.

RESULTS: The 3 FRI identification methods produced differing distributions of index FRI type and varying estimated expenditures: $12,171 [95% confidence interval (CI), $4662-$19,680], $5648 (95% CI, $3819-$7476), and $9388 (95% CI, $5969-$12,808). In all models, most spending occurred in hospital, outpatient, and skilled nursing facility (SNF) settings, but greater proportions of SNF and outpatient spending were observed with commonly used FRI identification methods. Patient cost-sharing was estimated at $691-$1900 across the 3 methods. Inpatient-treated index FRIs were more expensive than emergency department and outpatient-treated FRIs across all methods, but were substantially higher when identifying FRI using only e-codes. Estimated total FRI-related Medicare expenditures were highly variable across methods.

CONCLUSIONS: FRIs are costly, with implications for Medicare and its beneficiaries. However, expenditure estimates vary considerably based on the method used to identify FRIs.

VL - 54 UR - http://www.ncbi.nlm.nih.gov/pubmed/27057747 IS - 7 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27057747?dopt=Abstract ER - TY - JOUR T1 - Cohort Effects in the Genetic Influence on Smoking. JF - Behav Genet Y1 - 2016 A1 - Benjamin W Domingue A1 - Dalton C Conley A1 - Jason M. Fletcher A1 - Jason D Boardman KW - Aged KW - Cohort Effect KW - Female KW - Gene Frequency KW - Genetic Predisposition to Disease KW - Genotype KW - Humans KW - Male KW - Middle Aged KW - Multifactorial Inheritance KW - Smoking KW - Twins AB -

We examine the hypothesis that the heritability of smoking has varied over the course of recent history as a function of associated changes in the composition of the smoking and non-smoking populations. Classical twin-based heritability analysis has suggested that genetic basis of smoking has increased as the information about the harms of tobacco has become more prevalent-particularly after the issuance of the 1964 Surgeon General's Report. In the present paper we deploy alternative methods to test this claim. We use data from the Health and Retirement Study to estimate cohort differences in the genetic influence on smoking using both genomic-relatedness-matrix restricted maximum likelihood and a modified DeFries-Fulker approach. We perform a similar exercise deploying a polygenic score for smoking using results generated by the Tobacco and Genetics consortium. The results support earlier claims that the genetic influence in smoking behavior has increased over time. Emphasizing historical periods and birth cohorts as environmental factors has benefits over existing GxE research. Our results provide additional support for the idea that anti-smoking policies of the 1980s may not be as effective because of the increasingly important role of genotype as a determinant of smoking status.

PB - 46 VL - 46 UR - http://www.scopus.com/inward/record.url?eid=2-s2.0-84938496073andpartnerID=40andmd5=76a4f2cefad88fc22ebca2e435b4323e IS - 1 N1 - Export Date: 9 September 2015 Article in Press U1 - http://www.ncbi.nlm.nih.gov/pubmed/26223473?dopt=Abstract U2 - PMC4720550 ER - TY - JOUR T1 - Combat exposure, social relationships, and subjective well-being among middle-aged and older Veterans. JF - Aging Ment Health Y1 - 2016 A1 - Mai See Yang A1 - Jeffrey A Burr KW - Aged KW - Combat Disorders KW - depression KW - Health Status KW - Humans KW - Interpersonal Relations KW - Male KW - Middle Aged KW - Personal Satisfaction KW - United States KW - Veterans AB -

OBJECTIVES: This study described the association of subjective well-being with combat exposure and social relationships among middle-aged and older Veteran men in the USA. The stress-buffering hypothesis, which predicts social relationships may moderate the association between combat exposure and subjective well-being, was also examined.

METHOD: Data from the 2008 Health and Retirement Study (N = 2961) were used to estimate logistic regression models, focusing on three measures of subjective well-being: depression, life satisfaction, and self-reported health.

RESULTS: In the fully adjusted models, there were no statistically significant relationships between combat exposure and the three indicators of subjective well-being. However, compared to Veterans who had lower scores on the social relationship index, Veterans who had higher scores were less likely to be depressed and less likely to report poor or fair health. Veterans who had higher scores on the social relationships index reported higher levels of life satisfaction than those Veterans who had lower scores. There was no evidence for a social relationships buffering effect.

CONCLUSION: The results of this study demonstrated that combat exposure did not have a long-term relationship with subjective well-being. Longitudinal research designs with more comprehensive indicators of combat exposure may help researchers better understand some of the underlying complexity of this relationship. Complementary research with samples of women Veterans, as well as samples of Hispanic, and non-Black, non-White Veterans, is also needed.

PB - 20 VL - 20 UR - http://www.scopus.com/inward/record.url?eid=2-s2.0-84928663859andpartnerID=40andmd5=1e37c22429f6fa6e7b41027ddedf9237 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25928024?dopt=Abstract ER - TY - JOUR T1 - Combinations of Chronic Conditions, Functional Limitations, and Geriatric Syndromes that Predict Health Outcomes. JF - J Gen Intern Med Y1 - 2016 A1 - Siran M Koroukian A1 - Nicholas K Schiltz A1 - David F Warner A1 - Jiayang Sun A1 - Paul M Bakaki A1 - Kathleen A Smyth A1 - Kurt C Stange A1 - Charles W Given KW - Activities of Daily Living KW - Age Distribution KW - Aged KW - Aged, 80 and over KW - Chronic disease KW - Comorbidity KW - Female KW - Geriatric Assessment KW - Health Status KW - Health Status Indicators KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Mobility Limitation KW - Prognosis KW - Risk Factors KW - Self Report KW - Sex Distribution KW - Socioeconomic factors KW - Syndrome KW - United States AB -

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

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

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

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

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

VL - 31 UR - http://dx.doi.org/10.1007/s11606-016-3590-9 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26902246?dopt=Abstract ER - TY - JOUR T1 - Comparing Alternative Effect Decomposition Methods: The Role of Literacy in Mediating Educational Effects on Mortality. JF - Epidemiology Y1 - 2016 A1 - Thu T Nguyen A1 - Eric J. Tchetgen Tchetgen A1 - Ichiro Kawachi A1 - Stephen E. Gilman A1 - Stefan Walter A1 - M. Maria Glymour KW - Aged KW - Aged, 80 and over KW - Educational Status KW - Female KW - Humans KW - Literacy KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Mortality KW - Odds Ratio KW - Proportional Hazards Models KW - United States AB -

BACKGROUND: Inverse odds ratio weighting, a newly proposed tool to evaluate mediation in exposure-disease associations, may be valuable for a host of research questions, but little is known about its performance in real data. We compare this approach to a more conventional Baron and Kenny type of decomposition on an additive hazards scale to estimate total, direct, and indirect effects using the example of the role of literacy in mediating the effects of education on mortality.

METHODS: Health and Retirement Study participants born in the United States between 1900 and 1947 were interviewed biennially for up to 12 years (N = 17,054). Literacy was measured with a brief vocabulary assessment. Decomposition estimates were derived based on Aalen additive hazards models.

RESULTS: A 1 standard deviation difference in educational attainment (3 years) was associated with 6.7 fewer deaths per 1000 person-years (β = -6.7, 95% confidence interval [CI]: -7.9, -5.4). Of this decrease, 1.3 fewer deaths (β = -1.3, 95% CI: -4.0, 1.2) were attributed to the literacy pathway (natural indirect), representing 19% of the total effect. Baron and Kenny estimates were consistent with inverse odds ratio weighting estimates but were less variable (natural indirect effect: -1.2 [95% CI: -1.7, -0.69], representing 18% of total effect).

CONCLUSION: In a cohort of older Americans, literacy partially mediated the effect of education on mortality. See Video Abstract at http://links.lww.com/EDE/B78.

VL - 27 UR - http://www.ncbi.nlm.nih.gov/pubmed/27280331 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27280331?dopt=Abstract ER - TY - JOUR T1 - A Comparison of Educational Differences on Physical Health, Mortality, and Healthy Life Expectancy in Japan and the United States. JF - J Aging Health Y1 - 2016 A1 - Chi-Tsun Chiu A1 - Mark D Hayward A1 - Saito, Yasuhiko KW - Activities of Daily Living KW - Age Distribution KW - Aged KW - Cause of Death KW - Cross-Cultural Comparison KW - Educational Status KW - Employment KW - Family Characteristics KW - Female KW - Health Status KW - Health Surveys KW - Healthy Lifestyle KW - Humans KW - Japan KW - Life Expectancy KW - Life Tables KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Regression Analysis KW - Retirement KW - Sex Distribution KW - United States AB -

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

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

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

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

VL - 28 IS - 7 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27590801?dopt=Abstract ER - TY - JOUR T1 - Comparison of hypertension healthcare outcomes among older people in the USA and England. JF - J Epidemiol Community Health Y1 - 2016 A1 - Alan Marshall A1 - James Nazroo A1 - Feeney, Kevin A1 - Jinkook Lee A1 - Vanhoutte, Bram A1 - Pendleton, Neil KW - Aged KW - Aging KW - Antihypertensive Agents KW - Blood pressure KW - Cross-Sectional Studies KW - Delivery of Health Care KW - England KW - Female KW - Health Surveys KW - Humans KW - Hypertension KW - Logistic Models KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Outcome and Process Assessment, Health Care KW - Prevalence KW - Quality of Life KW - Socioeconomic factors KW - United States AB -

BACKGROUND: The USA and England have very different health systems. Comparing hypertension care outcomes in each country enables an evaluation of the effectiveness of each system.

METHOD: The English Longitudinal Study of Ageing and the Health and Retirement Survey are used to compare the prevalence of controlled, uncontrolled and undiagnosed hypertension within the hypertensive population (diagnosed or measured within the survey data used) aged 50 years and above in the USA and in England.

RESULTS: Controlled hypertension is more prevalent within the hypertensive population in the USA (age 50-64: 0.53 (0.50 to 0.57) and age 65+: 0.51 (0.49 to 0.53)) than in England (age 50-64: 0.45 (0.42 to 0.48) and age 65+: 0.42 (0.40 to 0.45)). This difference is driven by lower undiagnosed hypertension in the USA (age 50-64: 0.18 (0.15-0.21) and age 65+: 0.13 (0.12 to 0.14)) relative to England (age 50-64: 0.26 (0.24 to 0.29) and age 65+: 0.22 (0.20 to 0.24)). The prevalence of uncontrolled hypertension within the hypertensive population is very similar in the USA (age 50-64: 0.29 (0.26 to 0.32) and age 65+: 0.36 (0.34 to 0.38)) and England (age 50-64: 0.29 (0.26 to 0.32) and age 65+: 0.36 (0.34 to 0.39)). Hypertension care outcomes are comparable across US insurance categories. In both countries, undiagnosed hypertension is positively correlated with wealth (ages 50-64). Uncontrolled hypertension declines with rising wealth in the USA.

CONCLUSIONS: Different diagnostic practices are likely to drive the cross-country differences in undiagnosed hypertension. US government health systems perform at least as well as private healthcare and are more equitable in the distribution of care outcomes. Higher undiagnosed hypertension among the affluent may reflect less frequent medical contact.

VL - 70 UR - http://www.ncbi.nlm.nih.gov/pubmed/26598759 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26598759?dopt=Abstract U4 - ELSA HRS Hypertension Healthcare Universal healthcare ER - TY - JOUR T1 - Compression of disability between two birth cohorts of US adults with diabetes, 1992-2012: a prospective longitudinal analysis. JF - Lancet Diabetes Endocrinol Y1 - 2016 A1 - Barbara H. Bardenheier A1 - Ji Lin A1 - Zhuo, Xiaohui A1 - Mohammed K. Ali A1 - Theodore J Thompson A1 - Yiling J. Cheng A1 - Edward W Gregg KW - Activities of Daily Living KW - Aged KW - Diabetes Mellitus KW - Disabled Persons KW - Female KW - Health Status KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Prospective Studies KW - United States AB -

BACKGROUND: The life expectancy of the average American with diabetes has increased, but the quality of health and functioning during those extra years are unknown. We aimed to investigate the net effect of recent trends in diabetes incidence, disability, and mortality on the average age of disability onset and the number of healthy and disabled years lived by adults with and without diabetes in the USA. We assessed whether disability expanded or was compressed in the population with diabetes and compared the findings with those for the population without diabetes in two consecutive US birth cohorts aged 50-70 years.

METHODS: In this prospective longitudinal analysis, we analysed data for two cohorts of US adults aged 50-70 years from the Health and Retirement Study, including 1367 people with diabetes and 11 414 without diabetes. We assessed incident disability, remission from disability, and mortality between population-based cohort 1 (born 1931-41, follow-up 1992-2002) and cohort 2 (born 1942-47, follow up 2002-12). Disability was defined by mobility loss, difficulty with one or more instrumental activities of daily living, and difficulty with one or more activities of daily living. We entered age-specific probabilities representing the two birth cohorts into a five-state Markov model to estimate the number of years of disabled and disability-free life and life-years lost by age 70 years.

FINDINGS: In people with diabetes, compared with cohort 1 (n=1067), cohort 2 (n=300) had more disability-free and total years of life, later onset of disability, and fewer disabled years. Simulations of the Markov models suggest that in men with diabetes aged 50 years, this difference between cohorts amounted to a 0·8-2·3 year delay in disability across the three metrics (mobility, 63·0 [95% CI 62·3-63·6] to 64·8 [63·6-65·7], p=0·01; instrumental activities of daily living, 63·5 [63·0-64·0] to 64·3 [63·0-65·3], p=0·24; activities of daily living, 62·7 [62·1-63·3] to 65·0 [63·5-65·9], p<0·0001) and 1·3 fewer life-years lost (ie, fewer remaining life-years up to age 70 years; from 2·8 [2·5-3·2] to 1·5 [1·3-1·9]; p<0·0001 for all three measures of disability). Among women with diabetes aged 50 years, this difference between cohorts amounted to a 1·1-2·3 year delay in disability across the three metrics (mobility, 61·3 [95% CI 60·5-62·1] to 63·2 [61·5-64·5], p=0·0416; instrumental activities of daily living, 63·0 [62·4-63·7] to 64·1 [62·7-65·2], p=0·16; activities of daily living, 62·3 [61·6-63·0] to 64·6 [63·1-65·6], p<0·0001) and 0·8 fewer life-years lost by age 70 years (1·9 [1·7-2·2] to 1·1 [0·9-1·5]; p<0·0001 for all three measures of disability). Parallel improvements were gained between cohorts of adults without diabetes (cohort 1, n=8687; cohort 2, n=2727); within both cohorts, those without diabetes had significantly more disability-free years than those with diabetes (p<0·0001 for all comparisons).

INTERPRETATION: Irrespective of diabetes status, US adults saw a compression of disability and gains in disability-free life-years. The decrease in disability onset due to primary prevention of diabetes could play an important part in achieving longer disability-free life-years.

FUNDING: US Department of Health & Human Services and the US Centers for Disease Control and Prevention.

VL - 4 UR - http://www.ncbi.nlm.nih.gov/pubmed/27298181 IS - 8 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27298181?dopt=Abstract ER - TY - JOUR T1 - Correlated probit analysis of repeatedly measured ordinal and continuous outcomes with application to the Health and Retirement Study. JF - Stat Med Y1 - 2016 A1 - Dimitris Georgarakos A1 - Ralitza Gueorguieva KW - Aged KW - Algorithms KW - Female KW - Health Status KW - Humans KW - Longitudinal Studies KW - Male KW - Monte Carlo Method KW - Probability KW - Retirement KW - Smoking AB -

The Health and Retirement Study was designed to evaluate changes in health and labor force participation during and after the transition from working to retirement. Every 2 years, participants provided information about their self-rated health (SRH), body mass index (BMI), smoking status, and other characteristics. Our goal was to assess the effects of smoking and gender on trajectories of change in BMI and SRH over time. Joint longitudinal analysis of outcome measures is preferable to separate analyses because it allows to account for the correlation between the measures, to test the effects of predictors while controlling type I error, and potentially to improve efficiency. However, because SRH is an ordinal measure while BMI is continuous, formulating a joint model and parameter estimation is challenging. A joint correlated probit model allowed us to seamlessly account for the correlations between the measures over time. Established estimating procedures for such models are based on quasi-likelihood or numerical approximations that may be biased or fail to converge. Therefore, we proposed a novel expectation-maximization algorithm for parameter estimation and a Monte Carlo bootstrap approach for standard errors approximation. Expectation-maximization algorithms have been previously considered for combinations of binary and/or continuous repeated measures; however, modifications were needed to handle combinations of ordinal and continuous responses. A simulation study demonstrated that the algorithm converged and provided approximately unbiased estimates with sufficiently large sample sizes. In the Health and Retirement Study, male gender and smoking were independently associated with steeper deterioration in self-rated health and with lower average BMI. Copyright © 2016 John Wiley & Sons, Ltd.

VL - 35 UR - http://www.ncbi.nlm.nih.gov/pubmed/27222058 IS - 23 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27222058?dopt=Abstract ER - TY - JOUR T1 - Correlates and predictors of loneliness in older-adults: a review of quantitative results informed by qualitative insights. JF - Int Psychogeriatr Y1 - 2016 A1 - Cohen-Mansfield, Jiska A1 - Hazan, Haim A1 - Lerman, Yaffa A1 - Shalom, Vera KW - Aged KW - Aged, 80 and over KW - Aging KW - Cross-Sectional Studies KW - Female KW - Focus Groups KW - Humans KW - Loneliness KW - Male KW - Marital Status KW - Motor Activity KW - Qualitative Research KW - Quality of Life KW - Residence Characteristics KW - Sex Factors KW - Social Environment KW - social isolation KW - Socioeconomic factors AB -

BACKGROUND: Older persons are particularly vulnerable to loneliness because of common age-related changes and losses. This paper reviews predictors of loneliness in the older population as described in the current literature and a small qualitative study.

METHODS: Peer-reviewed journal articles were identified from psycINFO, MEDLINE, and Google Scholar from 2000-2012. Overall, 38 articles were reviewed. Two focus groups were conducted asking older participants about the causes of loneliness.

RESULTS: Variables significantly associated with loneliness in older adults were: female gender, non-married status, older age, poor income, lower educational level, living alone, low quality of social relationships, poor self-reported health, and poor functional status. Psychological attributes associated with loneliness included poor mental health, low self-efficacy beliefs, negative life events, and cognitive deficits. These associations were mainly studied in cross-sectional studies. In the focus groups, participants mentioned environmental barriers, unsafe neighborhoods, migration patterns, inaccessible housing, and inadequate resources for socializing. Other issues raised in the focus groups were the relationship between loneliness and boredom and inactivity, the role of recent losses of family and friends, as well as mental health issues, such as shame and fear.

CONCLUSIONS: Future quantitative studies are needed to examine the impact of physical and social environments on loneliness in this population. It is important to better map the multiple factors and ways by which they impact loneliness to develop better solutions for public policy, city, and environmental planning, and individually based interventions. This effort should be viewed as a public health priority.

VL - 28 UR - http://www.journals.cambridge.org/abstract_S1041610215001532 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26424033?dopt=Abstract JO - Int. Psychogeriatr. 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 - A cross-lagged model of the reciprocal associations of loneliness and memory functioning. JF - Psychol Aging Y1 - 2016 A1 - Liat Ayalon A1 - Sharon Shiovitz-Ezra A1 - Roziner, Ilan KW - Aged KW - Aging KW - depression KW - Female KW - Humans KW - Loneliness KW - Male KW - Memory KW - Models, Psychological KW - Social Behavior KW - Spouses KW - Surveys and Questionnaires KW - Time Factors AB -

The study was designed to evaluate the reciprocal associations of loneliness and memory functioning using a cross-lagged model. The study was based on the psychosocial questionnaire of the Health and Retirement Study, which is a U.S. nationally representative survey of individuals over the age of 50 and their spouses of any age. A total of 1,225 respondents had complete data on the loneliness measure in 2004 and at least in 1 of the subsequent waves (e.g., 2008, 2012) and were maintained for analysis. A cross-lagged model was estimated to examine the reciprocal associations of loneliness and memory functioning, controlling for age, gender, education, depressive symptoms, number of medical conditions, and the number of close social relationships. The model had adequate fit indices: χ2(860, N = 1,225) = 1,401.54, p < .001, Tucker-Lewis index = .957, comparative fit index = .963, and root mean square error of approximation = .023 (90% confidence interval [.021, .025]). The lagged effect of loneliness on memory functioning was nonsignificant, B(SE) = -.11(.08), p = .15, whereas the lagged effect of memory functioning on loneliness was significant, B(SE) = -.06(.02), p = .01, indicating that lower levels of memory functioning precede higher levels of loneliness 4 years afterward. Further research is required to better understand the mechanisms responsible for the temporal association between reduced memory functioning and increased loneliness. (PsycINFO Database Record

PB - 31 VL - 31 UR - http://psycnet.apa.org/journals/pag/31/3/255/ IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26974589?dopt=Abstract ER - TY - JOUR T1 - Depressed Mood in Middle-Aged and Older Adults in Europe and the United States: A Comparative Study Using Anchoring Vignettes. JF - J Aging Health Y1 - 2016 A1 - Ramin Mojtabai KW - Aged KW - Cross-Cultural Comparison KW - depression KW - Europe KW - Female KW - Health Surveys KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - United States AB -

OBJECTIVE: To compare self-ratings of depressed mood in middle-aged and older adults in the United States and nine European countries after adjustment by anchoring vignettes.

METHOD: Samples were drawn from three large surveys of middle-aged and older adults: the U.S. Health and Retirement Study, the English Longitudinal Study of Aging (ELSA), and the Survey of Health, Ageing and Retirement in Europe. Self-ratings of depressed mood were compared across countries before and after adjustment by anchoring vignettes depicting cases with different levels of depressed mood.

RESULTS: Compared with Europeans as a group, Americans rated both the cases presented in the vignettes and themselves as more depressed. However, after adjustment by vignette ratings, Americans appeared to be less depressed than their counterparts in all but two European countries.

DISCUSSION: Cultural differences in mental health norms reflected in vignette rating may partly explain between-country differences in self-reported depressive symptoms and perhaps other psychiatric complaints.

PB - 28 VL - 28 UR - http://jah.sagepub.com/content/early/2015/04/22/0898264315585506.abstract IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25953815?dopt=Abstract ER - TY - JOUR T1 - Depression and Frailty in Late Life: Evidence for a Common Vulnerability. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2016 A1 - Matthew C. Lohman A1 - Dumenci, Levent A1 - Briana Mezuk KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - depression KW - Female KW - Frail Elderly KW - Geriatric Assessment KW - Humans KW - Independent Living KW - Interview, Psychological KW - Male AB -

OBJECTIVES: The study purpose is to estimate the correlation between depression and competing models of frailty, and to determine to what degree the comorbidity of these syndromes is determined by shared symptomology.

METHODS: Data come from the 2010 Health and Retirement Study. Analysis was limited to community-dwelling participants 65 and older (N = 3,453). Depressive symptoms were indexed by the 8-item Centers for Epidemiologic Studies Depression (CESD) scale. Frailty was indexed by 3 alternative conceptual models: (a) biological syndrome, (b) frailty index, and (c) functional domains. Confirmatory factor analysis (CFA) was used to estimate the correlation between depression and each model of frailty.

RESULTS: Each of the 3 frailty latent factors was significantly correlated with depression: biological syndrome (ρ = .68, p < .01), functional domains (ρ = .70, p < .01), and frailty index (ρ = .61, p < .01). Substantial correlation remained when accounting for shared symptoms between depression and the biological syndrome (ρ = .45) and frailty index (ρ = .56) models.

DISCUSSION: Results indicate that the correlation of frailty and depression in late life is substantial. The association between the two constructs cannot be fully explained by symptom overlap, suggesting that psychological vulnerability may be an important component of frailty.

VL - 71 UR - http://www.ncbi.nlm.nih.gov/pubmed/25617399 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25617399?dopt=Abstract U4 - Depression Frailty Older adults Psychology ER - TY - JOUR T1 - Desire for predictive testing for Alzheimer's disease and impact on advance care planning: a cross-sectional study. JF - Alzheimers Res Ther Y1 - 2016 A1 - Sheffrin, Meera A1 - Stijacic-Cenzer, Irena A1 - Michael A Steinman KW - Advance care planning KW - Aged KW - Aged, 80 and over KW - Alzheimer disease KW - Cross-Sectional Studies KW - Female KW - Health Knowledge, Attitudes, Practice KW - Humans KW - Male KW - Patient Acceptance of Health Care AB -

BACKGROUND: It is unknown whether older adults in the United States would be willing to take a test predictive of future Alzheimer's disease, or whether testing would change behavior. Using a nationally representative sample, we explored who would take a free and definitive test predictive of Alzheimer's disease, and examined how using such a test may impact advance care planning.

METHODS: A cross-sectional study within the 2012 Health and Retirement Study of adults aged 65 years or older asked questions about a test predictive of Alzheimer's disease (N = 874). Subjects were asked whether they would want to take a hypothetical free and definitive test predictive of future Alzheimer's disease. Then, imagining they knew they would develop Alzheimer's disease, subjects rated the chance of completing advance care planning activities from 0 to 100. We classified a score > 50 as being likely to complete that activity. We evaluated characteristics associated with willingness to take a test for Alzheimer's disease, and how such a test would impact completing an advance directive and discussing health plans with loved ones.

RESULTS: Overall, 75% (N = 648) of the sample would take a free and definitive test predictive of Alzheimer's disease. Older adults willing to take the test had similar race and educational levels to those who would not, but were more likely to be ≤75 years old (odds ratio 0.71 (95% CI 0.53-0.94)). Imagining they knew they would develop Alzheimer's, 81% would be likely to complete an advance directive, although only 15% had done so already.

CONCLUSIONS: In this nationally representative sample, 75% of older adults would take a free and definitive test predictive of Alzheimer's disease. Many participants expressed intent to increase activities of advance care planning with this knowledge. This confirms high public interest in predictive testing for Alzheimer's disease and suggests this may be an opportunity to engage patients in advance care planning discussions.

VL - 8 UR - http://alzres.biomedcentral.com/articles/10.1186/s13195-016-0223-9http://link.springer.com/content/pdf/10.1186/s13195-016-0223-9.pdf IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27955707?dopt=Abstract JO - Alz Res Therapy 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 - Determinants of Private Long-Term Care Insurance Purchase in Response to the Partnership Program. JF - Health Serv Res Y1 - 2016 A1 - Lin, Haizhen A1 - Jeffrey T Prince KW - Aged KW - Awareness KW - Costs and Cost Analysis KW - Decision making KW - Female KW - Humans KW - Insurance, Long-Term Care KW - Male KW - Middle Aged KW - Socioeconomic factors AB -

OBJECTIVE: To assess three possible determinants of individuals' response in their private insurance purchases to the availability of the Partnership for Long-Term Care (PLTC) insurance program: bequest motives, financial literacy, and program awareness.

DATA SOURCES: The health and retirement study (HRS) merged with data on states' implementation of the PLTC program.

STUDY DESIGN: Individual-level decision on private long-term care insurance is regressed on whether the PLTC program is being implemented for a given state-year, asset dummies, policy determinant variable, two-way and three-way interactions of these variables, and other controls, using fixed effects panel regression.

DATA EXTRACTION METHODS: Analysis used a sample between 50 and 69 years of age from 2002 to 2010, resulting in 12,695 unique individuals with a total of 39,151 observations.

PRINCIPAL FINDINGS: We find mild evidence that intent to bequest influences individual purchase of insurance. We also find that program awareness is necessary for response, while financial literacy notably increases responsiveness.

CONCLUSIONS: Increasing response to the PLTC program among the middle class (the stated target group) requires increased efforts to create awareness of the program's existence and increased education about the program's benefits, and more generally, about long-term care risks and needs.

PB - 51 VL - 51 UR - http://onlinelibrary.wiley.com/doi/10.1111/1475-6773.12353/abstract IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26303435?dopt=Abstract U2 - PMC4799899 ER - TY - JOUR T1 - Differences Among Older Adults in the Types of Dental Services Used in the United States. JF - Inquiry Y1 - 2016 A1 - Richard J. Manski A1 - Jody Schimmel Hyde A1 - Haiyan Chen A1 - John F Moeller KW - Aged KW - Dental Care KW - Female KW - Humans KW - Insurance, Dental KW - Male KW - Middle Aged KW - Surveys and Questionnaires KW - United States AB -

The purpose of this article is to explore differences in the socioeconomic, demographic characteristics of older adults in the United States with respect to their use of different types of dental care services. The 2008 Health and Retirement Study (HRS) collected information about patterns of dental care use and oral health from individuals aged 55 years and older in the United States. We analyze these data and explore patterns of service use by key characteristics before modeling the relationship between service use type and those characteristics. The most commonly used service category was fillings, inlays, or bonding, reported by 43.6% of those with any utilization. Just over one third of those with any utilization reported a visit for a crown, implant, or prosthesis, and one quarter reported a gum treatment or tooth extraction. The strongest consistent predictors of use type are denture, dentate, and oral health status along with dental insurance coverage and wealth. Our results provide insights into the need for public policies to address inequalities in access to dental services among an older US population. Our findings show that lower income, less wealthy elderly with poor oral health are more likely to not use any dental services rather than using only preventive dental care, and that cost prevents most non-users who say they need dental care from going to the dentist. These results suggest a serious access problem and one that ultimately produces even worse oral health and expensive major procedures for this population in the future.

VL - 53 UR - http://www.ncbi.nlm.nih.gov/pubmed/27284127 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27284127?dopt=Abstract ER - TY - JOUR T1 - Disparity in dental attendance among older adult populations: a comparative analysis across selected European countries and the USA. JF - Int Dent J Y1 - 2016 A1 - Richard J. Manski A1 - John F Moeller A1 - Haiyan Chen A1 - Widstrom, Eeva A1 - Listl, Stefan KW - Aged KW - Aged, 80 and over KW - Demography KW - Dental Care KW - Europe KW - Female KW - Humans KW - Insurance Coverage KW - Interviews as Topic KW - Male KW - Middle Aged KW - Oral Health KW - Patient Acceptance of Health Care KW - United States AB -

BACKGROUND: The current study addresses the extent to which diversity in dental attendance across population subgroups exists within and between the USA and selected European countries.

METHOD: The analyses relied on 2006/2007 data from the Survey of Health, Ageing and Retirement in Europe (SHARE) and 2004-2006 data from the Health and Retirement Study (HRS) in the USA for respondents≥51 years of age. Logistic regression models were estimated to identify impacts of dental-care coverage, and of oral and general health status, on dental-care use.

RESULTS: We were unable to discern significant differences in dental attendance across population subgroups in countries with and without social health insurance, between the USA and European countries, and between European countries classified according to social welfare regime. Patterns of diverse dental use were found, but they did not appear predominately in countries classified according to welfare state regime or according to the presence or absence of social health insurance.

CONCLUSIONS: The findings of this study suggest that income and education have a stronger, and more persistent, correlation with dental use than the correlation between dental insurance and dental use across European countries. We conclude that: (i) higher overall rates of coverage in most European countries, compared with relatively lower rates in the USA, contribute to this finding; and that (ii) policies targeted to improving the income of older persons and their awareness of the importance of oral health care in both Europe and the USA can contribute to improving the use of dental services.

PB - 66 VL - 66 UR - http://onlinelibrary.wiley.com/doi/10.1111/idj.12190/epdf IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26465093?dopt=Abstract U2 - PMC4728006 ER - TY - JOUR T1 - Dispositional Optimism and Incidence of Cognitive Impairment in Older Adults. JF - Psychosom Med Y1 - 2016 A1 - Katerina A B Gawronski A1 - Eric S Kim A1 - Kenneth M. Langa A1 - Laura D Kubzansky KW - Aged KW - Aged, 80 and over KW - Cognitive Dysfunction KW - Female KW - Humans KW - Incidence KW - Male KW - Optimism KW - Protective factors KW - United States AB -

OBJECTIVE: Higher levels of optimism have been linked with positive health behaviors, biological processes, and health conditions that are potentially protective against cognitive impairment in older adults. However, the association between optimism and cognitive impairment has not been directly investigated. We examined whether optimism is associated with incident cognitive impairment in older adults.

METHODS: Data are from the Health and Retirement Study. Optimism was measured by using the Life Orientation Test-R and cognitive impairment with a modified version of the Telephone Interview for Cognitive Status derived from the Mini-Mental State Examination. Using multiple logistic regression models, we prospectively assessed whether optimism was associated with incident cognitive impairment in 4624 adults 65 years and older during a 4-year period.

RESULTS: Among participants, 312 women and 190 men developed cognitive impairment during the 4-year follow-up. Higher optimism was associated with decreased risk of incident cognitive impairment. When adjusted for sociodemographic factors, each standard deviation increase in optimism was associated with reduced odds (odds ratio [OR] = 0.70, 95% confidence interval [CI] = 0.61-0.81) of becoming cognitively impaired. A dose-response relationship was observed. Compared with those with the lowest levels of optimism, people with moderate levels had somewhat reduced odds of cognitive impairment (OR = 0.78, 95% CI = 0.59-1.03), whereas people with the highest levels had the lowest odds of cognitive impairment (OR = 0.52, 95% CI = 0.36-0.74). These associations remained after adjusting for health behaviors, biological factors, and psychological covariates that could either confound the association of interest or serve on the pathway.

CONCLUSIONS: Optimism was prospectively associated with a reduced likelihood of becoming cognitively impaired. If these results are replicated, the data suggest that potentially modifiable aspects of positive psychological functioning such as optimism play an important role in maintaining cognitive functioning.

VL - 78 UR - https://www.ncbi.nlm.nih.gov/pubmed/27284699 IS - 7 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27284699?dopt=Abstract ER - TY - JOUR T1 - Do Higher Levels of Resilience Buffer the Deleterious Impact of Chronic Illness on Disability in Later Life? JF - Gerontologist Y1 - 2016 A1 - Lydia K Manning A1 - Dawn C Carr A1 - Ben Lennox Kail KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Aging KW - Chronic disease KW - Disability Evaluation KW - Disabled Persons KW - Female KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Resilience, Psychological KW - Retirement KW - Surveys and Questionnaires AB -

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

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

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

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

VL - 56 UR - https://www.ncbi.nlm.nih.gov/pubmed/25063353 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25063353?dopt=Abstract ER - TY - JOUR T1 - Do working conditions at older ages shape the health gradient? JF - J Health Econ Y1 - 2016 A1 - Lauren L Schmitz KW - Aged KW - Female KW - Health Status KW - Humans KW - Income KW - Male KW - Middle Aged KW - Occupations KW - Retirement KW - Workplace AB -

This study examines whether working conditions at the end of workers' careers impact health and contribute to health disparities across occupations. A dynamic panel correlated random effects model is used in conjunction with a rich data set that combines information from the Health and Retirement Study (HRS), expert ratings of job demands from the Occupational Information Network (O*NET), and mid-career earnings records from the Social Security Administration's (SSA) Master Earnings File (MEF). Results reveal a strong relationship between positive aspects of the psychosocial work environment and improved self-reported health status, blood pressure, and cognitive function. However, there is little evidence to suggest that working conditions shape observed health disparities between occupations in the years leading up to retirement.

VL - 50 UR - http://linkinghub.elsevier.com/retrieve/pii/S016762961630337Xhttp://api.elsevier.com/content/article/PII:S016762961630337X?httpAccept=text/xmlhttp://api.elsevier.com/content/article/PII:S016762961630337X?httpAccept=text/plain U1 - http://www.ncbi.nlm.nih.gov/pubmed/27814483?dopt=Abstract JO - Journal of Health Economics ER - TY - JOUR T1 - Does Volunteering Experience Influence Advance Care Planning in Old Age? JF - J Gerontol Soc Work Y1 - 2016 A1 - Shen, Huei-Wern A1 - Khosla, Nidhi KW - Advance care planning KW - Aged KW - Aging KW - Female KW - Humans KW - Income KW - Logistic Models KW - Male KW - Middle Aged KW - Social Support KW - Socioeconomic factors KW - Terminal Care KW - Volunteers AB -

Advance care planning (ACP) increases the likelihood patients will receive end-of-life care that is congruent with their preferences and lowers stress among both patients and caregivers. Previous efforts to increase ACP have mainly focused on information provision in the very late stage of life. This study examines whether a relationship exists between volunteering and ACP, and whether this relationship is associated with social support. The sample comprises 877 individuals who were aged 55+ in 2008, and were deceased before 2010. The sample is derived from seven waves (1998-2010) of data from the Health and Retirement Study. Logistic regression results showed that overall ACP and durable power of attorney for health care (DPAHC) were both higher (OR = 1.61 and 1.71, respectively) for older adults with volunteering experience in the past 10 years than those without such experience. Available social support (relatives and friends living nearby) was not associated with the relationship between volunteering and ACP. Other factors related to ACP included poorer health, death being expected, death due to cancer, older age, and being a racial minority. Involving older people in volunteer work may help to increase ACP. Future research is encouraged to identify reasons for the association between volunteering and ACP.

VL - 59 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27592593?dopt=Abstract ER - TY - JOUR T1 - Effects of Recent Stress and Variation in the Serotonin Transporter Polymorphism (5-HTTLPR) on Depressive Symptoms: A Repeated-Measures Study of Adults Age 50 and Older. JF - Behavior Genetics Y1 - 2016 A1 - Thalida E. Arpawong A1 - Jinkook Lee A1 - Drystan F. Phillips A1 - Eileen M. Crimmins A1 - Morgan E. Levine A1 - Carol A Prescott KW - Aged KW - Alleles KW - depression KW - Depressive Disorder KW - Ethnic Groups KW - Female KW - Gene-Environment Interaction KW - Genetic Association Studies KW - Genetic Predisposition to Disease KW - Haplotypes KW - Humans KW - Life Change Events KW - Male KW - Middle Aged KW - Polymorphism, Single Nucleotide KW - Promoter Regions, Genetic KW - Serotonin Plasma Membrane Transport Proteins KW - Stress, Psychological AB -

Depending on genetic sensitivity to it, stress may affect depressive symptomatology differentially. Applying the stress-diathesis hypothesis to older adults, we postulate: (1) recent stress will associate with increased depressive symptom levels and (2) this effect will be greater for individuals with at least one short allele of the serotonin transporter gene promoter region (5-HTTLPR). Further, we employ a design that addresses specific limitations of many prior studies that have examined the 5-HTTLPR × SLE relation, by: (a) using a within-person repeated-measures design to address fluctuations that occur within individuals over time, increase power for detecting G × E, and address GE correlation; (b) studying reports of exogenous stressful events (those unlikely to be caused by depression) to help rule out reverse causation and negativity bias, and in order to assess stressors that are more etiologically relevant to depressive symptomatology in older adults. The sample is drawn from the Health and Retirement Study, a U.S. population-based study of older individuals (N = 28,248; mean age = 67.5; 57.3 % female; 80.7 % Non-Hispanic White, 14.9 % Hispanic/Latino, 4.5 % African American; genetic subsample = 12,332), from whom measures of depressive symptoms and exogenous stressors were collected biannually (1994-2010). Variation in the 5-HTTLPR was characterized via haplotype, using two single nucleotide polymorphisms (SNPs). Ordered logit models were constructed to predict levels of depressive symptoms from 5-HTTLPR and stressors, comparing results of the most commonly applied statistical approaches (i.e., comparing allelic and genotypic models, and continuous and categorical predictors) used in the literature. All models were stratified by race/ethnicity. Overall, results show a main effect of recent stress for all ethnic groups, and mixed results for the variation in 5-HTTLPR × stress interaction, contingent upon statistical model used. Findings suggest there may be a differential effect of stressors and 5-HTTLPR on depressive symptoms by ethnicity, but further research is needed, particularly when using a haplotype to characterize variation in 5-HTTLPR in population-based sample with a diverse ethnic composition.

PB - 46 VL - 46 IS - 1 U2 - PMC4720538 U4 - 5-HTTLPR/Depressive symptoms/G/Older adults/Race differences/Stressful life events/Genetic analysis ER - TY - JOUR T1 - The five-factor model of personality and self-reported versus biomarker diabetic control. JF - J Health Psychol Y1 - 2016 A1 - Phillips, Amanda S A1 - Charles A Guarnaccia KW - Aged KW - Aged, 80 and over KW - Biomarkers KW - Diabetes Mellitus KW - Female KW - Glycated Hemoglobin KW - Humans KW - Male KW - Middle Aged KW - Personality KW - Self Report AB -

Five-factor personality was examined as an element of self-report diabetic control accuracy versus biomarker control (HbA1c) for 1474 diabetics in the 2006 and 2008 Health and Retirement Study. Correlations of extraversion and self-reported control (r = -.06, p < .01), and extraversion and HbA1c (r = .03, non-significant), were significantly different (t = 2.87, p < .01). Correlations of openness and self-reported control (r = -.05, p < .05), and openness and HbA1c (r = .01, non-significant), were significantly different (t = 1.91, p < .05). Associations were found between self-reported control and conscientiousness (r = -.05, p < .05), neuroticism (r = .04, p < .05), and openness (r = -.05, p < .05). Neuroticism was associated with self-reports that diabetes was worse (r = .07, p < .01). Other correlations and comparisons were non-significant.

VL - 21 UR - http://hpq.sagepub.com/content/early/2015/03/24/1359105315576349.abstract IS - 10 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25814165?dopt=Abstract U4 - adults/chronic illness/clinical health psychology/diabetes/illness perception ER - TY - JOUR T1 - Functional health decline before and after retirement: A longitudinal analysis of the Health and Retirement Study. JF - Soc Sci Med Y1 - 2016 A1 - Sander K. R. van Zon A1 - Bültmann, Ute A1 - Reijneveld, Sijmen A A1 - Carlos F. Mendes de Leon KW - Aged KW - Aging KW - Female KW - Health Status KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Regression Analysis KW - Retirement KW - Social Class KW - United States AB -

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

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

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

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

VL - 170 UR - http://www.sciencedirect.com/science/article/pii/S0277953616305615 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27741444?dopt=Abstract ER - TY - JOUR T1 - Functional status in older women diagnosed with pelvic organ prolapse. JF - Am J Obstet Gynecol Y1 - 2016 A1 - Tatiana V D Sanses A1 - Nicholas K Schiltz A1 - Bruna M. Couri A1 - Sangeeta T Mahajan A1 - Holly E Richter A1 - David F Warner A1 - Jack M. Guralnik A1 - Siran M Koroukian KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Aging KW - Cross-Sectional Studies KW - Female KW - Health Status KW - Health Surveys KW - Humans KW - Medicare KW - Middle Aged KW - Mobility Limitation KW - Muscle Strength KW - Pelvic Organ Prolapse KW - United States KW - Upper Extremity AB -

BACKGROUND: Functional status plays an important role in the comprehensive characterization of older adults. Functional limitations are associated with an increased risk of adverse treatment outcomes, but there are limited data on the prevalence of functional limitations in older women with pelvic floor disorders.

OBJECTIVE: The aim of the study was to describe the prevalence of functional limitations based on health status in older women with pelvic organ prolapse (POP).

STUDY DESIGN: This pooled, cross-sectional study utilized data from the linked Health and Retirement Study and Medicare files from 1992 through 2008. The analysis included 890 women age ≥65 years with POP. We assessed self-reported functional status, categorized in strength, upper and lower body mobility, activities of daily living (ADL), and instrumental ADL (IADL) domains. Functional limitations were evaluated and stratified by respondents self-reported general health status. Descriptive statistics were used to compare categorical and continuous variables, and logistic regression was used to measure differences in the odds of functional limitation by increasing age.

RESULTS: The prevalence of functional limitations was 76.2% in strength, 44.9% in upper and 65.8% in lower body mobility, 4.5% in ADL, and 13.6% in IADL. Limitations were more prevalent in women with poor or fair health status than in women with good health status, including 91.5% vs 69.9% in strength, 72.9% vs 33.5% in upper and 88.0% vs 56.8% in lower body mobility, 11.6% vs 0.9% in ADL, and 30.6% vs 6.7% in IADL; all P < .01. The odds of all functional limitations also increased significantly with advancing age.

CONCLUSION: Functional limitations, especially in strength and body mobility domains, are highly prevalent in older women with POP, particularly in those with poor or fair self-reported health status. Future research is necessary to evaluate if functional status affects clinical outcomes in pelvic reconstructive and gynecologic surgery and whether it should be routinely assessed in clinical decision-making when treating older women with POP.

PB - 214 VL - 214 UR - http://www.sciencedirect.com/science/article/pii/S0002937815024783 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26704893?dopt=Abstract U2 - PMC4851569 U4 - activities of daily living/functional status/limitations/mobility/pelvic organ prolapse/strength ER - TY - JOUR T1 - Functioning, Forgetting, or Failing Health: Which Factors Are Associated With a Community-Based Move Among Older Adults? JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2016 A1 - Esther M Friedman A1 - Margaret M Weden A1 - Regina A Shih A1 - Stephanie Kovalchik A1 - Singh, Reema A1 - José J Escarce KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Aging KW - Cognitive Dysfunction KW - Female KW - Health Status KW - Health Surveys KW - Humans KW - Male KW - Middle Aged KW - Population Dynamics KW - Residence Characteristics KW - United States AB -

OBJECTIVE: To examine whether the health and functioning of middle-aged and older adults are associated with an increased likelihood of community-based moves.

METHOD: Biennial data from adults aged 51 and older in the Health and Retirement Study (HRS) and discrete-time survival models were used to assess the likelihood of community-based moves from 2000 to 2010 as a function of 11 measures of health and functioning.

RESULTS: Respondents diagnosed with heart disease, stroke, hypertension, lung disease, and psychiatric problems were more likely to move during the study period than those with no such diagnosis. Changes in activities of daily living and instrumental activities of daily living functioning, cognitive impairment, and falls were also related to a greater likelihood of moving during the study period. Cancer and diabetes were not related to overall moves, although diabetes was associated with an increased likelihood of local moves. For the most part, it was longstanding not recent diagnoses that were significantly related to the likelihood of moving.

DISCUSSION: Although some health conditions precipitate moves among middle-aged and older adults, others do not. This work has important implications for understanding the role of different aspects of health and functioning in the likelihood of migration among older adults.

VL - 71 UR - http://psychsocgerontology.oxfordjournals.org/content/early/2015/10/07/geronb.gbv075.abstract IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26450960?dopt=Abstract U4 - Activities of daily living/Aging/Cognition/Health/HEALTH STATUS/health condition/Migration ER - TY - JOUR T1 - Genetic evidence for natural selection in humans in the contemporary United States. JF - Proc Natl Acad Sci U S A Y1 - 2016 A1 - Jonathan P. Beauchamp KW - Aged KW - Blood Glucose KW - Body Height KW - Body Mass Index KW - Cholesterol KW - Educational Status KW - Female KW - Humans KW - Longitudinal Studies KW - Male KW - Menarche KW - Middle Aged KW - Models, Genetic KW - Phenotype KW - Schizophrenia KW - Selection, Genetic AB -

Recent findings from molecular genetics now make it possible to test directly for natural selection by analyzing whether genetic variants associated with various phenotypes have been under selection. I leverage these findings to construct polygenic scores that use individuals' genotypes to predict their body mass index, educational attainment (EA), glucose concentration, height, schizophrenia, total cholesterol, and (in females) age at menarche. I then examine associations between these scores and fitness to test whether natural selection has been occurring. My study sample includes individuals of European ancestry born between 1931 and 1953 who participated in the Health and Retirement Study, a representative study of the US population. My results imply that natural selection has been slowly favoring lower EA in both females and males, and are suggestive that natural selection may have favored a higher age at menarche in females. For EA, my estimates imply a rate of selection of about -1.5 mo of education per generation (which pales in comparison with the increases in EA observed in contemporary times). Although they cannot be projected over more than one generation, my results provide additional evidence that humans are still evolving-albeit slowly, especially compared with the rapid changes that have occurred over the past few generations due to cultural and environmental factors.

VL - 113 UR - http://www.ncbi.nlm.nih.gov/pubmed/27402742 IS - 28 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27402742?dopt=Abstract ER - TY - JOUR T1 - A Genetic Network Associated With Stress Resistance, Longevity, and Cancer in Humans. JF - J Gerontol A Biol Sci Med Sci Y1 - 2016 A1 - Morgan E. Levine A1 - Eileen M. Crimmins KW - Aged KW - Aged, 80 and over KW - Aging KW - Alleles KW - Case-Control Studies KW - Gene Regulatory Networks KW - Genome-Wide Association Study KW - Genotype KW - Humans KW - Longevity KW - Longitudinal Studies KW - Middle Aged KW - Neoplasms KW - Phenotype KW - Polymorphism, Single Nucleotide KW - Smoking KW - Stress, Physiological KW - United States AB -

Human longevity and diseases are likely influenced by multiple interacting genes within a few biologically conserved pathways. Using long-lived smokers as a phenotype (n = 90)-a group whose survival may signify innate resilience-we conducted a genome-wide association study comparing them to smokers at ages 52-69 (n = 730). These results were used to conduct a functional interaction network and pathway analysis, to identify single nucleotide polymorphisms that collectively related to smokers' longevity. We identified a set of 215 single nucleotide polymorphisms (all of which had p <5×10(-3) in the genome-wide association study) that were located within genes making-up a functional interaction network. These single nucleotide polymorphisms were then used to create a weighted polygenic risk score that, using an independent validation sample of nonsmokers (N = 6,447), was found to be significantly associated with a 22% increase in the likelihood of being aged 90-99 (n = 253) and an over threefold increase in the likelihood of being a centenarian (n = 4), compared with being at ages 52-79 (n = 4,900). Additionally, the polygenic risk score was also associated with an 11% reduction in cancer prevalence over up to 18 years (odds ratio: 0.89, p = .011). Overall, using a unique phenotype and incorporating prior knowledge of biological networks, this study identified a set of single nucleotide polymorphisms that together appear to be important for human aging, stress resistance, cancer, and longevity.

VL - 71 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26355015?dopt=Abstract ER - TY - JOUR T1 - GENOME-WIDE ASSOCIATION STUDY (GWAS) AND GENOME-WIDE BY ENVIRONMENT INTERACTION STUDY (GWEIS) OF DEPRESSIVE SYMPTOMS IN AFRICAN AMERICAN AND HISPANIC/LATINA WOMEN. JF - Depress Anxiety Y1 - 2016 A1 - Dunn, Erin C A1 - Wiste, Anna A1 - Radmanesh, Farid A1 - Almli, Lynn M A1 - Gogarten, Stephanie M A1 - Sofer, Tamar A1 - Jessica Faul A1 - Sharon L R Kardia A1 - Jennifer A Smith A1 - David R Weir A1 - Wei Zhao A1 - Soare, Thomas W A1 - Saira S Mirza A1 - Karin Hek A1 - Henning Tiemeier A1 - Goveas, Joseph S A1 - Sarto, Gloria E A1 - Snively, Beverly M A1 - Marilyn C Cornelis A1 - Karestan C Koenen A1 - Kraft, Peter A1 - Shaun M Purcell A1 - Ressler, Kerry J A1 - Rosand, Jonathan A1 - Wassertheil-Smoller, Sylvia A1 - Smoller, Jordan W KW - African Americans KW - Aged KW - depression KW - Female KW - Gene-Environment Interaction KW - Genome-Wide Association Study KW - Hispanic Americans KW - Humans KW - Life Change Events KW - Middle Aged KW - Phenotype KW - Polymorphism, Single Nucleotide KW - Risk Factors KW - Self Report AB -

BACKGROUND: Genome-wide association studies (GWAS) have made little progress in identifying variants linked to depression. We hypothesized that examining depressive symptoms and considering gene-environment interaction (GxE) might improve efficiency for gene discovery. We therefore conducted a GWAS and genome-wide by environment interaction study (GWEIS) of depressive symptoms.

METHODS: Using data from the SHARe cohort of the Women's Health Initiative, comprising African Americans (n = 7,179) and Hispanics/Latinas (n = 3,138), we examined genetic main effects and GxE with stressful life events and social support. We also conducted a heritability analysis using genome-wide complex trait analysis (GCTA). Replication was attempted in four independent cohorts.

RESULTS: No SNPs achieved genome-wide significance for main effects in either discovery sample. The top signals in African Americans were rs73531535 (located 20 kb from GPR139, P = 5.75 × 10(-8) ) and rs75407252 (intronic to CACNA2D3, P = 6.99 × 10(-7) ). In Hispanics/Latinas, the top signals were rs2532087 (located 27 kb from CD38, P = 2.44 × 10(-7) ) and rs4542757 (intronic to DCC, P = 7.31 × 10(-7) ). In the GEWIS with stressful life events, one interaction signal was genome-wide significant in African Americans (rs4652467; P = 4.10 × 10(-10) ; located 14 kb from CEP350). This interaction was not observed in a smaller replication cohort. Although heritability estimates for depressive symptoms and stressful life events were each less than 10%, they were strongly genetically correlated (rG = 0.95), suggesting that common variation underlying self-reported depressive symptoms and stressful life event exposure, though modest on their own, were highly overlapping in this sample.

CONCLUSIONS: Our results underscore the need for larger samples, more GEWIS, and greater investigation into genetic and environmental determinants of depressive symptoms in minorities.

VL - 33 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27038408?dopt=Abstract ER - TY - JOUR T1 - A Global View on the Effects of Work on Health in Later Life. JF - Gerontologist Y1 - 2016 A1 - Ursula M. Staudinger A1 - Finkelstein, Ruth A1 - Calvo, Esteban A1 - Sivaramakrishnan, Kavita KW - Aged KW - Aging KW - Employment KW - Humans KW - Public Policy KW - Retirement KW - Socioeconomic factors AB -

PURPOSE OF THE STUDY: Work is an important environment shaping the aging processes during the adult years. Therefore, the cumulative and acute effects of work characteristics on late-life health deserve great attention. Given that population aging has become a global trend with ensuing changes in labor markets around the world, increased attention is paid to investigating the effects of the timing of retirement around the world and the macroeconomic benefits often associated with delaying retirement. It will be essential for societies with aging populations to maintain productivity given an aging workforce and for individuals it will be crucial to add healthy and meaningful years rather than just years to their lives.

DESIGN AND METHODS: We first describe the available evidence about participation of older workers (65+) in the labor force in high, middle, and low-income countries. Second, we discuss the individual-level and societal influences that might govern labor-force participation of older adults. Thirdly, we review evidence on the association between work on the one and physical, mental, and cognitive health in later life on the other.

RESULTS AND IMPLICATIONS: Globally, both is true: work supports healthy aging and jeopordizes it. We draw implications for policymaking in terms of social protection, HR policies, and older employee employability.

VL - 56 Suppl 2 UR - http://www.ncbi.nlm.nih.gov/pubmed/26994267 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26994267?dopt=Abstract U4 - Work Late-life work Retirement Aging Labor markets ER - TY - JOUR T1 - GWAS analysis of handgrip and lower body strength in older adults in the CHARGE consortium. JF - Aging Cell Y1 - 2016 A1 - Amy M Matteini A1 - Toshiko Tanaka A1 - Karasik, David A1 - Atzmon, Gil A1 - Chou, Wen-Chi A1 - John D Eicher A1 - Andrew D Johnson A1 - Alice M. Arnold A1 - Michele L Callisaya A1 - Gail Davies A1 - Daniel S Evans A1 - Holtfreter, Birte A1 - Kurt Lohman A1 - Kathryn L Lunetta A1 - Mangino, Massimo A1 - Albert Vernon Smith A1 - Jennifer A Smith A1 - Teumer, Alexander A1 - Lei Yu A1 - Dan E Arking A1 - Aron S Buchman A1 - Chibinik, Lori B A1 - Philip L de Jager A1 - Jessica Faul A1 - Melissa E Garcia A1 - Gillham-Nasenya, Irina A1 - Gudnason, Vilmundur A1 - Hofman, Albert A1 - Hsu, Yi-Hsiang A1 - Ittermann, Till A1 - Lahousse, Lies A1 - David C Liewald A1 - Yongmei Liu A1 - Lopez, Lorna A1 - Fernando Rivadeneira A1 - Rotter, Jerome I A1 - Siggeirsdottir, Kristin A1 - John M Starr A1 - Thomson, Russell A1 - Tranah, Gregory J A1 - André G Uitterlinden A1 - Völker, Uwe A1 - Völzke, Henry A1 - David R Weir A1 - Kristine Yaffe A1 - Wei Zhao A1 - Wei Vivian Zhuang A1 - Zmuda, Joseph M A1 - David A Bennett A1 - Steven R Cummings A1 - Ian J Deary A1 - Luigi Ferrucci A1 - Tamara B Harris A1 - Sharon L R Kardia A1 - Kocher, Thomas A1 - Stephen B Kritchevsky A1 - Psaty, Bruce M A1 - Seshadri, Sudha A1 - Timothy Spector A1 - Velandai K Srikanth A1 - Beverly G Windham A1 - Zillikens, M Carola A1 - Anne B Newman A1 - Jeremy D Walston A1 - Douglas P Kiel A1 - Joanne M Murabito KW - Adult KW - Aged KW - Chromatin Immunoprecipitation KW - Cohort Studies KW - Epigenesis, Genetic KW - Genome-Wide Association Study KW - Hand Strength KW - Humans KW - Molecular Sequence Annotation KW - Muscle Strength KW - Polymorphism, Single Nucleotide KW - Quantitative Trait Loci KW - Reproducibility of Results AB -

Decline in muscle strength with aging is an important predictor of health trajectory in the elderly. Several factors, including genetics, are proposed contributors to variability in muscle strength. To identify genetic contributors to muscle strength, a meta-analysis of genomewide association studies of handgrip was conducted. Grip strength was measured using a handheld dynamometer in 27 581 individuals of European descent over 65 years of age from 14 cohort studies. Genomewide association analysis was conducted on ~2.7 million imputed and genotyped variants (SNPs). Replication of the most significant findings was conducted using data from 6393 individuals from three cohorts. GWAS of lower body strength was also characterized in a subset of cohorts. Two genomewide significant (P-value< 5 × 10(-8) ) and 39 suggestive (P-value< 5 × 10(-5) ) associations were observed from meta-analysis of the discovery cohorts. After meta-analysis with replication cohorts, genomewide significant association was observed for rs752045 on chromosome 8 (β = 0.47, SE = 0.08, P-value = 5.20 × 10(-10) ). This SNP is mapped to an intergenic region and is located within an accessible chromatin region (DNase hypersensitivity site) in skeletal muscle myotubes differentiated from the human skeletal muscle myoblasts cell line. This locus alters a binding motif of the CCAAT/enhancer-binding protein-β (CEBPB) that is implicated in muscle repair mechanisms. GWAS of lower body strength did not yield significant results. A common genetic variant in a chromosomal region that regulates myotube differentiation and muscle repair may contribute to variability in grip strength in the elderly. Further studies are needed to uncover the mechanisms that link this genetic variant with muscle strength.

VL - 15 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27325353?dopt=Abstract ER - TY - JOUR T1 - Health Effects of Short-Term Fluctuations in Macroeconomic Conditions: The Case of Hypertension for Older Americans. JF - Health Econ Y1 - 2016 A1 - Marco Angrisani A1 - Jinkook Lee KW - Aged KW - Commerce KW - Economic Recession KW - Female KW - Health Status KW - Humans KW - Hypertension KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Socioeconomic factors KW - Stress, Psychological KW - Surveys and Questionnaires KW - Unemployment KW - United States AB -

We investigate the health effects of short-term macroeconomic fluctuations as described by changes in unemployment rate, house, and stock market price indexes. The 'Great Recession' provides the opportunity to conduct this analysis as it involved contemporaneous shocks to the labor, housing, and stock markets. Using panel data from the Health and Retirement Study over the period 2004-2010, we relate changes in hypertension status to changes in state-level unemployment rate and house prices and to changes in stock market prices. We consider hypertension, a disease related to stress and of high prevalence among older adults, that has received little attention in the literature linking macroeconomic conditions to individual health. Our analysis exploits self-reports of hypertension diagnosis as well as directly measured blood pressure readings. Using both measures, we find that the likelihood of developing hypertension is negatively related to changes in house prices. Also, decreasing house prices lower the probability of stopping hypertension medication treatment for individuals previously diagnosed with the condition. We do not observe significant associations between hypertension and either changes in unemployment rate or stock market prices. We document heterogeneity in the estimated health effects of the recession by gender, education, asset ownership, and work status. Copyright © 2016 John Wiley & Sons, Ltd.

VL - 25 Suppl 2 UR - http://doi.wiley.com/10.1002/hec.3374https://api.wiley.com/onlinelibrary/tdm/v1/articles/10.1002%2Fhec.3374http://onlinelibrary.wiley.com/wol1/doi/10.1002/hec.3374/fullpdf U1 - http://www.ncbi.nlm.nih.gov/pubmed/27870298?dopt=Abstract JO - Health Econ. 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 - The Influence of Sociodemographic and Psychosocial Factors on Advance Care Planning. JF - J Gerontol Soc Work Y1 - 2016 A1 - Inoue, Megumi KW - Advance care planning KW - Advance directives KW - African Americans KW - Aged KW - Aged, 80 and over KW - Continental Population Groups KW - European Continental Ancestry Group KW - Female KW - Health Status KW - Hispanic Americans KW - Humans KW - Logistic Models KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Psychology KW - Social Class AB -

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

VL - 59 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27586074?dopt=Abstract ER - TY - JOUR T1 - Instrumental variable approaches to identifying the causal effect of educational attainment on dementia risk. JF - Ann Epidemiol Y1 - 2016 A1 - Thu T Nguyen A1 - Eric J. Tchetgen Tchetgen A1 - Ichiro Kawachi A1 - Stephen E. Gilman A1 - Stefan Walter A1 - Sze Y Liu A1 - Jennifer J Manly A1 - M. Maria Glymour KW - Aged KW - Aged, 80 and over KW - Dementia KW - Education, Nonprofessional KW - Educational Status KW - Female KW - Genetic Predisposition to Disease KW - Health Surveys KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Polymorphism, Single Nucleotide KW - Protective factors KW - Risk Factors KW - Schools KW - United States AB -

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

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

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

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

PB - 26 VL - 26 IS - 1 N1 - Times Cited: 0 0 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26633592?dopt=Abstract U2 - PMC4688127 U4 - Cognitive status/Genetic analysis/Dementia/EDUCATION ER - TY - JOUR T1 - Job Strain as a Risk Factor for Incident Diabetes Mellitus in Middle and Older Age U.S. Workers. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2016 A1 - Mutambudzi, Miriam A1 - Javed, Zulqarnain KW - Aged KW - Aging KW - Diabetes Mellitus KW - Female KW - Humans KW - Kaplan-Meier Estimate KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Proportional Hazards Models KW - Risk Factors KW - Stress, Psychological KW - United States KW - Work AB -

OBJECTIVES: The current study examined the relationship between the 4 quadrants of the job strain model and incident diabetes in U.S. working adults 50 years and older.

METHODS: This study used longitudinal data from the 2006-2012 waves of the Health and Retirement Study (n = 1,396). Kaplan-Meier survival curves and Cox proportional hazard regression models were used to examine whether job strain significantly predicted diabetes incidence.

RESULTS: Participants in high strain and passive jobs had significantly higher risk of diabetes relative to those in low strain jobs. In the univariate survival curves, significantly higher risk of diabetes was observed in men working in passive jobs. After adjustment for relevant covariates, participants in high strain (hazard ratio [HR] = 1.73, 95% confidence interval [CI] = 1.09-2.75) and passive (HR = 1.66, 95% CI = 1.01-2.73) jobs had a significantly increased risk of diabetes. Among adults 65 years and older, high strain and passive jobs were associated with an approximately fourfold increased risk of incident diabetes.

DISCUSSION: High strain and passive occupations which represent low control over work are associated with increased risk of diabetes incidence among older workers. More research is required to better understand how psychosocial work factors impact health in aging workers. Further, research should continue to explore gender differences in effects of job strain on diabetes.

VL - 71 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27445405?dopt=Abstract ER - TY - JOUR T1 - Late mortality after sepsis: propensity matched cohort study. JF - BMJ Y1 - 2016 A1 - Hallie C Prescott A1 - Osterholzer, John J A1 - Kenneth M. Langa A1 - Angus, Derek C A1 - Theodore J Iwashyna KW - Aged KW - Aged, 80 and over KW - Case-Control Studies KW - Cause of Death KW - Female KW - Hospital Mortality KW - Hospitalization KW - Humans KW - Longitudinal Studies KW - Male KW - Medicare KW - Propensity Score KW - Prospective Studies KW - Sepsis KW - Time Factors KW - United States AB -

OBJECTIVES:  To determine whether late mortality after sepsis is driven predominantly by pre-existing comorbid disease or is the result of sepsis itself.

DEIGN:  Observational cohort study.

SETTING:  US Health and Retirement Study.

PARTICIPANTS:  960 patients aged ≥65 (1998-2010) with fee-for-service Medicare coverage who were admitted to hospital with sepsis. Patients were matched to 777 adults not currently in hospital, 788 patients admitted with non-sepsis infection, and 504 patients admitted with acute sterile inflammatory conditions.

MAIN OUTCOME MEASURES:  Late (31 days to two years) mortality and odds of death at various intervals.

RESULTS:  Sepsis was associated with a 22.1% (95% confidence interval 17.5% to 26.7%) absolute increase in late mortality relative to adults not in hospital, a 10.4% (5.4% to 15.4%) absolute increase relative to patients admitted with non-sepsis infection, and a 16.2% (10.2% to 22.2%) absolute increase relative to patients admitted with sterile inflammatory conditions (P<0.001 for each comparison). Mortality remained higher for at least two years relative to adults not in hospital.

CONCLUSIONS:  More than one in five patients who survives sepsis has a late death not explained by health status before sepsis.

VL - 353 UR - https://www.ncbi.nlm.nih.gov/pubmed/27189000 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27189000?dopt=Abstract ER - TY - JOUR T1 - Life Course Pathways to Racial Disparities in Cognitive Impairment among Older Americans. JF - J Health Soc Behav Y1 - 2016 A1 - Zhang, Zhenmei A1 - Mark D Hayward A1 - Yu, Yan-Liang KW - African Continental Ancestry Group KW - Aged KW - Aged, 80 and over KW - Aging KW - Cognitive Dysfunction KW - European Continental Ancestry Group KW - Female KW - Health Status Disparities KW - Humans KW - Male KW - Neuropsychological tests KW - Risk Factors KW - Severity of Illness Index KW - United States AB -

Blacks are especially hard hit by cognitive impairment at older ages compared to whites. Here, we take advantage of the Health and Retirement Study (1998-2010) to assess how this racial divide in cognitive impairment is associated with the racial stratification of life course exposures and resources over a 12-year period among 8,946 non-Hispanic whites and blacks ages 65 and older in 1998. We find that blacks suffer from a higher risk of moderate/severe cognitive impairment at baseline and during the follow-up. Blacks are also more likely to report childhood adversity and to have grown up in the segregated South, and these early-life adversities put blacks at a significantly higher risk of cognitive impairment. Adulthood socioeconomic status is strongly associated with the risk of cognitive impairment, net of childhood conditions. However, racial disparities in cognitive impairment, though substantially reduced, are not eliminated when controlling for these life course factors.

VL - 57 UR - http://www.ncbi.nlm.nih.gov/pubmed/27247126 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27247126?dopt=Abstract ER - TY - JOUR T1 - Life Expectancy With and Without Pain in the U.S. Elderly Population. JF - J Gerontol A Biol Sci Med Sci Y1 - 2016 A1 - Zachary Zimmer A1 - Rubin, Sara KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Aging KW - Disabled Persons KW - Female KW - Health Status Indicators KW - Humans KW - Incidence KW - Life Expectancy KW - Life Tables KW - Male KW - Middle Aged KW - pain KW - Quality of Life KW - Risk Factors KW - Surveys and Questionnaires KW - United States AB -

BACKGROUND: This study contributes to dialogue on quality versus quantity of life by examining years older persons can expect to live in various states of pain.

METHODS: Data from seven waves of the Health and Retirement Study; N = 26,896; age 55+. Estimations using the Interpolative Markov Chain approach apply probability transitions to multistate life table functions. Two estimates are interpreted: (i) population-based, which provide population averages aggregated across baseline states and (ii) status-based, which provide independent estimates by baseline state. Age- and sex-specific years with no pain, milder nonlimiting, and severe or limiting pain are reported as is percent of life in states of pain.

RESULTS: Females have higher life expectancy than males but similar expectations of pain-free life. Total life expectancy varies only slightly by baseline pain states but pain-free life expectancy varies greatly. For example, an 85-year-old female pain-free at baseline expects 7.04 more years, 5.28 being pain-free. An 85-year-old female with severe pain at baseline expects 6.42 years with only 2.66 pain-free. Percent of life with pain decreases by age for those pain-free at baseline and increases for those with pain at baseline.

CONCLUSION: Pain is moderately associated with quantity of or total life but substantially and importantly associated with quality of or pain-free life.

VL - 71 UR - http://biomedgerontology.oxfordjournals.org/content/early/2016/03/17/gerona.glw028.abstract IS - 9 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26988661?dopt=Abstract U4 - Aging/Longevity/Demography/Health and Retirement Survey/Multistate life tables/Interpolative Markov Chains/Quality of life ER - TY - JOUR T1 - Life Satisfaction and Psychological Well-Being of Older Adults With Cancer Experience: The Role of Optimism and Volunteering. JF - Int J Aging Hum Dev Y1 - 2016 A1 - Jinmoo Heo A1 - Sanghee Chun A1 - Lee, Sunwoo A1 - Kim, Junhyoung KW - Aged KW - Aged, 80 and over KW - Aging KW - Female KW - Humans KW - Male KW - Middle Aged KW - Neoplasms KW - Optimism KW - Personal Satisfaction KW - Volunteers AB -

Promoting health and well-being among individuals of advancing age is a significant issue due to increased incidence of cancer among older adults. This study demonstrates the benefits of expecting positive outcomes and participating in volunteer activities among older adults with cancer. We used a nationally representative sample of 2,670 individuals who have experienced cancer from the 2008 wave of the Health and Retirement Study. We constructed a structural equation model to explore the associations of optimism, volunteerism, life satisfaction, and psychological well-being. The level of optimism was a significant predictor of volunteerism, which in turn affected life satisfaction and psychological well-being. The level of engagement in volunteer activities was found to have significant path coefficients toward both life satisfaction and psychological well-being. Our study provides evidence that older adults who have experienced cancer and maintained a positive outlook on their lives and engaged in personally meaningful activities tended to experience psychological well-being and life satisfaction.

VL - 83 UR - http://www.ncbi.nlm.nih.gov/pubmed/27273518 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27273518?dopt=Abstract ER - TY - JOUR T1 - Lifespan adversity and later adulthood telomere length in the nationally representative US Health and Retirement Study. JF - Proc Natl Acad Sci U S A Y1 - 2016 A1 - Puterman, Eli A1 - Gemmill, Alison A1 - Karasek, Deborah A1 - David R Weir A1 - Nancy E Adler A1 - Aric A Prather A1 - Elissa S Epel KW - Aged KW - Aged, 80 and over KW - Cellular Senescence KW - Female KW - Humans KW - Longevity KW - Male KW - Middle Aged KW - Multivariate Analysis KW - Odds Ratio KW - Public Health Surveillance KW - Risk Factors KW - Stress, Psychological KW - Telomere KW - Telomere Shortening KW - United States AB -

Stress over the lifespan is thought to promote accelerated aging and early disease. Telomere length is a marker of cell aging that appears to be one mediator of this relationship. Telomere length is associated with early adversity and with chronic stressors in adulthood in many studies. Although cumulative lifespan adversity should have bigger impacts than single events, it is also possible that adversity in childhood has larger effects on later life health than adult stressors, as suggested by models of biological embedding in early life. No studies have examined the individual vs. cumulative effects of childhood and adulthood adversities on adult telomere length. Here, we examined the relationship between cumulative childhood and adulthood adversity, adding up a range of severe financial, traumatic, and social exposures, as well as comparing them to each other, in relation to salivary telomere length. We examined 4,598 men and women from the US Health and Retirement Study. Single adversities tended to have nonsignificant relations with telomere length. In adjusted models, lifetime cumulative adversity predicted 6% greater odds of shorter telomere length. This result was mainly due to childhood adversity. In adjusted models for cumulative childhood adversity, the occurrence of each additional childhood event predicted 11% increased odds of having short telomeres. This result appeared mainly because of social/traumatic exposures rather than financial exposures. This study suggests that the shadow of childhood adversity may reach far into later adulthood in part through cellular aging.

VL - 113 UR - http://www.pnas.org/content/113/42/E6335.long IS - 42 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27698131?dopt=Abstract ER - TY - JOUR T1 - Longitudinal Relationships Between Productive Activities and Functional Health in Later Years: A Multivariate Latent Growth Curve Modeling Approach. JF - Int J Aging Hum Dev Y1 - 2016 A1 - Choi, Eunhee A1 - Tang, Fengyan A1 - Turk, Phillip KW - Activities of Daily Living KW - Aged KW - Aging KW - Employment KW - Female KW - Health Status KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Volunteers AB -

This study examined the longitudinal relationships between functional health in later years and three types of productive activities: volunteering, full-time, and part-time work. Using the data from five waves (2000-2008) of the Health and Retirement Study, we applied multivariate latent growth curve modeling to examine the longitudinal relationships among individuals 50 or over. Functional health was measured by limitations in activities of daily living. Individuals who volunteered, worked either full time or part time exhibited a slower decline in functional health than nonparticipants. Significant associations were also found between initial functional health and longitudinal changes in productive activity participation. This study provides additional support for the benefits of productive activities later in life; engagement in volunteering and employment are indeed associated with better functional health in middle and old age.

VL - 83 UR - http://ahd.sagepub.com/content/early/2016/07/21/0091415016657557.long IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27461262?dopt=Abstract ER - TY - JOUR T1 - The Long-Term Benefits of Increased Aspirin Use by At-Risk Americans Aged 50 and Older. JF - PLoS One Y1 - 2016 A1 - David B. Agus A1 - Gaudette, Étienne A1 - Dana P Goldman A1 - Messali, Andrew ED - Song, Qing KW - Aged KW - Aged, 80 and over KW - Anti-Inflammatory Agents, Non-Steroidal KW - Aspirin KW - Cardiovascular Diseases KW - Female KW - Humans KW - Incidence KW - Life Expectancy KW - Male KW - Middle Aged KW - Nutrition Surveys KW - Primary Prevention KW - Quality-Adjusted Life Years KW - Risk Assessment KW - United States AB -

BACKGROUND: The usefulness of aspirin to defend against cardiovascular disease in both primary and secondary settings is well recognized by the medical profession. Multiple studies also have found that daily aspirin significantly reduces cancer incidence and mortality. Despite these proven health benefits, aspirin use remains low among populations targeted by cardiovascular prevention guidelines. This article seeks to determine the long-term economic and population-health impact of broader use of aspirin by older Americans at higher risk for cardiovascular disease.

METHODS AND FINDINGS: We employ the Future Elderly Model, a dynamic microsimulation that follows Americans aged 50 and older, to project their lifetime health and spending under the status quo and in various scenarios of expanded aspirin use. The model is based primarily on data from the Health and Retirement Study, a large, representative, national survey that has been ongoing for more than two decades. Outcomes are chosen to provide a broad perspective of the individual and societal impacts of the interventions and include: heart disease, stroke, cancer, life expectancy, quality-adjusted life expectancy, disability-free life expectancy, and medical costs. Eligibility for increased aspirin use in simulations is based on the 2011-2012 questionnaire on preventive aspirin use of the National Health and Nutrition Examination Survey. These data reveal a large unmet need for daily aspirin, with over 40% of men and 10% of women aged 50 to 79 presenting high cardiovascular risk but not taking aspirin. We estimate that increased use by high-risk older Americans would improve national life expectancy at age 50 by 0.28 years (95% CI 0.08-0.50) and would add 900,000 people (95% CI 300,000-1,400,000) to the American population by 2036. After valuing the quality-adjusted life-years appropriately, Americans could expect $692 billion (95% CI 345-975) in net health benefits over that period.

CONCLUSIONS: Expanded use of aspirin by older Americans with elevated risk of cardiovascular disease could generate substantial population health benefits over the next twenty years and do so very cost-effectively.

VL - 11 UR - http://dx.plos.org/10.1371/journal.pone.0166103 IS - 11 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27902693?dopt=Abstract JO - PLoS ONE ER - TY - JOUR T1 - The Long-Term Consequences of Vietnam-Era Conscription and Genotype on Smoking Behavior and Health. JF - Behav Genet Y1 - 2016 A1 - Lauren L Schmitz A1 - Dalton C Conley KW - Adult KW - Aged KW - Female KW - Gene-Environment Interaction KW - Genetic Predisposition to Disease KW - Genotype KW - Humans KW - Male KW - Middle Aged KW - Risk Factors KW - Smoking KW - Tobacco Use Disorder KW - Veterans KW - Vietnam Conflict AB -

Research is needed to understand the extent to which environmental factors moderate links between genetic risk and the development of smoking behaviors. The Vietnam-era draft lottery offers a unique opportunity to investigate whether genetic susceptibility to smoking is influenced by risky environments in young adulthood. Access to free or reduced-price cigarettes coupled with the stress of military life meant conscripts were exposed to a large, exogenous shock to smoking behavior at a young age. Using data from the Health and Retirement Study (HRS), we interact a genetic risk score for smoking initiation with instrumented veteran status in an instrumental variables (IV) framework to test for genetic moderation (i.e. heterogeneous treatment effects) of veteran status on smoking behavior and smoking-related morbidities. We find evidence that veterans with a high genetic predisposition for smoking were more likely to have been smokers, smoke heavily, and are at a higher risk of being diagnosed with cancer or hypertension at older ages. Smoking behavior was significantly attenuated for high-risk veterans who attended college after the war, indicating post-service schooling gains from veterans' use of the GI Bill may have reduced tobacco consumption in adulthood.

VL - 46 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26341507?dopt=Abstract ER - TY - JOUR T1 - Management of diabetes mellitus in older people with comorbidities. JF - BMJ Y1 - 2016 A1 - Huang, Elbert S KW - Aged KW - Aging KW - Blood Glucose KW - Comorbidity KW - Diabetes Mellitus, Type 2 KW - Disease Management KW - Female KW - Glycemic Index KW - Guidelines as Topic KW - Health Services Needs and Demand KW - Humans KW - Hypoglycemic Agents KW - Male KW - Precision Medicine KW - Quality of Life AB -

Diabetes mellitus is a chronic disease of aging that affects more than 20% of people over 65. In older patients with diabetes, comorbidities are highly prevalent and their presence may alter the relative importance, effectiveness, and safety of treatments for diabetes. Randomized controlled trials have shown that intensive glucose control produces microvascular and cardiovascular benefits but typically after extended treatment periods (five to nine years) and with exposure to short term risks such as mortality (in one trial) and hypoglycemia. Decision analysis, health economics, and observational studies have helped to illustrate the importance of acknowledging life expectancy, hypoglycemia, and treatment burden when setting goals in diabetes. Guidelines recommend that physicians individualize the intensity of glucose control and treatments on the basis of the prognosis (for example, three tiers based on comorbidities and functional impairments) and preferences of individual patients. Very few studies have attempted to formally implement and study these concepts in clinical practice. To better meet the treatment needs of older patients with diabetes and comorbidities, more research is needed to determine the risks and benefits of intensifying, maintaining, or de-intensifying treatments in this population. This research effort should extend to the development and study of decision support tools as well as targeted care management.

VL - 353 UR - https://www.ncbi.nlm.nih.gov/pubmed/27307175 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27307175?dopt=Abstract 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 - Marital history and survival after a heart attack. JF - Soc Sci Med Y1 - 2016 A1 - Matthew E Dupre A1 - Nelson, Alicia KW - Aged KW - Aged, 80 and over KW - Cohort Studies KW - Divorce KW - Female KW - Humans KW - Male KW - Marital Status KW - Myocardial Infarction KW - Prospective Studies KW - Retrospective Studies KW - Single Person KW - Spouses KW - Survivors KW - United States KW - Widowhood AB -

Heart disease is the leading cause of death in the United States and nearly one million Americans will have a heart attack this year. Although the risks associated with a heart attack are well established, we know surprisingly little about how marital factors contribute to survival in adults afflicted with heart disease. This study uses a life course perspective and longitudinal data from the Health and Retirement Study to examine how various dimensions of marital life influence survival in U.S. older adults who suffered a heart attack (n = 2197). We found that adults who were never married (odds ratio [OR] = 1.73), currently divorced (OR = 1.70), or widowed (OR = 1.34) were at significantly greater risk of dying after a heart attack than adults who were continuously married; and the risks were not uniform over time. We also found that the risk of dying increased by 12% for every additional marital loss and decreased by 7% for every one-tenth increase in the proportion of years married. After accounting for more than a dozen socioeconomic, psychosocial, behavioral, and physiological factors, we found that current marital status remained the most robust indicator of survival following a heart attack. The implications of the findings are discussed in the context of life course inequalities in chronic disease and directions for future research.

VL - 170 UR - http://www.sciencedirect.com/science/article/pii/S0277953616305810 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27770749?dopt=Abstract ER - TY - JOUR T1 - Marital quality, marital dissolution, and mortality risk during the later life course. JF - Soc Sci Med Y1 - 2016 A1 - Jennifer R. Bulanda A1 - J Scott Brown A1 - Takashi Yamashita KW - Aged KW - Aged, 80 and over KW - Female KW - Humans KW - Male KW - Marital Status KW - Marriage KW - Middle Aged KW - Mortality KW - Retirement KW - Sex Factors AB -

This study examines the relationship between later-life marital quality, marital dissolution, and mortality using discrete-time event history models with data from nine waves (1992-2008) of the Health and Retirement Study (n = 7388). Results show marital status is more important for men's mortality risk than women's, whereas marital quality is more important for women's survival than men's. Being widowed or divorced more than two years raises mortality risk for men, but later-life marital dissolution is not significantly associated with women's mortality risk, regardless of the type of dissolution or length of time since it occurred. Low-quality marital interaction is negatively related to women's odds of death, but none of the marital quality measures are significantly associated with mortality for men. Marital satisfaction moderates the relationship between widowhood and mortality for women, but the relationship between marital dissolution and mortality is similar for men regardless of marital quality prior to divorce/widowhood. Results suggest the importance of accounting for both marital status and marital quality when examining older individuals' mortality risk.

VL - 165 UR - http://www.sciencedirect.com/science/article/pii/S0277953616303860 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27509579?dopt=Abstract ER - TY - JOUR T1 - Methodological Aspects of Subjective Life Expectancy: Effects of Culture-Specific Reporting Heterogeneity Among Older Adults in the United States. JF - The Journals of Gerontology: Series B Y1 - 2016 A1 - Lee, Sunghee A1 - Jacqui Smith KW - Aged KW - Aged, 80 and over KW - Bias KW - Cross-Cultural Comparison KW - Cross-Sectional Studies KW - Diagnostic Self Evaluation KW - Ethnic Groups KW - Female KW - Frail Elderly KW - Humans KW - Language KW - Life Expectancy KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Self Report KW - United States AB -

OBJECTIVES: Subjective life expectancy (SLE) has been suggested as a predictor of mortality and mortality-related behaviors. Although critical for culturally diverse societies, these findings do not consider cross-cultural methodological comparability. Culture-specific reporting heterogeneity is a well-known phenomenon introducing biases, and research on this issue with SLE is not established.

METHOD: Using data from the Health and Retirement Study, we examined reporting heterogeneity in SLE focusing on item nonresponse, focal points, and reports over time for five ethnic-cultural groups: non-Hispanic Whites, non-Hispanic Blacks, non-Hispanic other races, English-interviewed Hispanics, and Spanish-interviewed Hispanics.

RESULTS: On item nonresponse, Spanish-interviewed Hispanics said, "I don't know," to SLE significantly more than any other groups. Nearly half of the respondents chose 0, 50, or 100, making them focal points. However, the focal points differed: 50 for Whites, 100 for Blacks, and 0 for Spanish-interviewed Hispanics. The relationship of SLE measured at two time points was higher for Whites than minorities. Moreover, those who said "I don't know" to SLE showed higher subsequent mortality than those who gave an answer. SLE was not a significant mortality predictor for Hispanics.

DISCUSSION: Overall, SLE is not free from culture-specific reporting heterogeneity. This warrants further research about its culture-relevant measurement mechanisms.

PB - 71 VL - 71 IS - 3 U4 - Mortality predictions/Nonresponse/Racial and ethnic minorities/Reporting heterogeneity/Subjective life expectancy 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 - Multimorbidity is associated with anxiety in older adults in the Health and Retirement Study. JF - Int J Geriatr Psychiatry Y1 - 2016 A1 - Christine E Gould A1 - Ruth O'Hara A1 - Mary K. Goldstein A1 - Sherry A. Beaudreau KW - Aged KW - Aged, 80 and over KW - Anxiety Disorders KW - Chronic disease KW - Depressive Disorder KW - Female KW - Humans KW - Logistic Models KW - Male KW - multimorbidity KW - Retirement KW - United States AB -

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

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

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

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

VL - 31 UR - https://www.ncbi.nlm.nih.gov/pubmed/27441851 IS - 10 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27441851?dopt=Abstract ER - TY - JOUR T1 - Neighborhood Support and Aging-in-Place Preference Among Low-Income Elderly Chinese City-Dwellers. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2016 A1 - Terry Y S Lum A1 - Vivian W Q Lou A1 - Chen, Yanyan A1 - Wong, Gloria A1 - Luo, Hao A1 - Tracy Tong KW - Aged KW - Aged, 80 and over KW - Aging KW - Asian Continental Ancestry Group KW - Female KW - Hong Kong KW - Humans KW - Independent Living KW - Interview, Psychological KW - Male KW - Middle Aged KW - Poverty KW - Quality of Life KW - Residence Characteristics KW - Social Support KW - Urban Population AB -

OBJECTIVES: Preferences for aging-in-place are unclear among low-income elderly Chinese city-dwellers, who are more likely to be geographically bound, to have little care support, but possess strong filial values and family cohesiveness. This study investigated the preferences for aging-in-place and its contributing neighborhood factors among low-income Chinese elderly in a metropolitan city.

METHOD: We conducted interviews with 400 older people residing in public housing estates in Hong Kong.

RESULTS: The majority of low-income elderly persons (80.4%) prefer to age in place even if their health and functioning has deteriorated beyond independent living. Logistic regression showed that (a) having very low income (

DISCUSSION: Low-income elderly Chinese city-dwellers prefer to age in place, given appropriate neighborhood support. These findings can be interpreted in light of Lawton's ecological theory of aging and suggest a service model similar to the Naturally Occurring Retirement Community with Supportive Service Programs.

VL - 71 UR - http://www.ncbi.nlm.nih.gov/pubmed/25384636 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25384636?dopt=Abstract U4 - Aged Aged, 80 and over Aging/psychology Asian Continental Ancestry Group/psychology Female Hong Kong Humans *Independent Living/psychology/statistics & numerical data Interview, Psychological Male Middle Aged *Poverty/psychology/statistics & numerical data *Quality of Life *Residence Characteristics *Social Support Urban Population ER - TY - JOUR T1 - Neuroimaging overuse is more common in Medicare compared with the VA. JF - Neurology Y1 - 2016 A1 - James F. Burke A1 - Eve A Kerr A1 - Ryan J McCammon A1 - Holleman, Rob A1 - Kenneth M. Langa A1 - Brian C. Callaghan KW - Aged KW - Aged, 80 and over KW - Cohort Studies KW - Female KW - Headache Disorders, Primary KW - Humans KW - Male KW - Medicare KW - Neuroimaging KW - Peripheral Nervous System Diseases KW - United States KW - United States Department of Veterans Affairs KW - Unnecessary Procedures AB -

OBJECTIVE: To inform initiatives to reduce overuse, we compared neuroimaging appropriateness in a large Medicare cohort with a Department of Veterans Affairs (VA) cohort.

METHODS: Separate retrospective cohorts were established in Medicare and in VA for headache and neuropathy from 2004 to 2011. The Medicare cohorts included all patients enrolled in the Health and Retirement Study (HRS) with linked Medicare claims (HRS-Medicare; n = 1,244 for headache and 998 for neuropathy). The VA cohorts included all patients receiving services in the VA (n = 93,755 for headache and 183,642 for neuropathy). Inclusion criteria were age over 65 years and an outpatient visit for incident neuropathy or a primary headache. Neuroimaging use was measured with Current Procedural Terminology codes and potential overuse was defined using published criteria for use with administrative data. Increasingly specific appropriateness criteria excluded nontarget conditions for which neuroimaging may be appropriate.

RESULTS: For both peripheral neuropathy and headache, potentially inappropriate imaging was more common in HRS-Medicare compared with the VA. Forty-nine percentage of all headache patients received neuroimaging in HRS-Medicare compared with 22.1% in the VA (p < 0.001) and differences persist when analyzing more specific definitions of overuse. A total of 23.7% of all HRS-Medicare incident neuropathy patients received neuroimaging compared with 9.0% in the VA (p < 0.001), and the difference persisted after excluding nontarget conditions.

CONCLUSIONS: Overuse of neuroimaging is likely less common in the VA than in a Medicare population. Better understanding the reasons for the more selective use of neuroimaging in the VA could help inform future initiatives to reduce overuse of diagnostic testing.

VL - 87 UR - http://www.ncbi.nlm.nih.gov/pubmed/27402889 IS - 8 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27402889?dopt=Abstract ER - TY - JOUR T1 - Older adults with poor self-rated memory have less depressive symptoms and better memory performance when perceived self-efficacy is high. JF - Int J Geriatr Psychiatry Y1 - 2016 A1 - O'Shea, Deirdre M A1 - Vonetta M Dotson A1 - Fieo, Robert A A1 - Tsapanou, Angeliki A1 - Laura B Zahodne A1 - Stern, Yaakov KW - Aged KW - Aged, 80 and over KW - depression KW - Female KW - Humans KW - Male KW - Memory KW - Middle Aged KW - Regression Analysis KW - Self Efficacy KW - Surveys and Questionnaires AB -

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

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

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

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

VL - 31 UR - http://www.ncbi.nlm.nih.gov/pubmed/26679474 IS - 7 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26679474?dopt=Abstract U4 - Depression Depressive symptoms Self-rated memory Memory Self-efficacy ER - TY - JOUR T1 - One-Year Mortality After Hip Fracture: Development and Validation of a Prognostic Index. JF - J Am Geriatr Soc Y1 - 2016 A1 - Irena Cenzer A1 - Victoria L. Tang A1 - W John Boscardin A1 - Christine S Ritchie A1 - Margaret Wallhagen A1 - Espaldon, Roxanne A1 - Kenneth E Covinsky KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Cause of Death KW - Cohort Studies KW - Comorbidity KW - Disability Evaluation KW - Female KW - Hip Fractures KW - Humans KW - Incidence KW - Longitudinal Studies KW - Male KW - Prognosis KW - Retrospective Studies KW - Risk Assessment KW - Survival Analysis KW - United States AB -

OBJECTIVES: To develop a prediction index for 1-year mortality after hip fracture in older adults that includes predictors from a wide range of domains.

DESIGN: Retrospective cohort study.

SETTINGS: Health and Retirement Study (HRS).

PARTICIPANTS: HRS participants who experienced hip fracture between 1992 and 2010 as identified according to Medicare claims data (N = 857).

MEASUREMENTS: Outcome measure was death within 1 year of hip fracture. Predictor measures were participant demographic characteristics, socioeconomic status, social support, health, geriatric symptoms, and function. Variables independently associated with 1-year mortality were identified, and best-subsets regression was used to identify the final model. The selected variables were weighted to create a risk index. The index was internally validated using bootstrapping to estimate model optimism.

RESULTS: Mean age at time of hip fracture was 84, and 76% of the participants were women. There were 235 deaths (27%) during the 1-year follow up. Five predictors of mortality were included in the final model: aged 90 and older (2 points), male sex (2 points), congestive heart failure (2 points), difficulty preparing meals (2 points), and not being able to drive (1 point). The point scores of the index were associated with 1-year mortality, with 0 points predicting 10% risk and 7 to 9 points predicting 66% risk. The c-statistic for the final model was 0.73, with an estimated optimism penalty of 0.01, indicating very little evidence of overfitting.

CONCLUSION: The prognostic index combines demographic, comorbidity, and function variables and can be used to differentiate between individuals at low and high risk of 1-year mortality after hip fracture.

VL - 64 UR - http://www.ncbi.nlm.nih.gov/pubmed/27295578 IS - 9 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27295578?dopt=Abstract ER - TY - JOUR T1 - The Paradox of Leisure in Later Life. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2016 A1 - Nimrod, Galit A1 - Amit Shrira KW - Adaptation, Psychological KW - Aged KW - Aging KW - Cognition KW - Europe KW - Female KW - Health Status Disparities KW - Humans KW - Leisure activities KW - Male KW - Middle Aged KW - Quality of Life KW - Resilience, Psychological KW - Retirement KW - Socioeconomic factors KW - Surveys and Questionnaires AB -

OBJECTIVE: Numerous studies have shown that involvement in leisure activity has a significant impact on older adults' physical, psychological, social, and spiritual well-being. This study explores whether the association between leisure involvement and well-being in later life changes over time.

METHOD: Data were drawn from the first 4 waves of the Survey of Health, Ageing, and Retirement in Europe (SHARE). Growth curve models were applied to examine whether leisure moderated change in quality of life (QoL) over time among 7,875 retirees aged 60 and older.

RESULTS: Findings indicated that the association between leisure and QoL increased with time, as nonactive respondents displayed a decline in QoL over time, whereas those with high levels of leisure involvement showed an increase. Findings remained significant after controlling for sociodemographics, health, and cognitive functioning.

DISCUSSION: Results indicated that the significance of leisure to well-being increases throughout the later life course, and that leisure may act as a resource for resilience in old age. They also pointed out a paradoxical situation in which the older seniors, who may benefit from leisure involvement more than their younger peers, are precisely the ones who face the greater number of constraints to beneficial use of leisure.

VL - 71 UR - http://www.ncbi.nlm.nih.gov/pubmed/25315158 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25315158?dopt=Abstract U4 - Adaptation, Psychological Aged *Aging/physiology/psychology *Cognition Europe Female *Health Status Disparities Humans Leisure Activities/*psychology Male Middle Aged Quality of Life/*psychology *Resilience, Psychological Retirement/*psychology Socioeconomic Factors Surveys and Questionnaires ER - TY - JOUR T1 - Personality trait development at the end of life: Antecedents and correlates of mean-level trajectories. JF - J Pers Soc Psychol Y1 - 2016 A1 - Wagner, Jenny A1 - Ram, Nilam A1 - Jacqui Smith A1 - Denis Gerstorf KW - Aged KW - Aged, 80 and over KW - Aging KW - Anxiety Disorders KW - Berlin KW - Extraversion, Psychological KW - Female KW - Health Status KW - Human Development KW - Humans KW - Internal-External Control KW - Longitudinal Studies KW - Male KW - Neuroticism KW - Personality KW - Social Support AB -

Empirical evidence over the past 20 years has documented that key aspects of personality traits change during adulthood. However, it is essentially an open question whether and how traits change at the very end of life and what role health, cognitive performance, perceived control, and social factors play in those changes. To examine these questions, we applied growth models to 13-year longitudinal data obtained from now-deceased participants in the Berlin Aging Study (N = 463; age at baseline M = 85.9 years, SD = 8.4; 51% men). Results revealed that neuroticism, on average, increases (about 0.3 SD in the last 10 years) and that this increase becomes even steeper at the end of life. In contrast, extraversion and openness decline rather steadily at the end of life (about -0.5 SD in the last 10 years). Additionally, poor health manifested as a risk factor for declines in extraversion and openness late in life but not neuroticism. Similar to earlier phases of life, better cognitive performance related to more openness. More loneliness was associated with higher neuroticism, whereas more social activity was associated with higher levels of extraversion and openness. Intriguing additional insights indicated that more personal control was associated with higher levels of extraversion and openness, whereas the feeling that one's life is controlled by others was associated with higher neuroticism but also with higher openness closer to death. We discuss potential pathways by which health, cognitive performance, control, and social inclusion resources and risk factors affect personality development late in life. (PsycINFO Database Record

VL - 111 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26479363?dopt=Abstract ER - TY - JOUR T1 - Physical and/or Cognitive Impairment, Out-of-Pocket Spending, and Medicaid Entry among Older Adults. JF - J Urban Health Y1 - 2016 A1 - Willink, Amber A1 - Davis, Karen A1 - Schoen, Cathy A1 - Jennifer L. Wolff KW - Aged KW - Cognitive Dysfunction KW - Delivery of Health Care KW - Disabled Persons KW - Eligibility Determination KW - Female KW - Financing, Personal KW - Humans KW - Insurance Coverage KW - Insurance, Health KW - Male KW - Medicaid KW - Middle Aged KW - United States AB -

While Medicare provides health insurance coverage for those over 65 years of age, many still are underinsured, experiencing substantial out-of-pocket costs for covered and non-covered services as a proportion of their income. Using the Health and Retirement Study (HRS), this study found that being underinsured is a significant predictor of entering into Medicaid coverage over a 16-year period. The rate of entering Medicaid was almost twice as high for those who were underinsured and with physical and/or cognitive impairment than those who were not, while supplemental health insurance reduced the rate of entering Medicaid by 30 %. Providing more comprehensive coverage through the traditional Medicare program, including a ceiling on out-of-pocket expenditures or targeted support for those with physical or cognitive impairment, could postpone becoming covered by Medicaid and yield savings in Medicaid.

VL - 93 UR - https://link.springer.com/article/10.1007%2Fs11524-016-0078-1 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27653385?dopt=Abstract ER - TY - JOUR T1 - Physical, Cognitive, Social, and Emotional Mediators of Activity Involvement and Health in Later Life. JF - Res Aging Y1 - 2016 A1 - Matz-Costa, Christina A1 - Dawn C Carr A1 - Tay K. McNamara A1 - Jacquelyn Boone James KW - Aged KW - depression KW - Efficiency KW - Employment KW - Exercise KW - Female KW - Health Status KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Quality of Life KW - Volunteers AB -

The current study tests the indirect effect of activity-related physical activity, cognitive activity, social interaction, and emotional exchange on the relationship between activity involvement and health (physical and emotional) in later life. Longitudinal data from the Health and Retirement Study (N = 5,442) were used to estimate a series of linear regression models. We found significant indirect effects for social interaction and benefit to others (emotional exchange) on emotional health (depressive symptoms) and indirect effects for use of body and benefit to others (physical) on physical health (frailty). The most potent indirect effect associated with emotional and physical health was experienced by those engaged in all four domains (use of body, use of mind, social interaction, and benefit to others). While effect sizes are small and results should be interpreted with caution, findings shed light on ways in which public health interventions aimed toward increasing role engagement in later life could be improved.

VL - 38 UR - http://roa.sagepub.com/content/early/2015/09/30/0164027515606182.abstract IS - 7 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26429863?dopt=Abstract U4 - activity levels/productivity/employment/volunteer activity/health outcomes ER - TY - JOUR T1 - A pilot study among older adults of the concordance between their self-reports to a health survey and spousal proxy reports on their behalf. JF - BMC Health Serv Res Y1 - 2016 A1 - Frederic D Wolinsky A1 - Ayres, Lioness A1 - Michael P Jones A1 - Yiyue Lou A1 - George L Wehby A1 - Fred A Ullrich KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Epidemiologic Methods KW - Female KW - Health Status KW - Hospitalization KW - Humans KW - Iowa KW - Male KW - Medicare KW - Middle Aged KW - Patient Acceptance of Health Care KW - Physicians KW - Proxy KW - Spouses KW - United States AB -

BACKGROUND: Proxy respondents are frequently used in health surveys, and the proxy is most often the spouse. Longstanding concerns linger, however, about the validity of using spousal proxies, especially for older adults. The purpose of this pilot study was to evaluate the concordance between self-reports and spousal proxy reports to a standard health survey in a small convenience sample of older married couples.

METHODS: We used the Seniors Together in Aging Research (STAR) volunteer registry at the University of Iowa to identify and consent a cross-sectional, convenience sample of 28 married husband and wife couples. Private, personal interviews with each member of the married couple using a detailed health survey based on the 2012 Health and Retirement Study (HRS) instrument were conducted using computer assisted personal interviewing software. Within couples, each wife completed the health survey first for herself and then for her husband, and each husband completed the health survey first for himself and then for his wife. The health survey topics included health ratings, health conditions, mobility, instrumental activities of daily living (IADLs), health services use, and preventative services. Percent of agreement and prevalence and bias adjusted kappa statistics (PABAKs) were used to evaluate concordance.

RESULTS: PABAK coefficients indicated moderate to excellent concordance (PABAKs >0.60) for most of the IADL, health condition, hospitalization, surgery, preventative service, and mobility questions, but only slight to fair concordance (PABAKs = -0.21 to 0.60) for health ratings, and physician and dental visits.

CONCLUSIONS: These results do not allay longstanding concerns about the validity of routinely using spousal proxies in health surveys to obtain health ratings or the number of physician and dental visits among older adults. Further research is needed in a nationally representative sample of older couples in which each wife completes the health survey first for herself and then for her husband, each husband completes the health survey first for himself and then for his wife, and both spouses' Medicare claims are linked to their health survey responses to determine not just the concordance between spousal reports, but the concordance of those survey responses to the medical record.

VL - 16 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27612571?dopt=Abstract ER - TY - JOUR T1 - Predictors of bone mineral density testing among older women on Medicare. JF - Osteoporos Int Y1 - 2016 A1 - Yiyue Lou A1 - Edmonds, S. W. A1 - Michael P Jones A1 - Fred A Ullrich A1 - George L Wehby A1 - Cram, P. A1 - Frederic D Wolinsky KW - Absorptiometry, Photon KW - Aged KW - Bone density KW - Delivery of Health Care KW - Female KW - Humans KW - Medicare KW - Osteoporosis KW - Prospective Studies KW - United States AB -

Although dual-energy X-ray absorptiometry (DXA) is recommended for all women ≥65 and is covered by Medicare, 40 % of women on Medicare report never having had a DXA. In a longitudinal cohort of 3492 women followed for two decades, we identified several risk factors that should be targeted to improve DXA testing rates.

INTRODUCTION: DXA is used to measure bone mineral density, screen for osteoporosis, and assess fracture risk. DXA is recommended for all women ≥65 years old. Although Medicare covers DXA every 24 months for women, about 40 % report never having had a DXA test, and little is known from prospective cohort studies about which subgroups of women have low use rates and should be targeted for interventions. Our objective was to identify predictors of DXA use in a nationally representative cohort of women on Medicare.

METHODS: We used baseline and biennial follow-up survey data (1993-2012) for 3492 women ≥70 years old from the nationally representative closed cohort known as the Survey on Assets and Health Dynamics among the Oldest Old (AHEAD). The survey data for these women were then linked to their Medicare claims (1991-2012), yielding 17,345 person years of observation. DXA tests were identified from the Medicare claims, and Cox proportional hazard regression models were used with both fixed and time-dependent predictors from the survey interviews including demographic characteristics, socioeconomic factors, health status, health habits, and the living environment.

RESULTS: DXA use was positively associated with being Hispanic American, better cognition, higher income, having arthritis, using other preventative services, and living in Florida or other southern states. DXA use was negatively associated with age, being African-American, being overweight or obese, having mobility limitations, and smoking.

CONCLUSIONS: Interventions to increase DXA use should target the characteristics that were observed here to be negatively associated with such screening.

VL - 27 UR - http://link.springer.com/10.1007/s00198-016-3688-2 IS - 12 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27358177?dopt=Abstract JO - Osteoporos Int ER - TY - JOUR T1 - Prevalence and Outcomes of Breathlessness in Older Adults: A National Population Study. JF - J Am Geriatr Soc Y1 - 2016 A1 - David C. Currow A1 - Amy P Abernethy A1 - Miriam J Johnson A1 - Yinghui Miao A1 - W John Boscardin A1 - Christine S Ritchie KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Anxiety KW - Chronic disease KW - Comorbidity KW - depression KW - Dyspnea KW - Female KW - Geriatric Assessment KW - Hospitalization KW - Humans KW - Male KW - Prevalence KW - Proportional Hazards Models KW - Risk Assessment KW - Risk Factors KW - Symptom Assessment KW - United States AB -

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

SETTING: Community-dwelling older adults.

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

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

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

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

VL - 64 IS - 10 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27603500?dopt=Abstract ER - TY - JOUR T1 - Prevalence of weakness and its relationship with limitations based on the Foundations for the National Institutes for Health project: data from the Health and Retirement Study. JF - Eur J Clin Nutr Y1 - 2016 A1 - John A. Batsis A1 - Cassandra M Germain A1 - Elizabeth Vasquez A1 - Bartels, S. J. KW - Activities of Daily Living KW - Aged KW - Aging KW - Cross-Sectional Studies KW - Databases, Factual KW - Female KW - Humans KW - Male KW - Middle Aged KW - Muscle Weakness KW - National Institutes of Health (U.S.) KW - Retirement KW - sarcopenia KW - Surveys and Questionnaires KW - United States AB -

BACKGROUND/OBJECTIVES: The objectives of this study were to determine the prevalence of muscle weakness using the two 2014 Foundation for the National Institutes of Health (FNIH) Sarcopenia Project criteria and its relationship with physical limitations, basic activities of daily living (ADL) and instrumental ADL.

SUBJECTS/METHODS: We performed a cross-sectional analysis of community-dwelling adults from the Health and Retirement Study 2006-2008 and identified a subsample of 5092 adults aged ⩾60 years with grip strength (GS) data. Self-reported physical limitations, basic ADL and instrumental ADL were assessed. Criteria for GS (men<26 kg; women <16 kg) and GS adjusted for body mass index (GS/BMI; men <1.0; women <0.56) were applied to the sample. We determined the prevalence of muscle weakness in each sex. Multivariable logistic regression was used to calculate the association of physical limitations, basic ADL and instrument ADL with weakness definitions in each sex.

RESULTS: Mean age was 72.1 years (54.9% female). Mean GS was 38.3 and 22.9 kg and mean BMI was 29 kg/m, respectively, in men and women. Weakness prevalence using GS and GS:BMI definitions were 7.8 and 15.2 (P<0.001), respectively, in men and 11.4 and 13.3% (P=0.04) in women. Overall prevalence of physical limitations, basic ADL limitations and instrumental ADL limitations was 52.9, 28.1 and 35.9%, respectively. In those with weakness, prevalence of physical limitations, basic ADL and instrumental ADL was 78.5, 42.3 and 65.3%, respectively, using the GS definition, and 79.7, 40.7 and 58.8%, respectively, using the GS/BMI definition. GS and the GS/BMI definitions of weakness were strongly associated with physical limitations (odds ratio (OR) 2.19 (95% confidence interval (CI): (1.67-2.87)) and 2.52 (2.01-3.17)), basic ADL (OR 1.59 (1.22-2.07) and 1.66 (1.32-2.07)) and instrumental ADLs (OR 1.98 (1.28-2.54) and 1.78 (1.44-2.20)).

CONCLUSIONS: The new FNIH guidelines for weakness are associated with higher prevalence of physical limitations, basic ADL impairments and instrumental ADL impairments as compared with individuals without weakness.

VL - 70 UR - http://www.ncbi.nlm.nih.gov/pubmed/27245209 IS - 10 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27245209?dopt=Abstract ER - TY - JOUR T1 - Promoting and Protecting Against Stigma in Assisted Living and Nursing Homes. JF - Gerontologist Y1 - 2016 A1 - Zimmerman, Sheryl A1 - Dobbs, Debra A1 - Roth, Erin G A1 - Goldman, Susan A1 - Peeples, Amanda D A1 - Wallace, Brandy KW - Aged KW - Aged, 80 and over KW - Aging KW - Anthropology, Cultural KW - Assisted Living Facilities KW - Attitude of Health Personnel KW - Female KW - Humans KW - Male KW - Nursing homes KW - Prejudice KW - Social Stigma AB -

PURPOSE OF THE STUDY: To determine the extent to which structures and processes of care in multilevel settings (independent living, assisted living, and nursing homes) result in stigma in assisted living and nursing homes.

DESIGN AND METHODS: Ethnographic in-depth interviews were conducted in 5 multilevel settings with 256 residents, families, and staff members. Qualitative analyses identified the themes that resulted when examining text describing either structures of care or processes of care in relation to 7 codes associated with stigma.

RESULTS: Four themes related to structures of care and stigma were identified, including the physical environment, case mix, staff training, and multilevel settings; five themes related to processes of care and stigma, including dining, independence, respect, privacy, and care provision. For each theme, examples were identified illustrating how structures and processes of care can potentially promote or protect against stigma.

IMPLICATIONS: In no instance were examples or themes identified that suggested the staff intentionally promoted stigma; on the other hand, there was indication that some structures and processes were intentionally in place to protect against stigma. Perhaps the most important theme is the stigma related to multilevel settings, as it has the potential to reduce individuals' likelihood to seek and accept necessary care. Results suggest specific recommendations to modify care and reduce stigma.

VL - 56 UR - http://www.ncbi.nlm.nih.gov/pubmed/24928555 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/24928555?dopt=Abstract U4 - Assisted living, stigma, older adults, independence ER - TY - JOUR T1 - The Protective Effects of Religiosity on Depression: A 2-Year Prospective Study. JF - Gerontologist Y1 - 2016 A1 - Corina R Ronneberg A1 - Edward Alan Miller A1 - Dugan, Elizabeth A1 - Frank Porell KW - Adult KW - Aged KW - Aging KW - depression KW - Depressive Disorder KW - Female KW - Health Surveys KW - Humans KW - Male KW - Middle Aged KW - Prospective Studies KW - Religion KW - Religion and Psychology KW - Social Support KW - Spirituality KW - United States AB -

PURPOSE OF THE STUDY: Approximately 20% of older adults are diagnosed with depression in the United States. Extant research suggests that engagement in religious activity, or religiosity, may serve as a protective factor against depression. This prospective study examines whether religiosity protects against depression and/or aids in recovery.

DESIGN AND METHODS: Study data are drawn from the 2006 and 2008 waves of the Health and Retirement Study. The sample consists of 1,992 depressed and 5,740 nondepressed older adults (mean age = 68.12 years), at baseline (2006), for an overall sample size of 7,732. Logistic regressions analyzed the relationship between organizational (service attendance), nonorganizational (private prayer), and intrinsic measures of religiosity and depression onset (in the baseline nondepressed group) and depression recovery (in the baseline depressed group) at follow-up (2008), controlling for other baseline factors.

RESULTS: Religiosity was found to both protect against and help individuals recover from depression. Individuals not depressed at baseline remained nondepressed 2 years later if they frequently attended religious services, whereas those depressed at baseline were less likely to be depressed at follow-up if they more frequently engaged in private prayer.

IMPLICATIONS: Findings suggest that both organizational and nonorganizational forms of religiosity affect depression outcomes in different circumstances (i.e., onset and recovery, respectively). Important strategies to prevent and relieve depression among older adults may include improving access and transportation to places of worship among those interested in attending services and facilitating discussions about religious activities and beliefs with clinicians.

VL - 56 UR - https://www.ncbi.nlm.nih.gov/pubmed/25063937 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25063937?dopt=Abstract ER - TY - JOUR T1 - Racial and ethnic differences in cognitive function among older adults in the USA. JF - International Journal of Geriatric Psychiatry Y1 - 2016 A1 - Díaz-Venegas, Carlos A1 - Brian Downer A1 - Kenneth M. Langa A1 - Rebeca Wong KW - African Americans KW - Aged KW - Aged, 80 and over KW - Cognition KW - Ethnic Groups KW - European Continental Ancestry Group KW - Female KW - Hispanic Americans KW - Humans KW - Male KW - Middle Aged KW - United States AB -

OBJECTIVE: Examine differences in cognition between Hispanic, non-Hispanic black (NHB), and non-Hispanic white (NHW) older adults in the United States.

DATA/METHODS: The final sample includes 18 982 participants aged 51 or older who received a modified version of the Telephone Interview for Cognitive Status during the 2010 Health and Retirement Study follow-up. Ordinary least squares will be used to examine differences in overall cognition according to race/ethnicity.

RESULTS: Hispanics and NHB had lower cognition than NHW for all age groups (51-59, 60-69, 70-79, 80+). Hispanics had higher cognition than NHB for all age groups but these differences were all within one point. The lower cognition among NHB compared to NHW remained significant after controlling for age, gender, and education, whereas the differences in cognition between Hispanics and NHW were no longer significant after controlling for these covariates. Cognitive scores increased with greater educational attainment for all race/ethnic groups, but Hispanics exhibited the least benefit.

DISCUSSION: Our results highlight the role of education in race/ethnic differences in cognitive function during old age. Education seems beneficial for cognition in old age for all race/ethnic groups, but Hispanics appear to receive a lower benefit compared to other race/ethnic groups. Further research is needed on the racial and ethnic differences in the pathways of the benefits of educational attainment for late-life cognitive function. Copyright © 2016 John Wiley & Sons, Ltd.

VL - 31 IS - 9 U4 - Racial differences Whites Hispanics Non-Hispanic Whites Non-Hispanic Blacks Older Adults Cognitive function ER - TY - JOUR T1 - Racial and Ethnic Differences in End-of-Life Medicare Expenditures. JF - Journal of the American Geriatrics Society Y1 - 2016 A1 - Byhoff, Elena A1 - Tamara B Harris A1 - Kenneth M. Langa A1 - Theodore J Iwashyna KW - African Continental Ancestry Group KW - Aged KW - Aged, 80 and over KW - Cohort Studies KW - Comorbidity KW - Cross-Cultural Comparison KW - Ethnic Groups KW - European Continental Ancestry Group KW - Female KW - Health Care Surveys KW - Health Expenditures KW - Hispanic Americans KW - Humans KW - Life Support Care KW - Longitudinal Studies KW - Male KW - Medicare KW - Rate Setting and Review KW - Social Support KW - Socioeconomic factors KW - Terminal Care KW - United States AB -

OBJECTIVES: To determine to what extent demographic, social support, socioeconomic, geographic, medical, and End-of-Life (EOL) planning factors explain racial and ethnic variation in Medicare spending during the last 6 months of life.

DESIGN: Retrospective cohort study.

SETTING: Health and Retirement Study (HRS).

PARTICIPANTS: Decedents who participated in HRS between 1998 and 2012 and previously consented to survey linkage with Medicare claims (N = 7,105).

MEASUREMENTS: Total Medicare expenditures in the last 180 days of life according to race and ethnicity, controlling for demographic factors, social supports, geography, illness burden, and EOL planning factors, including presence of advance directives, discussion of EOL treatment preferences, and whether death had been expected.

RESULTS: The analysis included 5,548 (78.1%) non-Hispanic white, 1,030 (14.5%) non-Hispanic black, and 331 (4.7%) Hispanic adults and 196 (2.8%) adults of other race or ethnicity. Unadjusted results suggest that average EOL Medicare expenditures were $13,522 (35%, P < .001) more for black decedents and $16,341 (42%, P < .001) more for Hispanics than for whites. Controlling for demographic, socioeconomic, geographic, medical, and EOL-specific factors, the Medicare expenditure difference between groups fell to $8,047 (22%, P < .001) more for black and $6,855 (19%, P < .001) more for Hispanic decedents than expenditures for non-Hispanic whites. The expenditure differences between groups remained statistically significant in all models.

CONCLUSION: Individuals-level factors, including EOL planning factors do not fully explain racial and ethnic differences in Medicare spending in the last 6 months of life. Future research should focus on broader systemic, organizational, and provider-level factors to explain these differences.

VL - 64 IS - 9 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 - Racial/Ethnic Differences in Trajectories of Cognitive Function in Older Adults. JF - J Aging Health Y1 - 2016 A1 - Elizabeth Vasquez A1 - Anda Botoseneanu A1 - Joan M. Bennett A1 - Benjamin A Shaw KW - Aged KW - Aged, 80 and over KW - Black People KW - Cognition KW - Cognition Disorders KW - Female KW - Health Behavior KW - Hispanic or Latino KW - Humans KW - Male KW - White People AB -

OBJECTIVE: The objective of this study is to (a) examine racial/ethnic differences in trajectories of cognitive function and (b) evaluate the role of education and health behaviors (physical activity [PA] and smoking) as mediators of racial/ethnic differences in the rate of decline in cognitive function in older adults.

METHOD: Data for this study came from the Health and Retirement Study ( n = 3,424). Hierarchical linear models were used to define the trajectory of cognitive function between 2002 and 2008. Participants were classified based on PA as non-vigorously active, intermittent vigorously active, and consistently vigorously active.

RESULTS: After adding education, the Hispanic's and Black's disparities in cognitive performance were slightly attenuated (Hispanics, β = -1.049, p < .001; Blacks, β = -3.397, p < .001) but were still different from Whites. Smoking was not associated with the cognition intercept or rate of decline.

DISCUSSION: We found education had a partial mediating effect on racial differences in levels of cognition but not on the rate of change over time.

VL - 28 UR - http://jah.sagepub.com/content/early/2015/12/29/0898264315620589.abstract IS - 8 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26719488?dopt=Abstract U4 - cognition/education/ethnicity/physical activity/smoking ER - TY - JOUR T1 - The relationship between childhood poverty, military service, and later life depression among men: Evidence from the Health and Retirement Study. JF - J Affect Disord Y1 - 2016 A1 - Bareis, Natalie A1 - Briana Mezuk KW - Adult Survivors of Child Adverse Events KW - Aged KW - Depressive Disorder, Major KW - Female KW - Health Surveys KW - Humans KW - Life Change Events KW - Male KW - Middle Aged KW - Military Personnel KW - Odds Ratio KW - Poverty KW - Self Report KW - United States KW - Veterans AB -

BACKGROUND: Childhood poverty has been associated with depression in adulthood, but whether this relationship extends to later life major depression (MD) or is modified by military service is unclear.

METHODS: Data come from the Health and Retirement Study (HRS) 2010 wave, a longitudinal, nationally representative study of older adults. Men with data on military service and childhood poverty were included (N=6330). Childhood poverty was assessed by four indicators (i.e., parental unemployment, residential instability) experienced before age 16. Military service was categorized as veteran versus civilian, and during draft versus all-volunteer (after 1973) eras. Past year MD was defined by the Composite International Diagnostic Inventory.

RESULTS: Four in ten men ever served, with 13.7% in the all-volunteer military. Approximately 12% of civilians, 8% draft era and 24% all-volunteer era veterans had MD. Childhood poverty was associated with higher odds of MD (Odds Ratio (OR): 2.38, 95% Confidence Interval (CI): 1.32-4.32) and higher odds of military service (OR: 2.58, 95% CI: 1.58-4.21). Military service was marginally associated with MD (OR: 1.28, 95% CI: 0.98-1.68) and did not moderate the association between childhood poverty and MD.

LIMITATIONS: Self-report data is subject to recall bias. The HRS did not assess childhood physical and emotional abuse, or military combat exposure.

CONCLUSIONS: Men raised in poverty had greater odds of draft and all-volunteer military service. Early-life experiences, independent of military service, appear associated with greater odds of MD. Assessing childhood poverty in service members may identify risk for depression in later life.

VL - 206 UR - https://www.ncbi.nlm.nih.gov/pubmed/27455351 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27455351?dopt=Abstract ER - TY - JOUR T1 - Relationship between marijuana and other illicit drug use and depression/suicidal thoughts among late middle-aged and older adults. JF - Int Psychogeriatr Y1 - 2016 A1 - Namkee G Choi A1 - DiNitto, Diana M A1 - Marti, C Nathan A1 - Bryan Y Choi KW - Age Distribution KW - Aged KW - Cannabis KW - Cross-Sectional Studies KW - depression KW - Depressive Disorder, Major KW - Female KW - Health Surveys KW - Humans KW - Illicit Drugs KW - Male KW - Marijuana Abuse KW - Marijuana Smoking KW - Middle Aged KW - Regression Analysis KW - Self Report KW - Substance-Related Disorders KW - Suicidal Ideation KW - Suicide, Attempted KW - United States AB -

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

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

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

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

VL - 28 UR - https://www.ncbi.nlm.nih.gov/pubmed/26542746 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26542746?dopt=Abstract ER - TY - JOUR T1 - Self-Reported Hearing in the Last 2 Years of Life in Older Adults. JF - J Am Geriatr Soc Y1 - 2016 A1 - Christine S Ritchie A1 - Yinghui Miao A1 - W John Boscardin A1 - Margaret Wallhagen KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - California KW - Demography KW - Female KW - Hearing aids KW - Hearing loss KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Prevalence KW - Quality of Life KW - Risk Factors KW - Self Report KW - Vulnerable Populations AB -

OBJECTIVES: To assess the prevalence and correlates of self-reported hearing loss during the last 2 years of life.

DESIGN: Observational cohort study.

SETTING: The Health and Retirement Study (HRS), a longitudinal nationally representative cohort of adults aged 50 and older (2000-13).

PARTICIPANTS: Older adults (N = 5,895, mean age at death 78, 53% female, 20% nonwhite).

MEASUREMENTS: The HRS interview closest to death was used (mean 12.2 months before death). Participants rated their hearing (excellent, very good, good, fair, poor) and indicated whether they used hearing aids. The prevalence and correlates of fair and poor ratings are described, adjusted for age and sex.

RESULTS: Thirty-two percent (95% confidence interval (CI) = 31-34%) of all participants and 60% (95% CI = 57-64%) of the 7% of participants who used hearing aids rated their hearing as fair or poor. The prevalence of fair or poor hearing was highest in participants interviewed closest to death (29% 19-24 months before death, 36% 1-6 months before death, P for trend = .01). Correlates of fair or poor hearing during the last 2 years of life included age at death (50-59, 22%; 60-69, 21%; 70-79, 26%; 80-89, 38%; ≥90, 50%), sex (men 35%, women 30%), race and ethnicity (Hispanic 42%, white 33%), wealth (lowest quartile 38%, highest quartile 27%), history of heart disease (yes 38%, no 27%), activity of daily living dependence (yes 42%, no 26%), difficulty taking medications (yes 46%, no 29%), and probable dementia (yes 44%, no 24%).

CONCLUSION: Self-reported hearing loss increases during the last 2 years of life and is associated with physical and social vulnerability.

VL - 64 UR - http://www.ncbi.nlm.nih.gov/pubmed/27341383 IS - 7 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27341383?dopt=Abstract 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 - Sex-Specific and Time-Varying Associations Between Cigarette Smoking and Telomere Length Among Older Adults. JF - Am J Epidemiol Y1 - 2016 A1 - Zhang, Chenan A1 - Diane S. Lauderdale A1 - Brandon L Pierce KW - Aged KW - Aged, 80 and over KW - Aging KW - Biomarkers KW - DNA KW - Female KW - Health Status KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Oxidative stress KW - Polymerase Chain Reaction KW - Prospective Studies KW - Saliva KW - Sex Distribution KW - Smoking KW - Smoking cessation KW - Telomere Shortening AB -

Inconsistent associations between smoking and telomere length (TL) have been reported in epidemiologic studies, perhaps because of the time-varying nature of smoking behaviors. We estimated the associations of TL, which was measured by quantitative polymerase chain reaction using saliva DNA, with concurrent and past smoking status reported biennially for up to 16 years before TL measurement in 5,624 participants in the Health and Retirement Study (1992-2008). Smoking was associated with reduced TL when we used prospective data on smoking statuses among men and women, but the association was strongly attenuated among men in cross-sectional analyses. This attenuation was largely due to a higher rate of smoking cessation during the study period among men with shorter TL than among men with longer TL. Short TL was also associated with poorer overall health in men, which suggests that male smokers with short TL were more likely to quit smoking because of poor health. Analyses of years since cessation, smoking duration, and pack-years of smoking all support the hypothesis that increased cigarette use shortens TL. Our results provide a potential explanation for the inconsistent associations between smoking and TL reported in previous cross-sectional studies. Time-varying associations should be considered in future studies of smoking behavior, TL, aging, and disease risk.

VL - 184 UR - http://aje.oxfordjournals.org/lookup/doi/10.1093/aje/kww102 IS - 12 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27856448?dopt=Abstract JO - Am. J. Epidemiol. ER - TY - JOUR T1 - Skin Cancer in U.S. Elderly Adults: Does Life Expectancy Play a Role in Treatment Decisions? JF - J Am Geriatr Soc Y1 - 2016 A1 - Linos, Eleni A1 - Chren, Mary-Margaret A1 - Irena Cenzer A1 - Kenneth E Covinsky KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Carcinoma, Basal Cell KW - Carcinoma, Squamous Cell KW - Comorbidity KW - Cost-Benefit Analysis KW - Cross-Sectional Studies KW - Curettage KW - Decision Support Techniques KW - Disability Evaluation KW - Electrosurgery KW - Female KW - Humans KW - Keratinocytes KW - Life Expectancy KW - Male KW - Mohs Surgery KW - Prognosis KW - Skin Neoplasms AB -

OBJECTIVES: To examine whether life expectancy influences treatment pattern of nonmelanoma skin cancer, or keratinocyte carcinoma (KC), the most common malignancy and the fifth most costly cancer to Medicare.

DESIGN: Nationally representative cross-sectional study.

SETTING: Nationally representative Health and Retirement Study linked to Medicare claims.

PARTICIPANTS: Treatments (N = 9,653) from individuals aged 65 and older treated for basal or squamous cell carcinoma between 1992 and 2012 (N = 2,702) were included.

MEASUREMENTS: Limited life expectancy defined according to aged 85 and older, medical comorbidities, Charlson Comorbidity Index score of 3 or greater, difficulty in at least one activity of daily living (ADL), and a Lee index of 13 or greater. Treatment type (Mohs micrographic surgery (MMS) (most intensive, highest cost), excision, or electrodesiccation and curettage (ED&C) (least intensive, lowest cost)), according to procedure code.

RESULTS: Most KCs (61%) were treated surgically. Rates of MMS (19%), excision (42%), and ED&C (39%) were no different in participants with limited life expectancy and those with normal life expectancy. For example, 19% of participants with difficulty or dependence in ADLs, 20% of those with a Charlson comorbidity score greater than 3, and 15% of those in their last year of life underwent MMS; participants who died within 1 year of diagnosis were treated in the same way as those who lived longer.

CONCLUSION: A one-size-fits-all approach in which advanced age, health status, functional status, and prognosis are not associated with intensiveness of treatment appears to guide treatment for KC, a generally nonfatal condition. Although intensive treatment of skin cancer when it causes symptoms may be indicated regardless of life expectancy, persons with limited life expectancy should be given choices to ensure that the treatment matches their goals and preferences.

VL - 64 UR - http://www.ncbi.nlm.nih.gov/pubmed/27303932 IS - 8 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27303932?dopt=Abstract ER - TY - JOUR T1 - Stress and Negative Relationship Quality among Older Couples: Implications for Blood Pressure. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2016 A1 - Kira S. Birditt A1 - Nicky J Newton A1 - James A. Cranford A1 - Lindsay H Ryan KW - Aged KW - Aging KW - Blood pressure KW - Family Relations KW - Female KW - Humans KW - Hypertension KW - Longitudinal Studies KW - Male KW - Marriage KW - Middle Aged KW - Stress, Psychological AB -

OBJECTIVES: The cardiovascular system may represent a significant pathway by which marriage and stress influence health, but research has focused on married individuals cross-sectionally. This study examined associations among chronic stress, negative spousal relationship quality, and systolic blood pressure over time among middle-aged and older husbands and wives.

METHOD: Participants were from the nationally representative longitudinal Health and Retirement Study. A total of 1,356 (N = 2,712) married and cohabitating couples completed psychosocial and biomeasure assessments in waves 2006 and 2010. Analyses examined whether Wave 1 (2006) relationship quality and stress were associated with changes in blood pressure over time.

RESULTS: The effects of stress and negative relationship quality were dyadic and varied by gender. Husbands had increased blood pressure when wives reported greater stress, and this link was exacerbated by negative spousal relationship quality. Negative relationship quality predicted increased blood pressure when both members of the couple reported negative quality relations.

DISCUSSION: Findings support the dyadic biopsychosocial model of marriage and health indicating: (a) stress and relationship quality directly effect the cardiovascular system, (b) relationship quality moderates the effect of stress, and (c) the dyad rather than only the individual should be considered when examining marriage and health.

VL - 71 UR - http://psychsocgerontology.oxfordjournals.org/content/early/2015/04/06/geronb.gbv023.abstract IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25852106?dopt=Abstract U4 - Blood pressure/Couples/Marriage/Middle age/Older adults/Stress ER - TY - JOUR T1 - Telomere length and health outcomes: A two-sample genetic instrumental variables analysis. JF - Exp Gerontol Y1 - 2016 A1 - Hamad, Rita A1 - Stefan Walter A1 - David Rehkopf KW - Aged KW - Aging KW - Coronary Artery Disease KW - Databases, Factual KW - Female KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Molecular Epidemiology KW - Polymorphism, Single Nucleotide KW - Self Report KW - Telomere KW - Telomere Homeostasis KW - United States AB -

OBJECTIVE: Previous studies linking telomere length (TL) and health have been largely associational. We apply genetic instrumental variables (IV) analysis, also known as Mendelian randomization, to test the hypothesis that shorter TL leads to poorer health. This method reduces bias from reverse causation or confounding.

METHODS: We used two approaches in this study that rely on two separate data sources: (1) individual-level data from the Health and Retirement Study (HRS) (N=3734), and (2) coefficients from genome-wide association studies (GWAS). We employed two-sample genetic IV analyses, constructing a polygenic risk score (PRS) of TL-associated single nucleotide polymorphisms. The first approach examined the association of the PRS with nine individual health outcomes in HRS. The second approach took advantage of estimates available in GWAS databases to estimate the impact of TL on five health outcomes using an inverse variance-weighted meta-analytic technique.

RESULTS: Using individual-level data, shorter TL was marginally statistically significantly associated with decreased risk of stroke and increased risk of heart disease. Using the meta-analytic approach, shorter TL was associated with increased risk of coronary artery disease (OR 1.02 per 100 base pairs, 95%CI: 1.00, 1.03).

DISCUSSION: With the exception of a small contribution to heart disease, our findings suggest that TL may be a marker of disease rather than a cause. They also demonstrate the utility of the inverse variance-weighted meta-analytic approach when examining small effect sizes.

VL - 82 UR - http://www.ncbi.nlm.nih.gov/pubmed/27321645 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27321645?dopt=Abstract ER - TY - JOUR T1 - Ten-Year Prevalence and Incidence of Urinary Incontinence in Older Women: A Longitudinal Analysis of the Health and Retirement Study. JF - J Am Geriatr Soc Y1 - 2016 A1 - Erekson, Elisabeth A A1 - Cong, Xiangyu A1 - Mary K Townsend A1 - Ciarleglio, Maria M KW - Aged KW - Female KW - Humans KW - Incidence KW - Longitudinal Studies KW - Prevalence KW - Prospective Studies KW - Surveys and Questionnaires KW - United States KW - Urinary incontinence AB -

OBJECTIVES: To measure the incidence of urinary incontinence (UI) over 10 years in older women who did not report UI at baseline in 1998, to estimate the prevalence of female UI according to severity and type, and to explore potential risk factors for development of UI.

DESIGN: Secondary analysis of a prospective cohort.

SETTING: Health and Retirement Study.

PARTICIPANTS: Women participating in the Health and Retirement Study between 1998 and 2008 who did not have UI at baseline (1998).

MEASUREMENTS: UI was defined as an answer of "yes" to the question, "During the last 12 months, have you lost any amount of urine beyond your control?" UI was characterized according to severity (according to the Sandvik Severity Index) and type (according to International Continence Society definitions) at each biennial follow-up between 1998 and 2008.

RESULTS: In 1998, 5,552 women aged 51 to 74 reported no UI. The cumulative incidence of UI in older women was 37.2% (95% confidence interval (CI)=36.0-38.5%). The most common incontinence type at the first report of leakage was mixed UI (49.1%, 95% CI=46.5-51.7%), and women commonly reported their symptoms at first leakage as moderate to severe (46.4%, 95% CI=43.8-49.0%).

CONCLUSION: Development of UI in older women was common and tended to result in mixed type and moderate to severe symptoms.

VL - 64 UR - https://www.ncbi.nlm.nih.gov/pubmed/27321606 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27321606?dopt=Abstract ER - TY - JOUR T1 - Trajectories of body mass indices and development of frailty: Evidence from the health and retirement study. JF - Obesity (Silver Spring) Y1 - 2016 A1 - Briana Mezuk A1 - Matthew C. Lohman A1 - Rock, Andrew K A1 - Payne, Martha E KW - Aged KW - Aged, 80 and over KW - Body Mass Index KW - Body Weight KW - Female KW - Frail Elderly KW - Geriatric Assessment KW - Health Status KW - Humans KW - Incidence KW - Longitudinal Studies KW - Male KW - Obesity KW - Retirement KW - Risk Factors KW - Weight Gain AB -

OBJECTIVE: To estimate trajectories of body mass index (BMI) and determine their association with incident frailty in later life.

METHODS: Data come from the 2004 to 2012 waves of the Health and Retirement Study, a longitudinal survey of older adults. Analysis was restricted to respondents who were not frail at baseline (n = 10,827). BMI (kg/m(2) ) was calculated from self-reported weight and height. Incident frailty was assessed using the Frailty Index. Longitudinal growth mixture modeling was used to estimate the relationship between BMI trajectories and incident frailty over a 10-year period.

RESULTS: Four trajectory classes were identified: weight gain (n = 162 [1.4%], mean final BMI = 42 kg/m(2) ), weight loss (n = 171 [1.7%], mean final BMI = 25.0 kg/m(2) ), consistent obesity (n = 640 [6.8%], mean final BMI = 34.7 kg/m(2) ), and consistent overweight (n = 9,864 [90.1%] mean final BMI = 26.0 kg/m(2) ). Cumulative incidence of frailty was 19.9%. Relative to the consistent overweight class, the weight gain class had the highest likelihood of incident frailty (odds ratio, OR: 3.61, 95% confidence interval, CI: 2.39-5.46). The consistent obesity (OR: 2.72, 95% CI: 2.06-3.58) and weight loss (OR: 2.81, 95% CI: 1.84-4.30) classes had similarly elevated risk of frailty.

CONCLUSIONS: Weight change and obesity are associated with risk of frailty.

VL - 24 UR - http://www.ncbi.nlm.nih.gov/pubmed/27355440 IS - 8 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27355440?dopt=Abstract ER - TY - JOUR T1 - Trajectories of depressive symptoms and oral health outcomes in a community sample of older adults. JF - Int J Geriatr Psychiatry Y1 - 2016 A1 - Celia F. Hybel A1 - Joan M. Bennett A1 - Lawrence R Landerman A1 - Jersey Liang A1 - Brenda L Plassman A1 - Bei Wu KW - Aged KW - Aged, 80 and over KW - Chronic disease KW - Depressive Disorder KW - Female KW - Humans KW - Longitudinal Studies KW - Male KW - Oral Health KW - Regression Analysis AB -

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

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

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

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

PB - 31 VL - 31 IS - 1 N1 - Export Date: 9 September 2015 Article in Press U1 - http://www.ncbi.nlm.nih.gov/pubmed/25962827?dopt=Abstract U2 - PMC4641817 U4 - Depressive symptoms/Edentulism/Latent class trajectory analysis/Oral health ER - TY - JOUR T1 - 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 - Validating a summary measure of weight history for modeling the health consequences of obesity. JF - Ann Epidemiol Y1 - 2016 A1 - Andrew C. Stokes A1 - Ni, Yu KW - Aged KW - Aged, 80 and over KW - Body Mass Index KW - Body Weight KW - Chronic disease KW - Female KW - Health Surveys KW - Humans KW - Logistic Models KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Obesity KW - Self Report KW - United States AB -

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

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

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

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

VL - 26 UR - http://linkinghub.elsevier.com/retrieve/pii/S1047279716304070http://api.elsevier.com/content/article/PII:S1047279716304070?httpAccept=text/xmlhttp://api.elsevier.com/content/article/PII:S1047279716304070?httpAccept=text/plain IS - 12 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27894565?dopt=Abstract JO - Annals of Epidemiology ER - TY - JOUR T1 - Volunteering Is Associated with Lower Risk of Cognitive Impairment. JF - J Am Geriatr Soc Y1 - 2016 A1 - Frank J Infurna A1 - Morris A Okun A1 - Kevin J. Grimm KW - Aged KW - Aged, 80 and over KW - Cognition Disorders KW - Female KW - Geriatric Assessment KW - Health Surveys KW - Humans KW - Interviews as Topic KW - Male KW - Middle Aged KW - Risk Factors KW - United States KW - Volunteers AB -

OBJECTIVES: To examine whether psychosocial factors that can be a target for interventions, such as volunteering, are associated with risk of cognitive impairment.

DESIGN: Health and Retirement Study (HRS) data from 1998 to 2012, a nationally representative longitudinal panel survey of older adults assessed every 2 years, were used.

SETTING: The HRS interviews participants aged 50 and older across the contiguous United States.

PARTICIPANTS: Individuals aged 60 and older in 1998 (N = 13,262).

MEASUREMENTS: Personal interviews were conducted with respondents to assess presence of cognitive impairment, measured using a composite across cognitive measures.

RESULTS: Volunteering at the initial assessment and volunteering regularly over time independently decreased the risk of cognitive impairment over 14 years, and these findings were maintained independent of known risk factors for cognitive impairment. Greater risk of onset of cognitive impairment was associated with being older, being female, being nonwhite, having fewer years of education, and reporting more depressive symptoms.

CONCLUSION: Consistent civic engagement in old age is associated with lower risk of cognitive impairment and provides impetus for interventions to protect against the onset of cognitive impairment. Given the increasing number of baby boomers entering old age, the findings support the public health benefits of volunteering and the potential role of geriatricians, who can promote volunteering by incorporating "prescriptions to volunteer" into their patient care.

VL - 64 IS - 11 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27696342?dopt=Abstract ER - TY - JOUR T1 - What are the experiences of people with dementia in employment? JF - Dementia (London) Y1 - 2016 A1 - Chaplin, Ruth A1 - Davidson, Ian KW - Aged KW - Alzheimer disease KW - Dementia, Vascular KW - Employment KW - Female KW - Humans KW - Interviews as Topic KW - Male KW - Middle Aged KW - Qualitative Research KW - United Kingdom KW - Work Performance AB -

Statistics show that an increase in the statutory retirement age in the UK will mean that many more people will develop a dementia while still in employment. A review of the literature confirmed that there are no existing studies in the UK which examine this issue in any detail. The aim of this study was to investigate the experiences of people who develop a dementia while still in employment and to understand how they make sense of these experiences; therefore a qualitative explorative inquiry based on an Interpretive Phenomenological Analysis methodology was used. Interviews with five people who had developed a dementia while still in employment were carried out, with ages ranging from 58 to 74 years. Interview transcripts were analysed and four super-ordinate themes were identified: the realization that something is wrong; managing the situation in the workplace; trying to make sense of change; and coming to terms with retirement or unemployment. The results showed that people who develop a dementia while still in employment do not always receive the 'reasonable adjustments' in the workplace to which they are entitled under the Equality Act (2010). Some of the participants felt that they were poorly treated by their workplace and described some distressing experiences. The study highlights the need for more effective specialized advice and support regarding employment issues and more research into the numbers of people in the UK that are affected by this issue.

VL - 15 UR - http://www.ncbi.nlm.nih.gov/pubmed/24419354 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/24419354?dopt=Abstract ER - TY - JOUR T1 - Work-Family Trajectories and the Higher Cardiovascular Risk of American Women Relative to Women in 13 European Countries. JF - Am J Public Health Y1 - 2016 A1 - van Hedel, Karen A1 - Mejía-Guevara, Iván A1 - Mauricio Avendano A1 - Erika L. Sabbath A1 - Lisa F Berkman A1 - Johan P Mackenbach A1 - van Lenthe, Frank J KW - Adolescent KW - Adult KW - Aged KW - Aged, 80 and over KW - Cardiovascular Diseases KW - Computer Simulation KW - Europe KW - Female KW - Humans KW - Middle Aged KW - Obesity KW - Single Parent KW - Smoking KW - Socioeconomic factors KW - United States KW - Women, Working KW - Young Adult AB -

OBJECTIVES: To investigate whether less-healthy work-family life histories contribute to the higher cardiovascular disease prevalence in older American compared with European women.

METHODS: We used sequence analysis to identify distinct work-family typologies for women born between 1935 and 1956 in the United States and 13 European countries. Data came from the US Health and Retirement Study (1992-2006) and the Survey of Health, Aging, and Retirement in Europe (2004-2009).

RESULTS: Work-family typologies were similarly distributed in the United States and Europe. Being a lone working mother predicted a higher risk of heart disease, stroke, and smoking among American women, and smoking for European women. Lone working motherhood was more common and had a marginally stronger association with stroke in the United States than in Europe. Simulations indicated that the higher stroke risk among American women would only be marginally reduced if American women had experienced the same work-family trajectories as European women.

CONCLUSIONS: Combining work and lone motherhood was more common in the United States, but differences in work-family trajectories explained only a small fraction of the higher cardiovascular risk of American relative to European women.

VL - 106 UR - http://www.ncbi.nlm.nih.gov/pubmed/27310346 IS - 8 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27310346?dopt=Abstract ER - TY - JOUR T1 - Adherence to diabetes guidelines for screening, physical activity and medication and onset of complications and death. JF - J Diabetes Complications Y1 - 2015 A1 - Chen, Yiqun A1 - Frank A Sloan A1 - Arseniy P Yashkin KW - Aged KW - Aged, 80 and over KW - Combined Modality Therapy KW - Diabetes Complications KW - Diabetes Mellitus KW - Early Diagnosis KW - Female KW - Health Promotion KW - Health Surveys KW - Humans KW - Hypoglycemic Agents KW - Longitudinal Studies KW - Male KW - Mass Screening KW - Medicare Part A KW - Medicare Part B KW - Medication Adherence KW - Motor Activity KW - Patient Compliance KW - Practice Guidelines as Topic KW - Risk KW - United States AB -

AIMS: Analyze relationships between adherence to guidelines for diabetes care - regular screening; physical activity; and medication - and diabetes complications and mortality.

METHODS: Outcomes were onset of congestive heart failure (CHF), stroke, renal failure, moderate complications of lower extremities, lower-limb amputation, proliferative diabetic retinopathy (PDR), and mortality during follow-up. Participants were persons aged 65+ in the Health and Retirement Study (HRS) 2003 Diabetes Study and had Medicare claims in follow-up period (2004-8).

RESULTS: Adherence to screening recommendations decreased risks of developing CHF (odds ratio (OR)=0.83; 95% confidence interval (CI): 0.72-0.96), stroke (OR=0.80; 95% CI: 0.68-0.94); renal failure (OR=0. 82; 95% CI: 0.71-0.95); and death (OR=0.86; 95% CI: 0.74-0.99). Adherence to physical activity recommendation reduced risks of stroke (OR=0.64; 95% CI: 0.45-0.90), renal failure (OR=0.71; 95% CI: 0.52-0.97), moderate lower-extremity complications (OR=0.71; 95% CI: 0.51-0.99), having a lower limb amputation (OR=0.31, 95% CI: 0.11-0.85), and death (OR=0.56, 95% CI: 0.41-0.77). Medication adherence was associated with lower risks of PDR (OR=0.35, 95% CI: 0.13-0.93).

CONCLUSIONS: Adherence to screening, physical activity and medication guidelines was associated with lower risks of diabetes complications and death. Relative importance of adherence differed among outcome measures.

PB - 29 VL - 29 IS - 8 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26316423?dopt=Abstract U2 - PMC4656150 U4 - Diabetes complications/Mortality/health status/adherence interventions/adherence interventions/Physical activity/Guidelines ER - TY - JOUR T1 - Anchoring vignettes in the Health and Retirement Study: how do medical professionals and disability recipients characterize the severity of work limitations? JF - PLoS One Y1 - 2015 A1 - Frank Heiland A1 - Yin, Na KW - Aged KW - Cardiovascular Diseases KW - depression KW - Disabled Persons KW - Female KW - Health Personnel KW - Humans KW - Male KW - Middle Aged KW - pain KW - Retirement KW - Self Report AB -

PURPOSE: Recent studies report systematic differences in how individuals categorize the severity of identical health and work limitation vignettes. We investigate how health professionals and disability recipients characterize the severity of work limitations and whether their reporting patterns are robust to demographic, education, and health characteristics. We use the results to illustrate the potential impact of reporting heterogeneity on the distribution of work disability estimated from self-reported categorical health and disability data.

METHOD: Nationally representative data on anchoring disability vignettes from the 2004 Health and Retirement Study (HRS) are used to investigate how respondents with an occupation background in health and Social Security disability beneficiaries categorize work limitation vignettes. Using pain, cardiovascular health, and depression vignettes, we estimate generalized ordered probit models (N = 2,660 individuals or 39,681 person-vignette observations) that allow the severity thresholds to vary by respondent characteristics.

RESULTS: We find that health professionals (excluding nurses) and disability recipients tend to classify identical work limitations as more severe compared to non-health professional non-disabled respondents. For disability recipients, the differences are most pronounced and particularly visible in the tails of the work limitations distribution. For health professionals, we observe smaller differences, affecting primarily the classification of mildly and moderately severe work limitations. The patterns for health professionals (excluding nurses) are robust to demographics, education, and health conditions. The greater likelihood of viewing the vignette person as more severely work limited observed among disability recipients is mostly explained by the fact that these respondents also tend to be in poorer health which itself predicts a more inclusive scale.

CONCLUSIONS: Knowledge of reporting scales from health professionals and disabled individuals can benefit researchers in a broad range of applications in health and disability research. They may be useful as reference scales to evaluate disability survey data. Such knowledge may be beneficial when studying disability programs. Given the increasing availability of anchoring vignette data in surveys, this is a promising area for future evaluation research.

PB - 10 VL - 10 UR - http://dx.doi.org/10.1371 2Fjournal.pone.0126218 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25966316?dopt=Abstract U2 - PMC4428751 U4 - Disabilities/Nurses/Health education and awareness/Demography/Educational attainment/Welfare (social security)/Behavioral and social aspects of health/Professions ER - TY - JOUR T1 - Antidepressant Use and Cognitive Decline: The Health and Retirement Study. JF - Am J Med Y1 - 2015 A1 - Jane S Saczynski A1 - Allison B Rosen A1 - Ryan J McCammon A1 - Zivin, Kara A1 - Susan E. Andrade A1 - Kenneth M. Langa A1 - Sandeep Vijan A1 - Paul A Pirraglia A1 - Becky A. Briesacher KW - Age Distribution KW - Aged KW - Aged, 80 and over KW - Antidepressive Agents KW - Cognition KW - Cross-Sectional Studies KW - Depressive Disorder KW - Female KW - Follow-Up Studies KW - Geriatric Assessment KW - Humans KW - Incidence KW - Male KW - Middle Aged KW - Reference Values KW - Risk Assessment KW - Sex Distribution KW - Surveys and Questionnaires KW - United States AB -

BACKGROUND: Depression is associated with cognitive impairment and dementia, but whether treatment for depression with antidepressants reduces the risk for cognitive decline is unclear. We assessed the association between antidepressant use and cognitive decline over 6 years.

METHODS: Participants were 3714 adults aged 50 years or more who were enrolled in the nationally representative Health and Retirement Study and had self-reported antidepressant use. Depressive symptoms were assessed using the 8-item Center for Epidemiologic Studies Depression Scale. Cognitive function was assessed at 4 time points (2004, 2006, 2008, 2010) using a validated 27-point scale. Change in cognitive function over the 6-year follow-up period was examined using linear growth models, adjusted for demographics, depressive symptoms, comorbidities, functional limitations, and antidepressant anticholinergic activity load.

RESULTS: At baseline, cognitive function did not differ significantly between the 445 (12.1%) participants taking antidepressants and those not taking antidepressants (mean, 14.9%; 95% confidence interval, 14.3-15.4 vs mean, 15.1%; 95% confidence interval, 14.9-15.3). During the 6-year follow up period, cognition declined in both users and nonusers of antidepressants, ranging from -1.4 change in mean score in those with high depressive symptoms and taking antidepressants to -0.5 change in mean score in those with high depressive symptoms and not taking antidepressants. In adjusted models, cognition declined in people taking antidepressants at the same rate as those not taking antidepressants. Results remained consistent across different levels of baseline cognitive function, age, and duration of antidepressant use (prolonged vs short-term).

CONCLUSIONS: Antidepressant use did not modify the course of 6-year cognitive change in this nationally representative sample.

PB - 128 VL - 128 IS - 7 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25644319?dopt=Abstract U2 - PMC4618694 U4 - Antidepressants/Cognition/Depression/CES Depression Scale/CES Depression Scale/COMORBIDITY/Depressive Symptoms ER - TY - JOUR T1 - Are older adults living in more equal counties healthier than older adults living in more unequal counties? A propensity score matching approach. JF - Soc Sci Med Y1 - 2015 A1 - Choi, Hwajung A1 - Sarah A. Burgard A1 - Irma Elo A1 - Michele M Heisler KW - Aged KW - Aged, 80 and over KW - Female KW - Health Status Indicators KW - Health Surveys KW - Healthcare Disparities KW - Humans KW - Logistic Models KW - Male KW - Middle Aged KW - Propensity Score KW - Self Report KW - Socioeconomic factors AB -

We assessed the potential contextual effect of income inequality on health by: 1) comparing individuals with similar socioeconomic status (SES) but who reside in counties with different levels of income inequality; and 2) examining whether the potential effect of county-level income inequality on health varies across SES groups. We used the Health and Retirement Study, a nationally representative study of Americans over the age of 50. Using propensity score matching, we selected SES-comparable individuals living in high-income inequality counties and in low-income inequality counties. We examined differences in self-rated overall health outcomes and in other specific physical/mental health outcomes between the two groups using logistic regression (n = 34,994) and imposing different sample restrictions based on residential duration in the area. We then used logistic regression with interactions to assess whether, and if so how, health outcomes differed among participants of different SES groups defined by wealth, income, and education. In bivariate analyses of the unmatched full sample, adults living in high-income inequality counties have worse health outcomes for most health measures. After propensity score matching, adults in high-income inequality counties had worse self-rated health status (AOR = 1.12; 95% CI 1.04-1.19) and were more likely to report diagnosed psychiatric problems (AOR = 1.08; 95% CI 0.99-1.19) than their matched counterparts in low-income inequality counties. These associations were stronger with longer-term residents in the area. Adverse health outcomes associated with living in high-income inequality counties were significant particularly for individuals in the 30(th) or greater percentiles of income/wealth distribution and those without a college education. In summary, after using more precise matching methods to compare individuals with similar characteristics and addressing measurement error by excluding more recently arrived county residents, adults living in high-income inequality counties had worse reported overall physical and mental health than adults living in low-income inequality counties.

PB - 141 VL - 141 N1 - Times Cited: 0 0 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26256736?dopt=Abstract U2 - PMC4550487 U4 - income inequality/Socioeconomic Status/cross-national comparison ER - TY - JOUR T1 - Association Between Hospice Use and Depressive Symptoms in Surviving Spouses. JF - JAMA Intern Med Y1 - 2015 A1 - Katherine A Ornstein A1 - Melissa D. Aldridge A1 - Melissa M Garrido A1 - Rebecca Jean Gorges A1 - Diane E Meier A1 - Amy Kelley KW - Aged KW - Aged, 80 and over KW - Caregivers KW - depression KW - Female KW - Hospice Care KW - Hospices KW - Humans KW - Male KW - Prospective Studies KW - Spouses KW - Survivors AB -

IMPORTANCE: Family caregivers of individuals with serious illness are at risk for depressive symptoms and depression. Hospice includes the provision of support services for family caregivers, yet evidence is limited regarding the effect of hospice use on depressive symptoms among surviving caregivers.

OBJECTIVE: To determine the association between hospice use and depressive symptoms in surviving spouses.

DESIGN, SETTING, AND PARTICIPANTS: We linked data from the Health and Retirement Study, a nationally representative longitudinal survey of community-dwelling US adults 50 years or older, to Medicare claims. Participants included a propensity score-matched sample of 1016 Health and Retirement Study decedents with at least 1 serious illness and their surviving spouses interviewed between August 2002 and May 2011. We compared the spouses of individuals enrolled in hospice with the spouses of individuals who did not use hospice, performing our analysis between January 30, 2014, and January 16, 2015.

EXPOSURES: Hospice enrollment for at least 3 days in the year before death.

MAIN OUTCOMES AND MEASURES: Spousal depressive symptom scores measured 0 to 2 years after death with the Center for Epidemiologic Studies Depression Scale, which is scored from 0 (no symptoms) to 8 (severe symptoms).

RESULTS: Of the 1016 decedents in the matched sample, 305 patients (30.0%) used hospice services for 3 or more days in the year before death. Of the 1016 spouses, 51.9% had more depressive symptoms over time (mean [SD] change, 2.56 [1.65]), with no significant difference related to hospice use. A minority (28.2%) of spouses of hospice users had improved Center for Epidemiologic Studies Depression Scale scores compared with 21.7% of spouses of decedents who did not use hospice, although the difference was not statistically significant (P = .06). Among the 662 spouses who were the primary caregivers, 27.3% of spouses of hospice users had improved Center for Epidemiologic Studies Depression Scale scores compared with 20.7% of spouses of decedents who did not use hospice; the difference was not statistically significant (P = .10). In multivariate analysis, the odds ratio for the association of hospice enrollment with improved depressive symptoms after the spouse's death was 1.63 (95% CI, 1.00-2.65).

CONCLUSIONS AND RELEVANCE: After bereavement, depression symptoms increased overall for surviving spouses regardless of hospice use. A modest reduction in depressive symptoms was more likely among spouses of hospice users than among spouses of nonhospice users.

PB - 175 VL - 175 UR - http://dx.doi.org/10.1001/jamainternmed.2015.1722 IS - 7 N1 - 10.1001/jamainternmed.2015.1722 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26009859?dopt=Abstract U2 - PMC4494882 U4 - caregiver burden/caregivers/Depressive Symptoms/depression/Hospice/CES Depression Scale/CES Depression Scale/spouses ER - TY - JOUR T1 - The association between lower educational attainment and depression owing to shared genetic effects? Results in ~25,000 subjects. JF - Mol Psychiatry Y1 - 2015 A1 - Wouter J Peyrot A1 - Lee, S H A1 - Milaneschi, Y A1 - Abdel Abdellaoui A1 - Byrne, E M A1 - Tõnu Esko A1 - Eco J. C. de Geus A1 - Hemani, G A1 - Jouke-Jan Hottenga A1 - Kloiber, S A1 - Douglas F Levinson A1 - Lucae, S A1 - Nicholas G Martin A1 - Sarah E Medland A1 - Andres Metspalu A1 - Lili Milani A1 - Markus M Nöthen A1 - Potash, J B A1 - Rietschel, M A1 - Cornelius A Rietveld A1 - Ripke, S A1 - Jianxin Shi A1 - Gonneke Willemsen A1 - Zhihong Zhu A1 - Dorret I Boomsma A1 - Naomi R. Wray A1 - Brenda W J H Penninx KW - Adult KW - Aged KW - Cohort Studies KW - Depressive Disorder, Major KW - Educational Status KW - Estonia KW - Female KW - Gene-Environment Interaction KW - Genetic Association Studies KW - Genotype KW - Humans KW - Likelihood Functions KW - Male KW - Middle Aged KW - Netherlands KW - Odds Ratio KW - Polymorphism, Single Nucleotide KW - Psychiatric Status Rating Scales KW - Regression Analysis AB -

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

VL - 20 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25917368?dopt=Abstract ER - TY - JOUR T1 - The association of depression, cognitive impairment without dementia, and dementia with risk of ischemic stroke: a cohort study. JF - Psychosom Med Y1 - 2015 A1 - Dimitry S Davydow A1 - Deborah A Levine A1 - Zivin, Kara A1 - Wayne J Katon A1 - Kenneth M. Langa KW - Aged KW - Aged, 80 and over KW - Cognitive Dysfunction KW - Cohort Studies KW - Dementia KW - depression KW - Female KW - Humans KW - Male KW - Middle Aged KW - Psychiatric Status Rating Scales KW - Retrospective Studies KW - Risk Factors KW - Stroke KW - United States AB -

OBJECTIVE: To determine if depression, cognitive impairment without dementia (CIND), and/or dementia are each independently associated with risk of ischemic stroke and to identify characteristics that could modify these associations.

METHODS: This retrospective-cohort study examined a population-based sample of 7031 Americans older than 50 years participating in the Health and Retirement Study (1998-2008) who consented to have their interviews linked to their Medicare claims. The eight-item Center for Epidemiologic Studies Depression Scale and/or International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) depression diagnoses were used to identify baseline depression. The Modified Telephone Interview for Cognitive Status and/or ICD-9-CM dementia diagnoses were used to identify baseline CIND or dementia. Hospitalizations for ischemic stroke were identified via ICD-9-CM diagnoses.

RESULTS: After adjusting for demographics, medical comorbidities, and health-risk behaviors, CIND alone (odds ratio [OR] = 1.37, 95% confidence interval [CI] = 1.11-1.69) and co-occurring depression and CIND (OR = 1.65, 95% CI = 1.24-2.18) were independently associated with increased odds of ischemic stroke. Depression alone was not associated with odds of ischemic stroke (OR = 1.11, 95% CI = 0.88-1.40) in unadjusted analyses. Neither dementia alone (OR = 1.09, 95% CI = 0.82-1.45) nor co-occurring depression and dementia (OR = 1.25, 95% CI = 0.89-1.76) were associated with odds of ischemic stroke after adjusting for demographics.

CONCLUSIONS: CIND and co-occurring depression and CIND are independently associated with increased risk of ischemic stroke. Individuals with co-occurring depression and CIND represent a high-risk group that may benefit from targeted interventions to prevent stroke.

PB - 77 VL - 77 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25647752?dopt=Abstract ER - TY - JOUR T1 - The burden of health care costs for patients with dementia in the last 5 years of life. JF - Ann Intern Med Y1 - 2015 A1 - Amy Kelley A1 - Kathleen McGarry A1 - Rebecca Jean Gorges A1 - Jonathan S Skinner KW - Aged KW - Aged, 80 and over KW - Cost of Illness KW - Dementia KW - Female KW - Health Expenditures KW - Humans KW - Insurance, Health KW - Male KW - Medicaid KW - Medicare KW - Retrospective Studies KW - Socioeconomic factors KW - Terminal Care KW - United States AB -

BACKGROUND: Common diseases, particularly dementia, have large social costs for the U.S. population. However, less is known about the end-of-life costs of specific diseases and the associated financial risk for individual households.

OBJECTIVE: To examine social costs and financial risks faced by Medicare beneficiaries 5 years before death.

DESIGN: Retrospective cohort.

SETTING: The HRS (Health and Retirement Study).

PARTICIPANTS: Medicare fee-for-service beneficiaries, aged 70 years or older, who died between 2005 and 2010 (n = 1702), stratified into 4 groups: persons with a high probability of dementia or those who died because of heart disease, cancer, or other causes.

MEASUREMENTS: Total social costs and their components, including Medicare, Medicaid, private insurance, out-of-pocket spending, and informal care, measured over the last 5 years of life; and out-of-pocket spending as a proportion of household wealth.

RESULTS: Average total cost per decedent with dementia ($287 038) was significantly greater than that of those who died of heart disease ($175 136), cancer ($173 383), or other causes ($197 286) (P < 0.001). Although Medicare expenditures were similar across groups, average out-of-pocket spending for patients with dementia ($61 522) was 81% higher than that for patients without dementia ($34 068); a similar pattern held for informal care. Out-of-pocket spending for the dementia group (median, $36 919) represented 32% of wealth measured 5 years before death compared with 11% for the nondementia group (P < 0.001). This proportion was greater for black persons (84%), persons with less than a high school education (48%), and unmarried or widowed women (58%).

LIMITATION: Imputed Medicaid, private insurance, and informal care costs.

CONCLUSION: Health care expenditures among persons with dementia were substantially larger than those for other diseases, and many of the expenses were uncovered (uninsured). This places a large financial burden on families, and these burdens are particularly pronounced among the demographic groups that are least prepared for financial risk.

PRIMARY FUNDING SOURCE: National Institute on Aging.

PB - 163 VL - 163 IS - 10 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26502320?dopt=Abstract U4 - Care and treatment/Public Policy/Financial risk/Dementia/Medicare/Palliative care/Health care expenditures ER - TY - JOUR T1 - Changes in Depressive Symptoms and Incidence of First Stroke Among Middle-Aged and Older US Adults. JF - J Am Heart Assoc Y1 - 2015 A1 - Stefan Walter A1 - Eric J. Tchetgen Tchetgen A1 - Kristen K Patton A1 - J Robin Moon A1 - Benjamin D Capistrant A1 - Jessica R Marden A1 - Laura D Kubzansky A1 - Paola Gilsanz A1 - Ichiro Kawachi A1 - M. Maria Glymour KW - Adult KW - Aged KW - Aged, 80 and over KW - Aging KW - depression KW - Female KW - Humans KW - Incidence KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Proportional Hazards Models KW - Risk Factors KW - Sex Factors KW - Stroke KW - Time Factors AB -

BACKGROUND: Although research has demonstrated that depressive symptoms predict stroke incidence, depressive symptoms are dynamic. It is unclear whether stroke risk persists if depressive symptoms remit.

METHODS AND RESULTS: Health and Retirement Study participants (n=16 178, stroke free and noninstitutionalized at baseline) were interviewed biennially from 1998 to 2010. Stroke and depressive symptoms were assessed through self-report of doctors' diagnoses and a modified Center for Epidemiologic Studies - Depression scale (high was ≥3 symptoms), respectively. We examined whether depressive symptom patterns, characterized across 2 successive interviews (stable low/no, onset, remitted, or stable high depressive symptoms) predicted incident stroke (1192 events) during the subsequent 2 years. We used marginal structural Cox proportional hazards models adjusted for demographics, health behaviors, chronic conditions, and attrition. We also estimated effects stratified by age (≥65 years), race or ethnicity (non-Hispanic white, non-Hispanic black, Hispanic), and sex. Stroke hazard was elevated among participants with stable high (adjusted hazard ratio 2.14, 95% CI 1.69 to 2.71) or remitted (adjusted hazard ratio 1.66, 95% CI 1.22 to 2.26) depressive symptoms compared with participants with stable low/no depressive symptoms. Stable high depressive symptom predicted stroke among all subgroups. Remitted depressive symptoms predicted increased stroke hazard among women (adjusted hazard ratio 1.86, 95% CI 1.30 to 2.66) and non-Hispanic white participants (adjusted hazard ratio 1.66, 95% CI 1.18 to 2.33) and was marginally associated among Hispanics (adjusted hazard ratio 2.36, 95% CI 0.98 to 5.67).

CONCLUSIONS: In this cohort, persistently high depressive symptoms were associated with increased stroke risk. Risk remained elevated even if depressive symptoms remitted over a 2-year period, suggesting cumulative etiologic mechanisms linking depression and stroke.

PB - 4 VL - 4 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25971438?dopt=Abstract U2 - PMC4599421 U4 - depressive Symptoms/stroke risk/CES Depression Scale/CES Depression Scale/depression/stroke 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 - Cognitive function and the concordance between survey reports and Medicare claims in a nationally representative cohort of older adults. JF - Med Care Y1 - 2015 A1 - Frederic D Wolinsky A1 - Michael P Jones A1 - Fred A Ullrich A1 - Yiyue Lou A1 - George L Wehby KW - Aged KW - Aging KW - Cognition Disorders KW - Data collection KW - Female KW - Humans KW - Insurance Claim Review KW - Male KW - Medicare KW - Mental Health KW - Psychiatric Status Rating Scales KW - Self Report KW - United States AB -

BACKGROUND: While age-related cognitive decline may affect all stages in the response process--comprehension, retrieval, judgment, response selection, and response reporting--the associations between objective cognitive tests and the agreement between self-reports and Medicare claims has not been assessed. We evaluate those associations using the Survey on Assets and Health Dynamics among the Oldest Old (AHEAD).

METHODS: Eight waves of reinterviews (1995-2010) were linked to Medicare claims for 3661 self-respondents yielding 12,313 person-period observations. Cognitive function was measured by 2 episodic memory tests (immediate and delayed recall of 10 words) and 1 mental status test (backward counting, dates, and names). Survey reports on 12 diseases and 4 health services were mapped to Medicare claims to derive counts of concordant reports, underreports, and overreports, as were the numbers of hospital episodes and physician visits. GEE negative binomial and logistic regression models were used.

RESULTS: Better mental status was associated with more concordant reporting and less underreporting on disease history and the number of hospital episodes. Better mental status and delayed word recall were associated with more concordant reporting and less underreporting on health services use. Better delayed recall was significantly associated with less underreporting on the number of physician visits. These associations were not appreciably altered by adjustment for demographic characteristics, socioeconomic status, self-rated health, or secular trends.

CONCLUSION: We recommend that future surveys of older adults include an objective measure of mental status (rather than memory), especially when those survey reports cannot be verified by access to Medicare claims or chart review.

VL - 53 UR - https://www.ncbi.nlm.nih.gov/pubmed/25793268 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25793268?dopt=Abstract ER - TY - JOUR T1 - Comorbidity and functional trajectories from midlife to old age: the Health and Retirement Study. JF - J Gerontol A Biol Sci Med Sci Y1 - 2015 A1 - Stenholm, Sari A1 - Westerlund, Hugo A1 - Head, Jenny A1 - Hyde, Martin A1 - Ichiro Kawachi A1 - Pentti, Jaana A1 - Mika Kivimäki A1 - Vahtera, Jussi KW - Activities of Daily Living KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Chronic disease KW - Comorbidity KW - Female KW - Health Status KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Retirement KW - Socioeconomic factors KW - United States AB -

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

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

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

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

PB - 70 VL - 70 UR - http://biomedgerontology.oxfordjournals.org/content/early/2014/07/23/gerona.glu113.abstract IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25060316?dopt=Abstract U2 - PMC4336333 U4 - Aging/Comorbidity/Physical functioning/Disability/Disability ER - TY - JOUR T1 - Comprehensive gene- and pathway-based analysis of depressive symptoms in older adults. JF - J Alzheimers Dis Y1 - 2015 A1 - Nho, Kwangsik A1 - Vijay K Ramanan A1 - Horgusluoglu, Emrin A1 - Sungeun Kim A1 - Mark H Inlow A1 - Shannon L Risacher A1 - Brenna C McDonald A1 - Martin R Farlow A1 - Tatiana Foroud A1 - Gao, Sujuan A1 - Christopher M. Callahan A1 - Hugh C Hendrie A1 - Alexander B Niculescu A1 - Andrew J Saykin KW - Aged KW - Cohort Studies KW - depression KW - European Continental Ancestry Group KW - Female KW - Genotyping Techniques KW - Humans KW - Male KW - Psychiatric Status Rating Scales AB -

Depressive symptoms are common in older adults and are particularly prevalent in those with or at elevated risk for dementia. Although the heritability of depression is estimated to be substantial, single nucleotide polymorphism-based genome-wide association studies of depressive symptoms have had limited success. In this study, we performed genome-wide gene- and pathway-based analyses of depressive symptom burden. Study participants included non-Hispanic Caucasian subjects (n = 6,884) from three independent cohorts, the Alzheimer's Disease Neuroimaging Initiative (ADNI), the Health and Retirement Study (HRS), and the Indiana Memory and Aging Study (IMAS). Gene-based meta-analysis identified genome-wide significant associations (ANGPT4 and FAM110A, q-value = 0.026; GRM7-AS3 and LRFN5, q-value = 0.042). Pathway analysis revealed enrichment of association in 105 pathways, including multiple pathways related to ERK/MAPK signaling, GSK3 signaling in bipolar disorder, cell development, and immune activation and inflammation. GRM7, ANGPT4, and LRFN5 have been previously implicated in psychiatric disorders, including the GRM7 region displaying association with major depressive disorder. The ERK/MAPK signaling pathway is a known target of antidepressant drugs and has important roles in neuronal plasticity, and GSK3 signaling has been previously implicated in Alzheimer's disease and as a promising therapeutic target for depression. Our results warrant further investigation in independent and larger cohorts and add to the growing understanding of the genetics and pathobiology of depressive symptoms in aging and neurodegenerative disorders. In particular, the genes and pathways demonstrating association with depressive symptoms may be potential therapeutic targets for these symptoms in older adults.

VL - 45 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25690665?dopt=Abstract ER - TY - JOUR T1 - Control Beliefs and Risk for Death, Stroke and Myocardial Infarction in Middle-aged and Older Adults: An Observational Study. JF - J Gen Intern Med Y1 - 2015 A1 - Wei Duan-Porter A1 - Susan Nicole Hastings A1 - Brian Neelon A1 - Courtney Harold Van Houtven KW - Aged KW - Diabetes Mellitus KW - Female KW - Health Knowledge, Attitudes, Practice KW - Humans KW - Hypertension KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Myocardial Infarction KW - Patients KW - Retrospective Studies KW - Risk Factors KW - Stroke KW - Treatment Outcome AB -

BACKGROUND: Chronic health conditions account for the largest proportion of illness-related mortality and morbidity as well as most of healthcare spending in the USA. Control beliefs may be important for outcomes in individuals with chronic illness.

OBJECTIVE: To determine whether control beliefs are associated with the risk for death, incident stroke and incident myocardial infarction (MI), particularly for individuals with diabetes mellitus (DM) and/or hypertension.

DESIGN: Retrospective cohort study.

PARTICIPANTS: A total of 5,662 respondents to the Health and Retirement Study with baseline health, demographic and psychological data in 2006, with no history of previous stroke or MI.

MAIN MEASURES: Perceived global control, measured as two dimensions--"constraints" and "mastery"--and health-specific control were self-reported. Event-free survival was measured in years, where "event" was the composite of death, incident stroke and MI. Year of stroke or MI was self-reported; year of death was obtained from respondents' family.

KEY RESULTS: Mean baseline age was 66.2 years; 994 (16.7%) had DM and 3,023 (53.4%) hypertension. Overall, 173 (3.1%) suffered incident strokes, 129 (2.3%) had incident MI, and 465 (8.2%) died. There were no significant interactions between control beliefs and baseline DM or hypertension in predicting event-free survival. Elevated adjusted hazard ratios (HRs) were associated with DM (1.33, 95 % CI 1.07-1.67), hypertension (1.31, 95% CI 1.07-1.61) and perceived constraints in the third (1.55, 95% CI 1.12-2.15) and fourth quartiles (1.61, 95% CI 1.14-2.26). Health-specific control scores in the third (HR 0.78, 95% CI 0.59-1.03) and fourth quartiles (HR 0.70, 95% CI 0.53-0.92) were protective, but only the latter category had a statistically significant decreased risk. Combined high perceived constraints and low health-specific control had the highest risk (HR 1.93, 95% CI 1.41-2.64).

CONCLUSIONS: Control beliefs were not associated with differential risk for those with DM and/or hypertension, but they predicted significant differences in event-free survival for the general cohort.

PB - 30 VL - 30 IS - 8 N1 - Export Date: 29 May 2015 Article in Press U1 - http://www.ncbi.nlm.nih.gov/pubmed/25792069?dopt=Abstract U2 - PMC4510216 U4 - health condition/Mortality/MORBIDITY/incident stroke/myocardial infarction/diabetes mellitus/hypertension ER - TY - JOUR T1 - Cost of informal caregiving for patients with heart failure. JF - Am Heart J Y1 - 2015 A1 - Heesoo Joo A1 - Fang, Jing A1 - Jan L Losby A1 - Wang, Guijing KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Caregivers KW - Cost of Illness KW - Heart Failure KW - Humans KW - Linear Models KW - Male KW - Middle Aged KW - Models, Econometric AB -

BACKGROUND: Heart failure is a serious health condition that requires a significant amount of informal care. However, informal caregiving costs associated with heart failure are largely unknown.

METHODS: We used a study sample of noninstitutionalized US respondents aged ≥50 years from the 2010 HRS (n = 19,762). Heart failure cases were defined by using self-reported information. The weekly informal caregiving hours were derived by a sequence of survey questions assessing (1) whether respondents had any difficulties in activities of daily living or instrumental activities of daily living, (2) whether they had caregivers because of reported difficulties, (3) the relationship between the patient and the caregiver, (4) whether caregivers were paid, and (5) how many hours per week each informal caregiver provided help. We used a 2-part econometric model to estimate the informal caregiving hours associated with heart failure. The first part was a logit model to estimate the likelihood of using informal caregiving, and the second was a generalized linear model to estimate the amount of informal caregiving hours used among those who used informal caregiving. Replacement approach was used to estimate informal caregiving cost.

RESULTS: The 943 (3.9%) respondents who self-reported as ever being diagnosed with heart failure used about 1.6 more hours of informal caregiving per week than those who did not have heart failure (P < .001). Informal caregiving hours associated with heart failure were higher among non-Hispanic blacks (3.9 hours/week) than non-Hispanic whites (1.4 hours/week). The estimated annual informal caregiving cost attributable to heart failure was $3 billion in 2010.

CONCLUSION: The cost of informal caregiving was substantial and should be included in estimating the economic burden of heart failure. The results should help public health decision makers in understanding the economic burden of heart failure and in setting public health priorities.

PB - 169 VL - 169 UR - http://search.proquest.com/docview/1634498117/abstract/1B5FA0446C27487FPQ/46http://ac.els-cdn.com/S0002870314006176/1-s2.0-S0002870314006176-main.pdf?_tid=0594e8aa-b649-11e5-862d-00000aab0f6bandacdnat=1452286224_94f2bbbda86fc78991ea145942769029http://medi IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25497259?dopt=Abstract U2 - PMC4392718 U4 - Caregivers/Chronic illnesses/Costs/Cardiovascular Diseases/Mortality/Older people/Informal caregiver/Health Care Costs ER - TY - JOUR T1 - Cross-National Differences in Disability Among Elders: Transitions in Disability in Mexico and the United States. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2015 A1 - Kerstin Gerst A1 - Rebeca Wong A1 - Alejandra Michaels-Obregon A1 - Alberto Palloni KW - Aged KW - Aged, 80 and over KW - Aging KW - Cross-Cultural Comparison KW - Disabled Persons KW - Female KW - Humans KW - Male KW - Mexico KW - Middle Aged KW - Mortality KW - Prevalence KW - United States AB -

OBJECTIVES: Little is known about how exposure to a combination of infectious and chronic conditions throughout the lifecourse could impact disability in old age. This paper compares 2 cohorts of adults who have aged under very different country contexts by contrasting disability transitions among elders in Mexico with elders in the United States.

METHODS: Data comes from the Mexican Health and Aging Study (MHAS) and the U.S. Health and Retirement Study (HRS). Estimated probabilities of 2-year transitions among disability states and mortality are presented for adults aged 50 and older.

RESULTS: The levels of disability prevalence and 2 year transitions are consistent with a higher rate of disability for the United States compared to Mexico. In 2-year transitions, the U.S. sample was more likely to transition to a disabled state or increase the number of disabilities than the Mexican counterparts, while Mexicans are more likely to move out of disability or reduce the number of disabilities reported.

DISCUSSION: The findings suggest that the current rate of disability in old age is lower for a less developed country compared with a developed society. We discuss implications, possible explanations, and likely future scenarios.

PB - 70 VL - 70 UR - http://psychsocgerontology.oxfordjournals.org/content/early/2015/01/28/geronb.gbu185.abstract IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25633135?dopt=Abstract U2 - PMC4635645 U4 - Disability/Disability/Elders/Mexico/MHAS_/cross-national comparison/cross Cultural Comparison ER - TY - JOUR T1 - Dental use and expenditures for older uninsured Americans: the simulated impact of expanded coverage. JF - Health Serv Res Y1 - 2015 A1 - Richard J. Manski A1 - John F Moeller A1 - Haiyan Chen A1 - Jody Schimmel A1 - John V Pepper A1 - Patricia A St Clair KW - Aged KW - Dental Health Services KW - Female KW - Health Expenditures KW - Humans KW - Insurance, Dental KW - Male KW - Medically Uninsured KW - Middle Aged KW - Surveys and Questionnaires KW - United States AB -

OBJECTIVE: To determine if providing dental insurance to older Americans would close the current gaps in dental use and expenditure between insured and uninsured older Americans.

DATA SOURCES/STUDY SETTING: We used data from the 2008 Health and Retirement Survey (HRS) supplemented by data from the 2006 Medical Expenditure Panel Survey (MEPS).

STUDY DESIGN: We compared the simulated dental use and expenditures rates of newly insured persons against the corresponding rates for those previously insured.

DATA COLLECTION/EXTRACTION METHODS: The HRS is a nationally representative survey administered by the Institute for Social Research (ISR). The MEPS is a nationally representative household survey sponsored by the Agency for Healthcare Research and Quality (AHRQ).

PRINCIPAL FINDINGS: We found that expanding dental coverage to older uninsured Americans would close previous gaps in dental use and expense between uninsured and insured noninstitutionalized Americans 55 years and older.

CONCLUSIONS: Providing dental coverage to previously uninsured older adults would produce estimated monthly costs net of markups for administrative costs that comport closely to current market rates. Estimates also suggest that the total cost of providing dental coverage targeted specifically to nonusers of dental care may be less than similar costs for prior users.

PB - 50 VL - 50 IS - 1 N1 - Times Cited: 0 0 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25040355?dopt=Abstract U2 - PMC4295003 U4 - dental Care/health Insurance/Medical Expenditure Panel Survey/dental coverage ER - TY - JOUR T1 - Disability Trajectories at the End of Life: A "Countdown" Model. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2015 A1 - Douglas A. Wolf A1 - Vicki A Freedman A1 - Jan I Ondrich A1 - Christopher L Seplaki A1 - Brenda C Spillman KW - Aged KW - Aged, 80 and over KW - Aging KW - Death KW - Disabled Persons KW - Female KW - Humans KW - Male KW - Time Factors KW - United States AB -

OBJECTIVES: Studies of late-life disablement typically address the role of advancing age as a factor in developing disability, and in some cases have pointed out the importance of time to death (TTD) in understanding changes in functioning. However, few studies have addressed both factors simultaneously, and none have dealt satisfactorily with the problem of missing data on TTD in panel studies.

METHODS: We fit latent-class trajectory models of disablement using data from the Health and Retirement Study. Among survivors (~20% of the sample), TTD is unknown, producing a missing-data problem. We use an auxiliary regression equation to impute TTD and employ multiple imputation techniques to obtain final parameter estimates and standard errors.

RESULTS: Our best-fitting model has 3 latent classes. In all 3 classes, the probability of having a disability increases with nearness to death; however, in only 2 of the 3 classes is age associated with disability. We find gender, race, and educational differences in class-membership probabilities.

DISCUSSION: The model reveals a complex pattern of age- and time-dependent heterogeneity in late-life disablement. The techniques developed here could be applied to other phenomena known to depend on TTD, such as cognitive change, weight loss, and health care spending.

PB - 70 VL - 70 UR - http://psychsocgerontology.oxfordjournals.org/content/early/2015/04/23/geronb.gbu182.abstract IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25740918?dopt=Abstract U2 - PMC4635644 U4 - Disability/Disability/Latent classes/Time to death/Trajectories 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 - Discrimination in Healthcare Settings is Associated with Disability in Older Adults: Health and Retirement Study, 2008-2012. JF - J Gen Intern Med Y1 - 2015 A1 - Stephanie E Rogers A1 - Angela D Thrasher A1 - Yinghui Miao A1 - W John Boscardin KW - Activities of Daily Living KW - Aged KW - Ageism KW - Aging KW - Disabled Persons KW - Female KW - Follow-Up Studies KW - Health Status KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Retirement KW - Surveys and Questionnaires AB -

BACKGROUND: As our society ages, improving medical care for an older population will be crucial. Discrimination in healthcare may contribute to substandard experiences with the healthcare system, increasing the burden of poor health in older adults. Few studies have focused on the presence of healthcare discrimination and its effects on older adults.

OBJECTIVE: We aimed to examine the relationship between healthcare discrimination and new or worsened disability.

DESIGN: This was a longitudinal analysis of data from the nationally representative Health and Retirement Study administered in 2008 with follow-up through 2012.

PARTICIPANTS: Six thousand and seventeen adults over the age of 50 years (mean age 67 years, 56.3 % female, 83.1 % white) were included in this study.

MAIN MEASURES: Healthcare discrimination assessed by a 2008 report of receiving poorer service or treatment than other people by doctors or hospitals (never, less than a year=infrequent; more than once a year=frequent). Outcome was self-report of new or worsened disability by 2012 (difficulty or dependence in any of six activities of daily living). We used a Cox proportional hazards model adjusting for age, race/ethnicity, gender, net worth, education, depression, high blood pressure, diabetes, cancer, lung disease, heart disease, stroke, and healthcare utilization in the past 2 years.

KEY RESULTS: In all, 12.6 % experienced discrimination infrequently and 5.9 % frequently. Almost one-third of participants (29 %) reporting frequent healthcare discrimination developed new or worsened disability over 4 years, compared to 16.8 % of those who infrequently and 14.7 % of those who never experienced healthcare discrimination (p < 0.001). In multivariate analyses, compared to no discrimination, frequent healthcare discrimination was associated with new or worsened disability over 4 years (aHR = 1.63, 95 % CI 1.16-2.27).

CONCLUSIONS: One out of five adults over the age of 50 years experiences discrimination in healthcare settings. One in 17 experience frequent healthcare discrimination, and this is associated with new or worsened disability by 4 years. Future research should focus on the mechanisms by which healthcare discrimination influences disability in older adults to promote better health outcomes for an aging population.

PB - 30 VL - 30 UR - http://www.scopus.com/inward/record.url?eid=2-s2.0-84924662760andpartnerID=40andmd5=4aaf0227e962a58fb0e6670d3d3c6bff IS - 10 N1 - Export Date: 29 May 2015 Article in Press U1 - http://www.ncbi.nlm.nih.gov/pubmed/25773918?dopt=Abstract U2 - PMC4579241 U4 - health Care Use/discrimination/health outcomes/health care discrimination/Cox proportional hazards model ER - TY - JOUR T1 - Disease incidence and mortality among older Americans and Europeans. JF - Demography Y1 - 2015 A1 - Sole-Auro, Aida A1 - Pierre-Carl Michaud A1 - Michael D Hurd A1 - Eileen M. Crimmins KW - Age Distribution KW - Aged KW - Chronic disease KW - Europe KW - Health Behavior KW - Humans KW - Incidence KW - Middle Aged KW - Neoplasms KW - Prevalence KW - Risk Factors KW - Sex Distribution KW - Socioeconomic factors KW - United States AB -

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

VL - 52 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25715676?dopt=Abstract ER - TY - JOUR T1 - Do Statins Reduce the Health and Health Care Costs of Obesity? JF - Pharmacoeconomics Y1 - 2015 A1 - Gaudette, Étienne A1 - Dana P Goldman A1 - Messali, Andrew A1 - Sood, Neeraj KW - Aged KW - Computer Simulation KW - Cost-Benefit Analysis KW - Health Care Costs KW - Humans KW - Hydroxymethylglutaryl-CoA Reductase Inhibitors KW - Life Expectancy KW - Markov chains KW - Models, Economic KW - Obesity KW - Quality-Adjusted Life Years AB -

CONTEXT: Obesity impacts both individual health and, given its high prevalence, total health care spending. However, as medical technology evolves, health outcomes for a number of obesity-related illnesses improve. This article examines whether medical innovation can mitigate the adverse health and spending associated with obesity, using statins as a case study. Because of the relationship between obesity and hypercholesterolaemia, statins play an important role in the medical management of obese individuals and the prevention of costly obesity-related sequelae.

METHODS: Using well-recognized estimates of the health impact of statins and the Future Elderly Model (FEM)-an established dynamic microsimulation model of the health of Americans aged over 50 years-we estimate the changes in life expectancy, functional status and health care costs of obesity due to the introduction and widespread use of statins.

RESULTS: Life expectancy gains of statins are estimated to be 5-6 % greater for obese individuals than for healthy-weight individuals, but most of these additional gains are associated with some level of disability. Considering both medical spending and the value of quality-adjusted life-years, statins do not significantly alter the costs of class 1 and 2 obesity (body mass index [BMI] ≥30 and ≥35 kg/m(2), respectively) and they increase the costs of class 3 obesity (BMI ≥40 kg/m(2)) by 1.2 %.

CONCLUSIONS: Although statins are very effective medications for lowering the risk of obesity-associated illnesses, they do not significantly reduce the costs of obesity.

VL - 33 IS - 7 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25576147?dopt=Abstract ER - TY - JOUR T1 - Does Stroke Contribute to Racial Differences in Cognitive Decline? JF - Stroke Y1 - 2015 A1 - Deborah A Levine A1 - Mohammed U Kabeto A1 - Kenneth M. Langa A1 - Lynda D Lisabeth A1 - Mary A M Rogers A1 - Andrzej T Galecki KW - African Continental Ancestry Group KW - Aged KW - Aged, 80 and over KW - Cognition Disorders KW - European Continental Ancestry Group KW - Female KW - Humans KW - Longitudinal Studies KW - Male KW - Risk Factors KW - Stroke AB -

BACKGROUND AND PURPOSE: It is unknown whether blacks' elevated risk of dementia is because of racial differences in acute stroke, the impact of stroke on cognitive health, or other factors. We investigated whether racial differences in cognitive decline are explained by differences in the frequency or impact of incident stroke between blacks and whites, controlling for baseline cognition.

METHODS: Among 4908 black and white participants aged ≥65 years free of stroke and cognitive impairment in the nationally representative Health and Retirement Study with linked Medicare data (1998-2010), we examined longitudinal changes in global cognition (modified version of the Telephone Interview for Cognitive Status) by race, before and after adjusting for time-dependent incident stroke followed by a race-by-incident stroke interaction term, using linear mixed-effects models that included fixed effects of participant demographics, clinical factors, and cognition, and random effects for intercept and slope for time.

RESULTS: We identified 34 of 453 (7.5%) blacks and 300 of 4455 (6.7%) whites with incident stroke over a mean (SD) of 4.1 (1.9) years of follow-up (P=0.53). Blacks had greater cognitive decline than whites (adjusted difference in modified version of the Telephone Interview for Cognitive Status score, 1.47 points; 95% confidence interval, 1.21 to 1.73 points). With further adjustment for cumulative incidence of stroke, the black-white difference in cognitive decline persisted. Incident stroke was associated with a decrease in global cognition (1.21 points; P<0.001) corresponding to ≈7.9 years of cognitive aging. The effect of incident stroke on cognition did not statistically differ by race (P=0.52).

CONCLUSIONS: In this population-based cohort of older adults, incident stroke did not explain black-white differences in cognitive decline or impact cognition differently by race.

PB - 46 VL - 46 UR - http://stroke.ahajournals.org/content/early/2015/05/20/STROKEAHA.114.008156.abstract IS - 7 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25999389?dopt=Abstract U4 - dementia/Medicare/stroke/African American/cognitive status/decline ER - TY - JOUR T1 - Effect of APOE and CD33 on Cognitive Decline. JF - PLoS One Y1 - 2015 A1 - Kathleen M Hayden A1 - Michael W Lutz A1 - Kuchibhatla, Maragatha A1 - Cassandra M Germain A1 - Brenda L Plassman KW - Aged KW - Apolipoproteins E KW - Cognition Disorders KW - Female KW - Genetic Predisposition to Disease KW - Humans KW - Male KW - Polymorphism, Single Nucleotide KW - Sialic Acid Binding Ig-like Lectin 3 AB -

OBJECTIVE: An Alzheimer's disease (AD) diagnosis is preceded by a long period of cognitive decline. We previously demonstrated increased risk of decline among individuals possessing one or more APOE ε4 alleles together with a family history of AD. The objective of this study is to investigate the possibility that such an increased risk might be due to AD risk genes with small effects in combination with APOE.

METHODS: Participants in the Health and Retirement Study (HRS) over the age of 65, who contributed DNA, and had two or more evaluations with an abbreviated version of the modified Telephone Interview for Cognitive Status (TICS-m) were eligible for the study (n = 7451). A genetic risk score (g-score) was derived using AD risk genes' meta-analyses data, assigning risk according to the number of risk alleles and summed over all the risk genes. Trajectories of cognitive function were modeled in four groups of Caucasian participants with and without one or more APOE ε4 alleles and either a high or low g-score: APOE ε4-/low g-score; APOE ε4-/high g-score; APOE ε4+/low g-score; and APOE ε4+/high g-score. Post hoc analyses evaluated interactions between individual genes and APOE.

RESULTS: Individuals in the APOE ε4+/high g-score group exhibited the greatest cognitive decline over time (p<.0001). This risk appeared to be greater than the sum of the effects of either high g-score or APOE ε4 alone. When gene interactions were individually tested with APOE, a statistically significant interaction with CD33 was discovered (p = 0.04) although the interaction was no longer significant when adjusted for multiple comparisons.

CONCLUSIONS: Individuals with multiple AD risk genes in addition to having one or more APOE ε4 alleles are at greater risk of cognitive decline than individuals with either APOE ε4 or a high genetic risk score. Among those with one or more APOE ε4 alleles, having one or more copies of the CD33 C (risk) allele may further increase the risk of cognitive decline.

PB - 10 VL - 10 IS - 6 N1 - Times Cited: 1 0 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26102276?dopt=Abstract U2 - PMC4478019 U4 - Alzheimer disease/dementia/cognition/cognitive decline/TICS Scale/genetics/genetics/genetic analysis/risk alleles ER - TY - JOUR T1 - The effect of dental insurance on the use of dental care for older adults: a partial identification analysis. JF - Health Econ Y1 - 2015 A1 - Kreider, Brent A1 - Richard J. Manski A1 - John F Moeller A1 - John V Pepper KW - Aged KW - Dental Care KW - Female KW - Humans KW - Insurance Coverage KW - Insurance, Dental KW - Male KW - Middle Aged KW - Models, Econometric KW - Reproducibility of Results AB -

We evaluate the impact of dental insurance on the use of dental services using a potential outcomes identification framework designed to handle uncertainty created by unknown counterfactuals-that is, the endogenous selection problem-and uncertainty about the reliability of self-reported insurance status. Using data from the health and retirement study, we estimate that utilization rates of adults older than 50 years would increase from 75% to around 80% under universal dental coverage.

PB - 24 VL - 24 IS - 7 N1 - Export Date: 6 August 2014 Article in Press U1 - http://www.ncbi.nlm.nih.gov/pubmed/24890257?dopt=Abstract U2 - PMC4247826 U4 - Classification errors/Dental care/Dental insurance/Partial identification/Selection/Treatment effect ER - TY - JOUR T1 - The effects of constraints and mastery on mental and physical health: Conceptual and methodological considerations. JF - Psychol Aging Y1 - 2015 A1 - Frank J Infurna A1 - Axel Mayer KW - Aged KW - Confounding Factors, Epidemiologic KW - Cross-Sectional Studies KW - Factor Analysis, Statistical KW - Female KW - Health Status KW - Health Surveys KW - Humans KW - Longitudinal Studies KW - Male KW - Mental Health KW - Middle Aged KW - Motor Activity KW - Retirement KW - Self-control AB -

Perceived control and health are closely interrelated in adulthood and old age. However, less is known regarding the differential implications of 2 facets of perceived control, constraints and mastery, for mental and physical health. Furthermore, a limitation of previous research testing the pathways linking perceived control to mental and physical health is that mediation was tested with cross-sectional designs and not in a longitudinal mediation design that accounts for temporal ordering and prior confounds. Using data from the Health and Retirement Study (HRS; n = 7,612, M age = 68, SD = 10.66; 59% women) we examined the effect of constraints and mastery on 4-year changes in mental and physical health and whether physical activity mediated such effects in a longitudinal mediation design. Using confirmatory factor analysis, we modeled the 2-factor structure of perceived control that consisted of constraints and mastery. In our longitudinal mediation model, where we accounted for possible confounders (e.g., age, gender, education, neuroticism, conscientiousness, memory, and health conditions), constraints showed a stronger total effect on mental and physical health, than mastery, such that more constraints were associated with 4-year declines in mental and physical health. Physical activity did not mediate the effect of constraints and mastery on mental and physical health (indirect effect). To demonstrate the importance of a longitudinal mediation model that accounts for confounders, we also estimated the mediated effect using 2 models commonly used in the literature: cross-sectional mediation model and longitudinal mediation model without accounting for confounders. These mediation models indicated a spurious indirect effect that cannot be causally interpreted. Our results showcase that constraints and mastery have differential implications for mental and physical health, as well as how a longitudinal mediation design can illustrate (or not) pathways in developmental processes. Our discussion focuses on the conceptual and methodological implications of a 2 facet model of perceived control and the strengths of longitudinal mediation designs for testing conceptual models of human development.

PB - 30 VL - 30 IS - 2 N1 - Export Date: 29 May 2015 Article in Press U1 - http://www.ncbi.nlm.nih.gov/pubmed/25938243?dopt=Abstract U2 - PMC4451433 U4 - Adulthood and old age/Confirmatory factor analysis/Mediation/Sense of control/Perceived controls ER - TY - JOUR T1 - Effects of Co-Worker and Supervisor Support on Job Stress and Presenteeism in an Aging Workforce: A Structural Equation Modelling Approach. JF - Int J Environ Res Public Health Y1 - 2015 A1 - Tianan Yang A1 - Shen, Yu-Ming A1 - Zhu, Mingjing A1 - Liu, Yuanling A1 - Deng, Jianwei A1 - Chen, Qian A1 - See, Lai-Chu KW - Aged KW - Cross-Sectional Studies KW - Female KW - Health Surveys KW - Humans KW - Interpersonal Relations KW - Male KW - Middle Aged KW - Models, Statistical KW - Occupational Health KW - Population Dynamics KW - Presenteeism KW - Social Support KW - Stress, Psychological KW - United States AB -

We examined the effects of co-worker and supervisor support on job stress and presenteeism in an aging workforce. Structural equation modelling was used to evaluate data from the 2010 wave of the Health and Retirement Survey in the United States (n = 1649). The level of presenteeism was low and the level of job stress was moderate among aging US workers. SEM revealed that co-worker support and supervisor support were strongly correlated (β = 0.67; p < 0.001). Job stress had a significant direct positive effect on presenteeism (β = 0.30; p < 0.001). Co-worker support had a significant direct negative effect on job stress (β = -0.10; p < 0.001) and presenteeism (β = -0.11; p < 0.001). Supervisor support had a significant direct negative effect on job stress (β = -0.40; p < 0.001) but not presenteeism. The findings suggest that presenteeism is reduced by increased respect and concern for employee stress at the workplace, by necessary support at work from colleagues and employers, and by the presence of comfortable interpersonal relationships among colleagues and between employers and employees.

PB - 13 VL - 13 IS - 1 N1 - Times Cited: 0 0 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26703705?dopt=Abstract U2 - PMC4730463 U4 - job stress/Presenteeism/workplace/labor Force Participation 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 - Estimating the Effects of Obesity and Weight Change on Mortality Using a Dynamic Causal Model. JF - PLoS One Y1 - 2015 A1 - Cao, Bochen KW - Aged KW - Aged, 80 and over KW - Body Mass Index KW - Body Weight KW - Female KW - Humans KW - Male KW - Middle Aged KW - Models, Theoretical KW - Obesity KW - Overweight KW - Risk Factors KW - Thinness KW - Weight Gain KW - Weight Loss AB -

BACKGROUND: A well-known challenge in estimating the mortality risks of obesity is reverse causality attributable to illness-associated and smoking-associated weight loss. Given that the likelihood of chronic and acute illnesses rises with age, reverse causality is most threatening to estimates derived from elderly populations.

METHODS: I analyzed data from 12,523 respondents over 50 years old from a nationally representative longitudinal dataset, the Health and Retirement Study (HRS). The effects of both baseline body weight and time-varying weight change on mortality are estimated, adjusting for demographic and socio-economic variables, as well as time-varying confounders including illness and smoking. Body weight is measured by body mass index (BMI). In survival models for mortality, illness and smoking were lagged to minimize bias from reverse causality in estimates of the effect of weight change. Furthermore, because illness both causes and is caused by changes in BMI, I used a marginal structural model (MSM) rather than standard adjustment to control confounding by this and other time-dependent factors.

RESULTS: Overall, relative to normal weight, underweight and Class II/III at baseline are associated with hazard ratios that are 2.07 (95% confidence interval (CI): 1.28-3.37) and 1.82 (1.54-2.16) respectively, whereas overweight and Class I obesity do not significantly lower or raise the mortality risks. Furthermore, relative to stable weight change, all types of weight change lead to significantly increased risk of mortality. Specifically, large weight loss results in a mortality risk that is nearly 3.86 (3.26-4.58) times of staying in the stable weight range and small weight loss is about 1.81 (1.55-2.11 ) times riskier. In contrast, large weight gain and small weight gain are associated with hazard ratios that are 1.98 (1.67-2.35) and 1.20 (1.02-1.41) respectively.

CONCLUSIONS: Being underweight or severe obese at baseline is associated with excess mortality risk, and weight change tend to raise mortality risk. Both the confounding by illness and by smoking lead to overestimates of the effects of being underweight at baseline and of weight loss, but underestimates the effect of being obese at baseline.

PB - 10 VL - 10 IS - 6 N1 - Times Cited: 0 0 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26110432?dopt=Abstract U2 - PMC4481504 U4 - weight loss/illness/smoking/Reverse causality/Obesity/weight gain/mortality ER - TY - JOUR T1 - Explaining Disability Trends in the U.S. Elderly and Near-Elderly Population. JF - Health Serv Res Y1 - 2015 A1 - Chen, Yiqun A1 - Frank A Sloan KW - Activities of Daily Living KW - Age Distribution KW - Aged KW - Aged, 80 and over KW - Alcohol Drinking KW - Chronic disease KW - Disabled Persons KW - Female KW - Health Behavior KW - Health Surveys KW - Humans KW - Male KW - Middle Aged KW - Mobility Limitation KW - Obesity KW - Prevalence KW - Sex Distribution KW - Smoking KW - Socioeconomic factors KW - United States AB -

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

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

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

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

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

PB - 50 VL - 50 IS - 5 N1 - Times Cited: 1 0 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25655273?dopt=Abstract U2 - PMC4600360 U4 - ADL/IADL/Disabilities/sociodemographic factors/sociodemographic factors/Chronic Disease/Smoking/Alcohol/obesity ER - TY - JOUR T1 - Factors associated with cognitive evaluations in the United States. JF - Neurology Y1 - 2015 A1 - Vikas Kotagal A1 - Kenneth M. Langa A1 - Brenda L Plassman A1 - Gwenith G Fisher A1 - Bruno J Giordani A1 - Robert B Wallace A1 - James F. Burke A1 - David C Steffens A1 - Mohammed U Kabeto A1 - Roger L. Albin A1 - Norman L Foster KW - Aged KW - Aged, 80 and over KW - Cognition Disorders KW - Cohort Studies KW - Dementia KW - Female KW - Humans KW - Logistic Models KW - Male KW - Marital Status KW - Multivariate Analysis KW - Neuropsychological tests KW - Severity of Illness Index KW - United States AB -

OBJECTIVE: We aimed to explore factors associated with clinical evaluations for cognitive impairment among older residents of the United States.

METHODS: Two hundred ninety-seven of 845 subjects in the Aging, Demographics, and Memory Study (ADAMS), a nationally representative community-based cohort study, met criteria for dementia after a detailed in-person study examination. Informants for these subjects reported whether or not they had ever received a clinical cognitive evaluation outside of the context of ADAMS. Among subjects with dementia, we evaluated demographic, socioeconomic, and clinical factors associated with an informant-reported clinical cognitive evaluation using bivariate analyses and multivariable logistic regression.

RESULTS: Of the 297 participants with dementia in ADAMS, 55.2% (representing about 1.8 million elderly Americans in 2002) reported no history of a clinical cognitive evaluation by a physician. In a multivariable logistic regression model (n = 297) controlling for demographics, physical function measures, and dementia severity, marital status (odds ratio for currently married: 2.63 [95% confidence interval: 1.10-6.35]) was the only significant independent predictor of receiving a clinical cognitive evaluation among subjects with study-confirmed dementia.

CONCLUSIONS: Many elderly individuals with dementia do not receive clinical cognitive evaluations. The likelihood of receiving a clinical cognitive evaluation in elderly individuals with dementia associates with certain patient-specific factors, particularly severity of cognitive impairment and current marital status.

VL - 84 UR - http://www.neurology.org/cgi/doi/10.1212/WNL.0000000000001096 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25428689?dopt=Abstract JO - Neurology 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 - Financing Long-Term Services And Supports: Options Reflect Trade-Offs For Older Americans And Federal Spending. JF - Health Affairs (Project Hope) Y1 - 2015 A1 - Melissa Favreault A1 - Gleckman, Howard A1 - Richard W. Johnson KW - Aged KW - Financing KW - Government KW - Humans KW - Insurance KW - Insurance Coverage KW - Long-term Care KW - Medicaid KW - Middle Aged KW - Policy Making KW - United States AB -

About half of older Americans will need a high level of assistance with routine activities for a prolonged period of time. This help is commonly referred to as long-term services and supports (LTSS). Under current policies, these individuals will fund roughly half of their paid care out of pocket. Partly as a result of high costs and uncertainty, relatively few people purchase private long-term care insurance or save sufficiently to fully finance LTSS; many will eventually turn to Medicaid for help. To show how policy changes could expand insurance's role in financing these needs, we modeled several new insurance options. Specifically, we looked at a front-end-only benefit that provides coverage relatively early in the period of disability but caps benefits, a back-end benefit with no lifetime limit, and a combined comprehensive benefit. We modeled mandatory and voluntary versions of each option, and subsidized and unsubsidized versions of each voluntary option. We identified important differences among the alternatives, highlighting relevant trade-offs that policy makers can consider in evaluating proposals. If the primary goal is to significantly increase insurance coverage, the mandatory options would be more successful than the voluntary versions. If the major aim is to reduce Medicaid costs, the comprehensive and back-end mandatory options would be most beneficial.

VL - 34 IS - 12 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26572919?dopt=Abstract 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 - Gender Differences in Institutional Long-Term Care Transitions. JF - Womens Health Issues Y1 - 2015 A1 - Mudrazija, Stipica A1 - Thomeer, Mieke Beth A1 - Jacqueline L. Angel KW - Aged KW - Aged, 80 and over KW - Continuity of Patient Care KW - Family Characteristics KW - Female KW - Geriatric Assessment KW - Home Care Services KW - Humans KW - Length of Stay KW - Logistic Models KW - Long-term Care KW - Male KW - Marital Status KW - Middle Aged KW - Nursing homes KW - Patient Discharge KW - Residence Characteristics KW - Sex Characteristics KW - United States AB -

INTRODUCTION: This study investigates the relationship between gender, the likelihood of discharge from institutional long-term care (LTC) facilities, and post-discharge living arrangements, highlighting sociodemographic, health, socioeconomic, and family characteristics.

METHODS: We use the Health and Retirement Study to examine individuals age 65 and older admitted to LTC facilities between 2000 and 2010 (n = 3,351). We examine discharge patterns using survival analyses that account for the competing risk of death and estimate the probabilities of post-discharge living arrangements using multinomial logistic regression models.

RESULTS: Women are more likely than men to be discharged from LTC facilities during the first year of stay. Women are more likely to live alone or with kin after discharge, whereas men are more likely to live with a spouse or transfer to another institution. Gender differences in the availability and use of family support may partly account for the gender disparity of LTC discharge and post-discharge living arrangements.

CONCLUSION: Our findings suggest that women and men follow distinct pathways after LTC discharge. As local and federal efforts begin to place more emphasis on the transition from LTC facilities to prior communities (e.g., transitional care initiatives under the Patient Protection and Affordable Care Act), policymakers should take these gender differences into account in the design of community transition programs.

PB - 25 VL - 25 UR - http://www.sciencedirect.com/science/article/pii/S1049386715000638 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26123639?dopt=Abstract U2 - PMC4569522 U4 - Long Term Care/discharge likelihood/discharge planning/sociodemographic differences/sociodemographic differences/LTC discharge ER - TY - JOUR T1 - Genetic contributions to variation in general cognitive function: a meta-analysis of genome-wide association studies in the CHARGE consortium (N=53949). JF - Mol Psychiatry Y1 - 2015 A1 - Gail Davies A1 - Armstrong, N. A1 - Joshua C. Bis A1 - Bressler, J. A1 - Chouraki, V. A1 - Giddaluru, S. A1 - Edith Hofer A1 - Carla A Ibrahim-Verbaas A1 - Kirin, M. A1 - J. Lahti A1 - Sven J van der Lee A1 - Stephanie Le Hellard A1 - Tian Liu A1 - Riccardo E Marioni A1 - Christopher J Oldmeadow A1 - Postmus, I. A1 - Albert Vernon Smith KW - Aged KW - Aged, 80 and over KW - Atherosclerosis KW - Cognition KW - Cognition Disorders KW - Cohort Studies KW - Female KW - Genetic Predisposition to Disease KW - Genome-Wide Association Study KW - HMGN1 Protein KW - Humans KW - Male KW - Middle Aged KW - Neuropsychological tests KW - Phenotype KW - Polymorphism, Single Nucleotide KW - Scotland AB -

General cognitive function is substantially heritable across the human life course from adolescence to old age. We investigated the genetic contribution to variation in this important, health- and well-being-related trait in middle-aged and older adults. We conducted a meta-analysis of genome-wide association studies of 31 cohorts (N=53,949) in which the participants had undertaken multiple, diverse cognitive tests. A general cognitive function phenotype was tested for, and created in each cohort by principal component analysis. We report 13 genome-wide significant single-nucleotide polymorphism (SNP) associations in three genomic regions, 6q16.1, 14q12 and 19q13.32 (best SNP and closest gene, respectively: rs10457441, P=3.93 × 10(-9), MIR2113; rs17522122, P=2.55 × 10(-8), AKAP6; rs10119, P=5.67 × 10(-9), APOE/TOMM40). We report one gene-based significant association with the HMGN1 gene located on chromosome 21 (P=1 × 10(-6)). These genes have previously been associated with neuropsychiatric phenotypes. Meta-analysis results are consistent with a polygenic model of inheritance. To estimate SNP-based heritability, the genome-wide complex trait analysis procedure was applied to two large cohorts, the Atherosclerosis Risk in Communities Study (N=6617) and the Health and Retirement Study (N=5976). The proportion of phenotypic variation accounted for by all genotyped common SNPs was 29% (s.e.=5%) and 28% (s.e.=7%), respectively. Using polygenic prediction analysis, ~1.2% of the variance in general cognitive function was predicted in the Generation Scotland cohort (N=5487; P=1.5 × 10(-17)). In hypothesis-driven tests, there was significant association between general cognitive function and four genes previously associated with Alzheimer's disease: TOMM40, APOE, ABCG1 and MEF2C.

PB - 20 VL - 20 IS - 2 N1 - Times Cited: 0 0 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25644384?dopt=Abstract U2 - PMC4356746 U4 - genetics/genetics/GENOME-WIDE ASSOCIATION/TOMM40/ABCG1/MEF2C/complex train anaysis/Atherosclerosis Risk in Communities Study/cross-national study ER - TY - JOUR T1 - Genetic vulnerability to diabetes and obesity: does education offset the risk? JF - Soc Sci Med Y1 - 2015 A1 - Sze Y Liu A1 - Stefan Walter A1 - Jessica R Marden A1 - David Rehkopf A1 - Laura D Kubzansky A1 - Thu T Nguyen A1 - M. Maria Glymour KW - Aged KW - Body Mass Index KW - Diabetes Mellitus, Type 2 KW - Educational Status KW - European Continental Ancestry Group KW - Female KW - Genetic Predisposition to Disease KW - Genotype KW - Glycated Hemoglobin A KW - Health Status Disparities KW - Humans KW - Male KW - Middle Aged KW - Obesity KW - Risk Factors KW - Social determinants of health AB -

The prevalence of type 2 diabetes (T2D) and obesity has recently increased dramatically. These common diseases are likely to arise from the interaction of multiple genetic, socio-demographic and environmental risk factors. While previous research has found genetic risk and education to be strong predictors of these diseases, few studies to date have examined their joint effects. This study investigates whether education modifies the association between genetic background and risk for type 2 diabetes (T2D) and obesity. Using data from non-Hispanic Whites in the Health and Retirement Study (HRS, n = 8398), we tested whether education modifies genetic risk for obesity and T2D, offsetting genetic effects; whether this effect is larger for individuals who have high risk for other (unobserved) reasons, i.e., at higher quantiles of HbA1c and BMI; and whether effects differ by gender. We measured T2D risk using Hemoglobin A1c (HbA1c) level, and obesity risk using body-mass index (BMI). We constructed separate genetic risk scores (GRS) for obesity and diabetes respectively based on the most current available information on the single nucleotide polymorphism (SNPs) confirmed as genome-wide significant predictors for BMI (29 SNPs) and diabetes risk (39 SNPs). Linear regression models with years of schooling indicate that the effect of genetic risk on HbA1c is smaller among people with more years of schooling and larger among those with less than a high school (HS) degree compared to HS degree-holders. Quantile regression models show that the GRS × education effect systematically increased along the HbA1c outcome distribution; for example the GRS × years of education interaction coefficient was -0.01 (95% CI = -0.03, 0.00) at the 10th percentile compared to -0.03 (95% CI = -0.07, 0.00) at the 90th percentile. These results suggest that education may be an important socioeconomic source of heterogeneity in responses to genetic vulnerability to T2D.

VL - 127 UR - http://www.sciencedirect.com/science/article/pii/S0277953614005760 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25245452?dopt=Abstract ER - TY - JOUR T1 - Genetically predicted body mass index and Alzheimer's disease-related phenotypes in three large samples: Mendelian randomization analyses. JF - Alzheimers Dement Y1 - 2015 A1 - Mukherjee, Shubhabrata A1 - Stefan Walter A1 - Kauwe, John S K A1 - Andrew J Saykin A1 - David A Bennett A1 - Eric B Larson A1 - Paul K Crane A1 - M. Maria Glymour KW - Aged KW - Aged, 80 and over KW - Alzheimer disease KW - Body Mass Index KW - Female KW - Genotype KW - Humans KW - Linear Models KW - Male KW - Mendelian Randomization Analysis KW - Obesity KW - Phenotype KW - Polymorphism, Single Nucleotide KW - Risk Factors AB -

Observational research shows that higher body mass index (BMI) increases Alzheimer's disease (AD) risk, but it is unclear whether this association is causal. We applied genetic variants that predict BMI in Mendelian randomization analyses, an approach that is not biased by reverse causation or confounding, to evaluate whether higher BMI increases AD risk. We evaluated individual-level data from the AD Genetics Consortium (ADGC: 10,079 AD cases and 9613 controls), the Health and Retirement Study (HRS: 8403 participants with algorithm-predicted dementia status), and published associations from the Genetic and Environmental Risk for AD consortium (GERAD1: 3177 AD cases and 7277 controls). No evidence from individual single-nucleotide polymorphisms or polygenic scores indicated BMI increased AD risk. Mendelian randomization effect estimates per BMI point (95% confidence intervals) were as follows: ADGC, odds ratio (OR) = 0.95 (0.90-1.01); HRS, OR = 1.00 (0.75-1.32); GERAD1, OR = 0.96 (0.87-1.07). One subscore (cellular processes not otherwise specified) unexpectedly predicted lower AD risk.

VL - 11 IS - 12 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26079416?dopt=Abstract ER - TY - JOUR T1 - Greater Perceived Age Discrimination in England than the United States: Results from HRS and ELSA. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2015 A1 - Rippon, Isla A1 - Zaninotto, Paola A1 - Andrew Steptoe KW - Aged KW - Aged, 80 and over KW - Ageism KW - England KW - Female KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Perception KW - Surveys and Questionnaires KW - United States AB -

OBJECTIVES: We examined cross-national differences in perceptions of age discrimination in England and the United States. Under the premise that the United States has had age discrimination legislation in place for considerably longer than England, we hypothesized that perceptions of age discrimination would be lower in the United States.

METHODS: We analyzed data from two nationally representative studies of aging, the U.S. Health and Retirement Study (n = 4,818) and the English Longitudinal Study of Ageing (n = 7,478). Respondents aged 52 years and older who attributed any experiences of discrimination to their age were treated as cases of perceived age discrimination. We used multivariable logistic regression to estimate the odds ratios of experiencing perceived age discrimination in relation to selected sociodemographic factors.

RESULTS: Perceptions of age discrimination were significantly higher in England than the United States, with 34.8% of men and women in England reporting age discrimination compared with 29.1% in the United States. Associations between perceived age discrimination and older age and lower levels of household wealth were observed in both countries, but we found differences between England and the United States in the relationship between perceived age discrimination and education.

DISCUSSION: Our study revealed that levels of perceived age discrimination are lower in the United States than England and are less socially patterned. This suggests that differing social and political circumstances in the two countries may have an important role to play.

PB - 70 VL - 70 UR - http://psychsocgerontology.oxfordjournals.org/content/early/2015/07/28/geronb.gbv040.abstract IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26224759?dopt=Abstract U2 - PMC4600302 U4 - Ageism/Older adults/Cross-National Studies/Age discrimination/mental Health/International comparisons/Demographics/ELSA_ ER - TY - JOUR T1 - GWAS of longevity in CHARGE consortium confirms APOE and FOXO3 candidacy. JF - J Gerontol A Biol Sci Med Sci Y1 - 2015 A1 - Broer, Linda A1 - Aron S Buchman A1 - Deelen, Joris A1 - Daniel S Evans A1 - Jessica Faul A1 - Kathryn L Lunetta A1 - Sebastiani, Paola A1 - Jennifer A Smith A1 - Albert Vernon Smith A1 - Toshiko Tanaka A1 - Lei Yu A1 - Alice M. Arnold A1 - Aspelund, Thor A1 - Emelia J Benjamin A1 - Philip L de Jager A1 - Guðny Eiríksdóttir A1 - Melissa E Garcia A1 - Hofman, Albert A1 - Kaplan, Robert C A1 - Sharon L R Kardia A1 - Douglas P Kiel A1 - Ben A Oostra A1 - Orwoll, Eric S A1 - Parimi, Neeta A1 - Psaty, Bruce M A1 - Fernando Rivadeneira A1 - Rotter, Jerome I A1 - Seshadri, Sudha A1 - Andrew B Singleton A1 - Henning Tiemeier A1 - André G Uitterlinden A1 - Wei Zhao A1 - Bandinelli, Stefania A1 - David A Bennett A1 - Luigi Ferrucci A1 - Gudnason, Vilmundur A1 - Tamara B Harris A1 - Karasik, David A1 - Lenore J Launer A1 - Thomas T Perls A1 - Eline P Slagboom A1 - Tranah, Gregory J A1 - David R Weir A1 - Anne B Newman A1 - Cornelia M van Duijn A1 - Joanne M Murabito KW - Aged KW - Aged, 80 and over KW - Apolipoproteins E KW - Cell Adhesion Molecules KW - Cohort Studies KW - Female KW - Forkhead Box Protein O3 KW - Forkhead Transcription Factors KW - Genome-Wide Association Study KW - Humans KW - Longevity KW - Male KW - Middle Aged KW - Polymorphism, Single Nucleotide KW - Receptors, Kainic Acid AB -

BACKGROUND: The genetic contribution to longevity in humans has been estimated to range from 15% to 25%. Only two genes, APOE and FOXO3, have shown association with longevity in multiple independent studies.

METHODS: We conducted a meta-analysis of genome-wide association studies including 6,036 longevity cases, age ≥90 years, and 3,757 controls that died between ages 55 and 80 years. We additionally attempted to replicate earlier identified single nucleotide polymorphism (SNP) associations with longevity.

RESULTS: In our meta-analysis, we found suggestive evidence for the association of SNPs near CADM2 (odds ratio [OR] = 0.81; p value = 9.66 × 10(-7)) and GRIK2 (odds ratio = 1.24; p value = 5.09 × 10(-8)) with longevity. When attempting to replicate findings earlier identified in genome-wide association studies, only the APOE locus consistently replicated. In an additional look-up of the candidate gene FOXO3, we found that an earlier identified variant shows a highly significant association with longevity when including published data with our meta-analysis (odds ratio = 1.17; p value = 1.85×10(-10)).

CONCLUSIONS: We did not identify new genome-wide significant associations with longevity and did not replicate earlier findings except for APOE and FOXO3. Our inability to find new associations with survival to ages ≥90 years because longevity represents multiple complex traits with heterogeneous genetic underpinnings, or alternatively, that longevity may be regulated by rare variants that are not captured by standard genome-wide genotyping and imputation of common variants.

VL - 70 UR - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4296168/ IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25199915?dopt=Abstract ER - TY - JOUR T1 - Harmonizing Measures of Cognitive Performance Across International Surveys of Aging Using Item Response Theory. JF - J Aging Health Y1 - 2015 A1 - Kitty S. Chan A1 - Alden L Gross A1 - Liliana E Pezzin A1 - Jason Brandt A1 - Judith D Kasper KW - Aged KW - Aged, 80 and over KW - Aging KW - Cognition KW - Female KW - Humans KW - Internationality KW - Longitudinal Studies KW - Male KW - Psychological Theory KW - Reproducibility of Results KW - Surveys and Questionnaires KW - United Kingdom KW - United States AB -

OBJECTIVE: To harmonize measures of cognitive performance using item response theory (IRT) across two international aging studies.

METHOD: Data for persons ≥65 years from the Health and Retirement Study (HRS, N = 9,471) and the English Longitudinal Study of Aging (ELSA, N = 5,444). Cognitive performance measures varied (HRS fielded 25, ELSA 13); 9 were in common. Measurement precision was examined for IRT scores based on (a) common items, (b) common items adjusted for differential item functioning (DIF), and (c) DIF-adjusted all items.

RESULTS: Three common items (day of date, immediate word recall, and delayed word recall) demonstrated DIF by survey. Adding survey-specific items improved precision but mainly for HRS respondents at lower cognitive levels.

DISCUSSION: IRT offers a feasible strategy for harmonizing cognitive performance measures across other surveys and for other multi-item constructs of interest in studies of aging. Practical implications depend on sample distribution and the difficulty mix of in-common and survey-specific items.

PB - 27 VL - 27 IS - 8 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26526748?dopt=Abstract U4 - ELSA_/item response theory/cognitive performance/Public Policy/Cognitive ability/Aging/cross-national comparison 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 - Historical improvements in well-being do not hold in late life: Birth- and death-year cohorts in the United States and Germany. JF - Dev Psychol Y1 - 2015 A1 - Hülür, Gizem A1 - Ram, Nilam A1 - Denis Gerstorf KW - Aged KW - Aging KW - Cohort Effect KW - depression KW - Epidemiologic Research Design KW - Female KW - Germany KW - Health Status KW - Health Surveys KW - Humans KW - Longitudinal Studies KW - Male KW - Propensity Score KW - United States AB -

One key objective of life span research is to examine how individual development is shaped by the historical time people live in. Secular trends favoring later-born cohorts on fluid cognitive abilities have been widely documented, but findings are mixed for well-being. It remains an open question whether secular increases in well-being seen in earlier phases of life also manifest in the last years of life. To examine this possibility, we made use of longitudinal data obtained from the mid-1980s until the late 2000s in 2 large national samples in the United States (Health and Retirement Study [HRS]) and Germany (German Socio-Economic Panel [SOEP]). We operationally defined historical time from 2 complementary perspectives: birth-year cohorts based on the years in which people were born (earlier: 1930s vs. later: 1940s) and death-year cohorts based on the years in which people died (earlier: 1990s vs. later: 2000s). To control for relevant covariates, we used case-matched groups based on age (at death) and education and covaried for gender, health, and number of observations. Results from both countries revealed that well-being in old age was indeed developing at higher levels among later-born cohorts. However, for later-deceased cohorts, no evidence for secular increases in well-being was found. To the contrary, later-dying SOEP participants reported lower levels of well-being at age 75 and 2 years prior to death and experienced steeper late-life declines. Our results suggest that secular increases in well-being observed in old age do not manifest in late life, where "manufactured" survival may be exacerbating age- and mortality-related declines.

PB - 51 VL - 51 IS - 7 N1 - Times Cited: 0 0 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26098582?dopt=Abstract U2 - PMC4654950 U4 - life span research/Cognitive ability/cross-national comparison/well being ER - TY - JOUR T1 - Hospitalization Type and Subsequent Severe Sepsis. JF - Am J Respir Crit Care Med Y1 - 2015 A1 - Hallie C Prescott A1 - Dickson, R. P. A1 - Mary A M Rogers A1 - Kenneth M. Langa A1 - Lwashyna, T. J. KW - Aged KW - Aged, 80 and over KW - Anti-Bacterial Agents KW - Clostridioides difficile KW - Dysbiosis KW - Enterocolitis, Pseudomembranous KW - Female KW - Hospitalization KW - Humans KW - Incidence KW - Information Storage and Retrieval KW - Longitudinal Studies KW - Male KW - Medicare KW - Patient Readmission KW - Retrospective Studies KW - Risk Factors KW - Sepsis KW - United States AB -

RATIONALE: Hospitalization is associated with microbiome perturbation (dysbiosis), and this perturbation is more severe in patients treated with antimicrobials.

OBJECTIVES: To evaluate whether hospitalizations known to be associated with periods of microbiome perturbation are associated with increased risk of severe sepsis after hospital discharge.

METHODS: We studied participants in the U.S. Health and Retirement Study with linked Medicare claims (1998-2010). We measured whether three hospitalization types associated with increasing severity of probable dysbiosis (non-infection-related hospitalization, infection-related hospitalization, and hospitalization with Clostridium difficile infection [CDI]) were associated with increasing risk for severe sepsis in the 90 days after hospital discharge. We used two study designs: the first was a longitudinal design with between-person comparisons and the second was a self-controlled case series design using within-person comparison.

MEASUREMENTS AND MAIN RESULTS: We identified 43,095 hospitalizations among 10,996 Health and Retirement Study-Medicare participants. In the 90 days following non-infection-related hospitalization, infection-related hospitalization, and hospitalization with CDI, adjusted probabilities of subsequent admission for severe sepsis were 4.1% (95% confidence interval [CI], 3.8-4.4%), 7.1% (95% CI, 6.6-7.6%), and 10.7% (95% CI, 7.7-13.8%), respectively. The incidence rate ratio (IRR) of severe sepsis was 3.3-fold greater during the 90 days after hospitalizations than during other observation periods. The IRR was 30% greater after an infection-related hospitalization versus a non-infection-related hospitalization. The IRR was 70% greater after a hospitalization with CDI than an infection-related hospitalization without CDI.

CONCLUSIONS: There is a strong dose-response relationship between events known to result in dysbiosis and subsequent severe sepsis hospitalization that is not present for rehospitalization for nonsepsis diagnoses.

PB - 192 VL - 192 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26016947?dopt=Abstract U4 - humans/microbiota/self-controlled case series/patient readmission/dysbiosis/CLOSTRIDIUM-DIFFICILE INFECTION/RESPIRATORY SYSTEM/COMMUNITY/PNEUMONIA/CRITICAL CARE MEDICINE/METAANALYSIS/INTESTINAL MICROBIOTA/GUT MICROBIOTA/ANTIBIOTIC-TREATMENT/DISEASE/PREMATURE-INFANTS/FECAL MICROBIOTA TRANSPLANTATION/Enterocolitis, Pseudomembranous - epidemiology/Dysbiosis - epidemiology/Sepsis - epidemiology/Anti-Bacterial Agents - therapeutic use/Hospitalization - statistics/numerical data/Patient Readmission - statistics/numerical data ER - TY - JOUR T1 - How old do you feel? The role of age discrimination and biological aging in subjective age. JF - PLoS One Y1 - 2015 A1 - Yannick Stephan A1 - Angelina R Sutin A1 - Antonio Terracciano KW - Aerobiosis KW - Aged KW - Aged, 80 and over KW - Aging KW - Cardiovascular Physiological Phenomena KW - Cellular Senescence KW - Discrimination, Psychological KW - Emotions KW - Female KW - Humans KW - Male KW - Middle Aged KW - Muscle Strength KW - Perception AB -

Subjective age, or how young or old individuals experience themselves to be relative to their chronological age, is a crucial construct in gerontology. Subjective age is a significant predictor of important health outcomes, but little is known about the criteria by which individuals' subjectively evaluate their age. To identify psychosocial and biomedical factors linked to the subjective evaluation of age, this study examined whether perceived age discrimination and markers of biological aging are associated with subjective age. Participants were 4776 adults (Mage = 68) from the 2008 and 2010 waves of the Health and Retirement Study (HRS) who completed measures of subjective age, age discrimination, demographic variables, self-rated health and depression, and had physical health measures, including peak expiratory flow, grip strength, waist circumference, systolic and diastolic blood pressure. Telomere length was available for a subset of participants in the 2008 wave (n = 2214). Regression analysis indicated that perceived age discrimination, lower peak expiratory flow, lower grip strength, and higher waist circumference were associated with an older subjective age, controlling for sociodemographic factors, self-rated health, and depression. In contrast, blood pressure and telomere length were not related to subjective age. These findings are consistent with the hypothesis that how old a person feels depends in part on psychosocial and biomedical factors, including the experiences of ageism and perceptible indices of fitness and biological age.

PB - 10 VL - 10 IS - 3 N1 - Times Cited: 0 0 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25738579?dopt=Abstract U2 - PMC4349738 U4 - subjective age/health outcomes/psychosocial factors/psychosocial factors/biomedical factors/Biological aging ER - TY - JOUR T1 - Improving the validity of activity of daily living dependency risk assessment. JF - J Appl Gerontol Y1 - 2015 A1 - Daniel O. Clark A1 - Timothy E. Stump A1 - Tu, Wanzhu A1 - Douglas K Miller KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Cognition KW - Cognition Disorders KW - Female KW - Gait KW - Geriatric Assessment KW - Humans KW - Independent Living KW - Interviews as Topic KW - Male KW - Quality Improvement KW - Reproducibility of Results KW - Risk Assessment AB -

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

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

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

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

PB - 34 VL - 34 IS - 3 N1 - Times Cited: 1 0 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/24652867?dopt=Abstract U2 - PMC4597469 U4 - ADL/IADL/Cognitive measures/Cognitive measures/ADL dependency 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 - A Life Course Approach to Inequality: Examining Racial/Ethnic Differences in the Relationship between Early Life Socioeconomic Conditions and Adult Health Among Men. JF - Ethn Dis Y1 - 2015 A1 - Taylor W. Hargrove A1 - Tyson H Brown KW - Adult KW - Aged KW - ethnicity KW - Humans KW - Life Change Events KW - Male KW - Men's health KW - Middle Aged KW - Racial Groups KW - Socioeconomic factors KW - United States AB -

OBJECTIVE: Previous research has documented a relationship between childhood socioeconomic conditions and adult health, but less is known about racial/ethnic differences in this relationship, particularly among men. This study utilizes a life course approach to investigate racial/ethnic differences in the relationships among early and later life socioeconomic circumstances and health in adulthood among men.

DESIGN: Panel data from the Health and Retirement Study and growth curve models are used to examine group differences in the relationships among childhood and adult socioeconomic factors and age-trajectories of self-rated health among White, Black and Mexican American men aged 51-77 years (N=4147).

RESULTS: Multiple measures of childhood socioeconomic status (SES) predict health in adulthood for White men, while significantly fewer measures of childhood SES predict health for Black and Mexican American men. Moreover, the health consequences of childhood SES diminish with age for Black and Mexican American men. The childhood SES-adult health relationship is largely explained by measures of adult SES for White men.

CONCLUSIONS: The life course pathways linking childhood SES and adult health differ by race/ethnicity among men. Similar to arguments that the universality of the adult SES-health relationship should not be assumed, results from our study suggest that scholars should not assume that the significance and nature of the association between childhood SES and health in adulthood is similar across race/ethnicity among men.

PB - 25 VL - 25 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26674267?dopt=Abstract U2 - PMC4671423 U4 - Life course/race/ethnicity/health ER - TY - JOUR T1 - Life satisfaction and use of preventive health care services. JF - Health Psychol Y1 - 2015 A1 - Eric S Kim A1 - Laura D Kubzansky A1 - Jacqui Smith KW - Aged KW - Aged, 80 and over KW - Female KW - Health Behavior KW - Humans KW - Male KW - Mammography KW - Middle Aged KW - Personal Satisfaction KW - Preventive Health Services KW - Prospective Studies AB -

OBJECTIVE: Although a growing body of research shows that life satisfaction is linked with enhanced health behaviors and physical health, no study has examined life satisfaction's association with use of preventive health care services. From prior research the authors hypothesized that people with higher life satisfaction would be more proactive in taking care of their health, hence more likely to use preventive health care services.

METHOD: Multiple logistic regression models were used to examine the association between life satisfaction and preventive services. Participants were drawn from the Health and Retirement Study, a prospective and nationally representative panel study of adults (age >50). Participants' use of preventive services was collected over 2 years of follow-up.

RESULTS: In models adjusting for sociodemographic factors, each standard deviation increase in life satisfaction was associated with a higher likelihood that people would obtain a cholesterol test. Further, women with higher life satisfaction were more likely to obtain a mammogram-x-ray or pap smear and also regularly check their breasts for lumps, whereas men were more likely to obtain a prostate exam.

CONCLUSION: Higher life satisfaction was associated with higher use of several preventive services. A growing body of randomized controlled trials targeting life satisfaction has shown that levels of life satisfaction are modifiable. Thus, if these findings are replicated, life satisfaction may provide an important target for interventions aimed at enhancing preventive behaviors and health.

PB - 779-782 VL - 34 IS - 7 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25420064?dopt=Abstract U2 - PMC4442077 U4 - life satisfaction/life satisfaction/successful aging/health care utilization/preventive health care service/health screening/subjective well-being ER - TY - JOUR T1 - Lifespan and Healthspan: Past, Present, and Promise. JF - Gerontologist Y1 - 2015 A1 - Eileen M. Crimmins KW - Aged KW - Aged, 80 and over KW - Aging KW - Disabled Persons KW - Humans KW - Life Expectancy KW - Socioeconomic factors KW - United States AB -

The past century was a period of increasing life expectancy throughout the age range. This resulted in more people living to old age and to spending more years at the older ages. It is likely that increases in life expectancy at older ages will continue, but life expectancy at birth is unlikely to reach levels above 95 unless there is a fundamental change in our ability to delay the aging process. We have yet to experience much compression of morbidity as the age of onset of most health problems has not increased markedly. In recent decades, there have been some reductions in the prevalence of physical disability and dementia. At the same time, the prevalence of disease has increased markedly, in large part due to treatment which extends life for those with disease. Compressing morbidity or increasing the relative healthspan will require "delaying aging" or delaying the physiological change that results in disease and disability. While moving to life expectancies above age 95 and compressing morbidity substantially may require significant scientific breakthroughs; significant improvement in health and increases in life expectancy in the United States could be achieved with behavioral, life style, and policy changes that reduce socioeconomic disparities and allow us to reach the levels of health and life expectancy achieved in peer societies.

VL - 55 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26561272?dopt=Abstract ER - TY - JOUR T1 - Loneliness, eudaimonia, and the human conserved transcriptional response to adversity. JF - Psychoneuroendocrinology Y1 - 2015 A1 - Steven W. Cole A1 - Morgan E. Levine A1 - Jesusa M. G. Arevalo A1 - Ma, Jeffrey A1 - David R Weir A1 - Eileen M. Crimmins KW - Aged KW - Aged, 80 and over KW - Down-Regulation KW - Female KW - Humans KW - Inflammation KW - Loneliness KW - Longitudinal Studies KW - Male KW - Mental Health KW - Middle Aged KW - social isolation KW - Social Support KW - Stress, Psychological KW - Transcriptome AB -

BACKGROUND: Chronic social adversity activates a conserved transcriptional response to adversity (CTRA) marked by increased expression of pro-inflammatory genes and decreased expression of antiviral- and antibody-related genes. Recent findings suggest that some psychological resilience factors may help buffer CTRA activation, but the relative impact of resilience and adversity factors remains poorly understood. Here we examined the relative strength of CTRA association for the two best-established psychological correlates of CTRA gene expression-the risk factor of perceived social isolation (loneliness) and the resilience factor of eudaimonic well-being (purpose and meaning in life).

METHODS: Peripheral blood samples and validated measures of loneliness and eudaimonic well-being were analyzed in 108 community-dwelling older adults participating in the longitudinal US Health and Retirement Study (56% female, mean age 73). Mixed effect linear model analyses quantified the strength of association between CTRA gene expression and measures of loneliness and eudaimonic well-being in separate and joint analyses.

RESULTS: As in previous studies, separate analyses found CTRA gene expression to be up-regulated in association with loneliness and down-regulated in association with eudaimonic well-being. In joint analyses, effects of loneliness were completely abrogated whereas eudaimonic well-being continued to associate with CTRA down-regulation. Similar eudaimonia-dominant effects were observed for positive and negative affect, optimism and pessimism, and anxiety symptoms. All results were independent of demographic and behavioral health risk factors.

CONCLUSIONS: Eudaimonic well-being may have the potential to compensate for the adverse impact of loneliness on CTRA gene expression. Findings suggest a novel approach to targeting the health risks associated with social isolation by promoting purpose and meaning in life.

PB - 62 VL - 62 UR - http://www.sciencedirect.com/science/article/pii/S0306453015002358 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26246388?dopt=Abstract U2 - PMC4637182 U4 - Social genomics/Psychoneuroimmunology/Gene expression/Transcriptome/Microarray/Stress/Social support/Psychological well-being/Eudaimonia/Positive psychology ER - TY - JOUR T1 - Longitudinal patient-oriented outcomes in neuropathy: Importance of early detection and falls. JF - Neurology Y1 - 2015 A1 - Brian C. Callaghan A1 - Kevin Kerber A1 - Kenneth M. Langa A1 - Banerjee, Mousumi A1 - Rodgers, Ann A1 - Ryan J McCammon A1 - James F. Burke A1 - Eva L Feldman KW - Accidental Falls KW - Aged KW - Aged, 80 and over KW - Early Diagnosis KW - Female KW - Humans KW - International Classification of Diseases KW - Longitudinal Studies KW - Male KW - Medicare KW - Patient-Centered Care KW - Peripheral Nervous System Diseases KW - Treatment Outcome KW - United States AB -

OBJECTIVE: To evaluate longitudinal patient-oriented outcomes in peripheral neuropathy over a 14-year time period including time before and after diagnosis.

METHODS: The 1996-2007 Health and Retirement Study (HRS)-Medicare Claims linked database identified incident peripheral neuropathy cases (ICD-9 codes) in patients ≥65 years. Using detailed demographic information from the HRS and Medicare claims, a propensity score method identified a matched control group without neuropathy. Patient-oriented outcomes, with an emphasis on self-reported falls, pain, and self-rated health (HRS interview), were determined before and after neuropathy diagnosis. Generalized estimating equations were used to assess differences in longitudinal outcomes between cases and controls.

RESULTS: We identified 953 peripheral neuropathy cases and 953 propensity-matched controls. The mean (SD) age was 77.4 (6.7) years for cases, 76.9 (6.6) years for controls, and 42.1% had diabetes. Differences were detected in falls 3.0 years before neuropathy diagnosis (case vs control; 32% vs 25%, p = 0.008), 5.0 years for pain (36% vs 27%, p = 0.002), and 5.0 years for good to excellent self-rated health (61% vs 74%, p < 0.0001). Over time, the proportion of fallers increased more rapidly in neuropathy cases compared to controls (p = 0.002), but no differences in pain (p = 0.08) or self-rated health (p = 0.9) were observed.

CONCLUSIONS: In older persons, differences in falls, pain, and self-rated health can be detected 3-5 years prior to peripheral neuropathy diagnosis, but only falls deteriorates more rapidly over time in neuropathy cases compared to controls. Interventions to improve early peripheral neuropathy detection are needed, and future clinical trials should incorporate falls as a key patient-oriented outcome.

PB - 85 VL - 85 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26019191?dopt=Abstract U2 - PMC4501944 U4 - Peripheral neuropathy/Peripheral neuropathy/Medicare/Propensity score ER - TY - JOUR T1 - Measurement Invariance of Cognitive Abilities Across Ethnicity, Gender, and Time Among Older Americans. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2015 A1 - A Nayena Blankson A1 - John J McArdle KW - Aged KW - Aged, 80 and over KW - Black People KW - Female KW - Hispanic or Latino KW - Humans KW - Male KW - Memory, Episodic KW - Mental Processes KW - Middle Aged KW - Neuropsychological tests KW - Psychometrics KW - Psychomotor Performance KW - Reproducibility of Results KW - Sex Factors KW - Time Factors KW - United States KW - White People AB -

OBJECTIVES: The aim of this research was to test the invariance of the cognitive variables in the Health and Retirement Study/Asset Health Dynamics Among the Oldest Old studies (HRS/AHEAD) across ethnicity, gender, and time.

METHOD: Analyses were conducted using a selected subsample of the HRS/AHEAD data set. The cognitive performance tests measuring episodic memory and mental status were used, and invariance of a two-factor structure was tested using confirmatory factor analyses and multilevel modeling for longitudinal data.

RESULTS: Results provided some support for "strict" factorial invariance of the episodic memory and mental status measures across ethnicity and gender. Further support of weak ("metric") measurement invariance was found across time.

DISCUSSION: Results of the research further our understanding of invariance of the HRS/AHEAD cognitive ability measures. Further implications are discussed.

PB - 70 VL - 70 UR - http://psychsocgerontology.oxfordjournals.org/content/early/2013/10/25/geronb.gbt106.abstract IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/24170715?dopt=Abstract U2 - PMC4542644 U4 - Cognitive Aging/Group Differences/Latent Variable Modeling/Measurement Invariance/Structural Equation Modeling ER - TY - JOUR T1 - Multimorbidity redefined: prospective health outcomes and the cumulative effect of co-occurring conditions. JF - Prev Chronic Dis Y1 - 2015 A1 - Siran M Koroukian A1 - David F Warner A1 - Owusu, Cynthia A1 - Charles W Given KW - Aged KW - Aged, 80 and over KW - Alcohol Drinking KW - Body Mass Index KW - Chronic disease KW - Cognition Disorders KW - Comorbidity KW - Cross-Sectional Studies KW - Data Interpretation, Statistical KW - ethnicity KW - Female KW - Health Status Indicators KW - Humans KW - Interviews as Topic KW - Male KW - Middle Aged KW - Mobility Limitation KW - Outcome Assessment, Health Care KW - Prospective Studies KW - Recurrence KW - Retirement KW - Self Report KW - Smoking KW - Social Class KW - Syndrome KW - United States KW - Vulnerable Populations AB -

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

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

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

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

PB - 12 VL - 12 N1 - Times Cited: 0 0 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25906436?dopt=Abstract U2 - PMC4415428 U4 - MORBIDITY/health status/health decline/mortality/baseline multimorbidity/health status ER - TY - JOUR T1 - The Paulson-Lichtenberg Frailty Index: evidence for a self-report measure of frailty. JF - Aging Ment Health Y1 - 2015 A1 - Daniel Paulson A1 - Peter A Lichtenberg KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Aging KW - Fatigue KW - Female KW - Frail Elderly KW - Geriatric Assessment KW - Health Status KW - Health Surveys KW - Humans KW - Longitudinal Studies KW - Male KW - Self Report KW - Socioeconomic factors KW - Walking AB -

OBJECTIVES: This study evaluates the Paulson-Lichtenberg Frailty Index (PLFI), a self-report measure that is based on Fried's well-established frailty phenotype. The PLFI is examined using longitudinal data from the Health and Retirement Study (HRS) database, for which it was developed.

METHODS: The sample was drawn from the HRS and included 8844 community-dwelling older adults. Frailty was measured using the PLFI's five-item frailty index (wasting, weakness, slowness, falls, and fatigue).

RESULTS: In comparison to intermediate-frail or non-frail respondents, frail respondents were found to be older, more medically compromised, and less independent for activities of daily living (ADLs) and instrumental activities of daily living (IADLs). On average, frail respondents reported worse self-rated health and had fewer years of education. Women, ethnic minorities, and those who were not partnered were also more likely to be frail. Over subsequent years, frail respondents were more likely to be hospitalized, report more loss of independence, and experience higher mortality rates.

CONCLUSIONS: The PLFI is a valid tool for assessing frailty in the HRS data set.

PB - 19 VL - 19 IS - 10 N1 - Export Date: 20 January 2015 Article in Press U1 - http://www.ncbi.nlm.nih.gov/pubmed/25537004?dopt=Abstract U2 - PMC4480217 U4 - aging/decline/health outcomes/measurement/ADL and IADL Impairments ER - TY - JOUR T1 - Perceived discrimination and physical, cognitive, and emotional health in older adulthood. JF - Am J Geriatr Psychiatry Y1 - 2015 A1 - Angelina R Sutin A1 - Yannick Stephan A1 - Carretta, H. A1 - Antonio Terracciano KW - Aged KW - Cognition KW - Female KW - Health Status KW - Humans KW - Longitudinal Studies KW - Male KW - Mental Health KW - Prejudice KW - Social Perception AB -

OBJECTIVE: To examine whether perceived discrimination based on multiple personal characteristics is associated with physical, emotional, and cognitive health concurrently, prospectively, and with change in health over time among older adults.

DESIGN: Longitudinal.

SETTING: Health and Retirement Study (HRS).

PARTICIPANTS: Participants (N = 7,622) who completed the Leave-Behind Questionnaire as part of the 2006 HRS assessment (mean age 67 years); participants (N = 6,450) completed the same health measures again in 2010.

MEASUREMENTS: Participants rated their everyday experience with discrimination and attributed those experiences to eight personal characteristics: race, ancestry, sex, age, weight, physical disability, appearance, and sexual orientation. At both the 2006 and 2010 assessments, participants completed measures of physical health (subjective health, disease burden), emotional health (life satisfaction, loneliness), and cognitive health (memory, mental status).

RESULTS: Discrimination based on age, weight, physical disability, and appearance was associated with poor subjective health, greater disease burden, lower life satisfaction, and greater loneliness at both assessments and with declines in health across the four years. Discrimination based on race, ancestry, sex, and sexual orientation was associated with greater loneliness at both time points, but not with change over time. Discrimination was mostly unrelated to cognitive health.

CONCLUSIONS: The detrimental effect of discrimination on physical and emotional health is not limited to young adulthood but continues to contribute to health and well-being in old age. These effects were driven primarily by discrimination based on personal characteristics that change over time (e.g., age, weight) rather than discrimination based on more stable characteristics (e.g., race, sex).

PB - 23 VL - 23 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/24745563?dopt=Abstract U2 - PMC4170050 U4 - Discrimination/disease burden/loneliness/stress/well-being/Self assessed health/Physical health/emotional health ER - TY - JOUR T1 - The prevalence of older couples with ADL limitations and factors associated with ADL help receipt. JF - J Gerontol Soc Work Y1 - 2015 A1 - Shen, Huei-Wern A1 - Sheila Feld A1 - Ruth E Dunkle A1 - Tracy Schroepfer A1 - Amanda J Lehning KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Cross-Sectional Studies KW - Female KW - Health Services Accessibility KW - Humans KW - Male KW - Social Support KW - Socioeconomic factors AB -

Using the Andersen-Newman model, we investigated the prevalence of activities of daily living (ADLs) limitations in married couples, and couple characteristics associated with ADL help-receipt. In this sample of 3,235 couples age 65+ in the 2004 Health and Retirement Study, 74.3%, 22.1%, and 3.6% were couples in which neither partner, one partner, or both partners had limitations, respectively. Logistic regression results indicate that help-receipt was associated with certain health needs in the couple, but not with their predisposing characteristics or enabling resources. Social workers could target couples most in need of assistance by assessing both partners' health problems.

PB - 58 VL - 58 UR - http://dx.doi.org/10.1080/01634372.2014.944248 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25036802?dopt=Abstract U2 - PMC4297741 U4 - health/functional limitations/care needs/spousal caregiving/marital dyad ER - TY - JOUR T1 - Prostate Cancer Screening Among American Indians and Alaska Natives: The Health and Retirement Survey, 1996-2008. JF - Prev Chronic Dis Y1 - 2015 A1 - R. Turner Goins A1 - Marc B Schure A1 - Carolyn Noonan A1 - Dedra S. Buchwald KW - Aged KW - Alaska KW - Analysis of Variance KW - Black or African American KW - Health Behavior KW - Health Surveys KW - Healthcare Disparities KW - Humans KW - Indians, North American KW - Male KW - Mass Screening KW - Middle Aged KW - Prevalence KW - Prostatic Neoplasms KW - Regression Analysis KW - Retirement KW - Self Report KW - Surveys and Questionnaires KW - United States KW - White People AB -

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

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

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

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

PB - 12 VL - 12 N1 - Times Cited: 0 0 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26247423?dopt=Abstract U2 - PMC4552140 U4 - prostate cancer/Screening/native Americans/african Americans/minorities ER - TY - JOUR T1 - Race/Ethnic Differentials in the Health Consequences of Caring for Grandchildren for Grandparents. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2015 A1 - Chen, Feinian A1 - Christine A Mair A1 - Bao, Luoman A1 - Yang Claire Yang KW - Aged KW - Black People KW - Female KW - Frail Elderly KW - Health Status KW - Health Status Disparities KW - Hispanic or Latino KW - Humans KW - Intergenerational Relations KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Parenting KW - Residence Characteristics KW - Socioeconomic factors KW - United States AB -

OBJECTIVES: The phenomenon of grandparents caring for grandchildren is disproportionately observed among different racial/ethnic groups in the United States. This study examines the influence of childcare provision on older adults' health trajectories in the United States with a particular focus on racial/ethnic differentials.

METHOD: Analyzing nationally representative, longitudinal data on grandparents over the age of 50 from the Health and Retirement Study (1998-2010), we conduct growth curve analysis to examine the effect of living arrangements and caregiving intensity on older adults' health trajectories, measured by changing Frailty Index (FI) in race/ethnic subsamples. We use propensity score weighting to address the issue of potential nonrandom selection of grandparents into grandchild care.

RESULTS: We find that some amount of caring for grandchildren is associated with a reduction of frailty for older adults, whereas coresidence with grandchildren results in health deterioration. For non-Hispanic black grandparents, living in a skipped generation household appears to be particularly detrimental to health. We also find that Hispanic grandparents fare better than non-Hispanic black grandparents despite a similar level of caregiving and rate of coresidence. Finally, financial and social resources assist in buffering some of the negative effects of coresidence on health (though this effect also differs by race/ethnicity).

DISCUSSION: Our findings suggest that the health consequences of grandchild care are mixed across different racial/ethnic groups and are further shaped by individual characteristics as well as perhaps cultural context.

PB - 70 VL - 70 UR - http://psychsocgerontology.oxfordjournals.org/content/early/2014/12/06/geronb.gbu160.abstract IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25481922?dopt=Abstract U2 - PMC4635642 U4 - Caregiving/Grandparents/Health disparities/Race/ethnic differences/family Caregivers/transfers/socioeconomic Differences ER - TY - JOUR T1 - A Research Note on Transitions in Out-of-Pocket Spending on Dental Services. JF - Res Aging Y1 - 2015 A1 - Richard J. Manski A1 - John F Moeller A1 - Haiyan Chen A1 - Jody Schimmel Hyde A1 - John V Pepper A1 - Patricia A St Clair KW - Aged KW - Aged, 80 and over KW - Dental Care KW - Female KW - Health Expenditures KW - Humans KW - Insurance, Dental KW - Longitudinal Studies KW - Male KW - Middle Aged KW - United States AB -

OBJECTIVE: We analyze correlates of the direction and magnitude of changes in out-of-pocket (OOP) payments for dental care by older Americans over a recent 4-year period.

METHODS: We analyzed data from the 2006 and 2008 waves of the Health and Retirement Study. We estimated multinomial logistic models of the direction and linear regression models of the amounts of OOP changes over survey periods.

RESULTS: Financial-based factors were more strongly associated with the direction and magnitude of changing self-payments for dental care than were health factors.

DISCUSSION: Findings suggested that dental coverage, income, and wealth and changes in these financial factors were more strongly correlated with the persistence of and changes in OOP payments for dental care over time than were health status and changes in health status. The sensitivity to dental coverage changes should be considered as insurance and retirement policy reforms are deliberated.

PB - 37 VL - 37 UR - http://roa.sagepub.com/content/early/2014/10/03/0164027514552681.abstract IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25651590?dopt=Abstract U2 - PMC4387101 U4 - dental insurance/coverage/dental use/self-payments/Out of pocket costs ER - TY - JOUR T1 - Social Relationships, Gender, and Recovery From Mobility Limitation Among Older Americans. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2015 A1 - Kenzie Latham A1 - Philippa J Clarke A1 - Gregory Pavela KW - Aged KW - Aged, 80 and over KW - Cohort Studies KW - Family KW - Female KW - Humans KW - Interpersonal Relations KW - Male KW - Middle Aged KW - Mobility Limitation KW - Peer Group KW - Recovery of Function KW - Residence Characteristics KW - Sex Factors KW - Social Support KW - United States AB -

OBJECTIVES: Evidence suggests social relationships may be important facilitators for recovery from functional impairment, but the extant literature is limited in its measurement of social relationships including an over emphasis on filial social support and a paucity of nationally representative data.

METHODS: Using data from Waves 4-9 (1998-2008) of the Health and Retirement Study (HRS), this research examines the association between social relationships and recovery from severe mobility limitation (i.e., difficulty walking one block or across the room) among older Americans. Using a more nuanced measure of recovery that includes complete and partial recovery, a series of discrete-time event history models with multiple competing recovery outcomes were estimated using multinomial logistic regression.

RESULTS: Providing instrumental support to peers increased the odds of complete and partial recovery from severe mobility limitation, net of numerous social, and health factors. Having relatives living nearby decreased the odds of complete recovery, while being engaged in one's neighborhood increased the odds of partial recovery. The influence of partner status on partial and complete recovery varied by gender, whereby partnered men were more likely to experience recovery relative to partnered women. The effect of neighborhood engagement on partial recovery also varied by gender. Disengaged women were the least likely to experience partial recovery compared with any other group.

DISCUSSION: The rehabilitative potential of social relationships has important policy implications. Interventions aimed at encouraging older adults with mobility limitation to be engaged in their neighborhoods and/or provide instrumental support to peers may improve functional health outcomes.

PB - 70 VL - 70 UR - http://psychsocgerontology.oxfordjournals.org/content/early/2015/01/11/geronb.gbu181.abstract IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25583597?dopt=Abstract U2 - PMC4635643 U4 - Functional health/Gender/Mobility/Recovery/neighborhood effects/Social relationships/Social support ER - TY - JOUR T1 - Socioeconomic stratification and multidimensional health trajectories: evidence of convergence in later old age. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2015 A1 - Xiao Xu A1 - Jersey Liang A1 - Joan M. Bennett A1 - Anda Botoseneanu A1 - Heather G. Allore KW - Aged KW - Aged, 80 and over KW - Aging KW - Cognition Disorders KW - Disabled Persons KW - Educational Status KW - Female KW - Health Status KW - Humans KW - Male KW - Social Class KW - United States AB -

OBJECTIVES: This research sought to examine socioeconomic stratification in the joint trajectories of physical, emotional, and cognitive functioning among older Americans and how it differs by age groups.

METHODS: We used data from a nationally representative sample of 9,237 Americans age 65 or older from the Health and Retirement Study, who were observed biennially from 1998 to 2010. Joint trajectories of physical, emotional, and cognitive functioning were characterized using a group-based mixture model. We then applied multinomial logistic regression analysis to evaluate their linkages with socioeconomic status and how the linkages differ by age groups.

RESULTS: We identified four distinct patterns of joint changes in physical, emotional, and cognitive functioning over time. Accounting for 29.3%, 23.5%, 24.5%, and 22.6% of the older Americans, respectively, these trajectory patterns characterized groups of individuals experiencing minimal to severe levels of impairment and deterioration. Lower education, income, and net worth were associated with trajectories featuring greater impairment or more rapid deterioration in these functional dimensions. Disparities based on education, however, attenuated in later old age, whereas health benefits associated with higher income and higher net worth persisted into advanced age.

DISCUSSION: Distinct patterns of joint trajectories of physical, emotional, and cognitive functioning exist in old age. There were significant socioeconomic differences in the joint trajectories, with education-based inequality in health converging in later old age. Further research identifying strategies to alleviate the disproportionate burden of poor multidimensional health trajectories in lower socioeconomic groups is important.

PB - 70 VL - 70 UR - http://psychsocgerontology.oxfordjournals.org/content/early/2014/08/25/geronb.gbu095.abstract IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25161216?dopt=Abstract U2 - PMC4462671 U4 - Socioeconomic status/Joint trajectories/Elderly/Disability/Disability/Depression/Cognition. ER - TY - JOUR T1 - Spouse and Child Availability for Newly Disabled Older Adults: Socioeconomic Differences and Potential Role of Residential Proximity. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2015 A1 - Choi, Hwajung A1 - Robert F. Schoeni A1 - Kenneth M. Langa A1 - Michele M Heisler KW - Activities of Daily Living KW - Adult children KW - Aged KW - Aged, 80 and over KW - Aging KW - Disabled Persons KW - Female KW - Home Nursing KW - Humans KW - Male KW - Middle Aged KW - Nursing homes KW - Residence Characteristics KW - Social Class KW - Spouses AB -

OBJECTIVES: To examine the potential role of child and spousal availability in facilitating community-based care for disabled older adults.

METHOD: We used the Health and Retirement Study, a nationally representative longitudinal study of older adults. The analysis sample included older adults who were nondisabled at baseline, but who then developed at least one activity of daily living (ADL) limitation over the subsequent 2-year period (N = 2,094). Using multivariate, multinomial logistic regression, we examined the association of child and spouse availability prior to disablement of the older adults with ADL care receipt status after the onset of disablement, after adjusting for other sociodemographic and clinical characteristics.

RESULTS: Lower socioeconomic status (SES) was associated with less availability of a spouse but greater availability of children at baseline. Compared with older adults who had no children nearby (i.e., all children lived further than 30 miles), older adults who had at least one child living with or near them prior to the onset of the ADL limitation were less likely to go to a nursing home (adjusted odds ratio [AOR]: 0.26 for coresident; AOR: 0.44 for 1- 30 miles) and less likely to depend on formal care (AOR: 0.39 for coresident; AOR: 0.51 for 1-30 miles) after the onset of new ADL limitation/s.

DISCUSSION: Understanding SES variations in the informal care resources, and potential role of child geographic availability, may inform the development of cost-effective community-based care programs and policies.

PB - 70 VL - 70 UR - http://psychsocgerontology.oxfordjournals.org/content/early/2014/03/06/geronb.gbu015.abstract IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/24607786?dopt=Abstract U4 - Disability/Disability/Geographic proximity/Informal care/Socioeconomic status/community-based care/activities of daily living ER - TY - JOUR T1 - Spouses and depressive symptoms in older adulthood. JF - Sci Rep Y1 - 2015 A1 - Pradeep, Neeti A1 - Angelina R Sutin KW - Aged KW - depression KW - Female KW - Humans KW - Longitudinal Studies KW - Male KW - Sex Distribution KW - Spouses AB -

Depressive symptoms may co-occur within couples and follow similar trajectories, but relatively little is known about this process in old age. This study thus examined the association between some spousal characteristics (spouse's depressive symptoms, age difference between spouses) and the trajectory of depressive symptoms in older adults. Participants ≥ 65 years old were drawn from the Health and Retirement Study (N = 12,010; Mean age = 70.60 and 69.16 for target husbands and wives, respectively). Depressive symptoms were measured with a short form of the Center for Epidemiological Studies Depression (CES-D) scale. Hierarchical Linear Modeling was used to model up to 9 assessments of depressive symptoms of target spouses (Mean number of CESD assessments per target spouse = 3, range 1-9). Depressive symptoms between spouses were correlated; convergence over time was modest. For both husbands and wives, having a younger spouse was associated with more depressive symptoms at age 65. These results suggest that there is concordance between spouses' depressive symptoms and that the age difference between spouses contribute to depressive symptoms as couples enter old age. The association between spouses' depressive symptoms is nearly as strong as the effect of each decade increase in age.

PB - 5 VL - 5 N1 - Times Cited: 0 0 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25716455?dopt=Abstract U2 - PMC4341217 U4 - Depressive Symptoms/depression/spousal characteristics/Trajectories/Hierarchical Linear Modeling ER - TY - JOUR T1 - Substance-use coping and self-rated health among US middle-aged and older adults. JF - Addict Behav Y1 - 2015 A1 - Pia M Mauro A1 - Sarah L. Canham A1 - Silvia S Martins A1 - Adam P Spira KW - Adaptation, Psychological KW - Aged KW - Aged, 80 and over KW - Alcohol Drinking KW - depression KW - Female KW - Health Status KW - Humans KW - Male KW - Middle Aged KW - Smoking KW - Substance-Related Disorders KW - United States AB -

The prevalence of alcohol, drug, and tobacco use among US middle-aged and older adults is increasing. A subset of this population uses substances to cope with stress, but the characteristics of these individuals, and the association between substance-use coping and health outcomes remain unclear. We identified correlates of substance-use coping and measured its association with self-rated health in a community-based sample of adults aged 54-99 in the Health and Retirement Study (HRS). In the 2008 HRS, 1351 participants reported their frequency of prescription/other drug-, alcohol-, and cigarette-use coping with stress and reported self-rated health (excellent/very good, good, or fair/poor); 1201 of these participants also reported self-rated health in 2010. One in six participants frequently used substances to cope. The oldest participants were least likely to engage in frequent alcohol-use coping. Those with elevated depressive symptoms were more likely to frequently engage in cigarette- and prescription/other drug-use coping. In multivariable-adjusted analyses, participants who frequently used cigarettes (compared to participants who infrequently used cigarettes) to cope had 2.7 times (95% CI=1.1-6.7) the odds of poor (vs. excellent) self-rated health. Relative to participants who infrequently used prescription/other drugs to cope, participants who frequently used prescription/other drugs to cope had 2.4 times (95% CI=1.1-5.1) the odds of reporting poor self-rated health. The association between prescription/other drug-use coping in 2008 and self-rated health in 2010 was statistically significant (relative OR=3.5, 95% CI=1.7-7.2). Participants engaging in substance-use coping likely have particular demographic and clinical characteristics. Interventions to reduce substance-use coping may prevent adverse health outcomes.

PB - 42 VL - 42 N1 - Export Date: 20 January 2015 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25437264?dopt=Abstract U2 - PMC4596550 U4 - Coping/Older adults/Self-rated health/Substance use/Alcohol use/Drug Use/Smoking/stress/health outcomes ER - TY - JOUR T1 - Variation in the effects of family background and birth region on adult obesity: results of a prospective cohort study of a Great Depression-era American cohort. JF - BMC Public Health Y1 - 2015 A1 - Hui Zheng A1 - Dmitry Tumin KW - Aged KW - Aged, 80 and over KW - Body Weight KW - Cohort Studies KW - ethnicity KW - Family Characteristics KW - Female KW - Health Behavior KW - Humans KW - Interviews as Topic KW - Logistic Models KW - Male KW - Middle Aged KW - Obesity KW - Prospective Studies KW - Qualitative Research KW - Retirement KW - Risk Factors KW - Socioeconomic factors KW - United States AB -

BACKGROUND: Studies have identified prenatal and early childhood conditions as important contributors to weight status in later life. To date, however, few studies have considered how weight status in adulthood is shaped by regional variation in early-life conditions, rather than the characteristics of the individual or their family. Furthermore, gender and life course differences in the salience of early life conditions to weight status remain unclear. This study investigates whether the effect of family background and birth region on adult obesity status varies by gender and over the life course.

METHODS: We used data from a population-based cohort of 6,453 adults from the Health and Retirement Study, 1992-2008. Early life conditions were measured retrospectively at and after the baseline. Obesity was calculated from self-reported height and weight. Logistic models were used to estimate the net effects of family background and birth region on adulthood obesity risk after adjusting for socioeconomic factors and health behaviors measured in adulthood. Four economic and demographic data sets were used to further test the birthplace effect.

RESULTS: At ages 50-61, mother's education and birth region were associated with women's obesity risk, but not men's. Each year's increase in mother's education significantly reduces the odds of being obese by 6% (OR = 0.94; 95% CI: 0.92, 0.97) among women, and this pattern persisted at ages 66-77. Women born in the Mountain region were least likely to be obese in late-middle age and late-life. Measures of per capita income and infant mortality rate in the birth region were also associated with the odds of obesity among women.

CONCLUSIONS: Women's obesity status in adulthood is influenced by early childhood conditions, including regional conditions, while adulthood health risk factors may be more important for men's obesity risk. Biological and social mechanisms may account for the gender difference.

PB - 15 VL - 15 UR - http://www.scopus.com/inward/record.url?eid=2-s2.0-84934903370andpartnerID=40andmd5=b19c15d412d4437881f0111906f49570 N1 - Export Date: 9 September 2015 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26088317?dopt=Abstract U2 - PMC4474348 U4 - Birth place/Early-life conditions/Gender/Life course/Mothers education/Obesity ER - TY - JOUR T1 - Weight Discrimination and Risk of Mortality. JF - Psychol Sci Y1 - 2015 A1 - Angelina R Sutin A1 - Yannick Stephan A1 - Antonio Terracciano KW - Adult KW - Aged KW - Female KW - Humans KW - Male KW - Mental Health KW - Middle Aged KW - Mortality KW - Overweight KW - Prejudice KW - Proportional Hazards Models KW - Social Discrimination KW - Stress, Psychological KW - Surveys and Questionnaires KW - United States AB -

Discrimination based on weight is a stressful social experience linked to declines in physical and mental health. We examined whether this harmful association extends to risk of mortality. Participants in the Health and Retirement Study (HRS; N = 13,692) and the Midlife in the United States Study (MIDUS; N = 5,079) reported on perceived discriminatory experiences and attributed those experiences to a number of personal characteristics, including weight. Weight discrimination was associated with an increase in mortality risk of nearly 60% in both HRS participants (hazard ratio = 1.57, 95% confidence interval = [1.34, 1.84]) and MIDUS participants (hazard ratio = 1.59, 95% confidence interval = [1.09, 2.31]). This increased risk was not accounted for by common physical and psychological risk factors. The association between mortality and weight discrimination was generally stronger than that between mortality and other attributions for discrimination. In addition to its association with poor health outcomes, weight discrimination may shorten life expectancy.

PB - 26 VL - 26 IS - 11 N1 - Times Cited: 0 0 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26420442?dopt=Abstract U2 - PMC4636946 U4 - psychological stress/open data/open materials/health Status/body Mass Index/PERCEIVED DISCRIMINATION/OBESITY/Discrimination/Mortality/Risk factors ER - TY - JOUR T1 - What can genes tell us about the relationship between education and health? JF - Soc Sci Med Y1 - 2015 A1 - Jason D Boardman A1 - Benjamin W Domingue A1 - Daw, Jonathan KW - Aged KW - Aged, 80 and over KW - Body Mass Index KW - Computer Simulation KW - depression KW - Educational Status KW - Female KW - Gene-Environment Interaction KW - Genetic Predisposition to Disease KW - Genome-Wide Association Study KW - Health Status KW - Health Status Disparities KW - Humans KW - Male KW - Phenotype KW - Polymorphism, Single Nucleotide KW - Social determinants of health KW - Socioeconomic factors KW - White People AB -

We use genome wide data from respondents of the Health and Retirement Study (HRS) to evaluate the possibility that common genetic influences are associated with education and three health outcomes: depression, self-rated health, and body mass index. We use a total of 1.7 million single nucleotide polymorphisms obtained from the Illumina HumanOmni2.5-4v1 chip from 4233 non-Hispanic white respondents to characterize genetic similarities among unrelated persons in the HRS. We then used the Genome Wide Complex Trait Analysis (GCTA) toolkit, to estimate univariate and bivariate heritability. We provide evidence that education (h(2) = 0.33), BMI (h(2) = 0.43), depression (h(2) = 0.19), and self-rated health (h(2) = 0.18) are all moderately heritable phenotypes. We also provide evidence that some of the correlation between depression and education as well as self-rated health and education is due to common genetic factors associated with one or both traits. We find no evidence that the correlation between education and BMI is influenced by common genetic factors.

PB - 127 VL - 127 UR - http://www.sciencedirect.com/science/article/pii/S0277953614005188 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25113566?dopt=Abstract U2 - PMC4314507 U4 - education/health/depression/self-rated health/genetics/genetics ER - TY - JOUR T1 - Are people healthier if their partners are more optimistic? The dyadic effect of optimism on health among older adults. JF - J Psychosom Res Y1 - 2014 A1 - Eric S Kim A1 - William J. Chopik A1 - Jacqui Smith KW - Adult KW - Affect KW - Aged KW - Aged, 80 and over KW - Female KW - Health Status KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Personal Satisfaction KW - Self Report KW - Spouses AB -

OBJECTIVE: Optimism has been linked with an array of positive health outcomes at the individual level. However, researchers have not examined how a spouse's optimism might impact an individual's health. We hypothesized that being optimistic (and having an optimistic spouse) would both be associated with better health.

METHODS: Participants were 3940 adults (1970 couples) from the Health and Retirement Study, a nationally representative panel study of American adults over the age of 50. Participants were tracked for four years and outcomes included: physical functioning, self-rated health, and number of chronic illnesses. We analyzed the dyadic data using the actor-partner interdependence model.

RESULTS: After controlling for several psychological and demographic factors, a person's own optimism and their spouse's optimism predicted better self-rated health and physical functioning (bs = .08-.25, ps<.01). More optimistic people also reported better physical functioning (b = -.11, p<.01) and fewer chronic illnesses (b=-.01, p<.05) over time. Further, having an optimistic spouse uniquely predicted better physical functioning (b = -.09, p<.01) and fewer chronic illnesses (b = -.01, p<.05) over time. The strength of the relationship between optimism and health did not diminish over time.

CONCLUSIONS: Being optimistic and having an optimistic spouse were both associated with better health. Examining partner effects is important because such analyses reveal the unique role that spouses play in promoting health. These findings may have important implications for future health interventions.

PB - 76 VL - 76 UR - http://www.sciencedirect.com/science/article/pii/S0022399914001731 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/24840138?dopt=Abstract U2 - PMC4610812 U4 - Optimism/Optimism/Aging/Relationships/Successful aging/Positive psychology/Psychological well-being ER - TY - JOUR T1 - Chiropractic use in the Medicare population: prevalence, patterns, and associations with 1-year changes in health and satisfaction with care. JF - J Manipulative Physiol Ther Y1 - 2014 A1 - Paula A Weigel A1 - Jason Hockenberry A1 - Frederic D Wolinsky KW - Aged KW - Aged, 80 and over KW - Female KW - Humans KW - Male KW - Manipulation, Chiropractic KW - Medicare KW - Patient Satisfaction KW - Time Factors KW - Treatment Outcome KW - United States AB -

OBJECTIVE: The purpose of this study was to examine how chiropractic care compares to medical treatments on 1-year changes in self-reported function, health, and satisfaction with care measures in a representative sample of Medicare beneficiaries.

METHODS: Logistic regression using generalized estimating equations is used to model the effect of chiropractic relative to medical care on decline in 5 functional measures and 2 measures of self-rated health among 12170 person-year observations. The same method is used to estimate the comparative effect of chiropractic on 6 satisfaction with care measures. Two analytic approaches are used, the first assuming no selection bias and the second using propensity score analyses to adjust for selection effects in the outcome models.

RESULTS: The unadjusted models show that chiropractic is significantly protective against 1-year decline in activities of daily living, lifting, stooping, walking, self-rated health, and worsening health after 1 year. Persons using chiropractic are more satisfied with their follow-up care and with the information provided to them. In addition to the protective effects of chiropractic in the unadjusted model, the propensity score results indicate a significant protective effect of chiropractic against decline in reaching.

CONCLUSION: This study provides evidence of a protective effect of chiropractic care against 1-year declines in functional and self-rated health among Medicare beneficiaries with spine conditions, and indications that chiropractic users have higher satisfaction with follow-up care and information provided about what is wrong with them.

VL - 37 UR - https://www.ncbi.nlm.nih.gov/pubmed/25233887 IS - 8 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25233887?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 - Cohort Profile: the Health and Retirement Study (HRS). JF - Int J Epidemiol Y1 - 2014 A1 - Amanda Sonnega A1 - Jessica Faul A1 - Mary Beth Ofstedal A1 - Kenneth M. Langa A1 - John W R Phillips A1 - David R Weir KW - Aged KW - Female KW - Genetic Predisposition to Disease KW - Health Status KW - Humans KW - Longitudinal Studies KW - Male KW - Mental Health KW - Middle Aged KW - Physical Fitness KW - Retirement KW - United States AB -

The Health and Retirement Study (HRS) is a nationally representative longitudinal survey of more than 37 000 individuals over age 50 in 23 000 households in the USA. The survey, which has been fielded every 2 years since 1992, was established to provide a national resource for data on the changing health and economic circumstances associated with ageing at both individual and population levels. Its multidisciplinary approach is focused on four broad topics-income and wealth; health, cognition and use of healthcare services; work and retirement; and family connections. HRS data are also linked at the individual level to administrative records from Social Security and Medicare, Veteran's Administration, the National Death Index and employer-provided pension plan information. Since 2006, data collection has expanded to include biomarkers and genetics as well as much greater depth in psychology and social context. This blend of economic, health and psychosocial information provides unprecedented potential to study increasingly complex questions about ageing and retirement. The HRS has been a leading force for rapid release of data while simultaneously protecting the confidentiality of respondents. Three categories of data-public, sensitive and restricted-can be accessed through procedures described on the HRS website (hrsonline.isr.umich.edu).

PB - 43 VL - 43 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/24671021?dopt=Abstract U4 - administrative data/Restricted data ER - TY - JOUR T1 - Cumulative inequality and racial disparities in health: private insurance coverage and black/white differences in functional limitations. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2014 A1 - Ben Lennox Kail A1 - Miles G Taylor KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Black or African American KW - Cross-Sectional Studies KW - Female KW - Health Status Disparities KW - Hispanic or Latino KW - Humans KW - Insurance Coverage KW - Insurance, Health KW - Longitudinal Studies KW - Male KW - Medicare KW - Socioeconomic factors KW - United States AB -

OBJECTIVES: To test different forms of private insurance coverage as mediators for racial disparities in onset, persistent level, and acceleration of functional limitations among Medicare age-eligible Americans.

METHOD: Data come from 7 waves of the Health and Retirement Study (1996-2008). Onset and progression latent growth models were used to estimate racial differences in onset, level, and growth of functional limitations among a sample of 5,755 people aged 65 and older in 1996. Employer-provided insurance, spousal insurance, and market insurance were next added to the model to test how differences in private insurance mediated the racial gap in physical limitations.

RESULTS: In baseline models, African Americans had larger persistent level of limitations over time. Although employer-provided, spousal provided, and market insurances were directly associated with lower persistent levels of limitation, only differences in market insurance accounted for the racial disparities in persistent level of limitations.

DISCUSSION: Results suggest private insurance is important for reducing functional limitations, but market insurance is an important mediator of the persistently larger level of limitations observed among African Americans.

PB - 69 VL - 69 UR - http://psychsocgerontology.oxfordjournals.org/content/early/2014/02/24/geronb.gbu005.abstract IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/24569001?dopt=Abstract U2 - PMC4189650 U4 - Cumulative inequality/Insurance/Functional limitations/Private insurance ER - TY - JOUR T1 - Depression and risk of hospitalization for pneumonia in a cohort study of older Americans. JF - J Psychosom Res Y1 - 2014 A1 - Dimitry S Davydow A1 - Catherine L Hough A1 - Zivin, Kara A1 - Kenneth M. Langa A1 - Wayne J Katon KW - Aged KW - Aged, 80 and over KW - Cohort Studies KW - Comorbidity KW - depression KW - Depressive Disorder KW - Female KW - Hospitalization KW - Humans KW - Logistic Models KW - Male KW - Middle Aged KW - Odds Ratio KW - Pneumonia KW - Risk Assessment KW - Risk Factors KW - United States AB -

OBJECTIVE: The aim of this study is to determine if depression is independently associated with risk of hospitalization for pneumonia after adjusting for demographics, medical comorbidity, health-risk behaviors, baseline cognition and functional impairments.

METHODS: This secondary analysis of prospectively collected data examined a population-based sample of 6704 Health and Retirement Study (HRS) (1998-2008) participants>50years old who consented to have their interviews linked to their Medicare claims and were without a dementia diagnosis. The eight-item Center for Epidemiologic Studies Depression Scale and/or International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) depression diagnoses were used to identify baseline depression. ICD-9-CM diagnoses were used to identify hospitalizations for which the principal discharge diagnosis was for bacterial or viral pneumonia. The odds of hospitalization for pneumonia for participants with depression relative to those without depression were estimated using logistic regression models. Population attributable fractions were calculated to determine the extent that hospitalizations for pneumonia could be attributable to depression.

RESULTS: After adjusting for demographic characteristics, clinical factors, and health-risk behaviors, depression was independently associated with increased odds of hospitalization for pneumonia (odds ratio [OR]: 1.28, 95% confidence interval [95%CI]: 1.08, 1.53). This association persisted after adjusting for baseline cognition and functional impairments (OR: 1.24, 95%CI: 1.03, 1.50). In this cohort, 6% (95%CI: 2%, 10%) of hospitalizations for pneumonia were potentially attributable to depression.

CONCLUSION: Depression is independently associated with increased odds of hospitalization for pneumonia. This study provides additional rationale for integrating mental health care into medical settings in order to improve outcomes for older adults.

PB - 77 VL - 77 IS - 6 N1 - Times Cited: 0 0 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25139125?dopt=Abstract U2 - PMC4259844 U4 - Depression/Pneumonia/Hospitalization/Outcome assessment (health care)/health Care Utilization/mental Health ER - TY - JOUR T1 - Development and validation of a brief dementia screening indicator for primary care. JF - Alzheimers Dement Y1 - 2014 A1 - Deborah E Barnes A1 - Alexa S. Beiser A1 - Anne Lee A1 - Kenneth M. Langa A1 - Alain Koyama A1 - Sarah R Preis A1 - John Neuhaus A1 - Ryan J McCammon A1 - Kristine Yaffe A1 - Seshadri, Sudha A1 - Mary Haan A1 - David R Weir KW - Aged KW - Cohort Studies KW - Dementia KW - Female KW - Humans KW - Male KW - Mass Screening KW - Predictive Value of Tests KW - Primary Health Care KW - Proportional Hazards Models KW - Risk Assessment AB -

BACKGROUND: Detection of "any cognitive impairment" is mandated as part of the Medicare annual wellness visit, but screening all patients may result in excessive false positives.

METHODS: We developed and validated a brief Dementia Screening Indicator using data from four large, ongoing cohort studies (the Cardiovascular Health Study [CHS]; the Framingham Heart Study [FHS]; the Health and Retirement Study [HRS]; the Sacramento Area Latino Study on Aging [SALSA]) to help clinicians identify a subgroup of high-risk patients to target for cognitive screening.

RESULTS: The final Dementia Screening Indicator included age (1 point/year; ages, 65-79 years), less than 12 years of education (9 points), stroke (6 points), diabetes mellitus (3 points), body mass index less than 18.5 kg/m(2) (8 points), requiring assistance with money or medications (10 points), and depressive symptoms (6 points). Accuracy was good across the cohorts (Harrell's C statistic: CHS, 0.68; FHS, 0.77; HRS, 0.76; SALSA, 0.78).

CONCLUSIONS: The Dementia Screening Indicator is a simple tool that may be useful in primary care settings to identify high-risk patients to target for cognitive screening.

PB - 10 VL - 10 UR - http://www.scopus.com/inward/record.url?eid=2-s2.0-84893186546andpartnerID=40andmd5=3b617dce24578e022db389d90ad9ddd1 IS - 6 N1 - Export Date: 21 April 2014 Source: Scopus Article in Press U1 - http://www.ncbi.nlm.nih.gov/pubmed/24491321?dopt=Abstract U2 - PMC4119094 U4 - Dementia/Primary care/Risk prediction modeling/Screening/Cognitive Impairment ER - TY - JOUR T1 - The disability burden associated with stroke emerges before stroke onset and differentially affects blacks: results from the health and retirement study cohort. JF - J Gerontol A Biol Sci Med Sci Y1 - 2014 A1 - Benjamin D Capistrant A1 - Nicte I Mejia A1 - Sze Y Liu A1 - Qianyi Wang A1 - M. Maria Glymour KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Aging KW - Black or African American KW - Cohort Studies KW - Disabled Persons KW - Female KW - Humans KW - Male KW - Prospective Studies KW - Stroke KW - United States KW - White People AB -

BACKGROUND: Few longitudinal studies compare changes in instrumental activities of daily living (IADLs) among stroke-free adults to prospectively document IADL changes among adults who experience stroke. We contrast annual declines in IADL independence for older individuals who remain stroke free to those for individuals who experienced stroke. We also assess whether these patterns differ by sex, race, or Southern birthplace.

METHODS: Health and Retirement Study participants who were stroke free in 1998 (n = 17,741) were followed through 2010 (average follow-up = 8.9 years) for self- or proxy-reported stroke. We used logistic regressions to compare annual changes in odds of self-reported independence in six IADLs among those who remained stroke free throughout follow-up (n = 15,888), those who survived a stroke (n = 1,412), and those who had a stroke and did not survive to participate in another interview (n = 442). We present models adjusted for demographic and socioeconomic covariates and also stratified on sex, race, and Southern birthplace.

RESULTS: Compared with similar cohort members who remained stroke free, participants who developed stroke had faster declines in IADL independence and lower probability of IADL independence prior to stroke. After stroke, independence declined at an annual rate similar to those who did not have stroke. The black-white disparity in IADL independence narrowed poststroke.

CONCLUSION: Racial differences in IADL independence are apparent long before stroke onset. Poststroke differences in IADL independence largely reflect prestroke disparities.

PB - 69 VL - 69 UR - http://biomedgerontology.oxfordjournals.org/content/early/2014/01/19/gerona.glt191.abstract IS - 7 U1 - http://www.ncbi.nlm.nih.gov/pubmed/24444610?dopt=Abstract U2 - PMC4067116 U4 - Minority aging/Disablement process/Stroke/Cardiovascular/Epidemiology. ER - TY - JOUR T1 - Does duration of spousal caregiving affect risk of depression onset? Evidence from the Health and Retirement Study. JF - Am J Geriatr Psychiatry Y1 - 2014 A1 - Benjamin D Capistrant A1 - Lisa F Berkman A1 - M. Maria Glymour KW - Aged KW - Caregivers KW - depression KW - Female KW - Health Surveys KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Retirement KW - Risk Factors KW - Spouses KW - Time Factors KW - United States AB -

OBJECTIVES: To assess the association of current and long-term spousal caregiving with risk of depression in a nationally (U.S.) representative sample of older adults.

METHODS: We studied married and depression-free Health and Retirement Study respondents aged 50 years and older (n = 9,420) at baseline from 2000 to 2010. Current (≥14 hours per week of help with instrumental/activities of daily living for a spouse in the most recent biennial survey) and long-term caregiving (care at two consecutive surveys) were used to predict onset of elevated depressive symptoms (≥3 on a modified Centers for Epidemiologic Studies Depression scale) with discrete-time hazards models and time-updated exposure and covariate information.

RESULTS: Current caregiving was associated with significant elevations in risk of depression onset (hazard ratio: 1.64; Wald χ(2), 1 df: 28.34; p <0.0001). Effect estimates for long-term caregiving were similar (hazard ratio: 1.52, Wald χ(2), 1 df: 3.63; p = 0.06).

CONCLUSIONS: Current spousal caregiving significantly predicted onset of depression; the association was not exacerbated by longer duration of caregiving.

PB - 22 VL - 22 IS - 8 N1 - Times Cited: 0 U1 - http://www.ncbi.nlm.nih.gov/pubmed/23791537?dopt=Abstract U2 - PMC3785551 U4 - Caregiving/depression/depressive symptoms/older adults/spouses/spousal caregiving 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 - Factors influencing the use of intensive procedures at the end of life. JF - J Am Geriatr Soc Y1 - 2014 A1 - Evan C Tschirhart A1 - Qingling Du A1 - Amy Kelley KW - Advance directives KW - Aged KW - Aged, 80 and over KW - Alzheimer disease KW - Cause of Death KW - Chronic disease KW - Critical Care KW - Female KW - Homes for the Aged KW - Humans KW - Life Support Care KW - Logistic Models KW - Male KW - Multivariate Analysis KW - Neoplasms KW - Nursing homes KW - Odds Ratio KW - Terminal Care KW - United States KW - Utilization Review AB -

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

DESIGN: Retrospective cohort study.

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

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

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

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

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

PB - 62 VL - 62 IS - 11 N1 - Times Cited: 0 0 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25376084?dopt=Abstract U2 - PMC4241150 U4 - end-of-life decisions/terminal care/intensive care/Medicare/Advance Directives/regional variations/MEDICARE EXPENDITURES/SUSTAINING TREATMENTS/PATIENT PREFERENCES ER - TY - JOUR T1 - Fine particulate matter air pollution and cognitive function among older US adults. JF - Am J Epidemiol Y1 - 2014 A1 - Jennifer A Ailshire A1 - Eileen M. Crimmins KW - Aged KW - Aged, 80 and over KW - Cognition KW - Cognition Disorders KW - Cross-Sectional Studies KW - Female KW - Humans KW - Inhalation Exposure KW - Male KW - Memory, Episodic KW - Middle Aged KW - Neuropsychological tests KW - Particulate Matter KW - Socioeconomic factors KW - United States KW - Urban Population AB -

Existing research on the adverse health effects of exposure to pollution has devoted relatively little attention to the potential impact of ambient air pollution on cognitive function in older adults. We examined the cross-sectional association between residential concentrations of particulate matter with aerodynamic diameter of 2.5 μm or less (PM2.5) and cognitive function in older adults. Using hierarchical linear modeling, we analyzed data from the 2004 Health and Retirement Study, a large, nationally representative sample of US adults aged 50 years or older. We linked participant data with 2000 US Census tract data and 2004 census tract-level annual average PM2.5 concentrations. Older adults living in areas with higher PM2.5 concentrations had worse cognitive function (β = -0.26, 95% confidence interval: -0.47, -0.05) even after adjustment for community- and individual-level social and economic characteristics. Results suggest that the association is strongest for the episodic memory component of cognitive function. This study adds to a growing body of research highlighting the importance of air pollution to cognitive function in older adults. Improving air quality in large metropolitan areas, where much of the aging US population resides, may be an important mechanism for reducing age-related cognitive decline.

PB - 180 VL - 180 UR - http://aje.oxfordjournals.org/content/early/2014/06/24/aje.kwu155.abstract IS - 4 N1 - Ailshire, Jennifer A Crimmins, Eileen M eng K99 AG039528/AG/NIA NIH HHS/ K99AG039528/AG/NIA NIH HHS/ P30 AG017265/AG/NIA NIH HHS/ P30AG17265/AG/NIA NIH HHS/ R00 AG039528/AG/NIA NIH HHS/ R21 AG045625/AG/NIA NIH HHS/ T32 AG000037/AG/NIA NIH HHS/ T32AG0037/AG/NIA NIH HHS/ U01 AG009740/AG/NIA NIH HHS/ U01AG009740/AG/NIA NIH HHS/ Research Support, N.I.H., Extramural 2014/06/27 06:00 Am J Epidemiol. 2014 Aug 15;180(4):359-66. doi: 10.1093/aje/kwu155. Epub 2014 Jun 24. U1 - http://www.ncbi.nlm.nih.gov/pubmed/24966214?dopt=Abstract ER - TY - JOUR T1 - Five-factor model personality traits and inflammatory markers: new data and a meta-analysis. JF - Psychoneuroendocrinology Y1 - 2014 A1 - Martina Luchetti A1 - James M Barkley A1 - Yannick Stephan A1 - Antonio Terracciano A1 - Angelina R Sutin KW - Adult KW - Aged KW - Aged, 80 and over KW - Biomarkers KW - C-reactive protein KW - Female KW - Humans KW - Inflammation KW - Male KW - Middle Aged KW - Personality AB -

The purpose of this research is to examine the association between five major dimensions of personality and systemic inflammation through (a) new data on C-reactive protein (CRP) from three large national samples of adults that together cover most of the adult lifespan and (b) a meta-analysis of published studies on CRP and interleukin-6 (IL-6). New data (total N=26,305) were drawn from the National Longitudinal Study of Adolescent Health, the Midlife in the United States study, and the Health and Retirement Study. PRISMA guidelines were used for the meta-analysis to combine results of up to seven studies on CRP (N=34,067) and six on IL-6 (N=7538). Across the three new samples, higher conscientiousness was associated with lower CRP. The conscientiousness-CRP relation was virtually identical controlling for smoking; controlling for body mass index attenuated this association but did not eliminate it. Compared to participants in the highest quartile of conscientiousness, participants in the lowest quartile had an up to 50% increased risk of CRP levels that exceeded the clinical threshold (≥3 mg/l). The meta-analysis supported the association between conscientiousness and both CRP and IL-6 and also suggested a negative association between openness and CRP; no associations were found for neuroticism, extraversion and agreeableness. The present work indicates a modest, but consistent, association between conscientiousness and a more favorable inflammatory profile, which may contribute to the role of conscientiousness in better health across the lifespan.

PB - 50 VL - 50 N1 - Times Cited: 0 0 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25233337?dopt=Abstract U2 - PMC4544833 U4 - Personality/Personality/Conscientiousness/Conscientiousness/C-reactive protein/Interleukin-6/Meta-analysis ER - TY - JOUR T1 - Genetic susceptibility to accelerated cognitive decline in the US Health and Retirement Study. JF - Neurobiol Aging Y1 - 2014 A1 - Zhang, Chenan A1 - Brandon L Pierce KW - African Americans KW - Aged KW - Aged, 80 and over KW - Chromosomes, Human, Pair 9 KW - Cognition KW - Cognition Disorders KW - Cross-Sectional Studies KW - Female KW - Gene-Environment Interaction KW - Genetic Predisposition to Disease KW - Genetic Variation KW - Genome-Wide Association Study KW - Humans KW - Male KW - Membrane Transport Proteins KW - Middle Aged KW - Phenotype KW - Polymorphism, Single Nucleotide KW - Risk Factors KW - United States AB -

Age-related cognitive decline is a major public health concern facing a large segment of the US population. To identify genetic risk factors related to cognitive decline, we used nationally representative longitudinal data from the US Health and Retirement Study to conduct genome-wide association studies with 5765 participants of European ancestry, and 890 participants of African ancestry. Mixed effects models were used to derive cognitive decline phenotypes from data on repeated cognitive assessments and to perform single nucleotide polymorphism-based heritability estimation. We found 2 independent associations among European-Americans in the 19q13.32 region: rs769449 (APOE intron; p = 3.1 × 10(-20)) and rs115881343 (TOMM40 intron; p = 6.6 × 10(-11)). rs769449 was also associated with cognitive decline among African-Americans (p = 0.005), but rs115881343 was not. Cross-sectional cognitive function showed moderate heritability (15%-32%) across several age strata (50-59, 60-69, 70-79 years), but the cognitive decline heritability estimate was low (∼5%). These results indicate that despite multiple association signals for cognitive decline in the 19q13.32 region, inter-individual variation is likely influenced substantially by environmental factors.

VL - 35 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/24468470?dopt=Abstract ER - TY - JOUR T1 - Geographic variation in out-of-pocket expenditures of elderly Medicare beneficiaries. JF - J Am Geriatr Soc Y1 - 2014 A1 - Lena M. Chen A1 - Edward C Norton A1 - Kenneth M. Langa A1 - Le, Sidney A1 - Arnold M. Epstein KW - Aged KW - Aged, 80 and over KW - Cohort Studies KW - Female KW - Geography KW - Health Care Costs KW - Health Expenditures KW - Humans KW - Male KW - Medicare KW - Retrospective Studies KW - United States AB -

OBJECTIVES: To examine whether out-of-pocket expenditures (OOPEs) exhibit the same geographic variation as Medicare claims, given wide variation in the costs of U.S. health care, but no information on how that translates into OOPEs or financial burden for older Americans.

DESIGN: Retrospective cohort study.

SETTING: Data from the Health and Retirement Study linked to Medicare claims.

PARTICIPANTS: A nationally representative cohort of 4,657 noninstitutionalized, community-dwelling, fee-for-service elderly Medicare beneficiaries interviewed in 2006 and 2008.

MEASUREMENTS: The primary predictor was per capita Medicare spending quintile according to hospital referral region. The primary outcome was a self-reported, validated measure of annual OOPEs excluding premiums.

RESULTS: Mean and median adjusted per capita Medicare payments were $5,916 and $2,635, respectively; mean and median adjusted OOPEs were $1,525 and $779, respectively. Adjusted median Medicare payments were $3,474 in the highest cost quintile and $1,942 in the lowest cost quintile (ratio 1.79, P < .001 for difference). In contrast, adjusted median OOPEs were not higher in the highest than in the lowest Medicare cost quintile ($795 vs $764 for a Q5:Q1 ratio of 1.04, P = .42). The Q5:Q1 ratio was 1.48 for adjusted mean Medicare payments and 1.04 for adjusted mean OOPEs (both P < .001).

CONCLUSION: Medicare payments vary widely between high- and low-cost regions, but OOPEs do not.

PB - 62 VL - 62 IS - 6 N1 - Times Cited: 0 U1 - http://www.ncbi.nlm.nih.gov/pubmed/24852182?dopt=Abstract U4 - Medicare/geographic variation/out-of-pocket expenditures ER - TY - JOUR T1 - The health effects of US unemployment insurance policy: does income from unemployment benefits prevent cardiovascular disease? JF - PLoS One Y1 - 2014 A1 - Stefan Walter A1 - M. Maria Glymour A1 - Mauricio Avendano KW - Aged KW - Cardiovascular Diseases KW - Female KW - Geography KW - Humans KW - Incidence KW - Insurance Benefits KW - Insurance, Health KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Risk Factors KW - Unemployment KW - United States AB -

OBJECTIVE: Previous studies suggest that unemployment predicts increased cardiovascular disease (CVD) risk, but whether unemployment insurance programs mitigate this risk has not been assessed. Exploiting US state variations in unemployment insurance benefit programs, we tested the hypothesis that more generous benefits reduce CVD risk.

METHODS: Cohort data came from 16,108 participants in the Health and Retirement Study (HRS) aged 50-65 at baseline interviewed from 1992 to 2010. Data on first and recurrent CVD diagnosis assessed through biennial interviews were linked to the generosity of unemployment benefit programmes in each state and year. Using state fixed-effect models, we assessed whether state changes in the generosity of unemployment benefits predicted CVD risk.

RESULTS: States with higher unemployment benefits had lower incidence of CVD, so that a 1% increase in benefits was associated with 18% lower odds of CVD (OR:0.82, 95%-CI:0.71-0.94). This association remained after introducing US census regional division fixed effects, but disappeared after introducing state fixed effects (OR:1.02, 95%-CI:0.79-1.31).This was consistent with the fact that unemployment was not associated with CVD risk in state-fixed effect models.

CONCLUSION: Although states with more generous unemployment benefits had lower CVD incidence, this appeared to be due to confounding by state-level characteristics. Possible explanations are the lack of short-term effects of unemployment on CVD risk. Future studies should assess whether benefits at earlier stages of the life-course influence long-term risk of CVD.

PB - 9 VL - 9 IS - 7 N1 - Times Cited: 0 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25025281?dopt=Abstract U2 - PMC4098914 U4 - Unemployment insurance/Cardiovascular disease/unemployment insurance ER - TY - JOUR T1 - Health numeracy: the importance of domain in assessing numeracy. JF - Med Decis Making Y1 - 2014 A1 - Helen G Levy A1 - Peter A. Ubel A1 - Amanda J. Dillard A1 - David R Weir A1 - Angela Fagerlin KW - Aged KW - Humans KW - Mathematics KW - Middle Aged KW - Self Efficacy KW - Surveys and Questionnaires KW - Task Performance and Analysis AB -

BACKGROUND AND OBJECTIVE: Existing research concludes that measures of general numeracy can be used to predict individuals' ability to assess health risks. We posit that the domain in which questions are posed affects the ability to perform mathematical tasks, raising the possibility of a separate construct of "health numeracy" that is distinct from general numeracy. The objective was to determine whether older adults' ability to perform simple math depends on domain.

METHODS: Community-based participants completed 4 math questions posed in 3 different domains: a health domain, a financial domain, and a pure math domain. Participants were 962 individuals aged 55 and older, representative of the community-dwelling US population over age 54.

RESULTS: We found that respondents performed significantly worse when questions were posed in the health domain (54% correct) than in either the pure math domain (66% correct) or the financial domain (63% correct). Our experimental measure of numeracy consisted of only 4 questions, and it is possible that the apparent effect of domain is specific to the mathematical tasks that these questions require.

CONCLUSIONS: These results suggest that health numeracy is strongly related to general numeracy but that the 2 constructs may not be the same. Further research is needed into how different aspects of general numeracy and health numeracy translate into actual medical decisions.

PB - 34 VL - 34 UR - http://mdm.sagepub.com/content/34/1/107.abstract IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/23824401?dopt=Abstract U4 - Health Numeracy/Health Literacy/Health Literacy/Cognition ER - TY - JOUR T1 - Heterogeneity in healthy aging. JF - J Gerontol A Biol Sci Med Sci Y1 - 2014 A1 - David J Lowsky A1 - S Jay Olshansky A1 - Bhattacharya, Jay A1 - Dana P Goldman KW - Aged KW - Aged, 80 and over KW - Aging KW - Female KW - Health Status KW - Humans KW - Male KW - Middle Aged KW - Population Surveillance KW - Quality of Life KW - Retrospective Studies KW - United States AB -

For a surprisingly large segment of the older population, chronological age is not a relevant marker for understanding, measuring, or experiencing healthy aging. Using the 2003 Medical Expenditure Panel Survey and the 2004 Health and Retirement Study to examine the proportion of Americans exhibiting five markers of health and the variation in health-related quality of life across each of eight age groups, we find that a significant proportion of older Americans is healthy within every age group beginning at age 51, including among those aged 85+. For example, 48% of those aged 51-54 and 28% of those aged 85+ have excellent or very good self-reported health status; similarly, 89% of those aged 51-54 and 56% of those aged 85+ report no health-based limitations in work or housework. Also, health-related quality of life ranges widely within every age group, yet there is only a comparatively small variation in median quality of life across age groups, suggesting that older Americans today may be experiencing substantially different age-health trajectories than their predecessors. Patterns are similar for medical expenditures. Several policy implications are explored.

PB - 69 VL - 69 UR - http://biomedgerontology.oxfordjournals.org/content/early/2013/11/13/gerona.glt162.abstract IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/24249734?dopt=Abstract U2 - PMC4022100 U4 - Healthy Aging/Quality of Life/Compression of Morbidity ER - TY - JOUR T1 - Identifying diabetics in Medicare claims and survey data: implications for health services research. JF - BMC Health Serv Res Y1 - 2014 A1 - Joseph W Sakshaug A1 - David R Weir A1 - Lauren Hersch Nicholas KW - Aged KW - Aged, 80 and over KW - Algorithms KW - Diabetes Mellitus KW - Female KW - Glycated Hemoglobin KW - Health Services Research KW - Humans KW - Insurance Claim Review KW - Male KW - Medicare KW - Prevalence KW - United States AB -

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

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

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

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

PB - 14 VL - 14 N1 - Export Date: 21 April 2014 Source: Scopus Article in Press U1 - http://www.ncbi.nlm.nih.gov/pubmed/24693862?dopt=Abstract U2 - PMC3975984 U4 - Diabetes/Survey data/Medicare claims/Chronic condition warehouse ER - TY - JOUR T1 - Increased 1-year healthcare use in survivors of severe sepsis. JF - Am J Respir Crit Care Med Y1 - 2014 A1 - Hallie C Prescott A1 - Kenneth M. Langa A1 - Liu, Vincent A1 - Gabriel J. Escobar A1 - Theodore J Iwashyna KW - Aged KW - Female KW - Health Facilities KW - Humans KW - Insurance Claim Review KW - Long-term Care KW - Male KW - Medical Record Linkage KW - Medicare KW - Mortality KW - Outcome Assessment, Health Care KW - Patient Readmission KW - Prospective Studies KW - Sepsis KW - Skilled Nursing Facilities KW - Survivors KW - United States AB -

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

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

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

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

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

PB - 190 VL - 190 IS - 1 N1 - Times Cited: 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/24872085?dopt=Abstract U4 - healthcare facilities/sepsis/hospitalization/patient outcomes assessment/patient readmission/skilled nursing facility 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 - An investigation of activity profiles of older adults. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2014 A1 - Morrow-Howell, Nancy A1 - Putnam, Michelle A1 - Lee, Yung Soo A1 - Jennifer C. Greenfield A1 - Inoue, Megumi A1 - Chen, Huajuan KW - Aged KW - Aged, 80 and over KW - Aging KW - Black or African American KW - Cohort Studies KW - Cross-Sectional Studies KW - Employment KW - Female KW - Florida KW - Health Surveys KW - Hispanic or Latino KW - Human Activities KW - Humans KW - Male KW - Middle Aged KW - Models, Psychological KW - Motor Activity KW - Prospective Studies KW - Regression Analysis KW - United States AB -

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

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

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

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

PB - 69 VL - 69 UR - http://psychsocgerontology.oxfordjournals.org/content/early/2014/02/12/geronb.gbu002.abstract IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/24526690?dopt=Abstract U2 - PMC4189653 U4 - Activity/Activity patterns/Engagement/Time use ER - TY - JOUR T1 - Leveraging the health and retirement study to advance palliative care research. JF - J Palliat Med Y1 - 2014 A1 - Amy Kelley A1 - Kenneth M. Langa A1 - John G. Cagle A1 - Katherine A Ornstein A1 - Maria J Silveira A1 - Lauren Hersch Nicholas A1 - Kenneth E Covinsky A1 - Christine S Ritchie KW - Aged KW - Caregivers KW - Evidence-Based Practice KW - Health Services Research KW - Health Surveys KW - Humans KW - Longitudinal Studies KW - Needs Assessment KW - Pain Management KW - Palliative care KW - Quality of Life KW - Retirement KW - Sociological Factors KW - United States AB -

BACKGROUND: The critical need to expand and develop the palliative care evidence base was recently highlighted by the Journal of Palliative Medicine's series of articles describing the Research Priorities in Geriatric Palliative Care. The Health and Retirement Study (HRS) is uniquely positioned to address many priority areas of palliative care research. This nationally representative, ongoing, longitudinal study collects detailed survey data every 2 years, including demographics, health and functional characteristics, information on family and caregivers, and personal finances, and also conducts a proxy interview after each subject's death. The HRS can also be linked with Medicare claims data and many other data sources, e.g., U.S. Census, Dartmouth Atlas of Health Care.

SETTING: While the HRS offers innumerable research opportunities, these data are complex and limitations do exist. Therefore, we assembled an interdisciplinary group of investigators using the HRS for palliative care research to identify the key palliative care research gaps that may be amenable to study within the HRS and the strengths and weaknesses of the HRS for each of these topic areas.

CONCLUSION: In this article we present the work of this group as a potential roadmap for investigators contemplating the use of HRS data for palliative care research.

PB - 17 VL - 17 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/24694096?dopt=Abstract U2 - PMC4012620 U4 - Caregivers/Evidence-Based Practice/Needs Assessment/Pain Management/Palliative Care ER - TY - JOUR T1 - Life satisfaction and frequency of doctor visits. JF - Psychosom Med Y1 - 2014 A1 - Eric S Kim A1 - Nansook Park A1 - Jennifer K Sun A1 - Jacqui Smith A1 - Christopher Peterson KW - Aged KW - Female KW - Health Behavior KW - Humans KW - Male KW - Middle Aged KW - Office Visits KW - Personal Satisfaction KW - Prospective Studies KW - United States AB -

OBJECTIVE: Identifying positive psychological factors that reduce health care use may lead to innovative efforts that help build a more sustainable and high-quality health care system. Prospective studies indicate that life satisfaction is associated with good health behaviors, enhanced health, and longer life, but little information about the association between life satisfaction and health care use is available. We tested whether higher life satisfaction was prospectively associated with fewer doctor visits. We also examined potential interactions between life satisfaction and health behaviors.

METHODS: Participants were 6379 adults from the Health and Retirement Study, a prospective and nationally representative panel study of American adults older than 50 years. Participants were tracked for 4 years. We analyzed the data using a generalized linear model with a gamma distribution and log link.

RESULTS: Higher life satisfaction was associated with fewer doctor visits. On a 6-point life satisfaction scale, each unit increase in life satisfaction was associated with an 11% decrease in doctor visits--after adjusting for sociodemographic factors (relative risk = 0.89, 95% confidence interval = 0.86-0.93). The most satisfied respondents (n = 1121; 17.58%) made 44% fewer doctor visits than did the least satisfied (n = 182; 2.85%). The association between higher life satisfaction and reduced doctor visits remained even after adjusting for baseline health and a wide range of sociodemographic, psychosocial, and health-related covariates (relative risk = 0.96, 95% confidence interval = 0.93-0.99).

CONCLUSIONS: Higher life satisfaction is associated with fewer doctor visits, which may have important implications for reducing health care costs.

PB - 76 VL - 76 UR - http://www.psychosomaticmedicine.org/content/76/1/86.abstract IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/24336427?dopt=Abstract U4 - Life Satisfaction/Life Satisfaction/Successful Aging/Health Care Use/Doctor Visit/Psychological Well-Being/Positive Psychology 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 - Neuropsychiatric disorders and potentially preventable hospitalizations in a prospective cohort study of older Americans. JF - J Gen Intern Med Y1 - 2014 A1 - Dimitry S Davydow A1 - Zivin, Kara A1 - Wayne J Katon A1 - Gregory M Pontone A1 - Lydia Chwastiak A1 - Kenneth M. Langa A1 - Theodore J Iwashyna KW - Aged KW - Aged, 80 and over KW - Cognition Disorders KW - Cohort Studies KW - Dementia KW - depression KW - Female KW - Hospitalization KW - Humans KW - Male KW - Mental Disorders KW - Prospective Studies KW - Risk Factors KW - United States AB -

BACKGROUND: The relative contributions of depression, cognitive impairment without dementia (CIND), and dementia to the risk of potentially preventable hospitalizations in older adults are not well understood.

OBJECTIVE(S): To determine if depression, CIND, and/or dementia are each independently associated with hospitalizations for ambulatory care-sensitive conditions (ACSCs) and rehospitalizations within 30 days after hospitalization for pneumonia, congestive heart failure (CHF), or myocardial infarction (MI).

DESIGN: Prospective cohort study.

PARTICIPANTS: Population-based sample of 7,031 Americans > 50 years old participating in the Health and Retirement Study (1998-2008).

MAIN MEASURES: The eight-item Center for Epidemiologic Studies Depression Scale and/or International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) depression diagnoses were used to identify baseline depression. The Modified Telephone Interview for Cognitive Status and/or ICD-9-CM dementia diagnoses were used to identify baseline CIND or dementia. Primary outcomes were time to hospitalization for an ACSC and presence of a hospitalization within 30 days after hospitalization for pneumonia, CHF, or MI.

KEY RESULTS: All five categories of baseline neuropsychiatric disorder status were independently associated with increased risk of hospitalization for an ACSC (depression alone: Hazard Ratio [HR]: 1.33, 95% Confidence Interval [95%CI]: 1.18, 1.52; CIND alone: HR: 1.25, 95%CI: 1.10, 1.41; dementia alone: HR: 1.32, 95%CI: 1.12, 1.55; comorbid depression and CIND: HR: 1.43, 95%CI: 1.20, 1.69; comorbid depression and dementia: HR: 1.66, 95%CI: 1.38, 2.00). Depression (Odds Ratio [OR]: 1.37, 95%CI: 1.01, 1.84), comorbid depression and CIND (OR: 1.98, 95%CI: 1.40, 2.81), or comorbid depression and dementia (OR: 1.58, 95%CI: 1.06, 2.35) were independently associated with increased odds of rehospitalization within 30 days after hospitalization for pneumonia, CHF, or MI.

CONCLUSIONS: Depression, CIND, and dementia are each independently associated with potentially preventable hospitalizations in older Americans. Older adults with comorbid depression and cognitive impairment represent a particularly at-risk group that could benefit from targeted interventions.

PB - 29 VL - 29 IS - 10 N1 - Export Date: 6 August 2014 Article in Press U1 - http://www.ncbi.nlm.nih.gov/pubmed/24939712?dopt=Abstract U2 - PMC4175651 U4 - depression/dementia/ambulatory care-sensitive/condition/hospitalization/rehospitalization/cognitive impairment ER - TY - JOUR T1 - Obesity and 1-year outcomes in older Americans with severe sepsis. JF - Crit Care Med Y1 - 2014 A1 - Hallie C Prescott A1 - Virginia W Chang A1 - James M. O'Brien Jr A1 - Kenneth M. Langa A1 - Theodore J Iwashyna KW - Aged KW - Aged, 80 and over KW - Body Mass Index KW - Cohort Studies KW - Comorbidity KW - Critical Illness KW - Delivery of Health Care KW - Female KW - Health Expenditures KW - Hospitalization KW - Humans KW - Male KW - Medicare KW - Middle Aged KW - Obesity KW - Sepsis KW - Survival Rate KW - Survivors KW - United States AB -

OBJECTIVES: Although critical care physicians view obesity as an independent poor prognostic marker, growing evidence suggests that obesity is, instead, associated with improved mortality following ICU admission. However, this prior empirical work may be biased by preferential admission of obese patients to ICUs, and little is known about other patient-centered outcomes following critical illness. We sought to determine whether 1-year mortality, healthcare utilization, and functional outcomes following a severe sepsis hospitalization differ by body mass index.

DESIGN: Observational cohort study.

SETTING: U.S. hospitals.

PATIENTS: We analyzed 1,404 severe sepsis hospitalizations (1999-2005) among Medicare beneficiaries enrolled in the nationally representative Health and Retirement Study, of which 597 (42.5%) were normal weight, 473 (33.7%) were overweight, and 334 (23.8%) were obese or severely obese, as assessed at their survey prior to acute illness. Underweight patients were excluded a priori.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN RESULTS: Using Medicare claims, we identified severe sepsis hospitalizations and measured inpatient healthcare facility use and calculated total and itemized Medicare spending in the year following hospital discharge. Using the National Death Index, we determined mortality. We ascertained pre- and postmorbid functional status from survey data. Patients with greater body mass indexes experienced lower 1-year mortality compared with nonobese patients, and there was a dose-response relationship such that obese (odds ratio = 0.59; 95% CI, 0.39-0.88) and severely obese patients (odds ratio = 0.46; 95% CI, 0.26-0.80) had the lowest mortality. Total days in a healthcare facility and Medicare expenditures were greater for obese patients (p < 0.01 for both comparisons), but average daily utilization (p = 0.44) and Medicare spending were similar (p = 0.65) among normal, overweight, and obese survivors. Total function limitations following severe sepsis did not differ by body mass index category (p = 0.64).

CONCLUSIONS: Obesity is associated with improved mortality among severe sepsis patients. Due to longer survival, obese sepsis survivors use more healthcare and result in higher Medicare spending in the year following hospitalization. Median daily healthcare utilization was similar across body mass index categories.

PB - 42 VL - 42 IS - 8 N1 - Export Date: 21 April 2014 Source: Scopus Article in Press U1 - http://www.ncbi.nlm.nih.gov/pubmed/24717466?dopt=Abstract U2 - PMC4205159 U4 - body mass index/critical care/outcomes assessment/prognosis/sepsis/utilization ER - TY - JOUR T1 - Perceived neighbourhood social cohesion and myocardial infarction. JF - J Epidemiol Community Health Y1 - 2014 A1 - Eric S Kim A1 - Armani M. Hawes A1 - Jacqui Smith KW - Aged KW - Aged, 80 and over KW - Confounding Factors, Epidemiologic KW - Female KW - Health Behavior KW - Health Status KW - Health Surveys KW - Humans KW - Incidence KW - Interviews as Topic KW - Male KW - Mental Health KW - Middle Aged KW - Multilevel Analysis KW - Myocardial Infarction KW - Perception KW - Prospective Studies KW - Protective factors KW - Residence Characteristics KW - Self Report KW - Social Environment KW - Socioeconomic factors KW - United States AB -

BACKGROUND: The main strategy for alleviating heart disease has been to target individuals and encourage them to change their health behaviours. Although important, emphasis on individuals has diverted focus and responsibility away from neighbourhood characteristics, which also strongly influence people's behaviours. Although a growing body of research has repeatedly demonstrated strong associations between neighbourhood characteristics and cardiovascular health, it has typically focused on negative neighbourhood characteristics. Only a few studies have examined the potential health enhancing effects of positive neighbourhood characteristics, such as perceived neighbourhood social cohesion.

METHODS: Using multiple logistic regression models, we tested whether higher perceived neighbourhood social cohesion was associated with lower incidence of myocardial infarction. Prospective data from the Health and Retirement Study--a nationally representative panel study of American adults over the age of 50--were used to analyse 5276 participants with no history of heart disease. Respondents were tracked for 4 years and analyses adjusted for relevant sociodemographic, behavioural, biological and psychosocial factors.

RESULTS: In a model that adjusted for age, gender, race, marital status, education and total wealth, each SD increase in perceived neighbourhood social cohesion was associated with a 22% reduced odds of myocardial infarction (OR=0.78, 95% CI 0.63 to 0.94. The association between perceived neighbourhood social cohesion and myocardial infarction remained even after adjusting for behavioural, biological and psychosocial covariates.

CONCLUSIONS: Higher perceived neighbourhood social cohesion may have a protective effect against myocardial infarction.

PB - 68 VL - 68 IS - 11 N1 - Times Cited: 0 0 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25135074?dopt=Abstract U2 - PMC4600604 U4 - coronary artery disease/heart disease/risk factors/logistic regression analysis/physical activity/stroke/mortality ER - TY - JOUR T1 - A polygenic risk score associated with measures of depressive symptoms among older adults. JF - Biodemography Soc Biol Y1 - 2014 A1 - Morgan E. Levine A1 - Eileen M. Crimmins A1 - Carol A Prescott A1 - Drystan F. Phillips A1 - Thalida E. Arpawong A1 - Jinkook Lee KW - Aged KW - Aged, 80 and over KW - Depressive Disorder, Major KW - Female KW - Genetic Predisposition to Disease KW - Genetic Variation KW - Genome-Wide Association Study KW - Humans KW - Male KW - Middle Aged KW - Multifactorial Inheritance KW - Odds Ratio KW - Risk Factors AB -

It has been suggested that depression is a polygenic trait, arising from the influences of multiple loci with small individual effects. The aim of this study is to generate a polygenic risk score (PRS) to examine the association between genetic variation and depressive symptoms. Our analytic sample included N = 10,091 participants aged 50 and older from the Health and Retirement Study (HRS). Depressive symptoms were measured by Center for Epidemiological Studies-Depression scale (CESD) scores assessed on up to nine occasions across 18 years. We conducted a genome-wide association analysis for a discovery set (n = 7,000) and used the top 11 single-nucleotide polymorphisms, all with p < 10(-5) to generate a weighted PRS for our replication sample (n = 3,091). Results showed that the PRS was significantly associated with mean CESD score in the replication sample (β = .08, p = .002). The R(2) change for the inclusion of the PRS was .003. Using a multinomial logistic regression model, we also examined the association between genetic risk and chronicity of high (4+) CESD scores. We found that a one-standard-deviation increase in PRS was associated with a 36 percent increase in the odds of having chronically high CESD scores relative to never having had high CESD scores. Our findings are consistent with depression being a polygenic trait and suggest that the cumulative influence of multiple variants increases an individual's susceptibility for chronically experiencing high levels of depressive symptoms.

PB - 60 VL - 60 IS - 2 N1 - Times Cited: 0 SI 0 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25343367?dopt=Abstract U2 - PMC4298361 U4 - GENOME-WIDE ASSOCIATION/INDIVIDUAL GENETIC RISK/MAJOR DEPRESSION/DISEASE RISK/HERITABILITY/genetics/genetics/depression/Depressive Symptoms/CES Depression Scale/CES Depression Scale/regression Analysis ER - TY - JOUR T1 - Predictors of older adults' personal and community mobility: using a comprehensive theoretical mobility framework. JF - Gerontologist Y1 - 2014 A1 - M. Renée Umstattd Meyer A1 - Megan C Janke A1 - Beaujean, A. Alexander KW - Aged KW - Female KW - Humans KW - Male KW - Mobility Limitation KW - Models, Theoretical AB -

PURPOSE OF THE STUDY: Forty-six percent of older adults report limitations in their mobility, and maintaining mobility is considered an important factor in keeping adults independent and active in later life. This study tests a comprehensive theoretical framework of mobility (Webber, S. C., Porter, M. M., & Menec, V. H. [2010]. Mobility in older adults: A comprehensive framework. The Gerontologist, 50[4], 443-450. doi:10.1093/geront/gnq013) identifying multiple determinants that additively influence mobility (financial, psychosocial, environmental, physical, and cognitive), as well as cross-cutting influences of gender, culture, and biography.

DESIGN AND METHODS: Structural equation modeling was used to examine several models of mobility using data from 6,112 respondents in the Health and Retirement Study (mean age: 74.74, 85% white, 41% male, 57% married).

RESULTS: The original measurement model fit the data well. When both personal and community mobility were simultaneously predicted, only the physical, cognitive, psychosocial, and environmental determinants were retained in the independent models. Age and marital status also predicted personal and community mobility. Although most of these relationships were in the expected direction, interestingly when both forms of mobility were included in the model, poorer cognitive ability was associated with greater personal mobility in the final model.

IMPLICATIONS: Results indicate the importance of accounting for and examining comprehensive models of mobility. The factors affecting older adults' mobility are complex, and these relationships need to be explored in more depth to ensure the maintenance of individuals' independence and quality of life.

PB - 54 VL - 54 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/23749391?dopt=Abstract U4 - Health and Retirement Study/Structural equation modeling/Theory testing ER - TY - JOUR T1 - Preparedness for natural disasters among older US adults: a nationwide survey. JF - Am J Public Health Y1 - 2014 A1 - Tala M. Al-rousan A1 - Linda M. Rubenstein A1 - Robert B Wallace KW - Aged KW - Aged, 80 and over KW - Disaster Planning KW - Female KW - Humans KW - Male KW - Middle Aged KW - Surveys and Questionnaires KW - United States AB -

OBJECTIVES: We sought to determine natural disaster preparedness levels among older US adults and assess factors that may adversely affect health and safety during such incidents.

METHODS: We sampled adults aged 50 years or older (n = 1304) from the 2010 interview survey of the Health and Retirement Study. The survey gathered data on general demographic characteristics, disability status or functional limitations, and preparedness-related factors and behaviors. We calculated a general disaster preparedness score by using individual indicators to assess overall preparedness.

RESULTS: Participant (n = 1304) mean age was 70 years (SD = 9.3). Only 34.3% reported participating in an educational program or reading materials about disaster preparation. Nearly 15% reported using electrically powered medical devices that might be at risk in a power outage. The preparedness score indicated that increasing age, physical disability, and lower educational attainment and income were independently and significantly associated with worse overall preparedness.

CONCLUSIONS: Despite both greater vulnerability to disasters and continuous growth in the number of older US adults, many of the substantial problems discovered are remediable and require attention in the clinical, public health, and emergency management sectors of society.

VL - 104 UR - http://dx.doi.org/10.2105/AJPH.2013.301559 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/24432877?dopt=Abstract U4 - disaster preparedness/public policy/emergency management ER - TY - JOUR T1 - Prospective study of the association between dispositional optimism and incident heart failure. JF - Circ Heart Fail Y1 - 2014 A1 - Eric S Kim A1 - Jacqui Smith A1 - Laura D Kubzansky KW - Affect KW - Aged KW - Aged, 80 and over KW - Emotions KW - Female KW - Heart Failure KW - Humans KW - Incidence KW - Logistic Models KW - Male KW - Middle Aged KW - Outcome Assessment, Health Care KW - Prospective Studies KW - Retrospective Studies KW - Risk Factors KW - Socioeconomic factors KW - United States AB -

BACKGROUND: Although higher optimism has been linked with an array of positive health behaviors, biological processes, and cardiovascular outcomes, the relationship between optimism and heart failure has not been examined. In the United States, 80% of heart failures occur in adults aged 65+ years. Therefore, we examined whether higher optimism was linked with a reduced incidence of heart failure among older adults.

METHODS AND RESULTS: Prospective data were from the Health and Retirement Study, a nationally representative study of older US adults. Our sample included 6808 participants who were followed for 4 years. Multiple logistic regression models were used to assess whether optimism was independently associated with incident heart failure. We adjusted for sociodemographic, behavioral, biological, and psychological covariates. Higher optimism was associated with a lower risk of incident heart failure during the follow-up period. In a model that adjusted for sociodemographic factors, each SD increase in optimism had an odds ratio of 0.74 (95% confidence interval, 0.63-0.85) for heart failure. Effects of optimism persisted even after adjusting for a wide range of covariates. There was also evidence of a dose-response relationship. As optimism increased, risk of developing heart failure decreased monotonically, with a 48% reduced odds among people with the highest versus lowest optimism.

CONCLUSIONS: This is the first study to suggest that optimism is associated with a lower risk of heart failure. If future studies confirm these findings, they may be used to inform new strategies for preventing or delaying the onset of heart failure.

PB - 7 VL - 7 IS - 3 N1 - Times Cited: 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/24647117?dopt=Abstract U4 - heart attack/cardiovascular disease/optimism/optimism/sociodemographic factors/sociodemographic factors/Logistic regression analysis ER - TY - JOUR T1 - Public beliefs and knowledge about risk and protective factors for Alzheimer's disease. JF - Alzheimers Dement Y1 - 2014 A1 - J Scott Roberts A1 - Sara J McLaughlin A1 - Cathleen M. Connell KW - Aged KW - Alzheimer disease KW - Female KW - Health Knowledge, Attitudes, Practice KW - Humans KW - Male KW - Middle Aged KW - Protective factors KW - United States AB -

BACKGROUND: The purpose of this study was to assess public beliefs and knowledge about risk and protective factors for Alzheimer's disease (AD).

METHODS: A brief survey module was added to the Health and Retirement Study, a longstanding national panel study of the U.S. population over the age of 50.

RESULTS: Respondents were 1641 adults (mean age=64.4 years, 53.6% female, 81.7% White). Most (60.1%) indicated interest in learning their AD risk, with 29.4% expressing active worry. Many failed to recognize that medications to prevent AD are not available (39.1%) or that having an affected first-degree relative is associated with increased disease risk (32%). Many respondents believed that various actions (e.g., mental activity, eating a healthy diet) would be effective in reducing AD risk.

CONCLUSION: Older and middle-aged adults are interested in their AD risk status and believe that steps can be taken to reduce disease risk. Tailored education efforts are needed to address potential misconceptions about risk and protective factors.

PB - 10 VL - 10 UR - http://www.scopus.com/inward/record.url?eid=2-s2.0-84895853906andpartnerID=40andmd5=336a2df47951d1d5c021f44b8055d10e IS - 5 Suppl N1 - Export Date: 21 April 2014 Source: Scopus Article in Press U1 - http://www.ncbi.nlm.nih.gov/pubmed/24630852?dopt=Abstract U2 - PMC4163539 U4 - Attitudes and beliefs/Health education/Illness perceptions/National survey/Public understanding ER - TY - JOUR T1 - Purpose in life and use of preventive health care services. JF - Proc Natl Acad Sci U S A Y1 - 2014 A1 - Eric S Kim A1 - Victor J Strecher A1 - Carol D Ryff KW - Aged KW - Aged, 80 and over KW - Early Detection of Cancer KW - Educational Status KW - ethnicity KW - Female KW - Habits KW - Hematologic Tests KW - Hospitalization KW - Humans KW - Influenza Vaccines KW - Insurance Coverage KW - Male KW - Marital Status KW - Middle Aged KW - Models, Psychological KW - Motivation KW - Patient Acceptance of Health Care KW - Preventive Health Services KW - Surveys and Questionnaires KW - Vaccination AB -

Purpose in life has been linked with better health (mental and physical) and health behaviors, but its link with patterns of health care use are understudied. We hypothesized that people with higher purpose would be more proactive in taking care of their health, as indicated by a higher likelihood of using preventive health care services. We also hypothesized that people with higher purpose would spend fewer nights in the hospital. Participants (n = 7,168) were drawn from the Health and Retirement Study, a nationally representative panel study of American adults over the age of 50, and tracked for 6 y. After adjusting for sociodemographic factors, each unit increase in purpose (on a six-point scale) was associated with a higher likelihood that people would obtain a cholesterol test [odds ratio (OR) = 1.18, 95% confidence interval (CI) = 1.08-1.29] or colonoscopy (OR = 1.06, 95% CI = 0.99-1.14). Furthermore, females were more likely to receive a mammogram/X-ray (OR = 1.27, 95% CI = 1.16-1.39) or pap smear (OR = 1.16, 95% CI = 1.06-1.28), and males were more likely to receive a prostate examination (OR = 1.31, 95% CI = 1.18-1.45). Each unit increase in purpose was also associated with 17% fewer nights spent in the hospital (rate ratio = 0.83, 95% CI = 0.77-0.89). An increasing number of randomized controlled trials show that purpose in life can be raised. Therefore, with additional research, findings from this study may inform the development of new strategies that increase the use of preventive health care services, offset the burden of rising health care costs, and enhance the quality of life among people moving into the ranks of our aging society.

PB - 111 VL - 111 IS - 46 N1 - Times Cited: 0 0 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25368165?dopt=Abstract U2 - PMC4246300 U4 - purpose in life/meaning in life/well-being/health screening/preventive health care/Public Policy/depressive Symptoms/proactive health behavior ER - TY - JOUR T1 - Question context and priming meaning of health: effect on differences in self-rated health between Hispanics and non-Hispanic Whites. JF - Am J Public Health Y1 - 2014 A1 - Lee, Sunghee A1 - Schwarz, Norbert KW - Aged KW - Female KW - Health Status KW - Health Surveys KW - Hispanic or Latino KW - Humans KW - Male KW - Middle Aged KW - Mortality KW - Self Report KW - United States KW - White People AB -

OBJECTIVES: We examined the implications of the current recommended data collection practice of placing self-rated health (SRH) before specific health-related questions (hence, without a health context) to remove potential context effects, between Hispanics and non-Hispanics.

METHODS: We used 2 methodologically comparable surveys conducted in English and Spanish that asked SRH in different contexts: before and after specific health questions. Focusing on the elderly, we compared the influence of question contexts on SRH between Hispanics and non-Hispanics and between Spanish and English speakers.

RESULTS: The question context influenced SRH reports of Spanish speakers (and Hispanics) significantly but not of English speakers (and non-Hispanics). Specifically, on SRH within a health context, Hispanics reported more positive health, decreasing the gap with non-Hispanic Whites by two thirds, and the measurement utility of SRH was improved through more consistent mortality prediction across ethnic and linguistic groups.

CONCLUSIONS: Contrary to the current recommendation, asking SRH within a health context enhanced measurement utility. Studies using SRH may result in erroneous conclusions when one does not consider its question context.

PB - 104 VL - 104 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/23678900?dopt=Abstract U4 - Medical Sciences/Medical research/Language/Studies/Polls/surveys/Hispanic Americans/Interviews/Whites/Personal health/United States--US ER - TY - JOUR T1 - Racial/Ethnic predictors of falls among older adults: the health and retirement study. JF - J Aging Health Y1 - 2014 A1 - Emily J Nicklett A1 - Taylor, Robert Joseph KW - Accidental Falls KW - Aged KW - Black or African American KW - Female KW - Health Surveys KW - Hispanic or Latino KW - Humans KW - Logistic Models KW - Male KW - Poisson Distribution KW - Risk Factors KW - White People AB -

OBJECTIVE: The objective of this study was to examine racial/ethnic differences in the probability and frequency of falls among adults aged 65 and older.

METHOD: Using data from the Health and Retirement Study (HRS) from 2000 to 2010, the authors conducted random-intercept logistic and Poisson regression analyses to examine whether race/ethnicity predicted the likelihood of a fall event and the frequency of falls.

RESULTS: The analytic sample included 10,484 older adults. Baseline analyses showed no significant racial/ethnic differences in the probability or number of falls. However, in the longitudinal random-intercept models, African Americans had significantly lower odds (0.65) of experiencing at least one fall compared with non-Hispanic Whites. Among fallers, African Americans had significantly fewer falls (24%) than non-Hispanic Whites, controlling for health and sociodemographic covariates (all ps < .05). Latinos did not differ from non-Hispanic Whites in the likelihood or number of falls.

DISCUSSION: African Americans are less likely to experience initial or recurrent falls than non-Hispanic Whites.

PB - 26 VL - 26 IS - 6 N1 - Times Cited: 0 0 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25005171?dopt=Abstract U2 - PMC4227632 U4 - falls/fall rates/fall risk/ethnicity/older adults/risk factors/ethnic differences/African Americans/hispanics ER - TY - JOUR T1 - Satisfaction with aging and use of preventive health services. JF - Prev Med Y1 - 2014 A1 - Eric S Kim A1 - Kyle D Moored A1 - Hannah L. Giasson A1 - Jacqui Smith KW - Aged KW - Aged, 80 and over KW - Aging KW - Chronic disease KW - Female KW - Health Behavior KW - Health Knowledge, Attitudes, Practice KW - Humans KW - Influenza Vaccines KW - Logistic Models KW - Male KW - Mammography KW - Middle Aged KW - Patient Acceptance of Health Care KW - Patient Satisfaction KW - Personal Satisfaction KW - Preventive Health Services KW - Prostatic Neoplasms KW - Surveys and Questionnaires KW - United States KW - Vaginal Smears AB -

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

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

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

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

PB - 69 VL - 69 N1 - Times Cited: 0 0 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25240763?dopt=Abstract ER - TY - JOUR T1 - Self-rated health changes and oldest-old mortality. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2014 A1 - Eric M Vogelsang KW - Aged KW - Aged, 80 and over KW - Diagnostic Self Evaluation KW - Female KW - Health Status KW - Humans KW - Longitudinal Studies KW - Male KW - Mortality KW - Proportional Hazards Models KW - Randomized Controlled Trials as Topic KW - Risk KW - United States AB -

OBJECTIVES: This study explores how 2 measures of self-rated health (SRH) change are related to mortality among oldest-old adults. In doing so, it also considers how associations between SRH and mortality may depend on prior SRH.

METHOD: Data come from the Asset and Health Dynamics survey--the oldest-old portion of the Health and Retirement Study-and follow 6,233 individuals across 13 years. I use parametric hazard models to examine relationships between death and 2 measures of short-term SRH change--a computed measure comparing SRH at time t-1 and t, and a respondent-provided retrospectively reported change.

RESULTS: Respondents who demonstrate or report any SRH change between survey waves died at a greater rate than those with consistent SRH. After controlling for morbidity, individual characteristics, and SRH, those who changed SRH categories between survey waves and those who retrospectively reported an improvement in health continue to have a greater risk of death, when compared with those with no change.

DISCUSSION: These findings suggest that the well-established associations between SRH status and mortality may understate the risk of death for oldest-old individuals with recent subjective health improvements.

PB - 69 VL - 69 UR - http://psychsocgerontology.oxfordjournals.org/content/early/2014/03/02/geronb.gbu013.abstract IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/24589929?dopt=Abstract U2 - PMC4049148 U4 - Hazard models/Mortality/Oldest-old/Self-rated health/United States ER - TY - JOUR T1 - Self-rated health in the last 12 years of life compared to matched surviving controls: the Health and Retirement Study. JF - PLoS One Y1 - 2014 A1 - Stenholm, Sari A1 - Pentti, Jaana A1 - Ichiro Kawachi A1 - Westerlund, Hugo A1 - Mika Kivimäki A1 - Vahtera, Jussi KW - Adult KW - Aged KW - Aged, 80 and over KW - Diagnostic Self Evaluation KW - Female KW - health KW - Health Status KW - Humans KW - Life Style KW - Male KW - Middle Aged KW - Mortality KW - Retirement KW - Retrospective Studies AB -

Self-rated health (SRH) is a valid measure of health status and associated with mortality. Based on individual-level biannual repeat data on SRH we sought to characterize the natural history of poor SRH during the 12 years prior to death in men and women in different age groups. We conducted a retrospective analysis of the Health and Retirement Study participants who died between 1998 and 2010 and had at least two SRH measurements in the 12 years prior to death. We used a nested case-control design to compare SRH trajectories of deceased men and women aged 30-64, 65-79 and 80 years versus surviving participants. The cases comprised 3,350 deceased participants who were matched to surviving controls (n = 8,127). SRH was dichotomized into good vs. poor health. Men and women dying at age 65-79 and ≥ 80 years had 1.5 to 3 times higher prevalence of poor SRH already 11-12 years prior to death compared to surviving controls. The risk estimates remained statistically significant even after adjusting for life-style related risk factors and diagnosed diseases. Prevalence of poor SRH before death was lowest among those aged ≥ 80 years and highest in 30-64 year-olds. In conclusion, men and women who subsequently die perceive their health worse already 11-12 years prior to death compared to their surviving controls.

PB - 9 VL - 9 IS - 9 N1 - Times Cited: 0 0 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25237814?dopt=Abstract U2 - PMC4169624 U4 - Self assessed health/Mortality/health Status/retrospective analysis/health trajectories/health trajectories ER - TY - JOUR T1 - Social relationships, leisure activity, and health in older adults. JF - Health Psychol Y1 - 2014 A1 - Chang, Po-Ju A1 - Linda A. Wray A1 - Lin, Yeqiang KW - Aged KW - Aged, 80 and over KW - Female KW - Health Status KW - Humans KW - Interpersonal Relations KW - Leisure activities KW - Longitudinal Studies KW - Male KW - Middle Aged KW - United States AB -

OBJECTIVE: Although the link between enhanced social relationships and better health has generally been well established, few studies have examined the role of leisure activity in this link. This study examined how leisure influences the link between social relationships and health in older age.

METHOD: Using data from the 2006 and 2010 waves of the nationally representative U.S. Health and Retirement Study and structural equation modeling analyses, we examined data on 2,965 older participants to determine if leisure activities mediated the link between social relationships and health in 2010, controlling for race, education level, and health in 2006.

RESULTS: The results demonstrated that leisure activities mediate the link between social relationships and health in these age groups. Perceptions of positive social relationships were associated with greater involvement in leisure activities, and greater involvement in leisure activities was associated with better health in older age.

CONCLUSION: The contribution of leisure to health in these age groups is receiving increasing attention, and the results of this study add to the literature on this topic, by identifying the mediating effect of leisure activity on the link between social relationships and health. Future studies aimed at increasing leisure activity may contribute to improved health outcomes in older adults.

PB - 33 VL - 33 IS - 6 N1 - Times Cited: 1 Si U1 - http://www.ncbi.nlm.nih.gov/pubmed/24884905?dopt=Abstract U2 - PMC4467537 U4 - Social relationships/leisure activity/health outcomes ER - TY - JOUR T1 - Validation of a polygenic risk score for dementia in black and white individuals. JF - Brain Behav Y1 - 2014 A1 - Jessica R Marden A1 - Stefan Walter A1 - Eric J. Tchetgen Tchetgen A1 - Ichiro Kawachi A1 - M. Maria Glymour KW - African Americans KW - Aged KW - Aged, 80 and over KW - Dementia KW - European Continental Ancestry Group KW - Female KW - Humans KW - Male KW - Middle Aged KW - Multifactorial Inheritance KW - Polymorphism, Genetic KW - Reproducibility of Results KW - Risk Assessment KW - Risk Factors KW - Surveys and Questionnaires KW - United States AB -

OBJECTIVE: To determine whether a polygenic risk score for Alzheimer's disease (AD) predicts dementia probability and memory functioning in non-Hispanic black (NHB) and non-Hispanic white (NHW) participants from a sample not used in previous genome-wide association studies.

METHODS: Non-Hispanic white and NHB Health and Retirement Study (HRS) participants provided genetic information and either a composite memory score (n = 10,401) or a dementia probability score (n = 7690). Dementia probability score was estimated for participants' age 65+ from 2006 to 2010, while memory score was available for participants age 50+. We calculated AD genetic risk scores (AD-GRS) based on 10 polymorphisms confirmed to predict AD, weighting alleles by beta coefficients reported in AlzGene meta-analyses. We used pooled logistic regression to estimate the association of the AD-GRS with dementia probability and generalized linear models to estimate its effect on memory score.

RESULTS: Each 0.10 unit change in the AD-GRS was associated with larger relative effects on dementia among NHW aged 65+ (OR = 2.22; 95% CI: 1.79, 2.74; P < 0.001) than NHB (OR=1.33; 95% CI: 1.00, 1.77; P = 0.047), although additive effect estimates were similar. Each 0.10 unit change in the AD-GRS was associated with a -0.07 (95% CI: -0.09, -0.05; P < 0.001) SD difference in memory score among NHW aged 50+, but no significant differences among NHB (β = -0.01; 95% CI: -0.04, 0.01; P = 0.546). [Correction added on 29 July 2014, after first online publication: confidence intervalshave been amended.] The estimated effect of the GRS was significantly smaller among NHB than NHW (P < 0.05) for both outcomes.

CONCLUSION: This analysis provides evidence for differential relative effects of the GRS on dementia probability and memory score among NHW and NHB in a new, national data set.

VL - 4 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25328845?dopt=Abstract 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 - Adults with cardiovascular disease who help others: a prospective study of health outcomes. JF - J Behav Med Y1 - 2013 A1 - Michele M Heisler A1 - Choi, Hwajung A1 - John D Piette A1 - Ann Marie Rosland A1 - Kenneth M. Langa A1 - Stephanie Brown KW - Activities of Daily Living KW - Aged KW - Cardiovascular Diseases KW - depression KW - Female KW - Health Status KW - Helping Behavior KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Prospective Studies KW - Time Factors AB -

Little is known about the health impact of helping behaviors among individuals with high-risk chronic diseases such as cardiovascular disease (CVD). Using a nationally representative, longitudinal survey, we examined the subsequent health of adults with CVD (n = 4,491) who spent time providing non-paid assistance to family and friends outside of their households compared with those who had provided no assistance. After both adjusting for baseline characteristics and using propensity score matching methods, spending up to 200 h over the prior 12 months helping others was associated with lower odds of experiencing a new CVD event or dying in the subsequent 2 years. Providing up to 100 h of assistance was associated with reporting fewer depressive symptoms. This threshold effect raises the question of whether assistance beyond a certain number of hours may impose a burden that mitigates health benefits from helping others. Health care providers could play an important role exploring ways that patients with CVD can provide beneficial levels of assistance to others in their own social networks or communities, thereby possibly also improving their own health.

PB - 36 VL - 36 UR - http://search.proquest.com.proxy.lib.umich.edu/docview/1318045378?accountid=14667 IS - 2 N1 - Copyright - Springer Science Business Media New York 2013 Last updated - 2013-04-30 DOI - 2922261571; 76454332; 69709; BVMD; 22481214; SPVLBVMD108653629414 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22481214?dopt=Abstract U4 - Psychology/Cardiovascular disease/Chronic conditions/caregivers/Depressive Symptoms/health care policy ER - TY - JOUR T1 - The apolipoprotein E genotype predicts longitudinal transitions to mild cognitive impairment but not to Alzheimer's dementia: findings from a nationally representative study. JF - Neuropsychology Y1 - 2013 A1 - Brainerd, C. J. A1 - V. F. Reyna A1 - Ronald C Petersen A1 - Glenn E Smith A1 - Kenney, A. E. A1 - C. J. Gross A1 - Taub, E. S. A1 - Brenda L Plassman A1 - Gwenith G Fisher KW - Aged KW - Aged, 80 and over KW - Alzheimer disease KW - Apolipoproteins E KW - Cognitive Dysfunction KW - disease progression KW - Female KW - Genetic Predisposition to Disease KW - Genetic Testing KW - Genotype KW - Humans KW - Logistic Models KW - Longitudinal Studies KW - Male KW - National Institutes of Health (U.S.) KW - Neuropsychological tests KW - Risk Factors KW - United States AB -

OBJECTIVE: The ε4 allele of the apolipoprotein E (APOE) genotype is the most widely accepted genetic risk factor for Alzheimer's dementia (AD), but findings on whether it is a risk factor for the AD prodrome, mild cognitive impairment (MCI), have been inconsistent. In a prospective longitudinal design, we investigated (a) whether transitions to MCI and other forms of neurocognitive impairment without dementia (CIND) are more frequent among normal ε4 carriers than among noncarriers and (b) whether subsequent transitions to AD from MCI and from other forms of CIND are more frequent among ε4 carriers than among noncarriers.

METHOD: The frequency of the ε4 allele was studied in older adults (mean age > 70), who had participated in two or more waves of neuropsychological testing and diagnosis in the Aging, Demographics, and Memory Study (ADAMS) of the United States Department of Health and Human Services, National Institutes of Health, National Institute on Aging's Health and Retirement Study, conducted by the University of Michigan. The association between ε4 and longitudinal transitions to specific types of CIND and dementia can be determined with this data set.

RESULTS: Epsilon 4 increased the rate of progression from normal functioning to MCI (58% of new diagnoses were carriers) but not to other forms of CIND. The rate of progression to AD from MCI or from other forms of CIND was not increased by ε4.

CONCLUSIONS: The results support the hypothesis that ε4 is a risk factor for transitions from normal functioning to MCI but not for subsequent transitions to AD. In the ADAMS sample, the reason ε4 is elevated in AD individuals is because it is already elevated in MCI individuals, who are the primary source of new AD diagnoses.

VL - 27 UR - http://psycnet.apa.org/journals/neu/27/1/86/ IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/23356599?dopt=Abstract 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 - Cohorts based on decade of death: no evidence for secular trends favoring later cohorts in cognitive aging and terminal decline in the AHEAD study. JF - Psychol Aging Y1 - 2013 A1 - Hülür, Gizem A1 - Frank J Infurna A1 - Ram, Nilam A1 - Denis Gerstorf KW - Aged KW - Aged, 80 and over KW - Aging KW - Death KW - Epidemiologic Research Design KW - Female KW - Health Surveys KW - Humans KW - Longitudinal Studies KW - Male KW - Memory Disorders KW - Memory, Episodic KW - Time Factors KW - United States AB -

Studies of birth-year cohorts examined over the same age range often report secular trends favoring later-born cohorts, who are cognitively fitter and show less steep cognitive declines than earlier-born cohorts. However, there is initial evidence that those advantages of later-born cohorts do not carry into the last years of life, suggesting that pervasive mortality-related processes minimize differences that were apparent earlier in life. Elaborating this work from an alternative perspective on cohort differences, we compared rates of cognitive aging and terminal decline in episodic memory between cohorts based on the year participants had died, earlier (between 1993 and 1999) or later in historical time (between 2000 and 2010). Specifically, we compared trajectories of cognitive decline in 2 death-year cohorts of participants in the Asset and Health Dynamics Among the Oldest Old study that were matched on age at death and education and controlled for a variety of additional covariates. Results revealed little evidence of secular trends favoring later cohorts. To the contrary, the cohort that died in the 2000s showed a less favorable trajectory of age-related memory decline than the cohort that died in the 1990s. In examinations of change in relation to time to death, the cohort dying in the 2000s experienced even steeper terminal declines than the cohort dying in the 1990s. We suggest that secular increases in "manufacturing" survival may exacerbate age- and mortality-related cognitive declines among the oldest old.

PB - 28 VL - 28 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/23046001?dopt=Abstract U2 - PMC3543759 U4 - cognitive decline/Cognitive Ability/Episodic Memory/Age Differences/Cohort Analysis/terminal decline ER - TY - JOUR T1 - Combining direct and proxy assessments to reduce attrition bias in a longitudinal study. JF - Alzheimer Dis Assoc Disord Y1 - 2013 A1 - Bei Wu A1 - Tchetgen Tchetgen, Eric J A1 - Theresa L Osypuk A1 - White, Kellee A1 - Mujahid, Mahasin A1 - M. Maria Glymour KW - Aged KW - Bias KW - Caregivers KW - Dementia KW - Female KW - Humans KW - Longitudinal Studies KW - Male KW - Neuropsychological tests KW - Prevalence KW - Proxy AB -

Retaining severely impaired individuals poses a major challenge in longitudinal studies of determinants of dementia or memory decline. In the Health and Retirement Study (HRS), participants complete direct memory assessments biennially until they are too impaired to complete the interview. Thereafter, proxy informants, typically spouses, assess the subject's memory and cognitive function using standardized instruments. Because there is no common scale for direct memory assessments and proxy assessments, proxy reports are often excluded from longitudinal analyses. The Aging, Demographics, and Memory Study (ADAMS) implemented full neuropsychological examinations on a subsample (n=856) of HRS participants, including respondents with direct or proxy cognitive assessments in the prior HRS core interview. Using data from the ADAMS, we developed an approach to estimating a dementia probability and a composite memory score on the basis of either proxy or direct assessments in HRS core interviews. The prediction model achieved a c-statistic of 94.3% for DSM diagnosed dementia in the ADAMS sample. We applied these scoring rules to HRS core sample respondents born 1923 or earlier (n=5483) for biennial assessments from 1995 to 2008. Compared with estimates excluding proxy respondents in the full cohort, incorporating information from proxy respondents increased estimated prevalence of dementia by 12 percentage points in 2008 (average age=89) and suggested accelerated rates of memory decline over time.

PB - 27 VL - 27 IS - 3 N1 - Times Cited: 0 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22992720?dopt=Abstract U2 - PMC3731387 U4 - Dementia/Memory decline/dementia probability/composite memory score/Cognitive assessments/Proxy informants ER - TY - JOUR T1 - Dementia and out-of-pocket spending on health care services. JF - Alzheimers Dement Y1 - 2013 A1 - Delavande, Adeline A1 - Michael D Hurd A1 - Martorell, Paco A1 - Kenneth M. Langa KW - Aged KW - Dementia KW - Female KW - Financing, Personal KW - Health Expenditures KW - Humans KW - Male AB -

BACKGROUND: High levels of out-of-pocket (OOP) spending for health care may lead patients to forego needed services and medications as well as hamper their ability to pay for other essential goods. Because it leads to disability and the loss of independence, dementia may put patients and their families at risk for high OOP spending, especially for long-term care services.

METHODS: We used data from the Aging, Demographics, and Memory Study, a nationally representative subsample (n = 743) of the Health and Retirement Study, to determine whether individuals with dementia had higher self-reported OOP spending compared with those with cognitive impairment without dementia and those with normal cognitive function. We also examined the relationship between dementia and utilization of dental care and prescription medications-two types of health care that are frequently paid for OOP. Multivariate and logistic regression models were used to adjust for the influence of potential confounders.

RESULTS: After controlling for demographics and comorbidities, those with dementia had more than three times the yearly OOP spending compared with those with normal cognition ($8216 for those with dementia vs. $2570 for those with normal cognition, P < .01). Higher OOP spending for those with dementia was mainly driven by greater expenditures on nursing home care (P < .01). Dementia was not associated with the likelihood of visiting the dentist (P = .76) or foregoing prescription medications owing to cost (P = .34).

CONCLUSIONS: Dementia is associated with high levels of OOP spending but not with the use of dental care or foregoing prescription medications, suggesting that excess OOP spending among those with dementia does not "crowd out" spending on these other health care services.

PB - 9 VL - 9 IS - 1 N1 - Times Cited: 0 U1 - http://www.ncbi.nlm.nih.gov/pubmed/23154049?dopt=Abstract U3 - 23154049 U4 - Out of pocket costs/health Care/Long Term Care/Dementia/dental Care/COMORBIDITY/health care services ER - TY - JOUR T1 - Disability during the last two years of life. JF - JAMA Intern Med Y1 - 2013 A1 - Alexander K Smith A1 - Louise C Walter A1 - Yinghui Miao A1 - W John Boscardin A1 - Kenneth E Covinsky KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Disability Evaluation KW - Disabled Persons KW - Educational Status KW - Female KW - Frail Elderly KW - Humans KW - Income KW - Longitudinal Studies KW - Male KW - Marital Status KW - Middle Aged KW - Prospective Studies KW - Sex Distribution KW - Socioeconomic factors KW - United States AB -

IMPORTANCE: Whereas many persons at advanced ages live independently and are free of disability, we know little about how likely older people are to be disabled in the basic activities of daily living that are necessary for independent living as they enter the last years of life.

OBJECTIVE: To determine national estimates of disability during the last 2 years of life.

DESIGN: Prospective cohort study.

SETTING: A nationally representative study of older adults in the United States.

PARTICIPANTS: Participants 50 years and older who died while enrolled in the Health and Retirement Study between 1995 and 2010. Each participant was interviewed once at a varying time point in the last 24 months of life. We used these interviews to calculate national estimates of the prevalence of disability across the 2 years prior to death. We modeled the prevalence of disability in the 2 years prior to death for groups defined by age at death and sex.

MAIN OUTCOMES AND MEASURES: Disability was defined as need for help with at least 1 of the following activities of daily living: dressing, bathing, eating, transferring, walking across the room, and using the toilet.

RESULTS: There were 8232 decedents (mean [SD] age at death, 79 [11] years; 52% women). The prevalence of disability increased from 28% (95% CI, 24%-31%) 2 years before death to 56% (95% CI, 52%-60%) in the last month of life. Those who died at the oldest ages were much more likely to have disability 2 years before death (ages 50-69 years, 14%; 70-79 years, 21%; 80-89 years, 32%; 90 years or more, 50%; P for trend, <.001). Disability was more common in women 2 years before death (32% [95% CI, 28%-36%]) than men (21% [95% CI, 18%-25%]; P < .001), even after adjustment for older age at death.

CONCLUSIONS AND RELEVANCE: Those who live to an older age are likely to be disabled, and thus in need of caregiving assistance, many months or years prior to death. Women have a substantially longer period of end-of-life disability than men.

PB - 173 VL - 173 IS - 16 N1 - Copyright - Copyright American Medical Association Sep 9, 2013 Last updated - 2013-09-18 SubjectsTermNotLitGenreText - United States--US U1 - http://www.ncbi.nlm.nih.gov/pubmed/23836120?dopt=Abstract U2 - PMC3773297 U4 - Medical Sciences/Older people/Disability/Disability/Palliative care/Aging/United States--US ER - TY - JOUR T1 - Does the association between depressive symptoms and cardiovascular mortality risk vary by race? Evidence from the Health and Retirement Study. JF - Ethn Dis Y1 - 2013 A1 - Benjamin D Capistrant A1 - Paola Gilsanz A1 - J Robin Moon A1 - Anna Kosheleva A1 - Kristen K Patton A1 - M. Maria Glymour KW - Aged KW - Black or African American KW - Cardiovascular Diseases KW - depression KW - Female KW - Humans KW - Male KW - Middle Aged KW - Proportional Hazards Models KW - Risk Assessment KW - Risk Factors KW - White People AB -

OBJECTIVE: To test whether the association between depressive symptoms and cardiovascular disease (CVD) mortality is stronger among Blacks than Whites.

DESIGN, SETTING AND PARTICIPANTS: 2,638 Black and 15,132 White participants from a prospective, observational study of community-dwelling Health and Retirement Study participants (a nationally representative sample of U.S. adults aged > or = 50). Average follow-up was 9.2 years.

OUTCOME MEASURE: Cause of death (per ICD codes) and month of death were identified from National Death Index linkages.

METHODS: The associations between elevated depressive symptoms and mortality from stroke, ischemic heart disease (IHD), or total CVD were assessed using Cox proportional hazards models to estimate adjusted hazard ratios (HRs). We used interaction terms for race by depressive symptoms to assess effect modification (multiplicative scale).

RESULTS: For both Whites and Blacks, depressive symptoms were associated with a significantly elevated hazard of total CVD mortality (Whites: HR=1.46; 95% CI: 1.33, 1.61; Blacks: HR=1.42, 95% CI: 1.10, 1.83). Adjusting for health and socioeconomic covariates, Whites with elevated depressive symptoms had a 13% excess hazard of CVD mortality (HR=1.13, 95% CI: 1.03, 1.25) compared to Whites without elevated depressive symptoms. The HR in Blacks was similar, although the confidence interval included the null (HR=1.12, 95% CI: .86, 1.46). The hazard associated with elevated depressive symptoms did not differ significantly by race (P>.15 for all comparisons). Patterns were similar in analyses restricted to respondents age > or =65.

CONCLUSION: Clinicians should consider the depressive state of either Black or White patients as a potential CVD mortality risk factor.

PB - 23 VL - 23 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/23530295?dopt=Abstract U2 - PMC3616329 U4 - cardiovascular disease/Racial Differences/Depressive Disorder/Depression in old age/Mortality/African Americans/Proportional Hazards Models/risk assessment/risk Factors ER - TY - JOUR T1 - Early life predictors of atrial fibrillation-related mortality: evidence from the health and retirement study. JF - Health Place Y1 - 2013 A1 - M. Maria Glymour A1 - Emelia J Benjamin A1 - Anna Kosheleva A1 - Paola Gilsanz A1 - Lesley H Curtis A1 - Kristen K Patton KW - Aged KW - Atrial Fibrillation KW - Child KW - Geography, Medical KW - Humans KW - Middle Aged KW - Risk Factors KW - Social determinants of health KW - Socioeconomic factors KW - Southeastern United States AB -

Prior research found that Americans born in 6 southeastern states (the AF-risk zone) had elevated risk of AF-related mortality, but no mechanisms were identified. We hypothesized the association between AF-related mortality and AF-risk zone birth is explained by indicators of childhood social disadvantage or adult risk factors. In 24,323 participants in the US Health and Retirement Study, we found that birth in the AF-risk zone was significantly associated with hazard of AF-related mortality. Among whites, the relationship was specific to place of birth, rather than place of adult residence. Neither paternal education nor subjectively assessed childhood SES predicted AF-related mortality. Conventional childhood and adult cardiovascular risk factors did not explain the association between place of birth and AF-related mortality.

PB - 21 VL - 21 U1 - http://www.ncbi.nlm.nih.gov/pubmed/23454734?dopt=Abstract U2 - PMC3640834 U4 - Mortality/LOW-BIRTH-WEIGHT/FIRST STROKE/HEIGHT/LIFECOURSE SOCIAL CONDITIONS/CARDIOVASCULAR-DISEASE/STROKE BELT/RISK-FACTOR/Lifecourse/Public Health/occupational health/environmental health/CHILDHOOD/Atrial fibrillation/CORONARY-HEART-DISEASE/Residence ER - TY - JOUR T1 - Fall-associated difficulty with activities of daily living in functionally independent individuals aged 65 to 69 in the United States: a cohort study. JF - J Am Geriatr Soc Y1 - 2013 A1 - Nishant K. Sekaran A1 - Choi, Hwajung A1 - Rodney A. Hayward A1 - Kenneth M. Langa KW - Accidental Falls KW - Activities of Daily Living KW - Aged KW - Aging KW - Disability Evaluation KW - Disabled Persons KW - Female KW - Follow-Up Studies KW - Geriatric Assessment KW - Health Status KW - Humans KW - Male KW - Odds Ratio KW - Retrospective Studies KW - Risk Factors KW - United States KW - Wounds and Injuries AB -

OBJECTIVES: To determine whether falling would be a marker for future difficulty with activities of daily (ADLs) that would vary according to fall frequency and associated injury.

DESIGN: Longitudinal analysis.

SETTING: Community.

PARTICIPANTS: Nationally representative cohort of 2,020 community-living, functionally independent older adults aged 65 to 69 at baseline followed from 1998 to 2008.

MEASUREMENTS: ADL difficulty.

RESULTS: Experiencing one fall with injury (odds ratio (OR) = 1.78, 95% confidence interval (CI) = 1.29-2.48), at least two falls without injury (OR = 2.36, 95% CI = 1.80-3.09), or at least two falls with at least one injury (OR = 3.75, 95% CI = 2.55-5.53) in the prior 2 years was independently associated with higher rates of ADL difficulty after adjustment for sociodemographic, behavioral, and clinical covariates.

CONCLUSION: Falling is an important marker for future ADL difficulty in younger, functionally independent older adults. Individuals who fall frequently or report injury are at highest risk.

PB - 61 VL - 61 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/23311555?dopt=Abstract U4 - falls/Fall prevention/disability/disability/older adults/ADL/IADL/activities of daily living/Mobility/functional impairment/health Status ER - TY - JOUR T1 - Former stepparents' contact with their stepchildren after midlife. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2013 A1 - Claire Noël-Miller KW - Adolescent KW - Adult KW - Aged KW - Aged, 80 and over KW - Child KW - Family Characteristics KW - Female KW - Health Surveys KW - Humans KW - Male KW - Marital Status KW - Middle Aged KW - Parent-Child Relations KW - Parents KW - Social Support KW - Young Adult AB -

OBJECTIVES: Based on the life course perspective and gender differences in stepparental roles, this study examines frequency of social contact between mid- to late-life stepparents and their stepchildren after stepparents' marriage to their stepchildren's biological parent has been dissolved through widowhood or divorce.

METHOD: Using 5 waves of panel data on stepparent-stepchild pairs from the Health and Retirement Study (N = 12,947 stepchild observations on 4,063 stepchildren belonging to 1,663 stepparents) spanning 10 years (1998-2008), I estimate ordered logit multilevel models predicting former stepparent-stepchild contact frequency.

RESULTS: Results indicate that former stepparents have notably less frequent contact with their stepchildren than current stepparents, particularly following divorce. Widowed stepparents' contact with their stepchildren diminishes gradually following union disruption, whereas divorced stepparents' contact frequency drops abruptly. Former stepfathers have less contact with their stepchildren than former stepmothers. Finally, I uncover evidence of the moderating role of (step)parents' marriage length and stepparents' number of biological children on widowed stepparent-stepchild contact frequency.

DISCUSSION: Older stepparents' social contact with their stepchildren is largely conditional on stepparents' enduring marital bond to their stepchildren's biological parent. This study contributes to a growing literature portraying relatively weak ties between older adults and their stepchildren.

PB - 68 VL - 68 UR - http://search.proquest.com.proxy.lib.umich.edu/docview/1329184768?accountid=14667 IS - 3 N1 - Copyright - Copyright Oxford University Press, UK May 2013 Last updated - 2013-04-19 DOI - 2948942401; 77441762; 9698; PGN2; INODPGN20000698908 U1 - http://www.ncbi.nlm.nih.gov/pubmed/23591569?dopt=Abstract U2 - PMC3693606 U4 - Middle age/Stepfamilies/intergenerational Transfers/Intergenerational relationships ER - TY - JOUR T1 - Functional disability, cognitive impairment, and depression after hospitalization for pneumonia. JF - Am J Med Y1 - 2013 A1 - Dimitry S Davydow A1 - Catherine L Hough A1 - Deborah A Levine A1 - Kenneth M. Langa A1 - Theodore J Iwashyna KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Cognitive Dysfunction KW - depression KW - Hospitalization KW - Humans KW - Logistic Models KW - Longitudinal Studies KW - Middle Aged KW - Myocardial Infarction KW - Pneumonia KW - Stroke AB -

OBJECTIVE: The study objective was to examine whether hospitalization for pneumonia is associated with functional decline, cognitive impairment, and depression, and to compare this impairment with that seen after known disabling conditions, such as myocardial infarction or stroke.

METHODS: We used data from a prospective cohort of 1434 adults aged more than 50 years who survived 1711 hospitalizations for pneumonia, myocardial infarction, or stroke drawn from the Health and Retirement Study (1998-2010). Main outcome measures included the number of Activities and Instrumental Activities of Daily Living requiring assistance and the presence of cognitive impairment and substantial depressive symptoms.

RESULTS: Hospitalization for pneumonia was associated with 1.01 new impairments in Activities and Instrumental Activities of Daily Living (95% confidence interval [CI], 0.71-1.32) among patients without baseline functional impairment and 0.99 new impairments in Activities and Instrumental Activities of Daily Living (95% CI, 0.57-1.41) among those with mild-to-moderate baseline limitations, as well as moderate-to-severe cognitive impairment (odds ratio, 2.46; 95% CI, 1.60-3.79) and substantial depressive symptoms (odds ratio, 1.63; 95% CI, 1.06-2.51). Patients without baseline functional impairment who survived pneumonia hospitalization had more subsequent impairments in Activities and Instrumental Activities of Daily Living than those who survived myocardial infarction hospitalization. There were no significant differences in subsequent moderate-to-severe cognitive impairment or substantial depressive symptoms between patients who survived myocardial infarction or stroke and those who survived pneumonia.

CONCLUSIONS: Hospitalization for pneumonia in older adults is associated with subsequent functional and cognitive impairment. Improved pneumonia prevention and interventions to ameliorate adverse sequelae during and after hospitalization may improve outcomes.

VL - 126 IS - 7 U1 - http://www.ncbi.nlm.nih.gov/pubmed/23499326?dopt=Abstract U2 - PMC3690157 U4 - Functional decline/Functional decline/cognitive Impairment/Depression/myocardial Infarction/Stroke/pneumonia/ADL/IADL/depressive symptoms/HOSPITALIZATION 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 - Health status and behavioral risk factors in older adult Mexicans and Mexican immigrants to the United States. JF - J Aging Health Y1 - 2013 A1 - Emma Aguila A1 - José J Escarce A1 - Leng, Mei A1 - Morales, Leo KW - Aged KW - Emigrants and Immigrants KW - Emigration and Immigration KW - Female KW - Health Status KW - Health Surveys KW - Humans KW - Male KW - Mexican Americans KW - Mexico KW - Middle Aged KW - Risk Factors KW - Risk-Taking KW - Social Class KW - United States AB -

OBJECTIVE: Investigate the "salmon-bias" hypothesis, which posits that Mexicans in the U.S. return to Mexico due to poor health, as an explanation for the Hispanic health paradox in which Hispanics in the United States are healthier than might be expected from their socioeconomic status.

METHOD: Sample includes Mexicans age 50 years or above living in the United States and Mexico from the 2003 Mexican Health and Aging Study and the 2004 Health and Retirement Study. Logistic regressions examine whether nonmigrants or return migrants have different odds than immigrants of reporting a health outcome.

RESULTS: The salmon-bias hypothesis holds for select health outcomes. However, nonmigrants and return migrants have better health outcomes than immigrants on a variety of indicators.

DISCUSSION: Overall, the results of this study do not support the salmon-bias hypothesis; other explanations for the paradox could be explored.

PB - 25 VL - 25 UR - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3663916/ IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/23264441?dopt=Abstract U2 - PMC3663916 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 - Hospital and nursing home use from 2002 to 2008 among U.S. older adults with cognitive impairment, not dementia in 2002. JF - Alzheimer Dis Assoc Disord Y1 - 2013 A1 - Daniel O. Clark A1 - Timothy E. Stump A1 - Tu, Wanzhu A1 - Douglas K Miller A1 - Kenneth M. Langa A1 - Frederick W Unverzagt A1 - Christopher M. Callahan KW - Aged KW - Aged, 80 and over KW - Aging KW - Cognition Disorders KW - Dementia KW - Female KW - Homes for the Aged KW - Hospitalization KW - Humans KW - Male KW - Nursing homes KW - United States AB -

Little is known about health care use in the cognitive impairment, not dementia (CIND) subpopulation. Using a cohort of 7130 persons aged 71 years or over from the Health and Retirement Survey, we compared mean and total health care use from 2002 to 2008 for those with no cognitive impairment, CIND, or dementia in 2002. Cognitive status was determined using a validated method based on self or proxy interview measures. Health care use was also based on self or proxy reports. On the basis of the Health and Retirement Survey, the CIND subpopulation in 2002 was 5.3 million or 23% of the total population 71 years of age or over. Mean hospital nights was similar and mean nursing home nights was less in persons with CIND compared with persons with dementia. The CIND subpopulation, however, had more total hospital and nursing home nights--71,000 total hospital nights and 223,000 total nursing home nights versus 32,000 hospital nights and 138,000 nursing home nights in the dementia subpopulation. A relatively large population and high health care use result in a large health care impact of the CIND subpopulation.

VL - 27 UR - http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00002093-201310000-00012 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/23151595?dopt=Abstract JO - Alzheimer Disease & Associated Disorders 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 - Longer lived parents: protective associations with cancer incidence and overall mortality. JF - J Gerontol A Biol Sci Med Sci Y1 - 2013 A1 - Ambarish Dutta A1 - Henley, William A1 - Robine, Jean-Marie A1 - Kenneth M. Langa A1 - Robert B Wallace A1 - David Melzer KW - Aged KW - Aged, 80 and over KW - Female KW - Humans KW - Incidence KW - Longevity KW - Male KW - Middle Aged KW - Mortality KW - Neoplasms KW - Parents AB -

BACKGROUND: Children of centenarians have lower cardiovascular disease prevalence and live longer. We aimed to estimate associations between the full range of parental attained ages and health status in a middle-aged U.S. representative sample.

METHODS: Using Health and Retirement Study data, models estimated disease incidence and mortality hazards for respondents aged 51-61 years at baseline, followed up for 18 years. Full adjustment included sex, race, smoking, wealth, education, body mass index, and childhood socioeconomic status. Mother's and father's attained age distributions were used to define short-, intermediate-, and long-lived groups, yielding a ranked parental longevity score (n = 6,055, excluding short-long discordance). Linear models (n = 8,340) tested mother's or father's attained ages, adjusted for each other.

RESULTS: With increasing mother's or father's survival (>65 years), all-cause mortality declined 19% (hazard ratio [HR] = 0.81, 95% CI: 0.76-0.86, p < .001) and 14% per decade (HR = 0.87, 95% CI: 0.81-0.92, p < .001). Estimates changed only modestly when fully adjusted. Parent-in-law survival was not associated with mortality (n = 1,809, HR = 1.00, 95% CI: 0.90-1.12, p = .98). Offspring with one or two long-lived parents had lower cancer incidence (938 cases, HR per parental longevity score = 0.76, 95% CI: 0.61-0.94, p = .01) versus two intermediate parents. Similar HRs for diabetes (HR = 0.89, 95% CI: 0.84-0.96, p = .001), heart disease (HR = 0.88, 95% CI: 0.82-0.93, p < .001), and stroke (HR = 0.86, 95% CI: 0.78-0.95, p = .002) were significant, but there was no trend for arthritis.

CONCLUSIONS: The results provide the first robust evidence that increasing parental attained age is associated with lower cancer incidence in offspring. Health advantages of having centenarian parents extend to a wider range of parental longevity and may provide a quantitative trait of slower aging.

PB - 68 VL - 68 IS - 11 N1 - Times Cited: 0 U1 - http://www.ncbi.nlm.nih.gov/pubmed/23685624?dopt=Abstract U4 - Family History/Parental Longevity/Cancer/Cardiovascular Disease/Centenarian/Lower Risk/Biomarkers ER - TY - JOUR T1 - Monetary costs of dementia in the United States. JF - N Engl J Med Y1 - 2013 A1 - Michael D Hurd A1 - Martorell, Paco A1 - Delavande, Adeline A1 - Kathleen J Mullen A1 - Kenneth M. Langa KW - Aged KW - Aged, 80 and over KW - Cost of Illness KW - Dementia KW - Female KW - Health Care Costs KW - Home Care Services KW - Home Nursing KW - Humans KW - Longitudinal Studies KW - Male KW - Medicare KW - Middle Aged KW - Nursing homes KW - United States AB -

BACKGROUND: Dementia affects a large and growing number of older adults in the United States. The monetary costs attributable to dementia are likely to be similarly large and to continue to increase.

METHODS: In a subsample (856 persons) of the population in the Health and Retirement Study (HRS), a nationally representative longitudinal study of older adults, the diagnosis of dementia was determined with the use of a detailed in-home cognitive assessment that was 3 to 4 hours in duration and a review by an expert panel. We then imputed cognitive status to the full HRS sample (10,903 persons, 31,936 person-years) on the basis of measures of cognitive and functional status available for all HRS respondents, thereby identifying persons in the larger sample with a high probability of dementia. The market costs associated with care for persons with dementia were determined on the basis of self-reported out-of-pocket spending and the utilization of nursing home care; Medicare claims data were used to identify costs paid by Medicare. Hours of informal (unpaid) care were valued either as the cost of equivalent formal (paid) care or as the estimated wages forgone by informal caregivers.

RESULTS: The estimated prevalence of dementia among persons older than 70 years of age in the United States in 2010 was 14.7%. The yearly monetary cost per person that was attributable to dementia was either $56,290 (95% confidence interval [CI], $42,746 to $69,834) or $41,689 (95% CI, $31,017 to $52,362), depending on the method used to value informal care. These individual costs suggest that the total monetary cost of dementia in 2010 was between $157 billion and $215 billion. Medicare paid approximately $11 billion of this cost.

CONCLUSIONS: Dementia represents a substantial financial burden on society, one that is similar to the financial burden of heart disease and cancer. (Funded by the National Institute on Aging.).

PB - 386 VL - 368 UR - http://www.nejm.org/doi/full/10.1056/NEJMsa1204629 IS - 14 U1 - http://www.ncbi.nlm.nih.gov/pubmed/23550670?dopt=Abstract U3 - 23550670 U4 - ADAMS/Dementia/Cognitive Impairment/cognitive assessment/PREVALENCE/Medicare/Out of pocket costs/nursing homes/Informal care/public policy ER - TY - JOUR T1 - Out-of-pocket spending in the last five years of life. JF - J Gen Intern Med Y1 - 2013 A1 - Amy Kelley A1 - Kathleen McGarry A1 - Sean Fahle A1 - Samuel M Marshall A1 - Qingling Du A1 - Jonathan S Skinner KW - Aged KW - Cause of Death KW - Female KW - Health Expenditures KW - Health Services for the Aged KW - Humans KW - Male KW - Marital Status KW - Medicare KW - Retrospective Studies KW - Socioeconomic factors KW - Terminal Care KW - United States AB -

BACKGROUND: A key objective of the Medicare program is to reduce risk of financial catastrophe due to out-of-pocket healthcare expenditures. Yet little is known about cumulative financial risks arising from out-of-pocket healthcare expenditures faced by older adults, particularly near the end of life.

DESIGN: Using the nationally representative Health and Retirement Study (HRS) cohort, we conducted retrospective analyses of Medicare beneficiaries' total out-of-pocket healthcare expenditures over the last 5 years of life.

PARTICIPANTS: We identified HRS decedents between 2002 and 2008; defined a 5 year study period using each subject's date of death; and excluded those without Medicare coverage at the beginning of this period (n = 3,209).

MAIN MEASURES: We examined total out-of-pocket healthcare expenditures in the last 5 years of life and expenditures as a percentage of baseline household assets. We then stratified results by marital status and cause of death. All measurements were adjusted for inflation to 2008 US dollars.

RESULTS: Average out-of-pocket expenditures in the 5 years prior to death were $38,688 (95 % Confidence Interval $36,868, $40,508) for individuals, and $51,030 (95 % CI $47,649, $54,412) for couples in which one spouse dies. Spending was highly skewed, with the median and 90th percentile equal to $22,885 and $89,106, respectively, for individuals, and $39,759 and $94,823, respectively, for couples. Overall, 25 % of subjects' expenditures exceeded baseline total household assets, and 43 % of subjects' spending surpassed their non-housing assets. Among those survived by a spouse, 10 % exceeded total baseline assets and 24 % exceeded non-housing assets. By cause of death, average spending ranged from $31,069 for gastrointestinal disease to $66,155 for Alzheimer's disease.

CONCLUSION: Despite Medicare coverage, elderly households face considerable financial risk from out-of-pocket healthcare expenses at the end of life. Disease-related differences in this risk complicate efforts to anticipate or plan for health-related expenditures in the last 5 years of life.

PB - 28 VL - 28 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22948931?dopt=Abstract U2 - PMC3614143 U4 - Public policy/Medicare/End of life/health expenditures/out of pocket costs ER - TY - JOUR T1 - Pain among older Hispanics in the United States: is acculturation associated with pain? JF - Pain Med Y1 - 2013 A1 - Jimenez, Nathalia A1 - Dansie, Elizabeth A1 - Buchwald, Dedra A1 - Goldberg, Jack KW - Acculturation KW - Aged KW - Confidence Intervals KW - Cross-Sectional Studies KW - Female KW - Health Status KW - Hispanic or Latino KW - Humans KW - Language KW - Logistic Models KW - Male KW - Middle Aged KW - Odds Ratio KW - pain KW - Pain Measurement KW - Prevalence KW - Socioeconomic factors KW - United States AB -

BACKGROUND: Previous studies suggest that acculturation may influence the experience of pain.

STUDY DESIGN: We conducted a cross-sectional study to estimate the association between acculturation and the prevalence, intensity, and functional limitations of pain in older Hispanic adults in the United States.

METHODS SUBJECTS: Participants were English- (HE) and Spanish-speaking (HS) Hispanic and non-Hispanic White (NHW) individuals aged 50 years and older who were interviewed for the Health and Retirement Study during 1998-2008.

MEASURES: We measured: 1) acculturation as defined by language used in interviews, and 2) the presence, intensity, and functional limitations of pain.

ANALYSIS: We applied logistic regression using generalized estimating equations, with NHW as the reference category.

RESULTS: Among 18,593 participants (16,733 NHW, 824 HE, and 1,036 HS), HS had the highest prevalence (odds ratio [OR] = 1.3; 95% confidence interval [CI  = 1.1-1.4) and intensity (OR = 1.6; 95% CI = 1.4-1.9) of pain, but these differences were not significant after adjusting for age, sex, years of education, immigration status (U.S.- vs non-U.S-born), and health status (number of health conditions). Even after adjustment, HS reported the lowest levels of functional limitation (OR = 0.7; 95% CI 0.6-0.9).

CONCLUSION: Pain prevalence and intensity were not related to acculturation after adjusting for sociodemographic factors, while functional limitation was significantly lower among HS even after adjusting for known risk factors. Future studies should explore the reasons for this difference.

PB - 14 VL - 14 UR - http://www.ncbi.nlm.nih.gov/pubmed/23718576 IS - 8 N1 - Times Cited: 0 U1 - http://www.ncbi.nlm.nih.gov/pubmed/23718576?dopt=Abstract U2 - PMC3748254 U4 - Acculturation/Language/Older Hispanics/Hispanic ER - TY - JOUR T1 - Pain as a risk factor for disability or death. JF - J Am Geriatr Soc Y1 - 2013 A1 - James S Andrews A1 - Irena Cenzer A1 - Yelin, Edward A1 - Kenneth E Covinsky KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Cohort Studies KW - Disabled Persons KW - Female KW - Geriatric Assessment KW - Health Status KW - Humans KW - Life Style KW - Male KW - Middle Aged KW - pain KW - Prevalence KW - Prognosis KW - Prospective Studies KW - Severity of Illness Index KW - Sex Distribution KW - Sex Factors KW - United States AB -

OBJECTIVES: To determine whether pain predicts future activity of daily living (ADL) disability or death in individuals aged 60 and older.

DESIGN: Prospective cohort study.

SETTING: The 1998 to 2008 Health and Retirement Study (HRS), a nationally representative study of older community-living individuals.

PARTICIPANTS: Twelve thousand six hundred thirty-one participants in the 1998 HRS aged 60 and older who did not need help in any ADL.

MEASUREMENTS: Participants reporting that they had moderate or severe pain most of the time were defined as having significant pain. The primary outcome was time to development of ADL disability or death over 10 yrs, assessed at five successive 2-year intervals. ADL disability was defined as needing help performing any ADL: bathing, dressing, transferring, toileting, eating, or walking across a room. A discrete hazards survival model was used to examine the relationship between pain and incident disability over each 2-year interval using only participants who started the interval with no ADL disability. Several potential confounders were adjusted for at the start of each interval: demographic factors, seven chronic health conditions, and functional limitations (ADL difficulty and difficulty with five measures of mobility).

RESULTS: At baseline, 2,283 (18%) participants had significant pain. Participants with pain were more likely (all P < .001) to be female (65% vs 54%), have ADL difficulty (e.g., transferring 12% vs 2%, toileting 11% vs 2%), have difficulty walking several blocks (60% vs 21%), and have difficulty climbing one flight of stairs (40% vs 12%). Over 10 years, participants with pain were more likely to develop ADL disability or death (58% vs 43%, unadjusted hazard ratio (HR) = 1.67, 95% confidence interval (CI) = 1.57-1.79), although after adjustment for confounders, participants with pain were not at greater risk for ADL disability or death (HR = 0.98, 95% CI = 0.91-1.07). Adjustment for functional status almost entirely explained the difference between the unadjusted and adjusted results.

CONCLUSION: Although there are strong cross-sectional relationships between pain and functional limitations, individuals with pain are not at higher risk of subsequent disability or death after accounting for functional limitations. Like many geriatric syndromes, pain and disability may represent interrelated phenomena that occur simultaneously and require unified treatment paradigms.

PB - 61 VL - 61 UR - http://search.proquest.com.proxy.lib.umich.edu/docview/1356928876?accountid=14667 IS - 4 N1 - Date revised - 2013-05-01 Last updated - 2013-05-31 DOI - 0b2ff290-e53b-4073-a3d7csamfg102v; 17944301; 0002-8614; 1532-5415 SubjectsTermNotLitGenreText - Demography; Mortality; Mobility; Risk factors; Disabilities; Survival; Pain U1 - http://www.ncbi.nlm.nih.gov/pubmed/23521614?dopt=Abstract U2 - PMC3628294 U4 - Demography/Risk Abstracts/Mortality/Mobility/Risk factors/Disabilities/Survival ER - TY - JOUR T1 - Patterns of older Americans' health care utilization over time. JF - Am J Public Health Y1 - 2013 A1 - Richard J. Manski A1 - John F Moeller A1 - Haiyan Chen A1 - Jody Schimmel A1 - Patricia A St Clair A1 - John V Pepper KW - Aged KW - Aged, 80 and over KW - Ambulatory Surgical Procedures KW - Delivery of Health Care KW - Female KW - Health Services KW - Health Status KW - Health Surveys KW - Home Care Services KW - Hospitalization KW - Humans KW - Income KW - Insurance Coverage KW - Logistic Models KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Office Visits KW - Patient Acceptance of Health Care KW - Time Factors KW - United States AB -

OBJECTIVES: We analyzed correlates of older Americans' continuous and transitional health care utilization over 4 years.

METHODS: We analyzed data for civilian, noninstitutionalized US individuals older than 50 years from the 2006 and 2008 waves of the Health and Retirement Study. We estimated multinomial logistic models of persistent and intermittent use of physician, inpatient hospital, home health, and outpatient surgery over the 2004-2008 survey periods.

RESULTS: Individuals with worse or worsening health were more likely to persistently use medical care and transition into care and not transition out of care over time. Financial variables were less often significant and, when significant, were often in an unexpected direction.

CONCLUSIONS: Older individuals' health and changes in health are more strongly correlated with persistence of and changes in care-seeking behavior over time than are financial status and changes in financial status. The more pronounced sensitivity to health status and changes in health are important considerations in insurance and retirement policy reforms.

PB - 103 VL - 103 IS - 7 U1 - http://www.ncbi.nlm.nih.gov/pubmed/23678922?dopt=Abstract U2 - PMC3676460 U4 - Older people/Hospitals/Health insurance/health Care Utilization/Public Policy ER - TY - JOUR T1 - Personality profile of the children of long-lived parents. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2013 A1 - Evangelia E Antoniou A1 - Ambarish Dutta A1 - Kenneth M. Langa A1 - David Melzer A1 - David J Llewellyn KW - Aged KW - Extraversion, Psychological KW - Fathers KW - Female KW - Health Status KW - Humans KW - Interviews as Topic KW - Longevity KW - Longitudinal Studies KW - Male KW - Mothers KW - Parents KW - Personality KW - Personality Inventory KW - Sex Factors AB -

OBJECTIVES: Past research has shown that parental longevity is related to offspring physical health and longevity. Preliminary studies suggest that parental longevity may be linked to the offspring's personality traits. A comprehensive 5-factor personality model has been related to physical health, but the association with parental longevity has not yet been investigated. We used a 5-factor personality model to investigate the relationship between parental longevity and offspring personality.

METHOD: Data from the longitudinal Health and Retirement Study (HRS) was used in the analyses. Using the Midlife Development Inventory and the Life Orientation test, the relationship between parental attained age and offspring personality was assessed using regression models for both men and women.

RESULTS: Male offspring of long-lived fathers and mothers were more likely to be open to new experiences (p < .01) and be more extroverted (p = .03) compared with male offspring of short-lived fathers or mothers. Maternal or paternal attained age had no effect on the female offspring personality traits.

DISCUSSION: Personality is an important phenotype to consider when investigating genetic and environmental determinants of longevity. Further research is needed to investigate the potential of gender-specific mechanisms.

VL - 68 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/23419869?dopt=Abstract U3 - 23419869 U4 - physical health/Longevity/personality/personality/Midlife Development Inventory/Life Orientatin Test ER - TY - JOUR T1 - Predicting 10-year mortality for older adults. JF - JAMA Y1 - 2013 A1 - Cruz, Marisa A1 - Kenneth E Covinsky A1 - Eric W Widera A1 - Stijacic-Cenzer, Irena A1 - Sei J. Lee KW - Aged KW - Aged, 80 and over KW - Cohort Studies KW - Female KW - Forecasting KW - Humans KW - Kaplan-Meier Estimate KW - Life Expectancy KW - Male KW - Middle Aged KW - Mortality KW - Risk Assessment KW - United States PB - 309 VL - 309 IS - 9 U1 - http://www.ncbi.nlm.nih.gov/pubmed/23462780?dopt=Abstract U2 - PMC3760279 U4 - mortality/cancer screening/Diabetes/glycemic control/glycemic control/preventive interventions ER - TY - JOUR T1 - A prospective study of volunteerism and hypertension risk in older adults. JF - Psychol Aging Y1 - 2013 A1 - Rodlescia S. Sneed A1 - Cohen, Sheldon KW - Aged KW - Aged, 80 and over KW - Female KW - Health Surveys KW - Humans KW - Hypertension KW - Male KW - Middle Aged KW - Prospective Studies KW - Risk Assessment KW - Time Factors KW - Volunteers AB -

The purpose of the current study was to determine whether volunteerism is prospectively associated with hypertension risk among older adults. Participants provided data during the 2006 and 2010 waves of the Health and Retirement Study, a longitudinal panel survey using a nationally representative sample of community-dwelling older adults (age > 50 years). Volunteerism and blood pressure were measured at baseline and again 4 years later. Analyses excluded individuals hypertensive at baseline and controlled for age, race, sex, education, baseline systolic/diastolic blood pressure, and major chronic illnesses. Those who had volunteered at least 200 hr in the 12 months prior to baseline were less likely to develop hypertension (OR = 0.60; 95% CI [0.40, 0.90]) than nonvolunteers. There was no association between volunteerism and hypertension risk at lower levels of volunteer participation. Volunteering at least 200 hr was also associated with greater increases in psychological well-being (B = 0.99, β = .05, p = .006) and physical activity (B = 0.21, β = .05, p = .04) compared with nonvolunteers; however, these factors did not explain the association of volunteerism with hypertension risk.

PB - 28 VL - 28 IS - 2 N1 - Copyright - Copyright American Psychological Association Jun 2013 Last updated - 2013-06-30 U1 - http://www.ncbi.nlm.nih.gov/pubmed/23795768?dopt=Abstract U2 - PMC3804225 U4 - Psychology/Hypertension/Older people/Volunteers/Mental health/psychological well-being ER - TY - JOUR T1 - The role of pain in understanding racial/ethnic differences in the frequency of physical activity among older adults. JF - J Aging Health Y1 - 2013 A1 - Grubert, Elizabeth A1 - Tamara A. Baker A1 - McGeever, Kelly A1 - Benjamin A Shaw KW - Aged KW - Aged, 80 and over KW - Black or African American KW - Female KW - Health Surveys KW - Hispanic or Latino KW - Humans KW - Male KW - Motor Activity KW - pain KW - Severity of Illness Index KW - United States KW - White People AB -

OBJECTIVE: To evaluate racial/ethnic differences in physical activity among white, black, and Hispanic adults aged 65 years and older, and to assess the potential role of pain as a mediator.

METHODS: Analyses were based on data from the 2008 Health and Retirement Study. Logistic regression was used to evaluate associations between race/ethnicity and pain and the odds of regular physical activity.

RESULTS: Compared to Whites, the odds of both light physical activity and moderate/vigorous physical activity were lower among Blacks, but not Hispanics. A graded inverse association between levels of pain severity and the odds of physical activity was found, but pain did not mediate racial/ethnic differences in physical activity.

DISCUSSION: When compared to Whites, older Blacks appear to have relatively low rates of physical activity even without comparatively high levels of pain, while older Hispanics experience relatively high rates of pain, but are perhaps more resilient to the effects of pain on physical activity.

PB - 25 VL - 25 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/23271728?dopt=Abstract U3 - 23271728 U4 - racial Differences/sociodemographic differences/sociodemographic differences/ethnic differences/Physical Activity/African American/Hispanic ER - TY - JOUR T1 - The socioeconomic origins of physical functioning among older U.S. adults. JF - Adv Life Course Res Y1 - 2013 A1 - Jennifer Karas Montez KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Educational Status KW - Female KW - Health Behavior KW - Health Status KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Obesity KW - Sex Factors KW - Socioeconomic factors KW - United States AB -

Mounting evidence finds that adult health reflects socioeconomic circumstances (SES) in early life and adulthood. However, it is unclear how the health consequences of SES in early life and adulthood accumulate-for example, additively, synergistically. This study tests four hypotheses about how the health effects of early-life SES (measured by parental education) and adult SES (measured by own education) accumulate to shape functional limitations, whether the accumulation differs between men and women, and the extent to which key mechanisms explain the accumulation. It uses data from the 1994-2010 Health and Retirement Study on U.S. adults 50-100 years of age (N=24,026). The physical functioning benefits of parental and own education accumulated additively among men. While the physical functioning benefits generally accumulated among women, the functioning benefits from one's own education were dampened among women with low-educated mothers. The dampening partly reflected a strong tie between mothers' education level and women's obesity risk. Taken together, the findings reveal subtle differences between men and women in the life course origins of physical functioning. They also shed light on a key mechanism-obesity-that may help explain why a growing number of studies find that early-life SES is especially important for women's health.

PB - 18 VL - 18 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/24796709?dopt=Abstract U4 - Education/Functional limitations/Gender/Health/Life course ER - TY - JOUR T1 - Spouses of stroke survivors may be at risk for poor cognitive functioning: a cross-sectional population-based study. JF - Top Stroke Rehabil Y1 - 2013 A1 - Peii Chen A1 - Amanda L. Botticello KW - Aged KW - Aged, 80 and over KW - Cognition Disorders KW - Community Health Planning KW - Cross-Sectional Studies KW - Female KW - Humans KW - Male KW - Neuropsychological tests KW - Retrospective Studies KW - Spouses KW - Stroke KW - Survivors KW - United States AB -

BACKGROUND: Stroke often results in chronic disability and the need for long-term assistance, which is provided in large part by spouses. Stroke caregivers experience poorer health and well-being compared with non-caregivers, but less is known about the specific toll that caregiving may exact on cognitive functioning.

OBJECTIVE: To investigate whether persons caring for a spouse who experienced a recent stroke may be at risk for poor cognitive functioning compared with non-caregivers.

METHODS: Existing data from the United States' Health and Retirement Study (HRS) were used to identify 146 caregivers from among couples in which 1 individual reported surviving a recent stroke and experiencing functional limitations. This cross-sectional population-based analysis compared the stroke caregivers with 3,416 non-caregivers in time orientation, working memory, semantic memory, learning, and episodic memory.

RESULTS: Overall, the caregiver group was considerably more disadvantaged than the non-caregiver group in terms of background characteristics, socioeconomic status, health, and well-being. Results of weighted Poisson regression models indicated that stroke caregivers were at risk for poorer performance than non-caregivers in working memory, semantic memory, learning, and episodic memory. The gap between stroke caregivers and non-caregivers in episodic memory remained after adjusting for systematic differences between the 2 groups across an array of risk factors.

CONCLUSIONS: Spousal caregivers of stroke survivors may be at risk for poor cognitive functioning. More work is needed to identify the processes that may contribute to the diminished cognitive capacity among these adults so that interventions may be developed to reduce caregiver burden and promote cognitive health.

PB - 20 VL - 20 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/23893836?dopt=Abstract U4 - cognitive function/family caregiving/chronic care/long Term Care/spousal care/memory/stroke ER - TY - JOUR T1 - Stroke-associated differences in rates of activity of daily living loss emerge years before stroke onset. JF - J Am Geriatr Soc Y1 - 2013 A1 - Benjamin D Capistrant A1 - Qianyi Wang A1 - Sze Y Liu A1 - M. Maria Glymour KW - Activities of Daily Living KW - Age of Onset KW - Aged KW - Aged, 80 and over KW - Bayes Theorem KW - Disability Evaluation KW - Disabled Persons KW - Female KW - Follow-Up Studies KW - Geriatric Assessment KW - Humans KW - Male KW - Middle Aged KW - Morbidity KW - Prospective Studies KW - Risk Assessment KW - Risk Factors KW - Socioeconomic factors KW - Stroke KW - Stroke Rehabilitation KW - Survival Rate KW - Survivors KW - Time Factors KW - United States AB -

OBJECTIVES: To compare typical age-related changes in activities of daily living (ADLs) independence in stroke-free adults with long-term ADL trajectories before and after stroke.

DESIGN: Prospective, observational study.

SETTING: Community-dwelling Health and Retirement Study (HRS) cohort.

PARTICIPANTS: HRS participants who were stroke free in 1998 and were followed through 2008 (average follow-up 7.9 years) (N = 18,441).

MEASUREMENTS: Strokes were assessed using self- or proxy-report of a doctor's diagnosis and month and year of event. Logistic regression was used to compare within-person changes in odds of self-reported independence in five ADLs in those who remained stroke free throughout follow-up (n = 16,816), those who survived a stroke (n = 1,208), and those who had a stroke and did not survive to participate in another interview (n = 417). Models were adjusted for demographic and socioeconomic covariates.

RESULTS: Even before stroke, those who later developed stroke had significantly lower ADL independence and were experiencing faster independence losses than similar-aged individuals who remained stroke free. Of those who developed a stroke, survivors experienced slower pre-stroke loss of ADL independence than those who died. ADL independence declined at the time of stroke and decline continued afterwards.

CONCLUSION: In adults at risk of stroke, disproportionate ADL limitations emerge well before stroke onset. Excess disability in stroke survivors should not be entirely attributed to effects of acute stroke or quality of acute stroke care. Although there are many possible causal pathways between ADL and stroke, the association may be noncausal. For example, ADL limitations may be a consequence of stroke risk factors (e.g., diabetes mellitus) or early cerebrovascular ischemia.

PB - 61 VL - 61 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/23668393?dopt=Abstract U4 - Gerontology And Geriatrics/ADL and IADL Impairments/Stroke/Self assessed health/risk Factors ER - TY - JOUR T1 - Symptoms of depression in survivors of severe sepsis: a prospective cohort study of older Americans. JF - Am J Geriatr Psychiatry Y1 - 2013 A1 - Dimitry S Davydow A1 - Catherine L Hough A1 - Kenneth M. Langa A1 - Theodore J Iwashyna KW - Aged KW - Aged, 80 and over KW - Cohort Studies KW - depression KW - Female KW - Hospitalization KW - Humans KW - Longitudinal Studies KW - Male KW - Poisson Distribution KW - Prospective Studies KW - Regression Analysis KW - Risk Factors KW - Sepsis KW - Severity of Illness Index KW - Survivors KW - United States AB -

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

DESIGN: Prospective longitudinal cohort study.

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

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

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

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

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

PB - 21 VL - 21 IS - 9 U1 - http://www.ncbi.nlm.nih.gov/pubmed/23567391?dopt=Abstract U2 - PMC3462893 U4 - Critical care/Depression/Outcome assessment (healthcare)/Sepsis/health Care Utilization/HOSPITALIZATION ER - TY - JOUR T1 - 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 - Trends in late-life activity limitations in the United States: an update from five national surveys. JF - Demography Y1 - 2013 A1 - Vicki A Freedman A1 - Brenda C Spillman A1 - Patricia Andreski A1 - Jennifer C. Cornman A1 - Eileen M. Crimmins A1 - Kramarow, Ellen A1 - Lubitz, James A1 - Linda G Martin A1 - Sharon S. Merkin A1 - Robert F. Schoeni A1 - Teresa Seeman A1 - Timothy A Waidmann KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Disabled Persons KW - Female KW - Health Surveys KW - Humans KW - Male KW - Mobility Limitation KW - Models, Statistical KW - United States AB -

This article updates trends from five national U.S. surveys to determine whether the prevalence of activity limitations among the older population continued to decline in the first decade of the twenty-first century. Findings across studies suggest that personal care and domestic activity limitations may have continued to decline for those ages 85 and older from 2000 to 2008, but generally were flat since 2000 for those ages 65-84. Modest increases were observed for the 55- to 64-year-old group approaching late life, although prevalence remained low for this age group. Inclusion of the institutional population is important for assessing trends among those ages 85 and older in particular.

PB - 50 VL - 50 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/23104207?dopt=Abstract U2 - PMC3586750 U4 - methodology/Meta-analysis/ADL and IADL Impairments/Public Policy/health Care Costs/PREVALENCE ER - TY - JOUR T1 - Type of high-school credentials and older age ADL and IADL limitations: is the GED credential equivalent to a diploma? JF - Gerontologist Y1 - 2013 A1 - Sze Y Liu A1 - Chavan, Niraj R. A1 - M. Maria Glymour KW - Activities of Daily Living KW - Adult KW - Aged KW - Aged, 80 and over KW - Aging KW - Disabled Persons KW - Educational Status KW - Female KW - Follow-Up Studies KW - Humans KW - Kaplan-Meier Estimate KW - Logistic Models KW - Male KW - Socioeconomic factors KW - United States AB -

PURPOSE: Educational attainment is a robust predictor of disability in elderly Americans: older adults with high-school (HS) diplomas have substantially lower disability than individuals who did not complete HS. General Educational Development (GED) diplomas now comprise almost 20% of new HS credentials issued annually in the United States but it is unknown whether the apparent health advantages of HS diplomas extend to GED credentials. This study examines whether adults older than 50 years with GEDs have higher odds of incident instrumental or basic activities of daily living (IADLs) limitations compared with HS degree holders.

METHODS: We compared odds of incident IADL limitations by HS credential type using discrete-time survival models among 9,426 Health and Retirement Study participants followed from 1998 through 2008.

RESULTS: HS degree holders had lower odds of incident IADLs than GED holders (OR = 0.72, 95% CI = 0.58, 0.90 and OR = 0.69, 95% CI = 0.56, 0.86 for ADLs and IADLs, respectively). There was no significant difference in odds of incident IADL limitations between GED holders and respondents without HS credentials (OR = 0.89, 95% CI = 0.71, 1.11 for ADLs; OR = 0.88, 95% CI = 0.70, 1.12 for IADLs).

IMPLICATIONS: Although GEDs are widely accepted as equivalent to high school diplomas, they are not associated with comparable health advantages for physical limitations in older age.

PB - 53 VL - 53 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22859434?dopt=Abstract U4 - EDUCATION/disabilities/ADL/IADL/Activities Of Daily Living/Public Policy ER - TY - JOUR T1 - Understanding heterogeneity in price elasticities in the demand for alcohol for older individuals. JF - Health Econ Y1 - 2013 A1 - Padmaja Ayyagari A1 - Deb, Partha A1 - Jason M. Fletcher A1 - William T Gallo A1 - Jody L Sindelar KW - Adult KW - Aged KW - Aged, 80 and over KW - Alcohol Drinking KW - Alcoholic Beverages KW - Behavior KW - Body Height KW - Costs and Cost Analysis KW - Female KW - Health Status KW - Humans KW - Male KW - Middle Aged KW - Models, Econometric KW - Socioeconomic factors KW - Taxes KW - United States AB -

This paper estimates the price elasticity of demand for alcohol using Health and Retirement Study data. To account for unobserved heterogeneity in price responsiveness, we use finite mixture models. We recover two latent groups, one is significantly responsive to price, but the other is unresponsive. The group with greater responsiveness is disadvantaged in multiple domains, including health, financial resources, education and perhaps even planning abilities. These results have policy implications. The unresponsive group drinks more heavily, suggesting that a higher tax would fail to curb the negative alcohol-related externalities. In contrast, the more disadvantaged group is more responsive to price, thus suffering greater deadweight loss, yet this group consumes fewer drinks per day and might be less likely to impose negative externalities.

PB - 22 VL - 22 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22162113?dopt=Abstract U2 - PMC3641566 U4 - Alcohol/Price elasticity/alcohol taxation/Public Policy/Elasticity of demand/heterogeneous policy responses/Fiscal policy/Fiscal policy/latent groups ER - TY - JOUR T1 - Vascular depression: an early warning sign of frailty. JF - Aging Ment Health Y1 - 2013 A1 - Daniel Paulson A1 - Peter A Lichtenberg KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Aging KW - Cerebrovascular Disorders KW - depression KW - Disabled Persons KW - Female KW - Follow-Up Studies KW - Frail Elderly KW - Geriatric Assessment KW - Health Status KW - Humans KW - Incidence KW - Logistic Models KW - Male KW - Prevalence KW - Psychiatric Status Rating Scales KW - Risk Factors KW - Socioeconomic factors KW - United States AB -

OBJECTIVES: Frailty is a common geriatric disorder associated with activities of daily living (ADL) impairment, hospitalization, and death. Phenomenological evidence suggests that late-life depression (Katz, 2004 ), particularly vascular depression, may be a risk factor for frailty. This study tests that hypothesis.

METHODS: We identified a sample of stroke-free women over the age of 80 from the Health and Retirement Survey. The sample included 984 respondents in 2000 (incidence sample). Of these, 459 were non-frail at baseline and still alive in 2004 (prevalence sample). Frail respondents experienced at least three of the following: wasting, exhaustion, weakness, slowness, and falls. Vascular depression was represented using two dummy variables. The first represented respondents with either high cerebrovascular burden (CVB; at least two cerebrovascular risk factors) or probable depression (score ≥3 on the 8-item Center for Epidemiological Studies Depression Scale (CES-D)), and the second represented respondents with both high CVB and probable depression.

RESULTS: At baseline, the prevalence of frailty was 31.5%. Over four years the incidence of frailty was 31.8%. After controlling for age, education, ADL and IADL disability, arthritis, pulmonary disorders, cancer, and self-rated health, respondents with either high CVB or probable depression were more likely to be frail at baseline, and those with both were at even higher risk. Of those who were not frail at the 2000 wave, respondents who reported both high CVB and probable depression were more likely to become frail by 2004.

DISCUSSION: These findings suggest that vascular depression is a prodrome for frailty.

VL - 17 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22724516?dopt=Abstract U2 - PMC3492543 U4 - activities of daily living/depression/cerebrovascular burden/frailty ER - TY - JOUR T1 - What do parents have to do with my cognitive reserve? Life course perspectives on twelve-year cognitive decline. JF - Neuroepidemiology Y1 - 2013 A1 - Hector M González A1 - Wassim Tarraf A1 - Mary E Bowen A1 - Michelle D Johnson-Jennings A1 - Gwenith G Fisher KW - Aged KW - Aged, 80 and over KW - Cognition Disorders KW - Cognitive Reserve KW - Cohort Studies KW - Female KW - Humans KW - Longevity KW - Longitudinal Studies KW - Male KW - Parents KW - Prospective Studies KW - Socioeconomic factors KW - United States AB -

BACKGROUND/AIMS: To examine the cognitive reserve hypothesis by comparing the contribution of early childhood and life course factors related to cognitive functioning in a nationally representative sample of older Americans.

METHODS: We examined a prospective, national probability cohort study (Health and Retirement Study; 1998-2010) of older adults (n=8,833) in the contiguous 48 United States. The main cognitive functioning outcome was a 35-point composite of memory (recall), mental status, and working memory tests. The main predictors were childhood socioeconomic position (SEP) and health, and individual-level adult achievement and health.

RESULTS: Individual-level achievement indicators (i.e., education, income, and wealth) were positively and significantly associated with baseline cognitive function, while adult health was negatively associated with cognitive function. Controlling for individual-level adult achievement and other model covariates, childhood health presented a relatively small negative, but statistically significant association with initial cognitive function. Neither individual achievement nor childhood SEP was statistically linked to decline over time.

CONCLUSIONS: Cognitive reserve purportedly acquired through learning and mental stimulation across the life course was associated with higher initial global cognitive functioning over the 12-year period in this nationally representative study of older Americans. We found little supporting evidence that childhood economic conditions were negatively associated with cognitive function and change, particularly when individual-level achievement is considered.

PB - 41 VL - 41 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/23860477?dopt=Abstract U2 - PMC3811933 U4 - Cognitive reserve/Older adults/Life course/Development/CHILDHOOD/Socioeconomic Status 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 - Antigenic challenge in the etiology of autoimmune disease in women. JF - J Autoimmun Y1 - 2012 A1 - Mary A M Rogers A1 - Deborah A Levine A1 - Neil Blumberg A1 - Gwenith G Fisher A1 - Mohammed U Kabeto A1 - Kenneth M. Langa KW - Aged KW - Aged, 80 and over KW - Antigens KW - Autoimmune Diseases KW - Female KW - Humans KW - Incidence KW - Middle Aged KW - Prevalence KW - Risk Factors KW - United States AB -

Infection has long been implicated as a trigger for autoimmune disease. Other antigenic challenges include receipt of allogeneic tissue or blood resulting in immunomodulation. We investigated antigenic challenges as possible risk factors for autoimmune disease in women using the Health and Retirement Study, a nationally representative longitudinal study, linked to Medicare files, years 1991-2007. The prevalence of autoimmune disease (rheumatoid arthritis, Hashimoto's disease, Graves' disease, systemic lupus erythematosus, celiac disease, systemic sclerosis, Sjögren syndrome and multiple sclerosis) was 1.4% in older women (95% CI: 1.3%, 1.5%) with significant variation across regions of the United States. The risk of autoimmune disease increased by 41% (95% CI of incidence rate ratio (IRR): 1.10, 1.81) with a prior infection-related medical visit. The risk of autoimmune disease increased by 90% (95% CI of IRR: 1.36, 2.66) with a prior transfusion without infection. Parity was not associated with autoimmune disease. Women less than 65 years of age and Jewish women had significantly elevated risk of developing autoimmune disease, as did individuals with a history of heart disease or end-stage renal disease. Antigenic challenges, such as infection and allogeneic blood transfusion, are significant risk factors for the development of autoimmune disease in older women.

PB - 38 VL - 38 IS - 2-3 N1 - Rogers, Mary A M Levine, Deborah A Blumberg, Neil Fisher, Gwenith G Kabeto, Mohammed Langa, Kenneth M 5R21HL093129-02/HL/NHLBI NIH HHS/ HL078603/HL/NHLBI NIH HHS/ HL095467/HL/NHLBI NIH HHS/ HL100051/HL/NHLBI NIH HHS/ R21 HL093129-01A1/HL/NHLBI NIH HHS/ R21 HL093129-02/HL/NHLBI NIH HHS/ U01AG009740/AG/NIA NIH HHS/ England J Autoimmun. 2012 May;38(2-3):J97-J102. Epub 2011 Aug 30. U1 - http://www.ncbi.nlm.nih.gov/pubmed/21880464?dopt=Abstract U2 - PMC3242155 U4 - infection/autoimmune disease/allogeneic blood transfusion/risk Factors/WOMEN ER - TY - JOUR T1 - Association of chronic diseases and impairments with disability in older adults: a decade of change? JF - Med Care Y1 - 2012 A1 - William W. Hung A1 - Joseph S. Ross A1 - Boockvar, Kenneth S A1 - Albert L Siu KW - Activities of Daily Living KW - Aged KW - Aging KW - Cardiovascular Diseases KW - Chronic disease KW - Cognition Disorders KW - Cross-Sectional Studies KW - Diabetes Mellitus KW - Disabled Persons KW - Female KW - Health Surveys KW - Hearing loss KW - Humans KW - Hypertension KW - Male KW - Mobility Limitation KW - Residence Characteristics KW - Respiratory Tract Diseases KW - Self Care KW - Socioeconomic factors KW - United States KW - Vision Disorders AB -

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

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

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

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

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

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

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

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

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

VL - 21 IS - 9 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22764038?dopt=Abstract U3 - 22764038 U4 - African-americans/biomarker data/trivariate probit model/Hispanics/self assessed health/diabetes/Hypertension ER - TY - JOUR T1 - Burden of cirrhosis on older Americans and their families: analysis of the health and retirement study. JF - Hepatology Y1 - 2012 A1 - M. O. Rakoski A1 - Ryan J McCammon A1 - John D Piette A1 - Theodore J Iwashyna A1 - J. A. Marrero A1 - Lok, Anna S A1 - Kenneth M. Langa A1 - Volk, Michael L KW - Aged KW - Black People KW - Caregivers KW - Comorbidity KW - Cost of Illness KW - Databases, Factual KW - Disability Evaluation KW - Female KW - Health Care Costs KW - Health Status KW - Hispanic or Latino KW - Humans KW - Incidence KW - Liver Cirrhosis KW - Male KW - Medicaid KW - Medicare KW - Prevalence KW - Prospective Studies KW - Retirement KW - United States KW - White People AB -

UNLABELLED: Prevalence of cirrhosis among older adults is expected to increase; therefore, we studied the health status, functional disability, and need for supportive care in a large national sample of individuals with cirrhosis. A prospective cohort of individuals with cirrhosis was identified within the longitudinal, nationally representative Health and Retirement Study. Cirrhosis cases were identified in linked Medicare data via ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification) codes and compared to an age-matched cohort without cirrhosis. Two primary outcome domains were assessed: (1) patients' health status (perceived health status, comorbidities, health care utilization, and functional disability as determined by activities of daily living and instrumental activities of daily living), and (2) informal caregiving (hours of caregiving provided by a primary informal caregiver and associated cost). Adjusted negative binomial regression was used to assess the association between cirrhosis and functional disability. A total of 317 individuals with cirrhosis and 951 age-matched comparators were identified. Relative to the comparison group, individuals with cirrhosis had worse self-reported health status, more comorbidities, and used significantly more health care services (hospitalizations, nursing home stays, physician visits; P < 0.001 for all bivariable comparisons). They also had greater functional disability (P < 0.001 for activities of daily living and instrumental activities of daily living), despite adjustment for covariates such as comorbidities and health care utilization. Individuals with cirrhosis received more than twice the number of informal caregiving hours per week (P < 0.001), at an annual cost of US $4700 per person.

CONCLUSION: Older Americans with cirrhosis have high rates of disability, health care utilization, and need for informal caregiving. Improved care coordination and caregiver support is necessary to optimize management of this frail population.

PB - 55 VL - 55 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21858847?dopt=Abstract U2 - PMC3462487 U4 - alcohol Abuse/cirrhosis/cirrhosis/Self assessed health/COMORBIDITY/health care/HOSPITALIZATION/physician visits/physician visits 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 - Clinical complexity and mortality in middle-aged and older adults with diabetes. JF - J Gerontol A Biol Sci Med Sci Y1 - 2012 A1 - Christine T Cigolle A1 - Mohammed U Kabeto A1 - Pearl G. Lee A1 - Caroline S Blaum KW - Activities of Daily Living KW - Aged KW - Comorbidity KW - Diabetes Complications KW - Diabetes Mellitus KW - Female KW - Health Status KW - Humans KW - Male KW - Middle Aged KW - Proportional Hazards Models KW - Self Care AB -

BACKGROUND: Middle-aged and older adults with diabetes are heterogeneous and may be characterized as belonging to one of three clinical groups: a relatively healthy group, a group having characteristics likely to make diabetes self-management difficult, and a group with poor health status for whom current management targets have uncertain benefit.

METHODS: We analyzed waves 2004-2008 of the Health and Retirement Study and the supplemental Health and Retirement Study 2003 Diabetes Study. The sample included adults with diabetes 51 years and older (n = 3,507, representing 13.6 million in 2004). We investigated the mortality outcomes for the three clinical groups, using survival analysis and Cox proportional hazard models.

RESULTS: The 5-year survival probabilities were Relatively Healthy Group, 90.8%; Self-Management Difficulty Group, 79.4%; and Uncertain Benefit Group, 52.5%. For all age groups and clinical groups, except those 76 years and older in the Uncertain Benefit Group, survival exceeded 50%.

CONCLUSIONS: This study reveals the substantial survival of middle-aged and older adults with diabetes, regardless of health status. These findings have implications for the clinical management of and future research about diabetes patients with multiple comorbidities.

PB - 67 VL - 67 IS - 12 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22492022?dopt=Abstract U4 - Mortality/Diabetes Mellitus/Disease management/Physiological aspects/Prevalence/Demographic aspects/Diabetics/Health aspects/Older people ER - TY - JOUR T1 - Cohort differences in the availability of informal caregivers: are the Boomers at risk? JF - Gerontologist Y1 - 2012 A1 - Lindsay H Ryan A1 - Jacqui Smith A1 - Toni C Antonucci A1 - James S Jackson KW - Aged KW - Aged, 80 and over KW - Aging KW - Caregivers KW - Censuses KW - Family Characteristics KW - Female KW - Health Status KW - Humans KW - Likelihood Functions KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Nuclear Family KW - Population Growth KW - Residence Characteristics KW - Retirement KW - Risk KW - Socioeconomic factors AB -

PURPOSE OF THE STUDY: We compare the close family resources of Baby Boomers (BBs) to previous cohorts of older adults at population level and then examine individual-level cohort comparisons of age-related trajectories of informal care availability from midlife into old age.

DESIGN AND METHODS: Population data from the U.S. Census and from the Health and Retirement Study (HRS) are used to identify a cohort similar to the BBs on marital status and fertility rates. Using generalized linear mixed models and 10-year longitudinal data from Depression and WWII parents (DWP; n = 1,052) and the parents of BBs (PBB; n = 3,573) in the HRS, we examine cohort differences in the time-varying likelihoods of being married and of having an adult child living within 10 miles.

RESULTS: The DWP had similar informal care resources at entry to old age as is expected in the BB. Longitudinal analyses of the DWP and PBB cohorts in HRS reveal that the availability of family changes over time and that the DWP cohort was significantly less likely to have a spouse or a grown child living nearby.

IMPLICATIONS: These findings, and future projections based on them, have significant implications for institutions and public policy concerned with the informal caregiving needs of the Boomer cohort as they age.

PB - 52 VL - 52 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22298747?dopt=Abstract U2 - PMC3304892 U4 - Baby boomers/Caregivers/Older people/Public policy/Generalized linear models/Generalized linear models 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 - Current and long-term spousal caregiving and onset of cardiovascular disease. JF - J Epidemiol Community Health Y1 - 2012 A1 - Benjamin D Capistrant A1 - J Robin Moon A1 - Lisa F Berkman A1 - M. Maria Glymour KW - Activities of Daily Living KW - Adult KW - Aged KW - Aged, 80 and over KW - Cardiovascular Diseases KW - Caregivers KW - Female KW - Follow-Up Studies KW - Humans KW - Incidence KW - Interviews as Topic KW - Long-term Care KW - Male KW - Middle Aged KW - Proportional Hazards Models KW - Risk Factors KW - Self Report KW - Socioeconomic factors KW - Spouses KW - Stress, Psychological KW - United States AB -

BACKGROUND: Prior evidence suggests that caregiving may increase risk of cardiovascular disease (CVD) onset. This association has never been examined in a nationally (USA) representative sample, and prior studies could not fully control for socioeconomic confounders. This paper seeks to estimate the association between spousal caregiving and incident CVD in older Americans.

METHODS: Married, CVD-free Health and Retirement Study respondents aged 50+ years (n=8472) were followed up to 8 years (1669 new stroke or heart disease diagnoses). Current caregiving exposure was defined as assisting a spouse with basic or instrumental activities of daily living ≥14 h/week according to the care recipients' report in the most recent prior biennial survey; we define providing ≥14 h/week of care at two consecutive biennial surveys as 'long-term caregiving'. Inverse probability weighted discrete-time hazard models with time-updated exposure and covariate information (including socioeconomic and cardiovascular risk factors) were used to estimate the effect of caregiving on incident CVD.

RESULTS: Caregiving significantly predicted CVD incidence (HR=1.35, 95% CI 1.06 to 1.68) in the population overall. Long-term caregiving was associated with double the risk of CVD onset (HR=1.95, 95% CI 1.19 to 3.18). This association for long-term care givers varied significantly by race (p<0.01): caregiving predicted CVD onset for white (HR=2.37, 95% CI 1.43 to 3.92) but not for non-white (HR=0.28, 95% CI 0.06 to 1.28).

CONCLUSIONS: Spousal caregiving independently predicted risk of CVD in a large sample of US adults. There was significant evidence that the effect for long-term care givers differs for non-whites and white.

VL - 66 IS - 10 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22080816?dopt=Abstract U3 - 22080816 U4 - Spousal care/cardiovascular disease/Socioeconomic Differences/risk Factors/Activities Of Daily Living/IADLs 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 - Despite 'welcome to Medicare' benefit, one in eight enrollees delay first use of part B services for at least two years. JF - Health Aff (Millwood) Y1 - 2012 A1 - Frank A Sloan A1 - Kofi F Acquah A1 - Paul P Lee A1 - Devdutta G. Sangvai KW - Aged KW - Female KW - Humans KW - Insurance Claim Review KW - Male KW - Medicare Part B KW - Time Factors KW - United States AB -

Much research has focused on the possible overuse of health care services within Medicare, but there is also substantial evidence of underuse. In recent years, Congress has added a "welcome to Medicare" physician visit and a number of preventive services with no cost sharing to the Medicare benefit package to encourage early and appropriate use of services. We examined national longitudinal data on first claims for Part B services-the portion of Medicare that covers physician visits-to learn how people used these benefits. We found that 12 percent of people, or about one in eight, who enrolled in Medicare at age sixty-five waited more than two years before making their first use of care covered by Part B. In part, this delay reflected patterns of use before enrollment, in that people who sought preventive care before turning sixty-five continued to do so after enrolling in Medicare. Enrollees with Medigap coverage, higher household wealth, and a higher level of education typically received care under Part B sooner than others, whereas having greater tolerance for risk was more likely to lead enrollees to delay use of Part B services. Men had a lower probability of using Part B services early than women; blacks and members of other minority groups were less likely to use services early than whites. Although the "welcome to Medicare" checkup does not appear to have had a positive effect on use of services soon after enrollment, the percentage of beneficiaries receiving Part B services in the first two years after enrollment has steadily increased over time. Whether or not delays in receipt of care should be a considerable public policy concern may depend on what factors are leading specific categories of enrollees to delay care and how such delays affect health.

PB - 31 VL - 31 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22665838?dopt=Abstract U2 - PMC3508513 U4 - Health care utilization/Public Health And Safety/Medicare/public policy ER - TY - JOUR T1 - Disability and decline in physical function associated with hospital use at end of life. JF - J Gen Intern Med Y1 - 2012 A1 - Amy Kelley A1 - Susan L Ettner A1 - R Sean Morrison A1 - Qingling Du A1 - Catherine A Sarkisian KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Chronic disease KW - Dementia KW - Disability Evaluation KW - Disabled Persons KW - Female KW - Frail Elderly KW - Geriatric Assessment KW - Hospitalization KW - Humans KW - Length of Stay KW - Longitudinal Studies KW - Male KW - Medicare KW - Socioeconomic factors KW - Terminal Care KW - United States AB -

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

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

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

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

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

PB - 27 VL - 27 IS - 7 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22382455?dopt=Abstract U2 - PMC3378753 U4 - Public Policy/Medicare/end of life/Functional decline/Functional decline/Hospital Care Intensity Index/Hospital Care Intensity Index/end-of-life ER - TY - JOUR T1 - The Disability burden of COPD. JF - COPD Y1 - 2012 A1 - Thornton Snider, Julia A1 - J. A. Romley A1 - Ken S Wong A1 - Zhang, Jie A1 - Eber, Michael A1 - Dana P Goldman KW - Aged KW - Cost of Illness KW - Disabled Persons KW - Employment KW - Female KW - Humans KW - Income KW - Insurance, Disability KW - Likelihood Functions KW - Logistic Models KW - Male KW - Middle Aged KW - Pulmonary Disease, Chronic Obstructive KW - Social Security KW - United States AB -

Affecting an estimated 12.6 million people and causing over 100,000 deaths per year, chronic obstructive pulmonary disease (COPD) exacts a heavy burden on American society. Despite knowledge of the impact of COPD on morbidity, mortality, and health care costs, little is known about the association of the disease with economic outcomes such as employment and the collection of disability. We quantify the impact of COPD on Americans aged 51 and older-in particular, their employment prospects and their likelihood of collecting federal disability benefits-by conducting longitudinal regression analysis using the Health and Retirement Study. Controlling for initial health status and a variety of sociodemographic factors, we find that COPD is associated with a decrease in the likelihood of employment of 8.6 percentage points (OR = 0.58, 95% CI 0.50-0.67), from 44% to 35%. This association rivals that of stroke and is larger than those of heart disease, cancer, hypertension, and diabetes. Furthermore, COPD is associated with a 3.9 percentage point (OR 2.52, 95% CI 2.00-3.17) increase in the likelihood of collecting Social Security Disability Insurance (SSDI), from 3.2% to 7.1%, as well as a 1.7 percentage point (OR 2.87, 95% CI 2.02-4.08) increase in the likelihood of collecting Supplemental Security Income (SSI), from 1.0% to 2.7%. The associations of COPD with SSDI and SSI are the largest of any of the conditions studied. Our results are consistent with the hypothesis that COPD imposes a substantial burden on American society by inhibiting employment and creating disability.

VL - 9 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22721264?dopt=Abstract U2 - PMID: 22721264 (PMC in pr U4 - chronic obstructive pulmonary disease/employment/disability/disability/Morbidity/Mortality/health care costs/social security/Social Security Disability Insurance/Supplemental Security Income ER - TY - JOUR T1 - Effect of obesity on falls, injury, and disability. JF - J Am Geriatr Soc Y1 - 2012 A1 - Christine L Himes A1 - Sandra L Reynolds KW - Accidental Falls KW - Activities of Daily Living KW - Aged KW - Body Mass Index KW - Disability Evaluation KW - Disabled Persons KW - Female KW - Follow-Up Studies KW - Humans KW - Incidence KW - Male KW - Obesity KW - Odds Ratio KW - Prevalence KW - Retrospective Studies KW - Risk Factors KW - United States KW - Wounds and Injuries AB -

OBJECTIVES: To examine the effect of obesity on the propensity of older adults to fall, sustain a fall-related injury, and develop disability in activities of daily living (ADLs) after a fall.

DESIGN: Longitudinal population-based survey.

SETTING: Five waves of the Health and Retirement Study (HRS), 1998-2006.

PARTICIPANTS: Ten thousand seven hundred fifty-five respondents aged 65 and older in 31,602 person-intervals.

MEASUREMENTS: Falls within any 2-year interval (9,621 falls). Injuries requiring medical attention (3,130 injuries). Increased ADL disability after a fall within any 2-year interval (2,162 events). Underweight and three classes of obesity (body mass index (BMI) 30.0-34.9 kg/m(2) , Class 1) 35.0-39.9 kg/m(2) , Class 2; ≥40.0 kg/m(2) , Class 3), calculated from self-reported height and weight. Self-reported presence of lower body limitation, pain, dizziness, or vision problems. Self-reported doctor's diagnosis of diabetes mellitus, stroke, or arthritis.

RESULTS: Compared with normal-weight respondents, the odds ratios (OR) for risk of falling were 1.12 (95% confidence interval (CI) = 1.01-1.24) for obesity Class 1, 1.26 (95% CI = 1.05-1.51) for obesity Class 2, and 1.50 (95% CI = 1.21-1.86) for obesity Class 3. Conditional on falling, only obesity Class 3 was related to a lower propensity for a fall-related injury (OR = 0.62, 95% CI = 0.44-0.87). Obesity Classes 1 and 2 were associated with a higher risk of greater ADL disability after a fall than normal-weight respondents (OR = 1.17, 95% CI = 1.02-1.34; OR = 1.39, 95% CI = 1.10-1.75, respectively). Being underweight was not related to risk of falling or to reported injury or greater ADL limitation after a fall. The presence of measured health problems and chronic conditions was associated with greater risk of falling and, of those who fell, greater ADL limitation but not serious injury.

CONCLUSION: Obesity appears to be associated with greater risk of falling in older adults, as well as a higher risk of greater ADL disability after a fall. Obesity (BMI ≥ 40 kg/m(2) ) may reduce the risk of injury from a fall. Further investigation of the mechanisms of obesity on falls and related health outcomes is warranted.

PB - 60 VL - 60 IS - 1 N1 - Himes, Christine L Reynolds, Sandra L United States Journal of the American Geriatrics Society J Am Geriatr Soc. 2012 Jan;60(1):124-9. doi: 10.1111/j.1532-5415.2011.03767.x. Epub 2011 Dec 8. U1 - http://www.ncbi.nlm.nih.gov/pubmed/22150343?dopt=Abstract U3 - 22150343 U4 - Obesity/Falls/DISABILITY/DISABILITY/Activities Of Daily Living/Body Mass Index/Self assessed health 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 - The effect of stability and change in health behaviors on trajectories of body mass index in older Americans: a 14-year longitudinal study. JF - J Gerontol A Biol Sci Med Sci Y1 - 2012 A1 - Anda Botoseneanu A1 - Jersey Liang KW - Aged KW - Aging KW - Alcohol Drinking KW - Body Mass Index KW - Cohort Studies KW - Female KW - Health Behavior KW - Health Status KW - Humans KW - Linear Models KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Motor Activity KW - Smoking KW - Socioeconomic factors KW - United States AB -

BACKGROUND: Obesity is increasingly prevalent among older adults, yet little is known about the impact of health behaviors on the trajectories of body weight in this age group.

METHODS: We examined the effect of time-varying smoking, physical activity (PA), alcohol use, and changes thereof, on the 14-year (1992-2006) trajectory of body- mass index (BMI) in a cohort of 10,314 older adults from the Health and Retirements Study, aged 51-61 years at baseline. Hierarchical linear modeling (HLM) quantifies the effect of smoking, PA, and alcohol use (user status, initiation and cessation) on intercept and rate-of-change in BMI trajectory, and tests for variations in the strength of association between each behavior and BMI.

RESULTS: Over 14 years (82,512 observations), BMI increased approximated by a quadratic function. Smoking and PA (user status and initiation) were associated with significantly lower BMI trajectories over time. Cessation of smoking and PA resulted in higher BMI trajectories over time. The weight-gaining effect of smoking cessation increased, while the strength of association between BMI trajectories and PA or alcohol use were constant over time. Socio-economic and health status differences explained the effects of alcohol use on BMI trajectory.

CONCLUSIONS: In older adults, smoking and PA, and changes thereof, vary in their long-term effect on trajectories of BMI. Barring increases in PA levels, older smokers who quit today are expected to gain significantly more weight than two decades ago. This knowledge is essential for the design of smoking cessation, physical activityPA, and weight-control interventions in older adults.

VL - 67 IS - 10 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22459621?dopt=Abstract U2 - PMC3437967 U4 - Obesity/body Mass Index/smoking/alcohol use ER - TY - JOUR T1 - The effects of health shocks on employment and health insurance: the role of employer-provided health insurance. JF - Int J Health Care Finance Econ Y1 - 2012 A1 - Cathy J. Bradley A1 - David Neumark A1 - Meryl Motika KW - Adult KW - Aged KW - Employment KW - Health Benefit Plans, Employee KW - Health Status KW - Hospitalization KW - Humans KW - Longitudinal Studies KW - Lung Diseases KW - Male KW - Neoplasms KW - Occupations KW - Retirement KW - Socioeconomic factors KW - Spouses AB -

Employment-contingent health insurance (ECHI) has been criticized for tying insurance to continued employment. Our research sheds light on two central issues regarding employment-contingent health insurance: whether such insurance "locks" people who experience a health shock into remaining at work; and whether it puts people at risk for insurance loss upon the onset of illness, because health shocks pose challenges to continued employment. We study how men's dependence on their own employer for health insurance affects labor supply responses and health insurance coverage following a health shock. We use the Health and Retirement Study (HRS) surveys from 1996 through 2008 to observe employment and health insurance status at interviews 2 years apart, and whether a health shock occurred in the intervening period between the interviews. All employed married men with health insurance either through their own employer or their spouse's employer, interviewed in at least two consecutive HRS waves with non-missing data on employment, insurance, health, demographic, and other variables, and under age 64 at the second interview are included in the study sample. We then limited the sample to men who were initially healthy. Our analytical sample consisted of 1,582 men of whom 1,379 had ECHI at the first interview, while 203 were covered by their spouse's employer. Hospitalization affected 209 men with ECHI and 36 men with spouse insurance. A new disease diagnosis was reported by 103 men with ECHI and 22 men with other insurance. There were 171 men with ECHI and 25 men with spouse employer insurance who had a self-reported health decline. Labor supply response differences associated with ECHI-with men with health shocks and ECHI more likely to continue working-appear to be driven by specific types of health shocks associated with future higher health care costs but not with immediate increases in morbidity that limit continued employment. Men with ECHI who have a self-reported health decline are significantly more likely to lose health insurance than men with insurance through a spouse. With the passage of health care reform, the tendency of men with ECHI as opposed to other sources of insurance to remain employed following a health shock may be diminished, along with the likelihood of losing health insurance.

VL - 12 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22983813?dopt=Abstract U2 - PMC3518621 U4 - health insurance/labor force participation/employment/Employment-contingent health insurance/health decline/health Shocks 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 - An examination of healthy aging across a conceptual continuum: prevalence estimates, demographic patterns, and validity. JF - J Gerontol A Biol Sci Med Sci Y1 - 2012 A1 - Sara J McLaughlin A1 - Alan M Jette A1 - Cathleen M. Connell KW - Aged KW - Aged, 80 and over KW - Aging KW - Cognition KW - Female KW - health KW - Humans KW - Male KW - Odds Ratio KW - Prevalence KW - Reproducibility of Results AB -

BACKGROUND: Although the notion of healthy aging has gained wide acceptance in gerontology, measuring the phenomenon is challenging. Guided by a prominent conceptualization of healthy aging, we examined how shifting from a more to less stringent definition of healthy aging influences prevalence estimates, demographic patterns, and validity.

METHODS: Data are from adults aged 65 years and older who participated in the Health and Retirement Study. We examined four operational definitions of healthy aging. For each, we calculated prevalence estimates and examined the odds of healthy aging by age, education, gender, and race-ethnicity in 2006. We also examined the association between healthy aging and both self-rated health and death.

RESULTS: Across definitions, the prevalence of healthy aging ranged from 3.3% to 35.5%. For all definitions, those classified as experiencing healthy aging had lower odds of fair or poor self-rated health and death over an 8-year period. The odds of being classified as "healthy" were lower among those of advanced age, those with less education, and women than for their corresponding counterparts across all definitions.

CONCLUSIONS: Moving across the conceptual continuum--from a more to less rigid definition of healthy aging--markedly increases the measured prevalence of healthy aging. Importantly, results suggest that all examined definitions identified a subgroup of older adults who had substantially lower odds of reporting fair or poor health and dying over an 8-year period, providing evidence of the validity of our definitions. Conceptualizations that emphasize symptomatic disease and functional health may be particularly useful for public health purposes.

PB - 67 VL - 67 IS - 7 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22367432?dopt=Abstract U2 - PMC3536546 U4 - Gerontology/Aging/Demographics/Personal health/Older people/Public health 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 - Gender differences in the link between excessive drinking and domain-specific cognitive functioning among older adults. JF - J Aging Health Y1 - 2012 A1 - Jiyoung Lyu A1 - SeungAh H. Lee KW - Aged KW - Alcohol Drinking KW - Alcohol-Related Disorders KW - Cognition KW - Cognition Disorders KW - Cross-Sectional Studies KW - Female KW - Humans KW - Intelligence KW - Male KW - Multivariate Analysis KW - Regression Analysis KW - Sex Factors AB -

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

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

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

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

VL - 24 IS - 8 N1 - . U1 - http://www.ncbi.nlm.nih.gov/pubmed/22992713?dopt=Abstract U3 - 22992713 U4 - alcohol Abuse/intelligence/Cognition/WOMEN/Cognitive ability/gender Differences ER - TY - JOUR T1 - The growth in Social Security benefits among the retirement-age population from increases in the cap on covered earnings. JF - Soc Secur Bull Y1 - 2012 A1 - Alan L Gustman A1 - Thomas L. Steinmeier A1 - N. Tabatabai KW - Aged KW - Cohort Studies KW - Female KW - Humans KW - Insurance Benefits KW - Male KW - Middle Aged KW - Models, Econometric KW - Public Policy KW - Salaries and Fringe Benefits KW - Social Security KW - Taxes KW - United States AB -

Analysts have proposed raising the maximum level of earnings subject to the Social Security payroll tax (the "tax max") to improve long-term Social Security Trust Fund solvency. This article investigates how raising the tax max leads to the "leakage" of portions of the additional revenue into higher benefit payments. Using Health and Retirement Study data matched to Social Security earnings records, we compare historical payroll tax payments and benefit amounts for Early Boomers (born 1948-1953) with tax and benefit simulations had they been subject to the tax max (adjusted for wage growth) faced by cohorts 12 and 24 years older. We find that 43.2 percent of the additional payroll tax revenue attributable to tax max increases affecting Early Boomers relative to taxes paid by the cohort 12 years older leaked into higher benefits. For Early Boomers relative to those 24 years older, we find 53.5 percent leakage.

PB - 72 VL - 72 UR - https://www.ssa.gov/policy/docs/ssb/v72n2/v72n2p49.html IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22799138?dopt=Abstract U4 - Social security/payroll tax/Public policy/retirement planning/taxation ER - TY - JOUR T1 - Half of older Americans seen in emergency department in last month of life; most admitted to hospital, and many die there. JF - Health Aff (Millwood) Y1 - 2012 A1 - Alexander K Smith A1 - Ellen P McCarthy A1 - Ellen Weber A1 - Irena Cenzer A1 - W John Boscardin A1 - Jonathan Fisher A1 - Kenneth E Covinsky KW - Aged KW - Aged, 80 and over KW - Emergency Service, Hospital KW - Female KW - Hospital Mortality KW - Hospitalization KW - Humans KW - Insurance Claim Review KW - Male KW - Terminal Care KW - Terminally Ill KW - United States AB -

Emergency department use contributes to high end-of-life costs and is potentially burdensome for patients and family members. We examined emergency department use in the last months of life for patients age sixty-five or older who died while enrolled in a longitudinal study of older adults in the period 1992-2006. We found that 51 percent of the 4,158 [corrected] decedents visited the emergency department in the last month of life, and 75 percent in the last six months of life. Repeat visits were common. A total of 77 percent of the patients seen in the emergency department in the last month of life were admitted to the hospital, and 68 percent of those who were admitted died there. In contrast, patients who enrolled in hospice at least one month before death rarely visited the emergency department in the last month of life. Policies that encourage the preparation of patients and families for death and early enrollment in hospice may prevent emergency department visits at the end of life.

PB - 31 VL - 31 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22665840?dopt=Abstract U2 - PMC3736978 U4 - elderly/Medicare/Primary Care/public policy/Health care policy/emergency department service use/emergency department service use 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 - Health service use among the previously uninsured: is subsidized health insurance enough? JF - Health Econ Y1 - 2012 A1 - Decker, Sandra L A1 - Jalpa A Doshi A1 - Amy E. Knaup A1 - Daniel Polsky KW - Aged KW - Female KW - Health Care Surveys KW - Health Services KW - Health Status KW - Humans KW - Insurance Coverage KW - Insurance, Health KW - Male KW - Medically Uninsured KW - Medicare KW - Middle Aged KW - Socioeconomic factors KW - United States AB -

Although it has been shown that gaining Medicare coverage at age 65 years increases health service use among the uninsured, difficulty in changing habits or differences in the characteristics of previously uninsured compared with insured individuals may mean that the previously uninsured continue to use the healthcare system differently from others. This study uses Medicare claims data linked to two different surveys--the National Health Interview Survey and the Health and Retirement Study--to describe the relationship between insurance status before age 65 years and the use of Medicare-covered services beginning at age 65 years. Although we do not find statistically significant differences in Medicare expenditures or in the number of hospitalizations by previous insurance status, we do find that individuals who were uninsured before age 65 years continue to use the healthcare system differently from those who were privately insured. Specifically, they have 16% fewer visits to office-based physicians but make 18% and 43% more visits to hospital emergency and outpatient departments, respectively. A key question for the future may be why the previously uninsured seem to continue to use the healthcare system differently from the previously insured. This question may be important to consider as health coverage expansions are implemented.

PB - 21 VL - 21 IS - 10 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22945812?dopt=Abstract U3 - 22945812 U4 - Medicare/health Services/ utilization/health Services/ utilization/health Insurance/Uninsured people/Public policy ER - TY - JOUR T1 - How safe is your neighborhood? Perceived neighborhood safety and functional decline in older adults. JF - J Gen Intern Med Y1 - 2012 A1 - Vivien K Sun A1 - Irena Cenzer A1 - Helen Kao A1 - Cyrus Ahalt A1 - Brie A Williams KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Health Status Disparities KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Perception KW - Residence Characteristics KW - Safety KW - Surveys and Questionnaires AB -

BACKGROUND: Neighborhood characteristics are associated with health and the perception of safety is particularly important to exercise and health among older adults. Little is known about the relationship between perception of neighborhood safety and functional decline in older adults.

OBJECTIVE: To determine the relationship between perceived neighborhood safety and functional decline in older adults.

DESIGN/SETTING: Longitudinal, community-based.

PARTICIPANTS: 18,043 persons, 50 years or older, who participated in the 1998 and 2008 Health and Retirement Study.

MAIN MEASURES: The primary outcome was 10-year functional decline (new difficulty or dependence in any Activity of Daily Living, new mobility difficulty, and/or death). The primary predictor was perceived neighborhood safety categorized into three groups: "very safe", "moderately safe", and "unsafe." We evaluated the association between perceived neighborhood safety and 10-year functional decline using a modified Poisson regression to generate unadjusted and adjusted relative risks (ARR).

KEY RESULTS: At baseline 11,742 (68.0%) participants perceived their neighborhood to be very safe, 4,477 (23.3%) moderately safe, and 1,824 (8.7%) unsafe. Over 10 years, 10,338 (53.9%) participants experienced functional decline, including 6,266 (50.2%) who had perceived their neighborhood to be very safe, 2,839 (61.2%) moderately safe, and 1,233 (63.6%) unsafe, P < 0.001. For the 11,496 (63.3%) of participants who were functionally independent at baseline, perceived neighborhood safety was associated with 10-year functional decline (moderately safe ARR 1.15 95% CI 1.09-1.20; unsafe ARR 1.21 95% CI: 1.03-1.31 compared to very safe group). The relationship between perceived neighborhood safety and 10-year functional decline was not statistically significant for participants who had baseline functional impairment.

CONCLUSION: Asking older adults about their perceived neighborhood safety may provide important information about their risk of future functional decline. These findings also suggest that future studies might focus on assessing whether interventions that promote physical activity while addressing safety concerns help reduce functional decline in older adults.

VL - 27 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22160889?dopt=Abstract U2 - PMC3326109 U4 - neighborhood Characteristics/Safety/Functional decline/Functional decline/Activities Of Daily Living/Mobility/HEALTH ER - TY - JOUR T1 - The impact of socioeconomic inequalities and lack of health insurance on physical functioning among middle-aged and older adults in the United States. JF - Health Soc Care Community Y1 - 2012 A1 - Kim, Jinhyun A1 - Virginia E. Richardson KW - Activities of Daily Living KW - Aged KW - Black or African American KW - Female KW - Health Status KW - Healthcare Disparities KW - Humans KW - Longitudinal Studies KW - Male KW - Medically Uninsured KW - Middle Aged KW - Poverty KW - Sex Factors KW - Socioeconomic factors KW - Time Factors KW - United States KW - White People AB -

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

PB - 20 VL - 20 IS - 1 N1 - Kim, Jinhyun Richardson, Virginia England Health and social care in the community Health Soc Care Community. 2012 Jan;20(1):42-51. doi: 10.1111/j.1365-2524.2011.01012.x. Epub 2011 Jul 6. U1 - http://www.ncbi.nlm.nih.gov/pubmed/21733029?dopt=Abstract U3 - 21733029 U4 - Socioeconomic Differences/health Insurance/health disparities/economic Status/WOMEN/Physical function ER - TY - JOUR T1 - The influence of diabetes psychosocial attributes and self-management practices on change in diabetes status. JF - Patient Educ Couns Y1 - 2012 A1 - Donna M Zulman A1 - Ann Marie Rosland A1 - Choi, Hwajung A1 - Kenneth M. Langa A1 - Michele M Heisler KW - Aged KW - Blood Glucose Self-Monitoring KW - Cross-Sectional Studies KW - Diabetes Mellitus, Type 1 KW - Diabetes Mellitus, Type 2 KW - Disease Management KW - Female KW - Glycated Hemoglobin KW - Health Knowledge, Attitudes, Practice KW - Health Status KW - Humans KW - Interviews as Topic KW - Male KW - Middle Aged KW - Multivariate Analysis KW - Risk Factors KW - Self Care KW - Self Efficacy KW - Severity of Illness Index KW - Social Support KW - Stress, Psychological KW - Surveys and Questionnaires KW - Treatment Outcome AB -

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

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

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

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

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

PB - 87 VL - 87 UR - http://www.ncbi.nlm.nih.gov/pubmed/21840149 IS - 1 N1 - Zulman, Donna M Rosland, Ann-Marie Choi, Hwajung Langa, Kenneth M Heisler, Michele U01 AG09740/AG/NIA NIH HHS/ Ireland Patient Educ Couns. 2012 Apr;87(1):74-80. Epub 2011 Aug 15. U1 - http://www.ncbi.nlm.nih.gov/pubmed/21840149?dopt=Abstract U2 - PMC3229832 U4 - Diabetes/glycemic control/glycemic control/psycho-social/self-management ER - TY - JOUR T1 - Limited lung function: impact of reduced peak expiratory flow on health status, health-care utilization, and expected survival in older adults. JF - Am J Epidemiol Y1 - 2012 A1 - Melissa H. Roberts A1 - Douglas W Mapel KW - Activities of Daily Living KW - Aged KW - Chronic disease KW - Cohort Studies KW - Comorbidity KW - Diabetes Mellitus KW - Female KW - Health Services KW - Health Status KW - Heart Diseases KW - Hospitalization KW - Humans KW - Incidence KW - Logistic Models KW - Longitudinal Studies KW - Lung Diseases KW - Male KW - Middle Aged KW - Neoplasms KW - Odds Ratio KW - Peak Expiratory Flow Rate KW - Population Surveillance KW - Stroke KW - United States AB -

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

PB - 176 VL - 176 IS - 2 N1 - Roberts, Melissa H Mapel, Douglas W United States Am J Epidemiol. 2012 Jul 15;176(2):127-34. Epub 2012 Jun 28. U1 - http://www.ncbi.nlm.nih.gov/pubmed/22759722?dopt=Abstract U2 - PMC3493194 U4 - peak expiratory flow/disability/disability/hospitalization/physical fitness ER - TY - JOUR T1 - Loneliness, health, and mortality in old age: a national longitudinal study. JF - Soc Sci Med Y1 - 2012 A1 - Ye Luo A1 - Louise C Hawkley A1 - Linda J. Waite A1 - John T. Cacioppo KW - Aged KW - Aged, 80 and over KW - Aging KW - Cohort Studies KW - depression KW - Female KW - Health Behavior KW - Health Status KW - Humans KW - Interpersonal Relations KW - Loneliness KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Mortality KW - Social Support KW - Socioeconomic factors KW - United States AB -

This study examined the relationship between loneliness, health, and mortality using a U.S. nationally representative sample of 2101 adults aged 50 years and over from the 2002 to 2008 waves of the Health and Retirement Study. We estimated the effect of loneliness at one point on mortality over the subsequent six years, and investigated social relationships, health behaviors, and health outcomes as potential mechanisms through which loneliness affects mortality risk among older Americans. We operationalized health outcomes as depressive symptoms, self-rated health, and functional limitations, and we conceptualized the relationships between loneliness and each health outcome as reciprocal and dynamic. We found that feelings of loneliness were associated with increased mortality risk over a 6-year period, and that this effect was not explained by social relationships or health behaviors but was modestly explained by health outcomes. In cross-lagged panel models that tested the reciprocal prospective effects of loneliness and health, loneliness both affected and was affected by depressive symptoms and functional limitations over time, and had marginal effects on later self-rated health. These population-based data contribute to a growing literature indicating that loneliness is a risk factor for morbidity and mortality and point to potential mechanisms through which this process works.

PB - 74 VL - 74 UR - http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=2601961601andFmt=7andclientId=17822andRQT=309andVName=PQD IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22326307?dopt=Abstract U2 - PMC3303190 U4 - Emotions/Emotions/Mortality/Clinical outcomes/Health behavior/Risk factors/Personal health/Older people ER - TY - JOUR T1 - Loneliness in older persons: a predictor of functional decline and death. JF - Arch Intern Med Y1 - 2012 A1 - Perissinotto, Carla M A1 - Irena Cenzer A1 - Kenneth E Covinsky KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Female KW - Humans KW - Loneliness KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Mortality KW - United States KW - Upper Extremity KW - Walking AB -

BACKGROUND: Loneliness is a common source of distress, suffering, and impaired quality of life in older persons. We examined the relationship between loneliness, functional decline, and death in adults older than 60 years in the United States.

METHODS: This is a longitudinal cohort study of 1604 participants in the psychosocial module of the Health and Retirement Study, a nationally representative study of older persons. Baseline assessment was in 2002 and follow-up assessments occurred every 2 years until 2008. Subjects were asked if they (1) feel left out, (2) feel isolated, or (3) lack companionship. Subjects were categorized as not lonely if they responded hardly ever to all 3 questions and lonely if they responded some of the time or often to any of the 3 questions. The primary outcomes were time to death over 6 years and functional decline over 6 years on the following 4 measures: difficulty on an increased number of activities of daily living (ADL), difficulty in an increased number of upper extremity tasks, decline in mobility, or increased difficulty in stair climbing. Multivariate analyses adjusted for demographic variables, socioeconomic status, living situation, depression, and various medical conditions.

RESULTS: The mean age of subjects was 71 years. Fifty-nine percent were women; 81% were white, 11%, black, and 6%, Hispanic; and 18% lived alone. Among the elderly participants, 43% reported feeling lonely. Loneliness was associated with all outcome measures. Lonely subjects were more likely to experience decline in ADL (24.8% vs 12.5%; adjusted risk ratio [RR], 1.59; 95% CI, 1.23-2.07); develop difficulties with upper extremity tasks (41.5% vs 28.3%; adjusted RR, 1.28; 95% CI, 1.08-1.52); experience decline in mobility (38.1% vs 29.4%; adjusted RR, 1.18; 95% CI, 0.99-1.41); or experience difficulty in climbing (40.8% vs 27.9%; adjusted RR, 1.31; 95% CI, 1.10-1.57). Loneliness was associated with an increased risk of death (22.8% vs 14.2%; adjusted HR, 1.45; 95% CI, 1.11-1.88).

CONCLUSION: Among participants who were older than 60 years, loneliness was a predictor of functional decline and death.

PB - 172 VL - 172 IS - 14 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22710744?dopt=Abstract U3 - 22710744 U4 - loneliness/functional decline/functional decline/Mortality/psychosocial/Quality of Life/Multivariate Analysis ER - TY - JOUR T1 - Long-term rate of change in memory functioning before and after stroke onset. JF - Stroke Y1 - 2012 A1 - Qianyi Wang A1 - Benjamin D Capistrant A1 - Amy Ehntholt A1 - M. Maria Glymour KW - Aged KW - Aged, 80 and over KW - Cohort Studies KW - disease progression KW - Female KW - Follow-Up Studies KW - Humans KW - Linear Models KW - Longitudinal Studies KW - Male KW - Memory KW - Memory Disorders KW - Middle Aged KW - Stroke KW - Survivors KW - Time Factors AB -

BACKGROUND AND PURPOSE: Memory impairment is a predictor and a consequence of stroke, but memory decline is common even in healthy elderly individuals. We compared the long-term trajectory of memory functioning before and after stroke with memory change in stroke-free elderly individuals.

METHODS: Health and Retirement Study participants aged 50 years and older (n=17 340) with no stroke history at baseline were interviewed biennially up to 10 years for first self-reported or proxy-reported stroke (n=1574). Age-, sex-, and race-adjusted segmented linear regression models were used to compare annual rates of change in a composite memory score before and after stroke among 3 groups: 1189 stroke survivors; 385 stroke decedents; and 15 766 cohort members who remained stroke-free.

RESULTS: Before stroke onset, individuals who later survived stroke had significantly (P<0.001) faster average annual rates of memory decline (-0.143 points per year) than those who remained stroke-free throughout follow-up (-0.101 points per year). Stroke decedents had even faster prestroke memory decline (-0.212 points per year). At stroke onset, memory declined an average of -0.369 points among stroke survivors, comparable with 3.7 years of age-related decline in stroke-free cohort members. After stroke, memory in stroke survivors continued to decline at -0.142 points per year, similar to their prestroke rates (P=0.93). Approximately 50% of the memory difference between stroke survivors soon after stroke and age-matched stroke-free individuals was attributable to prestroke memory.

CONCLUSIONS: Although stroke onset induced large decrements in memory, memory differences were apparent years before stroke. Memory declines before stroke, especially among those who did not survive the stroke, were faster than declines among stroke-free adults.

VL - 43 IS - 10 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22935399?dopt=Abstract U2 - PMC3675175 U4 - Cognition/Cognitive impairment/memory impairment/cognitive decline/stroke 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 - Measurement equivalence in ADL and IADL difficulty across international surveys of aging: findings from the HRS, SHARE, and ELSA. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2012 A1 - Kitty S. Chan A1 - Judith D Kasper A1 - Jason Brandt A1 - Liliana E Pezzin KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Aging KW - Bias KW - Europe KW - Female KW - Health Surveys KW - Humans KW - Internationality KW - Longitudinal Studies KW - Male KW - United States AB -

OBJECTIVE: To examine the measurement equivalence of items on disability across three international surveys of aging.

METHOD: Data for persons aged 65 and older were drawn from the Health and Retirement Survey (HRS, n = 10,905), English Longitudinal Study of Aging (ELSA, n = 5,437), and Survey of Health, Ageing and Retirement in Europe (SHARE, n = 13,408). Differential item functioning (DIF) was assessed using item response theory (IRT) methods for activities of daily living (ADL) and instrumental activities of daily living (IADL) items.

RESULTS: HRS and SHARE exhibited measurement equivalence, but 6 of 11 items in ELSA demonstrated meaningful DIF. At the scale level, this item-level DIF affected scores reflecting greater disability. IRT methods also spread out score distributions and shifted scores higher (toward greater disability). Results for mean disability differences by demographic characteristics, using original and DIF-adjusted scores, were the same overall but differed for some subgroup comparisons involving ELSA.

DISCUSSION: Testing and adjusting for DIF is one means of minimizing measurement error in cross-national survey comparisons. IRT methods were used to evaluate potential measurement bias in disability comparisons across three international surveys of aging. The analysis also suggested DIF was mitigated for scales including both ADL and IADL and that summary indexes (counts of limitations) likely underestimate mean disability in these international populations.

VL - 67 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22156662?dopt=Abstract U2 - PMC3267026 U4 - measurement/SHARE/ELSA_/Activities Of Daily Living/instrumental activities of daily living/DISABILITY/DISABILITY/differential item functioning/differential item functioning 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 - Presepsis depressive symptoms are associated with incident cognitive impairment in survivors of severe sepsis: a prospective cohort study of older Americans. JF - J Am Geriatr Soc Y1 - 2012 A1 - Dimitry S Davydow A1 - Catherine L Hough A1 - Kenneth M. Langa A1 - Theodore J Iwashyna KW - Aged KW - Aged, 80 and over KW - Cognition Disorders KW - Cohort Studies KW - depression KW - Female KW - Humans KW - Longitudinal Studies KW - Male KW - Sepsis KW - Survivors AB -

OBJECTIVES: To test the hypothesis that presepsis depressive symptoms are associated with risk of new cognitive impairment in survivors of severe sepsis.

DESIGN: Prospective longitudinal cohort study.

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

PARTICIPANTS: Four hundred forty-seven individuals with normal presepsis cognition who survived 540 hospitalizations for severe sepsis and completed at least one follow-up interview.

MEASUREMENTS: Severe sepsis was identified using a validated algorithm in Medicare claims. Depressive symptoms were assessed prospectively using a modified version of the Center for Epidemiologic Studies Depression Scale. Cognitive function was assessed using versions of the Telephone Interview for Cognitive Status (TICS). Logistic regression with robust standard errors was used to examine associations between substantial depressive symptoms at any interview before sepsis and incident cognitive impairment (mild or moderate to severe cognitive impairment) at any interview after sepsis.

RESULTS: The prevalence of substantial depressive symptoms in participants with normal cognition before sepsis was 38% (95% confidence interval (CI) = 34-42%). After severe sepsis, 18% (95% CI = 15-20%) of survivors had incident cognitive impairment. In unadjusted analyses, presepsis substantial depressive symptoms were associated with postsepsis incident cognitive impairment (odds ratio (OR) = 2.56, 95% CI = 1.53-4.27). After adjustment for demographics, health-risk behaviors, clinical characteristics of the sepsis episode, and presepsis TICS scores, substantial presepsis depressive symptoms remained the strongest factor associated with postsepsis incident cognitive impairment (OR = 2.58, 95% CI = 1.45-4.59).

CONCLUSION: Substantial presepsis depressive symptoms are independently associated with incident postsepsis cognitive impairment. Depressed older adults may be particularly at risk of developing cognitive impairment after a serious medical illness.

PB - 60 VL - 60 IS - 12 U1 - http://www.ncbi.nlm.nih.gov/pubmed/23176643?dopt=Abstract U2 - PMC3521098 U4 - Depression/sepsis/Cognition/Cognitive Impairment/CES Depression Scale/CES Depression Scale/TICS Scale/Older Adults ER - TY - JOUR T1 - Prevalence of cognitive impairment in older adults with heart failure. JF - J Am Geriatr Soc Y1 - 2012 A1 - Tanya R Gure A1 - Caroline S Blaum A1 - Bruno J Giordani A1 - Todd M Koelling A1 - Andrzej T Galecki A1 - Susan J Pressler A1 - Scott L Hummel A1 - Kenneth M. Langa KW - Aged KW - Aged, 80 and over KW - Algorithms KW - Chi-Square Distribution KW - Cognition Disorders KW - Cross-Sectional Studies KW - Demography KW - Female KW - Heart Failure KW - Humans KW - Logistic Models KW - Male KW - Medicare KW - Prevalence KW - United States AB -

OBJECTIVES: To determine the prevalence of cognitive impairment in older adults with heart failure (HF).

DESIGN: Cross-sectional analysis of the 2004 wave of the nationally representative Health and Retirement Study linked to 2002 to 2004 Medicare administrative claims.

SETTING: United States, community.

PARTICIPANTS: Six thousand one hundred eighty-nine individuals aged 67 and older.

MEASUREMENTS: An algorithm was developed using a combination of self- and proxy report of a heart problem and the presence of one or more Medicare claims in administrative files using standard HF diagnostic codes. On the basis of the algorithm, three categories were created to characterize the likelihood of a HF diagnosis: high or moderate probability of HF, low probability of HF, and no HF. Cognitive function was assessed using a screening measure of cognitive function or according to proxy rating. Age-adjusted prevalence estimates of cognitive impairment were calculated for the three groups.

RESULTS: The prevalence of cognitive impairment consistent with dementia in older adults with HF was 15%, and the prevalence of mild cognitive impairment was 24%. The odds of dementia in those with HF were significantly higher, even after adjustment for age, education level, net worth, and prior stroke (odds ratio = 1.52, 95% confidence interval = 1.14-2.02).

CONCLUSION: Cognitive impairment is common in older adults with HF and is independently associated with risk of dementia. A cognitive assessment should be routinely incorporated into HF-focused models of care.

PB - 60 VL - 60 IS - 9 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22882000?dopt=Abstract U2 - PMC3445700 U4 - Cognition/Cognitive impairment/Cardiovascular disease/heart Diseases/epidemiology/dementia/PREVALENCE ER - TY - JOUR T1 - A prospective cohort study of health behavior profiles after age 50 and mortality risk. JF - BMC Public Health Y1 - 2012 A1 - Benjamin A Shaw A1 - Agahi, Neda KW - Aged KW - Alcohol-Related Disorders KW - Female KW - Follow-Up Studies KW - Humans KW - Male KW - Middle Aged KW - Prospective Studies KW - Regression Analysis KW - Risk Assessment KW - Risk-Taking KW - Sedentary Behavior KW - Smoking KW - United States AB -

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

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

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

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

PB - 12 VL - 12 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22989155?dopt=Abstract U4 - Alcohol/alcohol Abuse/Alcohol-Related Disorders -- mortality/Regression Analysis/Risk-Taking/Sedentary Lifestyle/Risk Assessment/smoking/Smoking -- mortality/Public Health And Safety/gender Differences ER - TY - JOUR T1 - 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/ethnic and nativity disparities in later life physical performance: the role of health and socioeconomic status over the life course. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2012 A1 - Steven A Haas A1 - Patrick M. Krueger A1 - Leah Rohlfsen KW - Aged KW - Aged, 80 and over KW - Aging KW - ethnicity KW - Female KW - Gait KW - Hand Strength KW - Health Status KW - Health Status Disparities KW - Health Surveys KW - Humans KW - Male KW - Middle Aged KW - Racial Groups KW - Respiratory Function Tests KW - Social Class KW - United States AB -

OBJECTIVES: We examine race/ethnic and nativity differences in objective measures of physical performance (i.e., peak expiratory flow, grip strength, and gait speed) in a nationally representative sample of older Whites, Blacks, and Hispanics. We also examine whether detailed measures of childhood and adult health and socioeconomic status (SES) mediate race/ethnic differences in physical performance.

METHOD: We use data from the Health and Retirement Study, a population-based sample of older Americans born before 1947, and 3 measures of physical performance. Nested ordinary least squares models examine whether childhood and adult health and SES mediate race/ethnic differences in performance.

RESULTS: We find large and significant race/ethnic and nativity differences in lung function, grip strength, and gait speed. Adjusting for childhood and current adult health and SES reduces race/ethnic differences in physical performance but does not eliminate them entirely. Childhood health and SES as well as more proximal levels of SES are important determinants of race/ethnic disparities in later life physical performance.

DISCUSSION: The analysis highlights that a large proportion of race/ethnic and nativity disparities result from health and socioeconomic disadvantages in both early life and adulthood and thus suggests multiple intervention points at which disparities can be reduced.

PB - 67B VL - 67 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22391749?dopt=Abstract U2 - PMC3410696 U4 - Racial differences/Socioeconomic factors/Cultural differences/Cultural differences/Aging/Intervention 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 - The relationship between body weight, frailty, and the disablement process. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2012 A1 - Mary E Bowen KW - Activities of Daily Living KW - Aged KW - Body Weight KW - Cross-Sectional Studies KW - Disability Evaluation KW - Disabled Persons KW - Female KW - Frail Elderly KW - Geriatric Assessment KW - Health Behavior KW - Health Surveys KW - Humans KW - Life Style KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Overweight KW - Physical Fitness KW - Prospective Studies KW - sarcopenia KW - Socioeconomic factors KW - Thinness KW - United States AB -

OBJECTIVES: To prospectively examine the relationship between body weight, frailty, and the disablement process.

METHOD: Longitudinal data from the Health and Retirement Study (1998-2006) were used to examine the relationship between being underweight, overweight, or obese (compared with normal weight) and the onset and progression of functional limitations and disabilities in instrumental activities of daily living (IADL) and activities of daily living (ADL) among a nationally representative sample of community-dwelling older adults (aged 50 and older) with characteristics of frailty (n= 11,491). Nonlinear multilevel models additionally adjusted for demographic characteristics and intra-individual changes in body weight, socioeconomic status, health behaviors, and health conditions over the course of 8 years.

RESULTS: Compared with their nonfrail normal weight counterparts, prefrail obese respondents have a 16% (p ≤ 0.001) reduction in the expected functional limitations rate and frail overweight and obese respondents have a 10% (p ≤ 0.01) and 36% (p ≤ 0.001) reduction in the expected functional limitations rate, respectively. In addition, frail obese respondents have a 27% (p ≤ 0.05) reduction in the expected ADL disability rate.

DISCUSSION: This study's findings suggest that underweight, overweight, and obese status differentially affect the risk for functional limitations and disabilities in IADL and ADL. Among prefrail and frail adults, some excess body weight in later life may be beneficial, reducing the rate of functional limitations and disability.

PB - 67 VL - 67 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22967933?dopt=Abstract U2 - PMC in process U4 - Weight/Frailty/Disability/Disability/Older people/Health behavior/Socioeconomic factors/activities Of Daily Living/ADL and IADL Impairments ER - TY - JOUR T1 - The relationship between cognitive impairment and diabetes self-management in a population-based community sample of older adults with Type 2 diabetes. JF - J Behav Med Y1 - 2012 A1 - Denise G Feil A1 - Carolyn Wei Zhu A1 - David L Sultzer KW - Aged KW - Aged, 80 and over KW - Blood Glucose KW - Cognition Disorders KW - Cross-Sectional Studies KW - Diabetes Mellitus, Type 2 KW - Exercise KW - Female KW - Health Surveys KW - Humans KW - Male KW - Middle Aged KW - Self Care AB -

Although nearly one-third of older diabetics are cognitively impaired, their diabetes management remains poorly understood. To examine the relationship between cognitive impairment and diabetes self-management in a population-based community sample of older adults with Type 2 diabetes. Cross-sectional observational analysis. 1,398 persons with diabetes, aged 60 years or older, who responded to the 2003 Health and Retirement Study Diabetes Survey. We conducted logistic regressions on the effects of cognitive impairment on respondents' self-management ability after controlling for diabetes comorbidities, demographics, and clinical characteristics. Participants with greater cognitive impairment were less likely to adhere to exercise (Adjusted Odds ratio [AOR] = 0.725 and 0.712 for moderate and severe cognitive impairment, both P < 0.05), and to diet (AOR = 0.906 and 0.618 for moderate and severe cognitive impairment, both P < 0.01). Cognitive impairment is associated with worse self-care and may pose challenges to diabetic older persons, notably in diet and exercise. Cognitive screening may be indicated in this high risk group.

VL - 35 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21503710?dopt=Abstract U3 - 21503710 U4 - Diabetes Mellitus/Type 2 diabetes/cognitive Impairment/COMORBIDITY/diabetes self-management/diabetes self-management 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 - Risk factors of falls in community-dwelling older adults: logistic regression tree analysis. JF - Gerontologist Y1 - 2012 A1 - Takashi Yamashita A1 - Noe, Douglas A. A1 - John A. Bailer KW - Accidental Falls KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Decision Trees KW - Female KW - Geriatric Assessment KW - Health Surveys KW - Humans KW - Logistic Models KW - Male KW - Predictive Value of Tests KW - Residence Characteristics KW - Risk Assessment KW - Socioeconomic factors KW - United States AB -

PURPOSE OF THE STUDY: A novel logistic regression tree-based method was applied to identify fall risk factors and possible interaction effects of those risk factors.

DESIGN AND METHODS: A nationally representative sample of American older adults aged 65 years and older (N = 9,592) in the Health and Retirement Study 2004 and 2006 modules was used. Logistic Tree with Unbiased Selection, a computer algorithm for tree-based modeling, recursively split the entire group in the data set into mutually exclusive subgroups and fit a logistic regression model in each subgroup to generate an easily interpreted tree diagram.

RESULTS: A subgroup of older adults with a fall history and either no activities of daily living (ADL) limitation and at least one instrumental activity of daily living or at least one ADL limitation was classified as at high risk of falling. Additionally, within each identified subgroup, the best predictor of falls varied over subgroups and was also evaluated.

IMPLICATIONS: Application of tree-based methods may provide useful information for intervention program design and resource allocation planning targeting subpopulations of older adults at risk of falls.

PB - 52 VL - 52 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22437329?dopt=Abstract U4 - falls/risk Factors/ADL and IADL Impairments/Methodology/Logistic Models 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 - Self-care and health outcomes of diabetes mellitus. JF - Clin Nurs Res Y1 - 2012 A1 - MinKyoung Song A1 - Sarah J Ratcliffe A1 - Nancy C Tkacs A1 - Barbara Riegel KW - Adult KW - Aged KW - Aged, 80 and over KW - Clinical Nursing Research KW - Diabetes Mellitus KW - Female KW - Follow-Up Studies KW - Hospitalization KW - Humans KW - Length of Stay KW - Male KW - Middle Aged KW - Self Care KW - Treatment Outcome AB -

Studies show that self-care improves diabetes mellitus (DM) outcomes; however, previous studies have focused on self-care maintenance, and little is known about self-care management. The objective of this study is to examine the influence of DM self-care maintenance and management on number of hospitalizations and hospitalization days. A cohort design with secondary analysis of data from the Health and Retirement Study 2002-2004 was used. Data from 726 adults with DM were analyzed with logistic regression and negative binomial regression adjusting for covariates. Self-care maintenance and management were significant determinants of hospitalization outcomes. Establishing a goal for HbA1c (self-care management) and eating ≥2 snacks or desserts per day (self-care maintenance) were associated with a decrease in hospitalizations (IRR = 0.860, p = .001; IRR = 0.914, p = .043, respectively). DM self-care maintenance and management influence health outcomes but in different ways. These data provide evidence that both elements are needed in the education of patients about DM.

VL - 21 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21926278?dopt=Abstract U3 - 21926278 U4 - Diabetes/self Care/methods/self Care/methods/HOSPITALIZATION ER - TY - JOUR T1 - Self-rated health and the "first move" around retirement: a longitudinal study of older Americans. JF - J Rural Health Y1 - 2012 A1 - Nan E. Johnson KW - Aged KW - Female KW - Health Status KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Population Dynamics KW - Retirement AB -

PURPOSE: I examine whether less favorable self-rated health raises the risk of outmigration more for young-old adults (aged 53-63 at the start of the 10-year longitudinal study in 1994) in nonmetro than metro counties and increases the odds that both groups of outmigrants will choose metro over nonmetro destinations. Finally, I examine whether nonmetro outmigrants are more likely than metro outmigrants to cite a health concern or a desire to get closer to relatives or friends as a reason for the migration.

METHODS: I use the Health and Retirement Study (HRS) to track the main residences of nonmetro and metro older adults from 1994-2003. With a discrete-time Event History Analysis, I assess the joint effects of nonmetro/metro residence in 1994 and self-rated health (updated at each biennial wave) upon the risk of a first migration. Those who migrated were asked to recall why.

FINDINGS: At worse levels of self-rated health, the odds of remaining in a nonmetro county of residence drop in favor of migrating to another nonmetro county. Among migrants, the worse the self-rated health, the higher the odds of within-type migration (nonmetro-nonmetro and metro-metro) over cross-type migration (nonmetro-metro and metro-nonmetro). The percentages of migrants citing a health concern or a desire to live closer to relatives or friends as a reason for migration do not differ by county type of origin.

CONCLUSIONS: An implication for rural health policy is that young-old adults with worse self-rated health tend to remain in nonmetro areas, even when they migrate.

PB - 28 VL - 28 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22458319?dopt=Abstract U4 - metropolitan/nonmetropolitan/reasons for migration/Public policy/urban areas/health Status/outmigration ER - TY - JOUR T1 - Self-reported and measured hypertension among older US- and foreign-born adults. JF - J Immigr Minor Health Y1 - 2012 A1 - White, Kellee A1 - Mauricio Avendano A1 - Benjamin D Capistrant A1 - J Robin Moon A1 - Sze Y Liu A1 - M. Maria Glymour KW - Aged KW - Black or African American KW - Blood Pressure Determination KW - Emigrants and Immigrants KW - Female KW - Hispanic or Latino KW - Humans KW - Hypertension KW - Male KW - Middle Aged KW - Nutrition Surveys KW - Reproducibility of Results KW - Self Report KW - United States KW - White People AB -

Self-reported hypertension is frequently used for health surveillance. However, little is known about the validity of self-reported hypertension among older Americans by nativity status. This study compared self-reported and measured hypertension among older black, white, and Hispanic Americans by nativity using the 2006 and 2008 Health and Retirement Study (n = 13,451). Sensitivity and specificity of self-reported hypertension were calculated using the Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure definition. Sensitivity was high among older blacks (88.9%), whites (82.8%), and Hispanics (84.0%), and both foreign-born (83.2%) and US-born (84.0%). Specificity was above 90% for both US-born and foreign-born, but higher for whites (92.8%) than blacks (86.0%). Despite the potential vulnerability of older foreign-born Americans, self-reported hypertension may be considered a reasonable estimate of hypertension status. Future research should confirm these findings in samples with a larger and more ethnically diverse foreign-born population.

PB - 14 VL - 14 UR - http://search.proquest.com.proxy.lib.umich.edu/docview/1022672464?accountid=14667http://mgetit.lib.umich.edu/?ctx_ver=Z39.88-2004andctx_enc=info:ofi/enc:UTF-8andrfr_id=info:sid/ProQ 3Aabiglobalandrft_val_fmt=info:ofi/fmt:kev:mtx:journalandrft.genre=articl IS - 4 N1 - Copyright - Springer Science Business Media, LLC 2012 Language of summary - English Location - United States--US Pages - 721-6 ProQuest ID - 1022672464 Document feature - References SubjectsTermNotLitGenreText - United States--US Last updated - 2012-07-11 Place of publication - New York Corporate institution author - White, Kellee; Avenda o, Mauricio; Capistrant, Benjamin D; Robin Moon, J; Liu, Sze Y; Maria Glymour, M DOI - 2699707771; 70149852; 53471; JIMH; 22109587; SPVLJIMH109031449549 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22109587?dopt=Abstract U3 - 22109587 U4 - Social policy/self assessed health/Hypertension/African-americans/Hispanics/Ethnic Interests ER - TY - JOUR T1 - The significance of education for mortality compression in the United States. JF - Demography Y1 - 2012 A1 - Dustin C. Brown A1 - Mark D Hayward A1 - Jennifer Karas Montez A1 - Robert A Hummer A1 - Chi-Tsun Chiu A1 - Mira M Hidajat KW - Aged KW - Aged, 80 and over KW - Aging KW - Educational Status KW - Female KW - Health Status Disparities KW - Humans KW - Life Expectancy KW - Male KW - Middle Aged KW - Mortality KW - Mortality, Premature KW - Sex Distribution KW - Socioeconomic factors KW - United States AB -

Recent studies of old-age mortality trends assess whether longevity improvements over time are linked to increasing compression of mortality at advanced ages. The historical backdrop of these studies is the long-term improvement in a population's socioeconomic resources that fueled longevity gains. We extend this line of inquiry by examining whether socioeconomic differences in longevity within a population are accompanied by old-age mortality compression. Specifically, we document educational differences in longevity and mortality compression for older men and women in the United States. Drawing on the fundamental cause of disease framework, we hypothesize that both longevity and compression increase with higher levels of education and that women with the highest levels of education will exhibit the greatest degree of longevity and compression. Results based on the Health and Retirement Study and the National Health Interview Survey Linked Mortality File confirm a strong educational gradient in both longevity and mortality compression. We also find that mortality is more compressed within educational groups among women than men. The results suggest that educational attainment in the United States maximizes life chances by delaying the biological aging process.

PB - 49 VL - 49 UR - http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=2712630621andFmt=7andclientId=17822andRQT=309andVName=PQD IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22556045?dopt=Abstract U2 - PMC3500099 U4 - Studies/Socioeconomic factors/Mortality/Educational attainment/Gender differences ER - TY - JOUR T1 - Social isolation, loneliness and health among older adults. JF - J Aging Health Y1 - 2012 A1 - Caitlin E. Coyle A1 - Dugan, Elizabeth KW - Aged KW - Cross-Sectional Studies KW - Diagnostic Self Evaluation KW - Female KW - Health Status KW - Humans KW - Logistic Models KW - Loneliness KW - Male KW - Mental Disorders KW - Middle Aged KW - Risk Factors KW - social isolation AB -

OBJECTIVE: To examine the relationship of social isolation, loneliness and health outcomes among older adults.

METHODS: Using data from the Leave Behind Questionnaire of the Health and Retirement Study (2006 and 2008), (n = 11,825) several indicators of social isolation were scaled and the Hughes 3-Item Loneliness Scale was used. Two measures of health (self-rated health and mental health conditions) were examined using logistic regression.

RESULTS: Loneliness and social isolation were not highly correlated with one another (r = 0.201, p = 0.000). Loneliness was associated with higher odds of having a mental health problem (OR: 1.17; CI: [1.13, 1.21], p = 0.000); and isolation was associated with higher odds of reporting one's health as being fair/poor (OR:1.39; CI: [1.21, 1.59], p = 0.000).

DISCUSSION: The results suggest that global measures of isolation, that fail to distinguish between social isolation and feelings of loneliness, may not detect the impact on physical and mental health in older adults.

PB - 24 VL - 24 IS - 8 U1 - http://www.ncbi.nlm.nih.gov/pubmed/23006425?dopt=Abstract U4 - psychosocial/social isolation/health outcomes/SELF-RATED HEALTH/health Status/mental and emotional health problems/Health behavior/loneliness/Risk factors ER - TY - JOUR T1 - Spousal caregiving and incident hypertension. JF - Am J Hypertens Y1 - 2012 A1 - Benjamin D Capistrant A1 - J Robin Moon A1 - M. Maria Glymour KW - Activities of Daily Living KW - Aged KW - Cardiovascular Diseases KW - Caregivers KW - Female KW - Follow-Up Studies KW - Humans KW - Hypertension KW - Male KW - Memory Disorders KW - Middle Aged KW - Odds Ratio KW - Spouses KW - Stress, Psychological AB -

BACKGROUND: Caring for one's spouse has been associated with poor health, including risk of cardiovascular disease (CVD) onset and mortality. However, few studies have assessed the risk of incident hypertension associated with spousal caregiving. This paper investigates this association in a large, nationally representative sample of American older adults.

METHODS: Married, hypertension-free, Health and Retirement Study (HRS) respondents aged 50+ in 2000, (n = 5,708) were followed up to 8 years (1,708 new self-reported hypertension diagnoses). Current caregiving exposure was defined as assisting a spouse with instrumental or basic activities of daily living (IADLs) 14+ h/week; we define providing ≥14 h/week of care at two consecutive biennial surveys as "long-term caregiving." We used inverse probability weighted discrete-time hazard models with time-updated exposure and covariates to estimate effects of current and long-term caregiving on incident hypertension. We tested for effect modification by race, gender, and recipient memory illness. Sensitivity analyses restricted to respondents whose spouses had care needs.

RESULTS: After adjusting for demographic, socioeconomic, and health factors, (including risk behaviors, comorbid conditions, and self-rated health), current caregiving significantly predicted hypertension incidence (risk ratio (RR) = 1.36, 95% confidence interval (CI): 1.01, 1.83). For long-term caregivers, there was significant evidence of risk of hypertension onset associated with caregiving (RR = 2.29, 95% CI: 1.17, 4.49). The risk of hypertension onset associated with both current and long-term caregiving did not vary by race, gender, or recipient memory illness diagnosis. Sensitivity analyses supported the primary findings.

CONCLUSIONS: Providing IADL care to a spouse significantly predicted hypertension onset in a nationally representative sample of US adults.

PB - 25 VL - 25 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22189941?dopt=Abstract U3 - 22189941 U4 - ADL/IADL/caregiving/Spousal death/Spousal death/Hypertension/mortality/Hazard model ER - TY - JOUR T1 - Spurious inferences about long-term outcomes: the case of severe sepsis and geriatric conditions. JF - Am J Respir Crit Care Med Y1 - 2012 A1 - Theodore J Iwashyna A1 - Netzer, Giora A1 - Kenneth M. Langa A1 - Christine T Cigolle KW - Aged KW - Aged, 80 and over KW - Body Mass Index KW - Chronic pain KW - Cohort Studies KW - Comorbidity KW - Critical Illness KW - Disabled Persons KW - disease progression KW - Female KW - Geriatric Assessment KW - Hearing Disorders KW - Hospitalization KW - Humans KW - Incidence KW - Male KW - Musculoskeletal Diseases KW - Prognosis KW - Retrospective Studies KW - Risk Assessment KW - Sepsis KW - Survival Analysis KW - Survivors KW - Thinness KW - Time KW - Treatment Outcome KW - Urinary incontinence KW - Vision Disorders AB -

RATIONALE: Survivors of critical illness suffer significant limitations and disabilities.

OBJECTIVES: Ascertain whether severe sepsis is associated with increased risk of so-called geriatric conditions (injurious falls, low body mass index [BMI], incontinence, vision loss, hearing loss, and chronic pain) and whether this association is measured consistently across three different study designs.

METHODS: Patients with severe sepsis were identified in the Health and Retirement Study, a nationally representative cohort interviewed every 2 years, 1998 to 2006, and in linked Medicare claims. Three comparators were used to assess an association of severe sepsis with geriatric conditions in survivors: the prevalence in the United States population aged 65 years and older, survivors' own pre-sepsis levels assessed before hospitalization, or survivors' own pre-sepsis trajectory.

MEASUREMENTS AND MAIN RESULTS: Six hundred twenty-three severe sepsis hospitalizations were followed a median of 0.92 years. When compared with the 65 years and older population, surviving severe sepsis was associated with increased rates of low BMI, injurious falls, incontinence, and vision loss. Results were similar when comparing survivors to their own pre-sepsis levels. The association of low BMI and severe sepsis persisted when controlling for patients' pre-sepsis trajectories, but there was no association of severe sepsis with injurious falls, incontinence, vision loss, hearing loss, and chronic pain after such controls.

CONCLUSIONS: Geriatric conditions are common after severe sepsis. However, severe sepsis is associated with increased rates of only a subset of geriatric conditions, not all. In studying outcomes after acute illness, failing to measure and control for both preillness levels and trajectories may result in erroneous conclusions.

PB - 185 VL - 185 IS - 8 N1 - Iwashyna, Theodore J Netzer, Giora Langa, Kenneth M Cigolle, Christine K08 AG031837/AG/NIA NIH HHS/ K08 HL091249/HL/NHLBI NIH HHS/ K12 RR023250/RR/NCRR NIH HHS/ P30-AG028747/AG/NIA NIH HHS/ P60 DK-20572/DK/NIDDK NIH HHS/ R01 AG030155/AG/NIA NIH HHS/ U01 AG09740/AG/NIA NIH HHS/ UL1RR024986/RR/NCRR NIH HHS/ Am J Respir Crit Care Med. 2012 Apr 15;185(8):835-41. Epub 2012 Feb 9. U1 - http://www.ncbi.nlm.nih.gov/pubmed/22323301?dopt=Abstract U2 - PMC3360570 U4 - Body Mass Index/Cohort Studies/Comorbidity/DISABILITY/DISABILITY/Geriatric Assessment/Hearing Disorders/Hospitalization/Musculoskeletal Diseases/Risk Assessment/Sepsis/Survival Analysis/body Weight/Treatment Outcome/Urinary Incontinence/Vision Disorders ER - TY - JOUR T1 - Stability and change in financial transfers from adult children to older parents. JF - Can J Aging Y1 - 2012 A1 - Maximiliane E Szinovacz A1 - Adam Davey KW - Adult children KW - Aged KW - Female KW - Financial Support KW - Humans KW - Male KW - Middle Aged KW - Parent-Child Relations KW - Parents AB -

We sought to identify the extent and predictors of longitudinal changes in adult children's financial assistance to parents and in transfer networks over a two-year period. Analyses rely on pooled data from 1994 to 2000 of the Health and Retirement Study, using families in which adult children with no more than four siblings financially supported parents over two years. Change in the help network occurred in about 40 per cent of these families over the two-year period. When change occurred, it most commonly involved cessation of support by a child, followed by addition of another child to the network, whereas exchange of supporting children was relatively rare. Change reflected children's ability to provide care and the burden created by parents' needs. However, the size and composition of the adult-child network and of the initial support group also played an important role. Results highlight the dynamic and systemic nature of intergenerational financial networks.

PB - 31 VL - 31 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/23217582?dopt=Abstract U4 - Financial assistance/intergenerational Transfers/parent Child Relations/adult Children/help network 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 - Subjective social status and functional decline in older adults. JF - J Gen Intern Med Y1 - 2012 A1 - Bonnie Chen A1 - Kenneth E Covinsky A1 - Irena Cenzer A1 - Nancy E Adler A1 - Brie A Williams KW - Activities of Daily Living KW - Aged KW - Aging KW - Female KW - Health Status Disparities KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Mobility Limitation KW - Risk Factors KW - Self Report KW - Social Class AB -

BACKGROUND: It is unknown whether subjective assessment of social status predicts health outcomes in older adults.

OBJECTIVE: To describe the relationship between subjective social status and functional decline in older adults.

DESIGN: Longitudinal cohort study.

SETTING: The Health and Retirement Study, a nationally representative survey of community-dwelling older adults (2004-2008).

PARTICIPANTS: Two thousand five hundred and twenty-three community-dwelling older adults.

MAIN MEASURES: Self-report of social status (SSS), categorized into three groups, reported by participants who marked a 10-rung ladder to represent where they stand in society. Four-year functional decline (new difficulty in any of five activities of daily living, mobility decline and/or death)

KEY RESULTS: Mean age was 64; 46% were male, 85% were white. At baseline, lower SSS was associated with being younger, unmarried, of nonwhite race/ethnicity, higher rates of chronic medical conditions and ADL impairment (P < 0.01). Over 4 years, 50% in the lowest SSS group declined in function, compared to the middle and highest groups (28% and 26%), P-trend <0.001. Those in the lowest rungs of SSS were at increased risk of 4-year functional decline (unadjusted RR = 1.91, CI 1.-9-2.46). The relationship between a subjective belief that one is worse off than others and functional decline persisted after serial adjustment for demographics, objective SES measures, and baseline health and functional status (RR 1.36, CI 1.08-1.73).

CONCLUSIONS: In older adults, the belief that one is in the lowest rungs of social status is a measure of socioeconomic distress and of significant risk for functional decline. These findings suggest that self-report of low subjective social status may give clinicians additional information about which older adults are at high risk for future functional decline.

VL - 27 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22215272?dopt=Abstract U2 - PMC3358399 U4 - health outcomes/socioeconomic Differences/social status/social status/functional decline/functional decline/ADL and IADL Impairments ER - TY - JOUR T1 - Tests and expenditures in the initial evaluation of peripheral neuropathy. JF - Arch Intern Med Y1 - 2012 A1 - Brian C. Callaghan A1 - Ryan J McCammon A1 - Kevin Kerber A1 - Xiao Xu A1 - Kenneth M. Langa A1 - Eva L Feldman KW - Aged KW - Antibodies, Antinuclear KW - Blood Cell Count KW - Blood Protein Electrophoresis KW - Blood Sedimentation KW - Brain KW - Diagnostic Tests, Routine KW - Electromyography KW - Female KW - Glucose Tolerance Test KW - Glycated Hemoglobin KW - Health Expenditures KW - Humans KW - International Classification of Diseases KW - Magnetic Resonance Imaging KW - Male KW - Medicare KW - Neural Conduction KW - Peripheral Nervous System Diseases KW - Quality Assurance, Health Care KW - Spine KW - Thyrotropin KW - United States KW - Vitamin B 12 AB -

BACKGROUND: Peripheral neuropathy is a common disorder in which an extensive evaluation is often unrevealing.

METHODS: We sought to define diagnostic practice patterns as an early step in identifying opportunities to improve efficiency of care. The 1996-2007 Health and Retirement Study Medicare claims-linked database was used to identify individuals with an incident diagnosis of peripheral neuropathy using International Classification of Diseases, Ninth Revision, codes and required no previous neuropathy diagnosis during the preceding 30 months. Focusing on 15 relevant tests, we examined the number and patterns of tests and specific test utilization 6 months before and after the incident neuropathy diagnosis. Medicare expenditures were assessed during the baseline, diagnostic, and follow-up periods.

RESULTS: Of the 12, 673 patients, 1031 (8.1%) received a new International Classification of Diseases, Ninth Revision, diagnosis of neuropathy and met the study inclusion criteria. Of the 15 tests considered, a median of 4 (interquartile range, 2-5) tests were performed, with more than 400 patterns of testing. Magnetic resonance imaging of the brain or spine was ordered in 23.2% of patients, whereas a glucose tolerance test was rarely obtained (1.0%). Mean Medicare expenditures were significantly higher in the diagnostic period than in the baseline period ($14,362 vs $8067, P < .001).

CONCLUSIONS: Patients diagnosed as having peripheral neuropathy typically undergo many tests, but testing patterns are highly variable. Almost one-quarter of patients receiving neuropathy diagnoses undergo high-cost, low-yield magnetic resonance imaging, whereas few receive low-cost, high-yield glucose tolerance tests. Expenditures increase substantially in the diagnostic period. More research is needed to define effective and efficient strategies for the diagnostic evaluation of peripheral neuropathy.

PB - 172 VL - 172 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22271119?dopt=Abstract U2 - PMC3694340 U4 - Peripheral neuropathy/Peripheral neuropathy/diagonistic practice patterns/health Services/Medicare/Medicare claims/glucose tolerance test 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 - Triggers of hospitalization for venous thromboembolism. JF - Circulation Y1 - 2012 A1 - Mary A M Rogers A1 - Deborah A Levine A1 - Neil Blumberg A1 - Scott A Flanders A1 - Vineet Chopra A1 - Kenneth M. Langa KW - Aged KW - Ambulatory Care Facilities KW - Comorbidity KW - Cross-Over Studies KW - Emergency Service, Hospital KW - Female KW - Hematinics KW - Home Care Services KW - Hospitalization KW - Humans KW - Immobilization KW - Incidence KW - Infections KW - Male KW - Medicare KW - Middle Aged KW - Office Visits KW - Postoperative Complications KW - Pulmonary Embolism KW - Risk Factors KW - Skilled Nursing Facilities KW - Transfusion Reaction KW - United States KW - Venous Thrombosis AB -

BACKGROUND: The rate of hospitalization for venous thromboembolism (VTE) is increasing in the United States. Although predictors of hospital-acquired VTE are well-known, triggers of VTE before hospitalization are not as clearly defined. The objective of this study was to evaluate triggers of hospitalization for VTE.

METHODS AND RESULTS: A case-crossover study was conducted. Subjects were participants in the Health and Retirement Study, a nationally representative sample of older Americans. Data were linked to Medicare files for hospital and nursing home stays, emergency department visits, outpatient visits including physician visits, and home health visits from years 1991 to 2007 (n=16 781). The outcome was hospitalization for venous thromboembolism (n=399). Exposures during the 90-day period before hospitalization for VTE were compared with exposures occurring in 4 comparison periods. Infection was the most common trigger of hospitalization for VTE, occurring in 52.4% of the risk periods before hospitalization. The adjusted incidence rate ratios (IRRs; 95% confidence interval) were 2.90 (2.13, 3.94) for all infection, 2.63 (1.90, 3.63) for infection without a previous hospital or skilled nursing facility stay, and 6.92 (4.46, 10.72) for infection with a previous hospital or skilled nursing facility stay. Erythropoiesis-stimulating agents and blood transfusion were also associated with VTE hospitalization (IRR=9.33, 95% confidence interval: 1.19, 73.42; IRR=2.57, 95% confidence interval: 1.17, 5.64; respectively). Other predictors included major surgeries, fractures (IRR=2.81), immobility (IRR=4.23), and chemotherapy (IRR=5.70). These predictors, combined, accounted for a large proportion (69.7%) of exposures before VTE hospitalization as opposed to 35.3% in the comparison periods.

CONCLUSIONS: Risk prediction algorithms for VTE should be reevaluated to include infection, erythropoiesis-stimulating agents, and blood transfusion.

PB - 125 VL - 125 UR - http://www.ncbi.nlm.nih.gov/pubmed/22474264 IS - 17 N1 - Rogers, Mary A M Levine, Deborah A Blumberg, Neil Flanders, Scott A Chopra, Vineet Langa, Kenneth M 5R21HL093129-02/HL/NHLBI NIH HHS/ R01 HL095467/HL/NHLBI NIH HHS/ U01AG009740/AG/NIA NIH HHS/ Circulation. 2012 May 1;125(17):2092-9. Epub 2012 Apr 3. U1 - http://www.ncbi.nlm.nih.gov/pubmed/22474264?dopt=Abstract U2 - PMC3342773 U4 - medicare claims/HOSPITALIZATION/venous thromboembolism/pulmonary embolism ER - TY - JOUR T1 - Variation in cognitive functioning as a refined approach to comparing aging across countries. JF - Proc Natl Acad Sci U S A Y1 - 2012 A1 - Skirbekk, V. A1 - Loichinger, E. A1 - Daniela Weber KW - Age Distribution KW - Aged KW - Aged, 80 and over KW - Aging KW - Cognition KW - Data collection KW - Databases as Topic KW - Humans KW - Internationality KW - Male KW - Middle Aged AB -

Comparing the burden of aging across countries hinges on the availability of valid and comparable indicators. The Old Age Dependency Ratio allows only a limited assessment of the challenges of aging, because it does not include information on any individual characteristics except age itself. Existing alternative indicators based on health or economic activity suffer from measurement and comparability problems. We propose an indicator based on age variation in cognitive functioning. We use newly released data from standardized tests of seniors' cognitive abilities for countries from different world regions. In the wake of long-term advances in countries' industrial composition, and technological advances, the ability to handle new job procedures is now of high and growing importance, which increases the importance of cognition for work performance over time. In several countries with older populations, we find better cognitive performance on the part of populations aged 50+ than in countries with chronologically younger populations. This variation in cognitive functioning levels may be explained by the fact that seniors in some regions of the world experienced better conditions during childhood and adult life, including nutrition, duration and quality of schooling, lower exposure to disease, and physical and social activity patterns. Because of the slow process of cohort replacement, those countries whose seniors already have higher cognitive levels today are likely to continue to be at an advantage for several decades to come.

PB - 109 VL - 109 IS - 3 N1 - Skirbekk, Vegard Loichinger, Elke Weber, Daniela 2R01AG017644/AG/NIA NIH HHS/United States 2R01AG7644-01A1/AG/NIA NIH HHS/United States P01 AG005842/AG/NIA NIH HHS/United States P01 AG08291/AG/NIA NIH HHS/United States P30 AG12815/AG/NIA NIH HHS/United States R21 AG025169/AG/NIA NIH HHS/United States U01 AG09740-13S2/AG/NIA NIH HHS/United States U01AG009740/AG/NIA NIH HHS/United States Y1-AG-4553-01/AG/NIA NIH HHS/United States Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't United States Proc Natl Acad Sci U S A. 2012 Jan 17;109(3):770-4. Epub 2011 Dec 19. U1 - http://www.ncbi.nlm.nih.gov/pubmed/22184241?dopt=Abstract U2 - PMC3271876 U4 - Age Distribution/Aged, 80 and over/Aging/ physiology/Aging/ physiology/Cognition/ physiology/Cognition/ physiology/Data Collection/Middle Aged/Cross Cultural Comparison ER - TY - JOUR T1 - Aging in a cultural context: cross-national differences in disability and the moderating role of personal control among older adults in the United States and England. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2011 A1 - Philippa J Clarke A1 - Jacqui Smith KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Aging KW - Cross-Cultural Comparison KW - Culture KW - Disabled Persons KW - England KW - Female KW - Gait KW - Health Status KW - Humans KW - Internal-External Control KW - Longitudinal Studies KW - Male KW - Mobility Limitation KW - Politics KW - Social Values KW - Socioeconomic factors KW - United States AB -

OBJECTIVES: We investigate cross-national differences in late-life health outcomes and focus on an intriguing difference in beliefs about personal control found between older adult populations in the U.K. and United States. We examine the moderating role of control beliefs in the relationship between physical function and self-reported difficulty with daily activities.

METHOD: Using national data from the United States (Health and Retirement Study) and England (English Longitudinal Study on Ageing), we examine the prevalence in disability across the two countries and show how it varies according to the sense of control. Poisson regression was used to examine the relationship between objective measures of physical function (gait speed) and disability and the modifying effects of control.

RESULTS: Older Americans have a higher sense of personal control than the British, which operates as a psychological resource to reduce disability among older Americans. However, the benefits of control are attenuated as physical impairments become more severe.

DISCUSSION: These results emphasize the importance of carefully considering cross-national differences in the disablement process as a result of cultural variation in underlying psychosocial resources. This paper highlights the role of culture in shaping health across adults aging in different sociopolitical contexts.

PB - 66B VL - 66 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21666145?dopt=Abstract U2 - PMC3132269 U4 - Older people/Disability/Disability/Aging/International comparisons/Self control 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 - Is the apolipoprotein e genotype a biomarker for mild cognitive impairment? Findings from a nationally representative study. JF - Neuropsychology Y1 - 2011 A1 - Brainerd, Charles J A1 - V. F. Reyna A1 - Ronald C Petersen A1 - Glenn E Smith A1 - Taub, Emily S KW - Aged KW - Aged, 80 and over KW - Aging KW - Analysis of Variance KW - Apolipoprotein E4 KW - Cognitive Dysfunction KW - Dementia KW - Female KW - Gene Frequency KW - Genetic Markers KW - Genetic Testing KW - Genotype KW - Humans KW - Male KW - National Institute on Aging (U.S.) KW - Neuropsychological tests KW - Reference Values KW - Reproducibility of Results KW - Risk Factors KW - United States AB -

OBJECTIVE: Although the ε4 allele of the apolipoprotein E (APOE) genotype is a known risk factor for Alzheimer's dementia (AD), prior findings on whether it is also a risk factor for mild cognitive impairment (MCI) have been inconsistent. We tested two contrasting explanations: (a) an ε4-AD specificity hypothesis, and (b) a measurement insensitivity hypothesis.

METHOD: The frequency of the ε4 allele was investigated in older adults (mean age > 70) with various types of cognitive impairment (including MCI) and various types of dementia (including AD) with the aging, demographics, and memory study (ADAMS) of the National Institute on Aging's Health and Retirement Study (HRS). The ADAMS controls sources of Type I and Type II error that are posited in the ε4-AD specificity hypothesis and the measurement insensitivity hypothesis, and it is the only nationally representative data set on aging and cognitive impairment.

RESULTS: ε4 was a reliable predictor of MCI, with a frequency of 32% in MCI subjects versus 20% in healthy control subjects. This link was specific to MCI because ε4 was not a risk factor for other forms of cognitive impairment without dementia.

CONCLUSIONS: The results support the measurement insensitivity hypothesis rather than the ε4-AD specificity hypothesis and are consistent with recent research showing modest reductions in cognitive performance among normal functioning ε4 carriers.

PB - 25 VL - 25 IS - 6 N1 - Brainerd, Charles J Reyna, Valerie F Petersen, Ronald C Smith, Glenn E Taub, Emily S 1RC1AG036915-01/AG/NIA NIH HHS/United States U01AG009740/AG/NIA NIH HHS/United States Research Support, N.I.H., Extramural United States Neuropsychology. 2011 Nov;25(6):679-89. U1 - http://www.ncbi.nlm.nih.gov/pubmed/21728427?dopt=Abstract U3 - 21728427 U4 - Aging/Analysis of Variance/Apolipoprotein E4/genetics/genetics/Dementia/Gene Frequency/Genetic Markers/Genetic Testing/Genotype/Mild Cognitive Impairment/Neuropsychological Tests/Reference Values/Reproducibility of Results/Risk Factors/Alzheimer disease/epsilon4 allele 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 - Can Food Stamps help to reduce Medicare spending on diabetes? JF - Econ Hum Biol Y1 - 2011 A1 - Lauren Hersch Nicholas KW - Aged KW - Aged, 80 and over KW - Biomarkers KW - Confidence Intervals KW - Cross-Sectional Studies KW - Diabetes Mellitus KW - Female KW - Glycated Hemoglobin KW - Health Care Costs KW - Humans KW - Longitudinal Studies KW - Male KW - Medicare KW - Middle Aged KW - Odds Ratio KW - Outpatients KW - Poverty KW - Prevalence KW - Public Assistance KW - Regression Analysis KW - Social Welfare KW - Treatment Outcome KW - United States AB -

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

PB - 9 VL - 9 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21112260?dopt=Abstract U2 - PMC3032985 U4 - Diabetes/Food Stamps/biomarker data/elderly/Medicare spending/HbA1c/Public Policy ER - TY - JOUR T1 - Caregiver burden and neuropsychiatric symptoms in older adults with cognitive impairment: the Aging, Demographics, and Memory Study (ADAMS). JF - Alzheimer Dis Assoc Disord Y1 - 2011 A1 - Okura, Toru A1 - Kenneth M. Langa KW - Aged KW - Aged, 80 and over KW - Caregivers KW - Cognition Disorders KW - Cost of Illness KW - Cross-Sectional Studies KW - Female KW - Humans KW - Male KW - Neuropsychological tests AB -

OBJECTIVES: To estimate the quantity of informal care associated with neuropsychiatric symptoms in older adults with cognitive impairment.

DESIGN: Cross-sectional analysis.

SETTING: The Aging, Demographics, and Memory Study.

PARTICIPANTS: A sample (n=450) of adults aged 71 years and older with cognitive impairment drawn form the Health and Retirement Study.

MEASUREMENTS: The presence of neuropsychiatric symptoms (delusions, hallucinations, agitation, depression, apathy, elation, anxiety, disinhibition, irritation, and aberrant motor behaviors) was identified using the neuropsychiatric inventory. Cognitive category [normal, cognitive impairment without dementia (CIND), or dementia] was assigned by a consensus panel. The hours per week of active help and supervision were ascertained by informant questionnaire.

RESULTS: Among older adults with CIND or dementia, those with no neuropsychiatric symptoms received an average of 10.2 hours of active help and 10.9 hours of supervision per week from informal caregivers. Those with 1 or 2 neuropsychiatric symptoms received an additional 10.0 hours of active help and 12.4 hours of supervision per week, while those with 3 or more symptoms received an additional 18.2 hours of active help and 28.7 hours of supervision per week (P<0.001). The presence of irritation (14.7 additional hours) was associated with the greatest number of additional hours of active help. The presence of aberrant motor behaviors (17.7 additional hours) and disinhibition (17.5 additional hours) were associated with the greatest number of additional hours of supervision.

CONCLUSIONS: Neuropsychiatric symptoms among those with CIND or dementia are associated with a significant increase in the provision of informal care. This care represents a significant time commitment for families and a significant economic cost to society.

PB - 25 VL - 25 IS - 2 N1 - Okura, Toru Langa, Kenneth M R01 AG027010/AG/NIA NIH HHS/United States R01 AG030155-01/AG/NIA NIH HHS/United States R01 AG030155-02/AG/NIA NIH HHS/United States R01 AG030155-03/AG/NIA NIH HHS/United States R01 AG030155-04/AG/NIA NIH HHS/United States R01 AG030155-05/AG/NIA NIH HHS/United States U01 AG09740/AG/NIA NIH HHS/United States Research Support, N.I.H., Extramural United States Alzheimer disease and associated disorders Nihms259646 Alzheimer Dis Assoc Disord. 2011 Apr-Jun;25(2):116-21. U1 - http://www.ncbi.nlm.nih.gov/pubmed/21192239?dopt=Abstract U2 - PMC3100441 U4 - Aged, 80 and over/Caregivers/ statistics/Caregivers/ statistics/numerical data/Cognition Disorders/ psychology/Cognition Disorders/ psychology/Cost of Illness/Cross-Sectional Studies/Female/Humans/Neuropsychological Tests ER - TY - JOUR T1 - Caring for individuals with dementia and cognitive impairment, not dementia: findings from the aging, demographics, and memory study. JF - J Am Geriatr Soc Y1 - 2011 A1 - Gwenith G Fisher A1 - Melissa M Franks A1 - Brenda L Plassman A1 - Stephanie Brown A1 - Guy G Potter A1 - David J Llewellyn A1 - Mary A M Rogers A1 - Kenneth M. Langa KW - Activities of Daily Living KW - Aged KW - Analysis of Variance KW - Caregivers KW - Cognition Disorders KW - Cross-Sectional Studies KW - Dementia KW - Female KW - Humans KW - Linear Models KW - Male KW - Neuropsychological tests KW - Time Factors KW - United States AB -

OBJECTIVES: To compare the characteristics and outcomes of caregivers of adults with dementia with those of caregivers of adults with cognitive impairment, not dementia (CIND).

DESIGN: Cross-sectional.

SETTING: In-home assessment for cognitive impairment and self-administered caregiving questionnaire.

PARTICIPANTS: One hundred sixty-nine primary family caregivers of participants in the Aging, Demographics, and Memory Study (ADAMS). ADAMS participants were aged 71 and older drawn from the nationally representative Health and Retirement Study.

MEASUREMENTS: Neuropsychological testing, neurological examination, clinical assessment, and medical history were used to assign a diagnosis of normal cognition, CIND, or dementia. Caregiving measures included caregiving time, functional limitations, depressive symptoms, physical and emotional strain, caregiving rewards, caregiver health, and demographic characteristics.

RESULTS: Dementia caregivers spent approximately 9 hours per day providing care, compared with 4 hours per day for CIND caregivers (P=.001). Forty-four percent of dementia caregivers exhibited depressive symptoms, compared with 26.5% of CIND caregivers (P=.03). Physical and emotional strains were similar in both groups of caregivers. Regardless of the strains, nearly all caregivers reported some benefits from providing care. Behavioral problems (P=.01) and difficulty with instrumental activities of daily living (P=.01) in persons with CIND partially explained emotional strain experienced by CIND caregivers. For those with dementia, behavioral problems predicted caregiver emotional strain (P<.001) and depressive symptoms (P=.01).

CONCLUSION: Although support services are available to dementia caregivers, CIND caregivers also expend considerable time and experience strains. The real caregiver burden of cognitive impairment in the U.S. population may therefore be greatly underestimated if people who have reached the diagnostic threshold for dementia are focused on exclusively.

PB - 59 VL - 59 UR - http://onlinelibrary.wiley.com/doi/10.1111/j.1532-5415.2010.03304.x/full IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21391939?dopt=Abstract U2 - PMC3646395 U4 - Activities of Daily Living/Analysis of Variance/Caregivers/ psychology/Caregivers/ psychology/Cognition Disorders/ nursing/Cognition Disorders/ nursing/Cross-Sectional Studies/Dementia/ nursing/Dementia/ nursing/Female/Humans/Linear Models/Linear Models/Neuropsychological Tests/Time Factors 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 - Chronic diseases and functional limitations among older construction workers in the United States: a 10-year follow-up study. JF - J Occup Environ Med Y1 - 2011 A1 - Xiuwen S Dong A1 - Wang, Xuanwen A1 - Daw, Christina A1 - Ringen, Knut KW - Aged KW - Aging KW - Arthritis KW - Chronic disease KW - Disabled Persons KW - Facility Design and Construction KW - Follow-Up Studies KW - Humans KW - Lung Diseases KW - Male KW - Middle Aged KW - Occupational Diseases KW - Occupations KW - United States AB -

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

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

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

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

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

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

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

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

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

PB - 30 VL - 30 IS - 5 N1 - Hill, Patrick L Turiano, Nicholas A Hurd, Michael D Mroczek, Daniel K Roberts, Brent W R01 AG021178-09/AG/NIA NIH HHS/United States United States Health psychology : official journal of the Division of Health Psychology, American Psychological Association Health Psychol. 2011 Sep;30(5):536-41. U1 - http://www.ncbi.nlm.nih.gov/pubmed/21604882?dopt=Abstract U2 - PMC3587967 U4 - Adult/Chronic Disease/mortality/psychology/Chronic Disease/mortality/psychology/Cognition/Educational Status/Female/Health Behavior/Health Status/Humans/Longevity/Longitudinal Studies/Middle Aged/Personality/Personality/Proportional Hazards Models/Psychological Tests ER - TY - JOUR T1 - Consequences of stroke in community-dwelling elderly: the health and retirement study, 1998 to 2008. JF - Stroke Y1 - 2011 A1 - Afshin A Divani A1 - Shahram Majidi A1 - Anna M Barrett A1 - Noorbaloochi, Siamak A1 - Andreas R Luft KW - Activities of Daily Living KW - Aged KW - Case-Control Studies KW - Cohort Studies KW - Comorbidity KW - Female KW - Geriatrics KW - Humans KW - Male KW - Quality of Life KW - Retirement KW - Risk KW - Social Environment KW - Stroke AB -

BACKGROUND AND PURPOSE: Stroke survivors are at risk of developing comorbidities that further reduce their quality of life. The purpose of this study was to determine the risk of developing a secondary health problem after stroke.

METHODS: We performed a case-control analysis using 6 biennial interview waves (1998 to 2008) of the Health and Retirement Study. We compared 631 noninstitutionalized individuals who had a single stroke with 631 control subjects matched for age, gender, and interview wave. We studied sleep problems, urinary incontinence, motor impairment, falls, and memory deficits among the 2 groups.

RESULTS: Stroke survivors frequently developed new or worsened motor impairment (33%), sleep problems (up to 33%), falls (30%), urinary incontinence (19%), and memory deficits (9%). As compared with control subjects, the risk of developing a secondary health problem was highest for memory deficits (OR, 2.45; 95% CI, 1.34 to 4.46) followed by urinary incontinence (OR, 1.86; 95% CI, 1.31 to 2.66), motor impairment (OR, 1.61; 95% CI, 1.16 to 2.24), falls (OR, 1.5; 95% CI, 1.12 to 2.0), and sleep disturbances (OR, 1.49; 95% CI, 1.09 to 2.03). In contrast, stroke survivors were not more likely to injure themselves during a fall (OR, 1.14; 95% CI, 0.72 to 1.79). After adjusting for cardiovascular risk factors, social status, psychiatric symptoms, and pain, the risks of falling or developing sleep problems were not different from the control subjects.

CONCLUSIONS: The risk of developing a secondary health problem that can impact daily life is markedly increased after stroke. A better understanding of frequencies and risks for secondary health problems after stroke is necessary for designing better preventive and rehabilitation strategies.

PB - 42 VL - 42 IS - 7 N1 - Divani, Afshin A Majidi, Shahram Barrett, Anna M Noorbaloochi, Siamak Luft, Andreas R K24 HD062647-01/HD/NICHD NIH HHS/United States K24 HD062647-02/HD/NICHD NIH HHS/United States K24HD062647/HD/NICHD NIH HHS/United States R01 NS055808/NS/NINDS NIH HHS/United States R01 NS055808-01A2/NS/NINDS NIH HHS/United States R01 NS055808-02/NS/NINDS NIH HHS/United States R01 NS055808-03/NS/NINDS NIH HHS/United States R01 NS055808-04/NS/NINDS NIH HHS/United States Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't United States Stroke; a journal of cerebral circulation Nihms297056 Stroke. 2011 Jul;42(7):1821-5. Epub 2011 May 19. U1 - http://www.ncbi.nlm.nih.gov/pubmed/21597018?dopt=Abstract U2 - PMC3125444 U4 - Activities of Daily Living/Case-Control Studies/Case-Control Studies/Cohort Studies/Comorbidity/Female/Geriatrics/methods/Geriatrics/methods/Humans/Quality of Life/Retirement/Social Environment/Stroke/ complications/ epidemiology/Stroke/ complications/ epidemiology ER - TY - JOUR T1 - Depression and the onset of chronic illness in older adults: a 12-year prospective study. JF - J Behav Health Serv Res Y1 - 2011 A1 - Mustafa C. Karakus A1 - Lisa C Patton KW - Activities of Daily Living KW - Age Distribution KW - Aged KW - Chronic disease KW - depression KW - Female KW - Follow-Up Studies KW - Humans KW - Male KW - Middle Aged KW - Prospective Studies KW - Psychiatric Status Rating Scales KW - Risk Factors KW - Sex Distribution KW - Socioeconomic factors KW - United States AB -

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

PB - 38 VL - 38 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21293976?dopt=Abstract U4 - Chronic illnesses/Older people/Correlation analysis/Mental depression/Experiment/theoretical treatment/Health care industry ER - TY - JOUR T1 - Determinants of death in the hospital among older adults. JF - J Am Geriatr Soc Y1 - 2011 A1 - Amy Kelley A1 - Susan L Ettner A1 - Neil S. Wenger A1 - Catherine A Sarkisian KW - Aged KW - Aged, 80 and over KW - Female KW - Hospital Mortality KW - Humans KW - Male KW - Multivariate Analysis KW - Risk Factors KW - Socioeconomic factors AB -

OBJECTIVES: To investigate patient-level determinants of in-hospital death, adjusting for patient and regional characteristics.

DESIGN: Using multivariable regression, the relationship between in-hospital death and participants' social, functional, and health characteristics was investigated, controlling for regional Hospital Care Intensity Index (HCI) from the Dartmouth Atlas of Health Care.

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

PARTICIPANTS: People aged 67 and older who died between 2,000 and 2,006 (N = 3,539) were sampled.

MEASUREMENTS: In-hospital death.

RESULTS: Thirty-nine percent (n = 1,380) of participants died in the hospital (range 34% in Midwest to 45% in Northeast). Nursing home residence, functional dependence, and cancer or dementia diagnosis, among other characteristics, were associated with lower adjusted odds of in-hospital death. Being black or Hispanic, living alone, and having more medical comorbidities were associated with greater adjusted odds, as was higher HCI. Sex, education, net worth, and completion of an advance directive did not correlate with in-hospital death.

CONCLUSION: Black race, Hispanic ethnicity, and other functional and social characteristics are correlates of in-hospital death, even after controlling for the role of HCI. Further work must be done to determine whether preferences, provider characteristics and practice patterns, or differential access to medical and community services drive this difference.

PB - 59 VL - 59 IS - 12 N1 - Kelley, Amy S Ettner, Susan L Wenger, Neil S Sarkisian, Catherine A United States Journal of the American Geriatrics Society J Am Geriatr Soc. 2011 Dec;59(12):2321-5. doi: 10.1111/j.1532-5415.2011.03718.x. Epub 2011 Nov 8. U1 - http://www.ncbi.nlm.nih.gov/pubmed/22092014?dopt=Abstract U3 - 22092014 U4 - in-hospital death/in-hospital death/COMORBIDITY/African American/hispanic/Hospital Mortality/Hospital Mortality/Hospital Care Intensity Index/Hospital Care Intensity Index ER - TY - JOUR T1 - Determinants of medical expenditures in the last 6 months of life. JF - Annals of Internal Medicine Y1 - 2011 A1 - Amy Kelley A1 - Susan L Ettner A1 - R Sean Morrison A1 - Qingling Du A1 - Neil S. Wenger A1 - Catherine A Sarkisian KW - Aged KW - Aged, 80 and over KW - Chronic disease KW - Ethnic Groups KW - Female KW - Health Expenditures KW - Humans KW - Income KW - Independent Living KW - Male KW - Medicare KW - Regression Analysis KW - Social Support KW - Socioeconomic factors KW - Terminal Care KW - United States AB -

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

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

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

SETTING: United States, 2000 to 2006.

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

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

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

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

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

PRIMARY FUNDING SOURCE: The Brookdale Foundation.

VL - 154 IS - 4 ER - TY - JOUR T1 - Development and validation of a brief cognitive assessment tool: the sweet 16. JF - Arch Intern Med Y1 - 2011 A1 - Tamara G Fong A1 - Richard N Jones A1 - James L Rudolph A1 - Frances Margaret Yang A1 - Tommet, Douglas A1 - Habtemariam, Daniel A1 - Edward R Marcantonio A1 - Kenneth M. Langa A1 - Sharon K Inouye KW - Aged KW - Aged, 80 and over KW - Cognition Disorders KW - Cohort Studies KW - Dementia KW - Female KW - Humans KW - Male KW - Neuropsychological tests KW - Surveys and Questionnaires AB -

BACKGROUND: Cognitive impairment is often unrecognized among older adults. Meanwhile, current assessment instruments are underused, lack sensitivity, or may be restricted by copyright laws. To address these limitations, we created a new brief cognitive assessment tool: the Sweet 16.

METHODS: The Sweet 16 was developed in a cohort from a large post-acute hospitalization study (n=774) and compared with the Mini-Mental State Examination (MMSE). Equipercentile equating identified Sweet 16 cut points that correlated with widely used MMSE cut points. Sweet 16 performance characteristics were independently validated in a cohort from the Aging, Demographics, and Memory Study (n=709) using clinical consensus diagnosis, the modified Blessed Dementia Rating Scale, and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE).

RESULTS: The Sweet 16 correlated highly with the MMSE (Spearman r, 0.94; P<.001). Validated against the IQCODE, the area under the curve was 0.84 for the Sweet 16 and 0.81 for the MMSE (P=.06). A Sweet 16 score of less than 14 (approximating an MMSE score <24) demonstrated a sensitivity of 80% and a specificity of 70%, whereas an MMSE score of less than 24 showed a sensitivity of 64% and a specificity of 86% against the IQCODE. When compared with clinical diagnosis, a Sweet 16 score of less than 14 showed a sensitivity of 99% and a specificity of 72% in contrast to an MMSE score with a sensitivity of 87% and a specificity of 89%. For education of 12 years or more, the area under the curve was 0.90 for the Sweet 16 and 0.84 for the MMSE (P=.03).

CONCLUSIONS: The Sweet 16 is simple, quick to administer, and will be available open access. The performance of the Sweet 16 is equivalent or superior to that of the MMSE.

PB - 171 VL - 171 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21059967?dopt=Abstract U3 - 21059967 U4 - Older people/Cognition/reasoning/Correlation analysis/Medical diagnosis/Dementia/Hospitalization ER - TY - JOUR T1 - Is diabetes-specific health literacy associated with diabetes-related outcomes in older adults? JF - J Diabetes Y1 - 2011 A1 - Takashi Yamashita A1 - Cary S Kart KW - Adult KW - Aged KW - Aged, 80 and over KW - Blood Glucose KW - Diabetes Mellitus, Type 2 KW - Glycated Hemoglobin KW - Health Literacy KW - Humans KW - Logistic Models KW - Middle Aged KW - Multivariate Analysis KW - Self Care KW - Socioeconomic factors KW - Surveys and Questionnaires KW - United States AB -

BACKGROUND:  The present study examined the association between a measure of diabetes-specific health literacy and three different Type 2 diabetes outcome indicators in a national sample of older adults.

METHODS: Data were taken from the Health and Retirement Study (HRS) 2003 Diabetes module and the HRS 2002 core wave. Analysis was performed on data from 1318 respondents aged 42-96 years [mean (±SD) 67.96 ± 8.65 years] who submitted responses on all relevant independent variable measures along with an HbA1c test kit. The index of diabetes-specific health literacy was constructed from responses to 10 diabetes self-care regimen items (α = 0.927).

RESULTS: Using a multivariate regression strategy to analyze weighted data, the diabetes-specific health literacy index was significantly and positively associated with self-graded assessment of diabetes self-care (R2 = 0.231). However, diabetes-specific health literacy was not independently associated with the HbA1c level or the average number of days five recommended self-management behaviors were practiced each week.

CONCLUSIONS:  No previous single study has focused on the relationship between diabetes-specific health literacy and multiple diabetes-related outcomes. The direct association of diabetes-specific health literacy with patients' assessment of their self-care practice acumen is useful information for the design of effective patient intervention and/or communication strategies. Health literacy is a broad, multidimensional construct that bridges basic literacy skills and various health and illness contexts. Because it is so important to adults engaged in the self-management of chronic illness, indicators of disease-specific knowledge and/or understanding should be included in efforts to measure health literacy.

PB - 3 VL - 3 IS - 2 N1 - Yamashita, Takashi Kart, Cary S Australia Journal of diabetes J Diabetes. 2011 Jun;3(2):138-46. doi: 10.1111/j.1753-0407.2011.00112.x. U1 - http://www.ncbi.nlm.nih.gov/pubmed/21599867?dopt=Abstract U3 - 21599867 U4 - Aged, 80 and over/Blood Glucose/ metabolism/Blood Glucose/ metabolism/Diabetes Mellitus/Type 2 Diabetes/Health Literacy/Health Literacy/HbA1c/Logistic Models/Middle Aged/Multivariate Analysis/Self Care/methods/Self Care/methods/Socioeconomic Factors ER - TY - JOUR T1 - Differences in health between Americans and Western Europeans: Effects on longevity and public finance. JF - Soc Sci Med Y1 - 2011 A1 - Pierre-Carl Michaud A1 - Dana P Goldman A1 - Darius Lakdawalla A1 - Adam Gailey A1 - Yuhui Zheng KW - Activities of Daily Living KW - Adult KW - Aged KW - Body Mass Index KW - Cross-Cultural Comparison KW - Disabled Persons KW - Europe KW - Female KW - Health Expenditures KW - health policy KW - Health Status Disparities KW - Health Surveys KW - Humans KW - Internationality KW - Life Expectancy KW - Male KW - Middle Aged KW - Models, Economic KW - Models, Statistical KW - Mortality KW - Public Health KW - United States AB -

In 1975, 50-year-old Americans could expect to live slightly longer than most of their Western European counterparts. By 2005, American life expectancy had fallen behind that of most Western European countries. We find that this growing longevity gap is primarily due to real declines in the health of near-elderly Americans, relative to their Western European peers. We use a microsimulation approach to project what US longevity would look like, if US health trends approximated those in Western Europe. The model implies that differences in health can explain most of the growing gap in remaining life expectancy. In addition, we quantify the public finance consequences of this deterioration in health. The model predicts that gradually moving American cohorts to the health status enjoyed by Western Europeans could save up to $1.1 trillion in discounted total health expenditures from 2004 to 2050.

PB - 73 VL - 73 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21719178?dopt=Abstract U2 - PMC3383030 U4 - disability/disability/mortality/international comparisons/Cross-national/microsimulation/Europe/SHARE/ELSA_/longevity ER - TY - JOUR T1 - Dispositional optimism protects older adults from stroke: the Health and Retirement Study. JF - Stroke Y1 - 2011 A1 - Eric S Kim A1 - Nansook Park A1 - Christopher Peterson KW - Affect KW - Aged KW - Aged, 80 and over KW - Female KW - Follow-Up Studies KW - Humans KW - Incidence KW - Male KW - Middle Aged KW - Personality KW - Prospective Studies KW - Risk Factors KW - Stroke AB -

BACKGROUND AND PURPOSE: Although higher optimism has been linked to an array of positive health outcomes, the association between optimism and incidence of stroke remains unclear, especially among older adults. We examined whether higher optimism was associated with a lower incidence of stroke.

METHOD: Prospective data from the Health and Retirement Study--a nationally representative panel study of American adults aged>50 years--were used. Analyses were conducted for a 2-year follow-up on the subset of 6044 adults (2542 men, 3502 women) who were stroke-free at baseline. Analyses adjusted for chronic illnesses, self-rated health, and relevant sociodemographic, behavioral, biological, and psychological factors.

RESULTS: Higher optimism was associated with a lower risk of stroke. On an optimism measure ranging from 3 to 18, each unit increase in optimism was associated with an age-adjusted OR of 0.90 for stroke (95% CI, 0.84 to 0.97; P<0.01). The effect of optimism remained significant even after fully adjusting for a comprehensive set of sociodemographic, behavioral, biological, and psychological stroke risk factors.

CONCLUSIONS: Optimism may play an important role in protecting against stroke among older adults.

PB - 42 VL - 42 IS - 10 N1 - Kim, Eric S Park, Nansook Peterson, Christopher Research Support, Non-U.S. Gov't United States Stroke; a journal of cerebral circulation Stroke. 2011 Oct;42(10):2855-9. Epub 2011 Jul 21. U1 - http://www.ncbi.nlm.nih.gov/pubmed/21778446?dopt=Abstract U3 - 21778446 U4 - health outcomes/optimism/optimism/Chronic Disease/Self assessed health/sociodemographic factors/sociodemographic factors/risk Factors ER - TY - JOUR T1 - Does fall history influence residential adjustments? JF - Gerontologist Y1 - 2011 A1 - Leland, Natalie A1 - Frank Porell A1 - Susan L Murphy KW - Accidental Falls KW - Aged KW - Aged, 80 and over KW - Decision making KW - Environment Design KW - Female KW - Geriatric Assessment KW - Humans KW - Male KW - Residential Facilities KW - Risk Factors AB -

PURPOSE OF THE STUDY: To determine whether reported falls at baseline are associated with an older adult's decision to make a residential adjustment (RA) and the type of adjustment made in the subsequent 2 years.

DESIGN AND METHODS: Observations (n = 25,036) were from the Health and Retirement Study, a nationally representative sample of community-living older adults, 65 years of age and older. At baseline, fall history (no fall, 1 fall no injury, 2 or more falls no injury, or 1 or more falls with an injury) and factors potentially associated with RA were used to predict the initiation of an RA (i.e., moving, home modifications, increased use of adaptive equipment, family support, or personal care assistance) during the subsequent 2 years.

RESULTS: Compared with those with no history of falls, individuals with a history of falls had higher odds of making any RA. Among those making an RA, individuals with an injurious fall were more likely than those with no history of a fall to start using adaptive equipment or increase their use of personal care assistance.

IMPLICATIONS: The higher initiation of RAs among fallers may indicate proactive steps to prevent future falls and may be influenced by interactions with the health care system. To optimize fall prevention efforts, older adults would benefit from education and interventions addressing optimal use of RAs before falls occur.

PB - 51 VL - 51 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21047971?dopt=Abstract U2 - PMC3106369 U4 - Older people/Falls/Decision making/Health care ER - TY - JOUR T1 - Does informal care attenuate the cycle of ADL/IADL disability and depressive symptoms in late life? JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2011 A1 - Lin, I-Fen A1 - Wu, Hsueh-Sheng KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Caregivers KW - Cohort Studies KW - Cost of Illness KW - depression KW - Disability Evaluation KW - Female KW - Humans KW - Longitudinal Studies KW - Male KW - Models, Psychological KW - United States AB -

OBJECTIVE: Prior studies have extensively examined the reciprocal relation between disability and depressive symptoms in late life, but little is known about whether informal care attenuates the reciprocal relation over time. This study examined whether disability and depressive symptoms mobilize informal care and whether informal care, once mobilized, protects older adults against the progression of disability and depressive symptoms.

METHODS: The analysis was based on 6,454 community-dwelling older adults who were interviewed in one or more waves of the Health and Retirement Study between 1998 and 2006. Extending an autoregressive cross-lagged model, we constructed 3 cycles of the relations among disability, depressive symptoms, and informal care. Comparing the relations across 3 cycles informs us about the attenuating effect of informal care on the relation between disability and depressive symptoms over time.

RESULTS: Although older adults' disability and depressive symptoms mobilized informal care initially, worsening disability and depressive symptoms often exhausted support. Receipt of care generally increased, rather than decreased, disability and depressive symptoms, and the detrimental effects remained the same over time.

DISCUSSION: We need to better understand the linkage between disability and depressive symptoms and seek effective interventions to reduce caregiver strain and enhance care receivers' well-being.

PB - 66B VL - 66 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21746870?dopt=Abstract U2 - PMC3155031 U4 - Disability/Disability/Mental depression/Older people/Caregivers/Gerontology/Mobility ER - TY - JOUR T1 - Does self-reported health bias the measurement of health inequalities in U.S. adults? Evidence using anchoring vignettes from the Health and Retirement Study. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2011 A1 - Jennifer B Dowd A1 - Todd, Megan KW - Adult KW - Aged KW - Aged, 80 and over KW - Attitude to Health KW - Bias KW - Black People KW - Disability Evaluation KW - Educational Status KW - Female KW - Geriatric Assessment KW - Health Status Indicators KW - Health Surveys KW - Hispanic or Latino KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Socioeconomic factors KW - United States KW - White People AB -

OBJECTIVES: Measurement of health inequalities based on self-reports may be biased if individuals use response scales in systematically different ways. We use anchoring vignettes to test and adjust for reporting differences by education, race/ethnicity, and gender in self-reported health in 6 domains (pain, sleep, mobility, memory, shortness of breath, and depression).

METHOD: Using data from the 2006 U.S. Health and Retirement Study (HRS) and the 2007 Disability Vignette Survey, we estimated generalized ordered probit models of the respondent's rating of each vignette character's health problem, allowing cut-points to vary by age, gender, education, and race/ethnicity. We then used one-step hierarchical ordered probit (HOPIT) models to jointly estimate the respondent's cut-points from the vignettes and the severity of the respondent's own health problems based on these vignette cut-points.

RESULTS: We found strong evidence of reporting differences by age, gender, education, and race/ethnicity, with the magnitude depending on the specific health domain. Overall, traditional models not accounting for reporting differences underestimated the magnitude of health inequalities by education and race/ethnicity.

DISCUSSION: These results suggest caution in relying on self-reported health measures to quantify and explain health disparities by socioeconomic status and race/ethnicity/ethnicity in the United States. The findings support expansion of the use of anchoring vignettes to properly account for reporting differences in self-reports of health.

PB - 66B VL - 66 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21666144?dopt=Abstract U3 - 21666144 U4 - Health behavior/Medical research/Gerontology/Adults 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 - Dynamic links between memory and functional limitations in old age: longitudinal evidence for age-based structural dynamics from the AHEAD study. JF - Psychol Aging Y1 - 2011 A1 - Frank J Infurna A1 - Denis Gerstorf A1 - Lindsay H Ryan A1 - Jacqui Smith KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Aging KW - Cognition KW - depression KW - Female KW - Health Status KW - Humans KW - Interviews as Topic KW - Longitudinal Studies KW - Male KW - Memory KW - Memory Disorders KW - Memory, Episodic KW - Models, Statistical KW - Neuropsychological tests AB -

This study examined competing substantive hypotheses about dynamic (i.e., time-ordered) links between memory and functional limitations in old age. We applied the Bivariate Dual Change Score Model to 13-year longitudinal data from the Asset and Health Dynamics Among the Oldest Old Study (AHEAD; N = 6,990; ages 70 - 95). Results revealed that better memory predicted shallower increases in functional limitations. Little evidence was found for the opposite direction that functional limitations predict ensuing changes in memory. Spline models indicated that dynamic associations between memory and functional limitations were substantively similar between participants aged 70-79 and those aged 80-95. Potential covariates (gender, education, health conditions, and depressive symptoms) did not account for these differential lead-lag associations. Applying a multivariate approach, our results suggest that late-life developments in two key components of successful aging are intrinsically interrelated. Our discussion focuses on possible mechanisms why cognitive functioning may serve as a source of age-related changes in health both among the young-old and the old-old.

PB - 26 VL - 26 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21480716?dopt=Abstract U2 - PMC3575140 U4 - Memory/Aging/Cognitive ability/Multivariate analysis/Young adults/Personal health ER - TY - JOUR T1 - Education and health: evidence on adults with diabetes. JF - Int J Health Care Finance Econ Y1 - 2011 A1 - Padmaja Ayyagari A1 - Grossman, Daniel A1 - Frank A Sloan KW - Aged KW - Cognition KW - Cross-Sectional Studies KW - Diabetes Complications KW - Diabetes Mellitus KW - Female KW - Health Behavior KW - Health Knowledge, Attitudes, Practice KW - Health Services KW - Humans KW - Male KW - Patient Education as Topic KW - Self Efficacy KW - Sex Factors KW - Socioeconomic factors KW - Time Factors AB -

Although the education-health relationship is well documented, pathways through which education influences health are not well understood. This study uses data from a 2003-2004 cross sectional supplemental survey of respondents to the longitudinal Health and Retirement Study (HRS) who had been diagnosed with diabetes mellitus to assess effects of education on health and mechanisms underlying the relationship. The supplemental survey provides rich detail on use of personal health care services (e.g., adherence to guidelines for diabetes care) and personal attributes which are plausibly largely time invariant and systematically related to years of schooling completed, including time preference, self-control, and self-confidence. Educational attainment, as measured by years of schooling completed, is systematically and positively related to time to onset of diabetes, and conditional on having been diagnosed with this disease on health outcomes, variables related to efficiency in health production, as well as use of diabetes specialists. However, the marginal effects of increasing educational attainment by a year are uniformly small. Accounting for other factors, including child health and child socioeconomic status which could affect years of schooling completed and adult health, adult cognition, income, and health insurance, and personal attributes from the supplemental survey, marginal effects of educational attainment tend to be lower than when these other factors are not included in the analysis, but they tend to remain statistically significant at conventional levels.

PB - 11 VL - 11 IS - 1 N1 - Ayyagari, Padmaja Grossman, Daniel Sloan, Frank 2R37-AG-17473-05A1/AG/NIA NIH HHS/United States Research Support, N.I.H., Extramural United States International journal of health care finance and economics Int J Health Care Finance Econ. 2011 Mar;11(1):35-54. Epub 2011 Jan 7. U1 - http://www.ncbi.nlm.nih.gov/pubmed/21213044?dopt=Abstract U3 - 21213044 U4 - Cognition/Cross-Sectional Studies/Diabetes Complications/epidemiology/Diabetes Complications/epidemiology/Diabetes Mellitus/ epidemiology/ psychology/Diabetes Mellitus/ epidemiology/ psychology/Female/Health Behavior/Health Knowledge, Attitudes, Practice/Health Knowledge, Attitudes, Practice/Health Services/ utilization/Health Services/ utilization/Humans/Patient Education as Topic/ statistics/Patient Education as Topic/ statistics/numerical data/Self Efficacy/Self Efficacy/Sex Factors/Socioeconomic Factors/Time Factors ER - TY - JOUR T1 - Effects of smoking cessation on pain in older adults. JF - Nicotine Tob Res Y1 - 2011 A1 - Yu Shi A1 - Hooten, W Michael A1 - David O. Warner KW - Aged KW - Body Mass Index KW - depression KW - Female KW - Follow-Up Studies KW - Humans KW - Interviews as Topic KW - Logistic Models KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Odds Ratio KW - pain KW - Pain Perception KW - Smoking KW - Smoking cessation KW - Smoking Prevention AB -

INTRODUCTION: Smokers are at increased risk of developing chronic pain and suffering higher pain intensity. However, nicotine has analgesic properties, and smokers may view smoking as a means to cope with pain. Smoking cessation is clearly beneficial to the long-term health of smokers. However, it is not known how abstinence from smoking affects pain. The aim of this study was to determine the association between smoking cessation and changes in pain symptoms by secondary analysis of a large longitudinal dataset of older adults.

METHODS: Secondary analyses were performed of longitudinal biennial survey data (1992 through 2006) from the nationally representative Health and Retirement Study of United States adults older than 50 years. Multivariate logistic regressions were utilized to determine the relationship between the changes in smoking status and changes in pain symptoms, controlling for demographics, depression, self-rated health, history of arthritis, and body mass index.

RESULTS: In multivariate analyses, among the 4,695 smokers who reported no pain or mild pain at enrollment, smoking status was not independently associated with exacerbation of pain (odds ratio [OR]: 0.95, 95% CI: 0.84, 1.08). Among the 1,118 smokers who reported moderate to severe pain at enrollment, smoking status was not independently associated with improvement of pain (OR: 0.87, 95% CI: 0.70, 1.08).

CONCLUSIONS: Smoking cessation was not independently associated with changes in pain symptoms in older adults. These results suggest that concerns regarding the effects of abstinence from smoking on pain should not pose a barrier to offering tobacco use interventions to smokers with chronic pain.

PB - 13 VL - 13 IS - 10 N1 - Shi, Yu Hooten, W Michael Warner, David O U01AG009740/AG/NIA NIH HHS/United States Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't England Nicotine and tobacco research : official journal of the Society for Research on Nicotine and Tobacco Nicotine Tob Res. 2011 Oct;13(10):919-25. Epub 2011 May 12. U1 - http://www.ncbi.nlm.nih.gov/pubmed/21571690?dopt=Abstract U2 - PMC3179669 U4 - Smoking/chronic Disease/smoking Cessation/Socioeconomic Differences ER - TY - JOUR T1 - Gender differences in functional limitations in adults living with type 2 diabetes: biobehavioral and psychosocial mediators. JF - Ann Behav Med Y1 - 2011 A1 - Chiu, Ching-Ju A1 - Linda A. Wray KW - Adult KW - Aged KW - Aged, 80 and over KW - Biomarkers KW - Blood Glucose Self-Monitoring KW - Body Mass Index KW - Diabetes Mellitus, Type 2 KW - Exercise KW - Female KW - Health Behavior KW - Humans KW - Male KW - Middle Aged KW - Models, Psychological KW - Prospective Studies KW - Risk Factors KW - Self Report KW - Sex Characteristics KW - Socioeconomic factors KW - United States AB -

BACKGROUND: Differences in functional limitations between adults with and without diabetes are more evident in women than they are in men.

PURPOSE: This study aims to investigate if there are gender differences in biological, behavioral, and psychosocial variables, and how these gender-related variables explain the gender-functional limitations relationship in adults with type 2 diabetes.

METHODS: We drew data on 1,619 adults with type 2 diabetes from the Health and Retirement Study and its diabetes-specific mail survey. The fit of a series of mediation models to the data was assessed by structural equation modeling.

RESULTS: Although women had better diet and blood glucose self-monitoring behaviors than did men, they reported less favorable body mass index, glycosylated hemoglobin (HbA1c) value, blood pressure, early complications, exercise behaviors, perceived control, self-efficacy, coping, depressive symptoms, and family support than did men. Psychosocial factors made an indirect contribution in the gender-functional limitations relationship by way of their strong association with biological and behavioral factors, two factors that directly and completely mediated the gender-functional limitations relationship.

CONCLUSIONS: Interventions promoting psychosocial well-being and empowering perceived diabetes control, coping, and self-efficacy in women with type 2 diabetes may help improve biological and behavioral determinants, and further, their long-term functional health.

PB - 41 VL - 41 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20827519?dopt=Abstract U4 - Gender differences/Psychosocial well-being/Mediator/Structural equation modeling/Functional limitations ER - TY - JOUR T1 - Gender differences in health: results from SHARE, ELSA and HRS. JF - Eur J Public Health Y1 - 2011 A1 - Eileen M. Crimmins A1 - Jung K Kim A1 - Sole-Auro, Aida KW - Activities of Daily Living KW - Aged KW - Aging KW - Body Weights and Measures KW - Chronic disease KW - Employment KW - Female KW - Global Health KW - Health Behavior KW - Health Status KW - Humans KW - Male KW - Middle Aged KW - Self Report KW - Sex Factors AB -

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

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

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

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

VL - 21 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20237171?dopt=Abstract U2 - PMC3023013 U4 - cross-national comparison/gender Differences/ELSA_/SHARE/SELF-RATED HEALTH/health Behavior/disease prevalence/DISABILITY/DISABILITY ER - TY - JOUR T1 - Generational jeopardy? Parents' marital transitions and the provision of financial transfers to adult children. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2011 A1 - Shapiro, Adam A1 - R Corey Remle KW - Adolescent KW - Adult KW - Adult children KW - Aged KW - Divorce KW - Female KW - Financial Support KW - Humans KW - Intergenerational Relations KW - Male KW - Marriage KW - Middle Aged KW - Prejudice KW - Retirement KW - Widowhood KW - Young Adult AB -

OBJECTIVES: Transitions into and out of marriage are becoming more commonplace among persons in middle and later life. We assess the extent to which parental marital transitions influence inter vivos financial transfers to adult children at the family level.

METHODS: Panel data from 6,017 households with adult children in the 1992-1998 waves of the Health and Retirement Study are analyzed in this study.

RESULTS: Net of familial characteristics, those families experiencing a parental marriage were less likely than stably married households to make a financial transfer to an adult child. The effects of divorce or widowhood were modest. Divorce was associated with a slight increase in the probability of providing a transfer. Widowhood was associated with a slight increase in the total amount transferred to children.

DISCUSSION: The study adds weight to the growing argument that marital transitions may alter intergenerational exchanges. The results prompt us to further question how broader demographic and marriage patterns will influence relationships between parents and children in aging societies.

PB - 66 VL - 66 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20197303?dopt=Abstract U3 - 20197303 U4 - Divorce/Family structure/Intergenerational exchange/Marriage/Widowhood/INTER-VIVOS TRANSFERS/INTERGENERATIONAL EXCHANGES/FAMILY-STRUCTURE/DIVORCE/RETIREMENT/SUPPORT/WIDOWHOOD/HEALTH/MIDLIFE 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 - How does the trajectory of multimorbidity vary across Black, White, and Mexican Americans in middle and old age? JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2011 A1 - Ana R Quiñones A1 - Jersey Liang A1 - Joan M. Bennett A1 - Xiao Xu A1 - Wen Ye KW - Aged KW - Aged, 80 and over KW - Aging KW - Black or African American KW - Chronic disease KW - Female KW - Follow-Up Studies KW - Health Behavior KW - Health Status Disparities KW - Hispanic or Latino KW - Humans KW - Linear Models KW - Longitudinal Studies KW - Male KW - Middle Aged KW - United States KW - White People AB -

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

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

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

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

PB - 66 VL - 66 IS - 6 N1 - Quinones, Ana R Liang, Jersey Bennett, Joan M Xu, Xiao Ye, Wen F31-AG029783/AG/NIA NIH HHS/United States R01-AG015124/AG/NIA NIH HHS/United States R01-AG028116/AG/NIA NIH HHS/United States Comparative Study Research Support, N.I.H., Extramural United States The journals of gerontology. Series B, Psychological sciences and social sciences J Gerontol B Psychol Sci Soc Sci. 2011 Nov;66(6):739-49. Epub 2011 Oct 3. U1 - http://www.ncbi.nlm.nih.gov/pubmed/21968384?dopt=Abstract U2 - PMC3198247 U4 - African Americans/ statistics/African Americans/ statistics/numerical data/Aged, 80 and over/Aging/Chronic Disease/ ethnology/Chronic Disease/ ethnology/European Continental Ancestry Group/ statistics/European Continental Ancestry Group/ statistics/numerical data/Female/Follow-Up Studies/Follow-Up Studies/Health Behavior/ ethnology/Health Behavior/ ethnology/Health Status Disparities/Hispanic Americans/ statistics/Hispanic Americans/ statistics/numerical data/Humans/Linear Models/Linear Models/Longitudinal Studies/Middle Aged/United States/epidemiology/United States/epidemiology ER - TY - JOUR T1 - The impact of private long-term care insurance on the use of long-term care. JF - Inquiry Y1 - 2011 A1 - Yong Li A1 - Gail A Jensen KW - Aged KW - Aged, 80 and over KW - Decision making KW - Female KW - Health Services Accessibility KW - Home Care Services KW - Home Nursing KW - Humans KW - Insurance, Long-Term Care KW - Likelihood Functions KW - Long-term Care KW - Male KW - Models, Econometric KW - Nursing homes KW - Private Sector KW - Regression Analysis KW - United States AB -

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

PB - 48 VL - 48 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21634261?dopt=Abstract U3 - 21634261 U4 - Life insurance/health insurance/Experiment/theoretical treatment/Long term care insurance/Impact analysis/Long term health care/Elder care/Health services utilization ER - TY - JOUR T1 - Implementation of Medicare Part D and nondrug medical spending for elderly adults with limited prior drug coverage. JF - JAMA Y1 - 2011 A1 - J. Michael McWilliams A1 - Alan M. Zaslavsky A1 - Haiden A. Huskamp KW - Aged KW - Aged, 80 and over KW - Cost Control KW - Costs and Cost Analysis KW - Data collection KW - Female KW - Health Expenditures KW - Health Services KW - Humans KW - Insurance Claim Review KW - Longitudinal Studies KW - Male KW - Medicare Part D KW - Patient Care KW - Physicians KW - Skilled Nursing Facilities KW - United States AB -

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

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

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

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

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

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

PB - 306 VL - 306 IS - 4 N1 - McWilliams, J Michael Zaslavsky, Alan M Huskamp, Haiden A Comparative Study Research Support, Non-U.S. Gov't United States JAMA : the journal of the American Medical Association JAMA. 2011 Jul 27;306(4):402-9. U1 - http://www.ncbi.nlm.nih.gov/pubmed/21791689?dopt=Abstract U3 - 21791689 U4 - Aged, 80 and over/Cost Control/Cost Control/Costs and Cost Analysis/Data Collection/Female/Health Expenditures/ trends/Health Expenditures/ trends/Health Services/ economics/utilization/Health Services/ economics/utilization/Humans/Insurance Claim Review/Insurance Claim Review/Longitudinal Studies/Medicare Part D/ economics/Medicare Part D/ economics/Patient Care/ economics/Patient Care/ economics/Physicians/Skilled Nursing Facilities/ economics/Skilled Nursing Facilities/ economics/United States ER - TY - JOUR T1 - Incidence of dementia and cognitive impairment, not dementia in the United States. JF - Ann Neurol Y1 - 2011 A1 - Brenda L Plassman A1 - Kenneth M. Langa A1 - Ryan J McCammon A1 - Gwenith G Fisher A1 - Guy G Potter A1 - James R Burke A1 - David C Steffens A1 - Norman L Foster A1 - Bruno J Giordani A1 - Frederick W Unverzagt A1 - Kathleen A Welsh-Bohmer A1 - Steven G Heeringa A1 - David R Weir A1 - Robert B Wallace KW - Aged KW - Aged, 80 and over KW - Alzheimer disease KW - Cognition Disorders KW - Cohort Studies KW - Dementia KW - Diagnostic and Statistical Manual of Mental Disorders KW - disease progression KW - Female KW - Humans KW - Logistic Models KW - Longitudinal Studies KW - Male KW - Models, Statistical KW - United States AB -

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

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

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

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

VL - 70 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21425187?dopt=Abstract U2 - PMC3139807 U4 - Dementia/Cognitive Impairment/Alzheimer disease/vascular dementia/incident dementia ER - TY - JOUR T1 - Increasing and decreasing alcohol use trajectories among older women in the U.S. across a 10-year interval. JF - Int J Environ Res Public Health Y1 - 2011 A1 - Janet Kay Bobo A1 - April A Greek KW - Aged KW - Alcohol Drinking KW - Alcoholic Intoxication KW - Alcoholism KW - Cohort Studies KW - depression KW - Ethanol KW - Female KW - Follow-Up Studies KW - Humans KW - Longitudinal Studies KW - Middle Aged KW - Retirement KW - Risk Factors KW - Smoking KW - Surveys and Questionnaires KW - United States AB -

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

PB - 8 VL - 8 IS - 8 N1 - Bobo, Janet Kay Greek, April A AA016534/AA/NIAAA NIH HHS/United States R24 HD042828-10/HD/NICHD NIH HHS/United States Research Support, N.I.H., Extramural Switzerland International journal of environmental research and public health Int J Environ Res Public Health. 2011 Aug;8(8):3263-76. Epub 2011 Aug 5. U1 - http://www.ncbi.nlm.nih.gov/pubmed/21909305?dopt=Abstract U2 - PMC3166741 U4 - alcohol use/WOMEN/depression/Smoking 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 loss and depression: the role of subjective expectations. JF - Soc Sci Med Y1 - 2011 A1 - Mandal, Bidisha A1 - Padmaja Ayyagari A1 - William T Gallo KW - Adaptation, Psychological KW - Aged KW - Bias KW - depression KW - Empirical Research KW - Health Surveys KW - Humans KW - Mental Health KW - Middle Aged KW - Stress, Psychological KW - Unemployment KW - United States AB -

Although the importance of expectations is well documented in the decision-making literature, a key shortcoming of the empirical research into effects of involuntary job loss on depression is perhaps its neglect of the subjective expectations of job loss. Using data from the US Health and Retirement Study surveys we examine whether the impact of job loss on mental health is influenced by an individual's subjective expectations regarding future displacement. Our results imply that, among older workers in the age range of 55-65 year, subjective expectations are as significant predictors of depression as job loss itself, and ignoring them can bias the estimate of the impact of job loss on mental health.

PB - 72 VL - 72 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21183267?dopt=Abstract U2 - PMC3684950 U4 - Expectations/Older workers/Mental depression/Decision making/Impact analysis/Estimation bias/Mental health 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 - Lifecourse socioeconomic circumstances and multimorbidity among older adults. JF - BMC Public Health Y1 - 2011 A1 - Reginald D. Tucker-Seeley A1 - Li, Yi A1 - Sorensen, Glorian A1 - Subramanian, S V KW - Aged KW - Chronic disease KW - Comorbidity KW - Cross-Sectional Studies KW - Female KW - Humans KW - Male KW - Middle Aged KW - Social Class KW - United States AB -

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

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

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

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

PB - 11 VL - 11 N1 - Tucker-Seeley, Reginald D Li, Yi Sorensen, Glorian Subramanian, S V England BMC public health BMC Public Health. 2011 May 14;11:313. U1 - http://www.ncbi.nlm.nih.gov/pubmed/21569558?dopt=Abstract U2 - PMC3118239 U4 - Chronic Disease/epidemiology/Chronic Disease/epidemiology/Comorbidity/ trends/Comorbidity/ trends/Cross-Sectional Studies/Female/Humans/Middle Aged/Social Class/United States/epidemiology/United States/epidemiology ER - TY - JOUR T1 - Long-term declines in ADLs, IADLs, and mobility among older Medicare beneficiaries. JF - BMC Geriatr Y1 - 2011 A1 - Frederic D Wolinsky A1 - Suzanne E Bentler A1 - Jason Hockenberry A1 - Michael P Jones A1 - Maksym Obrizan A1 - Paula A Weigel A1 - Kaskie, Brian A1 - Robert B Wallace KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Cohort Studies KW - Disabled Persons KW - Female KW - Follow-Up Studies KW - Geriatric Assessment KW - Health Surveys KW - Humans KW - Insurance Benefits KW - Longitudinal Studies KW - Male KW - Medicare KW - Mobility Limitation KW - Prospective Studies KW - Time Factors KW - United States AB -

BACKGROUND: Most prior studies have focused on short-term (≤ 2 years) functional declines. But those studies cannot address aging effects inasmuch as all participants have aged the same amount. Therefore, the authors studied the extent of long-term functional decline in older Medicare beneficiaries who were followed for varying time lengths, and the authors also identified the risk factors associated with those declines.

METHODS: The analytic sample included 5,871 self- or proxy-respondents who had complete baseline and follow-up survey data that could be linked to their Medicare claims for 1993-2007. Functional status was assessed using activities of daily living (ADLs), instrumental ADLs (IADLs), and mobility limitations, with declines defined as the development of two of more new difficulties. Multiple logistic regression analysis was used to focus on the associations involving respondent status, health lifestyle, continuity of care, managed care status, health shocks, and terminal drop.

RESULTS: The average amount of time between the first and final interviews was 8.0 years. Declines were observed for 36.6% on ADL abilities, 32.3% on IADL abilities, and 30.9% on mobility abilities. Functional decline was more likely to occur when proxy-reports were used, and the effects of baseline function on decline were reduced when proxy-reports were used. Engaging in vigorous physical activity consistently and substantially protected against functional decline, whereas obesity, cigarette smoking, and alcohol consumption were only associated with mobility declines. Post-baseline hospitalizations were the most robust predictors of functional decline, exhibiting a dose-response effect such that the greater the average annual number of hospital episodes, the greater the likelihood of functional status decline. Participants whose final interview preceded their death by one year or less had substantially greater odds of functional status decline.

CONCLUSIONS: Both the additive and interactive (with functional status) effects of respondent status should be taken into consideration whenever proxy-reports are used. Encouraging exercise could broadly reduce the risk of functional decline across all three outcomes, although interventions encouraging weight reduction and smoking cessation would only affect mobility declines. Reducing hospitalization and re-hospitalization rates could also broadly reduce the risk of functional decline across all three outcomes.

PB - 11 VL - 11 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21846400?dopt=Abstract U2 - PMC3167753 U4 - SELF-RATED HEALTH/Medicare/Functional decline/Functional decline/ADL/IADL/risk Factors ER - TY - JOUR T1 - Memory predicts changes in depressive symptoms in older adults: a bidirectional longitudinal analysis. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2011 A1 - Jajodia, Archana A1 - Borders, Ashley KW - Aged KW - Aged, 80 and over KW - Comorbidity KW - Dementia, Vascular KW - depression KW - Female KW - Geriatric Assessment KW - Humans KW - Longitudinal Studies KW - Male KW - Mental Recall KW - Middle Aged KW - Models, Psychological KW - Retirement KW - Statistics as Topic KW - United States AB -

OBJECTIVES: Although research indicates that depressive symptoms and memory performance are related in older adults, the temporal associations between these variables remain unclear. This study examined whether depressive symptoms predicted later memory change and whether memory predicted later change in depressive symptoms.

METHODS: The sample consisted of more than 14,000 adults from the Health and Retirement Study, a biannual longitudinal study of health and retirement in Americans older than age 50 years. Measures of delayed recall and depressive symptoms served as the main study variables. We included age, sex, education, and history of vascular diseases as covariates.

RESULTS: Using dynamic change models with latent difference scores, we found that memory performance predicted change in depressive symptoms 2 years later. Depressive symptoms did not predict later change in memory. The inclusion of vascular health variables diminished the size of the observed relationship, suggesting that biological processes may partially explain the effect of memory on depressive symptoms.

IMPLICATIONS: Future research should explore both biological and psychological processes that may explain the association between worse memory performance and subsequent increases in depressive symptoms.

PB - 66B VL - 66 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21742642?dopt=Abstract U2 - PMC3155030 U4 - Older people/Mental depression/Memory/Gerontology/Cardiovascular disease 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 - Neighborhoods and chronic disease onset in later life. JF - Am J Public Health Y1 - 2011 A1 - Vicki A Freedman A1 - Irina B Grafova A1 - Jeannette Rogowski KW - Aged KW - Chronic disease KW - Environment Design KW - Factor Analysis, Statistical KW - Female KW - Health Resources KW - Health Status Disparities KW - Humans KW - Logistic Models KW - Male KW - Middle Aged KW - Poverty Areas KW - Residence Characteristics KW - Risk Factors KW - Small-Area Analysis KW - Social Environment KW - Social Problems KW - Socioeconomic factors KW - United States AB -

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

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

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

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

PB - 101 VL - 101 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20299643?dopt=Abstract U2 - PMC2912970 U4 - Chronic Disease/neighborhood Characteristics/Safety/crime/Heart disease/CANCER ER - TY - JOUR T1 - Neuropsychiatric symptoms and the risk of institutionalization and death: the aging, demographics, and memory study. JF - J Am Geriatr Soc Y1 - 2011 A1 - Okura, Toru A1 - Brenda L Plassman A1 - David C Steffens A1 - David J Llewellyn A1 - Guy G Potter A1 - Kenneth M. Langa KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Behavioral Symptoms KW - Caregivers KW - Cognition Disorders KW - Female KW - Humans KW - Institutionalization KW - Male KW - Neuropsychological tests KW - Proportional Hazards Models AB -

OBJECTIVES: To examine the association between neuropsychiatric symptoms and risk of institutionalization and death.

DESIGN: Analysis of longitudinal data.

SETTING: The Aging, Demographics, and Memory Study (ADAMS).

PARTICIPANTS: Five hundred thirty-seven adults aged 71 and older with cognitive impairment drawn from the Health and Retirement Study (HRS).

MEASUREMENTS: Neuropsychiatric symptoms (delusions, hallucinations, agitation, depression, apathy, elation, anxiety, disinhibition, irritation, and aberrant motor behaviors) and caregiver distress were identified using the Neuropsychiatric Inventory. A consensus panel in the ADAMS assigned cognitive category. Date of nursing home placement and information on death, functional limitations, medical comorbidity, and sociodemographic characteristics were obtained from the HRS and ADAMS.

RESULTS: Overall, the presence of one or more neuropsychiatric symptoms was not associated with a significantly higher risk for institutionalization or death during the 5-year study period, although when assessing each symptom individually, depression, delusions, and agitation were each associated with a significantly higher risk of institutionalization (hazard rate (HR)=3.06, 95% confidence interval (CI)=1.09-8.59 for depression; HR=5.74, 95% CI=1.94-16.96 for clinically significant delusions; HR=4.70, 95% CI=1.07-20.70 for clinically significant agitation). Caregiver distress mediated the association between delusions and agitation and institutionalization. Depression and hallucinations were associated with significantly higher mortality (HR=1.56, 95% CI=1.08-2.26 for depression; HR=2.59, 95% CI=1.09-6.16 for clinically significant hallucinations).

CONCLUSION: Some, but not all, neuropsychiatric symptoms are associated with a higher risk of institutionalization and death in people with cognitive impairment, and caregiver distress also influences institutionalization. Interventions that better target and treat depression, delusions, agitation, and hallucinations, as well as caregiver distress, may help delay or prevent these negative clinical outcomes.

PB - 59 VL - 59 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21391937?dopt=Abstract U2 - PMC3088883 U4 - Mental disorders/Cognition/reasoning/Caregivers/Risk factors/Nursing homes/Mortality/Older people ER - TY - JOUR T1 - Partner caregiving in older cohabiting couples. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2011 A1 - Claire Noël-Miller KW - Aged KW - Caregivers KW - Disabled Persons KW - Family Characteristics KW - Female KW - Frail Elderly KW - Humans KW - Interpersonal Relations KW - Male KW - Marriage KW - Middle Aged KW - Sex Factors KW - Single Person KW - Social Support AB -

OBJECTIVES: Despite the rapidly increasing prevalence of cohabitation among older adults, the caregiving literature has exclusively focused on formally married individuals. Extending prior work on intra-couple care, this study contrasts frail cohabitors' patterns of care receipt from a partner to that of frail spouses.

METHODS: Using nationally representative panel data from the Health and Retirement Study (2000, 2002, 2004, and 2006), we estimate random effects cross-sectional times series models predicting frail cohabitors' likelihood of receiving partner care compared with their married counterparts'. Conditional on the receipt of intra-couple care, we also examine differences in marital and nonmarital partners' caregiving hours and caregiving involvement relative to other helpers.

RESULTS: Net of sociodemographic, disability, and comorbidity factors, we find that cohabitors are less likely to receive partner care than married individuals. However, caregiving nonmarital partners provide as many hours of care as spouses while providing a substantially larger share of disabled respondents' care than marital partners.

DISCUSSION: Cohabitation and marriage have distinct implications for older adults' patterns of partner care receipt. This study adds weight to a growing body of research emphasizing the importance of accounting for older adults' nontraditional union forms and of examining the ramifications of cohabitation for older adults' well-being.

PB - 66 VL - 66 IS - 3 N1 - Noel-Miller, Claire M 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 May;66(3):341-53. Epub 2011 Apr 11. U1 - http://www.ncbi.nlm.nih.gov/pubmed/21482588?dopt=Abstract U2 - PMC3078761 U4 - Cohabitation/Caregivers/Disabled Persons/Family Characteristics/WOMEN/Frail Elderly/Interpersonal Relations/Interpersonal Relations/Marriage/Middle Aged/Sex Factors/Single Person/Single Person/Social Support ER - TY - JOUR T1 - Physical disability trajectories in older Americans with and without diabetes: the role of age, gender, race or ethnicity, and education. JF - Gerontologist Y1 - 2011 A1 - Chiu, Ching-Ju A1 - Linda A. Wray KW - Activities of Daily Living KW - Age Distribution KW - Aged KW - Aged, 80 and over KW - Cross-Sectional Studies KW - Diabetes Mellitus KW - Disabled Persons KW - Educational Status KW - ethnicity KW - Female KW - Health Status KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Models, Theoretical KW - Racial Groups KW - Sex Distribution KW - Time Factors KW - United States AB -

PURPOSE: This research combined cross-sectional and longitudinal data to characterize age-related trajectories in physical disability for adults with and without diabetes in the United States and to investigate if those patterns differ by age, gender, race or ethnicity, and education.

DESIGN AND METHODS: Data were examined on 20,433 adults aged 51 and older from the 1998 to 2006 Health and Retirement Study. Multilevel models and a cohort-sequential design were applied to quantitatively depict the age norm of physical disability after age 50.

RESULTS: Adults with diabetes not only experience greater levels of physical disability but also faster rates of deterioration over time. This pattern is net of attrition, time-invariant sociodemographic factors, and time-varying chronic disease conditions. Differences in physical disability between adults with and without diabetes were more pronounced in women, non-White, and those of lower education. The moderating effects of gender and education remained robust even after controlling for selected covariates in the model.

IMPLICATIONS: This study highlighted the consistently greater development of disability over time in adults with diabetes and particularly in those who are women, non-White, or adults of lower education. Future studies are recommended to examine the mechanisms underlying the differential effects of diabetes on physical disability by gender and education.

PB - 51 VL - 51 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20713455?dopt=Abstract U2 - PMC3018868 U4 - Gerontology/Older people/Diabetes/Gender/Ethnicity/Disability/Disability ER - TY - JOUR T1 - A prospective cohort study of long-term cognitive changes in older Medicare beneficiaries. JF - BMC Public Health Y1 - 2011 A1 - Frederic D Wolinsky A1 - Suzanne E Bentler A1 - Jason Hockenberry A1 - Michael P Jones A1 - Paula A Weigel A1 - Kaskie, Brian A1 - Robert B Wallace KW - Aged KW - Aged, 80 and over KW - Aging KW - Cognition KW - Cognition Disorders KW - Cohort Studies KW - Female KW - Humans KW - Interviews as Topic KW - Male KW - Medicare KW - Mental Health KW - Outcome Assessment, Health Care KW - Prospective Studies KW - Regression Analysis KW - Risk Factors KW - United States AB -

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

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

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

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

PB - 11 VL - 11 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21933430?dopt=Abstract U2 - PMC3190354 U4 - Cognition/Cognitive decline/public policy/Medicare/cognitive Function/TICS Scale ER - TY - JOUR T1 - Recent trends in chronic disease, impairment and disability among older adults in the United States. JF - BMC Geriatr Y1 - 2011 A1 - William W. Hung A1 - Joseph S. Ross A1 - Boockvar, Kenneth S A1 - Albert L Siu KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Chronic disease KW - Disabled Persons KW - Female KW - Health Surveys KW - Humans KW - Longitudinal Studies KW - Male KW - United States KW - Visually Impaired Persons AB -

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

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

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

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

PB - 11 VL - 11 N1 - Hung, William W Ross, Joseph S Boockvar, Kenneth S Siu, Albert L K08 AG032886/AG/NIA NIH HHS/United States U01AG009740/AG/NIA NIH HHS/United States Comparative Study Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't England BMC geriatrics BMC Geriatr. 2011 Aug 18;11:47. U1 - http://www.ncbi.nlm.nih.gov/pubmed/21851629?dopt=Abstract U2 - PMC3170191 U4 - PREVALENCE/concurrent prevalence trends/concurrent prevalence trends/Chronic Disease/impairment/impairment/DISABILITY/DISABILITY/ADL and IADL Impairments ER - TY - JOUR T1 - Recruitment and retention of minority participants in the health and retirement study. JF - Gerontologist Y1 - 2011 A1 - Mary Beth Ofstedal A1 - David R Weir KW - Aged KW - Biomarkers KW - Black or African American KW - Female KW - Health Promotion KW - Health Surveys KW - Hispanic or Latino KW - Humans KW - Male KW - Middle Aged KW - Minority Groups KW - Minority health KW - National Health Programs KW - Patient Dropouts KW - Patient Selection KW - Retirement KW - Sampling Studies KW - Surveys and Questionnaires KW - United States AB -

PURPOSE: Minority oversamples of African Americans and Hispanics have been a key feature of the Health and Retirement Study (HRS) design from its origins in 1992. The objective of this article was to assess the quality of the HRS with respect to the recruitment and retention of minority respondents.

DESIGN AND METHODS: To evaluate minority recruitment efforts, we examine baseline response rates for the early baby boom cohort that was added in the 2004 wave and the representativeness of this cohort with regard to demographic, socioeconomic, and health characteristics. To evaluate retention, we focus on minority differentials in 2008 interview, nonresponse and mortality outcomes for the full HRS sample. We also examine minority differentials in participation in supplemental components of the HRS.

RESULTS: Minority response rates at baseline and in longitudinal follow-ups for the main HRS interview have been equal to or better than that of majority Whites. Conversely, response rates to some specific supplemental components have been lower for minority sample members.

IMPLICATIONS: The oversample strategies that the HRS has employed have been successful at identifying and recruiting minority participants at response rates very comparable with that of Whites and others. Minority differentials in participation in supplemental components have been overcome to some extent through interviewer training and targeted follow-up strategies. The HRS experience suggests that well-trained interviewers can overcome most if not all of whatever race and ethnic differentials exist in willingness to participate in surveys, including those involving biological data collection.

PB - 51 Suppl 1 VL - 51 Suppl 1 IS - Suppl 1 N1 - Ofstedal, Mary B Weir, David R U01AG009740/AG/NIA NIH HHS/United States Comparative Study Research Support, N.I.H., Extramural United States The Gerontologist Gerontologist. 2011 Jun;51 Suppl 1:S8-20. U1 - http://www.ncbi.nlm.nih.gov/pubmed/21565822?dopt=Abstract U2 - PMC3106365 ER - TY - JOUR T1 - Regional variation in the association between advance directives and end-of-life Medicare expenditures. JF - JAMA Y1 - 2011 A1 - Lauren Hersch Nicholas A1 - Kenneth M. Langa A1 - Theodore J Iwashyna A1 - David R Weir KW - Advance directives KW - Aged KW - Aged, 80 and over KW - Data collection KW - Female KW - Health Expenditures KW - Hospice Care KW - Hospital Mortality KW - Hospitals KW - Humans KW - Kidney Failure, Chronic KW - Male KW - Medicare KW - Palliative care KW - Prospective Studies KW - Regression Analysis KW - Terminal Care KW - United States AB -

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

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

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

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

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

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

PB - 112 VL - 306 UR - http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=2590187421andFmt=7andclientId=17822andRQT=309andVName=PQD IS - 13 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21972306?dopt=Abstract U2 - PMC3332047 U4 - Advance directives/Palliative care/Health care expenditures/Medicare ER - TY - JOUR T1 - The relationships between major lifetime discrimination, everyday discrimination, and mental health in three racial and ethnic groups of older adults. JF - Aging Ment Health Y1 - 2011 A1 - Liat Ayalon A1 - Amber M Gum KW - Adaptation, Psychological KW - Aged KW - Aged, 80 and over KW - Asian KW - Black or African American KW - Cross-Cultural Comparison KW - depression KW - Discrimination, Psychological KW - ethnicity KW - Hispanic or Latino KW - Humans KW - Longitudinal Studies KW - Mental Health KW - Middle Aged KW - Personal Satisfaction KW - Prejudice KW - Prevalence KW - Social Perception KW - Socioeconomic factors KW - Surveys and Questionnaires KW - United States KW - White People AB -

OBJECTIVES: To evaluate the relationships between perceived exposure to major lifetime discrimination, everyday discrimination, and mental health in three racial/ethnic groups of older adults.

DESIGN: The Health and Retirement Study is a nationally representative sample of individuals 50 years and older living in the United States. A total of 6455 Whites, 716 Latinos, and 1214 Blacks were eligible to complete a self-report psychosocial questionnaire in the year 2006.

RESULTS: Whereas 30% of the general population reported at least one type of major lifetime discrimination, almost 45% of Black older adults reported such discrimination. Relative to the other two racial/ethnic groups (82% Whites, 82.6% Blacks), Latinos were significantly less likely to report any everyday discrimination (64.2%), whereas Blacks reported the greatest frequency of everyday discrimination. Whites reported the highest levels of life satisfaction and the lowest levels of depressive symptoms. Relative to major lifetime discrimination, everyday discrimination had a somewhat stronger correlation with mental health indicators. The relationships between discrimination and mental health outcomes were stronger for White compared to Black older adults, although everyday discrimination was still significantly associated with outcomes for Black older adults.

CONCLUSIONS: Black older adults experience the greatest number of discriminative events, but weaker associated mental health outcomes. This could be because they have become accustomed to these experiences, benefit from social or cultural resources that serve as buffers, or selective survival, with the present sample capturing only the most resilient older adults who have learned to cope with the deleterious effects of discrimination.

PB - 15 VL - 15 IS - 5 N1 - Ayalon, Liat Gum, Amber M U01AG009740/AG/NIA NIH HHS/United States Evaluation Studies Research Support, N.I.H., Extramural England Aging and mental health Aging Ment Health. 2011 Jul 1;15(5):587-94. U1 - http://www.ncbi.nlm.nih.gov/pubmed/21815851?dopt=Abstract U3 - 21815851 U4 - Adaptation, Psychological/African Americans/psychology/statistics/African Americans/psychology/statistics/numerical data/Aged, 80 and over/Asian Americans/psychology/statistics/Asian Americans/psychology/statistics/numerical data/Cross-Cultural Comparison/Cross-Cultural Comparison/Depression/ethnology/Depression/ethnology/Discrimination (Psychology)/Discrimination (Psychology)/Ethnic Groups/ psychology/statistics/Ethnic Groups/ psychology/statistics/numerical data/European Continental Ancestry Group/psychology/statistics/European Continental Ancestry Group/psychology/statistics/numerical data/Hispanic Americans/psychology/statistics/Hispanic Americans/psychology/statistics/numerical data/Humans/Longitudinal Studies/Mental Health/ ethnology/statistics/Mental Health/ ethnology/statistics/numerical data/Middle Aged/Personal Satisfaction/Personal Satisfaction/Prejudice/Prejudice/Prevalence/Questionnaires/Social Perception/Social Perception/Socioeconomic Factors/United States/epidemiology/United States/epidemiology 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 - Socioeconomic inequalities in old-age mortality: a comparison of Denmark and the USA. JF - Soc Sci Med Y1 - 2011 A1 - Rasmus Hoffmann KW - Aged KW - Aged, 80 and over KW - Analysis of Variance KW - Cross-Cultural Comparison KW - Denmark KW - Educational Status KW - Female KW - Health Expenditures KW - Humans KW - Income KW - Life Expectancy KW - Male KW - Middle Aged KW - Mortality KW - Political Systems KW - Social Class KW - Social Welfare KW - United States AB -

Previous studies have reported important variations in the magnitude of health inequalities between countries that belong to different welfare systems. This suggests that there is scope for reducing health inequalities by means of country-level interventions. The present study adds to this literature by exploring whether the magnitude of socioeconomic inequalities in mortality is associated with social inequality levels. Denmark and the USA belong to fundamentally different welfare systems (social democratic and liberal) and our study thereby contributes to the ongoing debate on whether welfare systems are linked to health inequalities. We analyze Denmark and the USA in terms of socioeconomic differences in mortality above age 58. The data sources were Danish register data from 1980 to 2002 (n = 2,029,324), and survey data from the US Health and Retirement Study (HRS) from 1992 to 2006 (n = 9374). Survival analysis was used to study the impact of socioeconomic status on mortality and the magnitude of mortality differences between the two countries was compared. The results showed surprisingly that mortality differentials were larger in Denmark than in the USA even after controlling for a number of covariates: The poorest 10 percent of the Danish elderly population have a mortality rate ratio of 3.32 (men) and 3.70 (women) compared to the richest 25 percent. In the USA the corresponding rate ratios are 1.67 and 1.56. Low income seems to be a more powerful risk factor for mortality than low education. A number of possible explanations for higher mortality differences in Denmark are discussed: unintended positive correlation between generous health services and health inequality, early life influences, mortality selection, and relative deprivation.

PB - 72 VL - 72 IS - 12 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21636194?dopt=Abstract U3 - 21636194 U4 - Socioeconomic factors/Inequality/Mortality/Older people/Cross Cultural Comparison ER - TY - JOUR T1 - Socioeconomic inequalities in self-rated health among middle-aged and older adults. JF - Soc Work Health Care Y1 - 2011 A1 - Kim, Jinhyun KW - Aged KW - Female KW - Health Status Disparities KW - Humans KW - Insurance Coverage KW - Insurance, Health KW - Male KW - Middle Aged KW - Self Report KW - Sex Factors KW - Socioeconomic factors AB -

Despite increased attention to health disparities in the United States, few studies have examined the impact of socioeconomic inequalities on self-rated health over time. Using data from the Health and Retirement Study, this article investigates socioeconomic inequalities in self-rated health among middle-aged and older adults. The findings indicated that higher level of income, assets, and education, and having private health insurance predicted better self-rated health. In particular, increases in income or assets predicted slower decline in self-rated health. Interestingly, economic status had greater impact on females' decline in self-rated health. Blacks were less likely to suffer rapid decline in self-rated health than were whites. The findings led to the conclusion that health disparities should be understood as the interplay of socioeconomic status, gender, and race/ethnicity.

PB - 50 VL - 50 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21347982?dopt=Abstract U3 - 21347982 U4 - socioeconomic inequalities/gender/self-rated health ER - TY - JOUR T1 - Socioeconomic status and race/ethnicity independently predict health decline among older diabetics. JF - BMC Public Health Y1 - 2011 A1 - Emily J Nicklett KW - Aged KW - Aged, 80 and over KW - Black People KW - Diabetes Mellitus, Type 2 KW - Diagnostic Self Evaluation KW - Female KW - Follow-Up Studies KW - Health Status Disparities KW - Hispanic or Latino KW - Humans KW - Male KW - Social Class KW - United States KW - White People AB -

BACKGROUND: There are pervasive racial and socioeconomic differences in health status among older adults with type 2 diabetes. The extent to which racial/ethnic and socioeconomic disparities unfold to differential health outcomes has yet to be investigated among older adults with diabetes. This study examines whether or not race/ethnicity and SES are independent predictors of steeper rates of decline in self-rated health among older adults in the U.S. with type 2 diabetes.

METHODS: The study population was a subset of diabetic adults aged 65 and older from the Health and Retirement Study. Respondents were followed up to 16 years. Multilevel cumulative logit regression models were used to examine the contributions of socioeconomic indicators, race/ethnicity, and covariates over time. Health decline was measured as a change in self-reported health status over the follow-up period.

RESULTS: Relative to whites, blacks had a significantly lower cumulative odds of better health status over time (OR: 0.61, p < .0001). Hispanics reported significantly lower cumulative odds better health over time relative to whites (OR: 0.59, p < .05). Although these disparities narrowed when socioeconomic characteristics were added to the model, significant differences remained. Including socioeconomic status did not remove the health effects of race/ethnicity among blacks and Hispanics.

CONCLUSIONS: The author found that race/ethnicity and some socioeconomic indicators were independent predictors of health decline among older adults with diabetes.

PB - 11 VL - 11 N1 - Nicklett, Emily J Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, P.H.S. England BMC public health BMC Public Health. 2011 Sep 2;11:684. U1 - http://www.ncbi.nlm.nih.gov/pubmed/21888645?dopt=Abstract U2 - PMC3175469 U4 - African Continental Ancestry Group/ statistics/African Continental Ancestry Group/ statistics/numerical data/Aged, 80 and over/Diabetes Mellitus, Type 2/ ethnology/Diabetes Mellitus, Type 2/ ethnology/Diagnostic Self Evaluation/Diagnostic Self Evaluation/European Continental Ancestry Group/ statistics/European Continental Ancestry Group/ statistics/numerical data/Female/Follow-Up Studies/Follow-Up Studies/Health Status Disparities/Hispanic Americans/ statistics/Hispanic Americans/ statistics/numerical data/Humans/Social Class/United States ER - TY - JOUR T1 - Sources of variability in estimates of the prevalence of Alzheimer's disease in the United States. JF - Alzheimers Dement Y1 - 2011 A1 - Robert S Wilson A1 - David R Weir A1 - Sue E Leurgans A1 - Denis A Evans A1 - Liesi Hebert A1 - Kenneth M. Langa A1 - Brenda L Plassman A1 - Brent J. Small A1 - David A Bennett KW - Aged KW - Aged, 80 and over KW - Alzheimer disease KW - Community Health Planning KW - Comorbidity KW - Dementia KW - Diagnosis, Differential KW - Female KW - Humans KW - Incidence KW - Male KW - Prevalence KW - United States AB -

BACKGROUND: The prevalence of Alzheimer's disease (AD) in the United States was estimated at 2.3 million in 2002 by the Aging, Demographics, and Memory Study (ADAMS), which is almost 50% less than the estimate of 4.5 million in 2000 derived from the Chicago Health and Aging Project.

METHODS: We considered how differences in diagnostic criteria may have contributed to these differences in AD prevalence.

RESULTS: We identified several important differences in diagnostic criteria that may have contributed to the differing estimates of AD prevalence. Two factors were especially noteworthy. First, the Diagnostic and Statistical Manual of Mental Disorders III-R and IV criteria of functional limitation documented by an informant used in ADAMS effectively concentrated the diagnosis of dementia toward a relatively higher level of cognitive impairment. ADAMS separately identified a category of cognitive impairment not dementia and within that group there were a substantial number of cases with "prodromal" AD (a maximum of 1.95 million with upweighting). Second, a substantial proportion of dementia in ADAMS was attributed to either vascular disease (representing a maximum of 0.59 million with upweighting) or undetermined etiology (a maximum of 0.34 million), whereas most dementia, including mixed dementia, was attributed to AD in the Chicago Health and Aging Project.

CONCLUSION: The diagnosis of AD in population studies is a complex process. When a diagnosis of AD excludes persons meeting criteria for vascular dementia, when not all persons with dementia are assigned an etiology, and when a diagnosis of dementia requires an informant report of functional limitations, the prevalence is substantially lower and the diagnosed cases most likely have a relatively higher level of impairment.

PB - 7 VL - 7 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21255745?dopt=Abstract U2 - PMC3145367 U4 - Epidemiology/Dementia/Alzheimers disease/Vascular dementia/Mild cognitive impairment/Cognitive impairment no dementia ER - TY - JOUR T1 - Spousal associations between functional limitation and depressive symptom trajectories: Longitudinal findings from the study of Asset and Health Dynamics Among the Oldest Old (AHEAD). JF - Health Psychol Y1 - 2011 A1 - Christiane A Hoppmann A1 - Denis Gerstorf A1 - Anita Hibbert KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Aging KW - depression KW - Female KW - Humans KW - Longitudinal Studies KW - Male KW - Psychometrics KW - Spouses KW - United States AB -

OBJECTIVE: To examine spousal associations between functional limitation and depressive symptom trajectories in a national sample of older long-term married couples.

DESIGN: We used 14.5-year longitudinal data on functional limitations and depressive symptoms from 1,704 couples participating in the Study of Asset and Health Dynamics Among the Oldest Old (AHEAD).

MAIN OUTCOME MEASURES: Activities of daily living and a short version of the Center for Epidemiologic Studies Depression scale were used.

RESULTS: Between-person difference findings corroborate previous research by showing that levels and changes in functional limitations and depressive symptoms are closely interrelated among wives and husbands. Our results further demonstrate sizable associations in levels and changes in functional limitations and depressive symptoms between spouses. For example, functional limitation levels in one spouse were associated with depressive symptom levels in the other spouse. Spousal associations remained after controlling for individual (age, education, cognition) and spousal covariates (marriage duration, number of children) and did not differ between women and men.

CONCLUSION: Our findings highlight the important role of marital relationships in shaping health trajectories in old age because they show that some of the well-documented between-person differences in functional limitations and depressive symptoms are in fact related to spouses.

PB - 30 VL - 30 IS - 2 N1 - Hoppmann, Christiane A Gerstorf, Denis Hibbert, Anita U01 AG009740-12/AG/NIA NIH HHS/United States U01AG009740/AG/NIA NIH HHS/United States Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't United States Nihms256806 Health Psychol. 2011 Mar;30(2):153-62. U1 - http://www.ncbi.nlm.nih.gov/pubmed/21401249?dopt=Abstract U2 - PMC3078040 U4 - Activities of Daily Living/Aging/Longitudinal Studies/Psychometrics/Spouses/marital Status/Functional limitations/Depressive Symptoms ER - TY - JOUR T1 - Subsidized housing not subsidized health: health status and fatigue among elders in public housing and other community settings. JF - Ethn Dis Y1 - 2011 A1 - Parsons, Pamela L A1 - Briana Mezuk A1 - Scott M Ratliff A1 - Kate L Lapane KW - Aged KW - Chronic disease KW - Comorbidity KW - Cross-Sectional Studies KW - Fatigue KW - Female KW - Health Status Disparities KW - Humans KW - Male KW - Poverty KW - Prevalence KW - Public Housing KW - United States AB -

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

DESIGN: Cross-sectional study.

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

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

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

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

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

PB - 21 VL - 21 UR - https://pubmed.ncbi.nlm.nih.gov/21462736/ IS - 1 N1 - Parsons, Pamela L Mezuk, Briana Ratliff, Scott Lapane, Kate L K12 HD055881/HD/NICHD NIH HHS/United States UL1 RR031990-01/RR/NCRR NIH HHS/United States UL1RR031990/RR/NCRR NIH HHS/United States Comparative Study Research Support, N.I.H., Extramural United States Ethnicity and disease Nihms287854 Ethn Dis. 2011 Winter;21(1):85-90. U1 - http://www.ncbi.nlm.nih.gov/pubmed/21462736?dopt=Abstract U2 - PMC3111957 U4 - Chronic Disease/epidemiology/Chronic Disease/epidemiology/Comorbidity/Cross-Sectional Studies/Fatigue/ epidemiology/Fatigue/ epidemiology/Female/Health Status Disparities/Humans/Poverty/Prevalence/Public Housing/Public Housing/United States/epidemiology/United States/epidemiology ER - TY - JOUR T1 - 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 - Utilization of blood transfusion among older adults in the United States. JF - Transfusion Y1 - 2011 A1 - Mary A M Rogers A1 - Neil Blumberg A1 - Heal, Joanna M A1 - Kenneth M. Langa KW - Age Distribution KW - Aged KW - Aged, 80 and over KW - Black or African American KW - Blood Transfusion KW - Female KW - Humans KW - Male KW - United States KW - White People AB -

BACKGROUND: While there have been epidemiologic studies of blood donors, the characteristics of individuals who receive transfusions have not been well described for the US population.

STUDY DESIGN AND METHODS: Subjects were from the nationally representative Health and Retirement Study whose data were linked to Medicare files from 1991 through 2007 (n = 16,377). A cohort study was conducted to assess the frequency of transfusion in older Americans over time and to describe the characteristics of blood recipients.

RESULTS: Thirty-one percent (95% confidence interval [CI], 30%-33%) of older Americans received at least one transfusion within a 10-year period and 5.8% (95% CI, 5.4%-6.2%) experienced repeated transfusion-related visits within 30 days. The mean number of transfusion-related visits was 2.3 over a 10-year period (95% CI, 2.2-2.4). Older Americans who lived in the South were most likely to receive a transfusion (34%), independent of demographic and health-related factors, while those who lived in the western United States were the least likely (26%). Predictors of transfusion included smoking, low body mass index, and a history of cancer, diabetes mellitus, end-stage renal disease, and heart disease. African-Americans and Mexican-Americans had greater rates of blood utilization than other races and other Hispanics (respectively). There were also differences in transfusion utilization by education, marital status, religion, and alcohol use.

CONCLUSIONS: Transfusion is common in older Americans. Regional variations in blood use are not explained by patient characteristics alone.

PB - 51 VL - 51 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21087284?dopt=Abstract U2 - PMC3078991 U4 - health services/blood transfusions/blood transfusions ER - TY - JOUR T1 - Volunteer transitions among older adults: the role of human, social, and cultural capital in later life. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2011 A1 - Tay K. McNamara A1 - Guillermo Ernest Gonzales KW - Aged KW - Aging KW - Caregivers KW - Community Participation KW - Cost of Illness KW - Educational Status KW - Employment KW - Female KW - Health Status KW - Health Surveys KW - Humans KW - Likelihood Functions KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Multivariate Analysis KW - Religion and Psychology KW - Social Environment KW - Social Identification KW - Social Support KW - Socioeconomic factors KW - United States KW - Volunteers AB -

OBJECTIVES: We aim to understand how human, social, and cultural capitals are associated with the volunteer process, that is, engagement (starting), intensity (number of hours), and cessation (stopping), among older adults.

METHOD: Data from the 2000 through 2008 Health and Retirement Study and the 2001 through 2009 Consumption and Activity Mail Survey provide a sample of 4,526 respondents. Random-effects pooled time series analyses incorporate not only the presence of various types of capital but also the quality of that capital.

RESULTS: Human and cultural capitals were positively associated with increased volunteer involvement. Effects of social capital (relationships in the family, employment status, and the community) depended on the quality of the relationships, not necessarily on their presence alone.

DISCUSSION: Results suggest that bolstering older adults' capitals, particularly among lower socioeconomic status groups, can increase volunteer engagement and intensity and reduce cessation. Additionally, a variety of organizational policies including respite programs for caregivers and employer policies allowing employees to reduce their work hours might indirectly affect participation rates and commitment. Potential pools of volunteers exist in families, workplaces, and religious organizations, but more research is necessary to identify how to recruit and retain individuals in social networks where volunteer participatory rates are low.

PB - 66B VL - 66 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21743042?dopt=Abstract U4 - Older people/Volunteers/Human capital/Social capital ER - TY - JOUR T1 - Volunteering and hypertension risk in later life. JF - J Aging Health Y1 - 2011 A1 - Jeffrey A Burr A1 - Jane Tavares A1 - Jan E Mutchler KW - Aged KW - Aged, 80 and over KW - Body Mass Index KW - Confidence Intervals KW - Female KW - Health Behavior KW - health policy KW - Health Status KW - Humans KW - Hypertension KW - Male KW - Middle Aged KW - Multivariate Analysis KW - Odds Ratio KW - Psychometrics KW - Regression Analysis KW - Risk Factors KW - Social Support KW - Surveys and Questionnaires KW - Volunteers AB -

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

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

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

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

PB - 23 VL - 23 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20971920?dopt=Abstract U3 - 20971920 U4 - Volunteers/Hypertension/Risk factors/Cardiovascular disease/Aging/Geriatrics/Older people ER - TY - JOUR T1 - Volunteering, driving status, and mortality in U.S. retirees. JF - J Am Geriatr Soc Y1 - 2011 A1 - Sei J. Lee A1 - Michael A Steinman A1 - Erwin J Tan KW - Activities of Daily Living KW - Aged KW - Automobile Driving KW - Female KW - Health Status KW - Humans KW - Male KW - Prospective Studies KW - Retirement KW - Risk Factors KW - Social Behavior KW - Survival Rate KW - United States KW - Volunteers AB -

OBJECTIVES: To evaluate how accounting for driving status altered the relationship between volunteering and mortality in U.S. retirees.

DESIGN: Observational prospective cohort.

SETTING: Nationally representative sample from the Health and Retirement Study in 2000 and 2002 followed to 2006.

PARTICIPANTS: Retirees aged 65 and older (N=6,408).

MEASUREMENTS: Participants self-reported their volunteering, driving status, age, sex, race or ethnicity, presence of chronic conditions, geriatric syndromes, socioeconomic factors, functional limitations, and psychosocial factors. Death by December 31, 2006, was the outcome.

RESULTS: For drivers, mortality in volunteers (9%) and nonvolunteers (12%) was similar; for limited or non-drivers, mortality for volunteers (15%) was markedly lower than for nonvolunteers (32%). Adjusted results showed that, for drivers, the volunteering-mortality odds ratio (OR) was 0.90 (95% confidence interval (CI)=0.66-1.22), whereas for limited or nondrivers, the OR was 0.62 (95% CI=0.49-0.78) (interaction P=.05). The effect of driving status was greater for rural participants, with greater differences between rural drivers and rural limited or nondrivers (interaction P=.02) and between urban drivers and urban limited or nondrivers (interaction P=.81).

CONCLUSION: The influence of volunteering in decreasing mortality seems to be stronger in rural retirees who are limited or nondrivers. This may be because rural or nondriving retirees are more likely to be socially isolated and thus receive more benefit from the greater social integration from volunteering.

PB - 59 VL - 59 IS - 2 N1 - Lee, Sei J Steinman, Michael A Tan, Erwin J K23 AG030999/AG/NIA NIH HHS/United States KL2RR024130/RR/NCRR NIH HHS/United States P30-AG02133/AG/NIA NIH HHS/United States Comparative Study Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't United States Journal of the American Geriatrics Society Nihms289698 J Am Geriatr Soc. 2011 Feb;59(2):274-80. doi: 10.1111/j.1532-5415.2010.03265.x. U1 - http://www.ncbi.nlm.nih.gov/pubmed/21314648?dopt=Abstract U2 - PMC3089440 U4 - Activities of Daily Living/Automobile Driving/driving Patterns/Health Status/Prospective Studies/Retirement planning/Risk Factors/Social Behavior/Social Behavior/Survival/volunteering ER - TY - JOUR T1 - Activities of daily living, social support, and future health of older Americans. JF - J Psychol Y1 - 2010 A1 - Bozo, Ozlem A1 - Charles A Guarnaccia KW - Activities of Daily Living KW - Adaptation, Psychological KW - Aged KW - Aging KW - Caregivers KW - Chronic disease KW - Female KW - Friends KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Personal Satisfaction KW - Retirement KW - Risk Factors KW - Sick Role KW - Social Support KW - Spouses AB -

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

PB - 144 VL - 144 IS - 1 N1 - Using Smart Source Parsing Jan-Feb Index Medicus U1 - http://www.ncbi.nlm.nih.gov/pubmed/20092067?dopt=Abstract U3 - 20092067 U4 - Activities of Daily Living/social Support/health care/families/Transfers ER - TY - JOUR T1 - Advance directives and outcomes of surrogate decision making before death. JF - N Engl J Med Y1 - 2010 A1 - Maria J Silveira A1 - Scott Y H Kim A1 - Kenneth M. Langa KW - Advance directives KW - Aged KW - Aged, 80 and over KW - Decision making KW - Female KW - Humans KW - Living Wills KW - Logistic Models KW - Male KW - Mental Competency KW - Middle Aged KW - Proxy KW - Terminal Care KW - United States AB -

BACKGROUND: Recent discussions about health care reform have raised questions regarding the value of advance directives.

METHODS: We used data from survey proxies in the Health and Retirement Study involving adults 60 years of age or older who had died between 2000 and 2006 to determine the prevalence of the need for decision making and lost decision-making capacity and to test the association between preferences documented in advance directives and outcomes of surrogate decision making.

RESULTS: Of 3746 subjects, 42.5% required decision making, of whom 70.3% lacked decision-making capacity and 67.6% of those subjects, in turn, had advance directives. Subjects who had living wills were more likely to want limited care (92.7%) or comfort care (96.2%) than all care possible (1.9%); 83.2% of subjects who requested limited care and 97.1% of subjects who requested comfort care received care consistent with their preferences. Among the 10 subjects who requested all care possible, only 5 received it; however, subjects who requested all care possible were far more likely to receive aggressive care as compared with those who did not request it (adjusted odds ratio, 22.62; 95% confidence interval [CI], 4.45 to 115.00). Subjects with living wills were less likely to receive all care possible (adjusted odds ratio, 0.33; 95% CI, 0.19 to 0.56) than were subjects without living wills. Subjects who had assigned a durable power of attorney for health care were less likely to die in a hospital (adjusted odds ratio, 0.72; 95% CI, 0.55 to 0.93) or receive all care possible (adjusted odds ratio, 0.54; 95% CI, 0.34 to 0.86) than were subjects who had not assigned a durable power of attorney for health care.

CONCLUSIONS: Between 2000 and 2006, many elderly Americans needed decision making near the end of life at a time when most lacked the capacity to make decisions. Patients who had prepared advance directives received care that was strongly associated with their preferences. These findings support the continued use of advance directives.

PB - 362 VL - 362 IS - 13 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20357283?dopt=Abstract U2 - PMC2880881 U4 - Right to die/Powers of attorney/Decision making/Health care/Advance directives ER - TY - JOUR T1 - Alcohol use trajectories in two cohorts of U.S. women aged 50 to 65 at baseline. JF - J Am Geriatr Soc Y1 - 2010 A1 - Janet Kay Bobo A1 - April A Greek A1 - Daniel H. Klepinger A1 - Jerald R Herting KW - Aged KW - Aging KW - Alcohol Drinking KW - Alcoholism KW - Cohort Studies KW - Female KW - Follow-Up Studies KW - Humans KW - Life Change Events KW - Middle Aged KW - Retirement KW - Risk Factors KW - Surveys and Questionnaires KW - United States AB -

OBJECTIVES: To examine drinking trajectories followed by two cohorts of older women over 8 to 10 years of follow-up.

DESIGN: Longitudinal analyses of two nationally representative cohorts using semiparametric group-based models weighted and adjusted for baseline age.

SETTING: Study data were obtained from detailed interviews conducted in the home or by telephone.

PARTICIPANTS: One cohort included 5,231 women in the Health and Retirement Study (HRS) aged 50 to 65 in 1996; the other included 1,658 women in the National Longitudinal Survey (NLS) aged 50 to 65 in 1995.

MEASUREMENTS: Both cohorts reported any recent drinking and average number of drinks per drinking day using similar but not identical questions. HRS women completed six interviews (one every other year) from 1996 to 2006. NLS women completed five interviews from 1995 to 2003.

RESULTS: All trajectory models yielded similar results. For HRS women, four trajectory groups were observed in the model based on drinks per day: increasing drinkers (4.9% of cohort), infrequent and nondrinkers (61.8%), consistent drinkers (25.9%), and decreasing drinkers (7.4%). Corresponding NLS values from the drinks per day model were 8.8%, 61.4%, 21.2%, and 8.6%, respectively. In 2006, the average number of drinks per day for HRS women in the increasing drinker and consistent drinker trajectories was 1.31 and 1.59, respectively. In 2003, these values for NLS women were 0.99 and 1.38, respectively.

CONCLUSION: Most women do not markedly change their drinking behavior after age 50, but some increase their alcohol use substantially, whereas others continue to exceed current recommendations. These findings underscore the importance of periodically asking older women about their drinking to assess, advise, and assist those who may be at risk for developing alcohol-related problems.

PB - 58 VL - 58 IS - 12 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21087226?dopt=Abstract U2 - PMC3064493 U4 - WOMEN/Alcohol Abuse/Drinking Behavior ER - TY - JOUR T1 - Can racial disparity in health between black and white Americans be attributed to racial disparities in body weight and socioeconomic status? JF - Health Soc Work Y1 - 2010 A1 - Kahng, Sang Kyoung KW - Aged KW - Black or African American KW - Body Mass Index KW - Body Weight KW - Female KW - Health Surveys KW - Healthcare Disparities KW - Humans KW - Male KW - Middle Aged KW - Social Class KW - United States KW - White People AB -

Few studies have examined to what extent racial disparities in chronic health conditions (CHCs) are attributable to racial differences in body weight (measured as body mass index [BMI]) and socioeconomic status (SES) among older adults. To address this gap, using longitudinal data from the Health and Retirement Study, the current study examined risk factors of CHC trajectory including race, BMI, and SES. The sample consists of 22,560 in 1998, 20,825 in 2000, and 19,004 in 2002. Data analysis was done through latent growth curve modeling. As expected, older adults presented an increasing trajectory of CHCs over time. Black Americans presented a significantly more negative CHC trajectory than did their white counterparts, confirming racial disparity in health over time. Consequent hierarchical analyses revealed that racial disparity in CHC trajectory can be explained by racial disparity in BMI and that racial disparity in BMI can be attributed to racial disparity in SES. Because low SES is closely related to unhealthy diet and negative health behaviors that may subsequently lead to obesity and chronic health conditions, the findings suggest that to address racial disparity in CHCs, it is important for social workers to continuously try to mitigate racial inequality in SES.

PB - 35 VL - 35 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21171533?dopt=Abstract U3 - 21171533 U4 - Racial Differences/Socioeconomic Status/Body Mass Index/Body Weight/Elderly/Health Problems/Black Americans/Health/Health Behavior/Inequality ER - TY - JOUR T1 - Causes and consequences of early-life health. JF - Demography Y1 - 2010 A1 - Case, Anne A1 - Paxson, Christina KW - Adolescent KW - Adult KW - Aged KW - Body Height KW - Child KW - Child Development KW - Child, Preschool KW - Educational Status KW - Employment KW - Family Characteristics KW - Female KW - Health Status KW - Humans KW - Income KW - Infant KW - Infant, Newborn KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Pregnancy KW - Prenatal Exposure Delayed Effects KW - Regression Analysis KW - Socioeconomic factors KW - United Kingdom AB -

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

PB - 47 VL - 47 Suppl IS - Suppl 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21302429?dopt=Abstract U4 - health outcomes/Cognition/cognitive development/childhood health ER - TY - JOUR T1 - 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 - Clinical complexity in middle-aged and older adults with diabetes: the Health and Retirement Study. JF - Med Care Y1 - 2010 A1 - Caroline S Blaum A1 - Christine T Cigolle A1 - Cynthia Boyd A1 - Jennifer L. Wolff A1 - Zhiyi Tian A1 - Kenneth M. Langa A1 - David R Weir KW - Aged KW - Cross-Sectional Studies KW - Diabetes Complications KW - Diabetes Mellitus, Type 2 KW - Female KW - Glycemic Index KW - Health Status KW - Health Surveys KW - Humans KW - Male KW - Middle Aged KW - Quality of Health Care KW - Self Care KW - Severity of Illness Index KW - Treatment Failure KW - United States AB -

BACKGROUND: Some patients with diabetes may have health status characteristics that could make diabetes self-management (DSM) difficult and lead to inadequate glycemic control, or limit the benefit of some diabetes management interventions.

OBJECTIVE: To investigate how many older and middle-aged adults with diabetes have such health status characteristics.

DESIGN: Secondary data analysis of a nationally representative health interview survey, the Health and Retirement Study, and its diabetes mail-out survey.

SETTING/PARTICIPANTS: Americans aged 51 and older with diabetes (n = 3506 representing 13.6 million people); aged 56 and older in diabetes survey (n = 1132, representing 9.9 million).

MEASUREMENTS: Number of adults with diabetes and (a) relatively good health; (b) health status that could make DSM difficult (eg, comorbidities, impaired instrumental activities of daily living; and (c) characteristics like advanced dementia and activities of daily living dependency that could limit benefit of some diabetes management. Health and Retirement Study measures included demographics. Diabetes Survey included self-measured HbA1c.

RESULTS: Nearly 22% of adults > or =51 with diabetes (about 3 million people) have health characteristics that could make DSM difficult. Another 10% (1.4 million) may receive limited benefit from some diabetes management. Mail-out respondents with health characteristics that could make DSM difficult had significantly higher mean HbA1c compared with people with relatively good health (7.6% vs. 7.3%, P < 0.04.).

CONCLUSIONS: Some middle-aged as well as older adults with diabetes have health status characteristics that might make DSM difficult or of limited benefit. Current diabetes quality measures, including measures of glycemic control, may not reflect what is possible or optimal for all patient groups.

PB - 48 VL - 48 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20355264?dopt=Abstract U2 - PMC3153504 U4 - Data analysis/Patients/Diabetes/Glycemic index/Older people/Middle age ER - TY - JOUR T1 - Comparison study on functional outcomes and perceived quality of life between all-inclusive and fee-for-service continuing care retirement communities. JF - J Am Med Dir Assoc Y1 - 2010 A1 - Young, Yuchi KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Cross-Sectional Studies KW - Fee-for-Service Plans KW - Female KW - Humans KW - Male KW - New York KW - Outcome Assessment, Health Care KW - Quality of Life KW - Residential Facilities AB -

OBJECTIVE: To examine the associations between 2 types of continuing care retirement communities' (CCRC) residents regarding physical function and perceived quality of life.

METHODS: Cross-sectional study (n=406). Eligibility criteria include age 65 years or older, residents of independent living units, and intact cognition (MMSE>or=24). All-inclusive CCRCs provide unlimited access to home health services and nursing home care as needed in return for the entry and monthly fee. Fee-for-service CCRCs offer home health and nursing home services at a full fee-for-service rate. Outcomes were functional status (ADLs and IADLs) and perceived quality of life. Multivariate regressions were used to examine the associations between residents of different types of CCRCs on selected outcomes while adjusting for covariates.

RESULTS: The all-inclusive CCRC sample was more likely to be married (53.8% versus 33.4%; P < .001), with more years of education (17.9 versus 14.4; P < .0001), and had few physician visits in the previous year in comparison to the FFS CCRC sample. Multivariate results indicate that the FFS group had worse ADL (beta=0.95; P=.0003), IADL (beta=0.57; P=.02) function than the all-inclusive group. There was no significant difference in perceived quality of life scores between the 2 groups.

CONCLUSIONS: Residents of both CCRCs reported equally good quality of life scores. Residents of the all-inclusive CCRC seem to have had better ADL and IADL function than the FFS CCRC residents. Prepaid home health services and nursing home care in the all-inclusive CCRC may facilitate ADL and IADL functional independence.

PB - 11 VL - 11 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20439045?dopt=Abstract U3 - 20439045 U4 - Activities of Daily Living/continuing care retirement communities/Quality of Life/nursing Homes/Home Care Services ER - TY - JOUR T1 - Continuity of care with a primary care physician and mortality in older adults. JF - J Gerontol A Biol Sci Med Sci Y1 - 2010 A1 - Frederic D Wolinsky A1 - Suzanne E Bentler A1 - Li Liu A1 - John F Geweke A1 - Elizabeth A Cook A1 - Maksym Obrizan A1 - Elizabeth A Chrischilles A1 - Kara B Wright A1 - Michael P Jones A1 - Gary E Rosenthal A1 - Robert L. Ohsfeldt A1 - Robert B Wallace KW - Aged KW - Continuity of Patient Care KW - Female KW - Health Services for the Aged KW - Humans KW - Male KW - Mortality KW - Physicians, Family AB -

BACKGROUND: We examined whether older adults who had continuity of care with a primary care physician (PCP) had lower mortality.

METHODS: Secondary analyses were conducted using baseline interview data (1993-1994) from the nationally representative Survey on Assets and Health Dynamics among the Oldest Old (AHEAD). The analytic sample included 5,457 self-respondents 70 years old or more who were not enrolled in managed care plans. AHEAD data were linked to Medicare claims for 1991-2005, providing up to 12 years of follow-up. Two time-dependent measures of continuity addressed whether there was more than an 8-month interval between any two visits to the same PCP during the prior 2-year period. The "present exposure" measure calculated this criterion on a daily basis and could switch "on" or "off" daily, whereas the "cumulative exposure" measure reflected the percentage of follow-up days, also on a daily basis allowing it to switch on or off daily, for which the criterion was met.

RESULTS: Two thousand nine hundred and fifty-four (54%) participants died during the follow-up period. Using the cumulative exposure measure, 27% never had continuity of care, whereas 31%, 20%, 14%, and 8%, respectively, had continuity for 1%-33%, 34%-67%, 68%-99%, and 100% of their follow-up days. Adjusted for demographics, socioeconomic status, social support, health lifestyle, and morbidity, both measures of continuity were associated (p < .001) with lower mortality (adjusted hazard ratios of 0.84 for the present exposure measure and 0.31, 0.39, 0.46, and 0.62, respectively, for the 1%-33%, 34%-67%, 68%-99%, and 100% categories of the cumulative exposure measure).

CONCLUSION: Continuity of care with a PCP, as assessed by two distinct measures, was associated with substantial reductions in long-term mortality.

PB - 65A VL - 65 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19995831?dopt=Abstract U2 - PMC2844057 U4 - continuity of care/medicare/primary care physician/MORTALITY 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 - Cross-national comparison of sex differences in health and mortality in Denmark, Japan and the US. JF - Eur J Epidemiol Y1 - 2010 A1 - Oksuzyan, Anna A1 - Eileen M. Crimmins A1 - Saito, Yasuhiko A1 - Angela M O'Rand A1 - James W Vaupel A1 - Christensen, Kaare KW - Aged KW - Aged, 80 and over KW - Denmark KW - Disability Evaluation KW - Female KW - Health Status KW - Humans KW - Japan KW - Male KW - Middle Aged KW - Mortality KW - Sex Distribution KW - United States AB -

The present study aims to compare the direction and magnitude of sex differences in mortality and major health dimensions across Denmark, Japan and the US. The Human Mortality Database was used to examine sex differences in age-specific mortality rates. The Danish twin surveys, the Danish 1905-Cohort Study, the Health and Retirement Study, and the Nihon University Japanese Longitudinal Study of Aging were used to examine sex differences in health. Men had consistently higher mortality rates at all ages in all three countries, but they also had a substantial advantage in handgrip strength compared with the same-aged women. Sex differences in activities of daily living (ADL) became pronounced among individuals aged 85+ in all three countries. Depression levels tended to be higher in women, particularly, in Denmark and the HRS, and only small sex differences were observed in the immediate recall test and Mini-Mental State Exam. The present study revealed consistent sex differentials in survival and physical health, self-rated health and cognition at older ages, whereas the pattern of sex differences in depressive symptoms was country-specific.

PB - 25 VL - 25 IS - 7 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20495953?dopt=Abstract U2 - PMC2903692 U4 - cross-national comparison/Activities of Daily Living/Sex Differences/depression/SELF-RATED HEALTH/NUJLSOA/NUJLSOA ER - TY - JOUR T1 - Defining emergency department episodes by severity and intensity: A 15-year study of Medicare beneficiaries. JF - BMC Health Serv Res Y1 - 2010 A1 - Kaskie, Brian A1 - Maksym Obrizan A1 - Elizabeth A Cook A1 - Michael P Jones A1 - Li Liu A1 - Suzanne E Bentler A1 - Robert B Wallace A1 - John F Geweke A1 - Kara B Wright A1 - Elizabeth A Chrischilles A1 - Claire E Pavlik A1 - Robert L. Ohsfeldt A1 - Gary E Rosenthal A1 - Frederic D Wolinsky KW - Aged KW - Aged, 80 and over KW - Cohort Studies KW - Emergency Service, Hospital KW - Humans KW - Insurance Claim Review KW - Medicare KW - Prospective Studies KW - Severity of Illness Index KW - United States AB -

BACKGROUND: Episodes of Emergency Department (ED) service use among older adults previously have not been constructed, or evaluated as multi-dimensional phenomena. In this study, we constructed episodes of ED service use among a cohort of older adults over a 15-year observation period, measured the episodes by severity and intensity, and compared these measures in predicting subsequent hospitalization.

METHODS: We conducted a secondary analysis of the prospective cohort study entitled the Survey on Assets and Health Dynamics among the Oldest Old (AHEAD). Baseline (1993) data on 5,511 self-respondents >or=70 years old were linked to their Medicare claims for 1991-2005. Claims then were organized into episodes of ED care according to Medicare guidelines. The severity of ED episodes was measured with a modified-NYU algorithm using ICD9-CM diagnoses, and the intensity of the episodes was measured using CPT codes. Measures were evaluated against subsequent hospitalization to estimate comparative predictive validity.

RESULTS: Over 15 years, three-fourths (4,171) of the 5,511 AHEAD participants had at least 1 ED episode, with a mean of 4.5 episodes. Cross-classification indicated the modified-NYU severity measure and the CPT-based intensity measure captured different aspects of ED episodes (kappa = 0.18). While both measures were significant independent predictors of hospital admission from ED episodes, the CPT measure had substantially higher predictive validity than the modified-NYU measure (AORs 5.70 vs. 3.31; p < .001).

CONCLUSIONS: We demonstrated an innovative approach for how claims data can be used to construct episodes of ED care among a sample of older adults. We also determined that the modified-NYU measure of severity and the CPT measure of intensity tap different aspects of ED episodes, and that both measures were predictive of subsequent hospitalization.

PB - 8 VL - 10 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20565949?dopt=Abstract U2 - PMC2903585 U4 - HOSPITALIZATION/emergency department service use/emergency department service use/medicare/predictive validity/predictive validity ER - TY - JOUR T1 - Dental care coverage and retirement. JF - J Public Health Dent Y1 - 2010 A1 - Richard J. Manski A1 - John F Moeller A1 - Jody Schimmel A1 - Patricia A St Clair A1 - Haiyan Chen A1 - Larry S. Magder A1 - John V Pepper KW - Aged KW - Employment KW - ethnicity KW - Female KW - Humans KW - Income KW - Insurance, Dental KW - Male KW - Middle Aged KW - Models, Statistical KW - Multivariate Analysis KW - Retirement KW - United States AB -

OBJECTIVES: To examine the convergence of an aging population and a decreased availability of dental care coverage using data from the Health and Retirement Study (HRS).

METHODS: We calculate national estimates of the number and characteristics of those persons age 51 years and above covered by dental insurance by labor force, retirement status, and source of coverage. We also estimate a multivariate model controlling for potentially confounding variables.

RESULTS: We show that being in the labor force is a strong predictor of having dental coverage. For older retired adults not in the labor force, the only source for dental coverage is either a postretirement health benefit or spousal coverage.

CONCLUSIONS: Dental care, generally not covered in Medicare, is an important factor in the decision to seek dental care. It is important to understand the relationship between retirement and dental coverage in order to identify the best ways of improving oral health and access to care among older Americans.

PB - 70 VL - 70 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19694939?dopt=Abstract U2 - PMC2864343 U4 - dental/utilization/dentistry/insurance/coverage/retirement 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 - Dental care utilization 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 - Aged KW - Confounding Factors, Epidemiologic KW - Dental Care KW - Employment KW - ethnicity KW - Female KW - health policy KW - Humans KW - Income KW - Insurance, Dental KW - Leisure activities KW - Logistic Models KW - Male KW - Middle Aged KW - Multivariate Analysis KW - Odds Ratio KW - Retirement KW - Socioeconomic factors KW - United States AB -

OBJECTIVE: The authors examine the relationship of dental care coverage, retirement, and utilization in an aging population using data from the Health and Retirement Study (HRS).

METHODS: The authors estimate dental care use as a function of dental care coverage status, retirement, and individual and household characteristics. They also estimate a multivariate model controlling for potentially confounding variables.

RESULTS: The authors show that that the loss of income and dental coverage associated with retirement may lead to lower use rates but this effect may be offset by other unobserved aspects of retirement including more available free time leading to an overall higher use rate.

CONCLUSIONS: The authors conclude from this study that full retirement accompanied by reduced income and dental insurance coverage produces lower utilization of dental services. However, they also show that retirement acts as an independent variable, whereas income, coverage, and free time (unobserved) act as intervening variables.

PB - 70 VL - 70 IS - 1 N1 - Manski, Richard J Moeller, John Chen, Haiyan St Clair, Patricia A Schimmel, Jody Magder, Larry Pepper, John V R01 AG026090-01A2/AG/NIA NIH HHS/United States R01 AG026090-03/AG/NIA NIH HHS/United States U01AG009740/AG/NIA NIH HHS/United States Research Support, N.I.H., Extramural United States Nihms172468 J Public Health Dent. 2010 Winter;70(1):67-75. U1 - http://www.ncbi.nlm.nih.gov/pubmed/19765203?dopt=Abstract U2 - PMC2864359 U4 - Confounding Factors (Epidemiology)/Dental Care/Employment/Ethnic Groups/Health Policy/Income/Dental Insurance/leisure/Logistic Models/Multivariate Analysis/Odds Ratio/Retirement planning/Socioeconomic Factors ER - TY - JOUR T1 - Depression among older adults in the United States and England. JF - Am J Geriatr Psychiatry Y1 - 2010 A1 - Zivin, Kara A1 - David J Llewellyn A1 - Iain A Lang A1 - Sandeep Vijan A1 - Mohammed U Kabeto A1 - Erin M Miller A1 - Kenneth M. Langa KW - Aged KW - Aged, 80 and over KW - depression KW - England KW - Female KW - Health Behavior KW - Health Status KW - Health Surveys KW - Humans KW - Male KW - Prevalence KW - Risk Factors KW - United States KW - White People AB -

CONTEXT: Depression negatively affects health and well being among older adults, but there have been no nationally representative comparisons of depression prevalence among older adults in England and the United States.

OBJECTIVE: The authors sought to compare depressive symptoms among older adults in these countries and identify sociodemographic and clinical correlates of depression in these countries.

DESIGN AND SETTING: The authors assessed depressive symptoms in non-Hispanic whites aged 65 years and older in 2002 in two nationally representative, population-based studies: the U.S. Health and Retirement Study and English Longitudinal Study of Ageing.

PARTICIPANTS: A total of 8,295 Health and Retirement Study respondents and 5,208 English Longitudinal Study of Ageing respondents.

MAIN OUTCOME MEASURES: The authors measured depressive symptoms using the eight-item Center for Epidemiologic Studies Depression Scale. The authors determined whether depressive symptom differences between the United States and England were associated with sociodemographic characteristics, chronic health conditions, and health behaviors.

RESULTS: Significant depressive symptoms (Center for Epidemiologic Studies Depression Scale score ≥4) were more prevalent in English than U.S. adults (17.6% versus 14.6%, adjusted Wald test F([1, 1593]) = 11.4, p < 0.001). Adjusted rates of depressive symptoms in England were 19% higher compared with the United States (odds ratio: 1.19, 95% confidence interval: 1.01-1.40). U.S. adults had higher levels of education, and net worth, but lower levels of activities of daily living/instrumental activities of daily living impairments, tobacco use, and cognitive impairment, which may have contributed to relatively lower levels of depressive symptoms in the United States.

CONCLUSIONS: Older adults in the United States had lower rates of depressive symptoms than their English counterparts despite having more chronic health conditions. Future cross-national studies should identify how depression treatment influences outcomes in these populations.

PB - 11 VL - 18 IS - 11 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20808088?dopt=Abstract U2 - PMC3786867 U4 - Aged, 80 and over/Depression/Health Behavior/Health Status/Health Surveys/Prevalence/Risk Factors/epidemiology ER - TY - JOUR T1 - Depressive symptoms predict incident stroke independently of memory impairments. JF - Neurology Y1 - 2010 A1 - M. Maria Glymour A1 - J Maselko A1 - Gilman, S E A1 - Kristen K Patton A1 - Mauricio Avendano KW - Aged KW - Aged, 80 and over KW - depression KW - Female KW - Health Surveys KW - Humans KW - Incidence KW - Kaplan-Meier Estimate KW - Longitudinal Studies KW - Male KW - Memory Disorders KW - Middle Aged KW - Neuropsychological tests KW - Predictive Value of Tests KW - Risk Factors KW - Statistics, Nonparametric KW - Stroke KW - United States AB -

BACKGROUND: We evaluated whether depressive symptoms predict the onset of first stroke independently of memory impairment. We conceptualized memory impairment as a marker of preexisting cerebrovascular disease. We hypothesized that if depressive symptoms are causally related to stroke through mechanisms unrelated to cerebrovascular disease, depressive symptoms should predict stroke independently of memory impairment.

METHODS: Incidence of first stroke was assessed with self or proxy reports from 19,087 participants in the Health and Retirement Study cohort (1,864 events). Elevated depressive symptoms (3+ on an 8-item Centers for the Epidemiologic Study of Depression scale) and memory impairment (score of ≤6 on a combined immediate and delayed recall of a 10-word list) were used as predictors of incident stroke in Cox survival models with adjustment for sociodemographic and cardiovascular risk factors.

RESULTS: After adjustment for sociodemographic and cardiovascular risk factors, elevated depressive symptoms (hazard ratio = 1.25; 95% confidence interval 1.12-1.39) and memory impairment (hazard ratio = 1.26; 95% confidence interval 1.13-1.41) each predicted stroke incidence in separate models. Hazard ratios were nearly unchanged and remained significant (1.23 for elevated depressive symptoms and 1.25 for memory impairment) when models were simultaneously adjusted for both elevated depressive symptoms and memory impairment. Elevated depressive symptoms also predicted stroke when restricting analyses to individuals with median memory score or better.

CONCLUSIONS: Memory impairments and depressive symptoms independently predict stroke incidence. Memory impairment may reflect undiagnosed cerebrovascular disease. These results suggest that depressive symptoms might be directly related to stroke rather than merely indicating preexisting cerebrovascular disease.

PB - 75 VL - 75 IS - 23 N1 - Glymour, M M Maselko, J Gilman, S E Patton, K K Avendano, M 1R01MH087544/MH/NIMH NIH HHS/United States 1R21 AG34385-01A1/AG/NIA NIH HHS/United States 1R21AG037889-01/AG/NIA NIH HHS/United States 1R21HD066312-01/HD/NICHD NIH HHS/United States 1RC4MH092707-01/MH/NIMH NIH HHS/United States 5R03MH083335/MH/NIMH NIH HHS/United States Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't United States Neurology Neurology. 2010 Dec 7;75(23):2063-70. U1 - http://www.ncbi.nlm.nih.gov/pubmed/21135381?dopt=Abstract U2 - PMC2995534 U4 - Aged, 80 and over/Depression/ etiology/Depression/ etiology/Female/Health Surveys/Humans/Incidence/Kaplan-Meier Estimate/Kaplan-Meier Estimate/Longitudinal Studies/Memory Disorders/complications/ epidemiology/Memory Disorders/complications/ epidemiology/Middle Aged/Neuropsychological Tests/Predictive Value of Tests/Predictive Value of Tests/Risk Factors/Statistics, Nonparametric/Statistics, Nonparametric/Stroke/ complications/ epidemiology/Stroke/ complications/ epidemiology/United States/epidemiology/United States/epidemiology ER - TY - JOUR T1 - Diabetes-related support, regimen adherence, and health decline among older adults. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2010 A1 - Emily J Nicklett A1 - Jersey Liang KW - Activities of Daily Living KW - Aged KW - Diabetes Mellitus, Type 2 KW - Disability Evaluation KW - Female KW - Health Behavior KW - Health Status KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Patient Compliance KW - Quality of Life KW - Social Support KW - Surveys and Questionnaires KW - United States AB -

UNLABELLED: OBJECTIVES. Social support is generally conceptualized as health promoting; however, there is little consensus regarding the mechanisms through which support is protective. Illness support has been proposed to promote regimen adherence and subsequent prevention of health decline. We hypothesize that (a) support for regimen adherence is negatively associated with self-reported health decline among older diabetic adults and that (b) regimen adherence is negatively associated with health decline among older diabetic adults.

METHODS: We used the Health and Retirement Study data on individuals over the age of 60 years with type 2 diabetes mellitus (n = 1,788), examining change in self-reported health status over a 2-year period using binomial and cumulative ordinal logistic regression models.

RESULTS: Diabetic support is not significantly associated with health decline, but it is strongly associated with adherence to health-promoting activities consisting of a diabetic regimen. Therefore, the extent to which one receives illness support for a given regimen component is highly positively associated with adhering to that component, although this adherence does not necessarily translate into protection against perceived decline in health.

CONCLUSIONS: Illness-related support appears to be a mechanism through which social support matters in the diabetic population. Although this relationship did not extend to prevention of health status decline among diabetics, the relationship between support and illness management is promising.

PB - 10 VL - 65B IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19541672?dopt=Abstract U2 - PMC2853599 U4 - Chronic Illness/diabetes/Health care management ER - TY - JOUR T1 - Differences in functional impairment across subtypes of dementia. JF - J Gerontol A Biol Sci Med Sci Y1 - 2010 A1 - Tanya R Gure A1 - Mohammed U Kabeto A1 - Brenda L Plassman A1 - John D Piette A1 - Kenneth M. Langa KW - Activities of Daily Living KW - Aged KW - Alzheimer disease KW - Dementia KW - Dementia, Vascular KW - Humans AB -

BACKGROUND: Dementia is a cause of disability in later life. Despite the importance of functional status to the diagnosis of dementia, limited information exists on differences in functional limitations by dementia subtype. We conducted a cross-sectional analysis using the Aging, Demographics, and Memory Study (ADAMS) to determine the extent of functional impairment among older adults with dementia due to different etiologies.

METHODS: The ADAMS sample consisted of 856 individuals aged 71 years and older originally surveyed as part of the Health and Retirement Study. Based on a comprehensive in-person cognitive evaluation, respondents were assigned to diagnostic categories of normal cognition, cognitive impairment not demented, and demented. Dementia subtypes were grouped into three categories: vascular dementia (VaD), Alzheimer's dementia (AD), and dementia due to other etiologies. For 744 of the 856 respondents, a proxy informant completed a questionnaire asking whether the respondent had difficulty completing instrumental activities of daily living and activities of daily living (ADLs).

RESULTS: Of 744 ADAMS participants, 263 had dementia: 199 (70.5%) with AD, 42 (16.9%) with VaD, and 22 (12.6%) were demented due to other etiologies. After adjustment for demographics, chronic illnesses, and dementia severity, participants with VaD (odds ratio [OR] 5.74; 95% confidence interval [CI] 2.60-12.69) and other etiologies of dementia (OR 21.23; 95% CI 7.25-62.16) were more likely to have greater than or equal to four ADL limitations compared with those with AD.

CONCLUSIONS: VaD is associated with significantly more ADL limitations than AD. These physical limitations should be considered when designing adult day care programs, which adequately accommodate the needs of non-AD patients.

PB - 65A VL - 65 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20018827?dopt=Abstract U2 - PMC2844058 U4 - Aging/Dementia/Demographics/Memory/Older people/Alzheimers disease/Questionnaires/Disability/Disability ER - TY - JOUR T1 - Disease prevalence, disease incidence, and mortality in the United States and in England. JF - Demography Y1 - 2010 A1 - James Banks A1 - Muriel, Alastair A1 - James P Smith KW - Aged KW - Aged, 80 and over KW - England KW - Health Status KW - Health Status Disparities KW - Humans KW - Incidence KW - Life Tables KW - Middle Aged KW - Morbidity KW - Mortality KW - Prevalence KW - Socioeconomic factors KW - United States AB -

We find that both disease incidence and disease prevalence are higher among Americans in age groups 55-64 and 70-80, indicating that Americans suffer from higher past cumulative disease risk and experience higher immediate risk of new disease onset compared with the English. In contrast, age-specific mortality rates are similar in the two countries, with an even higher risk among the English after age 65. We also examine reasons for the large financial gradients in mortality in the two countries. Among 55- to 64-year-olds, we estimate similar health gradients in income and wealth in both countries, but for 70- to 80-year-olds, we find no income gradient in the United Kingdom. Standard behavioral risk factors (work, marriage, obesity, exercise, and smoking) almost fully explain income gradients among those aged 55-64 in both countries and a significant part among Americans 70-80 years old. The most likely explanation of the absence of an English income gradient relates to the English income benefit system: below the median, retirement benefits are largely flat and independent of past income, and hence past health, during the working years. Finally, we report evidence using a long panel of American respondents that their subsequent mortality is not related to large changes in wealth experienced during the prior 10-year period.

PB - 47 VL - 47 Suppl IS - Suppl 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21302425?dopt=Abstract U3 - 21302425 U4 - health outcomes/disease incidence/disease prevalence/cross-national comparison ER - TY - JOUR T1 - Dynamics and heterogeneity in the process of human frailty and aging: evidence from the U.S. older adult population. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2010 A1 - Yang, Yang A1 - Lee, Linda C KW - Aged KW - Aged, 80 and over KW - Aging KW - Cohort Studies KW - Female KW - Frail Elderly KW - Humans KW - Male KW - Surveys and Questionnaires KW - United States AB -

OBJECTIVES: This study investigated the dynamics and heterogeneity of the frailty index (FI) conceived as a systemic indicator of biological aging in the community-dwelling older adult population in the United States.

METHODS: We used panel data on multiple birth cohorts from the Health and Retirement Survey 1993-2006 and growth curve models to estimate age trajectories of the FI and their differences by sex, race, and socioeconomic status (SES) within cohorts.

RESULTS: The FI for cohorts born before 1942 exhibit quadratic increases with age and accelerated increases in the accumulation of health deficits. More recent cohorts exhibit higher average levels of and rates of increment in the FI than their predecessors do at the same ages. Females, non-Whites, and individuals with low education and income exhibit greater degrees of physiological deregulation than their male, White, and high-SES counterparts at any age. Patterns of sex, race, and SES differentials in rates of aging vary across cohorts.

DISCUSSION: Adjusting for social behavioral factors, the analysis provides evidence for physiological differences in the aging process among recent cohorts of older adults, points to the need for biological explanations of female excess in general system damage, and reveals the insufficiency of any single mechanism for depicting the racial and SES differences in the process of physiological deterioration.

PB - CCCB CCCP VL - 65B IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20007299?dopt=Abstract U2 - PMC2981448 U4 - Frailty index/Deficits accumulation/Biological aging/Heterogeneity of frailty/age trajectories ER - TY - JOUR T1 - Early-life characteristics, psychiatric history, and cognition trajectories in later life. JF - Gerontologist Y1 - 2010 A1 - Maria T. Brown KW - Aged KW - Aged, 80 and over KW - Aging KW - Cognition KW - Cognition Disorders KW - Cohort Studies KW - Female KW - Health Status KW - Humans KW - Male KW - Mental Disorders KW - Middle Aged KW - Psychiatric Status Rating Scales KW - Social Environment KW - Socioeconomic factors KW - Time Factors AB -

PURPOSE OF THE STUDY: Although considerable attention has been paid to the relationship between later-life depression and cognitive function, the relationship between a history of psychiatric problems and cognitive function is not very well documented. Few studies of relationships between childhood health, childhood disadvantage, and cognitive function in later life consider both childhood health and disadvantage, include measures for psychiatric history, or use nationally representative longitudinal data.

DESIGN AND METHODS: This study uses growth curve models to analyze the relationships between childhood health and disadvantage, psychiatric history, and cognitive function using 6 waves of the Health and Retirement Study, controlling for demographics, health behavior, and health status.

RESULTS: A history of psychiatric problems is associated with lower cognitive function and steeper declines in cognitive function with age. The influence of childhood health is mediated by later-life health status and behaviors. A combined history of childhood disadvantage and psychiatric problems more strongly affects cognitive function, but cognitive declines remain consistent with those associated with psychiatric history. These effects are partially mediated by later-life demographic, socioeconomic, or health characteristics.

IMPLICATIONS: These findings demonstrate that cumulative disadvantage and a history of psychiatric problems shape later-life cognition and cognitive decline. This evidence can enhance public understanding of the trajectories of cognitive decline experienced by groups living with disadvantage and can enable policy makers and human services providers to better design and implement preventative interventions and support services for affected populations.

PB - 50 VL - 50 IS - 5 N1 - Using Smart Source Parsing pp. Oct Gerontological Society of America, Washington DC U1 - http://www.ncbi.nlm.nih.gov/pubmed/20566836?dopt=Abstract U3 - 20566836 U4 - cognitive Function/Cognitive decline/psychiatric history/Health outcomes/Childhood/Health Behavior/Public Policy/socioeconomic Status/demographics ER - TY - JOUR T1 - The effects of positive and negative support from children on widowed older adults' psychological adjustment: a longitudinal analysis. JF - Gerontologist Y1 - 2010 A1 - Jung-Hwa Ha KW - Adaptation, Psychological KW - Aged KW - Aged, 80 and over KW - Female KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Parent-Child Relations KW - Widowhood AB -

PURPOSE: This article examines the extent to which positive and negative support from children prior to and after spousal loss and changes in support from pre- to post-loss affect widowed older adults' depressive symptoms, anxiety, and anger 18 months following widowhood.

DESIGN AND METHODS: Analyses are based on the Changing Lives of Older Couples, a prospective study of 1,532 married individuals aged 65 years and older. The analytic sample includes 148 widowed persons who have at least one living child and participated in the baseline and two follow-up interviews conducted 6 and 18 months following widowhood.

RESULTS: The analyses revealed that higher levels of positive support from children 6 months following widowhood were associated with fewer depressive symptoms at the 18-month follow-up, whereas higher levels of negative support 18 months after loss and a decrease in positive support following loss were associated with more depressive symptoms. Greater negative support both prior to and after loss was associated with greater anxiety, whereas greater negative support 6 months after loss and an increase in negative support following loss were related to greater anger.

IMPLICATIONS: Given their differential impact on widowed persons' psychological adjustment, both positive and negative aspects of social support as well as its changing nature should be considered in working with bereaved older adults.

PB - 50 VL - 50 IS - 4 N1 - Using Smart Source Parsing pp. Aug Gerontological Society of America, Washington DC U1 - http://www.ncbi.nlm.nih.gov/pubmed/20019179?dopt=Abstract U2 - PMC2908534 U4 - socioeconomic Status/Poverty/income/assets/Medical Expenditures/Public Policy/social Security ER - TY - JOUR T1 - The epidemiology of pain during the last 2 years of life. JF - Ann Intern Med Y1 - 2010 A1 - Alexander K Smith A1 - Irena Cenzer A1 - Sara J Knight A1 - Kathleen A Puntillo A1 - Eric W Widera A1 - Brie A Williams A1 - W John Boscardin A1 - Kenneth E Covinsky KW - Aged KW - Aged, 80 and over KW - Arthritis KW - Chronic disease KW - Cross-Sectional Studies KW - Death KW - Female KW - Humans KW - Male KW - pain KW - Palliative care KW - Prevalence KW - Quality of Life KW - Socioeconomic factors KW - Terminally Ill KW - Time Factors AB -

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

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

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

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

PARTICIPANTS: Older adult decedents.

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

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

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

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

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

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

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

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

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

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

PB - 13 VL - 13 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20070641?dopt=Abstract U2 - PMC3013351 U4 - health Care Costs/socioeconomic Status/cost-related nonadherence/risk factors ER - TY - JOUR T1 - 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 - Functional declines, social support, and mental health in the elderly: does living in a state supportive of home and community-based services make a difference? JF - Soc Sci Med Y1 - 2010 A1 - Muramatsu, Naoko A1 - yin, Hongjun A1 - Hedeker, Donald KW - Activities of Daily Living KW - Aged KW - Cognition KW - Community Health Services KW - depression KW - Disabled Persons KW - Female KW - Home Care Services KW - Humans KW - Logistic Models KW - Male KW - Mental Health KW - Multilevel Analysis KW - Risk Factors KW - Social Support KW - Spouses KW - State Government KW - Stress, Psychological KW - United States AB -

This study examines how acute and chronic stresses associated with functional declines in seniors and their spouses are moderated by their informal and formal support contexts. In the United States, states vary greatly in their support for home and community-based services (HCBS) for seniors with disabilities. This state-to-state variation allowed us to examine mental health effects of living in a society supportive of HCBS for the oldest old, who are at high risk for low or declining functions in daily activities and cognitive abilities. Using a ten-year panel study of a nationally representative sample of the oldest old (>or=70 years old) covering the period 1993-2002, we conducted mixed-effects logistic regression analysis to incorporate time-varying characteristics of persons and states. As expected, low and declining functions in daily living and cognition constituted significant stressors among seniors and their spouse. Results demonstrated the important role of informal support available from non-spouse family/friends in lowering depression. Living in a state supportive of HCBS was associated with lower depression among seniors experiencing consistently low levels of function or recent functional declines, especially among those without informal support. Our findings were consistent with moderating or buffering models of formal support, suggesting that state HCBS support is effective mainly under conditions of high levels of stressors. Political will is needed to prepare US society to collectively support community-based long-term needs, given the difficulty of preparing ourselves fully for common, but often unexpected, functional declines in later life.

PB - 70 VL - 70 IS - 7 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20117865?dopt=Abstract U2 - PMC3360961 U4 - Stress/Home Care Services/community-based services/mental Health/depression ER - TY - JOUR T1 - Health outcomes of Experience Corps: a high-commitment volunteer program. JF - Soc Sci Med Y1 - 2010 A1 - S I Hong A1 - Morrow-Howell, Nancy KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - depression KW - Female KW - Health Promotion KW - Health Status KW - Humans KW - Male KW - Middle Aged KW - Program Evaluation KW - Regression Analysis KW - Self Concept KW - Volunteers AB -

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

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

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

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

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

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

PB - 22 VL - 22 IS - 7 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20710006?dopt=Abstract U3 - 20710006 U4 - Activities of Daily Living/Health/Migration/Health Care/Nursing Homes/Mobility/Employment ER - TY - JOUR T1 - Hospitalizations and deaths among adults with cardiovascular disease who underuse medications because of cost: a longitudinal analysis. JF - Med Care Y1 - 2010 A1 - Michele M Heisler A1 - Choi, Hwajung A1 - Allison B Rosen A1 - Sandeep Vijan A1 - Mohammed U Kabeto A1 - Kenneth M. Langa A1 - John D Piette KW - Aged KW - Aged, 80 and over KW - Cardiovascular Diseases KW - Female KW - Financing, Personal KW - Health Care Costs KW - Health Services Accessibility KW - Health Status Disparities KW - Hospitalization KW - Humans KW - Logistic Models KW - Longitudinal Studies KW - Male KW - Medication Adherence KW - Middle Aged KW - Multivariate Analysis KW - Risk Factors KW - United States AB -

CONTEXT: It is well-documented that the financial burden of out-of-pocket expenditures for prescription drugs often leads people with medication-sensitive chronic illnesses to restrict their use of these medications. Less is known about the extent to which such cost-related medication underuse is associated with increases in subsequent hospitalizations and deaths.

OBJECTIVE: We compared the risk of hospitalizations among 5401 and of death among 6135 middle-aged and elderly adults with one or more cardiovascular diseases (diabetes, coronary artery disease, heart failure, and history of stroke) according to whether participants did or did not report restricting prescription medications because of cost.

DESIGN AND SETTING: A retrospective biannual cohort study across 4 cross-sectional waves of the Health and Retirement Study, a nationally representative survey of adults older than age 50. Using multivariate logistic regression to adjust for baseline differences in sociodemographic and health characteristics, we assessed subsequent hospitalizations and deaths between 1998 and 2006 for respondents who reported that they had or had not taken less medicine than prescribed because of cost.

RESULTS: Respondents with cardiovascular disease who reported underusing medications due to cost were significantly more likely to be hospitalized in the next 2 years, even after adjusting for other patient characteristics (adjusted predicted probability of 47% compared with 38%, P < 0.001). The more survey waves respondents reported cost-related medication underuse during 1998 to 2004, the higher the probability of being hospitalized in 2006 (adjusted predicted probability of 54% among respondents reporting cost-related medication underuse in all 4 survey waves compared with 42% among respondents reporting no underuse, P < 0.001). There was no independent association of cost-related medication underuse with death.

CONCLUSIONS: In this nationally representative cohort, middle-aged and elderly adults with cardiovascular disease who reported cutting back on medication use because of cost were more likely to report being hospitalized over a subsequent 2-year period after they had reported medication underuse. The more extensively respondents reported cost-related underuse over time, the higher their adjusted predicted probability of subsequent hospitalization.

PB - 48 VL - 48 IS - 2 N1 - Using Smart Source Parsing Feb Comment In: Med Care. 2010 Feb;48(2):85-6 20057326 Index Medicus U1 - http://www.ncbi.nlm.nih.gov/pubmed/20068489?dopt=Abstract U2 - PMC3034735 U4 - Cardiovascular Diseases: drug therapy/Cardiovascular Diseases: economics/mortality/Health Care Costs/Services Accessibility: economics/Health Status Disparities/Hospitalization: economics/Hospitalization: statistics and numerical data/Logistic Models/Longitudinal Studies/Medication Adherence/Multivariate Analysis/Risk Factors ER - TY - JOUR T1 - Impact of cognitive impairment on screening mammography use in older US women. JF - Am J Public Health Y1 - 2010 A1 - Kala M. Mehta A1 - Kathy Z Fung A1 - Christine E Kistler A1 - Chang, Anna A1 - Louise C Walter KW - Aged KW - Aged, 80 and over KW - Cognition Disorders KW - Female KW - Humans KW - Incidence KW - Longitudinal Studies KW - Mammography KW - Medicare KW - Patient Acceptance of Health Care KW - Social Class KW - United States AB -

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

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

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

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

PB - 100 VL - 100 IS - 10 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20075325?dopt=Abstract U2 - PMC2936976 U4 - Cognition Disorders/Mammography/Medicare ER - TY - JOUR T1 - Length of stay for older adults residing in nursing homes at the end of life. JF - J Am Geriatr Soc Y1 - 2010 A1 - Kelly, Anne A1 - Conell-Price, Jessamyn A1 - Kenneth E Covinsky A1 - Irena Cenzer A1 - Chang, Anna A1 - W John Boscardin A1 - Alexander K Smith KW - Advance care planning KW - Aged KW - Aged, 80 and over KW - Female KW - Follow-Up Studies KW - Humans KW - Length of Stay KW - Male KW - Middle Aged KW - Nursing homes KW - Palliative care KW - Retrospective Studies KW - United States AB -

OBJECTIVES: To describe lengths of stay of nursing home decedents.

DESIGN: Retrospective cohort study.

SETTING: The Health and Retirement Study (HRS), a nationally representative survey of U.S. adults aged 50 and older.

PARTICIPANTS: One thousand eight hundred seventeen nursing home residents who died between 1992 and 2006.

MEASUREMENTS: The primary outcome was length of stay, defined as the number of months between nursing home admission and date of death. Covariates were demographic, social, and clinical factors drawn from the HRS interview conducted closest to the date of nursing home admission.

RESULTS: The mean age of decedents was 83.3 ± 9.0; 59.1% were female, and 81.5% were white. Median and mean length of stay before death were 5 months (interquartile range 1-20) and 13.7 ± 18.4 months, respectively. Fifty-three percent died within 6 months of placement. Large differences in median length of stay were observed according to sex (men, 3 months vs women, 8 months) and net worth (highest quartile, 3 months vs lowest quartile, 9 months) (all P <.001). These differences persisted after adjustment for age, sex, marital status, net worth, geographic region, and diagnosed chronic conditions (cancer, hypertension, diabetes mellitus, lung disease, heart disease, and stroke).

CONCLUSION: Nursing home lengths of stay are brief for the majority of decedents. Lengths of stay varied markedly according to factors related to social support.

PB - 58 VL - 58 IS - 9 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20738438?dopt=Abstract U2 - PMC2945440 U4 - nursing Homes/MORTALITY/death/health outcomes ER - TY - JOUR T1 - The longevity gap between Black and White men in the United States at the beginning and end of the 20th century. JF - Am J Public Health Y1 - 2010 A1 - Frank A Sloan A1 - Padmaja Ayyagari A1 - Salm, Martin A1 - Grossman, Daniel KW - Aged KW - Black or African American KW - Health Status Disparities KW - Humans KW - Longevity KW - Longitudinal Studies KW - Male KW - Men's health KW - Middle Aged KW - Mortality KW - Proportional Hazards Models KW - Survival Analysis KW - United States KW - Veterans KW - White People AB -

OBJECTIVES: We sought to assess whether the disparity in mortality rates between Black and White men decreased from the beginning to the end of the 20th century.

METHODS: We used Cox proportional hazard models for mortality to estimate differences in longevity between Black and White Civil War veterans from 1900 to 1914 (using data from a pension program) and a later cohort of male participants (using data from the 1992 to 2006 Health and Retirement Study). In sensitivity analysis, we compared relative survival of veterans for alternative baseline years through 1914.

RESULTS: In our survival analysis, the Black-White male difference in mortality, both unadjusted and adjusted for other influences, did not decrease from the beginning to the end of the 20th century. A 17% difference in Black-White mortality remained for the later cohort even after we controlled for other influences. Although we could control for fewer other influences on longevity, the Black-White differences in mortality for the earlier cohort was 18%.

CONCLUSIONS: In spite of overall improvements in longevity, a major difference in Black-White male mortality persists.

PB - 100 VL - 100 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20019309?dopt=Abstract U2 - PMC2804648 U4 - African Americans/European Continental Ancestry Group/Health Status Disparities/Longevity/Longitudinal Studies/Mens Health: ethnology/Middle Aged/Mortality: ethnology/Mortality: trends/Proportional Hazards Models/Survival Analysis/United States: epidemiology/Veterans: statistics and numerical data ER - TY - JOUR T1 - Longitudinal changes in disabled husbands' and wives' receipt of care. JF - Gerontologist Y1 - 2010 A1 - Claire Noël-Miller KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Caregivers KW - Disabled Persons KW - Female KW - Humans KW - Long-term Care KW - Longitudinal Studies KW - Male KW - Marriage KW - Middle Aged KW - Models, Theoretical KW - Sex Factors KW - Social Support KW - Socioeconomic factors KW - Spouses KW - Surveys and Questionnaires KW - Time Factors AB -

PURPOSE OF THE STUDY: This study contrasts 2-year adjustments in disabled husbands' and wives' amount of received care following both worsening and recovery in personal (activities of daily living [ADLs]) and routine care (instrumental activities of daily living [IADLs]) disability.

DESIGN AND METHODS: Using longitudinal data on 789 husbands and 778 wives from the Health and Retirement Study (2000 and 2002), changes in marital partners' monthly hours of spousal and nonspousal care were jointly modeled using bivariate Tobit models. In addition, asymmetry in the magnitude of responses to worsening and improvement of function was examined.

RESULTS: Disabled husbands receive more hours of spousal and nonspousal care following worsening in ADL function than wives. Conversely, disabled wives lose more spousal and nonspousal care hours following improvements in ADL disability than husbands. Moreover, wives recovering in ADL function lose more hours of spousal care than they receive following worsening in personal care disability. There is no evidence of corresponding gender differences in the dynamics of assistance received following changes in IADL function.

IMPLICATIONS: Compared with husbands, disabled wives are disadvantaged in the adjustment of their personal care hours. Although disabled married community residents receive more hours of care than their unmarried counterparts, there are important gender differences in the advantages offered by marriage.

PB - 50 VL - 50 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20382664?dopt=Abstract U2 - PMC2937250 U4 - Activities of Daily Living/instrumental activities of daily living/DISABILITY/DISABILITY/Handicapped/Sex Differences/spousal care/Home Care Services/gender Differences ER - TY - JOUR T1 - Long-term cognitive impairment and functional disability among survivors of severe sepsis. JF - JAMA Y1 - 2010 A1 - Theodore J Iwashyna A1 - E Wesley Ely A1 - Dylan M Smith A1 - Kenneth M. Langa KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Case-Control Studies KW - Cognition Disorders KW - Disabled Persons KW - Female KW - Health Status KW - Hospitalization KW - Humans KW - Male KW - Prospective Studies KW - Sepsis KW - Severity of Illness Index KW - Survivors KW - United States AB -

CONTEXT: Cognitive impairment and functional disability are major determinants of caregiving needs and societal health care costs. Although the incidence of severe sepsis is high and increasing, the magnitude of patients' long-term cognitive and functional limitations after sepsis is unknown.

OBJECTIVE: To determine the change in cognitive impairment and physical functioning among patients who survive severe sepsis, controlling for their presepsis functioning.

DESIGN, SETTING, AND PATIENTS: A prospective cohort involving 1194 patients with 1520 hospitalizations for severe sepsis drawn from the Health and Retirement Study, a nationally representative survey of US residents (1998-2006). A total of 9223 respondents had a baseline cognitive and functional assessment and had linked Medicare claims; 516 survived severe sepsis and 4517 survived a nonsepsis hospitalization to at least 1 follow-up survey and are included in the analysis.

MAIN OUTCOME MEASURES: Personal interviews were conducted with respondents or proxies using validated surveys to assess the presence of cognitive impairment and to determine the number of activities of daily living (ADLs) and instrumental ADLs (IADLs) for which patients needed assistance.

RESULTS: Survivors' mean age at hospitalization was 76.9 years. The prevalence of moderate to severe cognitive impairment increased 10.6 percentage points among patients who survived severe sepsis, an odds ratio (OR) of 3.34 (95% confidence interval [CI], 1.53-7.25) in multivariable regression. Likewise, a high rate of new functional limitations was seen following sepsis: in those with no limits before sepsis, a mean 1.57 new limitations (95% CI, 0.99-2.15); and for those with mild to moderate limitations before sepsis, a mean of 1.50 new limitations (95% CI, 0.87-2.12). In contrast, nonsepsis general hospitalizations were associated with no change in moderate to severe cognitive impairment (OR, 1.15; 95% CI, 0.80-1.67; P for difference vs sepsis = .01) and with the development of fewer new limitations (mean among those with no limits before hospitalization, 0.48; 95% CI, 0.39-0.57; P for difference vs sepsis <.001 and mean among those with mild to moderate limits, 0.43; 95% CI, 0.23-0.63; P for difference = .001). The declines in cognitive and physical function persisted for at least 8 years.

CONCLUSIONS: Severe sepsis in this older population was independently associated with substantial and persistent new cognitive impairment and functional disability among survivors. The magnitude of these new deficits was large, likely resulting in a pivotal downturn in patients' ability to live independently.

PB - 304 VL - 304 UR - http://jama.ama-assn.org/content/304/16/1787.abstract IS - 16 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20978258?dopt=Abstract U2 - PMC3345288 U4 - Sepsis/Cognitive psychology/Disability/Disability/Survivor/Inpatient care ER - TY - JOUR T1 - Military service and men's health trajectories in later life. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2010 A1 - Janet M Wilmoth A1 - Andrew S London A1 - Wendy M Parker KW - Activities of Daily Living KW - Aged KW - Aging KW - Health Status KW - Humans KW - Korean War KW - Male KW - Middle Aged KW - Military Personnel KW - Multivariate Analysis KW - Racial Groups KW - Self-Assessment KW - Veterans KW - Vietnam Conflict KW - World War II AB -

OBJECTIVES: This study examines differences in the relationship between veteran status and men's trajectories of health conditions, activities of daily living limitations, and self-rated health.

METHODS: We use data on 12,631 men drawn from the 1992-2006 waves of the Health and Retirement Study to estimate growth curve models that examine differences in health trajectories between nonveterans and veterans, veterans with and without wartime service, and war service veterans who served during World War II, Korea, Vietnam, and multiple wars.

RESULTS: The results indicate that veterans have better health at the mean age of 66.2 years, but experience greater age-related changes in health than nonveterans. Similarly, men who served during wartime have better health at the mean age, but more age-related changes in health than men who did not serve during wartime. Among war veterans, Vietnam veterans are in poorer health at the mean age, but they experience less substantial age-related health changes than men who served during previous wars.

DISCUSSION: Although veterans experience better health relative to nonveterans around retirement age, they have poorer health than nonveterans among the oldest old. These findings inform our understanding of the veteran-nonveteran health-mortality paradox found in previous research and suggest a health crossover among veterans and nonveterans in later life.

PB - 65B VL - 65 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20864570?dopt=Abstract U2 - PMC2954333 U4 - Veterans: statistics/numerical/Models/Mens health/Age differences/MORTALITY 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 and excess mortality among the elderly in the United States and Mexico. JF - Demography Y1 - 2010 A1 - Monteverde, Malena A1 - Noronha, Kenya A1 - Alberto Palloni A1 - Beatriz Novak KW - Aged KW - Aged, 80 and over KW - Body Mass Index KW - Chronic disease KW - Female KW - Humans KW - Logistic Models KW - Male KW - Mexico KW - Middle Aged KW - Mortality KW - Multivariate Analysis KW - Obesity KW - Risk Factors KW - Socioeconomic factors KW - United States AB -

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

PB - 47 VL - 47 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20355685?dopt=Abstract U2 - PMC3000005 U4 - health risk/Obesity/Body Mass Index/socioeconomic Status/Cross Cultural Comparison/cross-national comparison/MHAS_ ER - TY - JOUR T1 - 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 - Out-of-pocket burden of health care spending and the adequacy of the Medicare Part D low-income subsidy. JF - Med Care Y1 - 2010 A1 - Becky A. Briesacher A1 - Ross-Degnan, Dennis A1 - Anita K Wagner A1 - Hassan Fouayzi A1 - Fang Zhang A1 - Jerry Gurwitz A1 - Soumerai, Stephen B KW - Adult KW - Aged KW - Confidence Intervals KW - Cost of Illness KW - Deductibles and Coinsurance KW - Drug Prescriptions KW - Female KW - Financing, Personal KW - Health Expenditures KW - Humans KW - Income KW - Male KW - Medicare Part D KW - Middle Aged KW - Odds Ratio KW - Poverty KW - Socioeconomic factors KW - United States AB -

BACKGROUND: Evaluating the adequacy of Medicare prescription drug program (Part D) and its low-income subsidy (LIS) requires a comprehensive understanding of drug spending in relation to household resources.

OBJECTIVE: : To estimate out-of-pocket health care costs in the year before Part D, in context of total household spending, health status, and LIS eligibility.

RESEARCH DESIGN: Nationally representative cross-sectional study.

SUBJECTS: Two thousand two hundred thirty-one Medicare families in the 2005/2006 Health and Retirement Study.

METHODS: We assessed health care costs as a share of household resources remaining after spending on essential housing, food, personal care, and transportation. Burdensome health care costs were defined as exceeding 40% of nonessential resources. We used logistic regressions to assess the probability of incurring burdensome health expenditures, controlling for LIS eligibility.

RESULTS: In the year before Part D, more than half of Medicare families [56.0%; 95% confidence interval (CI): 55.3-59.9] experienced burdensome health care costs. Families in poor health allocated a median of 68.1% [interquartile range (IQR): 35.1-82.9] of nonessential resources to health care (compared with 34.0% median; IQR 11.9-52.2 among families in excellent health, P < 0.011). Most (64%) out-of-pocket health care spending was allocated to health insurance premiums and medications. As many as 26% of Medicare families had burdensome health care costs but were not eligible for LIS assistance.

CONCLUSIONS: Before Part D, burdensome health care expenditures were common in Medicare families. Our estimates of Part D and LIS benefits indicate a limited scope of relief.

PB - 48 VL - 48 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20473197?dopt=Abstract U2 - PMC3084515 U4 - Low income groups/Medicare/Medicare Part D/Health care expenditures/Prescription drug plans/Families and family life/Insurance premiums/Health insurance/Health care access 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 - Predicting positive well-being in older men and women. JF - Int J Aging Hum Dev Y1 - 2010 A1 - Erin L. Waddell A1 - Joy M Jacobs-Lawson KW - Aged KW - Aged, 80 and over KW - Aging KW - depression KW - Female KW - Health Status KW - Humans KW - Male KW - Marriage KW - Middle Aged KW - Personal Satisfaction KW - Predictive Value of Tests KW - Quality of Life KW - Regression Analysis KW - Religion and Psychology KW - Self Concept KW - Sex Distribution KW - Social Behavior KW - Surveys and Questionnaires KW - Volunteers AB -

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

PB - 70 VL - 70 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20503804?dopt=Abstract U3 - 20503804 U4 - Well Being/Elderly/Women/Health/Depression/Marital Status/Psycho-social ER - TY - JOUR T1 - Prevalence and predictors of fatigue in middle-aged and older adults: evidence from the health and retirement study. JF - J Am Geriatr Soc Y1 - 2010 A1 - Meng, Hongdao A1 - Hale, Lauren A1 - Friedberg, Fred KW - Aged KW - Aged, 80 and over KW - Fatigue KW - Female KW - Health Surveys KW - Humans KW - Male KW - Middle Aged KW - Prevalence KW - Retirement KW - Retrospective Studies KW - Survival Rate KW - United States PB - 58 VL - 58 IS - 10 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20929479?dopt=Abstract U2 - PMC2981161 U4 - fatigue/retirement/health outcomes/PREVALENCE ER - TY - JOUR T1 - Prevalence of neuropsychiatric symptoms and their association with functional limitations in older adults in the United States: the aging, demographics, and memory study. JF - J Am Geriatr Soc Y1 - 2010 A1 - Okura, Toru A1 - Brenda L Plassman A1 - David C Steffens A1 - David J Llewellyn A1 - Guy G Potter A1 - Kenneth M. Langa KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Behavioral Symptoms KW - Cognition Disorders KW - Cross-Sectional Studies KW - Dementia KW - Female KW - Humans KW - Male KW - Mental Disorders KW - Prevalence KW - United States AB -

OBJECTIVES: To estimate the prevalence of neuropsychiatric symptoms and examine their association with functional limitations.

DESIGN: Cross-sectional analysis.

SETTING: The Aging, Demographics, and Memory Study (ADAMS).

PARTICIPANTS: A sample of adults aged 71 and older (N=856) drawn from Health and Retirement Study (HRS), a nationally representative cohort of U.S. adults aged 51 and older.

MEASUREMENTS: The presence of neuropsychiatric symptoms (delusions, hallucinations, agitation, depression, apathy, elation, anxiety, disinhibition, irritation, and aberrant motor behaviors) was identified using the Neuropsychiatric Inventory. A consensus panel in the ADAMS assigned a cognitive category (normal cognition; cognitive impairment, no dementia (CIND); mild, moderate, or severe dementia). Functional limitations, chronic medical conditions, and sociodemographic information were obtained from the HRS and ADAMS.

RESULTS: Forty-three percent of individuals with CIND and 58% of those with dementia exhibited at least one neuropsychiatric symptom. Depression was the most common individual symptom in those with normal cognition (12%), CIND (30%), and mild dementia (25%), whereas apathy (42%) and agitation (41%) were most common in those with severe dementia. Individuals with three or more symptoms and one or more clinically significant symptoms had significantly higher odds of having functional limitations. Those with clinically significant depression had higher odds of activity of daily living limitations, and those with clinically significant depression, anxiety, or aberrant motor behaviors had significantly higher odds of instrumental activity of daily living limitations.

CONCLUSION: Neuropsychiatric symptoms are highly prevalent in older adults with CIND and dementia. Of those with cognitive impairment, a greater number of total neuropsychiatric symptoms and some specific individual symptoms are strongly associated with functional limitations.

PB - 58 VL - 58 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20374406?dopt=Abstract U2 - PMC2875937 U4 - dementia/functional limitations/Functional Assessment/depression/Neuropsychiatric symptoms ER - TY - JOUR T1 - Prior hospitalization and the risk of heart attack in older adults: a 12-year prospective study of Medicare beneficiaries. JF - J Gerontol A Biol Sci Med Sci Y1 - 2010 A1 - Frederic D Wolinsky A1 - Suzanne E Bentler A1 - Li Liu A1 - Michael P Jones A1 - Kaskie, Brian A1 - Jason Hockenberry A1 - Elizabeth A Chrischilles A1 - Kara B Wright A1 - John F Geweke A1 - Maksym Obrizan A1 - Robert L. Ohsfeldt A1 - Gary E Rosenthal A1 - Robert B Wallace KW - Aged KW - Educational Status KW - Female KW - Hospitalization KW - Humans KW - Male KW - Marital Status KW - Medicare KW - Myocardial Infarction KW - Patient Discharge KW - Proportional Hazards Models KW - Prospective Studies KW - Risk Factors KW - Sex Factors KW - United States AB -

BACKGROUND: We investigated whether prior hospitalization was a risk factor for heart attacks among older adults in the survey on Assets and Health Dynamics among the Oldest Old.

METHODS: Baseline (1993-1994) interview data were linked to 1993-2005 Medicare claims for 5,511 self-respondents aged 70 years and older and not enrolled in managed Medicare. Primary hospital International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) 410.xx discharge codes identified postbaseline hospitalizations for acute myocardial infarctions (AMIs). Participants were censored at death or postbaseline managed Medicare enrollment. Traditional risk factors and other covariates were included. Recent postbaseline non-AMI hospitalizations (ie, prior hospitalizations) were indicated by a time-dependent marker, and sensitivity analyses identified their peak effect.

RESULTS: The total number of person-years of surveillance was 44,740 with a mean of 8.1 (median = 9.1) per person. Overall, 483 participants (8.8%) suffered postbaseline heart attacks, with 423 participants (7.7%) having their first-ever AMI. As expected, significant traditional risk factors were sex (men); race (whites); marital status (never being married); education (noncollege); geography (living in the South); and reporting a baseline history of angina, arthritis, diabetes, and heart disease. Risk factors were similar for both any postbaseline and first-ever postbaseline AMI analyses. The time-dependent recent non-AMI hospitalization marker did not alter the effects of the traditional risk factors but increased AMI risk by 366% (adjusted hazards ratio = 4.66, p < .0001). Discussion. Our results suggest that some small percentage (<3%) of heart attacks among older adults might be prevented if effective short-term postdischarge planning and monitoring interventions were developed and implemented.

PB - 65 VL - 65 IS - 7 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20106961?dopt=Abstract U2 - PMC2904597 U4 - HOSPITALIZATION/heart disease/risk Factors/Medicare/Public Policy 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 - Reforming beneficiary cost sharing to improve Medicare performance. JF - Inquiry Y1 - 2010 A1 - Zuckerman, Stephen A1 - Shang, Baoping A1 - Timothy A Waidmann KW - Aged KW - Aged, 80 and over KW - Cost Sharing KW - Health Expenditures KW - Humans KW - Medicare KW - Middle Aged KW - Models, Economic KW - United States AB -

This paper explores options for reforming Medicare cost sharing in an effort to provide better financial protection for those beneficiaries with the greatest health care needs. Using data from the Health and Retirement Study (HRS) and the Medicare Current Beneficiary Survey (MCBS), we consider how unified annual deductibles, alternative coinsurance rates, and a limit on out-of-pocket spending would alter program spending, beneficiary cost sharing, and premiums for supplemental coverage. We show that adding an out-of-pocket limit and raising deductibles and coinsurance slightly would provide better safeguards to beneficiaries with high costs than the current Medicare benefit structure. Our estimates also suggest that policies protecting these beneficiaries could be structured in a way that would add little to overall program costs.

PB - 47 VL - 47 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21155416?dopt=Abstract U4 - Medicare/out of pocket costs/Beneficiaries ER - TY - JOUR T1 - The role of health behaviors in mediating the relationship between depressive symptoms and glycemic control in type 2 diabetes: a structural equation modeling approach. JF - Soc Psychiatry Psychiatr Epidemiol Y1 - 2010 A1 - Chiu, Ching-Ju A1 - Linda A. Wray A1 - Elizabeth A Beverly A1 - Oralia G Dominic KW - Adult KW - Aged KW - Blood Glucose KW - Body Weight KW - Comorbidity KW - depression KW - Diabetes Mellitus, Type 2 KW - Female KW - Follow-Up Studies KW - Glycated Hemoglobin KW - Glycemic Index KW - Health Behavior KW - Health Surveys KW - Humans KW - Life Style KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Models, Statistical KW - Self Care KW - Smoking KW - United States AB -

OBJECTIVES: We investigated the longitudinal association between depressive symptoms and glycemic control (HbA1c) in adults with type 2 diabetes, and the extent to which that association was explained by health behaviors.

METHODS: This study assessed data on 998 adults (aged 51 and above) with type 2 diabetes in the US nationally representative Health and Retirement Study and its diabetes-specific mail survey. Participants' depressive symptoms and baseline health behaviors (exercise, body weight control, and smoking status) were collected in 1998. Follow-up health behaviors and the glycemic control outcome were measured at a 2- and 5-year intervals, respectively.

RESULTS: Nearly one in four of participants (23%) reported moderate or high levels of depressive symptoms at baseline (CES-D score >or=3). Adults with higher levels of depressive symptoms at baseline showed lower scores on baseline and follow-up health behaviors as well as higher HbA1c levels at a 5-year follow-up. Structural equation models (SEM) reveal that health behaviors accounted for 13% of the link between depressive symptoms and glycemic control.

CONCLUSIONS: The long-term relationship between depressive symptoms and glycemic control was supported in the present study. Health behaviors, including exercise, body weight control, and smoking status, explained a sizable amount of the association between depressive symptoms and glycemic control. More comprehensive diabetes self-care behaviors should be examined with available data. Other competing explicators for the link, such as endocrinological process and antidepressant effects, also warrant further examination.

PB - 45 VL - 45 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19343264?dopt=Abstract U2 - PMC2804782 U4 - diabetes/Depressive Symptoms/Health care management ER - TY - JOUR T1 - Self-reported versus measured height and weight in the health and retirement study. JF - J Am Geriatr Soc Y1 - 2010 A1 - Meng, Hongdao A1 - Xiaoxing He A1 - Dixon, Denise KW - Aged KW - Body Height KW - Body Weight KW - Female KW - Humans KW - Male KW - Middle Aged KW - Obesity KW - Population Surveillance KW - Prevalence KW - Reproducibility of Results KW - Sensitivity and Specificity KW - United States PB - 58 VL - 58 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20370883?dopt=Abstract U3 - 20370883 U4 - Body Mass Index/height/reporting errors/Obesity/Demographics/health Status 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 - Sociodemographic and health-related risks for loneliness and outcome differences by loneliness status in a sample of U.S. older adults. JF - Res Gerontol Nurs Y1 - 2010 A1 - Laurie A. Theeke KW - Aged KW - Aged, 80 and over KW - Female KW - Health Status KW - Humans KW - Logistic Models KW - Loneliness KW - Male KW - Middle Aged KW - Multivariate Analysis KW - Risk Factors KW - Socioeconomic factors KW - United States AB -

This study assesses sociodemographic and health-related factors associated with loneliness and outcome differences between loneliness groups using a sample of 13,812 older adults from the U.S Health and Retirement Study. Descriptive and bivariate analyses were followed by logistic regression to evaluate risks and analysis of covariance testing to determine outcome differences. Overall, prevalence of loneliness was 16.9%. Nonmarried status, poorer self-report of health, lower educational level, functional impairment, increasing number of chronic illnesses, younger age, lower income, and less people living in the household were all associated with loneliness. The chronically lonely group reported less exercise, more tobacco use, less alcohol use, a greater number of chronic illnesses, higher depression scores, and greater average number of nursing home stays. Future research evaluating the effectiveness of both prevention and treatment interventions for loneliness in older adults would provide empirical data to further guide gerontological nursing practice.

PB - 3 VL - 3 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20415360?dopt=Abstract U3 - 20415360 U4 - Aged, 80 and over/Female/Health Status/Humans/Logistic Models/Loneliness/Middle Aged/Multivariate Analysis/Risk Factors/Socioeconomic Factors/United States ER - TY - JOUR T1 - Spousal loss, children, and the risk of nursing home admission. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2010 A1 - Claire Noël-Miller KW - Activities of Daily Living KW - Adult children KW - Aged KW - Aged, 80 and over KW - Aging KW - Bereavement KW - Caregivers KW - Family Characteristics KW - Female KW - Gender Identity KW - Homes for the Aged KW - Humans KW - Long-term Care KW - Male KW - Nursing homes KW - Parent-Child Relations KW - Patient Admission KW - Proportional Hazards Models KW - Social Support KW - Spouses KW - Utilization Review AB -

UNLABELLED: OBJECTIVES. Informed by a life course perspective, this study investigates the effects of spousal loss and availability of adult children on elderly husbands' and wives' risk of nursing home entry.

METHODS: Based on longitudinal data from the Health and Retirement Study, we studied 2,116 couples who were community residents in 1998. We estimate proportional hazards models for husbands' and wives' duration to first nursing home admission during 8 years of follow-up.

RESULTS: Overall, 438 (20.7%) husbands and 382 (18.1%) wives were institutionalized, and 362 (17.1%) husbands and 701 (33.1%) wives lost their spouse. Accounting for measured covariates, the risk of nursing home entry doubled for men following spousal death, but was unchanged for women. Results indicate that adult children reduced wives' risk of nursing home admission regardless of husbands' vital status, but buffered husbands' risk only after the death of their wives. We uncover suggestive evidence of parent-child gender concordance in children's buffering effect of widowed parents' risk of institutionalization. Discussion. Our findings are consistent with gender variations in spousal caregiving and in husbands' and wives' relative reliance on care from a partner and children. This study provides new evidence on the relationship between institutionalization and family structure among married elderly persons.

PB - 65B VL - 65B IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20371551?dopt=Abstract U2 - PMC2853605 U4 - Activities of Daily Living psychology/Adult Children/Aged, 80 and over/Aging psychology/Bereavement/Caregivers psychology supply/distribution utilization/Family Characteristics/Female/Gender Identity/Homes for the Aged utilization/Humans/Long-Term Care psychology/Nursing Homes utilization/Parent-Child Relations/Patient Admission statistics/numerical data/Proportional Hazards Models/Social Support/Spouses psychology statistics/numerical data/Utilization Review ER - TY - JOUR T1 - Stability and changes in living arrangements: relationship to nursing home admission and timing of placement. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2010 A1 - Judith D Kasper A1 - Liliana E Pezzin A1 - Rice, J Bradford KW - Aged KW - Aged, 80 and over KW - Family Characteristics KW - Female KW - Health Status KW - Homes for the Aged KW - Humans KW - Institutionalization KW - Male KW - Marital Status KW - Multivariate Analysis KW - Nursing homes KW - Risk Factors KW - Single Person KW - Socioeconomic factors KW - Time Factors KW - United States AB -

OBJECTIVES: To examine whether stability of living arrangements and changes in household composition-both types and frequency-influence nursing home placement or timing to entry among older people.

METHODS: Data from the first 5 waves of the Assets and Health Dynamics of the Elderly (1993-2002) on 8,093 persons aged 70 years or older at baseline are used in probit and hazard models to predict nursing home entry and time to entry.

RESULTS: Stable living arrangements carry different risks of institutionalization. Those living continuously alone or with others were at highest risk; at lowest risk were those living continuously with a spouse or the same child (lowest overall). Changes in household composition were protective against nursing home entry and slowed time to entry; types of change were not influential when number of changes was taken into account.

DISCUSSION: Results suggest that stability of living arrangements in and of itself is not protective against institutionalization. Having options that allow one to change living arrangements over time in response to changing needs for assistance is of importance if the goal is to avoid institutional care or extend community residence prior to entry.

PB - 65 VL - 65 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20442211?dopt=Abstract U2 - PMC2954324 U4 - nursing homes/housing/household composition/institutional care ER - TY - JOUR T1 - Successful aging in the United States: prevalence estimates from a national sample of older adults. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2010 A1 - Sara J McLaughlin A1 - Cathleen M. Connell A1 - Steven G Heeringa A1 - Lydia W Li A1 - J Scott Roberts KW - Affect KW - Aged KW - Aging KW - Female KW - Health Status KW - Humans KW - Male KW - Middle Aged KW - Prevalence KW - United States AB -

OBJECTIVES: To estimate the prevalence of successful aging in the United States, with the broad aim of contributing to the dialogue on Rowe and Kahn's concept of successful aging.

METHODS: Using data from the Health and Retirement Study, the prevalence of successful aging was calculated for adults aged 65 years and older at four time points: 1998, 2000, 2002, and 2004. Successful aging was operationalized in accordance with Rowe and Kahn's definition, which encompasses disease and disability, cognitive and physical functioning, social connections, and productive activities.

RESULTS: No greater than 11.9% of older adults were aging "successfully" in any year. The adjusted odds of successful aging were generally lower for those of advanced age, male gender, and lower socioeconomic status. Between 1998 and 2004, the odds of successful aging declined by 25%, after accounting for demographic changes in the older population.

DISCUSSION: Few older adults meet the criteria put forth in Rowe and Kahn's definition of successful aging, suggesting the need for modification if the concept is to be used for broad public health purposes. Disparities in successful aging were evident for socially defined subgroups, highlighting the importance of structural factors in enabling successful aging.

PB - 65B VL - 65B IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20008481?dopt=Abstract U2 - PMC2981444 U4 - Quality of Life/Aging/Public Health/Health Services/Socioeconomic Levels/United States/SF 36 Health Survey/Older Adults/Data Collection/ROWE, John W./KAHN, Robert L./Health disparities/Healthy aging/Prevalence/Successful aging ER - TY - JOUR T1 - Surgery as a teachable moment for smoking cessation. JF - Anesthesiology Y1 - 2010 A1 - Yu Shi A1 - David O. Warner KW - Aged KW - Aged, 80 and over KW - Ambulatory Surgical Procedures KW - Analysis of Variance KW - Cohort Studies KW - Female KW - Follow-Up Studies KW - General Surgery KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Patient Education as Topic KW - Regression Analysis KW - Smoking cessation KW - Treatment Outcome KW - United States AB -

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

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

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

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

PB - 112 VL - 112 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19996946?dopt=Abstract U3 - 19996946 U4 - Smoking/Smoking Cessation ER - TY - JOUR T1 - Take-up of Medicare Part D: results from the Health and Retirement Study. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2010 A1 - Helen G Levy A1 - David R Weir KW - Aged KW - ethnicity KW - Humans KW - Longitudinal Studies KW - Medically Uninsured KW - Medicare Part D KW - Multivariate Analysis KW - Poverty KW - prescription drugs KW - Prescription Fees KW - United States AB -

OBJECTIVES: To estimate the impact of Medicare Part D on prescription drug coverage among elderly Medicare beneficiaries and to analyze the predictors of program enrollment ("take-up") among those with no prior drug coverage.

METHODS: Multivariate analyses of data from the 2002, 2004, and 2006 waves of the Health and Retirement Study.

RESULTS: Take-up of Part D among those without drug coverage in 2004 was high; about 50%-60% of this group had Part D coverage in 2006. Only 7% of senior citizens lacked drug coverage in 2006 compared with 24% in 2004. Demand for prescription drugs was the most important determinant of the decision to enroll in Part D among those with no prior coverage. Many of those who remained without coverage in 2006 reported that they do not use prescribed medicines, and the majority had relatively low out-of-pocket spending.

CONCLUSION: For the most part, Medicare beneficiaries seem to have been able to make economically rational decisions about Part D enrollment despite the complexity of the program.

PB - 65 VL - 65 IS - 4 N1 - Times Cited: 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20034992?dopt=Abstract U4 - medicare/older people/prescription drugs/Multivariate Analysis/Medicare Part D 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 - A 12-year prospective study of stroke risk in older Medicare beneficiaries. JF - BMC Geriatr Y1 - 2009 A1 - Frederic D Wolinsky A1 - Suzanne E Bentler A1 - Elizabeth A Cook A1 - Elizabeth A Chrischilles A1 - Li Liu A1 - Kara B Wright A1 - John F Geweke A1 - Maksym Obrizan A1 - Claire E Pavlik A1 - Robert L. Ohsfeldt A1 - Michael P Jones A1 - Robert B Wallace A1 - Gary E Rosenthal KW - Aged KW - Aged, 80 and over KW - Female KW - Humans KW - Insurance Benefits KW - Male KW - Medicare KW - Prospective Studies KW - Risk Factors KW - Socioeconomic factors KW - Stroke KW - United States AB -

BACKGROUND: 5.8 M living Americans have experienced a stroke at some time in their lives, 780K had either their first or a recurrent stroke this year, and 150K died from strokes this year. Stroke costs about $66B annually in the US, and also results in serious, long-term disability. Therefore, it is prudent to identify all possible risk factors and their effects so that appropriate intervention points may be targeted.

METHODS: Baseline (1993-1994) interview data from the nationally representative Survey on Assets and Health Dynamics among the Oldest Old (AHEAD) were linked to 1993-2005 Medicare claims. Participants were 5,511 self-respondents >or= 70 years old. Two ICD9-CM case-identification approaches were used. Two approaches to stroke case-identification based on ICD9-CM codes were used, one emphasized sensitivity and the other emphasized specificity. Participants were censored at death or enrollment into managed Medicare. Baseline risk factors included sociodemographic, socioeconomic, place of residence, health behavior, disease history, and functional and cognitive status measures. A time-dependent marker reflecting post-baseline non-stroke hospitalizations was included to reflect health shocks, and sensitivity analyses were conducted to identify its peak effect. Competing risk, proportional hazards regression was used.

RESULTS: Post-baseline strokes occurred for 545 (9.9%; high sensitivity approach) and 374 (6.8%; high specificity approach) participants. The greatest static risks involved increased age, being widowed or never married, living in multi-story buildings, reporting a baseline history of diabetes, hypertension, or stroke, and reporting difficulty picking up a dime, refusing to answer the delayed word recall test, or having poor cognition. Risks were similar for both case-identification approaches and for recurrent and first-ever vs. only first-ever strokes. The time-dependent health shock (recent hospitalization) marker did not alter the static model effect estimates, but increased stroke risk by 200% or more.

CONCLUSION: The effect of our health shock marker (a time-dependent recent hospitalization indicator) was large and did not mediate the effects of the traditional risk factors. This suggests an especially vulnerable post-hospital transition period from adverse effects associated with both their underlying health shock (the reasons for the recent hospital admission) and the consequences of their treatments.

PB - 9 VL - 9 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19426528?dopt=Abstract U2 - PMC2683849 U4 - Stroke/risk factors/DISABILITY/DISABILITY/Health Shocks ER - TY - JOUR T1 - The accuracy of Medicare claims as an epidemiological tool: the case of dementia revisited. JF - J Alzheimers Dis Y1 - 2009 A1 - Donald H. Taylor Jr. A1 - Østbye, Truls A1 - Kenneth M. Langa A1 - David R Weir A1 - Brenda L Plassman KW - Aged KW - Aged, 80 and over KW - Alzheimer disease KW - Cohort Studies KW - Dementia KW - Female KW - Health Care Costs KW - Humans KW - Insurance Claim Reporting KW - Male KW - Medicare KW - Prevalence KW - Sensitivity and Specificity KW - United States AB -

Our study estimates the sensitivity and specificity of Medicare claims to identify clinically-diagnosed dementia, and documents how errors in dementia assessment affect dementia cost estimates. We compared Medicare claims from 1993-2005 to clinical dementia assessments carried out in 2001-2003 for the Aging Demographics and Memory Study (ADAMS) cohort (n = 758) of the Health and Retirement Study. The sensitivity and specificity of Medicare claims was 0.85 and 0.89 for dementia (0.64 and 0.95 for AD). Persons with dementia cost the Medicare program (in 2003) $7,135 more than controls (P < 0.001) when using claims to identify dementia, compared to $5,684 more when using ADAMS (P < 0.001). Using Medicare claims to identify dementia results in a 110% increase in costs for those with dementia as compared to a 68% increase when using ADAMS to identify disease, net of other variables. Persons with false positive Medicare claims notations of dementia were the most expensive group of subjects ($11,294 versus $4,065, for true negatives P < 0.001). Medicare claims overcount the true prevalence of dementia, but there are both false positive and negative assessments of disease. The use of Medicare claims to identify dementia results in an overstatement of the increase in Medicare costs that are due to dementia.

PB - 17 VL - 17 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19542620?dopt=Abstract U2 - PMC3697480 U4 - Medicare/dementia/Cost of Illness ER - TY - JOUR T1 - The aftermath of hip fracture: discharge placement, functional status change, and mortality. JF - Am J Epidemiol Y1 - 2009 A1 - Suzanne E Bentler A1 - Li Liu A1 - Maksym Obrizan A1 - Elizabeth A Cook A1 - Kara B Wright A1 - John F Geweke A1 - Elizabeth A Chrischilles A1 - Claire E Pavlik A1 - Robert B Wallace A1 - Robert L. Ohsfeldt A1 - Michael P Jones A1 - Gary E Rosenthal A1 - Frederic D Wolinsky KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - depression KW - Female KW - Health Status KW - Health Status Indicators KW - Hip Fractures KW - Humans KW - Interviews as Topic KW - Iowa KW - Length of Stay KW - Logistic Models KW - Medicare KW - Patient Discharge KW - Prospective Studies KW - Psychometrics KW - Socioeconomic factors KW - Time Factors KW - Treatment Outcome KW - United States AB -

The authors prospectively explored the consequences of hip fracture with regard to discharge placement, functional status, and mortality using the Survey on Assets and Health Dynamics Among the Oldest Old (AHEAD). Data from baseline (1993) AHEAD interviews and biennial follow-up interviews were linked to Medicare claims data from 1993-2005. There were 495 postbaseline hip fractures among 5,511 respondents aged >or=69 years. Mean age at hip fracture was 85 years; 73% of fracture patients were white women, 45% had pertrochanteric fractures, and 55% underwent surgical pinning. Most patients (58%) were discharged to a nursing facility, with 14% being discharged to their homes. In-hospital, 6-month, and 1-year mortality were 2.7%, 19%, and 26%, respectively. Declines in functional-status-scale scores ranged from 29% on the fine motor skills scale to 56% on the mobility index. Mean scale score declines were 1.9 for activities of daily living, 1.7 for instrumental activities of daily living, and 2.2 for depressive symptoms; scores on mobility, large muscle, gross motor, and cognitive status scales worsened by 2.3, 1.6, 2.2, and 2.5 points, respectively. Hip fracture characteristics, socioeconomic status, and year of fracture were significantly associated with discharge placement. Sex, age, dementia, and frailty were significantly associated with mortality. This is one of the few studies to prospectively capture these declines in functional status after hip fracture.

PB - 170 VL - 170 IS - 10 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19808632?dopt=Abstract U2 - PMC2781759 U4 - Functional Status/Mortality/Nursing Homes ER - TY - JOUR T1 - Are mature smokers misinformed? JF - J Health Econ Y1 - 2009 A1 - Ahmed Khwaja A1 - Daniel S. Silverman A1 - Frank A Sloan A1 - Wang, Yang KW - Aged KW - Deception KW - Female KW - Health Knowledge, Attitudes, Practice KW - Health Surveys KW - Humans KW - Male KW - Middle Aged KW - Risk Assessment KW - Smoking KW - United States AB -

While there are many reasons to continue to smoke in spite of its consequences for health, the concern that many smoke because they misperceive the risks of smoking remains a focus of public discussion and motivates tobacco control policies and litigation. In this paper we investigate the relative accuracy of mature smokers' risk perceptions about future survival, and a range of morbidities and disabilities. Using data from the survey on smoking (SOS) conducted for this research, we compare subjective beliefs elicited from the SOS with corresponding individual-specific objective probabilities estimated from the health and retirement study. Overall, consumers in the age group studied, 50-70, are not overly optimistic in their perceptions of health risk. If anything, smokers tend to be relatively pessimistic about these risks. The finding that smokers are either well informed or pessimistic regarding a broad range of health risks suggests that these beliefs are not pivotal in the decision to continue smoking. Although statements by the tobacco companies may have been misleading and thus encouraged some to start smoking, we find no evidence that systematic misinformation about the health consequences of smoking inhibits quitting.

PB - 28 VL - 28 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19178971?dopt=Abstract U3 - 19178971 U4 - Subjective Probabilities/Mortality/Health/Smoking ER - TY - JOUR T1 - Association between cognitive function and social support with glycemic control in adults with diabetes mellitus. JF - J Am Geriatr Soc Y1 - 2009 A1 - Okura, Toru A1 - Michele M Heisler A1 - Kenneth M. Langa KW - Aged KW - Blood Glucose KW - Cognition KW - Cross-Sectional Studies KW - Diabetes Mellitus KW - Female KW - Humans KW - Male KW - Middle Aged KW - Social Support AB -

OBJECTIVES: To examine whether cognitive impairment in adults with diabetes mellitus is associated with worse glycemic control and to assess whether level of social support for diabetes mellitus care modifies this relationship.

DESIGN: Cross-sectional analysis.

SETTING: The 2003 Health and Retirement Study (HRS) Mail Survey on Diabetes and the 2004 wave of the HRS.

PARTICIPANTS: Adults aged 50 and older with diabetes mellitus in the United States (N=1,097, mean age 69.2).

MEASUREMENTS: Glycosylated hemoglobin (HbA1c) level; cognitive function, measured with the 35-point HRS cognitive scale (HRS-cog); sociodemographic variables; duration of diabetes mellitus; depressed mood; social support for diabetes mellitus care; self-reported knowledge of diabetes mellitus; treatments for diabetes mellitus; components of the Total Illness Burden Index related to diabetes mellitus; and functional limitations.

RESULTS: In an ordered logistic regression model for the three ordinal levels of HbA1c (<7.0, 7.0-7.9, >or=8.0 mg/dL), respondents with HRS-cog scores in the lowest quartile had significantly higher HbA1c levels than those in the highest cognitive quartile (adjusted odds ratio=1.80, 95% confidence interval=1.11-2.92). A high level of social support for diabetes mellitus care modified this association; for respondents in the lowest cognitive quartile, those with high levels of support had significantly lower odds of having higher HbA1c than those with low levels of support (1.11 vs 2.87, P=.02).

CONCLUSION: Although cognitive impairment was associated with worse glycemic control, higher levels of social support for diabetes mellitus care ameliorated this negative relationship. Identifying the level of social support available to cognitively impaired adults with diabetes mellitus may help to target interventions for better glycemic control.

PB - 57 VL - 57 IS - 10 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19682129?dopt=Abstract U2 - PMC2810258 U4 - Cognitive Function/Social Support/Diabetes Mellitus/Health care management ER - TY - JOUR T1 - "Below average" self-assessed school performance and Alzheimer's disease in the Aging, Demographics, and Memory Study. JF - Alzheimers Dement Y1 - 2009 A1 - Kala M. Mehta A1 - Anita L Stewart A1 - Kenneth M. Langa A1 - Kristine Yaffe A1 - Sandra Y. Moody-Ayers A1 - Brie A Williams A1 - Kenneth E Covinsky KW - Aged KW - Aged, 80 and over KW - Aging KW - Alzheimer disease KW - Apolipoprotein E4 KW - Cognition Disorders KW - Educational Status KW - Female KW - Geriatric Assessment KW - Humans KW - Male KW - Memory KW - Neuropsychological tests KW - Risk Factors AB -

BACKGROUND: A low level of formal education is becoming accepted as a risk factor for Alzheimer's disease (AD). Although increasing attention has been paid to differences in educational quality, no previous studies addressed participants' own characterizations of their overall performance in school. We examined whether self-assessed school performance is associated with AD beyond the effects of educational level alone.

METHODS: Participants were drawn from the population-representative Aging, Demographics, and Memory Study (ADAMS, 2000-2002). The ADAMS participants were asked about their performance in school. Possible response options included "above average," "average," or "below average." The ADAMS participants also underwent a full neuropsychological battery, and received a research diagnosis of possible or probable AD.

RESULTS: The 725 participants (mean age, 81.8 years; 59% female; 16% African-American) varied in self-assessed educational performance: 29% reported "above average," 64% reported "average," and 7% reported "below average" school performance. Participants with a lower self-assessed school performance had higher proportions of AD: 11% of participants with "above average" self-assessed performance had AD, as opposed to 12% of participants with "average" performance and 26% of participants with "below average" performance (P < 0.001). After controlling for subjects' years in school, a literacy test score (Wide-Range Achievement Test), age, sex, race/ethnicity, apolipoprotein E-epsilon4 status, socioeconomic status, and self-reported comorbidities, respondents with "below average" self-assessed school performance were four times more likely to have AD compared with those of "average" performance (odds ratio, 4.0; 95% confidence interval, 1.2-14). "Above average" and "average" self-assessed school performance did not increase or decrease the odds of having AD (odds ratio, 0.9; 95% confidence interval, 0.5-1.7).

CONCLUSIONS: We suggest an association between "below average" self-assessed school performance and AD beyond the known association with formal education. Efforts to increase cognitive reserve through better school performance, in addition to increasing the number of years of formal education in early life, may be important in reducing vulnerability throughout the life course.

PB - 5 VL - 5 UR - http://www.sciencedirect.com/science?_ob=ArticleURLand_udi=B7W6D-4X6VH7W-7and_user=99318and_coverDate=09 2F30 2F2009and_rdoc=1and_fmt=highand_orig=searchand_origin=searchand_sort=dand_docanchor=andview=cand_acct=C000007678and_version=1and_urlVersion=0and_ IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19751917?dopt=Abstract U2 - PMC2787515 U4 - alzheimer disease/cognition Disorders/educational Status/Geriatric Assessment/neuropsychological Tests/risk Factors 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 - Changes in functional status among persons over age sixty-five undergoing total knee arthroplasty. JF - Med Care Y1 - 2009 A1 - Frank A Sloan A1 - Ruiz, David A1 - Alyssa C Platt KW - Activities of Daily Living KW - Aged KW - Arthroplasty, Replacement, Knee KW - Attitude to Health KW - Geriatric Assessment KW - Health Care Surveys KW - Health Status KW - Health Surveys KW - Humans KW - Insurance Claim Reporting KW - Logistic Models KW - Longitudinal Studies KW - Medicare KW - Mobility Limitation KW - Multivariate Analysis KW - Muscle Weakness KW - Osteoarthritis, Knee KW - pain KW - Sensitivity and Specificity KW - Surveys and Questionnaires KW - Treatment Outcome KW - United States AB -

BACKGROUND: This study assessed changes in physical functional status following receipt of total knee arthroplasty (TKA) for patients diagnosed with osteoarthritis (OA) of the knee in a national sample of persons aged 65+ in the United States relative to a sample of similar OA patients who did not receive TKA.

METHODS: Data from the Health Retirement Survey (HRS) and linked Medicare claims from 1994 to 2006 were used to identify persons with diagnoses of OA of the lower leg who received a TKA (n = 516) and those who did not receive TKA (n = 1756). Predicted probabilities of receiving total knee arthroplasty from logit analysis were used for matching TKA and comparison groups on demographic, socioeconomic, and baseline functional status factors. Functional status measures were: mobility, gross motor function, large muscle, and limitations in activities of daily living (ADL). Average treatment effects of the treated (ATT), which compares changes in functional status between those who received TKA with similar individuals who did not receive TKA, were computed using propensity score matching.

RESULTS: Mobility (average treatment effect of the treated (ATT = 0.315; 95% CI: 0.118-0.512), gross motor function (ATT = 0.314; 95% CI: 0.156-0.472), and ADL limitations (ATT = 0.174; 95% CI: 0.055-0.293), improved among persons receiving TKA relative to the comparison group. Relative to the mean values of the physical function at baseline, mobility, gross motor function, and ADL limitations persons receiving TKA had better functional outcomes than the comparison group by 17.5, 39.3, and 46.9 percent, respectively.

CONCLUSIONS: TKA is effective in improving functional status in elderly persons.

PB - 47 VL - 47 IS - 7 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19536027?dopt=Abstract U3 - 19536027 U4 - Activities of Daily Living/Arthroplasty/Knee Replacement/Attitude to Health/Geriatric Assessment/Insurance Claim Reporting/Logistic Models/Medicare/Mobility Limitation/Multivariate Analysis/Muscle Weakness/Osteoarthritis/Treatment Outcome ER - TY - JOUR T1 - Childhood socioeconomic status and racial differences in disability: evidence from the Health and Retirement Study (1998-2006). JF - Soc Sci Med Y1 - 2009 A1 - Mary E Bowen KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Black or African American KW - Disabled Persons KW - Female KW - Health Behavior KW - Humans KW - Male KW - Middle Aged KW - Models, Statistical KW - Prejudice KW - Prospective Studies KW - Racial Groups KW - Social Justice KW - Socioeconomic factors KW - Statistics as Topic KW - United States KW - White People AB -

This study used a life course approach to examine the ways in which childhood socioeconomic status (SES) may account for some of the racial differences in disability in later life. Eight years (5 waves) of longitudinal data from the US Health and Retirement Study (HRS; 1998-2006), a nationally representative sample of community-dwelling Black and White Americans over age 50 (N=14,588), were used in nonlinear multilevel models. Parental education and father's occupation were used to predict racial differences in activities of daily living (ADL) and instrumental activities of daily living (IADL). The role of adult SES (education, income, and wealth) and health behaviors (smoking, drinking alcohol, exercising, and being obese) were also examined and models were adjusted for health conditions (heart problems, diabetes, stroke, hypertension, cancer, lung disease, and arthritis). With the inclusion of childhood SES indicators, racial differences in ADL and IADL disability were reduced. Adult SES and health behaviors mediated some of the relationship between low childhood SES and disability, though low childhood SES continued to be associated with disability net of these. In support of a life course approach, these findings suggest that socioeconomic conditions in early life may have implications for racial differences in disability between older Black and older White adults.

PB - 69 VL - 69 IS - 3 N1 - PMID: 19541400 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19541400?dopt=Abstract U3 - 19541400 U4 - childhood conditions/socioeconomic status/DISABILITY/DISABILITY/Racial Differences ER - TY - JOUR T1 - Cognitive decline among patients with chronic obstructive pulmonary disease. JF - Am J Respir Crit Care Med Y1 - 2009 A1 - William W. Hung A1 - Juan P. Wisnivesky A1 - Albert L Siu A1 - Joseph S. Ross KW - Aged KW - Case-Control Studies KW - Cognition Disorders KW - Female KW - Health Surveys KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Pulmonary Disease, Chronic Obstructive KW - Pulmonary Ventilation KW - Risk Factors KW - Severity of Illness Index KW - Socioeconomic factors KW - United States AB -

RATIONALE: Prior research has suggested an association between chronic obstructive pulmonary disease (COPD) and the development of cognitive decline; however, these studies have been cross-sectional or small case series.

OBJECTIVES: To determine whether COPD increases the risk of cognitive decline among older adults surveyed in a large, population-based longitudinal cohort.

METHODS: We included data from the 1996 to 2002 waves of the Health and Retirement Study, a biennial nationally representative survey. We studied respondents who completed cognitive testing in 1996 and at least one subsequent survey, and excluded those with unknown history of COPD. Clinical history of COPD was based on self-report; severity was categorized based on use of oxygen or disease-related activity limitations. Our primary outcome was cognitive performance, measured using a validated 35-point scale. We examined the effect of COPD on cognition using multivariable mixed linear models accounting for repeated measurements, adjusted for sociodemographic and clinical characteristics.

MEASUREMENTS AND MAIN RESULTS: A total of 4,150 adults were included in our study. Among them, 12% reported a history of COPD (29% severe, 71% nonsevere disease). On repeated measurement, mean cognition scores of older adults with both severe and nonsevere COPD were significantly lower when compared with adults without COPD (2.6 points [P < 0.001] and 0.9 points [P < 0.001], respectively). After multivariable adjustment, mean scores of adults with severe COPD remained lower (0.9 point [P < 0.001]), whereas mean score of adults with nonsevere COPD was no longer different (P = 0.39) when compared with adults without COPD.

CONCLUSIONS: Severe COPD was associated with lower cognitive performance on standardized measurement over time.

PB - 180 VL - 180 IS - 2 N1 - PMID: 19423714 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19423714?dopt=Abstract U3 - 19423714 U4 - Cognitive Functioning ER - TY - JOUR T1 - Cognitive health among older adults in the United States and in England. JF - BMC Geriatr Y1 - 2009 A1 - Kenneth M. Langa A1 - David J Llewellyn A1 - Iain A Lang A1 - David R Weir A1 - Robert B Wallace A1 - Mohammed U Kabeto A1 - Felicia A Huppert KW - Aged KW - Aged, 80 and over KW - Aging KW - Cognition KW - Cognition Disorders KW - Cohort Studies KW - Cross-Sectional Studies KW - England KW - Female KW - Health Status KW - Humans KW - Longitudinal Studies KW - Male KW - Neuropsychological tests KW - United States AB -

BACKGROUND: Cognitive function is a key determinant of independence and quality of life among older adults. Compared to adults in England, US adults have a greater prevalence of cardiovascular risk factors and disease that may lead to poorer cognitive function. We compared cognitive performance of older adults in the US and England, and sought to identify sociodemographic and medical factors associated with differences in cognitive function between the two countries.

METHODS: Data were from the 2002 waves of the US Health and Retirement Study (HRS) (n = 8,299) and the English Longitudinal Study of Ageing (ELSA) (n = 5,276), nationally representative population-based studies designed to facilitate direct comparisons of health, wealth, and well-being. There were differences in the administration of the HRS and ELSA surveys, including use of both telephone and in-person administration of the HRS compared to only in-person administration of the ELSA, and a significantly higher response rate for the HRS (87% for the HRS vs. 67% for the ELSA). In each country, we assessed cognitive performance in non-hispanic whites aged 65 and over using the same tests of memory and orientation (0 to 24 point scale).

RESULTS: US adults scored significantly better than English adults on the 24-point cognitive scale (unadjusted mean: 12.8 vs. 11.4, P < .001; age- and sex-adjusted: 13.2 vs. 11.7, P < .001). The US cognitive advantage was apparent even though US adults had a significantly higher prevalence of cardiovascular risk factors and disease. In a series of OLS regression analyses that controlled for a range of sociodemographic and medical factors, higher levels of education and wealth, and lower levels of depressive symptoms, accounted for some of the US cognitive advantage. US adults were also more likely to be taking medications for hypertension, and hypertension treatment was associated with significantly better cognitive function in the US, but not in England (P = .014 for treatment x country interaction).

CONCLUSION: Despite methodological differences in the administration of the surveys in the two countries, US adults aged >/= 65 appeared to be cognitively healthier than English adults, even though they had a higher burden of cardiovascular risk factors and disease. Given the growing number of older adults worldwide, future cross-national studies aimed at identifying the medical and social factors that might prevent or delay cognitive decline in older adults would make important and valuable contributions to public health.

PB - 9 VL - 9 N1 - PMID: 19555494 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19555494?dopt=Abstract U2 - PMC2709651 U4 - Cross Cultural Comparison/Cognitive Function/Hypertension/Medicine/ELSA_/cross-national comparison ER - TY - JOUR T1 - Cognitive performance and informant reports in the diagnosis of cognitive impairment and dementia in African Americans and whites. JF - Alzheimers Dement Y1 - 2009 A1 - Guy G Potter A1 - Brenda L Plassman A1 - James R Burke A1 - Mohammed U Kabeto A1 - Kenneth M. Langa A1 - David J Llewellyn A1 - Mary A M Rogers A1 - David C Steffens KW - Activities of Daily Living KW - Age of Onset KW - Aged KW - Aged, 80 and over KW - Black or African American KW - Caregivers KW - Cognition Disorders KW - Cohort Studies KW - Culture KW - Dementia KW - Disability Evaluation KW - Female KW - Geriatric Assessment KW - Health Surveys KW - Humans KW - Male KW - Neuropsychological tests KW - Observer Variation KW - Population Surveillance KW - Predictive Value of Tests KW - Prevalence KW - Psychiatric Status Rating Scales KW - Psychometrics KW - Registries KW - Sensitivity and Specificity KW - Surveys and Questionnaires KW - White People AB -

BACKGROUND: The diagnosis of cognitive impairment and dementia must reflect an increasingly diverse and aging United States population. This study compared direct testing and informant reports of cognition with clinical diagnoses of cognitive impairment and dementia between African Americans and whites.

METHODS: Participants in the Aging, Demographics, and Memory Study completed in-person dementia evaluations, and were assigned clinical diagnoses (by a consensus panel of dementia experts) of normal; cognitive impairment, not demented (CIND); and dementia. The Consortium to Establish a Registry for Alzheimer's Disease (CERAD) total score and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) were used to assess cognitive performance and reported cognitive decline.

RESULTS: A higher CERAD total score was associated with lower odds of CIND and dementia, at comparable ratios between African Americans and whites. Higher IQCODE scores were associated with increased odds of dementia in both African Americans and whites. Higher IQCODE scores were associated with increased odds of CIND among whites, but not among African Americans.

CONCLUSIONS: Cultural differences may influence informant reports of prevalent CIND and dementia. Our findings also highlight the need for more comparative research to establish the cultural validity of measures used to diagnose these conditions.

PB - 5 VL - 5 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19896583?dopt=Abstract U2 - PMC2805266 U4 - CERAD/IQCODE/Cognitive decline/Dementia/African American ER - TY - JOUR T1 - Comparing models of frailty: the Health and Retirement Study. JF - J Am Geriatr Soc Y1 - 2009 A1 - Christine T Cigolle A1 - Mary Beth Ofstedal A1 - Zhiyi Tian A1 - Caroline S Blaum KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Chronic disease KW - Cross-Sectional Studies KW - Demography KW - Disability Evaluation KW - Frail Elderly KW - Geriatric Assessment KW - Health Surveys KW - Humans KW - Interviews as Topic KW - Logistic Models KW - Models, Theoretical KW - United States AB -

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

DESIGN: Cross-sectional analysis.

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

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

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

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

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

PB - 57 VL - 57 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19453306?dopt=Abstract U3 - 19453306 U4 - FRAILTY/Models, Theoretical ER - TY - JOUR T1 - Compensatory conscientiousness and health in older couples. JF - Psychol Sci Y1 - 2009 A1 - Brent W Roberts A1 - Jacqui Smith A1 - Joshua J Jackson A1 - Edmonds, Grant KW - Activities of Daily Living KW - Adult KW - Aged KW - Aged, 80 and over KW - Aging KW - Conscience KW - Female KW - Health Status KW - Humans KW - Longevity KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Neurotic Disorders KW - Personality Inventory KW - Social Conformity KW - Spouses AB -

The present study tested the effect of conscientiousness and neuroticism on health and physical limitations in a representative sample of older couples (N= 2,203) drawn from the Health and Retirement Study. As in past research, conscientiousness predicted better health and physical functioning, whereas neuroticism predicted worse health and physical functioning. Unique to this study was the finding that conscientiousness demonstrated a compensatory effect, such that husbands' conscientiousness predicted wives' health outcomes above and beyond wives' own personality. The same pattern held true for wives' conscientiousness as a predictor of husbands' health outcomes. Furthermore, conscientiousness and neuroticism acted synergistically, such that people who scored high for both traits were healthier than others. Finally, we found that the combination of high conscientiousness and high neuroticism was also compensatory, such that the wives of men with this combination of personality traits reported better health than other women.

PB - 20 VL - 20 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19476589?dopt=Abstract U2 - PMC2698025 U4 - aging/Couples/Personal relationships ER - TY - JOUR T1 - The co-occurrence of chronic diseases and geriatric syndromes: the health and retirement study. JF - J Am Geriatr Soc Y1 - 2009 A1 - Pearl G. Lee A1 - Christine T Cigolle A1 - Caroline S Blaum KW - Accidental Falls KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Angina Pectoris KW - Comorbidity KW - Cross-Sectional Studies KW - Diabetes Mellitus, Type 2 KW - Female KW - Geriatric Assessment KW - Health Surveys KW - Heart Failure KW - Humans KW - Male KW - Myocardial Infarction KW - Sick Role KW - Syndrome KW - United States KW - Urinary incontinence AB -

OBJECTIVES: To analyze the co-occurrence, in adults aged 65 and older, of five conditions that are highly prevalent, lead to substantial morbidity, and have evidence-based guidelines for management and well-developed measures of medical care quality.

DESIGN: Secondary data analysis of the 2004 wave of the Health and Retirement Study (HRS).

SETTING: Nationally representative health interview survey.

PARTICIPANTS: Respondents in the 2004 wave of the HRS aged 65 and older.

MEASUREMENTS: Self-reported presence of five index conditions (three chronic diseases (coronary artery disease, congestive heart failure, and diabetes mellitus) and two geriatric syndromes (urinary incontinence and injurious falls)) and demographic information (age, sex, race, living situation, net worth, and education).

RESULTS: Eleven thousand one hundred thirteen adults, representing 37.1 million Americans aged 65 and older, were interviewed. Forty-five percent were aged 76 and older, 58% were female, 8% were African American, and 4% resided in a nursing home. Respondents with more conditions were older and more likely to be female, single, and residing in a nursing home (all P<.001). Fifty-six percent had at least one of the five index conditions, and 23% had two or more. Of respondents with one condition, 20% to 55% (depending on the index condition) had two or more additional conditions.

CONCLUSION: Five common conditions (3 chronic diseases, 2 geriatric syndromes) often co-occur in older adults, suggesting that coordinated management of comorbid conditions, both diseases and geriatric syndromes, is important. Care guidelines and quality indicators, rather than considering one condition at a time, should be developed to address comprehensive and coordinated management of co-occurring diseases and geriatric syndromes.

PB - 57 VL - 57 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19187416?dopt=Abstract U3 - 19187416 U4 - COMORBIDITY/Chronic Disease/Diabetes Mellitus/Heart Diseases 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 - Dental care coverage transitions. JF - Am J Manag Care Y1 - 2009 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 - Aged KW - Career Mobility KW - Female KW - Health Benefit Plans, Employee KW - Humans KW - Insurance Coverage KW - Insurance, Dental KW - Interviews as Topic KW - Male KW - Middle Aged KW - United States AB -

OBJECTIVE: To examine dental insurance transition dynamics in the context of changing employment and retirement status.

STUDY DESIGN: Data from the Health and Retirement Study (HRS) were analyzed for individuals 51 years and older between the 2004 and 2006 waves of the HRS.

METHODS: The primary focus of the analysis is the relationship between retirement and transitions in dental care coverage. We calculate and present bivariate relationships between dental coverage and retirement status transitions over time and estimate a multivariable model of dental coverage controlling for retirement and other potentially confounding covariates.

RESULTS: Older adults are likely to lose their dental coverage on entering retirement compared with those who remain in the labor force between waves of the HRS. While more than half of those persons in the youngest group (51-64 years) were covered over this entire period, two-thirds of those in the oldest group (>or=75 years) were without coverage over the same period. We observe a high percentage of older persons flowing into and out of dental coverage over the period of our study, similar to flows into and out of poverty.

CONCLUSIONS: Dental insurance is an important factor in the decision to seek dental care. Yet, no dental coverage is provided by Medicare, which provides medical insurance for almost all Americans 65 years and older. This loss of coverage could lead to distortions in the timing of when to seek care, ultimately leading to worse oral and overall health.

PB - 15 VL - 15 IS - 10 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19845424?dopt=Abstract U2 - PMC2819283 U4 - Dental Care/Insurance Coverage/RETIREMENT/Medicare ER - TY - JOUR T1 - Doing well: a SEM analysis of the relationships between various activities of daily living and geriatric well-being. JF - J Genet Psychol Y1 - 2009 A1 - James A Katt A1 - Speranza, Linda A1 - Shore, Wendy A1 - Karen H. Saenz A1 - E. Lea Witta KW - Activities of Daily Living KW - Adaptation, Psychological KW - Aged KW - Cognition KW - depression KW - Humans KW - Models, Psychological KW - Socioeconomic factors KW - United States AB -

An existing large data set, the Health and Retirement Study (HRS) with the subsequent addition of the Consumption and Activities Mail Survey (CAMS) data, provides a rich data set for the examination of the activities of older adults. In this study HRS and CAMS data are used to examine relationships between various activities of daily living (ADLs) and well-being in older adults. Using structural equation modeling, influences of direct and indirect factors that affect older individuals' cognitive and emotional well-being are analyzed. The data suggest ability to perform ADLs has little to do with cognitive well-being, but is an influential factor in determining emotional well-being.

PB - 170 VL - 170 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19928315?dopt=Abstract U3 - 19928315 U4 - ADL and IADL Impairments/Cognitive Function/Well Being ER - TY - JOUR T1 - Early Life Health and Cognitive Function in Old Age. JF - Am Econ Rev Y1 - 2009 A1 - Case, Anne A1 - Paxson, Christina KW - Adult KW - Aged KW - Child KW - Cognition Disorders KW - Communicable Diseases KW - Health Status KW - Humans KW - Infant KW - Infant Mortality KW - United States PB - 99 VL - 99 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25147383?dopt=Abstract U4 - Health/Cognition/reasoning/Correlation analysis/Infant mortality ER - TY - JOUR T1 - The effect of depression and cognitive impairment on enrollment in Medicare Part D. JF - J Am Geriatr Soc Y1 - 2009 A1 - Zivin, Kara A1 - Mohammed U Kabeto A1 - Helen C Kales A1 - Kenneth M. Langa KW - Aged KW - Aged, 80 and over KW - Chi-Square Distribution KW - Cognition Disorders KW - depression KW - Female KW - Humans KW - Logistic Models KW - Longitudinal Studies KW - Male KW - Medicare Part D KW - Middle Aged KW - Patient Participation KW - Risk Factors KW - United States AB -

OBJECTIVES: To examine concerns that vulnerable populations, such as depressed or cognitively impaired beneficiaries would have challenges accessing Part D coverage.

DESIGN: Logistic regression analysis was used to assess whether elderly Medicare beneficiaries with depression or cognitive impairment differentially planned to and actually signed up for Part D.

SETTING: 2004 and 2006 data from the Health and Retirement Study (HRS) were used, including a subsample that completed the Prescription Drug Study (PDS) in 2005.

PARTICIPANTS: Nine thousand five hundred ninety-three HRS respondents and 3,567 PDS respondents.

MEASUREMENTS: The outcome variables of interest were planned and actual enrollment in Part D. The independent variables were depression and cognitive impairment status. The analyses were adjusted using clinical and demographic predictors including age, sex, race or ethnicity, educational attainment, net worth, marital status, health status, number of health conditions being treated with prescription medications, and presence of a caregiver.

RESULTS: Although having depression or cognitive impairment was associated with a higher likelihood of planning to and actually signing up for Part D in unadjusted analyses, in adjusted analyses, having depression or cognitive impairment was not significantly associated with whether Medicare beneficiaries planned to enroll in or actually enrolled in Part D.

CONCLUSION: Vulnerable Medicare beneficiaries with depression or cognitive impairment were able to access Part D benefits to the same extent as nonvulnerable beneficiaries. More research is needed to determine how well Part D meets the needs of these populations.

PB - 57 VL - 57 IS - 8 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19515100?dopt=Abstract U2 - PMC2810264 U4 - Depression/Cognition/Medicare ER - TY - JOUR T1 - Is the effect of reported physical activity on disability mediated by cognitive performance in white and african american older adults? JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2009 A1 - Mihaela A. Popa A1 - Sandra L Reynolds A1 - Brent J. Small KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Black or African American KW - Cognition Disorders KW - Cohort Studies KW - Disability Evaluation KW - Exercise KW - Female KW - Follow-Up Studies KW - Health Status Disparities KW - Humans KW - Male KW - Motor Activity KW - Neuropsychological tests KW - Socioeconomic factors KW - United States KW - White People AB -

This study examined if reported physical activity has beneficial outcomes on disability through cognitive performance-mediated effects and if these mediation effects are comparable for White and African American elders. Longitudinal data from the Assets and Health Dynamics among the Oldest Old study (N = 4,472) are used to test mediation in multilevel models. During the 7-year follow-up, cognitive performance mediated the effects of reported physical activity on disability in the entire sample and in Whites but not in African Americans. Our results indicate that reported physical activity may delay the disability development through improvement in cognitive performance. Unmeasured education and comorbidity influences may have obscured the mediation effects in African Americans. Reported physical activity plays a key role in the independence of older adults and should be particularly promoted in African Americans and during the entire life course.

PB - 64 VL - 64 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19196688?dopt=Abstract U2 - PMC2654991 U4 - SELF-RATED HEALTH/DISABILITY/DISABILITY/Cognitive Functioning ER - TY - JOUR T1 - The effect of retirement on weight. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2009 A1 - Chung, Sukyung A1 - Marisa E Domino A1 - Sally C. Stearns KW - Aged KW - Aging KW - Body Mass Index KW - Cohort Studies KW - Cross-Sectional Studies KW - Female KW - Geriatric Assessment KW - Health Status KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Models, Statistical KW - Motor Activity KW - Obesity KW - Overweight KW - Pensions KW - Retirement KW - Social Security KW - Socioeconomic factors KW - United States KW - Weight Gain AB -

OBJECTIVES: People who are close to retirement age show the highest rates of weight gain and obesity. We investigate the effect of retirement on the change in body mass index (BMI) in diverse groups varying by wealth status and occupation type.

METHODS: Six panels of the Health and Retirement Study (1992-2002) on individuals aged 50-71 were used (N = 37,807). We used fixed-effects regression models with instrumental variables method to estimate the causal effect of retirement on change in the BMI.

RESULTS: Retirement leads to modest weight gain, 0.24 BMI on average. Weight gain with retirement was found among people who were already overweight and those with lower wealth retiring from physically demanding occupations. The cumulative effect of aging among people in their 50s, however, outweighs the effect of retirement; the average BMI gain between ages 50 and 60 is 1.30, 5 times the effect of retirement.

CONCLUSIONS: Given the increasing number of people approaching retirement age, the population level impact of the weight gain ascribed to retirement on health outcomes and health care system might be significant. Future research should evaluate programs targeted to older adults who are most likely to gain weight with retirement.

PB - 64B VL - 64 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19357073?dopt=Abstract U3 - 19357073 U4 - RETIREMENT/Obesity/Body Mass Index/Occupations/Wealth ER - TY - JOUR T1 - The effects of developing a dual sensory loss on depression in older adults: a longitudinal study. JF - J Aging Health Y1 - 2009 A1 - Michele Capella McDonnall KW - Adaptation, Psychological KW - Adult KW - Aged KW - Aged, 80 and over KW - Black or African American KW - depression KW - Depressive Disorder KW - Female KW - Health Surveys KW - Hearing loss KW - Hispanic or Latino KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Models, Statistical KW - Multivariate Analysis KW - Rehabilitation KW - Retirement KW - Risk Factors KW - Sensation Disorders KW - United States KW - Vision Disorders KW - White People AB -

OBJECTIVE: To determine the effect of developing a dual sensory loss (DSL) on depression over time and evaluate the impact of preexisting single sensory loss on this effect.

METHOD: Multilevel modeling was used to analyze data (N = 2,689) from the Health and Retirement Study.

RESULTS: A significant increase in depression at the first report of DSL occurred, and depression increased at a significantly faster rate following DSL, in a curvilinear pattern. In addition, persons who eventually developed DSL began the study with a depression score significantly higher than persons who did not experience sensory loss. A preexisting single sensory loss did not alter the effect of DSL on depression.

DISCUSSION: Two sources of disparity in depression between persons with and without DSL were identified: preexisting differences and differences that occurred due to the DSL. The relationship exhibited between depression and developing a DSL indicated an adjustment process.

PB - 21 VL - 21 IS - 8 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19897782?dopt=Abstract U2 - PMC2789482 U4 - Depression/Hearing Impaired Persons/Visually Impaired Persons ER - TY - JOUR T1 - Estimating the quantity and economic value of family caregiving for community-dwelling older persons in the last year of life. JF - J Am Geriatr Soc Y1 - 2009 A1 - Rhee, YongJoo A1 - Howard B Degenholtz A1 - Anthony T. Lo Sasso A1 - Linda L Emanuel KW - Activities of Daily Living KW - Adult KW - Aged KW - Aged, 80 and over KW - Caregivers KW - Costs and Cost Analysis KW - Disability Evaluation KW - Female KW - Health Surveys KW - Home Health Aides KW - Home Nursing KW - Humans KW - Independent Living KW - Male KW - Middle Aged KW - Retrospective Studies KW - Terminal Care KW - United States AB -

OBJECTIVES: To estimate the quantity and economic value of informal care provided to older persons during their final year of life in the community.

DESIGN: Retrospective analysis of publicly available nationally representative survey data.

SETTING: This retrospective study used data from the Health and Retirement Study, a nationally representative, longitudinal study of community-dwelling older people.

PARTICIPANTS: Older people who died between 2000 and 2002.

MEASUREMENTS: Data were extracted from the 2002 "exit survey" and linked with characteristics of caregivers from the helper file. Ordinary least squares regression was used to estimate hours of informal caregiving for community-dwelling older people (N=990). Adjusted hours were multiplied by the 2002 national average home aide wage (9.16 USD per hour). Sensitivity tests were performed using the 10th percentile wage rate (6.56 USD) and 90th percentile wage rate (12.34 USD).

RESULTS: Older people who died in the community received on average 65.8 hours per week of informal care in the last year of life. The estimated economic value ranges from 22,514 USD to 42,351 USD, which is equivalent to the annual direct replacement cost with a home aide in 2002.

CONCLUSION: Family members provide substantial assistance during the last year of life for older people who die in the community. If the informal care provided in the last year of life is replaced with a home aide, the total economic value for the United States would be approximately 1.4 billion USD (in 2002).

PB - 57 VL - 57 IS - 9 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19682115?dopt=Abstract U3 - 19682115 U4 - Caregivers/Costs and Cost Analysis 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 - Fall risk in older adults: roles of self-rated vision, home modifications, and limb function. JF - J Aging Health Y1 - 2009 A1 - Bernard A Steinman A1 - Pynoos, Jon A1 - Anna Q D Nguyen KW - Accidental Falls KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Black or African American KW - Disabled Persons KW - Educational Status KW - Female KW - Health Status KW - Health Surveys KW - Humans KW - Logistic Models KW - Longitudinal Studies KW - Male KW - Musculoskeletal Physiological Phenomena KW - Risk KW - Risk Factors KW - Self-Assessment KW - Self-Help Devices KW - Surveys and Questionnaires KW - Vision, Low KW - Visual Acuity KW - White People AB -

Objective. To assess direct effects of self-rated vision, home modifications, and limb functioning, and moderating effects of self-rated vision on change in functioning of upper and lower limbs on fall risk in older adults. Method. Logistic regression was used to analyze 2004 and 2006 waves of the Health and Retirement Study. Results. Effects of self-rated vision and home modifications in predicting falls decreased after controlling functioning in upper and lower extremities. Declines/gains in functioning across short periods of time superseded self-rated vision in predicting falls. No evidence was found for a moderating effect of vision status on limb functioning. Discussion. Poor self-rated vision may not be a good indicator of fall risk in older adults. Thus, for older adults with visual impairments, preserving residual limb functioning through exercise and activity has the important potential to reduce fall risk in addition to improving muscle and bone strength as well as improving balance and gait.

PB - 21 VL - 21 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19494362?dopt=Abstract U3 - 19494362 U4 - Home Modifications/exercise/Visually Impaired Persons/Falls/risk factors ER - TY - JOUR T1 - Financial hardship and mortality among older adults using the 1996-2004 Health and Retirement Study. JF - Ann Epidemiol Y1 - 2009 A1 - Reginald D. Tucker-Seeley A1 - Li, Yi A1 - Subramanian, S V A1 - Sorensen, Glorian KW - Aged KW - Female KW - Geriatric Assessment KW - Health Surveys KW - Humans KW - Male KW - Medicaid KW - Middle Aged KW - Mortality KW - Poverty KW - Proportional Hazards Models KW - Prospective Studies KW - Retirement KW - Risk KW - Sex Factors KW - United States AB -

PURPOSE: We investigated the effect of financial hardship on mortality risk in a community-dwelling sample of adults 50 years of age and olderin the United States.

METHOD: The 1996 Health and Retirement Study cohorts were followed prospectively to 2004 (N = 8,377). Gender-stratified grouped Cox models were used to estimate the difference in the relative risk (RR) of mortality between a specific number of financial hardships (one, two, or three or more) and no hardships; and the predictive utility of each individual financial hardship for mortality during the follow-up period.

RESULTS: Gender-stratified models adjusted for demographics, socioeconomic characteristics, and functional limitations in 1996 showed that women reporting one (hazard ratio [HR] = 1.42; 95% confidence interval [CI]: 1.05-1.92) or three or more (HR = 1.60; 95% CI: 1.05-2.46) and men reporting two (HR = 1.80; 95% CI: 1.21-2.69) financial hardships had a substantially higher probability of mortality compared to those reporting no financial hardships. Individual financial hardships that predicted mortality in fully adjusted models for women included receiving Medicaid (HR = 2.23; 95% CI: 1.68-2.98) and for men receiving Medicaid (HR = 2.11; 95% CI: 1.57-2.84) and receiving food stamps (HR = 1.59; 95% CI: 1.09-2.33).

CONCLUSIONS: These findings suggest that over and above the influence of traditional measures of socioeconomic status, financial hardship exerts an influence on the risk of mortality among older adults and that the number and type of hardships important in predicting mortality may differ for men and women.

PB - 19 VL - 19 IS - 12 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19944348?dopt=Abstract U2 - PMC2835519 U4 - financial resources/socioeconomic status/Mortality/GENDER-DIFFERENCES ER - TY - JOUR T1 - Financial status, employment, and insurance among older cancer survivors. JF - J Gen Intern Med Y1 - 2009 A1 - Norredam, Marie A1 - Meara, Ellen A1 - Landrum, Mary Beth A1 - Haiden A. Huskamp A1 - Nancy L. Keating KW - Aged KW - Aged, 80 and over KW - Cohort Studies KW - Data collection KW - Employment KW - Female KW - Financing, Personal KW - Humans KW - Income KW - Insurance Coverage KW - Insurance, Health KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Neoplasms KW - Socioeconomic factors KW - Survivors AB -

BACKGROUND: Few data are available about the socioeconomic impact of cancer for long-term cancer survivors.

OBJECTIVES: To investigate socioeconomic outcomes among older cancer survivors compared to non-cancer patients.

DATA SOURCE: 2002 Health and Retirement Study.

STUDY DESIGN: We studied 964 cancer survivors of > 4 years and 14,333 control patients who had never had cancer from a population-based sample of Americans ages >or= 55 years responding to the 2002 Health and Retirement Study.

MEASURES: We compared household income, housing assets, net worth, insurance, employment, and future work expectations.

ANALYSES: Propensity score methods were used to control for baseline differences between cancer survivors and controls.

RESULTS: Female cancer survivors did not differ from non-cancer patients in terms of income, housing assets, net worth, or likelihood of current employment (all P > 0.20); but more were self-employed (25.0% vs. 17.7%; P = 0.03), and fewer were confident that if they lost their job they would find an equally good job in the next few months (38.4% vs. 45.9%; P = 0.03). Among men, cancer survivors and noncancer patients had similar income and housing assets (both P >or= 0.10) but differed somewhat in net worth (P = 0.04). Male cancer survivors were less likely than other men to be currently employed (25.2% vs. 29.7%) and more likely to be retired (66.9% vs. 62.2%), although the P value did not reach statistical significance (P = 0.06). Men were also less optimistic about finding an equally good job in the next few months if they lost their current job (33.5% vs. 46.9%), although this result was not significant (P = 0.11).

CONCLUSIONS: Despite generally similar socioeconomic outcomes for cancer survivors and noncancer patients ages >or=55 years, a better understanding of employment experience and pessimism regarding work prospects may help to shape policies to benefit cancer survivors.

PB - 24 VL - 24 Suppl 2 IS - Suppl 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19838847?dopt=Abstract U2 - PMC2763157 U4 - CANCER/financial resources/insurance/socioeconomic status ER - TY - JOUR T1 - Functional limitations, socioeconomic status, and all-cause mortality in moderate alcohol drinkers. JF - J Am Geriatr Soc Y1 - 2009 A1 - Sei J. Lee A1 - Rebecca L. Sudore A1 - Brie A Williams A1 - Lindquist, Karla A1 - Helen L. Chen A1 - Kenneth E Covinsky KW - Activities of Daily Living KW - Aged KW - Alcohol Drinking KW - Comorbidity KW - Education KW - Female KW - Humans KW - Income KW - Male KW - Obesity KW - Risk Factors KW - Sex Factors KW - Smoking KW - Socioeconomic factors AB -

OBJECTIVES: To determine whether the survival benefit associated with moderate alcohol use remains after accounting for nontraditional risk factors such as socioeconomic status (SES) and functional limitations.

DESIGN: Prospective cohort.

SETTING: The Health and Retirement Study (HRS), a nationally representative study of U.S. adults aged 55 and older.

PARTICIPANTS: Twelve thousand five hundred nineteen participants were enrolled in the 2002 wave of the HRS.

MEASUREMENTS: Participants were asked about their alcohol use, functional limitations (activities of daily living, instrumental activities of daily living, and mobility), SES (education, income, and wealth), psychosocial factors (depressive symptoms, social support, and the importance of religion), age, sex, race and ethnicity, smoking, obesity, and comorbidities. Death by December 31, 2006, was the outcome measure.

RESULTS: Moderate drinkers (1 drink/d) had a markedly more-favorable risk factor profile, with higher SES and fewer functional limitations. After adjusting for demographic factors, moderate drinking (vs no drinking) was strongly associated with less mortality (odds ratio (OR)=0.50, 95% confidence interval (CI)=0.40-0.62). When traditional risk factors (smoking, obesity, and comorbidities) were also adjusted for, the protective effect was slightly attenuated (OR=0.57, 95% CI=0.46-0.72). When all risk factors including functional status and SES were adjusted for, the protective effect was markedly attenuated but still statistically significant (OR=0.72, 95% CI=0.57-0.91).

CONCLUSION: Moderate drinkers have better risk factor profiles than nondrinkers, including higher SES and fewer functional limitations. Although these factors explain much of the survival advantage associated with moderate alcohol use, moderate drinkers maintain their survival advantage even after adjustment for these factors.

PB - 57 VL - 57 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19473456?dopt=Abstract U2 - PMC2847409 U4 - Alcohol Drinking/socioeconomic status/ADL and IADL Impairments/Mobility/Survival Analysis 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 - The health effects of Medicare for the near-elderly uninsured. JF - Health Serv Res Y1 - 2009 A1 - Daniel Polsky A1 - Jalpa A Doshi A1 - José J Escarce A1 - Manning, Willard A1 - Susan M Paddock A1 - Cen, Liyi A1 - Jeannette Rogowski KW - Aged KW - Attitude to Health KW - Female KW - Follow-Up Studies KW - Health Services Accessibility KW - Health Services Research KW - Health Status KW - Health Surveys KW - Humans KW - Insurance Coverage KW - Logistic Models KW - Male KW - Medically Uninsured KW - Medicare KW - Mortality KW - Multivariate Analysis KW - Program Evaluation KW - Retirement KW - Socioeconomic factors KW - Statistics, Nonparametric KW - United States AB -

OBJECTIVE: To determine whether Medicare enrollment at age 65 has an effect on the health trajectory of the near-elderly uninsured.

DATA SOURCES: Eight biennial waves (1992-2006) of the Health and Retirement Study, a nationally representative panel survey of noninstitutionalized 51-61 year olds and their spouses.

STUDY DESIGN: We use a quasi-experimental approach to compare the health effects of insurance for the near-elderly uninsured with previously insured contemporaneous controls. The primary outcome measure is overall self-reported health status combined with mortality (i.e., excellent to very good, good, fair to poor, dead).

RESULTS: The change in the trajectory of overall health status for the previously uninsured that can be attributed to Medicare is small and not statistically significant. For every 100 persons in the previously uninsured group, joining Medicare is associated with 0.6 fewer in excellent or very good health (95 percent CI: -4.8, 3.3), 0.3 more in good health (95 percent CI: -3.8, 4.1), 2.5 fewer in fair or poor health (95 percent CI: -7.4, 2.3), and 2.8 more dead (-4.0, 10.0) by age 73. The health trajectory patterns from physician objective health measures are similarly small and not statistically significant.

CONCLUSIONS: Medicare coverage at age 65 for the previously uninsured is not linked to improvements in overall health status.

PB - 44 VL - 44 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19674430?dopt=Abstract U2 - PMC2699915 U4 - Medicare/health status/Health Insurance/Health Benefits ER - TY - JOUR T1 - The health impact of remarriage behavior on chronic obstructive pulmonary disease: findings from the US longitudinal survey. JF - BMC Public Health Y1 - 2009 A1 - Noda, Tatsuya A1 - Ojima, Toshiyuki A1 - Hayasaka, Shinya A1 - Hagihara, Okihito A1 - Takayanagi, Ryoichi A1 - Nobutomo, Koichi KW - Aged KW - Bereavement KW - Educational Status KW - Female KW - Follow-Up Studies KW - Health Status KW - Health Surveys KW - Humans KW - Lung Diseases, Obstructive KW - Male KW - Marriage KW - Middle Aged KW - Outcome Assessment, Health Care KW - Proportional Hazards Models KW - Smoking KW - United States AB -

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a major disease among adults, and its deterioration was reported to be associated with psychological imbalance. Meanwhile, bereavement and divorce have proven harmful to the health status of a surviving spouse. But few studies have been conducted to evaluate the remedial effect on survivors' health outcome by remarriage after bereavement. The present study thus examined the associations between remarriage and the onset of COPD.

METHODS: Our cohort was drawn from Health and Retirement Study participants in the United States, and consisted of 2676 subjects who were divorced or bereaved from 1992 to 2002. We then followed them for up to 11 years and assessed the incidence rate of COPD using a Cox proportional hazard model after adjusting for marital status, age, gender, education and the number of cigarettes smoked.

RESULTS: Among all subjects, 224 who remarried after bereavement or divorce tended to be younger and more male dominated. Remarriage after bereavement/divorce was associated with significantly decreased risk of COPD onset for overall subjects [hazard ratio (HR): 0.51, 95% confidence interval (95% CI): 0.28-0.94], female subjects [HR: 0.36, 95% CI: 0.13-0.98], and for those under 70 years old [HR: 0.36, 95% CI: 0.17-0.79].

CONCLUSION: This study investigates the impact of remarriage on health outcome based on a large-scale population survey and indicates that remarriage significantly correlates with reduced risk of COPD incidence, even after adjusting smoking habit.

PB - 9 VL - 9 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19912659?dopt=Abstract U2 - PMC2781819 U4 - Marital Status/risk factors ER - TY - JOUR T1 - The impact of occupation on self-rated health: cross-sectional and longitudinal evidence from the health and retirement survey. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2009 A1 - Ralitza Gueorguieva A1 - Jody L Sindelar A1 - Tracy Falba A1 - Jason M. Fletcher A1 - Patricia S Keenan A1 - Wu, Ran A1 - William T Gallo KW - Aged KW - Attitude to Health KW - Cohort Studies KW - Cross-Sectional Studies KW - Educational Status KW - Female KW - Health Status Indicators KW - Health Surveys KW - Humans KW - Linear Models KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Mortality KW - Occupations KW - Odds Ratio KW - Retirement KW - Social Class KW - Socioeconomic factors KW - United States AB -

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

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

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

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

PB - 64 VL - 64 IS - 1 N1 - PMID 19196689 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19196689?dopt=Abstract U2 - PMC2654983 U4 - SELF-RATED HEALTH/Occupations ER - TY - JOUR T1 - Individual well-being in middle and older adulthood: do spousal beliefs matter? JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2009 A1 - Tim D Windsor A1 - Lindsay H Ryan A1 - Jacqui Smith KW - Adult KW - Affect KW - Aged KW - Aged, 80 and over KW - Aging KW - Attitude to Health KW - Culture KW - Female KW - Humans KW - Individuality KW - Internal-External Control KW - Male KW - Marriage KW - Middle Aged KW - Quality of Life KW - Spouses AB -

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

PB - 64B VL - 64 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19608855?dopt=Abstract U3 - 19608855 U4 - psycho-social/spousal care/SELF-RATED HEALTH/Couples ER - TY - JOUR T1 - The influence of long-term care insurance on the likelihood of nursing home admission. JF - J Am Geriatr Soc Y1 - 2009 A1 - Tanya R Gure A1 - Mohammed U Kabeto A1 - Kenneth M. Langa KW - Aged KW - Aged, 80 and over KW - Female KW - Humans KW - Insurance, Long-Term Care KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Nursing homes AB -

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

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

SETTING: Community-dwelling nationally representative sample.

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

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

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

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

PB - 57 VL - 57 IS - 10 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19694868?dopt=Abstract U2 - PMC2810263 U4 - Long-Term Care/Insurance, Long Term Care/Nursing Homes ER - TY - JOUR T1 - The intersection of sex, marital status, and cardiovascular risk factors in shaping stroke incidence: results from the health and retirement study. JF - J Am Geriatr Soc Y1 - 2009 A1 - J Maselko A1 - Lisa M. Bates A1 - Mauricio Avendano A1 - M. Maria Glymour KW - Aged KW - Cardiovascular Diseases KW - Female KW - Health Surveys KW - Humans KW - Incidence KW - Longitudinal Studies KW - Male KW - Marital Status KW - Middle Aged KW - Risk Factors KW - Sexuality KW - Stroke AB -

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

DESIGN: Longitudinal cohort.

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

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

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

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

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

PB - 57 VL - 57 IS - 12 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19874408?dopt=Abstract U3 - 19874408 U4 - Stroke/risk factors/Marital Status/Sex Differences ER - TY - JOUR T1 - Level and change in cognitive test scores predict risk of first stroke. JF - J Am Geriatr Soc Y1 - 2009 A1 - Triveni DeFries A1 - Mauricio Avendano A1 - M. Maria Glymour KW - Aged KW - Aged, 80 and over KW - Cognition Disorders KW - Cohort Studies KW - Dementia, Vascular KW - Female KW - Follow-Up Studies KW - Humans KW - Interviews as Topic KW - Kaplan-Meier Estimate KW - Male KW - Mental Status Schedule KW - Middle Aged KW - Predictive Value of Tests KW - Psychometrics KW - Risk KW - Stroke KW - United States AB -

OBJECTIVES: To determine whether cognitive test scores and cognitive decline predict incidence of first diagnosed stroke.

DESIGN: Stroke-free Health and Retirement Study participants were followed on average 7.6 years for self- or proxy-reported first stroke (1,483 events). Predictors included baseline performance on a modified Telephone Interview for Cognitive Status (Mental Status) and Word Recall test and decline between baseline and second assessment in either measure. Hazard ratios (HRs) were estimated using Cox proportional hazards models for the whole sample and stratified according to five major cardiovascular risk factors.

SETTING: National cohort study of noninstitutionalized adults with a mean baseline age of 64+/-9.9.

PARTICIPANTS: Health and Retirement Study participants (n=19,699) aged 50 and older.

RESULTS: Word Recall (HR for 1 standard deviation difference=0.92, 95% confidence interval (CI)=0.86-0.97)) and Mental Status (HR=0.89, 95% CI=0.84-0.95) predicted incident stroke. Mental Status predicted stroke risk in those with (HR=0.93, 95%=0.87-0.99) and without (HR=0.81, 95% CI=0.72-.91) one or more vascular risk factors. Word Recall declines predicted a 16% elevation in subsequent stroke risk (95% CI=1.01-1.34). Declines in Mental Status predicted a 37% elevation in stroke risk (95% CI=1.11-1.70).

CONCLUSION: Cognitive test scores predict future stroke risk, independent of other major vascular risk factors.

PB - 57 VL - 57 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19175440?dopt=Abstract U3 - 19175440 U4 - Stroke/Cognitive Function ER - TY - JOUR T1 - Material resources and population health: disadvantages in health care, housing, and food among adults over 50 years of age. JF - Am J Public Health Y1 - 2009 A1 - Dawn E Alley A1 - Beth J Soldo A1 - José A Pagán A1 - John McCabe A1 - deBlois, Madeleine A1 - Samuel H Field A1 - David A Asch A1 - Carolyn Cannuscio KW - Aged KW - Female KW - Food Supply KW - Health Status Disparities KW - Health Surveys KW - Healthcare Disparities KW - Housing KW - Humans KW - Logistic Models KW - Male KW - Middle Aged KW - Poverty KW - United States AB -

OBJECTIVES: We examined associations between material resources and late-life declines in health.

METHODS: We used logistic regression to estimate the odds of declines in self-rated health and incident walking limitations associated with material disadvantages in a prospective panel representative of US adults aged 51 years and older (N = 15,441).

RESULTS: Disadvantages in health care (odds ratio [OR] = 1.39; 95% confidence interval [CI] = 1.23, 1.58), food (OR = 1.69; 95% CI = 1.29, 2.22), and housing (OR = 1.20; 95% CI = 1.07, 1.35) were independently associated with declines in self-rated health, whereas only health care (OR = 1.43; 95% CI = 1.29, 1.58) and food (OR = 1.64; 95% CI = 1.31, 2.05) disadvantage predicted incident walking limitations. Participants experiencing multiple material disadvantages were particularly susceptible to worsening health and functional decline. These effects were sustained after we controlled for numerous covariates, including baseline health status and comorbidities. The relations between health declines and non-Hispanic Black race/ethnicity, poverty, marital status, and education were attenuated or eliminated after we controlled for material disadvantage.

CONCLUSIONS: Material disadvantages, which are highly policy relevant, appear related to health in ways not captured by education and poverty. Policies to improve health should address a range of basic human needs, rather than health care alone.

PB - 99 VL - 99 Suppl 3 IS - Suppl 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19890175?dopt=Abstract U2 - PMC2774171 ER - TY - JOUR T1 - Measuring socioeconomic differences in use of health care services by wealth versus by income. JF - Am J Public Health Y1 - 2009 A1 - Allin, Sara A1 - Masseria, Cristina A1 - Elias Mossialos KW - Aged KW - Aged, 80 and over KW - Aging KW - Data collection KW - Europe KW - Female KW - Health Services KW - Health Services Accessibility KW - Health Status Disparities KW - Humans KW - Income KW - Male KW - Middle Aged KW - Odds Ratio KW - Pensions KW - Retirement KW - Socioeconomic factors KW - Statistics as Topic KW - United Kingdom AB -

OBJECTIVES: We compared the extent of socioeconomic differences in use of health care services based on wealth (i.e., accumulated assets) as the socioeconomic ranking variable with the extent of differences based on income to explore the sensitivity of the estimates of equity to the choice of the socioeconomic indicator.

METHODS: We used data from the Health and Retirement Study in the United States and the Survey of Health, Ageing, and Retirement in Europe to estimate levels of income- and wealth-related disparity in use of physician and dental services among adults 50 or older in 12 countries.

RESULTS: We found socioeconomic differences in use of physician services after standardizing for need in about half of the countries studied. No consistent pattern in levels of disparity measured by wealth versus those measured by income was found. However, the rich were significantly more likely to use dental services in all countries. Wealth-related differences in dental service use were consistently higher than were income-related differences.

CONCLUSIONS: We found some support for wealth as a more sensitive indicator of socioeconomic status among older adults than was income. Wealth may thus allow more accurate measurements of socioeconomic differences in use of health care services for this population.

PB - 99 VL - 99 IS - 10 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19150899?dopt=Abstract U2 - PMC2741508 U4 - Health Care Utilization/socioeconomic status/Wealth/Cross Cultural Comparison/SHARE/cross-national comparison ER - TY - JOUR T1 - Medicare savings programs: analyzing options for expanding eligibility. JF - Inquiry Y1 - 2009 A1 - Zuckerman, Stephen A1 - Shang, Baoping A1 - Timothy A Waidmann KW - Aged KW - Demography KW - Disabled Persons KW - Eligibility Determination KW - Female KW - Health Status KW - Humans KW - Income KW - Male KW - Medical Assistance KW - Medicare KW - Medicare Part D KW - Public Policy KW - United States AB -

The Medicare Savings Programs (MSPs) are designed to provide financial assistance to Medicare beneficiaries who do not qualify for full Medicaid coverage. This paper considers changes in eligibility that would better align MSP program rules with those related to receiving low-income subsidies for the Medicare Part D drug benefit. These changes would make more people eligible for the MSPs and could encourage greater participation; similar changes were incorporated in recently passed legislation. Our analysis, based on 2006 data from the Health and Retirement Study, shows there is a trade-off between making larger numbers of beneficiaries eligible by eliminating resource requirements and better targeting of individuals with greater health care needs by expanding income standards.

PB - 46 VL - 46 UR - URL:http://www.inquiryjournal.org Publisher's URL IS - 4 N1 - Journal Article U1 - http://www.ncbi.nlm.nih.gov/pubmed/20184166?dopt=Abstract U3 - 20184166 U4 - Analysis of Health Care Markets/Health: Government Policy,/Public Health/Medicare Savings Programs/Health Care/Medicare/Medicare Part D ER - TY - JOUR T1 - Memory and depressive symptoms are dynamically linked among married couples: longitudinal evidence from the AHEAD study. JF - Dev Psychol Y1 - 2009 A1 - Denis Gerstorf A1 - Christiane A Hoppmann A1 - Kelly M Kadlec A1 - John J McArdle KW - Adaptation, Psychological KW - Aged KW - Aged, 80 and over KW - Aging KW - Cognition KW - depression KW - Female KW - Health Status KW - Humans KW - Interpersonal Relations KW - Longitudinal Studies KW - Male KW - Marriage KW - Mental Recall KW - Models, Psychological KW - Quality of Life KW - Spouses AB -

This study examined dyadic interrelations between episodic memory and depressive symptom trajectories of change in old and advanced old age. The authors applied dynamic models to 10-year incomplete longitudinal data of initially 1,599 married couples from the study of Asset and Health Dynamics Among the Oldest Old (M(age) = 75 years at Time 1). The authors found domain-specific lead-lag associations (time lags of 2 years) among wives and husbands as well as between spouses. For memory, better performance among husbands protected against subsequent memory decline among wives, with no evidence of a directed effect in the other direction. For depressive symptoms, wives' scores predicted subsequent depression increase and memory decline among husbands. Possible individual covariates (age, education, functional limitations) and spousal covariates (length of marriage, number of children, and whether the couple remained intact over the study period) did not account for differential lead-lag associations. The findings of antecedent-consequent relations between wives and husbands are consistent with life-span notions that individual development both influences and is influenced by contextual factors such as close social relationships.

PB - 45 VL - 45 IS - 6 N1 - PMID: 19899917 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19899917?dopt=Abstract U3 - 19899917 U4 - Depression Symptoms/Memory Disorders/Old Age/Spouses/Depression Symptoms/Couples ER - TY - JOUR T1 - Neighborhood safety, socioeconomic status, and physical activity in older adults. JF - Am J Prev Med Y1 - 2009 A1 - Reginald D. Tucker-Seeley A1 - Subramanian, S V A1 - Li, Yi A1 - Sorensen, Glorian KW - Aged KW - Aged, 80 and over KW - Cross-Sectional Studies KW - Female KW - Florida KW - Health Status KW - Humans KW - Leisure activities KW - Male KW - Middle Aged KW - Motor Activity KW - Recreation KW - Residence Characteristics KW - Safety KW - Sex Distribution KW - Social Support KW - Socioeconomic factors KW - Surveys and Questionnaires AB -

BACKGROUND: Neighborhood environment can have a substantial influence on the level of physical activity among older adults. Yet, the moderating influence of various measures of SES on the association between perceived neighborhood safety and leisure-time physical activity (LTPA) among older adults remains unknown.

PURPOSE: The study was designed to investigate the association between perceived neighborhood safety and LTPA in a nationally representative sample of older adults, and to evaluate SES characteristics as potential effect modifiers in the association between perceived neighborhood safety and LTPA.

METHODS: Cross-sectional data from the 2004 Health and Retirement Study of older adults aged >or=50 years were used to examine the association between perceived neighborhood safety and LTPA. Differences in LTPA were evaluated across three measures of SES: education, household income, and household wealth. SES was also evaluated as a potential effect modifier in the association between perceived neighborhood safety and LTPA. The analysis was conducted in 2008.

RESULTS: An SES gradient in LTPA was noted across measures of SES used in this study. After controlling for SES and demographic characteristics and functional limitations, older adults who perceived their neighborhood as safe had an 8% higher mean rate of LTPA compared to older adults who perceived their neighborhood as unsafe. The association was no longer significant when self-rated health was added. Additionally, SES was not a significant effect modifier in the association between perceived neighborhood safety and LTPA.

CONCLUSIONS: SES, demographic characteristics, and functional limitations substantially attenuated the positive association between perceived neighborhood safety and LTPA; however, with the inclusion of self-rated health, the association was no longer present. This finding suggests that self-rated health may mediate this association. The lack of significance in the interaction between perceived neighborhood safety and SES suggests that prevention efforts to increase physical activity among older adults should consider perceptions of neighborhood safety as a potential barrier regardless of SES.

PB - 37 VL - 37 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19595554?dopt=Abstract U2 - PMC3685411 U4 - Neighborhood Characteristics/Leisure/Physical Activity/socioeconomic status ER - TY - JOUR T1 - A new measure of medication affordability. JF - Soc Work Public Health Y1 - 2009 A1 - Becky A. Briesacher A1 - Ross-Degnan, Dennis A1 - Adams, Alyce A1 - Anita K Wagner A1 - Jerry Gurwitz A1 - Soumerai, Stephan KW - Aged KW - Data collection KW - Female KW - Financing, Personal KW - Humans KW - Male KW - Medicaid KW - Middle Aged KW - Poverty KW - Prescription Fees KW - United States AB -

This study developed a new measure of medication affordability that examines out-of-pocket drug expenses relative to available household resources. The authors assessed the spending patterns of approximately 2.1 million poor households (< or =100% federal poverty level) of adults aged 51 and older by Medicaid status. The data were drawn from the 2000-2001 Health and Retirement Study. Household spending was categorized into three broad types: basic living, health care, and discretionary. Older (aged 51 or older) poor households without Medicaid allocated about 72% of their total resources ($17,421, SE $783) to basic living needs. In comparison, those with Medicaid had scarcer total resources ($12,498, SE $423) and allocated 85% to basic living needs. Medication costs consumed the largest proportion of health care expenses for both types of poor households (Medicaid: $463, SE $67; non-Medicaid: $970, SE $102). After paying for basic living needs and health care costs, these families had, on average, only $16 left each week. Poor families have very few resources available for anything beyond basic living needs, even when they have Medicaid coverage. There is no great reservoir of discretionary funds to pay for increases in cost-sharing under Medicaid and Medicare Part D.

PB - 24 VL - 24 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19821195?dopt=Abstract U2 - PMC2893303 U4 - Medical Expenditures/Prescription Fees/Medicare ER - TY - JOUR T1 - Pain, functional limitations, and aging. JF - J Am Geriatr Soc Y1 - 2009 A1 - Kenneth E Covinsky A1 - Lindquist, Karla A1 - Dorothy D Dunlop A1 - Yelin, Edward KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Aging KW - Comorbidity KW - Cross-Sectional Studies KW - Disability Evaluation KW - Female KW - Geriatric Assessment KW - Health Behavior KW - Health Surveys KW - Humans KW - Life Style KW - Male KW - Middle Aged KW - Mobility Limitation KW - pain KW - Pain Measurement KW - Quality of Life KW - Risk Factors AB -

OBJECTIVES: To examine the relationship between functional limitations and pain across a spectrum of age, ranging from mid life to advanced old age.

DESIGN: Cross-sectional study.

SETTING: The 2004 Health and Retirement Study (HRS), a nationally representative study of community-living persons aged 50 and older.

PARTICIPANTS: Eighteen thousand five hundred thirty-one participants in the 2004 HRS.

MEASUREMENTS: Participants who reported that they were often troubled by pain that was moderate or severe most of the time were defined as having significant pain. For each of four functional domains, subjects were classified according to their degree of functional limitation: mobility (able to jog 1 mile, able to walk several blocks, able to walk one block, unable to walk one block), stair climbing (able to climb several flights, able to climb one flight, not able to climb a flight), upper extremity tasks (able to do 3, 2, 1, or 0), and activity of daily living (ADL) function (able to do without difficulty, had difficulty but able to do without help, need help).

RESULTS: Twenty-four percent of participants had significant pain. Across all four domains, participants with pain had much higher rates of functional limitations than subjects without pain. Participants with pain were similar in terms of their degree of functional limitation to participants 2 to 3 decades older. For example, for mobility, of subjects aged 50 to 59 without pain, 37% were able to jog 1 mile, 91% were able to walk several blocks, and 96% were able to walk one block without difficulty. In contrast, of subjects aged 50 to 59 with pain, 9% were able to jog 1 mile, 50% were able to walk several blocks, and 69% were able to walk one block without difficulty. Subjects aged 50 to 59 with pain were similar in terms of mobility limitations to subjects aged 80 to 89 without pain, of whom 4% were able to jog 1 mile, 55% were able to walk several blocks, and 72% were able to walk one block without difficulty. After adjustment for demographic characteristics, socioeconomic status, comorbid conditions, depression, obesity, and health habits, across all four measures, participants with significant pain were at much higher risk for having functional limitations (adjusted odds ratio (AOR)=2.85, 95% confidence interval (CI)=2.20-3.69, for mobility; AOR=2.84, 95% CI=2.48-3.26, for stair climbing; AOR=3.96, 95% CI=3.43-4.58, for upper extremity tasks; and AOR=4.33; 95% CI=3.71-5.06, for ADL function).

CONCLUSION: Subjects with pain develop the functional limitations classically associated with aging at much earlier ages.

PB - 57 VL - 57 IS - 9 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19682122?dopt=Abstract U2 - PMC2925684 U4 - Physical Activity/ADL and IADL Impairments/Mobility ER - TY - JOUR T1 - Parental education and late-life dementia in the United States. JF - J Geriatr Psychiatry Neurol Y1 - 2009 A1 - Mary A M Rogers A1 - Brenda L Plassman A1 - Mohammed U Kabeto A1 - Gwenith G Fisher A1 - John J McArdle A1 - David J Llewellyn A1 - Guy G Potter A1 - Kenneth M. Langa KW - Age Distribution KW - Aged KW - Aged, 80 and over KW - Apolipoproteins E KW - Biomarkers KW - Cognition Disorders KW - Dementia KW - Educational Status KW - Fathers KW - Female KW - Genetic Predisposition to Disease KW - Humans KW - Longitudinal Studies KW - Male KW - Mothers KW - Odds Ratio KW - Parents KW - Prevalence KW - Prospective Studies KW - Racial Groups KW - Risk Factors KW - Sex Distribution KW - United States AB -

We investigated the relation between parental education and dementia in the United States. Participants in the Aging, Demographics, and Memory Study were included, with information regarding parental education obtained from the Health and Retirement Study. The odds of dementia in elderly Americans whose mothers had less then 8 years of schooling were twice (95% CI, 1.1-3.8) that of individuals with higher maternal education, when adjusted for paternal education. Of elderly Americans with less educated mothers, 45.4% (95% CI, 37.4-53.4%) were diagnosed with dementia or ;;cognitive impairment, no dementia'' compared to 31.2% (95% CI, 25.0-37.4%) of elderly Americans whose mothers had at least an 8th grade education. The population attributable risk of dementia due to low maternal education was 18.8% (95% CI, 9.4-28.2%). The education of girls in a population may be protective of dementia in the next generation.

PB - 22 VL - 22 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19073840?dopt=Abstract U2 - PMC2670459 U4 - Dementia/Education/Women ER - TY - JOUR T1 - Patterns of food insecurity and participation in food assistance programmes over time in the elderly. JF - Public Health Nutr Y1 - 2009 A1 - Kim, Kirang A1 - Edward A Frongillo KW - Aged KW - diet KW - Food Supply KW - Humans KW - Longitudinal Studies KW - Malnutrition KW - National Health Programs KW - Patient Acceptance of Health Care KW - Prevalence KW - Public Assistance KW - United States AB -

OBJECTIVE: The present study aimed to understand the relationship between need and help-seeking behaviour in older adults by examining the patterns of food insecurity and participation in food assistance programmes (FAP), i.e. the Food Stamp Program and home-delivered meals.

DESIGN: Data from two longitudinal studies were used. The studies were designed to obtain nationally representative information on health, insurance coverage, financial status, family support systems, labour market status and retirement planning, every two years: the Health and Retirement Study (HRS, 1996-2002) and Asset and Health Dynamics Among the Oldest Old (AHEAD, 1995-2002).

SETTING: USA.

SUBJECTS: There were 7623 participants for HRS and 3378 for AHEAD.

RESULTS: The older adults appeared to have persistent patterns between food insecurity and participation in FAP, especially in the Food Stamp Program. More persistently food-insecure older adults had higher participation in FAP (P < 0.001). Food-insecure older adults at one time were more likely to shift from non-participation to participation in FAP the next time than food-secure older adults (P < 0.001). Regardless of previous food insecurity status, previous participants in FAP were more likely to participate subsequently.

CONCLUSIONS: The relationship between need and help-seeking behaviour in older adults was found to follow a persistent positive pattern, determined by looking at the patterns of food insecurity and participation in FAP. Although food insecurity as a need is a good predictor of participation in FAP, it is not enough to fully predict participation in FAP. Help-seeking behaviour (i.e. previous programme participation) is also important in predicting participation in FAP.

PB - 12 VL - 12 IS - 11 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19371452?dopt=Abstract U3 - 19371452 U4 - food stamps/Poverty ER - TY - JOUR T1 - Physician outpatient contacts and hospitalizations among cognitively impaired elderly. JF - Alzheimers Dement Y1 - 2009 A1 - Caspi, Eilon A1 - Nina M Silverstein A1 - Frank Porell A1 - Kwan, Ngai KW - Aged KW - Aged, 80 and over KW - Alzheimer disease KW - Ambulatory Care KW - Cognition Disorders KW - Community-Institutional Relations KW - Comorbidity KW - Female KW - Hospitalization KW - Housing for the Elderly KW - Humans KW - Male KW - Memory Disorders KW - Physicians KW - Prevalence KW - Severity of Illness Index AB -

BACKGROUND: This study examined how physician contacts and hospitalizations vary in relation to cognitive function level among community-residing older adults.

METHODS: Analysis of the 1998 wave of the Health and Retirement Survey (HRS) was conducted to create three levels of cognitive function among 6,991 older adults by using direct measures for self-respondents and proxy evaluations. Ordinary least square regression analyses were used to estimate the probability of physician outpatient contacts, number of hospitalizations, and nights hospitalized during the last 2 years.

RESULTS: Lower cognitive function level was found to be associated with decreasing levels of physician contacts and increasing levels of hospitalizations as well as nights hospitalized. In addition, lower cognitive function levels were consistently related to a variety of comorbidities. Moreover, many older adults with low cognitive function levels reported or were reported by their proxies as not having a diagnosis of a memory-related disease (MRD). Finally, having a diagnosis of an MRD was found to be associated with more physician contacts but fewer hospital nights compared with those who had never received such a diagnosis.

CONCLUSIONS: The findings suggest the need for increased outreach targeted at identification of community-dwelling older adults with decline in cognitive function who are in need of care but are underdiagnosed, underutilize physician care, and are overhospitalized.

PB - 5 VL - 5 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19118807?dopt=Abstract U3 - 19118807 U4 - Cognitive Functioning/Health Care Utilization ER - TY - JOUR T1 - Predictors of loneliness in U.S. adults over age sixty-five. JF - Arch Psychiatr Nurs Y1 - 2009 A1 - Laurie A. Theeke KW - Aged KW - Aged, 80 and over KW - Female KW - Health Status KW - Humans KW - Likelihood Functions KW - Logistic Models KW - Loneliness KW - Male KW - Prevalence KW - Risk Factors KW - Single Person KW - Socioeconomic factors KW - United States AB -

The purpose of this study was to examine sociodemographic and health-related risks for loneliness among older adults using Health and Retirement Study Data. Overall prevalence of loneliness was 19.3%. Marital status, self-report of health, number of chronic illnesses, gross motor impairment, fine motor impairment, and living alone were predictors of loneliness. Age, female gender, use of home care, and frequency of healthcare visits were not predictive. Loneliness is a prevalent problem for older adults in the United States with its own health-related risks. Future research of interventions targeting identified risks would enhance the evidence base for nursing and the problem of loneliness.

PB - 23 VL - 23 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19766930?dopt=Abstract U3 - 19766930 U4 - Loneliness/Marital Status/risk factors ER - TY - JOUR T1 - Prevalence of depression among older Americans: the Aging, Demographics and Memory Study. JF - Int Psychogeriatr Y1 - 2009 A1 - David C Steffens A1 - Gwenith G Fisher A1 - Kenneth M. Langa A1 - Guy G Potter A1 - Brenda L Plassman KW - Aged KW - Aged, 80 and over KW - Alzheimer disease KW - Black People KW - Cohort Studies KW - Comorbidity KW - Cross-Sectional Studies KW - Depressive Disorder KW - Female KW - Health Status KW - Hispanic or Latino KW - Humans KW - Male KW - Neuropsychological tests KW - Personality Assessment KW - Sex Factors KW - Socioeconomic factors KW - United States KW - White People AB -

BACKGROUND: Previous studies have attempted to provide estimates of depression prevalence in older adults. The Aging, Demographics and Memory Study (ADAMS) is a population-representative study that included a depression assessment, providing an opportunity to estimate the prevalence of depression in late life in the U.S.A.

METHODS: The ADAMS sample was drawn from the larger Health and Retirement Study. A total of 851 of 856 ADAMS participants aged 71 and older had available depression data. Depression was measured using the Composite International Diagnostic Interview - Short Form (CIDI-SF) and the informant depression section of the Neuropsychiatric Inventory (NPI). We estimated the national prevalence of depression, stratified by age, race, sex, and cognitive status. Logistic regression analyses were performed to examine the association of depression and previously reported risk factors for the condition.

RESULTS: When combining symptoms of major or minor depression with reported treatment for depression, we found an overall depression prevalence of 11.19%. Prevalence was similar for men (10.19%) and women (11.44%). Whites and Hispanics had nearly three times the prevalence of depression found in African-Americans. Dementia diagnosis and pain severity were associated with increased depression prevalence, while black race was associated with lower rates of depression.

CONCLUSIONS: The finding of similar prevalence estimates for depression in men and women was not consistent with prior research that has shown a female predominance. Given the population-representativeness of our sample, similar depression rates between the sexes in ADAMS may result from racial, ethnic and socioeconomic diversity.

PB - 21 VL - 21 IS - 5 N1 - PMID: 19519984 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19519984?dopt=Abstract U2 - PMC2747379 U4 - Depression/PREVALENCE/Elderly ER - TY - JOUR T1 - Proximity to death and participation in the long-term care market. JF - Health Econ Y1 - 2009 A1 - Weaver, France A1 - Sally C. Stearns A1 - Edward C Norton A1 - Spector, William KW - Aged KW - Aged, 80 and over KW - Caregivers KW - Female KW - Health Services Needs and Demand KW - Home Care Services KW - Humans KW - Interviews as Topic KW - Longevity KW - Male KW - Models, Statistical KW - Nursing homes KW - Terminal Care KW - United States AB -

The extent to which increasing longevity increases per capita demand for long-term care depends on the degree to which utilization is concentrated at the end of life. We estimate the marginal effect of proximity to death, measured by being within 2 years of death, on the probabilities of nursing home and formal home care use, and we determine whether this effect differs by availability of informal care--i.e. marital status and co-residence with an adult child. The analysis uses a sample of elderly aged 70+ from the 1993-2002 Health and Retirement Study. Simultaneous probit models address the joint decisions to use long-term care and co-reside with an adult child. Overall, proximity to death significantly increases the probability of nursing home use by 50.0% and of formal home care use by 12.4%. Availability of informal support significantly reduces the effect of proximity to death. Among married elderly, proximity to death has no effect on institutionalization. In conclusion, proximity to death is one of the main drivers of long-term care use, but changes in sources of informal support, such as an increase in the proportion of married elderly, may lessen its importance in shaping the demand for long-term care.

PB - 18 VL - 18 IS - 8 N1 - PMID: 18770873 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18770873?dopt=Abstract U2 - PMC3786420 U4 - Long-Term Care/Longevity/Nursing Homes/Home Nursing ER - TY - JOUR T1 - Recent hospitalization and the risk of hip fracture among older Americans. JF - J Gerontol A Biol Sci Med Sci Y1 - 2009 A1 - Frederic D Wolinsky A1 - Suzanne E Bentler A1 - Li Liu A1 - Maksym Obrizan A1 - Elizabeth A Cook A1 - Kara B Wright A1 - John F Geweke A1 - Elizabeth A Chrischilles A1 - Claire E Pavlik A1 - Robert L. Ohsfeldt A1 - Michael P Jones A1 - Kelly K Richardson A1 - Gary E Rosenthal A1 - Robert B Wallace KW - Accidental Falls KW - Age Distribution KW - Aged KW - Aged, 80 and over KW - Aging KW - Cohort Studies KW - Female KW - Follow-Up Studies KW - Geriatric Assessment KW - Hip Fractures KW - Hospitalization KW - Humans KW - Logistic Models KW - Male KW - Multivariate Analysis KW - Probability KW - Proportional Hazards Models KW - Prospective Studies KW - Risk Factors KW - Sex Distribution KW - Survival Analysis KW - United States AB -

BACKGROUND: We identified hip fracture risks in a prospective national study.

METHODS: Baseline (1993-1994) interview data were linked to Medicare claims for 1993-2005. Participants were 5,511 self-respondents aged 70 years and older and not in managed Medicare. ICD9-CM 820.xx (International Classification of Diseases, 9th Edition, Clinical Modification) codes identified hip fracture. Participants were censored at death or enrollment into managed Medicare. Static risk factors included sociodemographic, socioeconomic, place of residence, health behavior, disease history, and functional and cognitive status measures. A time-dependent marker reflecting postbaseline hospitalizations was included.

RESULTS: A total of 495 (8.9%) participants suffered a postbaseline hip fracture. In the static proportional hazards model, the greatest risks involved age (adjusted hazard ratios [AHRs] of 2.01, 2.82, and 4.91 for 75-79, 80-84, and > or =85 year age groups vs those aged 70-74 years; p values <.001), sex (AHR = 0.45 for men vs women; p < .001), race (AHRs of 0.37 and 0.46 for African Americans and Hispanics vs whites; p values <.001 and <.01), body mass (AHRs of 0.40, 0.77, and 1.73 for obese, overweight, and underweight vs normal weight; p values <.001, <.05, and <.01), smoking status (AHRs = 1.49 and 1.52 for current and former smokers vs nonsmokers; p values <.05 and <.001), and diabetes (AHR = 1.99; p < .001). The time-dependent recent hospitalization marker did not alter the static model effect estimates, but it did substantially increase the risk of hip fracture (AHR = 2.51; p < .001).

CONCLUSIONS: Enhanced discharge planning and home care for non-hip fracture hospitalizations could reduce subsequent hip fracture rates.

PB - 64 VL - 64 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19196641?dopt=Abstract U2 - PMC2655029 U4 - Accidental Falls/Aged, 80 and over/Geriatric Assessment/Hip Fractures/Hospitalization/Prospective Studies/Risk Factors/Sex Distribution/Survival Analysis ER - TY - JOUR T1 - Risk factors associated with injury attributable to falling among elderly population with history of stroke. JF - Stroke Y1 - 2009 A1 - Afshin A Divani A1 - Vazquez, Gabriela A1 - Anna M Barrett A1 - Asadollahi, Marjan A1 - Andreas R Luft KW - Accidental Falls KW - Aged KW - Aged, 80 and over KW - Aging KW - Causality KW - Cohort Studies KW - Comorbidity KW - disease progression KW - Female KW - Health Status KW - Humans KW - Male KW - Marital Status KW - Mental Disorders KW - Movement Disorders KW - Prevalence KW - Risk Factors KW - Risk Reduction Behavior KW - Sex Distribution KW - Stroke KW - Urinary incontinence KW - Wounds and Injuries AB -

BACKGROUND AND PURPOSE: Stroke survivors are at high risk for falling. Identifying physical, clinical, and social factors that predispose stroke patients to falls may reduce further disability and life-threatening complications, and improve overall quality of life.

METHODS: We used 5 biennial waves (1998-2006) from the Health and Retirement Study to assess risk factors associated with falling accidents and fall-related injuries among stroke survivors. We abstracted demographic data, living status, self-evaluated general health, and comorbid conditions. We analyzed the rate ratio (RR) of falling and the OR of injury within 2 follow-up years using a multivariate random effects model.

RESULTS: We identified 1174 stroke survivors (mean age+/-SD, 74.4+/-7.2 years; 53% female). The 2-year risks of falling, subsequent injury, and broken hip attributable to fall were 46%, 15%, and 2.1% among the subjects, respectively. Factors associated with an increased frequency of falling were living with spouse as compared to living alone (RR, 1.4), poor general health (RR, 1.1), time from first stroke (RR, 1.2), psychiatric problems (RR, 1.7), urinary incontinence (RR, 1.4), pain (RR, 1.4), motor impairment (RR, 1.2), and past frequency of > or = 3 falls (RR, 1.3). Risk factors associated with fall-related injury were female gender (OR, 1.5), poor general health (OR, 1.2), past injury from fall (OR, 3.2), past frequency of > or = 3 falls (OR, 3.1), psychiatric problems (OR, 1.4), urinary incontinence (OR, 1.4), impaired hearing (OR, 1.6), pain (OR, 1.8), motor impairment (OR, 1.3), and presence of multiple strokes (OR, 3.2).

CONCLUSIONS: This study demonstrates the high prevalence of falls and fall-related injuries in stroke survivors, and identifies factors that increase the risk. Modifying these factors may prevent falls, which could lead to improved quality of life and less caregiver burden and cost in this population.

PB - 40 VL - 40 IS - 10 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19628798?dopt=Abstract U2 - PMC2929376 U4 - Stroke/Falls/Elderly/risk factors 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 - Smoking kills, obesity disables: a multistate approach of the US Health and Retirement Survey. JF - Obesity (Silver Spring) Y1 - 2009 A1 - Mieke Reuser A1 - Luc G Bonneux A1 - Frans J Willekens KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Body Mass Index KW - Disability Evaluation KW - Educational Status KW - Female KW - Health Surveys KW - Humans KW - Life Expectancy KW - Life Tables KW - Male KW - Middle Aged KW - Obesity KW - Proportional Hazards Models KW - Prospective Studies KW - Smoking KW - United States KW - White People AB -

Increasing BMI causes concerns about the consequences for health care. Decreasing cardiovascular mortality has lowered obesity-related mortality, extending duration of disability. We hypothesized increased duration of disability among overweight and obese individuals. We estimated age-, risk-, and state-dependent probabilities of activities of daily living (ADL) disability and death and calculated multistate life tables, resulting in the comprehensive measure of life years with and without ADL disability. We used prospective data of 16,176 white adults of the Health and Retirement Survey (HRS). Exposures were self-reported BMI and for comparison smoking status and levels of education. Outcomes were years to live with and without ADL disability at age 55. The reference categories were high normal weight (BMI: 23-24.9), nonsmoking and high education. Mild obesity (BMI: 30-34.9) did not change total life expectancy (LE) but exchanged disabled for disability-free years. Mild obesity decreased disability-free LE with 2.7 (95% confidence limits 1.2; 3.2) year but increased LE with disability with 2.0 (0.6; 3.4) years among men. Among women, BMI of 30 to 34.9 decreased disability-free LE with 3.6 (2.1; 5.1) year but increased LE with disability with 3.2 (1.6;4.8) years. Overweight (BMI: 25-29.9) increases LE with disability for women only, by 2.1 (0.8; 3.3) years). Smoking compressed disability by high mortality. Smoking decreased LE with 7.2 years, and LE with disability with 1.3 (0.5; 2.5) years (men) and 1.4 (0.3; 2.6) years (women). A lower education decreased disability-free life, but not duration of ADL disability. In the aging baby boom, higher BMI will further increase care dependence.

PB - 17 VL - 17 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19165165?dopt=Abstract U3 - 19165165 U4 - Obesity/Smoking/Body Mass Index/DISABILITY/DISABILITY/Mortality ER - TY - JOUR T1 - Socioeconomic differentials in immune response. JF - Epidemiology Y1 - 2009 A1 - Jennifer B Dowd A1 - Allison E Aiello KW - Adult KW - Aged KW - Cytomegalovirus KW - Cytomegalovirus Infections KW - Female KW - Health Status Disparities KW - Humans KW - Male KW - Middle Aged KW - Nutrition Surveys KW - Regression Analysis KW - Social Class KW - United States AB -

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

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

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

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

PB - 20 VL - 20 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19797966?dopt=Abstract U2 - PMC2765221 U4 - Socioeconomic Differences/immune response ER - TY - JOUR T1 - Spouse-rated vs self-rated health as predictors of mortality. JF - Arch Intern Med Y1 - 2009 A1 - Liat Ayalon A1 - Kenneth E Covinsky KW - Aged KW - Cross-Sectional Studies KW - Female KW - Health Status KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Self-Assessment KW - Spouses AB -

BACKGROUND: The Health and Retirement Study is a national sample of Americans older than 50 years and their spouses. The present study evaluated cross-sectional and longitudinal data from January 2000 through December 2006. The objective of the study was to evaluate the roles of spouse-rated vs self-rated health as predictors of all-cause mortality among adults older than 50 years.

METHODS: A total of 673 dyads of married couples were randomly selected to participate in a Health and Retirement Study module examining spouse-rated health. For each couple, one member was asked to rate his or her overall health status, and his or her spouse was asked to report the partner's overall health status. Mortality data were available through 2006.

RESULTS: Our findings demonstrate that spouse-rated health (area under the curve, 0.75) is as strong a predictor of mortality as self-rated health (area under the curve, 0.73) (chi(2)(1) = 0.36, P = .54). Combining spouse-rated and self-rated health predicts mortality better than using self-rated health alone (area under the curve, 0.77) (chi(2)(1) = 6.72, P = .009).

CONCLUSIONS: Spouse ratings of health are at least as strongly predictive of mortality as self-rated health. This suggests that, when self-rated health is elicited as a prognostic indicator, spouse ratings can be used when self-ratings are unavailable. Both measures together may be more informative than either measure alone.

PB - 169 VL - 169 IS - 22 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20008702?dopt=Abstract U2 - PMC2920055 U4 - Cross-Sectional Studies/Health Status/SELF-RATED HEALTH/Longitudinal Studies/Middle Aged/Self Assessment/Spouses/MORTALITY ER - TY - JOUR T1 - Statistical design and estimation for the national social life, health, and aging project. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2009 A1 - O'Muircheartaigh, Colm A1 - Eckman, Stephanie A1 - Smith, Stephen KW - Aged KW - Aged, 80 and over KW - Aging KW - Bias KW - Data collection KW - Data Interpretation, Statistical KW - Female KW - Health Status KW - Health Surveys KW - Humans KW - Longitudinal Studies KW - Male KW - Mass Screening KW - Middle Aged KW - Research Design KW - Sampling Studies KW - Sexual Behavior KW - Social Behavior KW - United States AB -

OBJECTIVES: The paper discusses the sample design of the National Social Life, Health, and Aging Project (NSHAP) and how the design affects how estimates should be calculated from the survey data. The NSHAP study allows researchers to study the links between sexuality and health in older adults. The goal of the design was to represent adults aged 57-85 years in six demographic domains.

METHODS: The sample design begins with a national area probability sample of households, carried out jointly with the 2004 round of the Health and Retirement Study. Selection of respondents for NSHAP balanced age and gender subgroups and oversampled African Americans and Latinos. Data collection was carried out from July 2005 to March 2006.

RESULTS: The survey obtained an overall response rate of 75.5%.

DISCUSSION: The complex sample design requires that the selection probabilities and the field implementation be accounted for in estimating population parameters. The data set contains weights to compensate for differential probabilities of selection and response rates among demographic groups. Analysts should use weights in constructing estimates from the survey and account for the complex sample design in estimating standard errors for survey estimates.

PB - 64B VL - 64 Suppl 1 IS - Suppl 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19567827?dopt=Abstract U2 - PMC2763522 U4 - Survey Methods/Statistics and Numerical Data/Demographics 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 - Telephone interview for cognitive status: Creating a crosswalk with the Mini-Mental State Examination. JF - Alzheimers Dement Y1 - 2009 A1 - Tamara G Fong A1 - Michael A Fearing A1 - Richard N Jones A1 - Peilin Shi A1 - Edward R Marcantonio A1 - James L Rudolph A1 - Frances Margaret Yang A1 - Dan K Kiely A1 - Sharon K Inouye KW - Aged KW - Aged, 80 and over KW - Alzheimer disease KW - Cognition Disorders KW - Disability Evaluation KW - Female KW - Geriatric Assessment KW - Health Status KW - Humans KW - Interviews as Topic KW - Male KW - Mass Screening KW - Models, Statistical KW - Neuropsychological tests KW - Predictive Value of Tests KW - Psychiatric Status Rating Scales KW - Remote Consultation KW - Reproducibility of Results KW - Sensitivity and Specificity AB -

BACKGROUND: Brief cognitive screening measures are valuable tools for both research and clinical applications. The most widely used instrument, the Mini-Mental State Examination (MMSE), is limited in that it must be administered face-to-face, cannot be used in participants with visual or motor impairments, and is protected by copyright. Screening instruments such as the Telephone Interview for Cognitive Status (TICS) were developed to provide a valid alternative, with comparable cut-point scores to rate global cognitive function.

METHODS: The MMSE, TICS-30, and TICS-40 scores from 746 community-dwelling elders who participated in the Aging, Demographics, and Memory Study (ADAMS) were analyzed with equipercentile equating, a statistical process of determining comparable scores based on percentile equivalents for different forms of an examination.

RESULTS: Scores from the MMSE and TICS-30 and TICS-40 corresponded well, and clinically relevant cut-point scores were determined. For example, an MMSE score of 23 is equivalent to 17 and 20 on the TICS-30 and TICS-40, respectively.

CONCLUSIONS: These findings indicate that TICS and MMSE scores can be linked directly. Clinically relevant and important MMSE cut points and the respective ADAMS TICS-30 and TICS-40 cut-point scores are included, to identify the degree of cognitive impairment among respondents with any type of cognitive disorder. These results will help in the widespread application of TICS in both research and clinical practice.

PB - 5 VL - 5 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19647495?dopt=Abstract U2 - PMC278332 U4 - Cognitive Function/Survey Methods ER - TY - JOUR T1 - Trajectories of cognitive function in late life in the United States: demographic and socioeconomic predictors. JF - Am J Epidemiol Y1 - 2009 A1 - Arun S Karlamangla A1 - Miller-Martinez, Dana A1 - Carol S Aneshensel A1 - Teresa Seeman A1 - Richard G Wight A1 - Joshua Chodosh KW - Aged KW - Aged, 80 and over KW - Aging KW - Black or African American KW - Cognition KW - Confidence Intervals KW - Education KW - Female KW - Geriatric Assessment KW - Hispanic or Latino KW - Humans KW - Income KW - Male KW - Marital Status KW - Mexican Americans KW - Poverty KW - Sampling Studies KW - Socioeconomic factors KW - Surveys and Questionnaires KW - United States KW - White People AB -

This study used mixed-effects modeling of data from a national sample of 6,476 US adults born before 1924, who were tested 5 times between 1993 and 2002 on word recall, serial 7's, and other mental status items to determine demographic and socioeconomic predictors of trajectories of cognitive function in older Americans. Mean decline with aging in total cognition score (range, 0-35; standard deviation, 6.00) was 4.1 (0.68 standard deviations) per decade (95% confidence interval: 3.8, 4.4) and in recall score (range, 0-20; standard deviation, 3.84) was 2.3 (0.60 standard deviations) per decade (95% confidence interval: 2.1, 2.5). Older cohorts (compared with younger cohorts), women (compared with men), widows/widowers, and those never married (both compared with married individuals) declined faster, and non-Hispanic blacks (compared with non-Hispanic whites) and those in the bottom income quintile (compared with the top quintile) declined slower. Race and income differences in rates of decline were not sufficient to offset larger differences in baseline cognition scores. Educational level was not associated with rate of decline in cognition scores. The authors concluded that ethnic and socioeconomic disparities in cognitive function in older Americans arise primarily from differences in peak cognitive performance achieved earlier in the life course and less from declines in later life.

PB - 170 VL - 170 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19605514?dopt=Abstract U2 - PMC2727175 U4 - Cognition/health outcomes/Socioeconomic Factors ER - TY - JOUR T1 - Urban neighborhood context and change in depressive symptoms in late life. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2009 A1 - Richard G Wight A1 - Janet R. Cummings A1 - Arun S Karlamangla A1 - Carol S Aneshensel KW - Aged KW - Aged, 80 and over KW - Aging KW - Cultural Diversity KW - depression KW - Disability Evaluation KW - Educational Status KW - Female KW - Humans KW - Longitudinal Studies KW - Los Angeles KW - Male KW - Personality Inventory KW - Poverty KW - Psychosocial Deprivation KW - Residence Characteristics KW - Risk Factors KW - Urban Population AB -

OBJECTIVES: This study examines associations between urban neighborhood sociodemographic characteristics and change over time in late-life depressive symptoms.

METHODS: Survey data are from three waves (1993, 1995, and 1998) of the Study of Assets and Health Dynamics Among the Oldest Old, a U.S. national probability sample of noninstitutionalized persons aged 70 years or older in 1993. Neighborhoods are 1990 U.S. Census tracts. Hierarchical linear regression is used to estimate multilevel models.

RESULTS: The average change over time in depressive symptoms varies significantly across urban neighborhoods. Change in depressive symptoms is significantly associated with neighborhood-level socioeconomic disadvantage and ethnic composition in unadjusted models but not in models that control for individual-level characteristics.

CONCLUSIONS: Findings indicate that apparent neighborhood-level effects on change in depressive symptoms over time among urban-dwelling older adults reflect, for the most part, differences in characteristics of the neighborhood residents.

PB - 64B VL - 64 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19181693?dopt=Abstract U2 - PMC2655167 U4 - Depressive Symptoms/Neighborhood Characteristics ER - TY - JOUR T1 - Volunteer dynamics of older Americans. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2009 A1 - Barbara A Butrica A1 - Richard W. Johnson A1 - Sheila R Zedlewski KW - Aged KW - Aging KW - Cross-Sectional Studies KW - Female KW - Humans KW - Life Change Events KW - Male KW - Middle Aged KW - Probability KW - Retirement KW - United States KW - Volunteers AB -

OBJECTIVES: The impending retirement of boomers has spurred interest in tapping their productive energies to benefit society. This study examined volunteer transitions among older adults to understand the factors that affect volunteer dynamics.

METHODS: Using data from the Health and Retirement Study, the analysis examined entries into and exits from formal volunteer activities between 1996 and 2004 by adults aged 55-65 at study baseline. The study showed the duration of volunteer activities, the probability that older adults start and stop volunteering, and the factors that significantly predict volunteer transitions.

RESULTS: The findings reveal considerable stability among both volunteers and nonvolunteers; however, older adults are more likely to stop volunteering than to start. Volunteers who contribute intensely and for many years and who are married to volunteers are the least likely to quit. And nonvolunteers are more likely to start volunteering if they have been uninvolved for few years and their spouses volunteer.

CONCLUSIONS: The results point to the need to focus efforts on retaining older volunteers to maximize volunteer engagement during later years. Recruiting older adults in volunteer activities early on, ideally before they retire, could also help meet volunteer needs.

PB - 64B VL - 64 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19213847?dopt=Abstract U3 - 19213847 U4 - ADULTS/Time Utilization/Volunteering ER - TY - JOUR T1 - Weight change, initial BMI, and mortality among middle- and older-aged adults. JF - Epidemiology Y1 - 2009 A1 - Mikko Myrskylä A1 - Virginia W Chang KW - Aged KW - Body Mass Index KW - Humans KW - Middle Aged KW - Mortality KW - Proportional Hazards Models KW - Prospective Studies KW - United States KW - Weight Gain KW - Weight Loss AB -

BACKGROUND: It is not known how the relationship between weight change and mortality is influenced by initial body mass index (BMI) or the magnitude of weight change.

METHODS: We use the nationally representative Health and Retirement Study (n = 13,104; follow-up 1992-2006) and Cox regression analysis to estimate relative mortality risks for 2-year weight change by initial BMI among 50- to-70-year-old Americans. We defined small weight loss or gain as a change of 1-2.9 BMI units and large weight loss or gain as a change of 3-5 BMI units.

RESULTS: Large and small weight losses were associated with excess mortality for all initial BMI levels below 32 kg/m (eg, hazard ratio [HR] for large weight loss from BMI of 30 = 1.61 [95% confidence interval = 1.31-1.98]; HR for small weight loss from BMI of 30 = 1.19 [1.06-1.28]). Large weight gains were associated with excess mortality only at high BMIs (eg, HR for large weight gain from BMI of 35 = 1.33 [1.00-1.77]). Small weight gains were not associated with excess mortality for any initial BMI level. The weight loss-mortality association was robust to adjustments for health status and to sensitivity analyses considering unobserved confounders.

CONCLUSIONS: Weight loss is associated with excess mortality among normal, overweight, and mildly obese middle- and older-aged adults. The excess risk increases for larger losses and lower initial BMI. These results suggest that the potential benefits of a lower BMI may be offset by the negative effects associated with weight loss. Weight gain may be associated with excess mortality only among obese people with an initial BMI over 35.

PB - 20 VL - 20 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19806061?dopt=Abstract U2 - PMC2903861 U4 - Weight/Mortality/Body Mass Index ER - TY - JOUR T1 - Actuation of mobility intentions among the young-old: an event-history analysis. JF - Gerontologist Y1 - 2008 A1 - Don E Bradley A1 - Charles F Longino A1 - Eleanor P. Stoller A1 - William H Haas KW - Aged KW - Databases as Topic KW - Emigration and Immigration KW - Humans KW - Intention KW - Middle Aged KW - Population Dynamics KW - Retirement KW - United States AB -

PURPOSE: Although migration decision making is central to understanding later-life migration, the critical step between migration intentions and mobility outcomes has received only limited empirical attention. We address two questions: How often are intended moves actuated? What factors condition the likelihood that mobility intentions will be actuated?

DESIGN AND METHODS: We employ data from the 1994-2002 Health and Retirement Study, which is a nationally representative panel targeting households containing persons aged 53 to 63 years at baseline. Event-history techniques are used to examine the link between reported mobility intentions at baseline and mobility outcomes across the study period, net of relevant controls. We conduct separate household-level analyses for couple and noncouple households and recognize three types of moves: local, family oriented, and nonlocal.

RESULTS: Findings confirm the utility of mobility expectations as a predictor of future mobility. More importantly, results highlight the complex nature of later-life mobility. The actuation of mobility intentions appears to operate differently in couple than in noncouple households. Moreover, our findings suggest that the role of several key variables depends on the type of move under consideration.

IMPLICATIONS: The ability to identify potential "retirement migrants" may be of practical importance for state and local government officials as well as developers interested in recruiting or retaining young-old residents. Our study offers insight on the interpretation of stated mobility intentions. Moreover, consistent with early theoretical work in the field, our analysis suggests that empirical studies must account for heterogeneity among older movers in order to avoid misleading results.

PB - 48 VL - 48 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18483431?dopt=Abstract U3 - 18483431 U4 - migration/Mobility ER - TY - JOUR T1 - Age and racial/ethnic disparities in arthritis-related hip and knee surgeries. JF - Med Care Y1 - 2008 A1 - Dorothy D Dunlop A1 - Larry M Manheim A1 - Song, Jing A1 - Sohn, Min-Woong A1 - Joseph Feinglass A1 - Huan J. Chang A1 - Rowland W Chang KW - Age Distribution KW - Aged KW - Arthritis KW - Arthroplasty, Replacement, Hip KW - Arthroplasty, Replacement, Knee KW - Black or African American KW - Female KW - Health Services Accessibility KW - Healthcare Disparities KW - Hispanic or Latino KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Proportional Hazards Models KW - United States KW - Utilization Review KW - White People AB -

BACKGROUND: Nearly 18 million Americans experience limitations due to their arthritis. Documented disparities according to racial/ethnic groups in the use of surgical interventions such as knee and hip arthroplasty are largely based on data from Medicare beneficiaries age 65 or older. Whether there are disparities among younger adults has not been previously addressed.

OBJECTIVE: This study assesses age-specific racial/ethnic differences in arthritis-related knee and hip surgeries.

DESIGN: Longitudinal (1998-2004) Health and Retirement Study.

SETTING: National probability sample of US community-dwelling adults.

SAMPLE: A total of 2262 black, 1292 Hispanic, and 13,159 white adults age 51 and older.

MEASUREMENTS: The outcome is self-reported 2-year use of arthritis-related hip or knee surgery. Independent variables are demographic (race/ethnicity, age, gender), health needs (arthritis, chronic diseases, obesity, physical activity, and functional limitations), and medical access (income, wealth, education, and health insurance). Longitudinal data methods using discrete survival analysis are used to validly account for repeated (biennial) observations over time. Analyses use person-weights, stratum, and sampling error codes to provide valid inferences to the US population.

RESULTS: Black adults under the age of 65 years report similar age/gender adjusted rates of hip/knee arthritis surgeries [hazard ratio (HR) = 1.43, 95% confidence interval (CI) = 0.87-2.38] whereas older blacks (age 65+) have significantly lower rates (HR = 0.38, CI = 0.16-0.55) compared with whites. These relationships hold controlling for health and economic differences. Both under age 65 years (HR = 0.64, CI = 0.12-1.44) and older (age 65+) Hispanic adults (HR = 0.60, CI = 0.32-1.10) report lower utilization rates, although not statistically different than whites. A large portion of the Hispanic disparity is explained by economic differences.

CONCLUSIONS: These national data document lower rates of arthritis-related hip/knee surgeries for older black versus white adults age 65 or above, consistent with other national studies. However, utilization rates for black versus white under age 65 do not differ. Lower utilization among Hispanics versus whites in both age groups is largely explained by medical access factors. National utilization patterns may vary by age and merit further investigation.

PB - 46 VL - 46 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18219249?dopt=Abstract U3 - 18219249 U4 - arthritis/Ethnic Groups/Racial disparities ER - TY - JOUR T1 - Antecedents of bridge employment: a longitudinal investigation. JF - J Appl Psychol Y1 - 2008 A1 - Wang, Mo A1 - Zhan, Yujie A1 - Liu, Songqi A1 - Kenneth S. Shultz KW - Aged KW - Career Mobility KW - Employment KW - Female KW - Follow-Up Studies KW - Humans KW - Job Satisfaction KW - Male KW - Middle Aged KW - Psychological Theory KW - Retirement KW - Surveys and Questionnaires AB -

Bridge employment is the labor force participation pattern increasingly observed in older workers between their career jobs and their complete labor force withdrawal. It serves as a transition process from career employment to full retirement. Typical bridge employment decisions include full retirement, career bridge employment, and bridge employment in a different field. In the current study, 3 dominant theories (i.e., role theory, continuity theory, and life course perspective) on retirement processes were reviewed. On the basis of these theories, the authors proposed 4 categories of antecedents (i.e., individual attributes, job-related psychological variables, family-related variables, and a retirement-planning-related variable) of different types of bridge employment decisions. The authors used longitudinal data of a large, nationally representative sample from the Health and Retirement Study (F. Juster & R. Suzman, 1995) to test the current hypotheses. These data were analyzed with multinomial logistic regression, and most of the hypotheses were supported by the results. The implications of this study are discussed at both theoretical and practical levels.

PB - 98 VL - 93 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18642986?dopt=Abstract U3 - 18642986 U4 - Labor Force Participation/Bridge Jobs/Older workers/RETIREMENT ER - TY - JOUR T1 - The association between low vision and function. JF - J Aging Health Y1 - 2008 A1 - Berger, Sue A1 - Frank Porell KW - Activities of Daily Living KW - Aged KW - Aging KW - Disability Evaluation KW - Geriatric Assessment KW - Humans KW - International Classification of Diseases KW - Logistic Models KW - Vision, Low KW - Visual Acuity AB -

OBJECTIVE: This study considers the relationship between low vision and function, specifically exploring whether vision loss is differentially associated with activities of daily living (ADL) versus instrumental activities of daily living (IADL) disability.

METHODS: Guided by the World Health Organization's International Classification of Functioning, Disability, and Health framework, multinomial logistic regression analyses were performed for IADL and ADL on a sample of 9,115 adults aged 65 years and above from the 1998 Health and Retirement study.

RESULTS: The data supports the fact that ADL and IADL disabilities are associated with vision loss, and there is a differential relationship among functions, with IADLs being more challenging and requiring better visual abilities.

DISCUSSION: The findings provide evidence that ADL and IADLs require different skills and are associated differently depending on numerous variables. As the incidence of people living with vision loss is increasing to epidemic proportions due to an aging population, understanding the relationship between vision and participation in meaningful activities has important implications.

PB - 20 VL - 20 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18436856?dopt=Abstract U3 - 18436856 U4 - ADL and IADL Impairments/Visually Impaired Persons ER - TY - JOUR T1 - The burden of mortality of obesity at middle and old age is small. A life table analysis of the US Health and Retirement Survey. JF - Eur J Epidemiol Y1 - 2008 A1 - Mieke Reuser A1 - Luc G Bonneux A1 - Frans J Willekens KW - Aged KW - Aged, 80 and over KW - Body Mass Index KW - Educational Status KW - Female KW - Health Surveys KW - Humans KW - Life Expectancy KW - Life Tables KW - Male KW - Middle Aged KW - Multivariate Analysis KW - Obesity KW - Proportional Hazards Models KW - Smoking KW - United States KW - Weight Gain KW - Weight Loss AB -

The evidence of effect of overweight and obesity on mortality at middle and old age is conflicting. The increased relative risk of cardiovascular disease and diabetes for overweight and obese individuals compared to normal weight is well documented, but the absolute risk of cardiovascular death has decreased spectacularly since the 1980s. We estimate the burden of mortality of obesity among middle and old aged adults in the Health and Retirement Survey (HRS), a US prospective longitudinal study. We calculate univariate and multivariate age-specific probabilities and proportional hazard ratios of death in relation to self-reported body mass index (BMI), smoking and education. The life table translates age specific adjusted event rates in survival times, dependent on risk factor distributions (smoking, levels of education and self reported BMI). 95% confidence intervals are calculated by bootstrapping. The highest life expectancy at age 55 was found in overweight (BMI 25-29.9), highly educated non smokers: 30.7 (29.5-31.9) years (men) and 33.2 (32.1-34.3) (women), slightly higher than a BMI 23-24.9 in both sexes. Smoking decreased the population life expectancy with 3.5 (2.7-4.4) years (men) and 1.8 (1.0-2.5) years (women). Less than optimal education cost men and women respectively 2.8 (2.1-3.6) and 2.6 (1.6-3.6) years. Obesity and low normal weight decreased population life expectancy respectively by 0.8 (0.2-1.3) and 0.8 (0.0-1.5) years for men and women in a contemporary, US population. The burden of mortality of obesity is limited, compared to smoking and low education.

PB - 23 VL - 23 IS - 9 N1 - PMID: 18584293 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18584293?dopt=Abstract U3 - 18584293 U4 - Mortality/Obesity/Education/Smoking/Life Expectancy ER - TY - JOUR T1 - Changes in weight among U.S. adults aged 70 and over, 1993 to 2002. JF - Prev Med Y1 - 2008 A1 - Xiaoxing He A1 - Meng, Hongdao KW - Aged KW - Aged, 80 and over KW - Aging KW - Female KW - Humans KW - Interviews as Topic KW - Linear Models KW - Male KW - Multivariate Analysis KW - Population Growth KW - Retrospective Studies KW - United States KW - Weight Gain KW - Weight Loss AB -

OBJECTIVE: To describe the patterns and predictors of weight change among U.S. adults aged 70 and over.

METHOD: The study is a retrospective cohort study of 7441 community-dwelling U.S. adults aged 70 years and over during 1993-2002. We examined changes in weight for men and women, and by race/ethnicity groups. We used multivariate linear regression analysis to determine predictors of weight change while controlling for key covariates at baseline.

RESULTS: The mean body weight decreased in both genders and all ethnic groups. Unadjusted average weight loss was 3.41 kg for men and 3.29 kg for women over nine years. Black women had higher mean body weight at baseline and were more likely to report weight gains of 5 kg or more. Multivariate analysis showed that age and baseline weight were major predictors of weight loss. Physical activity was associated with less weight loss among men.

CONCLUSION: The trends of weight change among U.S. adults aged 70 and over were more prone to weight loss than weight gain, with substantial variations. Public health messages regarding weight control should take into account the heterogeneity of this population and target weight loss as well as weight gain to meet diverse needs of the population.

PB - 47 VL - 47 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18671999?dopt=Abstract U3 - 18671999 U4 - Weight/Elderly ER - TY - JOUR T1 - Chronic conditions and mortality among the oldest old. JF - Am J Public Health Y1 - 2008 A1 - Sei J. Lee A1 - Alan S Go A1 - Lindquist, Karla A1 - Bertenthal, Daniel A1 - Kenneth E Covinsky KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Chronic disease KW - Female KW - Health Behavior KW - Health Status KW - Humans KW - Male KW - Middle Aged KW - Models, Statistical KW - Predictive Value of Tests KW - Proportional Hazards Models KW - Reproducibility of Results KW - Risk Adjustment KW - Severity of Illness Index KW - Socioeconomic factors KW - Survival Analysis KW - United States AB -

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

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

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

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

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

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

PB - 66 VL - 66 IS - 7 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18222580?dopt=Abstract U2 - PMC2408829 U4 - aging/DISABILITY/DISABILITY/Health Risk ER - TY - JOUR T1 - Degree of disability and patterns of caregiving among older Americans with congestive heart failure. JF - J Gen Intern Med Y1 - 2008 A1 - Tanya R Gure A1 - Mohammed U Kabeto A1 - Caroline S Blaum A1 - Kenneth M. Langa KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Caregivers KW - Coronary Disease KW - Cross-Sectional Studies KW - Disabled Persons KW - Female KW - Health Surveys KW - Heart Failure KW - Hospitalization KW - Humans KW - Male KW - Nursing homes KW - United States AB -

OBJECTIVES: Although congestive heart failure (CHF) is a common condition, the extent of disability and caregiving needs for those with CHF are unclear. We sought to determine: (1) prevalence of physical disability and geriatric conditions, (2) whether CHF is independently associated with disability, (3) rates of nursing home admission, and (4) formal and informal in-home care received in the older CHF population.

METHODS: We used cross-sectional data from the 2000 wave of the Health and Retirement Study. We compared outcomes among three categories of older adults: (1) no coronary heart disease (CHD), (2) CHD, without CHF, and (3) CHF. Compared to those without CHF, respondents reporting CHF were more likely to be disabled (P < 0.001) and to have geriatric conditions (P < 0.001). Respondents reporting CHF were more likely to have been admitted to a nursing home (P < 0.05). CHF respondents were more functionally impaired than respondents without CHF.

RESULTS: The adjusted average weekly informal care hours for respondents reporting CHF was higher than for those reporting CHD but without CHF and those reporting no CHD (6.7 vs 4.1 vs 5.1, respectively; P < 0.05). Average weekly formal caregiving hours also differed among the three groups (1.3 CHF vs 0.9 CHD without CHF vs 0.7 no CHD; P > 0.05).

CONCLUSIONS: CHF imposes a significant burden on patients, families, and the long-term care system. Older adults with CHF have higher rates of disability, geriatric conditions, and nursing home admission.

PB - 23 VL - 23 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18030537?dopt=Abstract U2 - PMC2173919 U4 - Heart Diseases/DISABILITY/DISABILITY/Caregiving ER - TY - JOUR T1 - Divergent pathways? Racial/ethnic differences in older women's labor force withdrawal. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2008 A1 - Tyson H Brown A1 - David F Warner KW - Aged KW - Black People KW - Demography KW - Disability Evaluation KW - Disabled Persons KW - Employment KW - ethnicity KW - Hispanic or Latino KW - Humans KW - Middle Aged KW - Retirement KW - United States AB -

OBJECTIVES: The purpose of this study was to investigate how women's labor force withdrawal behavior varies across race/ethnicity and to identify life course factors that generate these differences.

METHODS: Using a sample of 7,235 women from the 1992-2004 Health and Retirement Study, we estimated cross-sectional multinomial logit models to explore racial/ethnic differences in labor force status at first interview. We then examined the prospective risk of exiting the labor force via retirement, work disability, or death using discrete-time hazard models.

RESULTS: Black and Hispanic women had twice the odds of Whites of being work-disabled at first interview. Whereas younger minorities had lower odds of being retired at first interview, older minorities had higher odds. The prospective results showed that both Blacks and Hispanics had higher risks of work disability but not of retirement or of dying in the labor force. Overall, racial/ethnic differences in mid- and later life work behavior stemmed primarily from disparities in life course capital.

DISCUSSION: This study shows that substantial racial/ethnic disparities in labor force exit behavior have already emerged by midlife. It is important to note that distinguishing between alternative pathways out of the labor force demonstrates that work disability is a more common experience for Black and Hispanic women than for Whites.

PB - 63B VL - 63 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18559687?dopt=Abstract U3 - 18559687 U4 - Women/Labor Force Participation/Racial Differences/Ethnic Groups ER - TY - JOUR T1 - Does childhood schooling affect old age memory or mental status? Using state schooling laws as natural experiments. JF - J Epidemiol Community Health Y1 - 2008 A1 - M. Maria Glymour A1 - Ichiro Kawachi A1 - Jencks, Christopher A1 - Lisa F Berkman KW - Aged KW - Aging KW - Censuses KW - Child KW - Cognition KW - Education KW - Educational Status KW - Female KW - Health Status KW - Humans KW - Least-Squares Analysis KW - Male KW - Massachusetts KW - Memory KW - Schools KW - Socioeconomic factors AB -

BACKGROUND: The association between schooling and old age cognitive outcomes such as memory disorders is well documented but, because of the threat of reverse causation, controversy persists over whether education affects old age cognition. Changes in state compulsory schooling laws (CSL) are treated as natural experiments (instruments) for estimating the effect of education on memory and mental status among the elderly. Changes in CSL predict changes in average years of schooling completed by children who are affected by the new laws. These educational differences are presumably independent of innate individual characteristics such as IQ.

METHODS: CSL-induced changes in education were used to obtain instrumental variable (IV) estimates of education's effect on memory (n = 10,694) and mental status (n = 9751) for white, non-Hispanic US-born Health and Retirement Survey participants born between 1900 and 1947 who did not attend college.

RESULTS: After adjustment for sex, birth year, state of birth and state characteristics, IV estimates of education's effect on memory were large and statistically significant. IV estimates for mental status had very wide confidence intervals, so it was not possible to draw meaningful conclusions about the effect of education on this outcome.

CONCLUSIONS: Increases in mandatory schooling lead to improvements in performance on memory tests many decades after school completion. These analyses condition on individual states, so differences in memory outcomes associated with CSL changes cannot be attributed to differences between states. Although unmeasured state characteristics that changed contemporaneously with CSL might account for these results, unobserved genetic variation is unlikely to do so.

VL - 62 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18477752?dopt=Abstract ER - TY - JOUR T1 - Dynamics of work disability and pain. JF - J Health Econ Y1 - 2008 A1 - Arie Kapteyn A1 - James P Smith A1 - Arthur H.O. vanSoest KW - Aged KW - Disabled Persons KW - Employment KW - Female KW - Humans KW - Male KW - Middle Aged KW - Models, Statistical KW - pain KW - United States AB -

This paper investigates the role of pain dynamics in subsequently affecting dynamics in self-reported work disability and the dynamics of employment patterns of older workers in the US. Not only is pain prevalence quite high, there also are many transitions in and out of pain at these ages. We investigate pain and its relationship to health (work disability) and work in a dynamic panel data model, using six biennial waves from the Health and Retirement Study. We find that the dynamics of the presence of pain are central to understanding the dynamics of self-reported work disability and through this pathway, pain dynamics are also a significant factor in the dynamic patterns of employment.

PB - 27 VL - 27 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18180063?dopt=Abstract U2 - PMC3654673 U4 - Older workers/DISABILITY/DISABILITY/Work Behavior ER - TY - JOUR T1 - Economic theory and evidence on smoking behavior of adults. JF - Addiction Y1 - 2008 A1 - Frank A Sloan A1 - Wang, Yang KW - Adult KW - Aged KW - Aged, 80 and over KW - Choice Behavior KW - Costs and Cost Analysis KW - health policy KW - Humans KW - Impulsive Behavior KW - Middle Aged KW - Risk Factors KW - Smoking KW - Smoking cessation KW - Time Factors AB -

AIMS: To describe: (i) three alternative conceptual frameworks used by economists to study addictive behaviors: rational, imperfectly rational and irrational addiction; (ii) empirical economic evidence on each framework and specific channels to explain adult smoking matched to the frameworks; and (iii) policy implications for each framework.

METHODS: A systematic review and appraisal of important theoretical and empirical economic studies on smoking.

RESULTS: There is some empirical support for each framework. For rational and imperfectly rational addiction there is some evidence that anticipated future cigarette prices influence current cigarette consumption, and quitting costs are high for smokers. Smokers are more risk-tolerant in the financial domain than are others and tend to attach a lower value to being in good health. Findings on differences in rates of time preference by smoking status are mixed; however, short-term rates are higher than long-term rates for both smokers and non-smokers, a stylized fact consistent with hyperbolic discounting. The economic literature lends no empirical support to the view that mature adults smoke because they underestimate the probability of harm to health from smoking. In support of the irrationality framework, smokers tend to be more impulsive than others in domains not related directly to smoking, implying that they may be sensitive to cues that trigger smoking.

CONCLUSIONS: Much promising economic research uses the imperfectly rational addiction framework, but empirical research based on this framework is still in its infancy.

PB - 103 VL - 103 UR - http://dx.doi.org/10.1111/j.1360-0443.2008.02329.x IS - 11 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18778387?dopt=Abstract U3 - 18778387 U4 - Addiction/cigarette prices/hyperbolic discounting/impulsivity/rationality/risk preference/time preferences/smoking ER - TY - JOUR T1 - Educational differentials in life expectancy with cognitive impairment among the elderly in the United States. JF - J Aging Health Y1 - 2008 A1 - Agnès Lièvre A1 - Dawn E Alley A1 - Eileen M. Crimmins KW - Aged KW - Aged, 80 and over KW - Cognition Disorders KW - Educational Status KW - Female KW - Humans KW - Life Expectancy KW - Male KW - United States AB -

OBJECTIVE: This article provides estimates of education differentials in life expectancy with and without cognitive impairment for the noninstitutionalized population aged 70 years and older in the United States.

METHOD: Life expectancy with cognitive impairment was calculated using multistate models, allowing transitions between cognitively intact and cognitively impaired states and from each of these states to death and allowing transition rates to vary across age and education. Four waves of the Assets and Health Dynamics of the Oldest Old survey were used.

RESULTS: Those with low levels of education are more likely to become cognitively impaired and do so at an earlier age. After age 70, persons with low educational levels can expect to live 11.6 years, and persons with high education 14.1 years, without cognitive impairment. Length of life with cognitive impairment differs by education (1.6 years and 1.0 years at age 70, respectively) but differs little by age.

DISCUSSION: Although those with higher education have lower rates of both cognitive impairment and mortality, those who do become cognitively impaired appear to be in poorer health, leading to a reduced probability of improved cognition and increased probability of mortality relative to those with lower educational levels.

PB - 20 VL - 20 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18448687?dopt=Abstract U2 - PMC2966893 U4 - cognition Disorders/cognitive Impairment/educational Status/life Expectancy/education/MORTALITY ER - TY - JOUR T1 - Effects of social integration on preserving memory function in a nationally representative US elderly population. JF - Am J Public Health Y1 - 2008 A1 - Karen A Ertel A1 - M. Maria Glymour A1 - Lisa F Berkman KW - Aged KW - Aged, 80 and over KW - Cognition Disorders KW - Female KW - Health Behavior KW - Health Status KW - Humans KW - Interpersonal Relations KW - Male KW - Mental Health KW - Mental Recall KW - Predictive Value of Tests KW - Reproducibility of Results KW - Severity of Illness Index KW - social isolation KW - Social Support KW - Socioeconomic factors KW - United States AB -

OBJECTIVES: We tested whether social integration protects against memory loss and other cognitive disorders in late life in a nationally representative US sample of elderly adults, whether effects were stronger among disadvantaged individuals, and whether earlier cognitive losses explained the association (reverse causation).

METHODS: Using data from the Health and Retirement Study (N = 16,638), we examined whether social integration predicted memory change over 6 years. Memory was measured by immediate and delayed recall of a 10-word list. Social integration was assessed by marital status, volunteer activity, and frequency of contact with children, parents, and neighbors. We examined growth-curve models for the whole sample and within subgroups.

RESULTS: The mean memory score declined from 11.0 in 1998 to 10.0 in 2004. Higher baseline social integration predicted slower memory decline in fully adjusted models (P<.01). Memory among the least integrated declined at twice the rate as among the most integrated. This association was largest for respondents with fewer than 12 years of education. There was no evidence of reverse causation.

CONCLUSIONS: Our study provides evidence that social integration delays memory loss among elderly Americans. Future research should focus on identifying the specific aspects of social integration most important for preserving memory.

PB - 98 VL - 98 IS - 7 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18511736?dopt=Abstract U2 - PMC2424091 U4 - Memory/Social Interaction/Cognitive Function ER - TY - JOUR T1 - Emergency department utilization patterns among older adults. JF - J Gerontol A Biol Sci Med Sci Y1 - 2008 A1 - Frederic D Wolinsky A1 - Li Liu A1 - Thomas R Miller A1 - An, Hyonggin A1 - John F Geweke A1 - Kaskie, Brian A1 - Kara B Wright A1 - Elizabeth A Chrischilles A1 - Claire E Pavlik A1 - Elizabeth A Cook A1 - Robert L. Ohsfeldt A1 - Kelly K Richardson A1 - Gary E Rosenthal A1 - Robert B Wallace KW - Aged KW - Emergency Service, Hospital KW - Factor Analysis, Statistical KW - Female KW - Humans KW - Logistic Models KW - Male KW - Medicare KW - Risk Factors KW - United States AB -

BACKGROUND: We identified 4-year (2 years before and 2 years after the index [baseline] interview) ED use patterns in older adults and the factors associated with them.

METHODS: A secondary analysis of baseline interview data from the nationally representative Survey on Assets and Health Dynamics Among the Oldest Old linked to Medicare claims data. Participants were 4310 self-respondents 70 years old or older. Current Procedural Terminology (CPT) codes 99281 and 99282 identified low-intensity use, and CPT codes 99283-99285 identified high-intensity use. Exploratory factor analysis and multivariable multinomial logistic regression were used.

RESULTS: The majority (56.6%) of participants had no ED visits during the 4-year period. Just 5.7% had only low-intensity ED use patterns, whereas 28.9% used the ED only for high-intensity visits, and 8.7% had a mixture of low-intensity and high-intensity use. Participants with lower immediate word recall scores and those who did not live in major metropolitan areas were more likely to be low-intensity-only ED users. Older individuals, those who did not live in rural counties, had greater morbidity and functional status burdens, and lower immediate word recall scores were more likely to be high-intensity-only ED users. Participants who were older, did not live in major cities, had lower education levels, had greater morbidity and functional status burdens, and lower immediate word recall scores were more likely to have mixed ED use patterns.

CONCLUSIONS: Nearly half of these older adults used the ED at least once over a 4-year period, with a mean annual ED use percentage of 18.4. Few, however, used the ED only for visits that may have been avoidable. This finding suggests that triaging Medicare patients would not decrease ED overcrowding, although continued surveillance is necessary to detect potential changes in ED use patterns among older adults.

PB - 63A VL - 63 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18314459?dopt=Abstract U2 - PMC2923576 U4 - Medicare/Health Care Utilization/Elderly ER - TY - JOUR T1 - End-of-life medical treatment choices: do survival chances and out-of-pocket costs matter? JF - Med Decis Making Y1 - 2008 A1 - Chao, Li-Wei A1 - José A Pagán A1 - Beth J Soldo KW - Aged KW - Choice Behavior KW - Female KW - Financing, Personal KW - Health Care Costs KW - Humans KW - Life Expectancy KW - Male KW - Medicare KW - Neoplasms KW - Socioeconomic factors KW - Terminal Care KW - United States AB -

BACKGROUND: Out-of-pocket medical expenditures incurred prior to the death of a spouse could deplete savings and impoverish the surviving spouse. Little is known about the public's opinion as to whether spouses should forego such end-of-life (EOL) medical care to prevent asset depletion.

OBJECTIVES: To analyze how elderly and near elderly adults assess hypothetical EOL medical treatment choices under different survival probabilities and out-of-pocket treatment costs.

METHODS: Survey data on a total of 1143 adults, with 589 from the Asset and Health Dynamics Among the Oldest Old (AHEAD) and 554 from the Health and Retirement Study (HRS), were used to study EOL cancer treatment recommendations for a hypothetical anonymous married woman in her 80s.

RESULTS: Respondents were more likely to recommend treatment when it was financed by Medicare than by the patient's own savings and when it had 60% rather than 20% survival probability. Black and male respondents were more likely to recommend treatment regardless of survival probability or payment source. Treatment uptake was related to the order of presentation of treatment options, consistent with starting point bias and framing effects.

CONCLUSIONS: Elderly and near elderly adults would recommend that the hypothetical married woman should forego costly EOL treatment when the costs of the treatment would deplete savings. When treatment costs are covered by Medicare, respondents would make the recommendation to opt for care even if the probability of survival is low, which is consistent with moral hazard. The sequence of presentation of treatment options seems to affect patient treatment choice.

PB - 28 VL - 28 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18441252?dopt=Abstract U2 - PMC2587497 U4 - Economics of the Elderly/Medical Expenditures/Survival/Survivors/Saving ER - TY - JOUR T1 - Exploring the determinants of racial and ethnic disparities in total knee arthroplasty: health insurance, income, and assets. JF - Med Care Y1 - 2008 A1 - Amresh D Hanchate A1 - Zhang, Yuqing A1 - David T Felson A1 - Arlene S Ash KW - Aged KW - Aged, 80 and over KW - Arthroplasty, Replacement, Knee KW - Comorbidity KW - ethnicity KW - Female KW - Healthcare Disparities KW - Humans KW - Income KW - Insurance, Health KW - Logistic Models KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Sex Distribution KW - Socioeconomic factors KW - United States AB -

OBJECTIVE: To estimate national total knee arthroplasty (TKA) rates by economic factors, and the extent to which differences in insurance coverage, income, and assets contribute to racial and ethnic disparities in TKA use.

DATA SOURCE: US longitudinal Health and Retirement Study survey data for the elderly and near-elderly (biennial rounds 1994-2004) from the Institute of Social Research, University of Michigan.

STUDY DESIGN: The outcome is dichotomous, whether the respondent received first TKA in the previous 2 years. Longitudinal, random-effects logistic regression models are used to assess associations with lagged economic indicators.

SAMPLE: Sample was 55,469 person-year observations from 18,439 persons; 663, with first TKA.

RESULTS: Racial/ethnic disparities in TKA were more prominent among men than women. For example, relative to white women, odds ratios (ORs) were 0.94, 0.46, and 0.79, for white, black, and Hispanic men, respectively (P < 0.05 for black men). After adjusting for economic factors, racial/ethnic differences in TKA rates for women essentially disappeared, while the deficit for black men remained large. Among Medicare-enrolled elderly, those with supplemental insurance may be more likely to have first TKA compared with those without it, whether the supplemental coverage was private [OR: 1.27; 95% confidence interval (CI): 0.82-1.96] or Medicaid (OR: 1.18; 95% CI: 0.93-1.49). Among the near-elderly (age 47-64), compared with the privately insured, the uninsured were less likely (OR: 0.61; 95% CI: 0.40-0.92) and those with Medicaid more likely (OR: 1.53; 95% CI: 1.03-2.26) to have first TKA.

CONCLUSIONS: Limited insurance coverage and financial constraints explain some of the racial/ethnic disparities in TKA rates.

PB - 46 VL - 46 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18438196?dopt=Abstract U2 - PMC2758246 U4 - Health Insurance Coverage/income/Assets/Racial disparities/Ethnicity 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 - Health and wealth of elderly couples: causality tests using dynamic panel data models. JF - J Health Econ Y1 - 2008 A1 - Pierre-Carl Michaud A1 - Arthur H.O. vanSoest KW - Aged KW - Causality KW - Family Characteristics KW - Female KW - Health Status Indicators KW - Humans KW - Income KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Models, Econometric KW - Retirement KW - Social Class KW - Spouses KW - United States AB -

A positive relationship between socio-economic status (SES) and health, the "health-wealth gradient", is repeatedly found in many industrialized countries. This study analyzes competing explanations for this gradient: causal effects from health to wealth (health causation) and causal effects from wealth to health (wealth or social causation). Using six biennial waves of couples aged 51-61 in 1992 from the US Health and Retirement Study, we test for causality in panel data models incorporating unobserved heterogeneity and a lag structure supported by specification tests. In contrast to tests relying on models with only first order lags or without unobserved heterogeneity, these tests provide no evidence of causal wealth health effects. On the other hand, we find strong evidence of causal effects from both spouses' health on household wealth. We also find an effect of the husband's health on the wife's mental health, but no other effects from one spouse's health to health of the other spouse.

PB - 27 VL - 27 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18513809?dopt=Abstract U2 - PMC2867362 U4 - Wealth/HEALTH/socioeconomic status ER - TY - JOUR T1 - Health insurance coverage as people approach and pass age-eligibility for Medicare. JF - J Aging Soc Policy Y1 - 2008 A1 - Caffrey, Christine A1 - Christine L Himes KW - Aged KW - Eligibility Determination KW - Female KW - Humans KW - Insurance Coverage KW - Insurance, Health KW - Male KW - Medicare KW - Middle Aged KW - United States AB -

This study uses six waves of the Health and Retirement Study (HRS) to measure dynamics of health insurance coverage as people approach and pass age-eligibility for Medicare. Thirteen percent of 59- to 64-year-olds were uninsured and 13% of 65- to 70-year-olds relied solely on Medicare. Those unmarried, in good health, and in poor health had an increased likelihood of being uninsured before age-eligibility for Medicare, while non-whites and those in good health had an increased likelihood of having Medicare-only coverage after age-eligibility for Medicare. Although only a small percentage was continually without coverage or with Medicare-only coverage, a substantial percentage had these coverage types at some point. Limitations and policy implications are included.

PB - 20 VL - 20 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18198158?dopt=Abstract U3 - 18198158 U4 - Health Insurance Coverage/Medicare ER - TY - JOUR T1 - [The health status of the elderly population: what do we need to know?]. JF - Cien Saude Colet Y1 - 2008 A1 - Reboucas, Monica A1 - Siulmara Cristina Galera A1 - Pereira, Silvia Regina Mendes A1 - Pereira, Mauricio Gomes KW - Aged KW - Brazil KW - Cross-Sectional Studies KW - Geriatric Assessment KW - Health Status Indicators KW - Humans KW - Middle Aged KW - United States AB -

The objective of this research was to evaluate the data on the health of the elderly population available in the Brazilian information system and their correspondence with the North American statistics using the Internet. The North American publication "Older Americans 2000: Key Indicators of Well-Being" was used as a standard. The databases and instruments used in the North American and Brazilian surveys are presented. The North American data are based on the Supplement on Aging and Second Supplement on Aging; Health and Retirement Study; National Health Interview Survey and National Long Term Care Survey. The Brazilian data were collected from the Mortality Information System; Information System of the National Program of Immunizations; National Household Sample Survey conducted in 1998 and 2003 and from the Household Survey on Risk Behavior and Morbidity from Not Transmissible Diseases of 2002-2003. There is a great number of Brazilian information about the aged population of the Country available in the Internet and with few exceptions the information on aged Brazilians corresponds to the information available about aged North Americans.

PB - 13 VL - 13 IS - 4 N1 - PMID: 18813630 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18813630?dopt=Abstract U3 - 18813630 U4 - Elderly/health status/Cross Cultural Comparison ER - TY - JOUR T1 - Identification of dementia: agreement among national survey data, medicare claims, and death certificates. JF - Health Serv Res Y1 - 2008 A1 - Truls Ostbye A1 - Donald H. Taylor Jr. A1 - Elizabeth C. Clipp A1 - Lynn Van Scoyoc A1 - Brenda L Plassman KW - Aged KW - Consensus KW - Data Interpretation, Statistical KW - Death Certificates KW - Dementia KW - Female KW - Health Surveys KW - Humans KW - Incidence KW - Insurance Claim Review KW - Male KW - Mass Screening KW - Medicare KW - Research Design KW - United States AB -

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

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

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

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

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

PB - 43 VL - 43 IS - 1 Pt 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18211532?dopt=Abstract U2 - PMC2323140 U4 - Dementia/Incidence/Cognitive Function/Survey questions/Medicare/Death Certificates ER - TY - JOUR T1 - Informal care and Medicare expenditures: testing for heterogeneous treatment effects. JF - J Health Econ Y1 - 2008 A1 - Courtney Harold Van Houtven A1 - Edward C Norton KW - Adult KW - Aged KW - Caregivers KW - Health Expenditures KW - Humans KW - Medicare KW - Models, Econometric KW - United States AB -

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

PB - 27 VL - 27 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/17462764?dopt=Abstract U3 - 17462764 U4 - Caregivers/Medicare and Medicaid spending/Marital Status ER - TY - JOUR T1 - Life with and without heart disease among women and men over 50. JF - J Women Aging Y1 - 2008 A1 - Eileen M. Crimmins A1 - Mark D Hayward A1 - Ueda, Hiroshi A1 - Saito, Yasuhiko A1 - Jung K Kim KW - Activities of Daily Living KW - Aged KW - Female KW - Health Status KW - Heart Diseases KW - Humans KW - Life Expectancy KW - Male KW - Middle Aged KW - Myocardial Infarction KW - Patient Education as Topic KW - Prejudice KW - Risk Factors KW - United States KW - Women's Health KW - Women's Health Services AB -

This article uses a demographic approach and data from the Health and Retirement Survey, a nationally representative sample of the U.S. population, to investigate sex differences in the length of life lived with heart disease and after a heart attack for persons in the United States age 50 and older. On average, women live longer than men with heart disease. At age 50 women can expect to live 7.9 years and men 6.7 years with heart disease. The average woman experiences heart disease onset three years older and heart attacks 4.4 years older than men.

PB - 20 VL - 20 IS - 1-2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18581697?dopt=Abstract U2 - PMC2994551 U4 - Activities of Daily Living/health Status/Heart disease/life Expectancy/EDUCATION/risk factors/WOMEN ER - TY - JOUR T1 - Lifecourse social conditions and racial disparities in incidence of first stroke. JF - Ann Epidemiol Y1 - 2008 A1 - M. Maria Glymour A1 - Mauricio Avendano A1 - Steven A Haas A1 - Lisa F Berkman KW - Aged KW - Aged, 80 and over KW - Black or African American KW - Cardiovascular Diseases KW - ethnicity KW - Female KW - Health Status Disparities KW - Humans KW - Incidence KW - Interviews as Topic KW - Life Style KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Models, Statistical KW - Risk Factors KW - Social Environment KW - Socioeconomic factors KW - Stroke KW - United States KW - White People AB -

PURPOSE: Some previous studies found excess stroke rates among black subjects persisted after adjustment for socioeconomic status (SES), fueling speculation regarding racially patterned genetic predispositions to stroke. Previous research was hampered by incomplete SES assessments, without measures of childhood conditions or adult wealth. We assess the role of lifecourse SES in explaining stroke risk and stroke disparities.

METHODS: Health and Retirement Study participants age 50+ (n = 20,661) were followed on average 9.9 years for self- or proxy-reported first stroke (2175 events). Childhood social conditions (southern state of birth, parental SES, self-reported fair/poor childhood health, and attained height), adult SES (education, income, wealth, and occupational status) and traditional cardiovascular risk factors were used to predict first stroke onset using Cox proportional hazards models.

RESULTS: Black subjects had a 48% greater risk of first stroke incidence than whites (95% confidence interval, 1.33-1.65). Childhood conditions predicted stroke risk in both blacks and whites, independently of adult SES. Adjustment for both childhood social conditions and adult SES measures attenuated racial differences to marginal significance (hazard ratio, 1.13; 95% CI, 1.00-1.28).

CONCLUSIONS: Childhood social conditions predict stroke risk in black and White American adults. Additional adjustment for adult SES, in particular wealth, nearly eliminated the disparity in stroke risk between black and white subjects.

PB - 18 VL - 18 IS - 12 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19041589?dopt=Abstract U2 - PMC2796851 U4 - Stroke/Socioeconomic Factors/Life Cycle/African-Americans 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 - Measurement differences in depression: chronic health-related and sociodemographic effects in older Americans. JF - Psychosom Med Y1 - 2008 A1 - Frances Margaret Yang A1 - Richard N Jones KW - Aged KW - Aged, 80 and over KW - Chronic disease KW - Cohort Studies KW - Comorbidity KW - Confounding Factors, Epidemiologic KW - Culture KW - depression KW - Diabetes Mellitus KW - Educational Status KW - ethnicity KW - Factor Analysis, Statistical KW - Female KW - Heart Diseases KW - Humans KW - Hypertension KW - Interviews as Topic KW - Lung Diseases KW - Male KW - Self-Assessment KW - Sex Factors KW - Stroke KW - United States AB -

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

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

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

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

PB - 70 VL - 70 IS - 9 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18981269?dopt=Abstract U2 - PMC2746732 U4 - Chronic Disease/Demographics/Depressive Symptoms/Psychology ER - TY - JOUR T1 - Memory decline and depressive symptoms in a nationally representative sample of older adults: the Health and Retirement Study (1998-2004). JF - Dement Geriatr Cogn Disord Y1 - 2008 A1 - Hector M González A1 - Mary E Bowen A1 - Gwenith G Fisher KW - Aged KW - Aged, 80 and over KW - depression KW - Female KW - Health Status KW - Humans KW - Incidence KW - Male KW - Memory Disorders KW - Neuropsychological tests KW - Prevalence KW - Retirement KW - United States AB -

BACKGROUND/AIMS: Inconsistencies in the relationship between depression and cognitive decline may exist because the expected cognitive domains at risk have not been specified in previous study designs. We aimed to examine the relationship between depressive symptoms and verbal episodic memory functioning over time.

METHODS: Data from a prospective cohort study (Health and Retirement Study; 1998-2004; n = 18,465), a multistage national probability sample of older adults in the United States, were analyzed. Verbal learning and memory of a 10-word list learning task were the main outcomes. Depressive symptoms (Center for Epidemiologic Studies - Depression Scale) constituted the main predictor.

RESULTS: Depressive symptoms were associated with significantly lower immediate (-0.05; p < 0.001) and delayed (-0.06; p < 0.001) word list recall scores after controlling for demographics and baseline and time-varying cardiovascular disease risks and diseases.

CONCLUSIONS: In this US national study of older adults, elevated depressive symptoms were associated with declines in episodic learning and memory over time. These associations were little affected by the demographic or medical conditions considered in this study. The results suggest that learning and memory decline may be a long-term feature associated with depressive symptoms among the nation's older adult population.

PB - 25 VL - 25 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18270489?dopt=Abstract U2 - PMC2292399 U4 - Depression/Cognitive Function ER - TY - JOUR T1 - A multilevel analysis of urban neighborhood socioeconomic disadvantage and health in late life. JF - Soc Sci Med Y1 - 2008 A1 - Richard G Wight A1 - Janet R. Cummings A1 - Miller-Martinez, Dana A1 - Arun S Karlamangla A1 - Teresa Seeman A1 - Carol S Aneshensel KW - Aged KW - Female KW - Health Behavior KW - Health Status Disparities KW - Humans KW - Male KW - Poverty KW - Small-Area Analysis KW - Socioeconomic factors KW - United States KW - Urban Population AB -

The associations between neighborhood context and various indicators of health are receiving growing empirical attention, but much of this research is regionally circumscribed or assumes similar effects across the life course. This study utilizes a U.S. national sample to investigate the association between urban neighborhood socioeconomic disadvantage and health specifically among older adults. Data are from 3442 participants aged 70 years and older in the 1993 Asset and Health Dynamics Among the Oldest Old (AHEAD) Study, and the 1990 U.S. Census. Our approach underscores the importance of multiple dimensions of health (self-reported physician-diagnosed cardiovascular disease [CVD], functional status, and self-rated health) as well as multiple dimensions of neighborhood disadvantage, which are conceptualized as environmental hazards that may lead to a physiologically consequential stress response. We find that individual-level factors attenuate the association between neighborhood disadvantage and both CVD and functional status, but not self-rated health. Net of covariates, high neighborhood socioeconomic disadvantage is significantly associated with reporting poor health. In late life, neighborhood socioeconomic disadvantage is more consequential to subjective appraisals of health than diagnosed CVD or functional limitations.

PB - 66 VL - 66 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18160194?dopt=Abstract U2 - PMC3681874 U4 - Urban Population/socioeconomic status/HEALTH ER - TY - JOUR T1 - Neighborhoods and obesity in later life. JF - Am J Public Health Y1 - 2008 A1 - Irina B Grafova A1 - Vicki A Freedman A1 - Kumar, Rizie A1 - Jeannette Rogowski KW - Aged KW - Air Pollution KW - Crime KW - Emigrants and Immigrants KW - Environment Design KW - Female KW - Health Status Indicators KW - Humans KW - Income KW - Logistic Models KW - Male KW - Middle Aged KW - Obesity KW - Odds Ratio KW - Overweight KW - Population Density KW - Residence Characteristics KW - Retirement KW - Social Class KW - Social Conditions KW - Social Environment KW - Socioeconomic factors KW - United States AB -

OBJECTIVES: We examined the influence of neighborhood environment on the weight status of adults 55 years and older.

METHODS: We conducted a 2-level logistic regression analysis of data from the 2002 wave of the Health and Retirement Study. We included 8 neighborhood scales: economic advantage, economic disadvantage, air pollution, crime and segregation, street connectivity, density, immigrant concentration, and residential stability.

RESULTS: When we controlled for individual- and family-level confounders, living in a neighborhood with a high level of economic advantage was associated with a lower likelihood of being obese for both men (odds ratio [OR] = 0.86; 95% confidence interval [CI] = 0.80, 0.94) and women (OR = 0.83; 95% CI = 0.77, 0.89). Men living in areas with a high concentration of immigrants and women living in areas of high residential stability were more likely to be obese. Women living in areas of high street connectivity were less likely to be overweight or obese.

CONCLUSIONS: The mechanisms by which neighborhood environment and weight status are linked in later life differ by gender, with economic and social environment aspects being important for men and built environment aspects being salient for women.

PB - 98 VL - 98 IS - 11 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18799770?dopt=Abstract U2 - PMC2636421 U4 - Obesity/Weight/Neighborhood Characteristics ER - TY - JOUR T1 - Parental marital disruption, family type, and transfers to disabled elderly parents. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2008 A1 - Liliana E Pezzin A1 - Robert A. Pollak A1 - Barbara Steinberg Schone KW - Adult KW - Aged KW - Altruism KW - Divorce KW - Family Characteristics KW - Female KW - Frail Elderly KW - Gift Giving KW - Humans KW - Likelihood Functions KW - Longitudinal Studies KW - Male KW - Multivariate Analysis KW - Parent-Child Relations KW - Residence Characteristics KW - Siblings KW - United States AB -

OBJECTIVE: The objective of this study was to investigate the effect of parental marital status, marital history, and family type on intergenerational living arrangements and adult children's time and cash transfers to their unpartnered disabled elderly parents.

METHODS: We used data from the Asset and Health Dynamics Among the Oldest Old survey to estimate the joint probabilities that an adult child provides time and/or cash transfers to a parent and to analyze a five-level categorical variable capturing parent-child living arrangements.

RESULT: The estimates suggest significant detrimental effects of parental divorce and step relationship on time transfers and on the probability of coresidence with the index child. Family type, as captured by the composition of the index child's sibling network according to kin relationship to the parent, also affected transfers and living arrangement choices of adult children.

DISCUSSION: The findings that transfers from adult children to their unpartnered disabled elderly parents depend on parental marital status and kin relationship suggest that changing family patterns are altering the traditional role of the family as a support network. These findings raise concerns about the care likely to be available to future cohorts of elderly persons who will have experienced substantially higher rates of divorce, remarriage, and step parenthood than the cohort considered in this study.

PB - 63B VL - 63 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19092044?dopt=Abstract U3 - 19092044 U4 - Divorce/Family Structure/Intergenerational Transfers/Caregiving ER - TY - JOUR T1 - Place of death among older Americans: does state spending on home- and community-based services promote home death? JF - Med Care Y1 - 2008 A1 - Muramatsu, Naoko A1 - Ruby L Hoyem A1 - yin, Hongjun A1 - Richard T. Campbell KW - Aged KW - Aged, 80 and over KW - Community Health Services KW - Death KW - Humans KW - Logistic Models KW - Nursing homes KW - Residence Characteristics KW - Terminal Care AB -

BACKGROUND: The majority of Americans die in institutions although most prefer to die at home. States vary greatly in their proportion of home deaths. Although individuals' circumstances largely determine where they die, health policies may affect the range of options available to them.

OBJECTIVE: To examine whether states' spending on home- and community-based services (HCBS) affects place of death, taking into consideration county health care resources and individuals' family, sociodemographic, and health factors.

METHODS: Using exit interview data from respondents in the Health and Retirement Study born in 1923 or earlier who died between 1993 and 2002 (N = 3362), we conducted discrete-time survival analysis of the risk of end-of-life nursing home relocation to examine whether states' HCBS spending would delay or prevent end-of-life nursing home admission. Then we ran logistic regression analysis to investigate the HCBS effects on place of death separately for those who relocated to a nursing home and those who remained in the community.

RESULTS: Living in a state with higher HCBS spending was associated with lower risk of end-of-life nursing home relocation, especially among people who had Medicaid. However, state HCBS support was not directly associated with place of death.

CONCLUSIONS: States' generosity for HCBS increases the chance of dying at home via lowering the risk of end-of-life nursing home relocation. State-to-state variation in HCBS spending may partly explain variation in home deaths. Our findings add to the emerging encouraging evidence for continued efforts to enhance support for HCBS.

PB - 46 VL - 46 IS - 8 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18665063?dopt=Abstract U2 - PMC2708119 U4 - Community Health Services/Mortality/Survival/Health Policy ER - TY - JOUR T1 - Predictors of non-local moves among older adults: a prospective study. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2008 A1 - Charles F Longino A1 - Don E Bradley A1 - Eleanor P. Stoller A1 - William H Haas KW - Aged KW - Emigration and Immigration KW - Female KW - Humans KW - Interpersonal Relations KW - Life Change Events KW - Male KW - Prospective Studies KW - Socioeconomic factors KW - Surveys and Questionnaires KW - Travel AB -

OBJECTIVES: The goal of this article was to test a series of established predictors of the hazard of moving for persons primarily in their 50s and 60s. We tested demographic covariates, resources, travel experience, and community and person ties using a prospective design.

METHODS: We employed data from the Health and Retirement Study, 1994 to 2002, based on a representative sample of households containing at least one member aged 51 to 61 in 1992. We employed measures available in the Health and Retirement Study to construct a series of Cox proportional hazards models that examined the causes of non-local moves.

RESULTS: Community and person ties emerged as important predictors of non-local moves.

DISCUSSION: Travel experience, when measured by regular vacationing and second homes, may increase community ties to a destination. The life-course model must be modified in its explanation of the importance of community and person ties, and of life transitions, as motivators of migration.

PB - 63B VL - 63 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18332203?dopt=Abstract U3 - 18332203 U4 - Mobility/migration/COMMUNITY ER - TY - JOUR T1 - Prevalence of cognitive impairment without dementia in the United States. JF - Ann Intern Med Y1 - 2008 A1 - Brenda L Plassman A1 - Kenneth M. Langa A1 - Gwenith G Fisher A1 - Steven G Heeringa A1 - David R Weir A1 - Mary Beth Ofstedal A1 - James R Burke A1 - Michael D Hurd A1 - Guy G Potter A1 - Willard L Rodgers A1 - David C Steffens A1 - John J McArdle A1 - Robert J. Willis A1 - Robert B Wallace KW - Aged KW - Aged, 80 and over KW - Cognition Disorders KW - Dementia KW - disease progression KW - Humans KW - Longitudinal Studies KW - Prevalence KW - United States AB -

BACKGROUND: Cognitive impairment without dementia is associated with increased risk for disability, increased health care costs, and progression to dementia. There are no population-based prevalence estimates of this condition in the United States.

OBJECTIVE: To estimate the prevalence of cognitive impairment without dementia in the United States and determine longitudinal cognitive and mortality outcomes.

DESIGN: Longitudinal study from July 2001 to March 2005.

SETTING: In-home assessment for cognitive impairment.

PARTICIPANTS: Participants in ADAMS (Aging, Demographics, and Memory Study) who were age 71 years or older drawn from the nationally representative HRS (Health and Retirement Study). Of 1770 selected individuals, 856 completed initial assessment, and of 241 selected individuals, 180 completed 16- to 18-month follow-up assessment.

MEASUREMENTS: Assessments, including neuropsychological testing, neurologic examination, and clinical and medical history, were used to assign a diagnosis of normal cognition, cognitive impairment without dementia, or dementia. National prevalence rates were estimated by using a population-weighted sample.

RESULTS: In 2002, an estimated 5.4 million people (22.2%) in the United States age 71 years or older had cognitive impairment without dementia. Prominent subtypes included prodromal Alzheimer disease (8.2%) and cerebrovascular disease (5.7%). Among participants who completed follow-up assessments, 11.7% with cognitive impairment without dementia progressed to dementia annually, whereas those with subtypes of prodromal Alzheimer disease and stroke progressed at annual rates of 17% to 20%. The annual death rate was 8% among those with cognitive impairment without dementia and almost 15% among those with cognitive impairment due to medical conditions.

LIMITATIONS: Only 56% of the nondeceased target sample completed the initial assessment. Population sampling weights were derived to adjust for at least some of the potential bias due to nonresponse and attrition.

CONCLUSION: Cognitive impairment without dementia is more prevalent in the United States than dementia, and its subtypes vary in prevalence and outcomes.

PB - 148 VL - 148 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18347351?dopt=Abstract U2 - PMC2670458 U4 - Cognitive Functioning/Dementia/Health Risk/PREVALENCE ER - TY - JOUR T1 - Preventive health behaviors among grandmothers raising grandchildren. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2008 A1 - Lindsey A Baker A1 - Merril Silverstein KW - Aged KW - Breast Self-Examination KW - Caregivers KW - Female KW - Health Behavior KW - Humans KW - Hypercholesterolemia KW - Influenza, Human KW - Intergenerational Relations KW - Logistic Models KW - Mass Screening KW - Middle Aged KW - Papanicolaou Test KW - Preventive Health Services KW - United States KW - Vaccination KW - Vaginal Smears AB -

OBJECTIVES: We examined differential preventive health behavior among grandmothers who recently began raising a grandchild, grandmothers raising a grandchild for at least 2 years, and grandmothers not raising a grandchild.

METHODS: Data came from the 2000, 2002, and 2004 waves of the Health and Retirement Study. We ran multivariate logistic regression models to assess receipt of influenza vaccination, cholesterol screening, monthly breast self-exam, mammography, and Papanicolaou (Pap) tests among grandmothers aged 50 to 75.

RESULTS: Grandmothers who recently began raising a grandchild were significantly less likely to report influenza vaccination and cholesterol screening than grandmothers not raising grandchildren, even after we controlled for increased emotional and financial strains within the household. We also observed this association for Pap tests, although this finding was only marginally significant. Grandmothers who had been raising a grandchild for at least 2 years were significantly more likely to report influenza vaccination and monthly breast self-exam than grandmothers not raising grandchildren.

DISCUSSION: The enhancement of preventive behavior seen among long-term grandparent caregivers does not fully offset the suppression of preventive behavior during the transition into care; support groups should target a range of interventions toward the promotion of healthy behavior among new grandparent caregivers.

PB - 63B VL - 63 IS - 5 N1 - ProCite field 6 : The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences U1 - http://www.ncbi.nlm.nih.gov/pubmed/18818451?dopt=Abstract U2 - PMC2633920 U4 - Health Physical/Caregiving/Grandparents/Grandchildren/Intergenerational Relations ER - TY - JOUR T1 - Productive activities and psychological well-being among older adults. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2008 A1 - Hao, Yanni KW - Activities of Daily Living KW - Aged KW - Cohort Studies KW - depression KW - Employment KW - Female KW - Health Status KW - Humans KW - Male KW - Mental Health KW - Middle Aged KW - Models, Psychological KW - Psychological Theory KW - Psychomotor Performance KW - Quality of Life KW - Social Environment KW - Volunteers AB -

OBJECTIVES: The purpose of this study was to test whether paid work and formal volunteering reduce the rate of mental health decline in later life.

METHODS: Using four waves of Health and Retirement Study data collected from a sample of 7,830 individuals aged 55 to 66, I estimated growth curve models to assess the effects of productive activities on mental health trajectories. The analytical strategy took into account selection processes when examining the beneficial effects of activities. The analyses also formally attended to the sample attrition problem inherent in longitudinal studies.

RESULTS: The results indicated that activity participants generally had better mental health at the beginning of the study. Full-time employment and low-level volunteering had independent protective effects against decline in psychological well-being. Joint participants of both productive activities enjoyed a slower rate of mental health decline than single-activity participants.

DISCUSSION: The results are consistent with activity theory and further confirm the role accumulation perspective. The finding that full-time work combined with low-level volunteering is protective of mental health reveals the complementary effect of volunteering to formal employment. Methodological and theoretical implications are discussed.

PB - 63B VL - 63 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18441271?dopt=Abstract U3 - 18441271 U4 - Work/Work, volunteer/Mental health ER - TY - JOUR T1 - Racial and ethnic differences in activities of daily living disability among the elderly: the case of Spanish speakers. JF - Arch Phys Med Rehabil Y1 - 2008 A1 - Manasi A. Tirodkar A1 - Song, Jing A1 - Rowland W Chang A1 - Dorothy D Dunlop A1 - Huan J. Chang KW - Acculturation KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Disability Evaluation KW - Disabled Persons KW - Female KW - Geriatric Assessment KW - Health Status Indicators KW - Hispanic or Latino KW - Humans KW - Male KW - Middle Aged AB -

OBJECTIVE: To compare incident disability patterns across racial and ethnic groups.

DESIGN: Prospective cohort study with 6-year follow-up (1998-2004).

SETTING: National probability sample.

PARTICIPANTS: A 1998 Health and Retirement Study sample of 12,288 non-Hispanic whites, 1952 African Americans, 575 Hispanics interviewed in Spanish (Hispanic-Spanish), and 518 Hispanics interviewed in English (Hispanic-English), older than 51 years, and free of disability at baseline.

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURE: Disability in activities of daily living (ADL) tasks (walking, dressing, transferring, bathing, toileting, feeding).

RESULTS: Hispanic-Spanish reported disproportionately lower rates of walking disability (standardized rates, 4.31% vs Hispanic-English [8.57%], black [7.54%], white [7.20%]) despite higher reported Hispanic-Spanish frequencies of lower-extremity dysfunction than other racial and ethnic groups. Across the 6 ADL tasks, the development of walking disability was most frequent among Hispanic-English subjects, African Americans, and whites. In contrast, Hispanic-Spanish subjects reported dressing as the most frequent ADL task disability, whereas walking ranked fourth.

CONCLUSIONS: Aggregating all Hispanics, regardless of interview language, may be inappropriate. Future research on linguistic group differences in self-reported health outcomes is necessary to ensure that health status measures will be appropriate for use in diverse racial and ethnic groups.

PB - 89 VL - 89 IS - 7 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18534555?dopt=Abstract U2 - PMC2740915 U4 - ADL and IADL Impairments/hispanics/DISABILITY/DISABILITY ER - TY - JOUR T1 - Racial and ethnic disparities in mobility device use in late life. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2008 A1 - Jennifer C. Cornman A1 - Vicki A Freedman KW - Aged KW - Cross-Sectional Studies KW - Demography KW - ethnicity KW - Female KW - Health Services Needs and Demand KW - Humans KW - Insurance, Health KW - Male KW - Self-Help Devices KW - Socioeconomic factors AB -

OBJECTIVE: Although racial and ethnic disparities in disability are well established and technology is increasingly used to bridge gaps between functional deficits and environmental demands, little research has focused on racial and ethnic disparities in device use. This study investigated whether use of mobility devices differs by race and ethnicity and explored several reasons for this difference.

METHODS: The sample included community-dwelling adults aged 65 and older from the 2002 and 2004 waves of the Health and Retirement Study. We used predisposing, need, and enabling factors to predict mobility device use alone and combined with personal care.

RESULT: Blacks had the highest rates of using mobility devices, followed by Hispanics and then Whites. Need and enabling factors explained differences between Blacks and Whites in wheelchair use but not cane use or use of devices without personal care. Other predisposing factors explained most differences between Hispanics and Whites.

DISCUSSION: Because minorities appear to be using mobility devices in proportion to underlying need, increasing device use by minorities may not reduce disparities in mobility disability. Efforts to address racial/ethnic disparities in mobility disability in late life, therefore, may need to focus on differences in underlying functional decline rather than the accommodation of it.

PB - 63B VL - 63 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18332200?dopt=Abstract U3 - 18332200 U4 - Racial Differences/Ethnic Groups/Mobility/Physical Vulnerability ER - TY - JOUR T1 - Racial disparities in receipt of hip and knee joint replacements are not explained by need: the Health and Retirement Study 1998-2004. JF - J Gerontol A Biol Sci Med Sci Y1 - 2008 A1 - Steel, Nicholas A1 - Clark, Allan A1 - Iain A Lang A1 - Robert B Wallace A1 - David Melzer KW - Aged KW - Arthroplasty, Replacement, Hip KW - Arthroplasty, Replacement, Knee KW - Black or African American KW - Educational Status KW - Female KW - Health Services Needs and Demand KW - Humans KW - Male KW - Middle Aged KW - United States AB -

BACKGROUND: Hip and knee joint replacement rates vary by demographic group. This article describes the epidemiology of need for joint replacement, and of subsequent receipt of a joint replacement by those in need.

METHODS: Data from the Health and Retirement Study were used to assess need for hip or knee joint replacement in a total of 14,807 adults aged 60 years or older in 1998, 2000, and 2002 and receipt of needed surgery 2 years later. "Need" classification was based on difficulty walking, joint pain, stiffness, or swelling and receipt of treatment for arthritis, without contraindications to surgery.

RESULTS: Need in 2002 was greater in participants who were older than 74 years (vs 60-64: adjusted odds ratio 2.06; 95% confidence interval, 1.68-2.53), women (vs men: 1.81; 1.53-2.14), less educated (vs college educated: 1.27; 1.06-1.52), in the poorest third (vs richest: 2.20; 1.78-2.72), or obese (vs nonobese: 2.39; 2.02-2.81). One hundred sixty-eight participants in need received a joint replacement, with lower receipt in black or African American participants (vs white: 0.47; 0.26-0.83) or less educated (vs college educated: 0.65; 0.44-0.96). These differences were not explained by current employment, access to medical care, family responsibilities, disability, living alone, comorbidity, or exclusion of those younger than Medicare eligibility age.

CONCLUSIONS: After taking variations in need into consideration, being black or African American or lacking a college education appears to be a barrier to receiving surgery, whereas age, sex, relative poverty, and obesity do not. These disparities maintain disproportionately high levels of pain and disability in disadvantaged groups.

PB - 63A VL - 63 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18559639?dopt=Abstract U3 - 18559639 U4 - DISABILITY/DISABILITY/Joint Replacement ER - TY - JOUR T1 - Retirement and weight changes among men and women in the health and retirement study. JF - J Gerontol B Psychol Sci Soc Sci 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 - Aged KW - Aging KW - Body Mass Index KW - Body Weight KW - Demography KW - depression KW - Female KW - Health Behavior KW - Health Status KW - Humans KW - Interviews as Topic KW - Male KW - Middle Aged KW - Obesity KW - Retirement AB -

OBJECTIVES: Older adults may experience weight changes upon retirement for a number of reasons, such as being less physically active; having less structured meal times; and consuming food in response to losing personal identity, the potential for social interactions, or the sense of accomplishment derived from working. The purpose of this study was to determine whether retirement was associated with either weight gain or weight loss.

METHODS: We used the 1994-2002 Health and Retirement Study to determine whether retirement between biennial interviews was associated with weight change, separately for men (n = 1,966) and women (n = 1,759). We defined weight change as a 5% increase or decrease in body mass index between interviews.

RESULT: . We did not find a significant association between retirement and weight change among men. Women who retired were more likely to gain weight than women who continued to work at least 20 hr per week (odds ratio [OR] = 1.24, 95% confidence interval [CI] = 1.04-1.48). We found a significant relationship between retirement and weight gain only for women who were normal weight upon retiring (OR = 1.30, 95% CI = 1.01-1.69) and who retired from blue-collar jobs (OR = 1.58, 95% CI = 1.13-2.21).

DISCUSSION: Public health interventions may be indicated for women, particularly those working in blue-collar occupations, in order to prevent weight gain upon retirement.

PB - 63B VL - 63 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18559689?dopt=Abstract U3 - 18559689 U4 - RETIREMENT/Weight/Women ER - TY - JOUR T1 - Risk perceptions, optimism, and natural hazards. JF - Risk Anal Y1 - 2008 A1 - V. Kerry Smith KW - Aged KW - Attitude KW - Cyclonic Storms KW - Decision making KW - Disaster Planning KW - Disasters KW - Florida KW - Health Knowledge, Attitudes, Practice KW - Humans KW - Longevity KW - Middle Aged KW - Perception KW - Risk KW - Risk Assessment KW - Social Behavior AB -

This article uses the panel survey developed for the Health and Retirement Study to evaluate whether Hurricane Andrew in 1992 altered longevity expectations of respondents who lived in Dade County, Florida, the location experiencing the majority of about 20 billion dollars of damage. Longevity expectations have been used as a proxy measure for both individual subjective risk assessments and dispositional optimism. The panel structure allows comparison of those respondents' longevity assessments when the timing of their survey responses bracket Andrew with those of individuals where it does not. After controlling for health effects, the results indicate a significant reduction in longevity expectations due to the information respondents appear to have associated with the storm.

PB - 28 VL - 28 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18627543?dopt=Abstract U3 - 18627543 U4 - Longevity/Life Expectancy ER - TY - JOUR T1 - Robustness in health research: do differences in health measures, techniques, and time frame matter? JF - J Health Econ Y1 - 2008 A1 - Frijters, Paul A1 - Ulker, Aydogan KW - Aged KW - Algorithms KW - Australia KW - Data Interpretation, Statistical KW - Female KW - Health Behavior KW - Health Services Research KW - Health Status Indicators KW - Humans KW - Male KW - Middle Aged KW - Morbidity KW - Mortality KW - Social Class AB -

Survey-based health research is in a boom phase following an increased amount of health spending in OECD countries and the interest in ageing. A general characteristic of survey-based health research is its diversity. Different studies are based on different health questions in different datasets; they use different statistical techniques; they differ in whether they approach health from an ordinal or cardinal perspective; and they differ in whether they measure short-term or long-term effects. The question in this paper is simple: do these differences matter for the findings? We investigate the effects of life-style choices (drinking, smoking, exercise) and income on six measures of health in the US Health and Retirement Study (HRS) between 1992 and 2002: (1) self-assessed general health status, (2) problems with undertaking daily tasks and chores, (3) mental health indicators, (4) BMI, (5) the presence of serious long-term health conditions, and (6) mortality. We compare ordinal models with cardinal models; we compare models with fixed effects to models without fixed-effects; and we compare short-term effects to long-term effects. We find considerable variation in the impact of different determinants on our chosen health outcome measures; we find that it matters whether ordinality or cardinality is assumed; we find substantial differences between estimates that account for fixed effects versus those that do not; and we find that short-run and long-run effects differ greatly. All this implies that health is an even more complicated notion than hitherto thought, defying generalizations from one measure to the others or one methodology to another.

PB - 27 VL - 27 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18639357?dopt=Abstract U3 - 18639357 U4 - Health Surveys/Methodology ER - TY - JOUR T1 - Screening mammography in older women. Effect of wealth and prognosis. JF - Arch Intern Med Y1 - 2008 A1 - Brie A Williams A1 - Lindquist, Karla A1 - Rebecca L. Sudore A1 - Kenneth E Covinsky A1 - Louise C Walter KW - Aged KW - Breast Neoplasms KW - Chi-Square Distribution KW - Female KW - Humans KW - Longitudinal Studies KW - Mammography KW - Mass Screening KW - Prognosis KW - Risk Factors KW - Social Class AB -

BACKGROUND: Wealthy women have higher rates of screening mammography than poor women do. Screening mammography is beneficial for women with substantial life expectancies, but women with limited life expectancies are unlikely to benefit. It is unknown whether higher screening rates in wealthy women are due to increased screening in women with substantial life expectancies, limited life expectancies, or both. This study examines the relationship between wealth and screening mammography use in older women according to life expectancy.

METHODS: A cohort study was performed of 4222 women 65 years or older with Medicare participating in the 2002 and 2004 Health and Retirement Survey. Women were categorized according to wealth and life expectancy (based on 5-year prognosis from a validated prognostic index). The outcome was self-reported receipt of screening mammography within 2 years.

RESULTS: Overall, within 2 years, 68% of women (2871 of 4222) received a screening mammogram. Screening was associated with wealth (net worth, > $100 000) and good prognosis (< or = 10% probability of dying in 5 years). Screening mammography was more common among wealthy women than among poor women (net worth, < $10 000) both for women with good prognosis (82% vs 68%; P < .001) and for women with limited prognoses (> or = 50% probability of dying in 5 years) (48% vs 32%; P = .02). These associations remained after multivariate analysis accounting for age, race, education, proxy report, and rural residence.

CONCLUSIONS: Poorer older women with favorable prognoses are at risk of not receiving screening mammography when they are likely to benefit. Wealthier older women with limited prognoses are often screened when they are unlikely to benefit.

PB - 168 VL - 168 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18332298?dopt=Abstract U3 - 18332298 U4 - Mammography/WOMEN/life Expectancy/Wealth/methodology/risk factors 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 - 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 - Trajectories of functional health: the 'long arm' of childhood health and socioeconomic factors. JF - Soc Sci Med Y1 - 2008 A1 - Steven A Haas KW - Aged KW - Child KW - Female KW - Health Behavior KW - Health Status Disparities KW - Humans KW - Male KW - Middle Aged KW - Social Class KW - Socioeconomic factors AB -

Few studies have specifically examined trajectories of functional health status or estimated the extent to which they are influenced by childhood health and socioeconomic conditions. This study examines how circumstances associated with early life may shape the level and progression of functional limitations among adults at or near retirement. Employing data from the US Health and Retirement Study (HRS), it estimates latent growth curve models (LGM) of functional limitation. The results demonstrate that functional health trajectories in old age continue to be shaped by childhood health and socioeconomic circumstances. Poor childhood health and disadvantaged social origins are associated with both more functional limitations at baseline and higher rates of increase over time. This association is net of baseline adult chronic disease and socioeconomic status. While both childhood and adult factors influence the baseline level of functional limitation, only childhood health and socioeconomic status are associated with the rate of change in limitations over time.

PB - 66 VL - 66 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18158208?dopt=Abstract U3 - 18158208 U4 - childhood conditions/Socioeconomic Factors/RETIREMENT/Health Status--ADL limitations ER - TY - JOUR T1 - Trends in the prevalence and mortality of cognitive impairment in the United States: is there evidence of a compression of cognitive morbidity? JF - Alzheimers Dement Y1 - 2008 A1 - Kenneth M. Langa A1 - Eric B Larson A1 - Jason H. Karlawish A1 - David M Cutler A1 - Mohammed U Kabeto A1 - Scott Y H Kim A1 - Allison B Rosen KW - Aged KW - Aged, 80 and over KW - Cognition Disorders KW - Female KW - Humans KW - Male KW - Neurology KW - Prevalence KW - Quality of Life KW - Socioeconomic factors KW - United States AB -

BACKGROUND: Recent medical, demographic, and social trends might have had an important impact on the cognitive health of older adults. To assess the impact of these multiple trends, we compared the prevalence and 2-year mortality of cognitive impairment (CI) consistent with dementia in the United States in 1993 to 1995 and 2002 to 2004.

METHODS: We used data from the Health and Retirement Study (HRS), a nationally representative population-based longitudinal survey of U.S. adults. Individuals aged 70 years or older from the 1993 (N = 7,406) and 2002 (N = 7,104) waves of the HRS were included. CI was determined by using a 35-point cognitive scale for self-respondents and assessments of memory and judgment for respondents represented by a proxy. Mortality was ascertained with HRS data verified by the National Death Index.

RESULTS: In 1993, 12.2% of those aged 70 or older had CI compared with 8.7% in 2002 (P < .001). CI was associated with a significantly higher risk of 2-year mortality in both years. The risk of death for those with moderate/severe CI was greater in 2002 compared with 1993 (unadjusted hazard ratio, 4.12 in 2002 vs 3.36 in 1993; P = .08; age- and sex-adjusted hazard ratio, 3.11 in 2002 vs 2.53 in 1993; P = .09). Education was protective against CI, but among those with CI, more education was associated with higher 2-year mortality.

CONCLUSIONS: These findings support the hypothesis of a compression of cognitive morbidity between 1993 and 2004, with fewer older Americans reaching a threshold of significant CI and a more rapid decline to death among those who did. Societal investment in building and maintaining cognitive reserve through formal education in childhood and continued cognitive stimulation during work and leisure in adulthood might help limit the burden of dementia among the growing number of older adults worldwide.

PB - 4 VL - 4 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18631957?dopt=Abstract U2 - PMC2390845 U4 - Dementia/Epidemiology/heart disease/Education ER - TY - JOUR T1 - Using subjective expectations to forecast longevity: do survey respondents know something we don't know? JF - Demography Y1 - 2008 A1 - Maria Perozek KW - Aged KW - Aged, 80 and over KW - Aging KW - Data collection KW - Demography KW - Female KW - health policy KW - Humans KW - Life Expectancy KW - Life Tables KW - Longevity KW - Male KW - Middle Aged KW - Mortality KW - Risk Factors KW - Sex Factors KW - United States AB -

Old-age mortality is notoriously difficult to predict because it requires not only an understanding of the process of senescence-which is influenced by genetic, environmental, and behavioral factors-but also a prediction of how these factors will evolve. In this paper I argue that individuals are uniquely qualified to predict their own mortality based on their own genetic background, as well as environmental and behavioral risk factors that are often known only to the individual. Given this private information, individuals form expectations about survival probabilities that may provide additional information to demographers and policymakers in their challenge to predict mortality. From expectations data from the 1992 Health and Retirement Study (HRS), I construct subjective, cohort life tables that are shown to predict the unusual direction of revisions to U.S. life expectancy by gender between 1992 and 2004: that is, for these cohorts, the Social Security Actuary (SSA) raised male life expectancy in 2004 and at the same lowered female life expectancy, narrowing the gender gap in longevity by 25% over this period. Further, although the subjective life expectancies for men appear to be roughly in line with the 2004 life tables, the subjective expectations of women suggest that female life expectancies estimated by the SSA might still be on the high side.

PB - 45 VL - 45 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18390293?dopt=Abstract U2 - PMC2831383 U4 - Life Expectancy/Subjective Probabilities of Survival/Mortality/Actuarial Analysis ER - TY - JOUR T1 - Within-group differences in depression among older Hispanics living in the United States. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2008 A1 - Frances Margaret Yang A1 - Cazorla-Lancaster, Yamileth A1 - Richard N Jones KW - Aged KW - Culture KW - Depressive Disorder, Major KW - Female KW - Hispanic or Latino KW - Humans KW - Insurance, Health KW - Male KW - Middle Aged KW - Prevalence KW - Severity of Illness Index KW - Socioeconomic factors KW - United States AB -

Using the Health and Retirement Study, we examine the prevalence of depression in different groups of Hispanic older adults. Respondents (n = 759) were aged 59 and older and identified themselves as Mexican American (56%), Cuban American (13%), Puerto Rican (8%), other (8%), or not specified (15%). We used a modified version of the Center for Epidemiologic Studies-Depression scale and the Composite International Diagnostic Interview to assess depressive symptoms and the presence of major depression. Relative to Puerto Ricans, each Hispanic group had significantly lower levels of depressive symptoms, except for Cuban Americans; and each Hispanic group had lower prevalence rates for major depression, except for other Hispanics, even after we adjusted for sociodemographic, cultural factors, socioeconomic, functional limitations, and chronic health conditions.

PB - 63B VL - 63 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18332191?dopt=Abstract U2 - PMC2366970 U4 - Hispanic Americans/Depression ER - TY - JOUR T1 - Work disability associated with cancer survivorship and other chronic conditions. JF - Psychooncology Y1 - 2008 A1 - Pamela F. Short A1 - Joseph J. Vasey A1 - BeLue, Rhonda KW - Adult KW - Aged KW - Chronic disease KW - Disability Evaluation KW - Employment KW - Female KW - Humans KW - Male KW - Maryland KW - Middle Aged KW - Neoplasms KW - Pennsylvania KW - Survivors AB -

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

PB - 17 VL - 17 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/17429835?dopt=Abstract U3 - 17429835 U4 - CANCER/Chronic Disease/DISABILITY/DISABILITY/Work Behavior ER - TY - JOUR T1 - 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 - All in the family: the impact of caring for grandchildren on grandparents' health. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2007 A1 - Mary Elizabeth Hughes A1 - Linda J. Waite A1 - Tracey A. LaPierre A1 - Ye Luo KW - Adaptation, Psychological KW - Aged KW - Aged, 80 and over KW - Aging KW - Caregivers KW - Child Care KW - Child, Preschool KW - Family Relations KW - Female KW - Health Status KW - Humans KW - Intergenerational Relations KW - Male KW - Middle Aged KW - Parenting KW - Risk Assessment KW - Stress, Psychological AB -

OBJECTIVES: The purpose of this study was to examine the effects of caring for grandchildren on health behaviors and mental and physical health among older adults.

METHODS: Using a sample of 12,872 grandparents aged 50 through 80 from the Health and Retirement Study, we examined the relationship between stability and change in various types of grandchild care and subsequent health, controlling for covariates and earlier health.

RESULTS: We found no evidence to suggest that caring for grandchildren has dramatic and widespread negative effects on grandparents' health and health behavior. We found limited evidence that grandmothers caring for grandchildren in skipped-generation households are more likely to experience negative changes in health behavior, depression, and self-rated health. We also found some evidence of benefits to grandmothers who babysit.

DISCUSSION: Our findings suggest that the health disadvantages found previously among grandparent caregivers arise from grandparents' prior characteristics, not as a consequence of providing care. Health declines as a consequence of grandchild care appear to be the exception rather than the rule. These findings are important given continuing reliance on grandparents for day care and increasing reliance on grandparents for custodial care. However, the findings should be tempered by the recognition that for a minority of grandparents, coresidential grandchild care may compromise health.

PB - 62 VL - 62 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/17379680?dopt=Abstract U2 - PMC2562755 U4 - Caregiving/Child Care/Health Physical ER - TY - JOUR T1 - Baseline health, socioeconomic status, and 10-year mortality among older middle-aged Americans: findings from the Health and Retirement Study, 1992 2002. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2007 A1 - Joseph Feinglass A1 - Lin, Suru A1 - Jason A. Thompson A1 - Joseph J Sudano A1 - Dorothy D Dunlop A1 - Song, Jing A1 - David W. Baker KW - Adult KW - Aged KW - Aged, 80 and over KW - Economics KW - Education KW - Follow-Up Studies KW - Health Status KW - Humans KW - Income KW - Middle Aged KW - Mortality KW - Motor Activity KW - Pilot Projects KW - Proportional Hazards Models KW - Retirement KW - Risk Factors KW - Risk-Taking KW - Smoking KW - Social Class KW - Thinness KW - United States AB -

OBJECTIVE: This study analyzed whether socioeconomic status in older middle age continues to be associated with 10-year survival after data are controlled for baseline health status.

METHODS: We confirmed deaths through 2002 for 9,759 participants in the Health and Retirement Study, aged 51 to 61 in 1992. We used discrete time survival models to examine hazard ratios over 10 years of follow-up. We examined associations of demographic characteristics and socioeconomic status measures before and after adjustment by health status and behavioral risk factors.

RESULT: The 10-year mortality rate was 10.9%, ranging from 4.7% for respondents reporting excellent health to 35.8% for those reporting poor health at baseline. Lower levels of education, income, and wealth were strongly associated with higher mortality risk after we controlled for just demographic characteristics. After further adjustment for health status and behavioral risk factors, only household income remained significant.

DISCUSSION: Baseline health by age 50 is an important pathway in the association between midlife socioeconomic status and mortality risk to age 70. The continuing effect of low household income on mortality risk was concentrated among respondents reporting excellent to good health at baseline. Socioeconomic disparities in middle-age health continue to limit disability-free life expectancy at older ages.

PB - 62 VL - 62 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/17673534?dopt=Abstract U4 - socioeconomic status/health status/Mortality ER - TY - JOUR T1 - Beyond comorbidity counts: how do comorbidity type and severity influence diabetes patients' treatment priorities and self-management? JF - J Gen Intern Med Y1 - 2007 A1 - Eve A Kerr A1 - Michele M Heisler A1 - Sarah L. Krein A1 - Mohammed U Kabeto A1 - Kenneth M. Langa A1 - David R Weir A1 - John D Piette KW - Aged KW - Attitude to Health KW - Cohort Studies KW - Comorbidity KW - Cross-Sectional Studies KW - Diabetes Mellitus KW - Female KW - Health Priorities KW - Heart Failure KW - Humans KW - Male KW - Middle Aged KW - Self Care KW - Severity of Illness Index KW - United States AB -

BACKGROUND: The majority of older adults have 2 or more chronic conditions and among patients with diabetes, 40% have at least three.

OBJECTIVE: We sought to understand how the number, type, and severity of comorbidities influence diabetes patients' self-management and treatment priorities.

DESIGN: Cross-sectional observation study.

PATIENTS: A total of 1,901 diabetes patients who responded to the 2003 Health and Retirement Study (HRS) diabetes survey.

MEASUREMENTS: We constructed multivariate models to assess the association between presence of comorbidities and each of 2 self-reported outcomes, diabetes prioritization and self-management ability, controlling for patient demographics. Comorbidity was characterized first by a count of all comorbid conditions, then by the presence of specific comorbidity subtypes (microvascular, macrovascular, and non-diabetes related), and finally by severity of 1 serious comorbidity: heart failure (HF).

RESULTS: 40% of respondents had at least 1 microvascular comorbidity, 79% at least 1 macrovascular comorbidity, and 61% at least 1 non-diabetes-related comorbidity. Patients with a greater overall number of comorbidities placed lower priority on diabetes and had worse diabetes self-management ability scores. However, only macrovascular and non-diabetes-related comorbidities, but not microvascular comorbidities, were associated with lower diabetes prioritization, whereas higher numbers of microvascular, macrovascular, and non-diabetes-related conditions were all associated with lower diabetes self-management ability scores. Severe, but not mild, HF was associated with lower diabetes prioritization and self-management scores.

CONCLUSIONS: The type and severity of comorbid conditions, and not just the comorbidity count, influence diabetes patients' self-management. Patients with severely symptomatic comorbidities and those with conditions they consider to be unrelated to diabetes may need additional support in making decisions about care priorities and self-management activities.

PB - 22 VL - 22 IS - 12 U1 - http://www.ncbi.nlm.nih.gov/pubmed/17647065?dopt=Abstract U2 - PMC2219819 U4 - diabetes/COMORBIDITY/Chronic Illness ER - TY - JOUR T1 - Burden of common multiple-morbidity constellations on out-of-pocket medical expenditures among older adults. JF - Gerontologist Y1 - 2007 A1 - Schoenberg, Nancy E. A1 - Hyungsoo Kim A1 - Edwards, William A1 - Fleming, Steven T. KW - Aged KW - Arthritis KW - Chronic disease KW - Comorbidity KW - Cost of Illness KW - Female KW - Financing, Personal KW - Health Expenditures KW - Health Surveys KW - Heart Diseases KW - Humans KW - Hypertension KW - Interviews as Topic KW - Male KW - Middle Aged KW - United States AB -

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

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

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

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

PB - 47 VL - 47 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/17766664?dopt=Abstract U4 - Chronic Disease/Morbidity,/Medical Expenditures ER - TY - JOUR T1 - Change in depression of spousal caregivers of dementia patients following patient's death. JF - Omega (Westport) Y1 - 2007 A1 - Tweedy, Maureen P. A1 - Charles A Guarnaccia KW - Adaptation, Psychological KW - Aged KW - Aged, 80 and over KW - Bereavement KW - Caregivers KW - Dementia KW - depression KW - Female KW - Humans KW - Life Change Events KW - Long-term Care KW - Longitudinal Studies KW - Male KW - Sex Factors KW - Spouses KW - Surveys and Questionnaires KW - United States AB -

Caring for an elderly spouse with dementia places a heavy burden on spousal caregivers and often results in chronic depression. Little has been written about change in depression caregivers experience from before to after the death of the spouse with dementia. This longitudinal study examines change in depression of spousal caregivers that occurs following death of the dementia patient. Two theoretical models, the Relief and Stress Models, are discussed in terms of caregiver depression after the death of the dementia-patient care-recipient spouse. These two theoretical models were tested using longitudinal data from the National Institute on Aging sponsored Health and Retirement Study. Both male and female spousal caregivers report an increase in depression after the death of the dementia-patient care-recipient spouse. As time passed following the spouse's death, the conjugally bereaved husbands showed a decrease in depression while the conjugally bereaved wives continued to report increased depression.

PB - 56 VL - 56 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18300648?dopt=Abstract U4 - Caregiving/Spouses/Dementia/Depression ER - TY - JOUR T1 - Childhood social and economic well-being and health in older age. JF - Am J Epidemiol Y1 - 2007 A1 - Sandra Y. Moody-Ayers A1 - Lindquist, Karla A1 - Sen, Saunak A1 - Kenneth E Covinsky KW - Aged KW - Aged, 80 and over KW - Black or African American KW - Child KW - Confidence Intervals KW - Educational Status KW - Female KW - Frail Elderly KW - Health Status KW - Health Status Indicators KW - Hispanic or Latino KW - Humans KW - Male KW - Middle Aged KW - Mobility Limitation KW - Odds Ratio KW - Poverty KW - Retrospective Studies KW - Sampling Studies KW - San Francisco KW - Socioeconomic factors KW - Surveys and Questionnaires KW - White People AB -

Childhood socioeconomic status (SES) acts over a lifetime to influence adult health outcomes. Whether the impact of childhood SES differs by age or race/ethnicity is unclear. The authors studied 20,566 community-living US adults aged > or =50 years. Parental education was the main predictor. Outcomes evaluated (1998-2002) included self-reported health and functional limitation. The influence of childhood SES on later-life health was also examined in groups stratified by age and race/ethnicity, with adjustment for demographic factors and current SES. Participants' mean age was 67 years; 57% were women. By race/ethnicity, 76% were White, 14% were Black, and 8% were Latino. The relation between low parental education and fair/poor self-rated health declined with advancing age (age 50-64 years: adjusted odds ratio (AOR) = 1.42, 95% confidence interval (CI): 1.24, 1.63; age > or =80 years: AOR = 1.14, 95% CI: 0.96, 1.36). The relation between low parental education and fair/poor self-rated health differed across racial/ethnic groups and was significant in White (AOR = 1.33, 95% CI: 1.21, 1.47) and Black (AOR = 1.37, 95% CI: 1.14, 1.64) participants but not Latinos. These findings suggest that childhood SES affects health status through midlife but the effects may abate in late life; its effects also may be weaker in Latinos than in Whites or Blacks.

PB - 166 VL - 166 IS - 9 U1 - http://www.ncbi.nlm.nih.gov/pubmed/17720682?dopt=Abstract U4 - childhood conditions/Socioeconomic Status/health status/Activities of Daily Living/Mobility Difficulty/Frail Elderly ER - TY - JOUR T1 - Does money buy better health? Unpacking the income to health association after midlife. JF - Health (London) Y1 - 2007 A1 - Berry, Brent M. KW - Aged KW - Attitude to Health KW - Employment KW - Health Status Indicators KW - Humans KW - Income KW - Middle Aged KW - Mobility Limitation KW - Models, Econometric KW - Retirement KW - Self Concept KW - Sociology, Medical KW - United States AB -

This article estimates the effect of household financial resources on health after midlife using models that minimize health-related selectivity and unobserved heterogeneity bias. I focus on the self-rated health and mobility limitations of adults transitioning into retirement over six panels of the Health and Retirement Study (1992-2002; age 51-61 at wave one; N = 7602). Standard regression models that adjust for health-related selection with prospective and retrospective controls suggest a significant influence of long-term income on health, but an insignificant influence of short-term income. Further adjustment for unobserved fixed effects also suggests that short-term income is insignificant. Sizable recent and long-term health feedbacks to income for a portion of the HRS respondents underscore the need to control for the confounding influence of health over the lifecourse. Together these results suggest that adults after midlife are heterogeneous with respect to the causal and selective processes generating the observed association between income and health.

PB - 11 VL - 11 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/17344272?dopt=Abstract U4 - HEALTH/income/Wealth ER - TY - JOUR T1 - Does more health care improve health among older adults? A longitudinal analysis. JF - J Aging Health Y1 - 2007 A1 - Ezra Golberstein A1 - Jersey Liang A1 - A. R. Quinones A1 - Frederic D Wolinsky KW - Activities of Daily Living KW - Aged KW - Health Services KW - Health Services for the Aged KW - Health Status KW - Humans KW - Longitudinal Studies KW - United States AB -

OBJECTIVE: This research assesses the association of health services use with subsequent physical health among older Americans, adjusting for the confounding between health care use and prior health.

METHOD: Longitudinal data are from the Survey on Assets and Health Dynamics Among the Oldest Old (AHEAD). Linear and logistic regressions are used to model the linkages between medical care use and health outcomes, including self-rated health, functional limitations, and mortality.

RESULTS: There is limited evidence that increased health care use is correlated with improved subsequent health. Increased use of medical care is largely associated with poorer health outcomes. Moreover, there are no significant interaction effects of health care use and baseline health on Activities of Daily Living and Instrumental Activities of Daily Living, despite the existence of a significant but very small interaction effect on self-rated health.

CONCLUSIONS: The findings have implications for the quality of care delivered by the American health care system.

PB - 19 VL - 19 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18165287?dopt=Abstract U4 - Health Services Research/Health Care Utilization/health status/ADL and IADL Impairments ER - TY - JOUR T1 - Does physician communication influence older patients' diabetes self-management and glycemic control? Results from the Health and Retirement Study (HRS). JF - J Gerontol A Biol Sci Med Sci Y1 - 2007 A1 - Michele M Heisler A1 - Cole, Ian A1 - David R Weir A1 - Eve A Kerr A1 - Rodney A. Hayward KW - Aged KW - Blood Glucose KW - Communication KW - Cross-Sectional Studies KW - Diabetes Mellitus KW - Female KW - Glycated Hemoglobin KW - Humans KW - Male KW - Multivariate Analysis KW - Physician-Patient Relations KW - Self Care AB -

BACKGROUND: Effective chronic disease self-management among older adults is crucial for improved clinical outcomes. We assessed the relative importance of two dimensions of physician communication-provision of information (PCOM) and participatory decision-making (PDM)-for older patients' diabetes self-management and glycemic control.

METHODS: We conducted a national cross-sectional survey among 1588 older community-dwelling adults with diabetes (response rate: 81%). Independent associations were examined between patients' ratings of their physician's PCOM and PDM with patients' reported diabetes self-management (medication adherence, diet, exercise, blood glucose monitoring, and foot care), adjusting for patient sociodemographics, illness severity, and comorbidities. Among respondents for whom hemoglobin A1c (HbA1c) values were available (n=1233), the relationship was assessed between patient self-management and HbA1c values.

RESULTS: In separate multivariate regressions, PCOM and PDM were each associated with overall diabetes self-management (p<.001) and with all self-management domains (p<.001 in all models), with the exception of PDM not being associated with medication adherence. In models with both PCOM and PDM, PCOM alone predicted medication adherence (p=.001) and foot care (p=.002). PDM alone was associated with exercise and blood glucose monitoring (both p<.001) and was a stronger independent predictor than PCOM of diet. Better patient ratings of their diabetes self-management were associated with lower HbA1c values (B= -.10, p=.005).

CONCLUSION: Among these older adults, both their diabetes providers' provision of information and efforts to actively involve them in treatment decision-making were associated with better overall diabetes self-management. Involving older patients in setting chronic disease goals and decision-making, however, appears to be especially important for self-care areas that demand more behaviorally complex lifestyle adjustments such as exercise, diet, and blood glucose monitoring.

PB - 62A VL - 62 IS - 12 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18166697?dopt=Abstract U4 - aging/Chronic Illness/diabetes ER - TY - JOUR T1 - The economic consequences of widowhood for older minority women. JF - Gerontologist Y1 - 2007 A1 - Jacqueline L. Angel A1 - Maren A. Jimenez A1 - Ronald J. Angel KW - Aged KW - Black or African American KW - Female KW - Hispanic or Latino KW - Humans KW - Longitudinal Studies KW - Middle Aged KW - United States KW - White People KW - Widowhood AB -

PURPOSE: We compare the economic consequences of widowhood for pre-retirement age and early-retirement age Black, Hispanic, and non-Hispanic White women.

METHODS: We use the 1992 and 2000 waves of the Health and Retirement Study to assess the effects of widowhood on the household incomes and assets of non-Hispanic White, Black, and Hispanic women who were 51 years of age or older at baseline (N = 4,544).

RESULTS: For women of all racial and ethnic groups, marital disruption, including widowhood, results in a substantial decline in household income and assets. Net of demographic controls, the relative loss is far greater for Black and Hispanic widows than for non-Hispanic White widows.

IMPLICATIONS: The data reveal a substantial widowhood penalty for total household income and net worth for women in each racial and ethnic group. However, the findings suggest that minority widows are at a particularly high risk of poverty in late life, given that they have lower incomes and fewer assets to begin with. Implications of the results for the financial security of women approaching retirement are discussed.

PB - 47 VL - 47 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/17440127?dopt=Abstract U4 - Widowhood/Minorities/Assets/income ER - TY - JOUR T1 - Educational disparities in the prevalence and consequence of physical vulnerability. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2007 A1 - Daniel O. Clark A1 - Timothy E. Stump A1 - Douglas K Miller A1 - Long, J. Scott KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Chronic disease KW - Cohort Studies KW - Cross-Sectional Studies KW - Educational Status KW - Female KW - Geriatric Assessment KW - Health Surveys KW - Humans KW - Male KW - Mobility Limitation KW - Risk Factors KW - Socioeconomic factors KW - Survival Analysis KW - United States AB -

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

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

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

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

PB - 62B VL - 62 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/17507595?dopt=Abstract U4 - Mortality/Physical Vulnerability/Education/ADULT HEALTH/DISABILITY/DISABILITY ER - TY - JOUR T1 - Evidence on early-life income and late-life health from America's Dust Bowl era. JF - Proceedings of the National Academy of Sciences Y1 - 2007 A1 - David M Cutler A1 - Grant Miller A1 - Douglas M Norton KW - Aged KW - Data collection KW - Female KW - Health Status KW - History, 20th Century KW - Humans KW - Income KW - Male KW - Middle Aged KW - Retirement KW - Socioeconomic factors KW - United States AB -

In recent decades, elderly Americans have enjoyed enormous gains in longevity and reductions in disability. The causes of this progress remain unclear, however. This paper investigates the role of fetal programming, exploring how economic progress early in the 20th century might be related to declining disability today. Specifically, we match sudden unexpected economic changes experienced in utero in America's Dust Bowl during the Great Depression to unusually detailed individual-level information about old-age disability and chronic disease. We are unable to detect any meaningful relationship between early life factors and outcomes in later life. We conclude that, if such a relationship exists in the United States, it is most likely not a quantitatively important explanation for declining disability today.

VL - 104 IS - 33 ER - TY - JOUR T1 - Exploring the association of dual use of the VHA and Medicare with mortality: separating the contributions of inpatient and outpatient services. JF - BMC Health Serv Res Y1 - 2007 A1 - Frederic D Wolinsky A1 - An, Hyonggin A1 - Li Liu A1 - Thomas R Miller A1 - Gary E Rosenthal KW - Aged KW - Aged, 80 and over KW - Ambulatory Care KW - Cluster Analysis KW - Continuity of Patient Care KW - Emergency Service, Hospital KW - Episode of Care KW - Hospital Mortality KW - Hospitals, Veterans KW - Humans KW - Male KW - Medicare KW - Proportional Hazards Models KW - United States KW - Veterans AB -

BACKGROUND: Older veterans may use both the Veterans Health Administration (VHA) and Medicare, but the association of dual use with health outcomes is unclear. We examined the association of indirect measures of dual use with mortality.

METHODS: Our secondary analysis used survey, claims, and National Death Index data from the Survey on Assets and Health Dynamics among the Oldest Old. The analytic sample included 1,521 men who were Medicare beneficiaries. Veterans were classified as dual users when their self-reported number of hospital episodes or physician visits exceeded that in their Medicare claims. Veterans reporting inpatient or outpatient visits but having no Medicare claims were classified as VHA-only users. Proportional hazards regression was used.

RESULTS: 897 (59%) of the men were veterans, of whom 134 (15%) were dual users. Among dual users, 60 (45%) met the criterion based on inpatient services, 54 (40%) based on outpatient services, and 20 (15%) based on both. 766 men (50%) died. Adjusting for covariates, the independent effect of any dual use was a 38% increased mortality risk (AHR = 1.38; p = .02). Dual use based on outpatient services marginally increased mortality risk by 45% (AHR = 1.45; p = .06), and dual use based on both inpatient and outpatient services increased the risk by 98% (AHR = 1.98; p = .02).

CONCLUSION: Indirect measures of dual use were associated with increased mortality risk. New strategies to better coordinate care, such as shared medical records, should be considered.

PB - 7 VL - 7 U1 - http://www.ncbi.nlm.nih.gov/pubmed/17490488?dopt=Abstract U2 - PMC1884152 U4 - Veterans: statistics/numerical/medicare/mortality/Physician visits/Physician visits/HOSPITALIZATION 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 - Health of previously uninsured adults after acquiring Medicare coverage. JF - JAMA Y1 - 2007 A1 - J. Michael McWilliams A1 - Meara, Ellen A1 - Alan M. Zaslavsky A1 - John Z. Ayanian KW - Aged KW - Cardiovascular Diseases KW - depression KW - Diabetes Mellitus KW - Female KW - Health Status KW - Health Surveys KW - Humans KW - Longitudinal Studies KW - Male KW - Medically Uninsured KW - Medicare KW - Middle Aged KW - Outcome Assessment, Health Care KW - United States AB -

CONTEXT: Uninsured near-elderly adults, particularly those with cardiovascular disease or diabetes, experience worse health outcomes than insured adults. However, the health benefits of providing insurance coverage for uninsured adults have not been clearly demonstrated.

OBJECTIVE: To assess the effect of acquiring Medicare coverage on the health of previously uninsured adults.

DESIGN AND SETTING: We conducted quasi-experimental analyses of longitudinal survey data from 1992 through 2004 from the nationally representative Health and Retirement Study. We compared changes in health trends reported by previously uninsured and insured adults after they acquired Medicare coverage at age 65 years.

PARTICIPANTS: Five thousand six adults who were continuously insured and 2227 adults who were persistently or intermittently uninsured from ages 55 to 64 years.

MAIN OUTCOME MEASURES: Differential changes in self-reported trends after age 65 years in general health, change in general health, mobility, agility, pain, depressive symptoms, and a summary measure of these 6 domains; and adverse cardiovascular outcomes (all trend changes reported in health scores per year).

RESULTS: Compared with previously insured adults, previously uninsured adults reported significantly improved health trends after age 65 years for the summary measure (differential change in annual trend, +0.20; P = .002) and several component measures. Relative to previously insured adults with cardiovascular disease or diabetes, previously uninsured adults with these conditions reported significantly improved trends in summary health (differential change in annual trend, +0.26; P = .006), change in general health (+0.02; P = .03), mobility (+0.04; P = .05), agility (+0.08; P = .003), and adverse cardiovascular outcomes (-0.015; P = .02) but not in depressive symptoms (+0.04; P = .32). Previously uninsured adults without these conditions reported differential improvement in depressive symptoms (+0.08; P = .002) but not in summary health (+0.10; P = .17) or any other measure. By age 70 years, the expected difference in summary health between previously uninsured and insured adults with cardiovascular disease or diabetes was reduced by 50%.

CONCLUSION: In this study, acquisition of Medicare coverage was associated with improved trends in self-reported health for previously uninsured adults, particularly those with cardiovascular disease or diabetes.

PB - 298 VL - 298 IS - 24 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18159058?dopt=Abstract U4 - Medicare/Insured Status/SELF-RATED HEALTH ER - TY - JOUR T1 - Hospital episodes and physician visits: the concordance between self-reports and medicare claims. JF - Med Care Y1 - 2007 A1 - Frederic D Wolinsky A1 - Thomas R Miller A1 - An, Hyonggin A1 - John F Geweke A1 - Robert B Wallace A1 - Kara B Wright A1 - Elizabeth A Chrischilles A1 - Li Liu A1 - Claire E Pavlik A1 - Elizabeth A Cook A1 - Robert L. Ohsfeldt A1 - Kelly K Richardson A1 - Gary E Rosenthal KW - Aged KW - Centers for Medicare and Medicaid Services, U.S. KW - Episode of Care KW - Female KW - Hospitalization KW - Humans KW - Insurance Claim Review KW - Interviews as Topic KW - Male KW - Physicians KW - Quality Assurance, Health Care KW - Self Disclosure KW - United States AB -

BACKGROUND: Health services use typically is examined using either self-reports or administrative data, but the concordance between the 2 is not well established.

OBJECTIVE: We evaluated the concordance of hospital and physician utilization data from self-reports and claims data, and identified factors associated with disagreement.

METHODS: We performed a secondary analysis on linked observational and administrative data. A national sample of 4310 respondents who were 70 years old or older at their baseline interviews was used. Self-reported and Medicare claims-based hospital episodes and physician visits for 12 months before baseline were examined. Kappa statistics were used to evaluate concordance, and multivariable multinomial logistic regression was used to identify factors associated with overreporting (self-reports > claims), underreporting (self-reports < claims), and concordant-reporting (self-reports approximately claims).

RESULTS: The concordance of hospital episodes was high (kappa = 0.767 for the 2 x 2 comparison of none vs. some and kappa = 0.671 for the 6 x 6 comparison of none, 1, ..., 4, or 5 or more), but concordance for physician visits was low (kappa = 0.255 for the 2 x 2 comparison of none versus some and kappa = 0.351 for the 14 x 14 comparison of none, 1, ..., 12, and 13 or more). Multivariable multinomial logistic regression indicated that over-, under-, and concordant-reporting of hospital episodes was significantly associated with gender, alcohol consumption, arthritis, cancer, heart disease, psychologic problems, lower body functional limitations, self-rated health, and depressive symptoms. Over-, under-, and concordant-reporting of physician visits were significantly associated with age, gender, race, living alone, veteran status, private health insurance, arthritis, cancer, diabetes, hypertension, heart disease, lower body functional limitations, and poor memory.

CONCLUSIONS: Concordance between self-reported and claims-based hospital episodes was high, but concordance for physician visits was low. Factors significantly associated with bidirectional (over- and underreporting) and unidirectional (over- or underreporting) error patterns were detected. Therefore, caution is advised when drawing conclusions based on just one physician visit data source.

PB - 45 VL - 45 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/17496713?dopt=Abstract U2 - PMC1904836 U4 - health Services/ADMINISTRATIVE DATA/Self-reported health/Medicare/HOSPITALIZATION ER - TY - JOUR T1 - Informal caregiving and Body Mass Index among older adults. JF - J Gerontol Nurs Y1 - 2007 A1 - Kristi Rahrig Jenkins A1 - Mohammed U Kabeto A1 - Fultz, Nancy H. A1 - Kenneth M. Langa KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Body Mass Index KW - Body Weight KW - Caregivers KW - Female KW - Geriatric Assessment KW - Humans KW - Male KW - Social Class AB -

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

PB - 33 VL - 33 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/17436868?dopt=Abstract U4 - Caregiving/Body Mass Index/Obesity ER - TY - JOUR T1 - An interpersonal continuity of care measure for Medicare Part B claims analyses. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2007 A1 - Frederic D Wolinsky A1 - Thomas R Miller A1 - John F Geweke A1 - Elizabeth A Chrischilles A1 - An, Hyonggin A1 - Robert B Wallace A1 - Claire E Pavlik A1 - Kara B Wright A1 - Robert L. Ohsfeldt A1 - Gary E Rosenthal KW - Aged KW - Aged, 80 and over KW - Continuity of Patient Care KW - Disability Evaluation KW - Female KW - Health Services Accessibility KW - Health Surveys KW - Humans KW - Insurance Claim Review KW - Male KW - Medicare Part B KW - Mobility Limitation KW - Physician-Patient Relations KW - Primary Health Care KW - United States AB -

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

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

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

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

PB - 62B VL - 62 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/17507591?dopt=Abstract U2 - PMC2914469 U4 - Medicare/Health Care Utilization ER - TY - JOUR T1 - Latent variable analyses of age trends of cognition in the Health and Retirement Study, 1992-2004. JF - Psychol Aging Y1 - 2007 A1 - John J McArdle A1 - Gwenith G Fisher A1 - Kelly M Kadlec KW - Aged KW - Aged, 80 and over KW - Aging KW - Cognition KW - Female KW - Health Surveys KW - Humans KW - Individuality KW - Longitudinal Studies KW - Male KW - Mental Recall KW - Mental Status Schedule KW - Middle Aged KW - Models, Statistical KW - Neuropsychological tests KW - Psychometrics KW - Retention, Psychology KW - Sex Factors KW - United States AB -

The present study was conducted to better describe age trends in cognition among older adults in the longitudinal Health and Retirement Study (HRS) from 1992 to 2004 (N = 17,000). The authors used contemporary latent variable models to organize this information in terms of both cross-sectional and longitudinal inferences about age and cognition. Common factor analysis results yielded evidence for at least 2 common factors, labeled Episodic Memory and Mental Status, largely separable from vocabulary. Latent path models with these common factors were based on demographic characteristics. Multilevel models of factorial invariance over age indicated that at least 2 common factors were needed. Latent curve models of episodic memory were based on age at testing and showed substantial age differences and age changes, including impacts due to retesting as well as several time-invariant and time-varying predictors.

PB - 22 VL - 22 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/17874952?dopt=Abstract U4 - Cognition/Methodology 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 - Mechanisms for racial and ethnic disparities in glycemic control in middle-aged and older Americans in the health and retirement study. JF - Arch Intern Med Y1 - 2007 A1 - Michele M Heisler A1 - Jessica Faul A1 - Rodney A. Hayward A1 - Kenneth M. Langa A1 - Caroline S Blaum A1 - David R Weir KW - Aged KW - Aged, 80 and over KW - Black People KW - Diabetes Mellitus KW - Female KW - Glycated Hemoglobin KW - Health Services Accessibility KW - Hispanic or Latino KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Patient Compliance KW - Socioeconomic factors KW - Treatment Refusal KW - United States KW - White People AB -

BACKGROUND: Mechanisms for racial/ethnic disparities in glycemic control are poorly understood.

METHODS: A nationally representative sample of 1901 respondents 55 years or older with diabetes mellitus completed a mailed survey in 2003; 1233 respondents completed valid at-home hemoglobin A(1c) (HbA(1c)) kits. We constructed multivariate regression models with survey weights to examine racial/ethnic differences in HbA(1c) control and to explore the association of HbA(1c) level with sociodemographic and clinical factors, access to and quality of diabetes health care, and self-management behaviors and attitudes.

RESULTS: There were no significant racial/ethnic differences in HbA(1c) levels in respondents not taking antihyperglycemic medications. In 1034 respondents taking medications, the mean HbA(1c) value (expressed as percentage of total hemoglobin) was 8.07% in black respondents and 8.14% in Latino respondents compared with 7.22% in white respondents (P < .001). Black respondents had worse medication adherence than white respondents, and Latino respondents had more diabetes-specific emotional distress (P < .001). Adjusting for hypothesized mechanisms accounted for 14.0% of the higher HbA(1c) levels in black respondents and 19.0% in Latinos, with the full model explaining 22.0% of the variance. Besides black and Latino ethnicity, only insulin use (P < .001), age younger than 65 years (P = .007), longer diabetes duration (P = .004), and lower self-reported medication adherence (P = .04) were independently associated with higher HbA(1c) levels.

CONCLUSIONS: Latino and African American respondents had worse glycemic control than white respondents. Socioeconomic, clinical, health care, and self-management measures explained approximately a fifth of the HbA(1c) differences. One potentially modifiable factor for which there were racial disparities--medication adherence--was among the most significant independent predictors of glycemic control.

PB - 167 VL - 167 IS - 17 U1 - http://www.ncbi.nlm.nih.gov/pubmed/17893306?dopt=Abstract U4 - Racial Differences/Diabetes Mellitus ER - TY - JOUR T1 - New evidence of racial differences in access and their effects on the use of nursing homes among older adults. JF - Med Care Y1 - 2007 A1 - Adaeze B Akamigbo A1 - Frederic D Wolinsky KW - Aged KW - Assisted Living Facilities KW - Attitude to Health KW - Black or African American KW - Female KW - Health Services Accessibility KW - Health Status KW - Homes for the Aged KW - Humans KW - Male KW - Nursing homes KW - Socioeconomic factors KW - Time Factors KW - White People AB -

BACKGROUND: Historical disparities in rates of nursing home placement between blacks and whites have been well documented, and are thought to result from more extensive and supportive social networks, cultural aversion, and poorer geographic access among African Americans. A few recent studies, however, suggest that these racial disparities may no longer exist. We used comprehensive data to assess whether racial differences in nursing home placement remain, and if so, to identify the reasons for them.

METHODS: Data on 6242 black and white self-respondents to the Survey of Assets and Health Dynamics Among the Oldest Old cohort who were 70 years old or older at baseline (1993) were used. Placement status was ascertained at each biennial follow-up through 2004, and discrete-time hazards models were estimated.

RESULTS: After adjusting for baseline covariates, it was found that blacks were 26% (lambda = 0.74, P < 0.001) less likely to use a nursing home over an 11-year period than whites. Moreover, the supply of skilled nursing beds was more salient for nursing home placement for blacks than whites, as was the increasing supply of assisted living beds.

CONCLUSIONS: The racial gap in nursing home placement remains, despite the increased supply of nursing home beds and the emergence of assisted living facilities as the preferred alternative. As the supply of skilled nursing beds increases, in part due to whites choosing assisted living facilities, the racial gap in the risks of nursing home placement may be lessening. Blacks, however, remain less likely to be placed in a nursing home than whites.

PB - 45 VL - 45 IS - 7 U1 - http://www.ncbi.nlm.nih.gov/pubmed/17571016?dopt=Abstract 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 - Participation in food assistance programs modifies the relation of food insecurity with weight and depression in elders. JF - J Nutr Y1 - 2007 A1 - Kim, Kirang A1 - Edward A Frongillo KW - Aged KW - depression KW - Female KW - Food Services KW - Food Supply KW - Health Surveys KW - Humans KW - Linear Models KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Models, Theoretical KW - Overweight KW - Public Assistance KW - United States AB -

The relation of food insecurity in elders with outcomes such as overweight and depression, and the influence of participation in food assistance programs on these relations, has not been established. The aim of this study was to examine the relation between food insecurity and weight and depression in elders, and determine whether participation in food assistance programs modifies the effect of food insecurity on weight and depression. Two longitudinal data sets were used: the Health and Retirement Study (1996-2002) and the Asset and Health Dynamics Among the Oldest Old (1995-2002). The relation of food insecurity and participation in food assistance programs was assessed by multilevel linear regression analysis. Food insecurity was positively related to weight and depression among elders. Some analyses supported that food-insecure elders who participated in food assistance programs were less likely to be overweight and depressed than those who did not participate in food assistance programs. This finding implies that food assistance programs can have both nutritional and non-nutritional impacts. The positive impact of participation in food assistance programs of reducing or preventing poor outcomes resulting from food insecurity will improve elders' quality of life, save on their healthcare expenses, and help to meet their nutritional needs.

PB - 137 VL - 137 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/17374668?dopt=Abstract U4 - Nutrition/Weight/Depression/Elderly ER - TY - JOUR T1 - Predicting the changes in depressive symptomatology in later life: how much do changes in health status, marital and caregiving status, work and volunteering, and health-related behaviors contribute? JF - J Aging Health Y1 - 2007 A1 - Namkee G Choi A1 - Bohman, Thomas M. KW - Aged KW - Caregivers KW - depression KW - Employment KW - Female KW - Forecasting KW - Health Behavior KW - Health Status KW - Humans KW - Male KW - Marital Status KW - Middle Aged KW - Netherlands KW - Regression Analysis KW - Sweden KW - United States KW - Volunteers AB -

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

PB - 19 VL - 19 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/17215206?dopt=Abstract U4 - Depression Symptoms/DISABILITY/DISABILITY/Caregiver Status/Marital Status/Work, volunteer ER - TY - JOUR T1 - Prevalence of dementia in the United States: the aging, demographics, and memory study. JF - Neuroepidemiology Y1 - 2007 A1 - Brenda L Plassman A1 - Kenneth M. Langa A1 - Gwenith G Fisher A1 - Steven G Heeringa A1 - David R Weir A1 - Mary Beth Ofstedal A1 - James R Burke A1 - Michael D Hurd A1 - Guy G Potter A1 - Willard L Rodgers A1 - David C Steffens A1 - Robert J. Willis A1 - Robert B Wallace KW - Age Distribution KW - Aged KW - Aged, 80 and over KW - Cohort Studies KW - Dementia KW - Female KW - Geriatric Assessment KW - Health Surveys KW - Humans KW - Logistic Models KW - Male KW - Prevalence KW - Sex Distribution KW - United States AB -

AIM: To estimate the prevalence of Alzheimer's disease (AD) and other dementias in the USA using a nationally representative sample.

METHODS: The Aging, Demographics, and Memory Study sample was composed of 856 individuals aged 71 years and older from the nationally representative Health and Retirement Study (HRS) who were evaluated for dementia using a comprehensive in-home assessment. An expert consensus panel used this information to assign a diagnosis of normal cognition, cognitive impairment but not demented, or dementia (and dementia subtype). Using sampling weights derived from the HRS, we estimated the national prevalence of dementia, AD and vascular dementia by age and gender.

RESULTS: The prevalence of dementia among individuals aged 71 and older was 13.9%, comprising about 3.4 million individuals in the USA in 2002. The corresponding values for AD were 9.7% and 2.4 million individuals. Dementia prevalence increased with age, from 5.0% of those aged 71-79 years to 37.4% of those aged 90 and older.

CONCLUSIONS: Dementia prevalence estimates from this first nationally representative population-based study of dementia in the USA to include subjects from all regions of the country can provide essential information for effective planning for the impending healthcare needs of the large and increasing number of individuals at risk for dementia as our population ages.

PB - 29 VL - 29 IS - 1-2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/17975326?dopt=Abstract U4 - aging/Dementia/Epidemiology ER - TY - JOUR T1 - Profiling retirees in the retirement transition and adjustment process: examining the longitudinal change patterns of retirees' psychological well-being. JF - Journal of Applied Psychology Y1 - 2007 A1 - Wang, Mo KW - Aged KW - Female KW - Follow-Up Studies KW - Humans KW - Male KW - Middle Aged KW - Quality of Life KW - Retirement KW - Social Adjustment AB -

The author used role theory, continuity theory, and the life course perspective to form hypotheses regarding the different retirement transition and adjustment patterns and how different individual and contextual variables related to those patterns. The longitudinal data of 2 samples (n(1) = 994; n(2) = 1,066) from the Health and Retirement Survey were used. Three latent growth curve patterns of retirees' psychological well-being were identified as coexisting in the retiree samples through growth mixture modeling (GMM) analysis. On the basis of the latent class membership derived from GMM, retiree subgroups directly linked to different growth curve patterns were profiled with individual (e.g., bridge job status) and contextual variables (e.g., spouse working status). By recognizing the existence of multiple retiree subgroups corresponding to different psychological well-being change patterns, this study suggests that retirees do not follow a uniform adjustment pattern during the retirement process, which reconciles inconsistent previous findings. A resource perspective is further introduced to provide a more integrated theory for the current findings. The practical implications of this study are also discussed at both individual level and policy level.

VL - 92 IS - 2 ER - TY - JOUR T1 - Racial/ethnic differences in the development of disability among older adults. JF - Am J Public Health Y1 - 2007 A1 - Dorothy D Dunlop A1 - Song, Jing A1 - Larry M Manheim A1 - Daviglus, Martha L. A1 - Rowland W Chang KW - Activities of Daily Living KW - Aged KW - Black or African American KW - Disabled Persons KW - Female KW - Health Behavior KW - Health Status Disparities KW - Health Surveys KW - Hispanic or Latino KW - Humans KW - Male KW - Prevalence KW - Proportional Hazards Models KW - Prospective Studies KW - Risk KW - Socioeconomic factors KW - Survival Analysis KW - United States KW - White People AB -

OBJECTIVES: We investigated differences in the development of disability in activities of daily living among non-Hispanic Whites, African Americans, Hispanics interviewed in Spanish, and Hispanics interviewed in English.

METHODS: We estimated 6-year risk for disability development among 8161 participants 65 years or older and free of baseline disability. We evaluated mediating factors amenable to clinical and public health intervention on racial/ethnic difference.

RESULTS: The risk for developing disability among Hispanics interviewed in English was similar to that among Whites (hazard ratio [HR]=0.99; 95% confidence interval [CI] = 0.6, 1.4) but was substantially higher among African Americans (HR=1.6; 95% CI=1.3, 1.9) and Hispanics interviewed in Spanish (HR=1.8; 95% CI=1.4, 2.1). Adjustment for demographics, health, and socioeconomic status reduced a large portion of those disparities (African American adjusted HR=1.1, Spanish-interviewed Hispanic adjusted HR=1.2).

CONCLUSIONS: Higher risks for developing disability among older African Americans, and Hispanics interviewed in Spanish compared with Whites were largely attenuated by health and socioeconomic differences. Language- and culture-specific programs to increase physical activity and promote weight maintenance may reduce rates of disability in activities of daily living and reduce racial/ethnic disparities in disability.

PB - 97 VL - 97 IS - 12 U1 - http://www.ncbi.nlm.nih.gov/pubmed/17971548?dopt=Abstract U4 - aging/Chronic Disease/DISABILITY/DISABILITY/Racial Differences ER - TY - JOUR T1 - The relationship between self-rated health and mortality in older black and white Americans. JF - J Am Geriatr Soc Y1 - 2007 A1 - Sei J. Lee A1 - Sandra Y. Moody-Ayers A1 - C. Seth Landefeld A1 - Louise C Walter A1 - Lindquist, Karla A1 - Mark Segal A1 - Kenneth E Covinsky KW - Age Distribution KW - Aged KW - Aged, 80 and over KW - Black People KW - Educational Status KW - Female KW - Health Status KW - Humans KW - Male KW - Middle Aged KW - Mortality KW - Population Surveillance KW - Prognosis KW - Self Disclosure KW - Sex Distribution KW - United States KW - White People AB -

OBJECTIVES: To determine whether the association between self-rated health (SRH) and 4-year mortality differs between black and white Americans and whether education affects this relationship.

DESIGN: Prospective cohort.

SETTING: Communities in the United States.

PARTICIPANTS: Sixteen thousand four hundred thirty-two subjects (14,004 white, 2,428 black) enrolled in the 1998 wave of the Health and Retirement Study (HRS), a population-based study of community-dwelling U.S. adults aged 50 and older.

MEASUREMENTS: Subjects were asked to self-identify their race and their overall health by answering the question, "Would you say your health is excellent, very good, good, fair, or poor?" Death was determined according to the National Death Index.

RESULTS: SRH is a much stronger predictor of mortality in whites than blacks (c-statistic 0.71 vs 0.62). In whites, poor SRH resulted in a markedly higher risk of mortality than excellent SRH (odds ratio (OR)=10.4, 95% confidence interval (CI)=8.0-13.6). In blacks, poor RSH resulted in a much smaller increased risk of mortality (OR=2.9, 95% CI=1.5-5.5). SRH was a stronger predictor of death in white and black subjects with higher levels of education, but differences in education could not account for the observed race differences in the prognostic effect of SRH.

CONCLUSION: This population-based study found that the relationship between SRH and mortality is stronger in white Americans and in subjects with higher levels of education. Because the association between SRH and mortality appears weakest in traditionally disadvantaged groups, SRH may not be the best measure to identify vulnerable older subjects.

PB - 55 VL - 55 IS - 10 U1 - http://www.ncbi.nlm.nih.gov/pubmed/17697102?dopt=Abstract U4 - Minorities/African Americans/SELF-RATED HEALTH/EDUCATION/MORTALITY ER - TY - JOUR T1 - Risk of nursing home admission among older americans: does states' spending on home- and community-based services matter? JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2007 A1 - Muramatsu, Naoko A1 - yin, Hongjun A1 - Richard T. Campbell A1 - Ruby L Hoyem A1 - Martha A. Jacob A1 - Christopher Ross KW - Aged KW - Aged, 80 and over KW - Caregivers KW - Cohort Studies KW - Cost Savings KW - Cost-Benefit Analysis KW - Female KW - Financing, Government KW - Health Expenditures KW - Home Care Services KW - Homes for the Aged KW - Humans KW - Insurance Coverage KW - Long-term Care KW - Male KW - Medicaid KW - Medicare KW - Nursing homes KW - Patient Admission KW - Patient Readmission KW - Risk Assessment KW - Risk Factors KW - State Health Plans KW - United States AB -

OBJECTIVE: States vary greatly in their support for home- and community-based services (HCBS) that are intended to help disabled seniors live in the community. This article examines how states' generosity in providing HCBS affects the risk of nursing home admission among older Americans and how family availability moderates such effects.

METHODS: We conducted discrete time survival analysis of first long-term (90 or more days) nursing home admissions that occurred between 1995 and 2002, using Health and Retirement Study panel data from respondents born in 1923 or earlier.

RESULT: State HCBS effects were conditional on child availability among older Americans. Living in a state with higher HCBS expenditures was associated with lower risk of nursing home admission among childless seniors (p <.001). However, the association was not statistically significant among seniors with living children. Doubling state HCBS expenditures per person aged 65 or older would reduce the risk of nursing home admission among childless seniors by 35%.

DISCUSSION: Results provided modest but important evidence supportive of increasing state investment in HCBS. Within-state allocation of HCBS resources, however, requires further research and careful consideration about fairness for individual seniors and their families as well as cost effectiveness.

PB - 62B VL - 62 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/17507592?dopt=Abstract U4 - Home Care Services/Nursing Homes/Health Policy/Elderly 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 - Urban neighborhoods and depressive symptoms among older adults. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2007 A1 - Carol S Aneshensel A1 - Richard G Wight A1 - Miller-Martinez, Dana A1 - Amanda L. Botticello A1 - Arun S Karlamangla A1 - Teresa Seeman KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Comorbidity KW - Cross-Sectional Studies KW - Depressive Disorder KW - Female KW - Health Status Indicators KW - Health Surveys KW - Humans KW - Incidence KW - Male KW - Minority Groups KW - Peer Group KW - Population Dynamics KW - Risk Factors KW - Social Environment KW - United States KW - Urban Population AB -

OBJECTIVE: This study seeks to determine whether depressive symptoms among older persons systematically vary across urban neighborhoods such that experiencing more symptoms is associated with low socioeconomic status (SES), high concentrations of ethnic minorities, low residential stability and low proportion aged 65 years and older.

METHODS: Survey data are from the Study of Assets and Health Dynamics Among the Oldest Old (AHEAD), a 1993 U.S. national probability sample of noninstitutionalized persons born in 1923 or earlier (i.e. people aged 70 or older). Neighborhood data are from the 1990 Census at the tract level. Hierarchical linear regression is used to estimate multilevel models.

RESULT: The average number of depressive symptoms varies across Census tracts independent of individual-level characteristics. Symptoms are not significantly associated with neighborhood SES, ethnic composition, or age structure when individual-level characteristics are controlled statistically. However, net of individual-level characteristics, symptoms are positively associated with neighborhood residential stability, pointing to a complex meaning of residential stability for the older population.

DISCUSSION: This study shows that apparent neighborhood-level socioeconomic effects on depressive symptoms among urban-dwelling older adults are largely if not entirely compositional in nature. Further, residential stability in the urban neighborhood may not be emotionally beneficial to its aged residents.

PB - 62 VL - 62 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/17284567?dopt=Abstract U4 - Depressive Symptoms/Socioeconomic Factors/Urban Population ER - TY - JOUR T1 - Use of health services by previously uninsured Medicare beneficiaries. JF - N Engl J Med Y1 - 2007 A1 - J. Michael McWilliams A1 - Meara, Ellen A1 - Alan M. Zaslavsky A1 - John Z. Ayanian KW - Aged KW - Cardiovascular Diseases KW - Diabetes Mellitus KW - Female KW - Health Expenditures KW - Health Services KW - Hospitalization KW - Humans KW - Insurance, Health KW - Logistic Models KW - Longitudinal Studies KW - Male KW - Medically Uninsured KW - Medicare KW - Middle Aged KW - Socioeconomic factors KW - United States AB -

BACKGROUND: Previously uninsured adults who enroll in the Medicare program at the age of 65 years may have greater morbidity, requiring more intensive and costlier care over subsequent years, than they would if they had been previously insured.

METHODS: We used longitudinal data from the nationally representative Health and Retirement Study to assess self-reported health care use and expenditures from 1992 through 2004 among 5158 adults who were privately insured or uninsured before Medicare coverage began at the age of 65 years. We used propensity-score methods to compare health care use and expenditures for previously insured and uninsured beneficiaries who were similar across numerous characteristics at 59 to 60 years of age and adjusted for differences in supplemental and prescription-drug coverage after 65 years of age.

RESULTS: Among 2951 adults with hypertension, diabetes, heart disease, or stroke diagnosed before 65 years of age, previously uninsured adults who acquired Medicare coverage at the age of 65 reported significantly greater increases in the numbers of doctor visits (P<0.001) and hospitalizations (P=0.001) and in total medical expenditures (P=0.02) than did previously insured adults. Significant differential increases were not evident among the 2207 adults without these conditions (P>0.12 for all comparisons). In analyses adjusted for supplemental and prescription-drug coverage, previously uninsured adults with these conditions reported more doctor visits (13% relative difference, P=0.04), more hospitalizations (20% relative difference, P=0.04), and higher total medical expenditures (51% relative difference, P=0.09) from ages 65 to 72 years than did previously insured adults.

CONCLUSIONS: The costs of expanding health insurance coverage for uninsured adults before they reach the age of 65 years may be partially offset by subsequent reductions in health care use and spending for these adults after the age of 65, particularly if they have cardiovascular disease or diabetes before the age of 65 years.

PB - 357 VL - 357 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/17625126?dopt=Abstract U4 - Medicare/Health Insurance Coverage/Health Care Utilization 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 - Driving cessation and consumption expenses in the later years. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2006 A1 - Hyungsoo Kim A1 - Virginia E. Richardson KW - Aged KW - Automobile Driving KW - Economics KW - Female KW - Health Status KW - Humans KW - Male KW - Sex Factors KW - Surveys and Questionnaires KW - Transportation AB -

OBJECTIVES: This study examined the association between consumption and driving status among older persons within the context of selected variables, including self-rated health and functional status.

METHODS: The data were from the 1998, 2000, and 2002 Health and Retirement Study and the 2003 Health and Retirement Study Consumption and Activities Mail Survey. We conducted Tobit regression analyses on five consumption categories of basic needs (such as food) and higher order needs (such as trips and dining out).

RESULTS: Consumption and driving status were significantly associated, showing that driving cessation was related to a 46% to 63% reduction in spending on trips, tickets, and dining out. Another significant relationship emerged between consumption and having never driven. Driving cessation was minimally related to consumption of basic needs (such as food and clothing) and was more strongly associated with higher order needs (such as trips).

DISCUSSION: The findings demonstrate the association between older people's driving status and consumption, specifically higher order activities. Older persons who drive and, presumably, have more opportunities to go to stores, restaurants, and other outside events, spend more on food, tickets, and dining out than those who cease driving or have never driven. Although the direction of causality remains unclear, these findings have implications for those concerned with alternative transportation resources for older adults.

PB - 61B VL - 61 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/17114315?dopt=Abstract U4 - Consumption/Driving Patterns/Elderly ER - TY - JOUR T1 - Dual use of Medicare and the Veterans Health Administration: are there adverse health outcomes? JF - BMC Health Serv Res Y1 - 2006 A1 - Frederic D Wolinsky A1 - Thomas R Miller A1 - An, Hyonggin A1 - Paul R Brezinski A1 - Thomas E Vaughn A1 - Gary E Rosenthal KW - Aged KW - Aged, 80 and over KW - Deductibles and Coinsurance KW - Episode of Care KW - Health Services Research KW - Hospitals, Veterans KW - Humans KW - Male KW - Medicare KW - Mortality KW - Outcome Assessment, Health Care KW - Proportional Hazards Models KW - Quality Indicators, Health Care KW - Risk Assessment KW - Selection Bias KW - Surveys and Questionnaires KW - United States KW - United States Department of Veterans Affairs KW - Veterans AB -

BACKGROUND: Millions of veterans are eligible to use the Veterans Health Administration (VHA) and Medicare because of their military service and age. This article examines whether an indirect measure of dual use based on inpatient services is associated with increased mortality risk.

METHODS: Data on 1,566 self-responding men (weighted N = 1,522) from the Survey of Assets and Health Dynamics among the Oldest Old (AHEAD) were linked to Medicare claims and the National Death Index. Dual use was indirectly indicated when the self-reported number of hospital episodes in the 12 months prior to baseline was greater than that observed in the Medicare claims. The independent association of dual use with mortality was estimated using proportional hazards regression.

RESULTS: 96 (11%) of the veterans were classified as dual users. 766 men (50.3%) had died by December 31, 2002, including 64.9% of the dual users and 49.3% of all others, for an attributable mortality risk of 15.6% (p < .003). Adjusting for demographics, socioeconomics, comorbidity, hospitalization status, and selection bias at baseline, as well as subsequent hospitalization for ambulatory care sensitive conditions, the independent effect of dual use was a 56.1% increased relative risk of mortality (AHR = 1.561; p = .009).

CONCLUSION: An indirect measure of veterans' dual use of the VHA and Medicare systems, based on inpatient services, was associated with an increased risk of death. Further examination of dual use, especially in the outpatient setting, is needed, because dual inpatient and dual outpatient use may be different phenomena.

PB - 6 VL - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/17029643?dopt=Abstract U2 - PMC1617101 U4 - Veterans: statistics/numerical/Medicare/public Policy/Mortality ER - TY - JOUR T1 - Effects of retirement and grandchild care on depressive symptoms. JF - Int J Aging Hum Dev Y1 - 2006 A1 - Maximiliane E Szinovacz A1 - Adam Davey KW - Aged KW - Aging KW - Child KW - Child Rearing KW - depression KW - Family Characteristics KW - Female KW - Holistic health KW - Humans KW - Intergenerational Relations KW - Leisure activities KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Retirement KW - Sex Factors KW - Social Responsibility KW - Surveys and Questionnaires KW - United States AB -

This study explores how grandchild care in conjunction with grandparents' retirement affects depressive symptoms, using data from the Health and Retirement Survey. The findings demonstrate that retirement moderates the influence of grandchild care obligations on well-being, measured by depressive symptoms. For retired men, freedom from grandchild care obligations is associated with heightened well-being. Among women, continued employment seems to protect against potential negative effects of extensive grandchild care obligations on well-being. The results for men seem most in line with the argument that family care obligations spoil retirement, whereas the results for women suggest a scenario that is most compatible with the role enhancement thesis.

PB - 62 VL - 62 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/16454480?dopt=Abstract U4 - Caregiving/Retirement/Children ER - TY - JOUR T1 - Expansion of elderly couples' IADL caregiver networks beyond the marital dyad. JF - Int J Aging Hum Dev Y1 - 2006 A1 - Sheila Feld A1 - Ruth E Dunkle A1 - Tracy Schroepfer KW - Activities of Daily Living KW - Aged KW - Caregivers KW - Female KW - Humans KW - Logistic Models KW - Male KW - Marriage KW - Multivariate Analysis KW - Self-Help Groups AB -

Factors influencing expansion of instrumental activities of daily living (IADL) caregiver networks beyond the spouse/partner were studied, using data from the Asset and Health Dynamics among the Oldest Old (AHEAD) nationally representative sample of American elders (ages 70 and older). Analyses were based on 427 Black and White couples in which one partner regularly received IADL assistance; nearly 20% had expanded networks. Logistic regression showed expanded networks were significantly more likely when spouses had IADL or basic personal activity of everyday living (ADL) limitations and help recipients were wives or had numerous IADL or ADL limitations; they also tended to be more common (p <.10) for couples with numerous nearby daughters and help recipients with proxies and those without serious cognitive problems. Network expansion was unrelated to recipients' number of health conditions and Medicaid coverage or couples' ages, marital duration, income, and number of proximate sons. Implications for service programs and caregiving theories of the circumstances linked to IADL assistance from outside the marital dyad are discussed.

PB - 37 VL - 63 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/17137029?dopt=Abstract U4 - Caregivers/Couples/ADL and IADL Impairments ER - TY - JOUR T1 - Functional impairment, race, and family expectations of death. JF - J Am Geriatr Soc Y1 - 2006 A1 - Brie A Williams A1 - Lindquist, Karla A1 - Sandra Y. Moody-Ayers A1 - Louise C Walter A1 - Kenneth E Covinsky KW - Activities of Daily Living KW - Aged KW - Attitude to Death KW - Black or African American KW - Cross-Sectional Studies KW - Disabled Persons KW - Family KW - Female KW - Hispanic or Latino KW - Humans KW - Male KW - White People AB -

OBJECTIVES: To assess the effect of functional impairment on family expectations of death and to examine how this association varies by race.

DESIGN: Cross-sectional.

SETTING: Community based.

PARTICIPANTS: Two thousand two hundred thirty-seven family members of decedents from the Health and Retirement Survey (HRS), a national study of persons aged 50 and older.

MEASUREMENTS: Families were interviewed within 2 years of the HRS participant's death. The primary outcome was whether death was expected. The primary predictors were the decedent's functional status (impairment in any activity of daily living (ADL; eating, dressing, transferring, toileting, or bathing) during the last 3 months of life and the decedent's race.

RESULTS: Overall, 58% of families reported that their family member's death was expected. Expecting death was strongly associated with functional impairment; 71% of families of decedents with ADL disability expected death, compared with 24% of those without ADL disability (P < .01). Death was expected more often in families of white decedents (60%) than African Americans (49%) (P < .01), although the effect of ADL disability was similar in both groups. After adjustment for potentially confounding factors, there were still significant associations between expecting death and functional impairment (odds ratio (OR) = 3.58, 95% confidence interval (CI) 2.73-4.70), and families of African Americans expected death less often than families of white decedents (OR = 0.63, 95% CI = 0.46-0.86).

CONCLUSION: Family members of older adults expected death only 58% of the time. Families of functionally impaired older people were more likely to expect death when it occurred than were families of older people who were not functionally impaired, and the expectation of death was lower for families of African Americans than for whites.

PB - 54 VL - 54 IS - 11 U1 - http://www.ncbi.nlm.nih.gov/pubmed/17087694?dopt=Abstract U4 - Activities of Daily Living/Minorities/Hispanic/African Americans/functional impairment/expectations/death ER - TY - JOUR T1 - Increased wealth and income as correlates of self-assessed retirement. JF - J Gerontol Soc Work Y1 - 2006 A1 - Caputo, Richard K. KW - Aged KW - Data collection KW - Employment KW - Female KW - Financing, Personal KW - Humans KW - Income KW - Interviews as Topic KW - Male KW - Middle Aged KW - Motivation KW - Organizational Policy KW - Pensions KW - Retirement KW - Self-Assessment KW - Social Security KW - Socioeconomic factors KW - United States AB -

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

PB - 47 VL - 47 IS - 1-2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/16901883?dopt=Abstract U4 - Labor Force/Retirement Behavior/Retirement Incomes ER - TY - JOUR T1 - Loneliness as a specific risk factor for depressive symptoms: cross-sectional and longitudinal analyses. JF - Psychol Aging Y1 - 2006 A1 - John T. Cacioppo A1 - Mary Elizabeth Hughes A1 - Linda J. Waite A1 - Louise C Hawkley A1 - Ronald A. Thisted KW - Aged KW - Cross-Sectional Studies KW - depression KW - Female KW - Follow-Up Studies KW - Health Status KW - Hostility KW - Humans KW - Loneliness KW - Male KW - Middle Aged KW - Risk Factors KW - Severity of Illness Index KW - Social Support KW - Stress, Psychological KW - Surveys and Questionnaires AB -

The extent to which loneliness is a unique risk factor for depressive symptoms was determined in 2 population-based studies of middle-aged to older adults, and the possible causal influences between loneliness and depressive symptoms were examined longitudinally in the 2nd study. In Study 1, a nationally representative sample of persons aged 54 and older completed a telephone interview as part of a study of health and aging. Higher levels of loneliness were associated with more depressive symptoms, net of the effects of age, gender, ethnicity, education, income, marital status, social support, and perceived stress. In Study 2, detailed measures of loneliness, social support, perceived stress, hostility, and demographic characteristics were collected over a 3-year period from a population-based sample of adults ages 50-67 years from Cook County, Illinois. Loneliness was again associated with more depressive symptoms, net of demographic covariates, marital status, social support, hostility, and perceived stress. Latent variable growth models revealed reciprocal influences over time between loneliness and depressive symptomatology. These data suggest that loneliness and depressive symptomatology can act in a synergistic effect to diminish well-being in middle-aged and older adults.

PB - 21 VL - 21 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/16594799?dopt=Abstract U4 - Loneliness/Depression/Social Support/Stress 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 - Religious influences on preventive health care use in a nationally representative sample of middle-age women. JF - J Behav Med Y1 - 2006 A1 - Benjamins, Maureen Reindl KW - Aged KW - Breast Self-Examination KW - Female KW - Health Behavior KW - Health Status Indicators KW - Health Surveys KW - Humans KW - Mammography KW - Mass Screening KW - Middle Aged KW - Papanicolaou Test KW - Preventive Health Services KW - Religion and Medicine KW - Religion and Psychology KW - Social Support KW - Socioeconomic factors KW - United States KW - Utilization Review KW - Vaginal Smears AB -

Despite the many benefits of preventive services, they are often underutilized. Social factors, such as religion, can figure prominently in these discrepancies by either creating barriers or facilitating use. Using data from the Health and Retirement Survey (HRS, 1992-1996), the current study examines the relationship between religious attendance, religious salience, and denomination and three types of female preventive services in a sample of middle-age women (N = 4253). Findings indicate that women who attend religious services more frequently use more mammograms, Pap smears, and self-breast exams. In addition, women belonging to Mainline Protestant or Jewish denominations use certain preventive services more than Evangelical Protestants. Finally, women with higher levels of religious salience are more likely to conduct self-breast exams. These findings add important information to the public health literature concerning factors that influence preventive service use. They also add to the growing field of religion and health research where preventive health care use is emerging as a possible mechanism linking religion to a wide variety of physical health outcomes.

PB - 29 VL - 29 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/16397821?dopt=Abstract U4 - prevention/Health Care/Religiosity/Womens Health 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 - Retirement patterns from career employment. JF - Gerontologist Y1 - 2006 A1 - Kevin E. Cahill A1 - Michael D. Giandrea A1 - Joseph F. Quinn KW - Aged KW - Aged, 80 and over KW - Aging KW - Career Choice KW - Employment KW - Female KW - Health Status KW - Humans KW - Income KW - Male KW - Middle Aged KW - Pensions KW - Retirement KW - Social Security KW - United States AB -

PURPOSE: This article investigates how older Americans leave their career jobs and estimates the extent of intermediate labor force activity (bridge jobs) between full-time work on a career job and complete labor-force withdrawal.

DESIGN AND METHODS: Using data from the Health and Retirement Study, we explored the work histories and retirement patterns of a cohort of retirees aged 51 to 61 in 1992 during a 10-year period in both cross-sectional and longitudinal contexts. We examined determinants of retirement patterns in a multinomial logistic regression model.

RESULTS: We found that a majority of older Americans with career jobs retire gradually, in stages, rather than all at once. We also found that the utilization of bridge jobs was more common among younger respondents, respondents without defined-benefit pension plans, and respondents at both the lower and upper ends of the wage distribution.

IMPLICATIONS: Older Americans are now working longer than pre-1980s trends would have predicted. Given concerns about the traditional sources of retirement income (Social Security, employer pensions, and prior savings), older Americans may have to rely more on earnings. This article suggests that many are already doing so by moving to bridge jobs after leaving their career employment.

PB - 46 VL - 46 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/16921005?dopt=Abstract U4 - Labor Force Attachment/Bridge Jobs/Retirement Behavior ER - TY - JOUR T1 - Social status, risky health behaviors, and diabetes in middle-aged and older adults. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2006 A1 - Linda A. Wray A1 - Duane F. Alwin A1 - Ryan J McCammon A1 - Manning, Timothy A1 - Best, Latrica E. KW - Aged KW - Body Mass Index KW - Diabetes Mellitus KW - Female KW - Follow-Up Studies KW - Health Behavior KW - Humans KW - Incidence KW - Male KW - Middle Aged KW - Prevalence KW - Risk-Taking KW - Social Behavior KW - Social Class KW - Surveys and Questionnaires AB -

OBJECTIVE: This article investigates: (a) how social status influences diabetes prevalence and incidence; (b) how risky health behaviors contribute to the prediction of incident diabetes; (c) if the effects of health behaviors mediate the effects of social status on incident diabetes; and (d) if these effects differ in midlife and older age.

METHODS: We examined nationally representative data from the 1992/1993-1998 panels of the Health and Retirement Study for middle-aged and older adults using logistic regression analyses.

RESULT: The odds of prevalent diabetes were higher for people of older age, men, Black adults, and Latino adults. Higher early-life social status (e.g., parental schooling) and achieved social status (e.g., respondent schooling, economic resources) reduced the odds in both age groups. We observed similar patterns for incident diabetes in midlife but not in older age. Risky health behaviors--particularly obesity--increased the odds of incident diabetes in both age groups independent of social status. The increased odds of incident diabetes in midlife persisted for Black and Latino adults net of other social status factors.

DISCUSSION: Risky health behaviors are key predictors of incident diabetes in both age groups. Economic resources also play an important protective role in incident diabetes in midlife but not in older age.

PB - 61B VL - 61 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/17114308?dopt=Abstract U4 - Health Insurance/mortality/health behaviors/diabetes ER - TY - JOUR T1 - The tide to come: elderly health in Latin America and the Caribbean. JF - J Aging Health Y1 - 2006 A1 - Alberto Palloni A1 - Mary McEniry A1 - Rebeca Wong A1 - Pelaez, M. KW - Aged KW - Aged, 80 and over KW - Caribbean Region KW - Child KW - Diabetes Mellitus KW - Forecasting KW - Health Status KW - Heart Diseases KW - Humans KW - Latin America KW - Malnutrition KW - Middle Aged KW - Mortality KW - Nutritional Status KW - United States AB -

This article introduces a conjecture and reviews partial evidence about peculiarities in the aging of populations in Latin America and the Caribbean (LAC) that may impact future elderly health status. Using Survey on Health and Well-Being of Elders data (SABE; n = 10,902), the authors estimated effects of early childhood conditions on adult diabetes and heart disease. Using Waaler-type surfaces, the authors obtained expected mortality risks for SABE and also U.S. elderly (Health and Retirement System, n = 12,527). Expected mortality risks using Waaler-type surfaces among elderly in LAC reflected excesses supporting our conjecture. There was partial evidence of a relation between various indicators of early childhood nutritional status (knee height, waist-to-hip ratio) and diabetes and even stronger evidence of a relation between rheumatic fever and adult heart disease. There is some evidence, albeit weak, to suggest that the conjecture regarding elderly health status' connection to early conditions has some merit.

PB - 18 VL - 18 IS - 2 N1 - Article English U1 - http://www.ncbi.nlm.nih.gov/pubmed/16614340?dopt=Abstract U4 - childhood conditions/diabetes/heart disease/Latin America/health/health outcomes/nutritional status/mortality/STATURE PREDICTION EQUATIONS/ADULT HEALTH/CHILDHOOD/MORTALITY/GROWTH/MORBIDITY/DYNAMICS/FRAILTY/IMPACT ER - TY - JOUR T1 - Urban neighborhood context, educational attainment, and cognitive function among older adults. JF - Am J Epidemiol Y1 - 2006 A1 - Richard G Wight A1 - Carol S Aneshensel A1 - Miller-Martinez, Dana A1 - Amanda L. Botticello A1 - Janet R. Cummings A1 - Arun S Karlamangla A1 - Teresa Seeman KW - Aged KW - Aged, 80 and over KW - Chi-Square Distribution KW - Cognition Disorders KW - Educational Status KW - Female KW - Humans KW - Linear Models KW - Male KW - Residence Characteristics KW - Risk Factors KW - Socioeconomic factors KW - United States KW - Urban Population AB -

Existing research has not addressed the potential impact of neighborhood context--educational attainment of neighbors in particular--on individual-level cognition among older adults. Using hierarchical linear modeling, the authors analyzed data from the 1993 Study of Assets and Health Dynamics Among the Oldest Old (AHEAD), a large, nationally representative sample of US adults born before 1924. Data from participants residing in urban neighborhoods (n = 3,442) were linked with 1990 US Census tract data. Findings indicate that 1) average cognitive function varies significantly across US Census tracts; 2) older adults living in low-education areas fare less well cognitively than those living in high-education areas, net of individual characteristics, including their own education; 3) this association is sustained when controlling for contextual-level median household income; and 4) the effect of individual-level educational attainment differs across neighborhoods of varying educational profiles. Promoting educational attainment among the general population living in disadvantaged neighborhoods may prove cognitively beneficial to its aging residents because it may lead to meliorations in stressful life conditions and coping deficiencies.

PB - 163 VL - 163 IS - 12 U1 - http://www.ncbi.nlm.nih.gov/pubmed/16707655?dopt=Abstract U4 - Cognition/EDUCATION/Socioeconomic Factors ER - TY - JOUR T1 - The validation of the Texas revised inventory of grief on an older Latino sample. JF - J Soc Work End Life Palliat Care Y1 - 2006 A1 - Wilson, Steve KW - Aged KW - Aged, 80 and over KW - Bereavement KW - Culture KW - Factor Analysis, Statistical KW - Female KW - Grief KW - Hispanic or Latino KW - Humans KW - Male KW - Middle Aged KW - Psychometrics KW - Reproducibility of Results KW - Socioeconomic factors KW - Surveys and Questionnaires KW - Texas AB -

PURPOSE: Bereavement is considered to be one of the most profound experiences in older adulthood. However, assessments of emotional reactions to grief and loss have often been based on measures tested on primarily Anglo samples. This study examined the validity and factor structure of a commonly used bereavement measure on an older Latino sample.

DESIGN AND METHODS: Using convergent and discriminant validation procedures, this instrument was tested using a purposive sample of 134 older, recently bereaved Latinos.

RESULTS: While the instrument was originally designed to measure two domains of grief: Past Behaviors and Present Feelings, confirmatory and exploratory factor analysis revealed a three-factor solution for this sample which included also Disbelief of the loss. Items within this domain included anger, rejection, and a sense of injustice.

IMPLICATIONS: This study underscores the need for improved measures in research on grief and bereavement to capture the intensity and severity of grief in a cross-cultural context.

VL - 2 IS - 4 ER - TY - JOUR T1 - Why don't people buy long-term-care insurance? JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2006 A1 - Cramer, Anne Theisen A1 - Gail A Jensen KW - Aged KW - Choice Behavior KW - Commerce KW - Decision making KW - Demography KW - Female KW - Humans KW - Insurance, Health KW - Long-term Care KW - Male KW - Middle Aged KW - United States AB -

OBJECTIVES: The objective of this article was to assess the determinants of an individual's decision to purchase long-term-care (LTC) insurance. This article focuses on the decision to purchase a new policy as opposed to renewing an existing policy. This study gave special consideration to the role of policy price, the savings associated with buying a policy now as opposed to later, the purchaser's education, and the purchaser's income.

METHODS: Using data from the 2002 Health and Retirement Survey, we estimated logistic regressions to model consumer decisions to purchase LTC insurance. We explored several alternative measures of the price of a policy.

RESULTS: Price was a significant determinant in decisions to purchase coverage. The demand for coverage, however, was price inelastic, with elasticities ranging from -0.23 to -0.87, depending on the specification of the model. The education level and income of the purchaser were also important.

DISCUSSION: This analysis provides the first estimates of price elasticity of demand for LTC insurance. The finding that demand is very price inelastic suggests that state initiatives that effectively subsidize premiums as a way of stimulating purchases are likely to meet with very limited success in the present environment.

PB - 61B VL - 61 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/16855039?dopt=Abstract U4 - Insurance, Long Term Care ER - TY - JOUR T1 - Disparities among older adults in measures of cognitive function by race or ethnicity. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2005 A1 - Frank A Sloan A1 - Wang, Jingshu KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Black or African American KW - Case-Control Studies KW - Cognition KW - Cognition Disorders KW - Cross-Sectional Studies KW - Female KW - Hispanic or Latino KW - Humans KW - Linear Models KW - Longitudinal Studies KW - Male KW - Racial Groups KW - United States AB -

This study examined racial or ethnic differences in cognitive function, cross-sectionally and longitudinally, using survey data from the Asset and Health Dynamics Among the Oldest Old. A version of the Telephone Interview for Cognitive Status (TICS), proxy assessments of cognition, and difficulties in performing daily tasks were assessed. Blacks performed below Whites on the TICS at baseline and on proxy assessments of cognition. TICS score declined with age for Whites and Blacks, with some relative gains for Blacks. At baseline, Blacks more often had difficulties in performing daily tasks, with some increase in difficulties relative to Whites with age. Differences between other groups and Whites were smaller than those between Blacks and Whites.

PB - 60B VL - 60 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/16131618?dopt=Abstract U4 - Racial disparities/Cognitive Function/Elderly ER - TY - JOUR T1 - Functional impairment as a risk factor for urinary incontinence among older Americans. JF - Neurourol Urodyn Y1 - 2005 A1 - Kristi Rahrig Jenkins A1 - Fultz, Nancy H. KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Chronic disease KW - Disability Evaluation KW - Female KW - Humans KW - Longitudinal Studies KW - Male KW - Motor Activity KW - Risk Factors KW - Socioeconomic factors KW - Urinary incontinence AB -

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

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

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

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

PB - 24 VL - 24 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15578629?dopt=Abstract U4 - WOMEN/Epidemiology/DISABILITY/DISABILITY ER - TY - JOUR T1 - Health and living arrangements among older Americans: does marriage matter? JF - J Aging Health Y1 - 2005 A1 - Jersey Liang A1 - Brown, Joseph W. A1 - Krause, Neal M. A1 - Mary Beth Ofstedal A1 - Joan M. Bennett KW - Adult children KW - Aged KW - Demography KW - Health Status KW - Humans KW - Institutionalization KW - Marital Status KW - Marriage KW - Mental Health KW - Parents KW - Residence Characteristics KW - Social Support KW - Socioeconomic factors KW - Spouses KW - United States AB -

OBJECTIVE: This research examines how physical and mental health influence living arrangements among older Americans and whether these effects differ for married and unmarried persons.

METHODS: Data came from the Asset and Health Dynamics Among the Oldest Old study. These two intervals were pooled, and hierarchical multinomial logistic regressions were used to analyze pooled time lags.

RESULTS: Functional status and cognitive functioning are significantly associated with living arrangements among those not married. Health conditions exert no significant effects among those married. Given the same functional status, unmarried elders are significantly more likely than their married counterparts to reside with their children or with others.

DISCUSSION: These results underscore the critical role of the spouse in influencing living arrangements, providing new evidence supporting the assertion that a spouse is the greatest guarantee of support in old age and the importance of the marriage institution.

PB - 17 VL - 17 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15857961?dopt=Abstract U4 - Health/Living Conditions/Marriage/Health Physical ER - TY - JOUR T1 - The impact of childhood and adult SES on physical, mental, and cognitive well-being in later life. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2005 A1 - Ye Luo A1 - Linda J. Waite KW - Aged KW - Aging KW - Black People KW - Child KW - Cognition KW - Cohort Studies KW - Data collection KW - Education KW - ethnicity KW - Female KW - Health Status KW - Hispanic or Latino KW - Humans KW - Income KW - Male KW - Mental Health KW - Middle Aged KW - Quality of Life KW - Retirement KW - Sex Factors KW - Social Class KW - White People AB -

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

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

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

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

PB - 60B VL - 60 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15746030?dopt=Abstract U2 - PMC2505177 U4 - Childhood/Socioeconomic Status/Well Being ER - TY - JOUR T1 - The impact of obesity on active life expectancy in older American men and women. JF - Gerontologist Y1 - 2005 A1 - Sandra L Reynolds A1 - Saito, Yasuhiko A1 - Eileen M. Crimmins KW - Activities of Daily Living KW - Aged KW - Female KW - Health Status KW - Health Surveys KW - Humans KW - Life Expectancy KW - Life Tables KW - Logistic Models KW - Male KW - Markov chains KW - Obesity KW - Risk Factors KW - United States AB -

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

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

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

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

PB - 45 VL - 45 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/16051906?dopt=Abstract U4 - Disability/Disability/Obesity/Life Expectancy ER - TY - JOUR T1 - The impact of own and spouse's urinary incontinence on depressive symptoms. JF - Soc Sci Med Y1 - 2005 A1 - Fultz, Nancy H. A1 - Kristi Rahrig Jenkins A1 - Truls Ostbye A1 - Donald H. Taylor Jr. A1 - Mohammed U Kabeto A1 - Kenneth M. Langa KW - Aged KW - Caregivers KW - Cohort Studies KW - depression KW - Female KW - Humans KW - Male KW - Middle Aged KW - United States KW - Urinary incontinence AB -

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

PB - 60 VL - 60 IS - 11 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15814179?dopt=Abstract U4 - Depression Symptoms/Incontinence/Health Services/Mental Health ER - TY - JOUR T1 - Labor market, financial, insurance and disability outcomes among near elderly Americans with depression and pain. JF - J Ment Health Policy Econ Y1 - 2005 A1 - Tian, Haijun A1 - Robinson, Rebecca L. A1 - Sturm, Roland KW - Aged KW - Cost of Illness KW - Cross-Sectional Studies KW - depression KW - Employment KW - Female KW - Humans KW - Male KW - Middle Aged KW - pain KW - United States AB -

BACKGROUND: The economic burden of depression has been documented, but the role of comorbid conditions is unclear. Depression and comorbid pain are particularly common, are associated with worse clinical outcomes and require different care than "pure'' depression. Does this comorbidity account for a large share of the adverse social outcomes attributed to depression?

AIMS OF STUDY: We analyzed the relationship between depression and comorbid pain, and labor market, financial, insurance and disability outcomes among Americans aged 55-65.

METHODS: Cross-sectional data were used from Wave 3 of the Health and Retirement Survey, a nationally representative sample of individuals aged 55-65 surveyed in 1996. Multivariate regression analyses, controlling for socio-demographics and chronic health conditions, estimated the associations between depression and pain, and economic outcomes. Outcomes included: employment and retirement status, household income, total medical expenditures, government health insurance, social security, limitations in activities of daily living (ADLs), and health limitations affecting work. Primary explanatory variables included the presence of severe pain, mild/moderate pain, or absence of pain, with or without depression.

RESULTS: Compared to depression alone, depression and comorbid pain was associated with worse labor market (non-employment, retirement), financial (total medical expenditures), insurance (government insurance, social security) and disability outcomes (limitations in ADLs, health limitations affecting work), after covariate adjustment (p

IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: The depressed with comorbid pain appear to experience greater burden through increased costs and worse functioning and may require different management than those with depression alone. The depressed with comorbid pain may benefit from treatment practices and guidelines that address the duality of these conditions throughout the process of care. IMPLICATION FOR HEALTH POLICIES: The depressed with comorbid pain were more likely to receive government support than depression alone. Given the central role of employer-sponsored health insurance in the U.S., they may have worse access to health care because they leave employment or retire earlier. With the evolving state of Medicare, broad formulary access to mental health treatments might be considered.

IMPLICATIONS FOR FURTHER RESEARCH: Further research should focus on causality of depression and comorbid pain on economic outcomes. Depression research should consider the heterogeneity of this disorder in outcomes assessment.

PB - 8 VL - 8 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/16385147?dopt=Abstract U4 - Chronic Disease/Comorbidity/Depression ER - TY - JOUR T1 - Life course pathways to adult-onset diabetes. JF - Soc Biol Y1 - 2005 A1 - Best, Latrica E. A1 - Mark D Hayward A1 - Mira M Hidajat KW - Aged KW - Child KW - Diabetes Mellitus, Type 2 KW - Family Health KW - Female KW - Follow-Up Studies KW - Humans KW - Life Style KW - Likelihood Functions KW - Logistic Models KW - Male KW - Middle Aged KW - Obesity KW - Poverty KW - Risk Factors KW - Social Class KW - United States AB -

Early life conditions, such as socioeconomic status (SES) and health, have the potential to set in motion multiple and reinforcing pathways that shape both the prevalence and onset of diabetes among older adults. Using data from the Health and Retirement Study (1998-2002) for persons age 51 years and older, we investigated the core mediating mechanisms linking early life conditions with diabetes prevalence in 1998 and onset over a 4-year follow-up period, focusing on adult achievement processes and obesity as key mechanisms. We found that father's education is negatively associated with diabetes prevalence for older men and women. However, no markers of early life SES are directly associated with older men's and women's onset of diabetes, and the negative effects of adult SES on diabetes onset pertain only to women. Early life health affects the onset of diabetes among women--but not the prevalence--and no evidence of this association was found for men. We found no evidence that obesity is an important mechanism connecting either early life or adult SES with diabetes development in men or women. We speculate that early life SES may accelerate the development of diabetes at younger ages, and that the pathways linking life course SES, early life health, and diabetes are partly gender-specific and biological in nature.

PB - 52 VL - 52 IS - 3-4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/17619606?dopt=Abstract U4 - diabetes/childhood conditions/socioeconomic status/Obesity ER - TY - JOUR T1 - Longitudinal analysis of the reciprocal effects of self-assessed global health and depressive symptoms. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2005 A1 - Karl Kosloski A1 - Stull, Donald E. A1 - Kercher, Kyle A1 - VanDussen, Daniel J. KW - Aged KW - Analysis of Variance KW - Attitude to Health KW - Chronic disease KW - depression KW - Disabled Persons KW - Female KW - Health Surveys KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Personality Inventory KW - Psychometrics KW - Reproducibility of Results KW - Self-Assessment KW - Statistics as Topic AB -

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

PB - 60 VL - 60 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/16260703?dopt=Abstract U4 - Depressive Symptoms/Subjective/Health ER - TY - JOUR T1 - Men who work at age 70 or older. JF - J Gerontol Soc Work Y1 - 2005 A1 - Martha N. Ozawa A1 - Terry Y S Lum KW - Aged KW - Employment KW - Health Status KW - Humans KW - Logistic Models KW - Male KW - Multivariate Analysis KW - Public Policy KW - Socioeconomic factors KW - United States AB -

The federal policy on older workers has shifted from the encouragement of early withdrawal from the labor force to the encouragement of continuous participation in the labor force. In this light, it is instructive to investigate the backgrounds of elderly people who work at age 70 or older. This article presents the findings of a study, using data from the 1993 Asset and Health Dynamics of the Oldest Old Study, that investigated the effects of health, economic conditions (net worth, employer-provided pensions, and supplemental medical insurance coverage), education, and spouse's work status on the probability of working among men aged 70 or older. The study addressed the probability of working, the probability of working fulltime and of working part-time, and the probability of being self-employed and of being employed by others. Implications for policy are discussed.

PB - 45 VL - 45 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/16219599?dopt=Abstract U4 - Older Workers/health status/Socioeconomic Factors/Public Policy ER - TY - JOUR T1 - Net worth predicts symptom burden at the end of life. JF - J Palliat Med Y1 - 2005 A1 - Maria J Silveira A1 - Mohammed U Kabeto A1 - Kenneth M. Langa KW - Aged KW - Aged, 80 and over KW - Data collection KW - Female KW - Humans KW - Logistic Models KW - Male KW - Severity of Illness Index KW - Social Class KW - Terminally Ill KW - United States AB -

OBJECTIVES: To explore the predictors of symptom burden at the end of life.

DESIGN: Observational, secondary analysis of Health and Retirement Study (HRS) data.

SETTING: USA.

PARTICIPANTS: Two thousand six hundred four deceased, older adults.

METHODS: Multivariate Poisson and logistic regression to explore the relationship between sociodemographic and clinical factors with symptoms.

RESULTS: Fatigue, pain, dyspnea, depression, and anorexia were common and severe; 58% of participants experienced more than 3 of these during their last year of life. Sociodemographic and clinical factors were associated with the number of symptoms as well as the presence of pain, depression, and dyspnea alone. Decedents in the highest quartile of net worth had fewer symptoms (incident rate ratio [IRR] 0.90, confidence interval [CI] 0.85-0.96) and less pain (odds ratio [OR] 0.66, CI 0.51-0.85) than comparisons did. Patients with cancer experienced more pain (OR 2.02, CI 1.62-2.53) and depression (OR 1.31, CI 1.07-1.61). Patients experienced more depression (OR 2.37, CI 1.85-3.03) and dyspnea (OR 1.40, CI 1.09-1.78).

LIMITATION: Use of proxy reports for primary data.

CONCLUSION: Older Americans experience a large symptom burden in the last year of life, largely with treatable symptoms such as pain, dyspnea, and depression. The adequacy of symptom control relates to clinical factors as well as net worth. This association between symptoms and wealth suggests that access to health care and other social services beyond those covered by Medicare may be important in decreasing symptom burden at the end of life.

PB - 8 VL - 8 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/16128657?dopt=Abstract U4 - Quality of Life/Net Worth ER - TY - JOUR T1 - Physical and mental health status of older long-term cancer survivors. JF - J Am Geriatr Soc Y1 - 2005 A1 - Nancy L. Keating A1 - Norredam, Marie A1 - Landrum, Mary Beth A1 - Haiden A. Huskamp A1 - Meara, Ellen KW - Aged KW - Aged, 80 and over KW - Case-Control Studies KW - Chronic disease KW - Cohort Studies KW - Female KW - Health Behavior KW - Health Status KW - Humans KW - Logistic Models KW - Male KW - Mental Health KW - Middle Aged KW - Neoplasms KW - Survivors KW - United States AB -

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

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

SETTING: General community population in the United States.

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

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

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

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

PB - 53 VL - 53 IS - 12 U1 - http://www.ncbi.nlm.nih.gov/pubmed/16398900?dopt=Abstract U4 - Survivors/Mental Health/Health Physical ER - TY - JOUR T1 - Racial differences in activities of daily living limitation onset in older adults with arthritis: a national cohort study. JF - Arch Phys Med Rehabil Y1 - 2005 A1 - Shih, Vivian C. A1 - Song, Jing A1 - Rowland W Chang A1 - Dorothy D Dunlop KW - Activities of Daily Living KW - Aged KW - Arthritis KW - Black or African American KW - Female KW - Geriatric Assessment KW - Health Behavior KW - Health Services Needs and Demand KW - Hispanic or Latino KW - Humans KW - Longitudinal Studies KW - Male KW - Predictive Value of Tests KW - Prospective Studies KW - Risk Factors KW - United States KW - White People AB -

OBJECTIVE: To investigate factors that predict the onset of limitations in activities of daily living (ADLs) in adults 65 years old or older who have arthritis, in order to develop public health programs for minorities (African and Hispanic Americans) and white Americans.

DESIGN: Longitudinal cohort study.

SETTING: National probability sample.

PARTICIPANTS: Older adults with arthritis (N=3541) who participated in the 1998 and 2000 Health and Retirement Study interviews and who had no baseline ADL limitations.

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURE: Onset of ADL limitations was identified from reports of 1 or more ADL task limitations at 2-year follow-up.

RESULTS: Onset is most frequent among African Americans (24.4%), followed by Hispanics (22.2%), and whites (16.9%). Race specific multivariate analysis showed that the strongest risk factor predicting onset of limitations across all racial and ethnic groups is physical limitations. Low household income was significant for older minorities but not for whites. Comorbid cardiovascular disease was a unique multivariate risk factor among African Americans.

CONCLUSIONS: Physical limitation is a strong risk factor for ADL limitation onset that is shared by all racial and ethnic groups. Early identification and treatment of physical limitations may prevent the onset of ADL limitations and thus improve quality of life. Race specific public health interventions should be considered to reduce the development of ADL limitations among older adults with arthritis.

PB - 86 VL - 86 IS - 8 U1 - http://www.ncbi.nlm.nih.gov/pubmed/16084802?dopt=Abstract U4 - Activities of Daily Living/African-Americans/Hispanics ER - TY - JOUR T1 - Setting eligibility criteria for a care-coordination benefit. JF - J Am Geriatr Soc Y1 - 2005 A1 - Christine T Cigolle A1 - Kenneth M. Langa A1 - Mohammed U Kabeto A1 - Caroline S Blaum KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Case Management KW - Chronic disease KW - Cognition Disorders KW - Comorbidity KW - Cross-Sectional Studies KW - Disability Evaluation KW - Disease Management KW - Eligibility Determination KW - Female KW - Geriatric Assessment KW - Health Surveys KW - Humans KW - Longitudinal Studies KW - Male KW - Medicare KW - Middle Aged KW - Retirement KW - United States AB -

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

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

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

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

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

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

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

PB - 53 VL - 53 IS - 12 U1 - http://www.ncbi.nlm.nih.gov/pubmed/16398887?dopt=Abstract U4 - Chronic Disease/Cognition Disorders/ADL and IADL Impairments/Caregiving ER - TY - JOUR T1 - The significance of nonmarital cohabitation: marital status and mental health benefits among middle-aged and older adults. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2005 A1 - Susan L. Brown A1 - Jennifer R. Bulanda A1 - Lee, Gary R. KW - Aged KW - depression KW - Female KW - Humans KW - Insurance Benefits KW - Male KW - Marital Status KW - Mental Health Services KW - Middle Aged KW - Sexual Partners KW - Social Support KW - United States AB -

OBJECTIVES: According to the 2000 Census, about 1.2 million persons over age 50 are currently cohabiting. Do these unmarried cohabiting partnerships provide adults with mental health benefits that are similar to those enjoyed by marrieds? We extended prior work on marital status and depression by including cohabitation in our conceptualization of marital status.

METHODS: We used data from the 1998 Health and Retirement Study (N = 18,598) to examine the relationship between marital status and depressive symptoms among adults over age 50. We also examined gender differences in this association.

RESULTS: We found that cohabitors report more depressive symptoms, on average, than do marrieds, net of economic resources, social support, and physical health. Additional analyses revealed that only among men do cohabitors report significantly higher depression scores. Cohabiting and married women as well as cohabiting men experience similar levels of depression, and all of these groups report levels that are significantly higher than married men's.

DISCUSSION: Our findings demonstrate the importance of accounting for nontraditional living arrangements among persons aged 50 and older. Cohabitation appears to be more consequential for men's than women's depressive symptoms.

PB - 60B VL - 60 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15643043?dopt=Abstract U4 - Couples/Depression/Housing/Social Support ER - TY - JOUR T1 - Social status and risky health behaviors: results from the health and retirement study. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2005 A1 - Linda A. Wray A1 - Duane F. Alwin A1 - Ryan J McCammon KW - Aged KW - Aging KW - Alcohol Drinking KW - Body Weight KW - Exercise KW - Female KW - Health Behavior KW - Humans KW - Life Style KW - Likelihood Functions KW - Logistic Models KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Smoking KW - Social Class KW - United States AB -

OBJECTIVES: We focus on a hypothesized mechanism that may underlie the well-documented link between social status and health-behavioral health risks.

METHODS: We use longitudinal data from representative samples of 6,106 middle-aged and 3,636 older adults from the Health and Retirement Study to examine the relationships between social status-including early life social status (e.g., parental schooling), ascribed social status (e.g., sex, race-ethnicity), and achieved social status (e.g., schooling, economic resources)-and behavioral health risks (e.g., weight, smoking, drinking, physical activity) to (1) assess how early life and ascribed social statuses are linked to behavioral health risks, (2) investigate the role of achieved factors in behavioral health risks, (3) test whether achieved status explains the contributions of early life and ascribed status, and (4) examine whether the social status and health risk relationships differ at midlife and older age.

RESULTS: We find that early life, achieved, and ascribed social statuses strongly predict behavioral health risks, although the effects are stronger in midlife than they are in older age.

DISCUSSION: Ascribed social statuses (and interactions of sex and race-ethnicity), which are important predictors of behavioral health risks even net of early life and achieved social status, should be explored in future research.

PB - 60B VL - 60 Spec No 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/16251597?dopt=Abstract U4 - Social Stratification/Health Behaviors ER - TY - JOUR T1 - Supplemental private health insurance and depressive symptoms in older married couples. JF - Int J Aging Hum Dev Y1 - 2005 A1 - Min, Meeyoung O. A1 - Aloen L. Townsend A1 - Baila Miller A1 - Rovine, Michael J. KW - Aged KW - Aged, 80 and over KW - Analysis of Variance KW - Black People KW - Chi-Square Distribution KW - depression KW - Female KW - Humans KW - Insurance Coverage KW - Insurance, Health KW - Linear Models KW - Male KW - Risk Factors KW - Spouses KW - United States KW - White People AB -

Stress process theory is applied to examine lack of supplemental private health insurance as a risk factor for depressive symptomatology among older married couples covered by Medicare. Dyadic data from 130 African-American couples and 1,429 White couples in the 1993 Asset and Health Dynamics Among the Oldest-Old Survey were analyzed using hierarchical generalized linear modeling. Lack of supplemental insurance is operationalized at the household level in terms of neither spouse covered, one spouse covered, or both spouses covered. Controlling for covariates at both individual and couple levels, supplemental insurance has significant impact on depression, but the pattern differs by race. White couples report the highest depression when neither spouse is covered by private health insurance; African-American couples report the highest depression when only one spouse is covered. Results suggest lack of supplemental private health insurance coverage is a stressor that significantly affects depressive symptoms.

PB - 61 VL - 61 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/16320444?dopt=Abstract U4 - Economic Status/ADULTS/Medicare ER - TY - JOUR T1 - Survival expectations of the obese: Is excess mortality reflected in perceptions? JF - Obes Res Y1 - 2005 A1 - Tracy Falba A1 - Susan H. Busch KW - Aged KW - Body Mass Index KW - Body Weight KW - Diabetes Mellitus KW - Female KW - Health Surveys KW - Humans KW - Hypertension KW - Male KW - Obesity KW - Perception KW - Retirement KW - Smoking KW - Surveys and Questionnaires KW - Survival Rate AB -

OBJECTIVE: This study compared self-reported subjective life expectancy (i.e., probability of living to age 75) for normal-weight, overweight, and obese weight groups to examine whether individuals are internalizing information about the health risks due to excessive weight.

RESEARCH METHODS AND PROCEDURES: Using data from the Health and Retirement Study, a total of 9035 individuals 51 to 61 years old were analyzed by BMI category. The primary outcome measure was individuals' reports about their own expectations of survival to age 75. Absolute and relative risks of survival were compared with published estimates of survival to age 75.

RESULTS: Consistently, higher levels of BMI were associated with lower self-estimated survival probabilities. Differences relative to normal weight ranged from 4.9% (p < 0.01) for male nonsmokers to 8.8% (p < 0.001) for female nonsmokers. However, these differences were substantially less than those obtained from published survival curve estimates, suggesting that obese individuals tended to underestimate mortality risks.

DISCUSSION: Individuals appeared to underestimate the mortality risks of excessive weight; thus, knowledge campaigns about the risks of obesity should remain a top priority.

PB - 13 VL - 13 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15897485?dopt=Abstract U4 - Health Behavior/Obesity/Life Expectancy/Subjective Probabilities of Survival/Survival ER - TY - JOUR T1 - Understanding the racial and ethnic differences in caregiving arrangements. JF - J Gerontol Soc Work Y1 - 2005 A1 - Terry Y S Lum KW - Aged KW - Caregivers KW - ethnicity KW - Family Characteristics KW - Female KW - Frail Elderly KW - Humans KW - Logistic Models KW - Male KW - Multivariate Analysis KW - Social work KW - Socioeconomic factors KW - United States AB -

In this study, the relative importance of family/household structure, socioeconomic status, and culture is examined, and their connection to racial and ethnic variations in caregiving networks is explored. Each of these three domains is seen as contributing to the race/ethnic variations in caregiving arrangements.

PB - 45 VL - 45 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/16219597?dopt=Abstract U4 - Caregiving/Racial Differences/Family Structure ER - TY - JOUR T1 - Use of complementary medicine in older Americans: results from the Health and Retirement Study. JF - Gerontologist Y1 - 2005 A1 - Ness, Jose A1 - Dominic J Cirillo A1 - David R Weir A1 - Nisly, Nicole L. A1 - Robert B Wallace KW - Activities of Daily Living KW - Aged KW - Chi-Square Distribution KW - Complementary Therapies KW - Female KW - Humans KW - Male KW - Middle Aged KW - Regression Analysis KW - Surveys and Questionnaires KW - United States AB -

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

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

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

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

PB - 45 VL - 45 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/16051914?dopt=Abstract U4 - Medicine/Chiropractic/Dietary Supplements ER - TY - JOUR T1 - A variables associated with occupational and physical therapy stroke rehabilitation utilization and outcomes. JF - J Allied Health Y1 - 2005 A1 - Chad Cook A1 - Stickley, Lois A1 - Ramey, Kevin A1 - Knotts, Valerie J. KW - Aged KW - Aged, 80 and over KW - Cross-Sectional Studies KW - Disability Evaluation KW - Female KW - Health Services Accessibility KW - Humans KW - Male KW - Occupational therapy KW - Physical Therapy Modalities KW - Risk Factors KW - Socioeconomic factors KW - Stroke Rehabilitation KW - United States AB -

Many studies have reported the benefits of a comprehensive stroke team including occupational therapy/physical therapy (OT/PT) services; however, factors associated with access to these services are less known. This study used a subsample of the Health and Retirement Study database, a cross-sectional survey of more than 11,126 Americans aged 65 to 106 years within the contiguous United States. The purposes of this study were to determine the associational factors that contribute to attending OT/PT and determine if attending OT/PT leads to a reduced report of stroke-related problems. The findings indicated that fewer than 10% of stroke survivors in a noninstitutionalized, community-based setting were currently accessing OT/PT. Additionally, access to OT/PT services was highly associated with report of having an attending physician, report of stroke-related weakness, higher monthly income, and older age. The increased odds of reported continued problems associated with a past stroke were associated with failure to access OT/PT services, lower monthly income, Hispanic culture, and age. OT/PT services were typically provided to patients who reported a higher level of physical dysfunction. Despite the greater degree of severity, OT/PT intervention led to reports of lower levels of disability and problems over time.

PB - 34 VL - 34 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15839599?dopt=Abstract U4 - Health Services/Disability/Disability/Stroke/Physical Therapy 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 - Body-weight change and physical functioning among young old adults. JF - J Aging Health Y1 - 2004 A1 - Kristi Rahrig Jenkins KW - Activities of Daily Living KW - Aged KW - Body Weight KW - Demography KW - Exercise KW - Health Behavior KW - Humans KW - Movement Disorders KW - Socioeconomic factors AB -

OBJECTIVES: The main purpose of this study is to examine if body weight change is a potential risk factor for the onset of functional impairment across time among various functional domains.

METHODS: Using longitudinal data from the Health and Retirement Study, logistic regression models on the onset of functional impairment over three time points are estimated for young old adults.

RESULTS: Results indicate that weight gain is associated with greater risk of lower body mobility impairment. An increase in body mass index of greater than 5% increases the likelihood of the onset of lower body mobility functional impairment.

DISCUSSION: Study findings support the promotion of healthy weight management. Future studies in this area may want to investigate effective interventions that contribute to healthy weight maintenance among this cohort.

PB - 16 VL - 16 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15030665?dopt=Abstract U4 - Body Mass Index/Health Physical ER - TY - JOUR T1 - Born to retire: the foreshortened life course. JF - Gerontologist Y1 - 2004 A1 - David J Ekerdt KW - Adolescent KW - Adult KW - Aged KW - Child KW - Female KW - Humans KW - Investments KW - Life Style KW - Male KW - Middle Aged KW - Pensions KW - Retirement KW - Social Security AB -

Retirement is no longer a concern solely for the second half of life. Rather, the idea that we will someday retire is increasingly present to all adults and it is even urged on adolescents. The earliest reaches of adulthood are being colonized by frequent reminders that it takes individual effort to achieve retirement. The changing nature of pensions, the identification of retirement saving with financial markets, the politics of Social Security, the aging baby boom generation, and the interests of a powerful industry and of government are daily compelling people's attention to retirement as a lifelong goal. With retirement as adulthood's great project of deferred gratification, the result could be greater personal readiness to retire but also some ironic outcomes, such as a stronger retirement norm, reluctance to spend on children, and outsized expectations for later life.

PB - 44 VL - 44 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/14978315?dopt=Abstract U4 - Retirement Behavior ER - TY - JOUR T1 - Brief communication: the relationship between having a living will and dying in place. JF - Ann Intern Med Y1 - 2004 A1 - Howard B Degenholtz A1 - Rhee, YongJoo A1 - Robert M. Arnold KW - Aged KW - Death KW - Health Status KW - Homes for the Aged KW - Hospices KW - Hospital Mortality KW - Housing KW - Humans KW - Living Wills KW - Nursing homes KW - Retrospective Studies AB -

BACKGROUND: Living wills, a type of advance directive, are promoted as a way for patients to document preferences for life-sustaining treatments should they become incompetent. Previous research, however, has found that these documents do not guide decision making in the hospital.

OBJECTIVE: To test the hypothesis that people with living wills are less likely to die in a hospital than in their residence before death.

DESIGN: Secondary analysis of data from a nationally representative longitudinal study.

SETTING: Publicly available data from the Asset and Health Dynamics Among the Oldest Old (AHEAD) study.

PATIENTS: People older than 70 years of age living in the community in 1993 who died between 1993 and 1995.

MEASUREMENTS: Self-report and proxy informant interviews conducted in 1993 and 1995.

RESULTS: Having a living will was associated with lower probability of dying in a hospital for nursing home residents and people living in the community. For people living in the community, the probability of in-hospital death decreased from 0.65 (95% CI, 0.58 to 0.71) to 0.52 (CI, 0.42 to 0.62). For people living in nursing homes, the probability of in-hospital death decreased from 0.35 (CI, 0.23 to 0.49) to 0.13 (CI, 0.07 to 0.22).

LIMITATIONS: Retrospective survey data do not contain detailed clinical information on whether the living will was consulted.

CONCLUSION: Living wills are associated with dying in place rather than in a hospital. This implies that previous research examining only people who died in a hospital suffers from selection bias. During advance care planning, physicians should discuss patients' preferences for location of death.

PB - 141 VL - 141 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15262666?dopt=Abstract U4 - Advance Directives/HOSPITALIZATION ER - TY - JOUR T1 - Cognitive deficits and the course of major depression in a cohort of middle-aged and older community-dwelling adults. JF - J Am Geriatr Soc Y1 - 2004 A1 - Ramin Mojtabai A1 - Mark Olfson KW - Aged KW - Chi-Square Distribution KW - Cognition Disorders KW - Depressive Disorder, Major KW - Female KW - Geriatric Assessment KW - Humans KW - Interviews as Topic KW - Logistic Models KW - Male KW - Middle Aged KW - Prospective Studies KW - Psychiatric Status Rating Scales KW - Residence Characteristics KW - Risk Factors KW - United States AB -

OBJECTIVES: To examine associations between cognitive deficits and persistent significant depressive symptoms at baseline and 2- and 4-year follow-ups in a sample of community-dwelling middle-aged and older adults.

DESIGN: Prospective cohort study.

SETTING: A U.S. national prospective cohort study of middle-aged and older adults, the Health and Retirement Study.

PARTICIPANTS: A sample of 661 participants of the 1996 wave of the Health and Retirement Study who met criteria for 12-month Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised major depression (MD).

MEASUREMENTS: MD was assessed using the World Health Organization Composite International Diagnostic Interview-Short Form. Persistent significant depressive symptoms were assessed using an eight-item version of the Center for Epidemiological Studies Depression scale.

RESULTS: Cognitive deficits were associated with persistent significant depressive symptoms at follow-up. In a latent state-trait analysis, two stable and strongly correlated traits best explained variations in cognitive functioning and depressive symptoms across assessment points.

CONCLUSION: Trait-like cognitive deficits commonly complicate the course of MD in community-dwelling middle-aged and older adults and may help to explain the persistent course of depressive symptoms in a large subgroup of adults with MD in this age range.

PB - 52 VL - 52 IS - 7 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15209642?dopt=Abstract U4 - Cognition/Depression/Female/Geriatric Assessment/Logistic Models/Prospective Studies/Psychiatric Status Rating Scales/Housing/Risk Factors ER - TY - JOUR T1 - Does urinary incontinence affect middle-aged and older women's time use and activity patterns? JF - Obstet Gynecol Y1 - 2004 A1 - Fultz, Nancy H. A1 - Gwenith G Fisher A1 - Kristi Rahrig Jenkins KW - Aged KW - Female KW - Humans KW - Interpersonal Relations KW - Leisure activities KW - Logistic Models KW - Middle Aged KW - Quality of Life KW - Urinary incontinence AB -

OBJECTIVE: To investigate the relationship between urinary incontinence and women's levels and hours of participation in 31 activities.

METHODS: A subset of panel members from the Health and Retirement Study completed the self-administered Consumption and Activities Mail Survey questionnaire in 2001. These data were linked with Health and Retirement Study 2000 data. Analyses were limited to 2,190 female Consumption and Activities Mail Survey self-respondents born in 1947 or earlier. Logistic regression was used to predict activity participation. Linear regression was used to predict the number of hours of participation.

RESULTS: The hypothesis that urinary incontinence affects women's time use and activity patterns was supported. Compared with the continent women, the incontinent women were less likely to have house cleaned, shopped, physically shown affection, or attended religious services in the recent past; and were more likely to have watched television or made music by singing or playing an instrument. Compared with continent activity participants, incontinent participants reported significantly fewer hours spent walking, communicating with friends and family by telephone or e-mail, working for pay, using a computer, and engaging in personal grooming and hygiene.

CONCLUSION: These findings substantiate prior work on the relationship between urinary incontinence and quality of life, and suggest a useful route for educating patients about the impact of urinary incontinence. Clinicians must be alert to opportunities for encouraging incontinent women to be active. It is also important to consider the implications for time use and activity patterns when advising patients about treatment and management options.

LEVEL OF EVIDENCE: II-2.

PB - 104 VL - 104 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15572498?dopt=Abstract U4 - Womens Health/Urinary Incontinence ER - TY - JOUR T1 - Economic status in later life among women who raised children outside of marriage. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2004 A1 - Richard W. Johnson A1 - Melissa Favreault KW - Adolescent KW - Adult KW - Aged KW - Aging KW - Child KW - Child Rearing KW - Demography KW - Female KW - Humans KW - Illegitimacy KW - Middle Aged KW - Single-Parent Family KW - Social Support KW - Socioeconomic factors AB -

OBJECTIVE: Many single mothers are likely to face special economic challenges in old age, because they often have limited employment histories and cannot rely on husbands for financial support. This article examines the economic status of these women in later life.

METHODS: The analysis uses nationally representative data from the Health and Retirement Study to estimate multivariate models of income, assets, and poverty rates for women aged 65-75 in 1999.

RESULT: Controlling for education, current marital status, and race and ethnicity, the models indicate that women who spent > or =10 years raising dependent children outside of marriage are 55% more likely to live in poverty at ages 65-75 than women who were always married when their children were young.

DISCUSSION: The financial difficulties confronting single mothers raising children persist into later life. Social Security reforms, especially those that are not tied to the current system of spousal and survivor benefits, could improve retirement security for these vulnerable women, whose numbers will begin to soar when the many women who raised children outside of marriage in the 1970s retire in coming years.

PB - 59B VL - 59 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15576862?dopt=Abstract U4 - Women/Marital Status/Children ER - TY - JOUR T1 - The effect of equipment usage and residual task difficulty on use of personal assistance, days in bed, and nursing home placement. JF - J Am Geriatr Soc Y1 - 2004 A1 - Donald H. Taylor Jr. A1 - Hoenig, H. KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Bed Rest KW - Cross-Sectional Studies KW - Disability Evaluation KW - Female KW - Homemaker Services KW - Humans KW - Least-Squares Analysis KW - Logistic Models KW - Longitudinal Studies KW - Male KW - Nursing homes KW - Risk Factors KW - Self-Help Devices AB -

OBJECTIVES: To determine whether residual difficulty in functioning in spite of equipment use is linked with increased use of personal assistance.

DESIGN: Longitudinal. Two waves of the Asset and Health Dynamics Among the Oldest Old (AHEAD) database were used to test the effect of residual difficulty on hours of personal assistance and bed days at Wave 1 on hours of personal assistance, bed days, and nursing home placement at Waves 1 and 2.

SETTING: A nationally representative setting of community-dwelling persons aged 70 and older and their spouses, regardless of age at Wave 1 AHEAD. There was movement of some respondents into nursing homes by the Wave 2 interview.

PARTICIPANTS: Respondents to the AHEAD survey, N=8,222 at Wave 1.

MEASUREMENTS: The dependent variables were hours of personal assistance in the month before the AHEAD survey (Waves 1 and 2), number of days in month before the survey in which the person did not get out of bed (Waves 1 and 2), and residence in a nursing home at Wave 2. The key explanatory variable was a mutually exclusive (four category) variable that specified whether there was residual difficulty (yes/no) in indoor mobility in spite of using equipment to aid specifically with indoor mobility. The four-category variable was defined by the four categories created by a cross-tabulation of equipment use (yes/no) and difficulty with indoor mobility (yes/no). A similar four-category variable was also defined for transferring in the home.

RESULTS: In cross section, equipment users with residual difficulty reported more hours of personal assistance in the case of indoor mobility impairment and were more likely to have some hours of personal assistance than those without residual difficulty with indoor mobility and transferring. Longitudinally, those with residual difficulty at Wave 1 were more likely to need some personal assistance hours at Wave 2 (odds ratio=1.67, 95% confidence interval= 1.23-2.26 for indoor mobility). For transferring, those with residual difficulty had 43 more hours of personal assistance per month (P=.001) than those for whom equipment resolved their disability. Residual disability was linked to more bed days for users of indoor mobility and transferring equipment, but it was not predictive of nursing home placement by Wave 2.

CONCLUSION: Equipment for indoor mobility or transfers apparently resolves difficulty for some users of the equipment but not for others. Residual task difficulty in spite of equipment for indoor mobility and transferring is linked with worse outcomes, including increased dependency on personal assistance and more days in bed. This shows that more attention is needed to determine whether equipment prescribed is appropriate for a patient's difficulty and that follow-up assessment is crucial after equipment is prescribed.

PB - 52 VL - 52 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/14687318?dopt=Abstract U4 - Mobility Difficulty ER - TY - JOUR T1 - The effect of heavy drinking on social security old-age and survivors insurance contributions and benefits. JF - Milbank Q Y1 - 2004 A1 - Ostermann, Jan A1 - Frank A Sloan KW - Accidents, Traffic KW - Adolescent KW - Adult KW - Aged KW - Aged, 80 and over KW - Alcoholism KW - Cost Sharing KW - Female KW - Health Behavior KW - Humans KW - Insurance Coverage KW - Life Expectancy KW - Male KW - Middle Aged KW - Old Age Assistance KW - Social Security KW - United States AB -

This article estimates the effects of heavy alcohol consumption on Social Security Old-Age and Survivor Insurance (OASI) contributions and benefits. The analysis accounts for differential earnings and mortality experiences of individuals with different alcohol consumption patterns and controls for other characteristics, including smoking. Relative to moderate drinkers, heavy drinkers receive fewer OASI benefits relative to their contributions. Ironically, for each cohort of 25-year-olds, eliminating heavy drinking costs the program an additional $3 billion over the cohort's lifetime. Public health campaigns are designed to improve individual health-relevant behaviors and, in the long run, increase longevity. Therefore, if programs for the elderly are structured as longevity-independent defined benefit programs, their success will reward healthier behaviors but increase these programs' outlays and worsen their financial condition.

PB - 82 VL - 82 IS - 3 N1 - RDA 1996-024 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15330975?dopt=Abstract U4 - Alcohol Drinking/Social Security ER - TY - JOUR T1 - The effect of smoking on years of healthy life (YHL) lost among middle-aged and older Americans. JF - Health Serv Res Y1 - 2004 A1 - Truls Ostbye A1 - Donald H. Taylor Jr. KW - Age Distribution KW - Aged KW - Aged, 80 and over KW - Female KW - Health Surveys KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Quality of Life KW - Quality-Adjusted Life Years KW - Regression Analysis KW - Sex Distribution KW - Smoking KW - Smoking cessation KW - United States AB -

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

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

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

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

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

PB - 39 VL - 39 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15149477?dopt=Abstract U4 - Life Expectancy/Quality of Life/Smoking ER - TY - JOUR T1 - The effect of spousal mental and physical health on husbands' and wives' depressive symptoms, among older adults: longitudinal evidence from the Health and Retirement Survey. JF - J Aging Health Y1 - 2004 A1 - Michele J. Siegel A1 - Elizabeth H Bradley A1 - William T Gallo A1 - Stanislav V Kasl KW - Aged KW - Caregivers KW - depression KW - Female KW - Health Status KW - Humans KW - Male KW - Mental Health KW - Models, Theoretical KW - Spouses KW - United States AB -

OBJECTIVE: To estimate the effect of spousal depressive symptoms and physical health on respondents' depressive symptoms in a national sample of older married couples.

METHOD: We used data on 5,035 respondent husbands and wives from the 1992 and 1994 waves of the Health and Retirement Survey. Multivariate regression models were estimated to examine the impact of spousal depressive symptoms and physical health on respondents' depressive symptoms.

RESULTS: Adjusting for respondent mental and physical health and sociodemographic traits, having a spouse with more depressive symptoms was associated with significantly higher follow-up depressive symptoms in the respondent (p < .001). Controlling for spousal depressive symptoms, a decline in the spouses' physical health was associated with a significant reduction in respondent depressive symptoms (p < .05).

DISCUSSION: Our findings suggest that health care providers treating older adults should be sensitive to the possibility that spouses may be affected when clients suffer poor mental or physical health.

PB - 16 VL - 16 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15155069?dopt=Abstract U4 - Depressive Symptoms/Spouses/Health Physical ER - TY - JOUR T1 - The effect of the tobacco settlement and smoking bans on alcohol consumption. JF - Health Econ Y1 - 2004 A1 - Gabriel A. Picone A1 - Frank A Sloan A1 - Justin G Trogdon KW - Aged KW - Alcohol Drinking KW - Behavior, Addictive KW - Data collection KW - Female KW - Humans KW - Male KW - Middle Aged KW - Models, Econometric KW - Smoking KW - United States AB -

In the last few years, the price of cigarettes has increased considerably in the USA. In addition, a number of states have also imposed smoking bans. These increases in the cost and barriers to smoking have created a natural experiment to study relationships between smoking and drinking behaviors. In this study, we employ data from the first six waves of the Health and Retirement Survey (HRS) to analyze the effects of smoking bans and cigarette prices on alcohol consumption. We also test if past cigarette and alcohol consumption affect current alcohol consumption as predicted by co-addiction models. We estimate dynamic panel models using GMM estimators. Our approach allows us to obtain consistent estimates irrespective of the number of time periods. The three main findings of this study are: (1) there is positive reinforcement effect of past cigarette consumption on current alcohol consumption, (2) smoking bans reduce alcohol consumption and (3) there is a positive effect of cigarette prices on alcohol consumption.

PB - 13 VL - 13 IS - 10 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15386690?dopt=Abstract U4 - Smoking/Alcohol Drinking ER - TY - JOUR T1 - Elders who delay medication because of cost: health insurance, demographic, health, and financial correlates. JF - Gerontologist Y1 - 2004 A1 - Klein, Dawn A1 - Carolyn L. Turvey A1 - Robert B Wallace KW - Aged KW - Aged, 80 and over KW - Cross-Sectional Studies KW - Drug Therapy KW - Fees, Pharmaceutical KW - Female KW - Health Status KW - Humans KW - Insurance, Pharmaceutical Services KW - Logistic Models KW - Male KW - Medicare KW - Multivariate Analysis KW - Patient Compliance KW - Self Administration KW - Socioeconomic factors KW - United States AB -

PURPOSE: Prescription medication use is essential to the health and well-being of many elderly persons. However, the cost of medications may be prohibitive and contribute to noncompliance with medical recommendations. This study identifies community-dwelling elders who reported a delay in medication use because of prescription medication cost.

DESIGN AND METHODS: This was a cross-sectional study of a nationwide sample of 6,535 elders participating in the Asset and Health Dynamics Among the Oldest Old (AHEAD) study. Participants reported if they had taken less medication than prescribed or if they had not filled prescriptions because of cost in the past 2 years. This response was then compared with the self-report of multiple variables, including demographic, health status, health insurance coverage, and financial variables.

RESULTS: Elders who were most vulnerable to medication delay as a result of cost included those with Medicare coverage only, low income, high out-of-pocket prescription costs, and poor health as well as African American elders and those aged 65-80 years.

IMPLICATIONS: This study provides important information about community-dwelling elders that reported a delay in medication use because of cost. As a Medicare prescription benefit has been passed, it will be important to monitor how these changes affect the elders identified at risk for medication delay.

PB - 44 VL - 44 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15611214?dopt=Abstract U4 - Prescription Fees/Elderly/Medicine/COSTS ER - TY - JOUR T1 - Extent and cost of informal caregiving for older Americans with symptoms of depression. JF - Am J Psychiatry Y1 - 2004 A1 - Kenneth M. Langa A1 - Marcia A. Valenstein A1 - A. Mark Fendrick A1 - Mohammed U Kabeto A1 - Sandeep Vijan KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Caregivers KW - Comorbidity KW - Costs and Cost Analysis KW - Depressive Disorder KW - Fees and Charges KW - Female KW - Health Care Costs KW - Home Nursing KW - Humans KW - Longitudinal Studies KW - Male KW - Personality Inventory KW - Workload AB -

OBJECTIVE: The purpose of this study was to obtain nationally representative estimates of the additional time and cost associated with informal caregiving for older Americans with depressive symptoms.

METHOD: Data from the 1993 Asset and Health Dynamics Among the Oldest Old Study, a nationally representative survey of people age 70 years or older (N=6,649), were used to determine the weekly hours and imputed costs of informal caregiving for elderly people with no depressive symptoms in the last week, one to three depressive symptoms in the last week, and four to eight depressive symptoms in the last week.

RESULTS: Forty-four percent of survey respondents reported one to three depressive symptoms, and 18% reported four to eight depressive symptoms. In multivariate regression analyses that adjusted for sociodemographics, caregiver network, and coexisting chronic health conditions, respondents with no depressive symptoms received an average of 2.9 hours per week of informal care, compared with 4.3 hours per week for those with one to three symptoms and 6.0 hours per week for those with four to eight symptoms. Caregiving associated with depressive symptoms in elderly Americans represented a yearly cost of about $9 billion.

CONCLUSIONS: Depressive symptoms in elderly persons are independently associated with significantly higher levels of informal caregiving, even after the effects of major coexisting chronic conditions are adjusted. The additional hours of care attributable to depressive symptoms represent a significant time commitment for family members and, therefore, a significant societal economic cost. Further research should evaluate the causal pathways by which depressive symptoms lead to high levels of caregiving and should examine whether successful treatment of depression reduces the need for informal care.

PB - 161 VL - 161 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15121651?dopt=Abstract U4 - Depression Symptoms/Caregiving ER - TY - JOUR T1 - The health effects of restricting prescription medication use because of cost. JF - Med Care Y1 - 2004 A1 - Michele M Heisler A1 - Kenneth M. Langa A1 - Eby, Elizabeth L. A1 - A. Mark Fendrick A1 - Mohammed U Kabeto A1 - John D Piette KW - Aged KW - Chronic disease KW - Female KW - Financing, Personal KW - Health Services Accessibility KW - Health Status KW - Humans KW - Male KW - Middle Aged KW - Multivariate Analysis KW - Patient Compliance KW - Prospective Studies KW - Risk KW - United States AB -

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

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

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

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

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

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

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

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

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

PB - 11 VL - 11 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15616418?dopt=Abstract U4 - quality of life/Elderly/COMORBIDITY/risk factors ER - TY - JOUR T1 - Honeymoons and joint lunches: effects of retirement and spouse's employment on depressive symptoms. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2004 A1 - Maximiliane E Szinovacz A1 - Adam Davey KW - Adaptation, Psychological KW - Aged KW - Aging KW - Data collection KW - depression KW - Employment KW - Female KW - Humans KW - Life Change Events KW - Longitudinal Studies KW - Male KW - Mental Health KW - Middle Aged KW - Retirement KW - Sex Factors KW - Spouses AB -

With hypotheses derived from a life course perspective in conjunction with life event stress and role theories, we examine whether a spouse's employment and length of retirement affect a person's postretirement depressive symptoms and whether such effects differ by gender. Analyses use pooled data from Waves 1-4 of the Health and Retirement Survey, using a subsample of married individuals who either remained continuously employed over time or completely retired since the Wave 1 interviews (N = 2,695). Recently retired men seem to be negatively affected by their spouses' continuous employment when compared with men whose wives were continuously not employed. In contrast, spouses' joint retirement has a beneficial influence on both recently retired and longer-retired men. However, for recently retired men, the positive effect of wives' retirement seems to be contingent on spouses' enjoyment of joint activities. Among women, effects of spouses' employment occur only among very recently retired wives (0-6 months). These wives report more depressive symptoms if their spouses were already nonemployed prior to wives' retirement. These results demonstrate the complexity of retirement adaptation processes and suggest that marital context plays an important role in retirement well-being.

PB - 59B VL - 59 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15358796?dopt=Abstract U4 - Spouses/Retirement Behavior/Depressive Symptoms/Gender Differences ER - TY - JOUR T1 - Increasing obesity rates and disability trends. JF - Health Aff (Millwood) Y1 - 2004 A1 - Sturm, Roland A1 - Ringel, Jeanne S. A1 - Andreyeva, Tatiana KW - Aged KW - Disabled Persons KW - Female KW - Humans KW - Male KW - Middle Aged KW - Obesity KW - Population Surveillance KW - United States AB -

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

PB - 23 VL - 23 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15046144?dopt=Abstract U4 - Health Status/Obesity/Disability/Disability ER - TY - JOUR T1 - Informal care and health care use of older adults. JF - J Health Econ Y1 - 2004 A1 - Courtney Harold Van Houtven A1 - Edward C Norton KW - Aged KW - Female KW - Health Care Surveys KW - health policy KW - Health Services for the Aged KW - Home Care Services KW - Home Nursing KW - Homes for the Aged KW - Humans KW - Male KW - Nursing homes KW - United States AB -

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

PB - 23 VL - 23 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15556241?dopt=Abstract U4 - Caregiving/Health Care Utilization/Elderly 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 - Moderate and severe obesity have large differences in health care costs. JF - Obes Res Y1 - 2004 A1 - Andreyeva, Tatiana A1 - Sturm, Roland A1 - Ringel, Jeanne S. KW - Aged KW - Ambulatory Care KW - Body Mass Index KW - Body Weight KW - Female KW - Health Care Costs KW - Hospitalization KW - Humans KW - Male KW - Middle Aged KW - Obesity KW - Sex Characteristics AB -

OBJECTIVE: To analyze health care use and expenditures associated with varying degrees of obesity for a nationally representative sample of individuals 54 to 69 years old.

RESEARCH METHODS AND PROCEDURES: Data from the Health and Retirement Study, a nationwide biennial longitudinal survey of Americans in their 50s, were used to estimate multivariate regression models of the effect of weight class on health care use and costs. The main outcomes were total health care expenditures, the number of outpatient visits, the probability of any inpatient stay, and the number of inpatient days.

RESULTS: The results indicated that there were large differences in obesity-related health care costs by degree of obesity. Overall, a BMI of 35 to 40 was associated with twice the increase in health care expenditures above normal weight (about a 50% increase) than a BMI of 30 to 35 (about a 25% increase); a BMI of over 40 doubled health care costs (approximately 100% higher costs above those of normal weight). There was a difference by gender in how health care use and costs changed with obesity class. The primary effect of increasing weight class on health care use appeared to be through elevated use of outpatient health care services.

DISCUSSION: Obesity imposes an increasing burden on the health care system, and that burden grows disproportionately large for the most obese segment of the U.S. population. Because the prevalence of severe obesity is increasing much faster than that of moderate obesity, average estimates of obesity effects obscure real consequences for individuals, physician practices, hospitals, and health plans.

PB - 12 VL - 12 IS - 12 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15687394?dopt=Abstract U4 - Body Mass Index/Weight/Health Expenditures/Female/Health Care Costs/Obesity ER - TY - JOUR T1 - Nonmetro residence and impaired vision among elderly Americans. JF - J Rural Health Y1 - 2004 A1 - Nan E. Johnson KW - Aged KW - Aged, 80 and over KW - Cardiovascular Diseases KW - Cataract KW - Chronic disease KW - Comorbidity KW - Diabetes Mellitus KW - Humans KW - Hypertension KW - Prevalence KW - Risk Assessment KW - Rural Health KW - United States KW - Urban Health KW - Vision Disorders AB -

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

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

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

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

PB - 20 VL - 20 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15085628?dopt=Abstract U4 - Visually Impaired Persons/Residential Segregation ER - TY - JOUR T1 - Nonmetro residence, hearing loss, and its accommodation among elderly people. JF - J Rural Health Y1 - 2004 A1 - Nan E. Johnson KW - Aged KW - Aged, 80 and over KW - Comorbidity KW - Female KW - Health Surveys KW - Hearing aids KW - Hearing loss KW - Humans KW - Male KW - Memory Disorders KW - Odds Ratio KW - Rural Health KW - United States KW - Urban Population AB -

BACKGROUND: No previous studies compare the prevalence of physiological hearing loss among older adults by nonmetro/metro residence. Also, there is little information on their relative successes in accommodating hearing loss with a hearing aid.

PURPOSE: This study sought to bridge these gaps by analyzing the 8,222 respondents to Wave 1 (1993-1994) of the national Asset and Health Dynamics Among the Oldest Old (AHEAD) Survey.

METHODS: Respondents were classified into 4 categories of hearing status: (1) physiologically normal hearing; and physiologically abnormal hearing with (2) full accommodation of lost hearing with a hearing aid, (3) partial accommodation, and (4) no hearing aid. A multinomial logistic regression was used to predict the odds of having any of the 3 statuses of physiologically abnormal hearing rather than normal hearing.

FINDINGS: Nonmetro residents had the same odds as metro residents of having no residual hearing loss when a hearing aid was worn (versus having physiologically normal hearing). But nonmetro residents had a much greater risk than their metro counterparts of having a hearing loss but no hearing aid or a residual hearing loss even when wearing an aid. The association of nonmetro residence with either of these latter hearing-loss statuses was greater than that of age, a more traditionally acknowledged hearing-risk factor.

CONCLUSION: Future studies should add nonmetro residence to the list of risk factors for negative hearing outcomes, especially since the percentage of elderly nonmetro residents is expected to grow over the next 2 decades.

PB - 20 VL - 20 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15085627?dopt=Abstract U4 - Hearing Impaired Persons/Residential Segregation ER - TY - JOUR T1 - Number of children associated with obesity in middle-aged women and men: results from the health and retirement study. JF - J Womens Health (Larchmt) Y1 - 2004 A1 - Weng, Haoling H. A1 - Bastian, Lori A. A1 - Donald H. Taylor Jr. A1 - Truls Ostbye KW - Adult KW - Aged KW - Body Mass Index KW - Family Characteristics KW - Female KW - Health Behavior KW - Health Surveys KW - Humans KW - Male KW - Middle Aged KW - Obesity KW - Parity KW - Risk Assessment KW - United States AB -

OBJECTIVE: To study associations between number of children and obesity in middle-aged women and men.

METHODS: In the Health and Retirement Study, a national survey of households, we tested the association between increasing number of children and obesity (body mass index [BMI] >or= 30) in 9046 middle-aged women and men (4523 couples).

RESULTS: Women (n = 4523) who were obese were more frequently nonwhite, reported lower household income, were more frequently employed outside the home, were less frequently covered by health insurance, and were more frequently less educated compared with nonobese women. Men (n = 4523) who were obese were younger, were more frequently African American, and were more frequently less educated and poorer compared with nonobese men. Among women, a 7% increase in risk of obesity was noted for each additional child, adjusting for age, race, household income, work status, physical activity, tobacco use, and alcohol use. Among men, a 4% increase in risk of obesity was noted for each additional child, adjusting for the same covariates. These sex differences were not significantly different.

CONCLUSIONS: Previous research has demonstrated an association between number of children and obesity among women. These results suggest a similar association among men. Public health interventions focused on obesity prevention should target both parents, especially those parents with several children.

PB - 12 VL - 13 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15006281?dopt=Abstract U4 - Obesity ER - TY - JOUR T1 - Obesity's effects on the onset of functional impairment among older adults. JF - Gerontologist Y1 - 2004 A1 - Kristi Rahrig Jenkins KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Body Weight KW - Chronic disease KW - Disabled Persons KW - Exercise KW - Female KW - Humans KW - Longitudinal Studies KW - Male KW - Motor Activity KW - Movement KW - Obesity KW - Risk-Taking KW - United States AB -

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

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

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

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

PB - 44 VL - 44 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15075417?dopt=Abstract U4 - Obesity/Health Status--ADL limitations ER - TY - JOUR T1 - Out-of-pocket health care expenditures among older Americans with dementia. JF - Alzheimer Dis Assoc Disord Y1 - 2004 A1 - Kenneth M. Langa A1 - Eric B Larson A1 - Robert B Wallace A1 - A. Mark Fendrick A1 - Norman L Foster A1 - Mohammed U Kabeto A1 - David R Weir A1 - Robert J. Willis A1 - A. Regula Herzog KW - Aged KW - Aged, 80 and over KW - Alzheimer disease KW - Costs and Cost Analysis KW - Data Interpretation, Statistical KW - Female KW - Financing, Personal KW - Health Care Costs KW - Health Expenditures KW - Health Surveys KW - Humans KW - Insurance Coverage KW - Longitudinal Studies KW - Male AB -

The number of older individuals with dementia will likely increase significantly in the next decades, but there is currently limited information regarding the out-of-pocket expenditures (OOPE) for medical care made by cognitively impaired individuals and their families. We used data from the 1993 and 1995 Asset and Health Dynamics Study, a nationally representative longitudinal survey of older Americans, to determine the OOPE for individuals with and without dementia. Dementia was identified in 1993 using a modified version of the Telephone Interview for Cognitive Status for self-respondents, and proxy assessment of memory and judgment for proxy respondents. In 1995, respondents reported OOPE over the prior 2 years for: 1) hospital and nursing home stays, 2) outpatient services, 3) home care, and 4) prescription medications. The adjusted mean annual OOPE was 1,350 US dollars for those without dementia, 2,150 US dollars for those with mild/moderate dementia, and 3,010 US dollars for those with severe dementia (p < 0.01). Expenditures for hospital/nursing home care (1,770 per year US dollars) and prescription medications (800 per year US dollars) were the largest OOPE components for those with severe dementia. We conclude that dementia is independently associated with significantly higher OOPE for medical care compared with those with normal cognitive function. Severe dementia is associated with a doubling of OOPE, mainly due to higher payments for long-term care. Given that the number of older Americans with dementia will likely increase significantly in the coming decades, changes in public funding aimed at reducing OOPE for both long-term care and prescription medications would have considerable impact on individuals with dementia and their families.

PB - 18 VL - 18 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15249853?dopt=Abstract U4 - Dementia/Health Expenditures ER - TY - JOUR T1 - Out-of-pocket health-care expenditures among older Americans with cancer. JF - Value Health Y1 - 2004 A1 - Kenneth M. Langa A1 - A. Mark Fendrick A1 - M.E. Chernew A1 - Mohammed U Kabeto A1 - Paisley, Kerry L. A1 - Hayman, James A. KW - Aged KW - Aged, 80 and over KW - Cost of Illness KW - Family Characteristics KW - Female KW - Financing, Personal KW - Health Expenditures KW - Health Services Research KW - Humans KW - Insurance, Health KW - Longitudinal Studies KW - Male KW - Medicaid KW - Medicare KW - Michigan KW - Neoplasms AB -

OBJECTIVE: There is currently limited information regarding the out-of-pocket expenditures (OOPE) for medical care made by elderly individuals with cancer. We sought to quantify OOPE for community-dwelling individuals age 70 or older with: 1) no cancer (No CA), 2) a history of cancer, not undergoing current treatment (CA/No Tx), and 3) a history of cancer, undergoing current treatment (CA/Tx).

METHODS: We used data from the 1995 Asset and Health Dynamics Study, a nationally representative survey of community-dwelling elderly individuals. Respondents identified their cancer status and reported OOPE for the prior 2 years for: 1) hospital and nursing home stays, 2) outpatient services, 3) home care, and 4) prescription medications. Using a multivariable two-part regression model to control for differences in sociodemographics, living situation, functional limitations, comorbid chronic conditions, and insurance coverage, the additional cancer-related OOPE were estimated.

RESULTS: Of the 6370 respondents, 5382 (84%) reported No CA, 812 (13%) reported CA/No Tx, and 176 (3%) reported CA/Tx. The adjusted mean annual OOPE for the No CA, CA/No Tx, and CA/Tx groups were 1210 dollars, 1450 dollars, and 1880 dollars, respectively (P < .01). Prescription medications (1120 dollars per year) and home care services (250 dollars) accounted for most of the additional OOPE associated with cancer treatment. Low-income individuals undergoing cancer treatment spent about 27% of their yearly income on OOPE compared to only 5% of yearly income for high-income individuals with no cancer history (P < .01).

CONCLUSIONS: Cancer treatment in older individuals results in significant OOPE, mainly for prescription medications and home care services. Economic evaluations and public policies aimed at cancer prevention and treatment should take note of the significant OOPE made by older Americans with cancer.

PB - 7 VL - 7 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15164808?dopt=Abstract U4 - Health Care Costs/Health Expenditures ER - TY - JOUR T1 - Quality of preventive clinical services among caregivers in the health and retirement study. JF - J Gen Intern Med Y1 - 2004 A1 - Kim, Catherine A1 - Mohammed U Kabeto A1 - Robert B Wallace A1 - Kenneth M. Langa KW - Aged KW - Caregivers KW - Cohort Studies KW - Cross-Sectional Studies KW - Female KW - Health Care Surveys KW - Humans KW - Male KW - Middle Aged KW - Patient Acceptance of Health Care KW - Preventive Health Services KW - Quality of Health Care KW - Time Factors KW - United States AB -

We examined the association between caregiving for a spouse and preventive clinical services (self-reported influenza vaccination, cholesterol screening, mammography, Pap smear, and prostate cancer screening over 2 years and monthly self-breast exam) for the caregiver in a cross-sectional analysis of the Health and Retirement Study, a nationally representative sample of U.S. adults aged > or = 50 years (N = 11,394). Spouses engaged in 0, 1-14, or > or = 14 hours per week of caregiving. Each service was examined in logistic regression models adjusting for caregiver characteristics. After adjustment for covariates, there were no significant associations between spousal caregiving and likelihood of caregiver receipt of preventive services.

PB - 19 VL - 19 IS - 8 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15242474?dopt=Abstract U4 - Caregiving/Spouses/Health Care Utilization/Caregivers/Health Services ER - TY - JOUR T1 - Race, gender, and the retirement decisions of people ages 60 to 80: prospects for age integration in employment. JF - Int J Aging Hum Dev Y1 - 2004 A1 - Tay K. McNamara A1 - Williamson, John B. KW - Age Distribution KW - Aged KW - Aged, 80 and over KW - Black People KW - Educational Status KW - Employment KW - Female KW - Health Status KW - Humans KW - Income KW - Logistic Models KW - Male KW - Middle Aged KW - Retirement KW - Sex Distribution KW - White People AB -

UNLABELLED: Demographic projections have prompted concerns about the potential economic burden of an aging population. This article, drawing on the 1998 Health and Retirement Study, explores ways in which race, gender, and age moderate the effects of various factors on labor force participation among people ages 60 to 80. Key findings center on health, education, and non-wage income. First, the effect of low non-wage income is weaker at older ages due to higher levels of functional disability. Second, the effect of low education is stronger for women, who perceive their chances of finding employment as low. Third, the effect of health is weaker for blacks, as they are less likely to find steady employment regardless of health.

POLICY IMPLICATIONS: Employer flexibility in number of hours worked might make sense for workers close to retirement age, while job search and training programs might be preferable for workers past the typical retirement age.

PB - 59 VL - 59 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15566013?dopt=Abstract U4 - Racial disparities/Labor Force Participation ER - TY - JOUR T1 - Religion and preventative health care utilization among the elderly. JF - Soc Sci Med Y1 - 2004 A1 - Benjamins, Maureen Reindl A1 - Brown, Carolyn KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Catholicism KW - Diagnostic Tests, Routine KW - Female KW - Health Services for the Aged KW - Health Status KW - Humans KW - Interviews as Topic KW - Jews KW - Logistic Models KW - Longitudinal Studies KW - Male KW - Patient Acceptance of Health Care KW - Preventive Health Services KW - Primary Health Care KW - Protestantism KW - Religion and Psychology KW - Socioeconomic factors KW - United States AB -

Evidence supporting a relationship between religion and physical health has increased substantially in the recent past. One possible explanation for this relationship that has not received much attention in the literature is that health care utilization may differ by religious involvement or religious denomination. A nationally representative sample of older adults was used to estimate the effects of religious salience and denomination on six different types of preventative health care (i.e. flu shots, cholesterol screening, breast self-exams, mammograms, pap smears, and prostate screening). Findings show that both men and women who report high levels of religiosity are more likely to use preventative services. Denominational differences show that affiliated individuals, especially those who are Jewish, are significantly more likely to use each type of preventative care than non-affiliated individuals. The results of this study open the door to further exploration of this potentially important, but relatively neglected, link between religion and health.

PB - 58 VL - 58 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/14572925?dopt=Abstract U4 - Religiosity/Elderly/Health Care Utilization 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 - Retirement transitions and spouse disability: effects on depressive symptoms. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2004 A1 - Maximiliane E Szinovacz A1 - Adam Davey KW - Activities of Daily Living KW - Adaptation, Psychological KW - Aged KW - Caregivers KW - Demography KW - depression KW - Disabled Persons KW - Female KW - Follow-Up Studies KW - Humans KW - Male KW - Middle Aged KW - Retirement KW - Spouses KW - Surveys and Questionnaires AB -

OBJECTIVES: The purpose of this study was to investigate the effects of type of retirement (forced, early, abrupt) and spouse's disability on longitudinal change in depressive symptoms.

METHODS: The analyses rely on Waves 1-4 of the Health and Retirement Survey (N = 2,649). Generalized estimating equations models with bootstrapped standard errors and adjustment for survey design and non-independence of dyad members estimate effects of retirement, type of retirement, and spouse's disability on depressive symptoms, controlling for relevant covariates.

RESULTS: The results suggest that depressive symptoms increase when retirement is abrupt and perceived as too early or forced. Women retirees who stopped employment and were either forced into retirement or perceived their retirement as too early report significantly more depressive symptoms with increasing spouse activities of daily living (ADLs) limitations. There is no similar effect for men. In contrast, for working retirees who retired on time, depressive symptoms decrease with increasing spouse ADLs.

DISCUSSION: These results highlight the importance of retirement context on postretirement well-being. They suggest that both type of retirement transition and marital contexts such as spouse's disability influence postretirement well-being, and these effects differ by gender.

PB - 59B VL - 59 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15576864?dopt=Abstract U4 - Retirement Behavior/Spouse/Disability/Disability/Depressive Symptoms ER - TY - JOUR T1 - Urinary incontinence and its association with death, nursing home admission, and functional decline. JF - J Am Geriatr Soc Y1 - 2004 A1 - Holroyd-Leduc, Jayna M. A1 - Kala M. Mehta A1 - Kenneth E Covinsky KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Body Mass Index KW - Female KW - Follow-Up Studies KW - Frail Elderly KW - Health Status KW - Humans KW - Male KW - Nursing homes KW - Outcome Assessment, Health Care KW - Risk Factors KW - Smoking KW - Socioeconomic factors KW - Time Factors KW - Urinary incontinence AB -

OBJECTIVES: To determine whether urinary incontinence (UI) is an independent predictor of death, nursing home admission, decline in activities of daily living (ADLs), or decline in instrumental activities of daily living (IADLs).

DESIGN: A population-based prospective cohort study from 1993 to 1995.

SETTING: Community-dwelling within the United States.

PARTICIPANTS: Six thousand five hundred six of the 7,447 subjects aged 70 and older in the Asset and Health Dynamics Among the Oldest Old study who had complete information on continence status and did not require a proxy interview at baseline.

MEASUREMENTS: The predictor was UI, and the outcomes were death, nursing home admission, ADL decline, and IADL decline. Potential confounders considered were comorbid conditions, baseline function, sensory impairment, cognition, depressive symptoms, body mass index, smoking and alcohol, demographics, and socioeconomic status.

RESULTS: The prevalence of UI was 14.8% (18.5% in women; 8.5% in men). At 2-year follow-up, subjects incontinent at baseline were more likely to have died (10.9% vs 8.7%; unadjusted odds ratio (OR)=1.29, 95% confidence interval (CI)=1.02-1.64), be admitted to a nursing home (4.4% vs 2.6%, OR=1.77; 95% CI=1.18-2.63), and to have declined in ADL function (13.6% vs 8.1%; OR=1.78, 95% CI=1.36-2.33) and IADL function (21.2% vs 13.8%; OR 1.69, 95% CI 1.39-2.05). However, after adjusting for confounders, UI was not an independent predictor of death (adjusted OR (AOR)= 0.90, 95% CI=0.67-1.21), nursing home admission (AOR=1.33, 95% CI=0.86-2.04), or ADL decline (AOR=1.24, 95% CI=0.92-1.68). Incontinence remained a predictor of IADL decline (AOR=1.31; 95% CI=1.05-1.63), although adjustment markedly reduced the strength of this association.

CONCLUSION: Higher levels of baseline illness severity and functional impairment appear to mediate the relationship between UI and adverse outcomes. The results suggest that, although UI appears to be a marker of frailty in community-dwelling elderly, it is not a strong independent risk factor for death, nursing home admission, or functional decline.

PB - 52 VL - 52 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15086650?dopt=Abstract U4 - Urinary Incontinence/Mortality/Nursing Homes/Activities of Daily Living ER - TY - JOUR T1 - Use of an IRT-based latent variable model to link different forms of the CES-D from the Health and Retirement Study. JF - Soc Psychiatry Psychiatr Epidemiol Y1 - 2004 A1 - Richard N Jones A1 - Stephanie J. Fonda KW - Adult KW - Aged KW - Aging KW - Calibration KW - Depressive Disorder KW - Female KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Models, Psychological KW - Psychological Tests KW - Psychometrics KW - United States AB -

BACKGROUND: The goal of this study was to calibrate depressive symptoms collected using different versions of the Centers for Epidemiologic Studies - Depression (CES-D) instrument in different waves of the Health and Retirement Study (HRS).

METHOD: The HRS is a prospective and nationally representative cohort study. This analysis included a sample of HRS participants, adults aged 23-85 years in 1992 who had complete data on depressive symptoms at initial 2- and 4-year follow-up interviews (N= 5,734). Depressive symptoms were assessed with the CES-D. Symptom coverage and response categories varied across study wave. The first wave (1992) used a four-category response, whereas subsequent waves (1994 and 1996) used a two-category response. A structural equations model (SEM) based in Item Response Theory (IRT) was used to calibrate symptoms and generate linked depressive symptom burden scores.

RESULTS: Linked depressive symptom burden scores, derived from calibrated symptoms, were distributed similarly across HRS wave.

CONCLUSION: Our results demonstrate the applicability of an IRT-based SEM to address a common challenge in prospective studies: changes in the content and context of symptom assessment. Future investigations may make use of our linked syndrome scores to further explore other aspects of depression from a longitudinal perspective.

PB - 39 VL - 39 IS - 10 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15669664?dopt=Abstract U4 - Depression ER - TY - JOUR T1 - Additive and interactive effects of comorbid physical and mental conditions on functional health. JF - J Aging Health Y1 - 2003 A1 - Fultz, Nancy H. A1 - Mary Beth Ofstedal A1 - A. Regula Herzog A1 - Robert B Wallace KW - Activities of Daily Living KW - Aged KW - Aging KW - Black or African American KW - Cognition Disorders KW - depression KW - Diabetes Complications KW - Educational Status KW - Health Surveys KW - Hispanic or Latino KW - Humans KW - Stroke KW - United States KW - White People AB -

OBJECTIVE: To understand the role of cognitive impairment and depressive symptoms on functional outcomes of stroke and diabetes. Evaluation approaches to functional outcomes have rarely focused on the presence of specific comorbidities, particularly those involving mental health disorders.

METHODS: Data are from the AHEAD cohort of the Health and Retirement Study (HRS), a nationally representative panel of persons 70+ years of age in 1993. Analyses are limited to 5,646 self-respondents for whom functional outcome data are available in 1995. Additive and interactive multiple regression models are compared for each outcome and focal condition combination.

RESULTS: The additive model is sufficient for the majority of outcome and focal condition combinations. The interaction term is significant in 4 of 12 comparisons.

DISCUSSION: Stroke, diabetes, cognitive impairment, and depressive symptoms exhibit strong independent effects on physical functioning. Support for the hypothesis that cognitive impairment and depression exacerbate the impact of stroke and diabetes is more limited.

PB - 15 VL - 15 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/12914014?dopt=Abstract U4 - Activities of Daily Living/Chronic Disease/Epidemiology/Health Surveys ER - TY - JOUR T1 - Additive effects of cognitive function and depressive symptoms on mortality in elderly community-living adults. JF - J Gerontol A Biol Sci Med Sci Y1 - 2003 A1 - Kala M. Mehta A1 - Kristine Yaffe A1 - Kenneth M. Langa A1 - Laura Sands A1 - Whooley, Mary A1 - Kenneth E Covinsky KW - Aged KW - Cognition KW - depression KW - Female KW - Humans KW - Male KW - Mortality KW - Proportional Hazards Models KW - Risk Factors AB -

BACKGROUND: Poor cognitive function and depressive symptoms are common in the elderly, frequently coexist, and are interrelated. Both risk factors are independently associated with mortality. Few studies have comprehensively described how the combination of poor cognitive function and depressive symptoms affect the risk for mortality. Our aim was to examine whether the combination of varying levels of cognitive function and depressive symptoms affect the risk of mortality in community-living elderly adults.

METHODS: We studied 6301 elderly adults (mean age, 77 years; 62% women; 81% white) enrolled in the Asset and Health Dynamics Among the Oldest Old (AHEAD) study, a prospective study of community-living participants conducted from 1993 to 1995. Cognitive function and depressive symptoms were measured using two validated measures developed for the AHEAD study. On each measure, participants were divided into tertiles representing the best, middle, and worst scores, and then placed into one of nine mutually exclusive groups ranging from best functioning on both measures to worst functioning on both measures. Mortality rates were assessed in each of the nine groups. Cox proportional hazards models were used to control for potentially confounding characteristics such as demographics, education, income, smoking, alcohol consumption, comorbidity, and baseline functional impairment.

RESULTS: During 2 years of follow-up, 9% (548) of the participants died. Together, cognitive function and depressive symptoms differentiated between elderly adults at markedly different risk for mortality, ranging from 3% in those with the best function on both measures to 16% in those with the worst function on both measures (p <.001). Furthermore, for each level of cognitive function, more depressive symptoms were associated with higher mortality rates, and for each level of depressive symptoms, worse cognitive function was associated with higher mortality rates. In participants with the best cognitive function, mortality rates were 3%, 5%, and 9% in participants with low, middle, and high depressive symptoms, respectively (p <.001 for trend). The corresponding rates were 6%, 7%, and 12% in participants with the middle level of cognitive function (p <.001 for trend), and 10%, 13%, and 16% in participants with the worst level of cognitive function (p <.001 for trend). After adjustment for confounders, participants with the worst function on both measures remained at considerably higher risk for death than participants with the best function on both measures (adjusted hazard ratio, 3.1; 95% confidence interval, 2.0-4.7).

CONCLUSIONS: Cognitive function and depressive symptoms can be used together to stratify elderly adults into groups that have significantly different rates of death. These two risk factors are associated with an increased risk in mortality in a progressive, additive manner.

PB - 58A VL - 58 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/12730257?dopt=Abstract U4 - Cognitive Function/Depressive Symptoms/Mortality ER - TY - JOUR T1 - Asking neutral versus leading questions: implications for functional limitation measurement. JF - J Aging Health Y1 - 2003 A1 - Vicki A Freedman A1 - Aykan, Hakan A1 - Kleban, Morton H. KW - Activities of Daily Living KW - Aged KW - Factor Analysis, Statistical KW - Health Surveys KW - Humans KW - Research Design KW - Surveys and Questionnaires KW - United States AB -

UNLABELLED: National surveys of older Americans routinely have included functional limitation items using either a leading approach ("how much difficulty do you have...") or a neutral approach ("do you have any difficulty..."). This article evaluates the performance of scales based on these two approaches.

METHODS: Using responses from 595 randomly selected participants to the 1994 Health and Retirement Study, the authors compared prevalences and evaluated scales based on each approach with respect to the extent of missing data, face validity, reliability, predictive validity, convergent validity, and robustness of odds ratios in predictive models.

RESULTS: The authors found that leading questions provided higher estimates of functional limitations than neutral questions, but both approaches yielded scales with similar validity and reliability. However, for both approaches, scales incorporating degree of difficulty had better validity and reliability than those based on counts of tasks. All four approaches yielded substantially similar coefficients in a model predicting disability onset.

DISCUSSION: The authors conclude that, because they minimize survey time without compromising validity and reliability, items that explicitly capture degree of difficulty by asking "How much difficulty do you have..." may be the optimal approach for survey designers.

PB - 15 VL - 15 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/14594023?dopt=Abstract U4 - Method of Questioning/Measurement/Survey Methods ER - TY - JOUR T1 - Cognitive function and acute care utilization. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2003 A1 - Walsh, Edith G. A1 - Bei Wu A1 - Mitchell, Janet B. A1 - Lisa F Berkman KW - Aged KW - Cognition Disorders KW - Female KW - Geriatric Assessment KW - Health Behavior KW - Health Status KW - Hospitalization KW - Hospitals KW - Humans KW - Length of Stay KW - Male KW - Neuropsychological tests KW - Outpatient Clinics, Hospital KW - Severity of Illness Index KW - United States AB -

OBJECTIVES: Little is known about variation in cognitive function across the aged population, or how use and costs of health care vary with cognitive impairment. This study was designed to create a typology of cognitive function in a nationally representative sample, and evaluate acute care use in relation to cognitive function, holding constant confounding factors. By including proxy assessments of cognitive function, this is the first study to include individuals unable to respond themselves.

METHODS: We analyzed the baseline year of the Asset and Health Dynamics Among the Oldest Old (AHEAD) survey, sponsored by the National Institute on Aging, to create three levels of cognitive function, using direct measures for self-respondents (n = 6,651) and proxy evaluations for the others (n = 792). We used a two-part model to predict the likelihood of using various health services and to evaluate intensity of care among users.

RESULTS: Sixteen percent, 64%, and 20% of the sample fell into the low, moderate, and high cognitive function groups, respectively, that differed significantly on almost all demographic and health status measures, and some utilization measures. Controlling for other health and functional status measures, lower cognitive function had a significant and negative effect on outpatient services, but did not affect hospital use directly.

DISCUSSION: Lower cognitive function may be a barrier to outpatient care, but these analyses should be repeated using administrative use and cost data.

PB - 58B VL - 58 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/12496307?dopt=Abstract U4 - Cognitive Function/Health Care Utilization 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 - Health care utilization among older adults with arthritis. JF - Arthritis Rheum Y1 - 2003 A1 - Dorothy D Dunlop A1 - Larry M Manheim A1 - Song, Jing A1 - Rowland W Chang KW - Aged KW - Aged, 80 and over KW - Ambulatory Surgical Procedures KW - Arthritis KW - Comorbidity KW - Cost of Illness KW - Female KW - Health Services KW - Home Care Services KW - Hospitals KW - Humans KW - Insurance, Health KW - Longitudinal Studies KW - Male KW - Nursing homes KW - Physicians' Offices KW - Social Class AB -

OBJECTIVE: To evaluate the effect of arthritis on subsequent 2-year use of health care services and out-of-pocket costs among older adults and determine if comorbidities or economic resources mitigate that effect.

METHODS: Data were analyzed from 6230 participants interviewed in 1993 and 1995 in the Asset and Health Dynamic Survey Among the Oldest Old (AHEAD), a national probability sample of community-dwelling adults. Baseline arthritis status was ascertained from the report of an arthritis-related physician's visit or a joint replacement not associated with a hip fracture. The effect of baseline arthritis on the odds of subsequent 2-year health care utilization and high out-of-pocket expenses were estimated from multiple logistic regression controlling for demographic factors, comorbidity, and economic resources.

RESULTS: Older adults with arthritis are significantly more likely to have a physician visit (odds ratio [OR] 3.0), hospital admission (OR 1.6), outpatient surgery (OR 1.3), receive home health care (OR 1.6), and have out-of-pocket cost >5000 US dollars (OR 1.6) compared with contemporaries having similar demographics (age, sex, racial/ethnic group, marital status), comorbid conditions, and economic resources (education, income, wealth, health insurance), but not reporting arthritis.

CONCLUSIONS: Older adults with symptomatic arthritis reported greater medical utilization and cost compared with people not reporting arthritis. These disparities persisted after accounting for differences in demographics, comorbidities, and economic factors. These findings document greater economic burdens on a personal and societal level among people with arthritis. As individuals, older adults with arthritis spend more out-of-pocket dollars for health care than their contemporaries without arthritis. On a societal level, these findings of greater health care utilization among people with arthritis point to increasing future demands on the US health care system due to demographic increases in the numbers of older adults with arthritis and support policies aimed at improving arthritis prevention and treatment as well as reducing the economic disparities between those with and without arthritis.

PB - 49 VL - 49 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/12687506?dopt=Abstract U4 - Arthritis/Health Care Utilization ER - TY - JOUR T1 - High out-of-pocket health care spending by the elderly. JF - Health Aff (Millwood) Y1 - 2003 A1 - Dana P Goldman A1 - Julie M Zissimopoulos KW - Aged KW - Drug Costs KW - Drug Prescriptions KW - Financing, Personal KW - Health Care Surveys KW - Health Expenditures KW - Health Maintenance Organizations KW - Health Services for the Aged KW - Humans KW - Insurance, Health KW - Medicare KW - Poverty KW - United States AB -

We use data from the Health and Retirement Study to examine the elderly's out-of-pocket health care spending. We find that Medicare HMOs, employer supplements, and Medicaid effectively insulate against the risk of high expenditures. At the ninetieth percentile, Medicare beneficiaries with employer supplements or enrolled in Medicare HMOs spend 1,600 dollars less out of pocket than beneficiaries with traditional Medicare spend. For the poor elderly, Medicaid offers similar protection. Among the near-poor elderly, there is little employer coverage, so Medicare HMOs provide most of the protection against financial risk. There is evidence that Medicare HMO benefits have eroded since 1998, raising the question of whether the near-poor have lost financial protection since then.

PB - 22 VL - 22 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/12757285?dopt=Abstract U4 - Health Expenditures/Medicaid/Medicare ER - TY - JOUR T1 - Immigrant status, living arrangements, and depressive symptoms among middle-aged and older adults. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2003 A1 - Janet M Wilmoth A1 - Pei-Chun Chen KW - Acculturation KW - Aged KW - Cross-Sectional Studies KW - depression KW - Emigration and Immigration KW - Female KW - Follow-Up Studies KW - Humans KW - Male KW - Middle Aged KW - Quality of Life KW - Residence Characteristics AB -

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

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

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

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

PB - 58B VL - 58 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/14507941?dopt=Abstract U4 - Immigrants/Living Conditions/Depression ER - TY - JOUR T1 - Life expectancy with cognitive impairment in the older population of the United States. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2003 A1 - Suthers, Kristen A1 - Jung K Kim A1 - Eileen M. Crimmins KW - Aged KW - Aged, 80 and over KW - Alzheimer disease KW - Cross-Sectional Studies KW - Female KW - Humans KW - Life Expectancy KW - Male KW - Neuropsychological tests KW - Probability KW - Psychometrics KW - Sex Factors KW - Survival Analysis KW - United States AB -

OBJECTIVES: This article provides estimates of the prevalence of cognitive impairment by age and sex for a nationally representative sample of the U.S. population aged 70 and over. From these estimates, years of life with and without cognitive impairment are calculated.

METHODS: Using data from the Assets and Health Dynamics of the Oldest Old (AHEAD) survey, the prevalence of cognitive impairment is estimated for a sample representing both the community-dwelling and institutionalized older American population. Sullivan's method is used to calculate the average number of years an elderly person can expect to live with and without cognitive impairment.

RESULTS: The prevalence of moderate to severe cognitive impairment in the total U.S. population aged 70 and over is 9.5%. At age 70, the average American can expect 1.5 years with cognitive impairment. Expected length of life with cognitive impairment is longer for women than men because of their longer life expectancy.

DISCUSSION: As total life expectancy continues to increase, the length of life with cognitive impairment for the American population will increase unless age-specific prevalence is reduced. There is great potential for improvement in future early treatment and diagnosis of this condition.

PB - 58B VL - 58 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/12730319?dopt=Abstract U4 - Cognitive Function/Life Expectancy ER - TY - JOUR T1 - Medication costs, adherence, and health outcomes among Medicare beneficiaries. JF - Health Aff (Millwood) Y1 - 2003 A1 - Ramin Mojtabai A1 - Mark Olfson KW - Aged KW - Aged, 80 and over KW - Chronic disease KW - Continuity of Patient Care KW - Family Characteristics KW - Female KW - Financing, Personal KW - Health Services Research KW - Humans KW - Income KW - Insurance, Pharmaceutical Services KW - Longitudinal Studies KW - Male KW - Medicare KW - Patient Compliance KW - Prevalence KW - Probability KW - Self Administration KW - Treatment Outcome KW - United States AB -

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

PB - 22 VL - 22 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/12889771?dopt=Abstract U4 - Medicare ER - TY - JOUR T1 - Racial disparities in joint replacement use among older adults. JF - Med Care Y1 - 2003 A1 - Dorothy D Dunlop A1 - Larry M Manheim A1 - Song, Jing A1 - Rowland W Chang KW - Aged KW - Aged, 80 and over KW - Arthroplasty, Replacement KW - Black or African American KW - Cohort Studies KW - Data Interpretation, Statistical KW - Health Services Accessibility KW - Health Services Needs and Demand KW - Health Status KW - Health Surveys KW - Hispanic or Latino KW - Humans KW - Interviews as Topic KW - Osteoarthritis KW - Sampling Studies KW - United States KW - White People AB -

BACKGROUND: Although joint replacement can restore function for arthritis patients with severe joint disease, this procedure has not been used equally across racial groups. Differences in joint replacement use are assessed from a national sample.

OBJECTIVE: This study evaluates the role of health conditions and economic access to explain differences in joint replacement among older black and Hispanic minorities relative to white persons.

DESIGN: Longitudinal (1993-1995) Asset and Health Dynamics Among the Oldest Old (AHEAD) study.

SETTING: National probability sample of US community-dwelling older adults.

PATIENT POPULATION: AHEAD participants (n = 6159) aged 69 to 103 years.

MEASUREMENTS: The outcome is subject-reported 2-year use of any arthritis-related joint-replacement. Independent variables are demographics, health needs (arthritis, other medical conditions, functional health), and economic access (income, assets, education, and health insurance).

RESULTS: Older minorities reported arthritis-related joint replacements (black: 0.98%; Hispanic: 0.97%, annually) less frequently compared with white persons (1.48% annually). Older minorities were significantly less likely to use joint replacement compared with white persons (OR, 0.37; 95% CI, 0.20, 0.71) controlling for demographics, and arthritis and other health needs. Disparities remained significant (OR, 0.46; 95% CI, 0.22, 0.98) after additionally controlling for economic medical access. Use was lower among people who depended solely on Medicare compared with those with supplemental health insurance (OR, 0.46; 95% CI, 0.22, 0.95).

CONCLUSIONS: These national data document low rates of arthritis-related joint replacement among older Hispanic persons comparable to black persons. Less use among older minorities compared with white persons is not explained by differences in health needs or economic access. Other cultural and attitudinal factors merit investigation to explain disparities.

PB - 41 VL - 41 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/12555056?dopt=Abstract U4 - Arthritis/Health Care/Racial disparities ER - TY - JOUR T1 - Racial/ethnic differences in rates of depression among preretirement adults. JF - Am J Public Health Y1 - 2003 A1 - Dorothy D Dunlop A1 - Song, Jing A1 - Lyons, J.S. A1 - Larry M Manheim A1 - Rowland W Chang KW - Aged KW - Black or African American KW - Cohort Studies KW - Comorbidity KW - Demography KW - Depressive Disorder, Major KW - Diagnostic and Statistical Manual of Mental Disorders KW - Female KW - Hispanic or Latino KW - Humans KW - Male KW - Middle Aged KW - Minority Groups KW - Probability KW - Risk Factors KW - Socioeconomic factors KW - United States KW - White People AB -

OBJECTIVES: We estimated racial/ethnic differences in rates of major depression and investigated possible mediators.

METHODS: Depression prevalence rates among African American, Hispanic, and White adults were estimated from a population-based national sample and adjusted for potential confounders.

RESULTS: African Americans (odds ratio [OR] = 1.16, 95% confidence interval [CI] = 0.93, 1.44) and Hispanics (OR = 1.44, 95% CI = 1.02, 2.04) exhibited elevated rates of major depression relative to Whites. After control for confounders, Hispanics and Whites exhibited similar rates, and African Americans exhibited significantly lower rates than Whites.

CONCLUSIONS: Major depression and factors associated with depression were more frequent among members of minority groups than among Whites. Elevated depression rates among minority individuals are largely associated with greater health burdens and lack of health insurance, factors amenable to public policy intervention.

PB - 93 VL - 93 IS - 11 U1 - http://www.ncbi.nlm.nih.gov/pubmed/14600071?dopt=Abstract U4 - Racial Differences/Depression 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 - Self-rated life expectancy as a predictor of mortality: evidence from the HRS and AHEAD surveys. JF - Gerontology Y1 - 2003 A1 - Michele J. Siegel A1 - Elizabeth H Bradley A1 - Stanislav V Kasl KW - Aged KW - Female KW - Health Status KW - Health Surveys KW - Humans KW - Life Expectancy KW - Male KW - Mortality KW - Prognosis KW - Proportional Hazards Models KW - Self Concept KW - Sex Distribution KW - Survival Analysis AB -

BACKGROUND: An extensive literature has demonstrated that self-ratings of health predict mortality, even after controlling for more objective measures of health, health habits and sociodemographic characteristics. We examine the role of a related concept, self-rated life expectancy, in predicting mortality.

OBJECTIVE: To assess whether self-rated life expectancy predicts mortality after controlling for measures of health, self-rated health, and sociodemographic characteristics.

METHODS: Using data from the 1992 Health and Retirement Survey (HRS), the 1993 Asset and Health Dynamics Among the Oldest Old (AHEAD) survey, and the second Tracker file (2.0), Cox proportional hazard models were estimated to assess whether self-rated life expectancy predicts mortality, after adjusting for self-rated health and several potential confounders that might otherwise explain this relationship. The AHEAD sample included 2,102 men and 3,160 women. During the 2 years of follow-up, 9% (n = 185) of the men died and 5% (n = 166) of the women died. The HRS sample was comprised of 4,090 men and 4,885 women. Four percent (n = 164) of the men died and 2% (n = 99) of the women died in the 3 years of follow-up.

RESULTS: In the older, AHEAD sample, both self-rated life expectancy (p < 0.01) and self-rated health (p < 0.05) predicted mortality for both men and women, even when the two measures were included in the model together. In the younger, HRS sample, self-rated life expectancy was not significantly associated with mortality when self-rated health was included in the model.

CONCLUSION: Our findings suggest that, although self-rated life expectancy and self-rated health may be conceptually related, they have independent empirical effects on mortality.

PB - 49 VL - 49 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/12792164?dopt=Abstract U4 - Subjective expectations/Mortality/Health ER - TY - JOUR T1 - Sickness and preventive medical behavior. JF - J Health Econ Y1 - 2003 A1 - Stephen Wu KW - Aged KW - Anxiety KW - Breast Self-Examination KW - Cholesterol KW - Female KW - Health Behavior KW - Health Expenditures KW - Health Status KW - Humans KW - Influenza Vaccines KW - Male KW - Mammography KW - Mass Screening KW - Middle Aged KW - Papanicolaou Test KW - Patient Acceptance of Health Care KW - Preventive Health Services KW - Primary Prevention KW - Prostatic Neoplasms KW - Retirement KW - Risk Factors KW - Vaginal Smears AB -

Using data from two sources, the Health and Retirement Study (HRS) and the Medical Expenditure Panel Survey (MEPS), I analyze the relationship between health status and the likelihood of engaging in medical screening and other preventive behavior. The results show that individuals who are in poorer health are more likely to get flu shots and cholesterol checks, but less likely to have mammograms, pap smears, breast examinations and prostate checks. There is some evidence that suggests that psychological factors such as fear and anxiety may be important reasons why sicker people are less likely to get cancer screens.

PB - 22 VL - 22 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/12842321?dopt=Abstract U4 - Health Status--physical, mental, and emotional/screening/prevention/anxiety ER - TY - JOUR T1 - Urinary incontinence and depression in middle-aged United States women. JF - Obstet Gynecol Y1 - 2003 A1 - Ingrid E Nygaard A1 - Carolyn L. Turvey A1 - Burns, Trudy L. A1 - Elizabeth A Chrischilles A1 - Robert B Wallace KW - Activities of Daily Living KW - Aged KW - Comorbidity KW - Cross-Sectional Studies KW - depression KW - Female KW - Humans KW - Logistic Models KW - Middle Aged KW - United States KW - Urinary incontinence AB -

OBJECTIVE: To determine the correlates of incontinence in middle-aged women and to test for an association between incontinence and depression.

METHODS: This was a population-based cross-sectional study of 5701 women who were residents of the United States, aged 50-69 years, and participated in the third interview of the Health and Retirement Study. The primary outcome measure was self-reported urinary incontinence. Depression was ascertained based on criteria set by the Diagnostic and Statistical Manual of Mental Disorders, using a short form of the Composite International Diagnostic Interview. In addition, depressive symptoms were assessed using the revised Center for Epidemiologic Studies Depression Scale. Multivariable logistic regression models were constructed to determine the independent association between incontinence and depression, after adjusting for confounders.

RESULTS: Approximately 16% reported either mild-moderate or severe incontinence. Depression, race, age, body mass index, medical comorbidities, and limited activities of daily living were associated with incontinence. After adjusting for medical morbidity, functional status, and demographic variables, women with severe and mild-moderate incontinence were 80% (odds ratio [OR] 1.82; 95% confidence interval [CI] 1.26, 2.63) and 40% (OR 1.41; 95% CI 1.06, 1.87) more likely, respectively, to have depression than continent women. The association did not hold for depressive symptoms measured by the revised Center for Epidemiologic Studies Depression Scale after adjusting for covariates.

CONCLUSION: Depression and incontinence are associated in middle-aged women. The strength of the association depends on the instrument used to classify depression. This reinforces the need to screen patients presenting for treatment of urinary incontinence for depression.

PB - 101 VL - 101 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/12517660?dopt=Abstract U4 - Depression/Women/Incontinence ER - TY - JOUR T1 - Driving life expectancy of persons aged 70 years and older in the United States. JF - Am J Public Health Y1 - 2002 A1 - Foley, Daniel J. A1 - Heimovitz, Harley K. A1 - Jack M. Guralnik A1 - Brock, Dwight B. KW - Accidents, Traffic KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Automobile Driving KW - Decision making KW - Family Characteristics KW - Female KW - Frail Elderly KW - Humans KW - Interviews as Topic KW - Licensure KW - Life Expectancy KW - Logistic Models KW - Male KW - Risk Factors KW - Transportation KW - United States AB -

OBJECTIVES: We estimated total life expectancy and driving life expectancy of US drivers aged 70 years and older.

METHODS: Life table methods were applied to 4699 elderly persons who were driving in 1993 and reassessed in a 1995 survey.

RESULTS: Drivers aged 70 to 74 years had a driving life expectancy of approximately 11 years. A higher risk of mortality among men as a cause of driving cessation offset a higher risk of driving cessation not related to mortality among women that resulted in similar driving life expectancies.

CONCLUSIONS: Nationwide, many elderly drivers quit driving each year and must seek alternative sources of transportation. Because of differences in life expectancy, women require more years of support for transportation, on average, than men after age 70.

PB - 92 VL - 92 IS - 8 U1 - http://www.ncbi.nlm.nih.gov/pubmed/12144985?dopt=Abstract U4 - Driving Patterns/Life Expectancy/Public Policy ER - TY - JOUR T1 - Individual consequences of volunteer and paid work in old age: health and mortality. JF - J Health Soc Behav Y1 - 2002 A1 - Luoh, M. A1 - A. Regula Herzog KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Employment KW - Female KW - Health Status KW - Humans KW - Male KW - Mortality KW - Multivariate Analysis KW - Prospective Studies KW - United States KW - Volunteers AB -

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

PB - 43 VL - 43 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/12664678?dopt=Abstract U4 - Labor Force Participation/Mortality/Work, volunteer ER - TY - JOUR T1 - Informal caregiving for diabetes and diabetic complications among elderly americans. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2002 A1 - Kenneth M. Langa A1 - Sandeep Vijan A1 - Rodney A. Hayward A1 - M.E. Chernew A1 - Caroline S Blaum A1 - Mohammed U Kabeto A1 - David R Weir A1 - Steven J. Katz A1 - Robert J. Willis A1 - A. Mark Fendrick KW - Aged KW - Aged, 80 and over KW - Caregivers KW - Cost of Illness KW - Costs and Cost Analysis KW - Diabetes Complications KW - Diabetes Mellitus KW - Disabled Persons KW - Female KW - Health Surveys KW - Humans KW - Hypoglycemic Agents KW - Insulin KW - Male KW - Time Factors AB -

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

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

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

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

PB - 57B VL - 57 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/11983744?dopt=Abstract U4 - Aged, 80 and Over/Caregivers/Cost of Illness/Costs and Cost Analysis/Diabetes Mellitus/Complications/Therapy/Disabled Persons/Female/Health Surveys/Hypoglycemic Agents/Insulin/Support, Non U.S. Government/Support, U.S. Government--non PHS/Support, U.S. Government--PHS/Time Factors ER - TY - JOUR T1 - Informal caregiving time and costs for urinary incontinence in older individuals in the United States. JF - J Am Geriatr Soc Y1 - 2002 A1 - Kenneth M. Langa A1 - Fultz, Nancy H. A1 - Sanjay Saint A1 - Mohammed U Kabeto A1 - A. Regula Herzog KW - Aged KW - Caregivers KW - Comorbidity KW - Confounding Factors, Epidemiologic KW - Female KW - Humans KW - Incontinence Pads KW - Male KW - Regression Analysis KW - Time Factors KW - United States KW - Urinary incontinence AB -

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

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

SETTING: Community-dwelling older people.

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

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

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

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

PB - 50 VL - 50 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/11982676?dopt=Abstract U4 - Caregivers/Comorbidity/Confounding Factors (Epidemiology)/Female/Incontinence Pads/Regression Analysis/Support, U.S. Government--PHS/Time Factors/United States/Epidemiology/Urinary Incontinence ER - TY - JOUR T1 - Linking clinical variables to health-related quality of life in Parkinson's disease. JF - Parkinsonism Relat Disord Y1 - 2002 A1 - Elizabeth A Chrischilles A1 - Linda M. Rubenstein A1 - Voelker, Margaret D. A1 - Robert B Wallace A1 - Rodnitzky, Robert L. KW - Aged KW - Cross-Sectional Studies KW - Female KW - Health Status KW - Humans KW - Male KW - Mental Health KW - Middle Aged KW - Parkinson Disease KW - Quality of Life AB -

OBJECTIVE: Identify the point-in-time relationship between Parkinson's disease (PD) signs and symptoms and measures of health-related quality of life (HRQL).

BACKGROUND: Clinical measures used in PD assessments traditionally emphasize physical signs and symptoms. We hypothesized that these measures would be strongly associated with the physical function dimensions of HRQL that reflect mental symptoms.

DESIGN/METHODS: A cross-sectional study of 193 neurology clinic PD patients employed self-administered in-clinic and take-home questionnaires and in-person clinical examinations and interviews.

RESULTS: The variance explained by PD physical signs and symptoms was substantial for physical function, but only modest for all other HRQL dimensions. Mental symptoms explained a larger proportion of variance than physical symptoms for 12 of the 14 HRQL measures.

CONCLUSION: PD patients' well-being, general health perceptions, health satisfaction and overall HRQL are strongly influenced by mental health symptoms and more weakly influenced by physical symptoms. Clinical evaluation of PD patients should include mental health and self-reported HRQL assessment.

PB - 8 VL - 8 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/12039432?dopt=Abstract U4 - Health Status/Mental Health/Quality of Life/Parkinson disease ER - TY - JOUR T1 - A longitudinal study of the effects of tobacco smoking and other modifiable risk factors on ill health in middle-aged and old Americans: results from the Health and Retirement Study and Asset and Health Dynamics among the Oldest Old survey. JF - Prev Med Y1 - 2002 A1 - Truls Ostbye A1 - Donald H. Taylor Jr. A1 - Sang-Hyuk Jung KW - Age Distribution KW - Aged KW - Aged, 80 and over KW - Alcohol Drinking KW - Attitude to Health KW - Chi-Square Distribution KW - Exercise KW - Female KW - Health Behavior KW - Health Status KW - Health Surveys KW - Humans KW - Life Style KW - Logistic Models KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Risk Assessment KW - Risk Factors KW - Sex Distribution KW - Smoking KW - Socioeconomic factors KW - Survival Rate KW - United States AB -

BACKGROUND: While the effects of smoking and other modifiable risk factors on mortality and specific diseases are well established, their effects on ill health more generally are less known. Using two national, longitudinal surveys, the objective of this study was to analyze the effect of smoking and other modifiable risk factors on ill health, defined in a multidimensional fashion (i.e., disability, impaired mobility, health care utilization, and self-reported health).

METHODS: The analyses were based on the Health and Retirement Study (HRS) (12,652 persons 50-60 years old surveyed in 1992, 1994, 1996, and 1998) and the Asset and Health Dynamics among the Oldest Old survey (8,124 persons 60-70 years old surveyed in 1993, 1996, and 1998).

RESULTS: Smoking was strongly related to mortality and to ill health, with similar relative effects in the middle-aged and the elderly. There were consistent adverse dose-response relationships between smoking and ill health in the HRS. Persons who had quit smoking at least 15 years prior to the survey were no more likely than never smokers to experience ill health. A dose-response relationship was found between exercise and ill health. For body mass index and alcohol, there were U-shaped relationships with ill health.

CONCLUSIONS: Public health efforts designed to encourage smoking cessation should emphasize improvements in ill health in addition to decreased mortality.

PB - 34 VL - 34 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/11902850?dopt=Abstract U4 - Smoking/Health Status/Health Behavior/Longitudinal Studies ER - TY - JOUR T1 - A national study of the quantity and cost of informal caregiving for the elderly with stroke. JF - Neurology Y1 - 2002 A1 - Hickenbottom, S.L. A1 - A. Mark Fendrick A1 - Kutcher, J.S. A1 - Mohammed U Kabeto A1 - Steven J. Katz A1 - Kenneth M. Langa KW - Aged KW - Aged, 80 and over KW - Caregivers KW - Confidence Intervals KW - Female KW - Humans KW - Longitudinal Studies KW - Male KW - Multivariate Analysis KW - Stroke KW - United States AB -

BACKGROUND: As the US population ages, increased stroke incidence will result in higher stroke-associated costs. Although estimates of direct costs exist, little information is available regarding informal caregiving costs for stroke patients.

OBJECTIVE: To determine a nationally representative estimate of the quantity and cost of informal caregiving for stroke.

METHODS: The authors used data from the first wave of the Asset and Health Dynamics (AHEAD) Study, a longitudinal study of people over 70, to determine average weekly hours of informal caregiving. Two-part multivariable regression analyses were used to determine the likelihood of receiving informal care and the quantity of caregiving hours for those with stroke, after adjusting for important covariates. Average annual cost for informal caregiving was calculated.

RESULTS: Of 7,443 respondents, 656 (8.8%) reported a history of stroke. Of those, 375 (57%) reported stroke-related health problems (SRHP). After adjusting for cormorbid conditions, potential caregiver networks, and sociodemographics, the proportion of persons receiving informal care increased with stroke severity, and there was an association of weekly caregiving hours with stroke +/- SRHP (p < 0.01). Using the median 1999 home health aide wage (8.20 dollars/hour) as the value for family caregiver time, the expected yearly caregiving cost per stroke ranged from 3,500 dollars to 8,200 dollars. Using conservative prevalence estimates from the AHEAD sample (750,000 US elderly patients with stroke but no SRHP and 1 million with stroke and SRHP), this would result in an annual cost of up to 6.1 billion dollars for stroke-related informal caregiving in the United States.

CONCLUSIONS: Informal caregiving-associated costs are substantial and should be considered when estimating the cost of stroke treatment.

PB - 58 VL - 58 IS - 12 U1 - http://www.ncbi.nlm.nih.gov/pubmed/12084872?dopt=Abstract U4 - Aged, 80 and Over/Caregivers/Economics/Statistics and Numerical Data/Cerebrovascular Accident/Economics/Epidemiology/Confidence Intervals/Female/Human/Longitudinal Studies/Multivariate Analysis/Support, Non U.S. Government/Support, U.S. Government--PHS/United States/Epidemiology ER - TY - JOUR T1 - Prevalence and correlates of depressive symptoms in a community sample of people suffering from heart failure. JF - J Am Geriatr Soc Y1 - 2002 A1 - Carolyn L. Turvey A1 - Schultz, K. A1 - Arndt, Stephan A1 - Robert B Wallace A1 - A. Regula Herzog KW - Aged KW - depression KW - Female KW - Heart Failure KW - Humans KW - Longitudinal Studies KW - Male KW - Prevalence KW - United States AB -

OBJECTIVES: To examine the rates and correlates of depressive symptoms and syndromal depression in people with self-reported heart failure participating in a community study of people aged 70 and older.

DESIGN: Cross-sectional.

SETTING: Community-based epidemiological study of older people from the continental United States.

PARTICIPANTS: Six thousand one hundred twenty-five older people participating in the longitudinal study of Assets and Health Dynamics. Participants had to be born in 1923 or earlier.

MEASUREMENTS: The short-form Composite International Diagnostic Interview assessed syndromal depression, and a revised version of the Center for Epidemiologic Studies-Depression scale assessed depressive symptoms. Medical illness was based on self-report. The authors compared the rates of syndromal depression and individual depressive symptoms in people with self-reported heart failure (n = 199) with those in people with other heart conditions (n = 1,856) and with no heart conditions (n = 4,070).

RESULTS: Eleven percent of those with heart failure met criteria for syndromal depression, compared with 4.8% of people with other heart conditions and 3.2% of those with no heart conditions. The association between heart failure and depression held even after controlling for disability, reported fatigue and breathlessness, and number of comorbid chronic illnesses.

CONCLUSION: Community-living older people with self-reported heart failure were at approximately twice the risk for syndromal depression of the rest of the community. Although fatigue and functional disability were also related to depression in this sample, these variables did not account for the association between syndromal depression and self-reported heart failure.

PB - 50 VL - 50 IS - 12 U1 - http://www.ncbi.nlm.nih.gov/pubmed/12473012?dopt=Abstract U4 - Heart Diseases/Depression ER - TY - JOUR T1 - The role of smoking and other modifiable lifestyle risk factors in maintaining and restoring lower body mobility in middle-aged and older Americans: results from the HRS and AHEAD. Health and Retirement Study. Asset and Health Dynamics Among the Oldest Ol JF - J Am Geriatr Soc Y1 - 2002 A1 - Truls Ostbye A1 - Donald H. Taylor Jr. A1 - Katrina M. Krause A1 - Scoyoc, L.V. KW - Age Distribution KW - Aged KW - Aged, 80 and over KW - Alcohol Drinking KW - Body Mass Index KW - Exercise KW - Female KW - Humans KW - Leg KW - Logistic Models KW - Longitudinal Studies KW - Male KW - Marital Status KW - Middle Aged KW - Risk Factors KW - Sex Distribution KW - Smoking KW - Smoking cessation KW - United States KW - Walking AB -

OBJECTIVES: To analyze the effect of smoking, smoking cessation, and other modifiable risk factors on mobility in middle-aged and older Americans.

DESIGN: Panel study; secondary data analysis.

SETTING: United States (national sample).

PARTICIPANTS: The Health and Retirement Study (HRS) includes data on 12,652 Americans aged 50 to 61 in four waves (1992-1998). The Asset and Health Dynamics Among the Oldest Old (AHEAD) survey followed 8,124 community-dwelling people aged 70 years and older in three waves (1993-1998).

MEASUREMENTS: The relationships between the primary outcome measure, lower body mobility (ability to walk several blocks and walk up one flight of stairs without difficulty), and smoking, exercise (HRS only), body mass index (BMI), and alcohol use were estimated in bivariate and multivariate analyses.

RESULTS: Not smoking was strongly positively related to mobility, and the relative effects were similar in both panels. Among those with impaired mobility at baseline, not smoking was also strongly related to recovery. In the middle aged, there were consistent dose-response relationships between amount smoked and impaired mobility. Fifteen years after quitting, the risk of impaired mobility returned to that of never smokers. There was also a strong dose-response relationship between level of exercise and mobility. Inverted U-shaped relationships with mobility were observed for BMI and alcohol consumption.

CONCLUSIONS: The relationships between not smoking and lower body mobility in middle-aged and older Americans are strong and consistent. Interventions aimed at reducing smoking have the potential to preserve mobility and thereby prolong health and independence in later life.

PB - 50 VL - 50 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/11982670?dopt=Abstract U4 - Middle Aged Adults/Smoking/Mobility Difficulty/Exercise ER - TY - JOUR T1 - State expenditures on home and community based services and use of formal and informal personal assistance: a multilevel analysis. JF - J Health Soc Behav Y1 - 2002 A1 - Muramatsu, Naoko A1 - Richard T. Campbell KW - Aged KW - Aged, 80 and over KW - Community Health Services KW - Female KW - Financing, Government KW - Frail Elderly KW - Health Care Surveys KW - Health Expenditures KW - Home Care Services KW - Humans KW - Logistic Models KW - Male KW - State Government AB -

Despite wide state variation in commitment to home and community-based services (HCBS) for functionally impaired older persons, little is known about how such variation affects older adults' strategies to compensate for their functional limitations. This study examines the association of state HCBS expenditures with use of formal and informal personal assistance among non-institutionalized older Americans aged 70 and older with functional limitations. We conducted multilevel multinomial logistic regression analysis using data from the first wave of the Assets and Health Dynamics among the Oldest Old Survey, combined with data on state HCBS expenditures. Controlling for individuals' demographic, socioeconomic, and care needs factors, persons residing in states with higher HCBS expenditures were more likely to use formal personal assistance, but not less likely to use informal assistance. Our study suggests state variation in HCBS expenditures leads to inequitable access to formal personal assistance, especially among those with high functional limitations.

PB - 43 VL - 43 IS - 1 N1 - RDA 1996-025 U1 - http://www.ncbi.nlm.nih.gov/pubmed/11949194?dopt=Abstract U4 - Aged, 80 and Over/Community Health Services/Female/Financing, Government/Statistics and Numerical Data/Frail Elderly/Health Care Surveys/Health Expenditures/Home Care Services/Logistic Models/State Government/Support, U.S. Government--PHS ER - TY - JOUR T1 - Arthritis prevalence and activity limitations in older adults. JF - Arthritis Rheum Y1 - 2001 A1 - Dorothy D Dunlop A1 - Larry M Manheim A1 - Song, Jing A1 - Rowland W Chang KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Arthritis KW - Data collection KW - Humans KW - Prevalence KW - Racial Groups KW - Socioeconomic factors KW - Surveys and Questionnaires AB -

OBJECTIVE: To evaluate the prevalence of arthritis and activity limitations among older Americans by assessing their demographic, ethnic, and economic characteristics.

METHODS: Data from the Asset and Health Dynamic Survey Among the Oldest Old (AHEAD), a national probability sample of community-dwelling adults born before 1924, were analyzed cross-sectionally. Arthritis that resulted in a physician's visit or a joint replacement not associated with a hip fracture was ascertained by self-report.

RESULTS: The prevalence of arthritis in older adults ranged from 25% in non-Hispanic whites to 40% in non-Hispanic blacks to 44% in Hispanics. A higher prevalence of arthritis was associated with less education as well as lower income and less wealth. The prevalence of limitations in activities of daily living (ADL) among non-Hispanic white, non-Hispanic black, and Hispanic adults who reported arthritis only was 29%, 30%, and 37%, respectively, and increased to 48%, 57%, and 56%, respectively, among those reporting arthritis plus other chronic conditions, after adjustment for age and sex.

CONCLUSION: Non-Hispanic black and Hispanic older adults reported having arthritis at a substantially higher frequency than did non-Hispanic whites. In addition, Hispanics reported higher rates of ADL limitations than did non-Hispanic whites with comparable disease burden. Further study is needed to confirm and elucidate the reasons for these racial and economic disparities in older populations.

PB - 44 VL - 44 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/11212163?dopt=Abstract U4 - Activities of Daily Living/Aged, 80 and Over/Arthritis/Epidemiology/Ethnology/Data Collection/Human/Prevalence/Questionnaires/Racial Stocks/Socioeconomic Factors/Support, Non U.S. Government/Support, U.S. Government--PHS ER - TY - JOUR T1 - Caregiver report of hallucinations and paranoid delusions in elders aged 70 or older. JF - Int Psychogeriatr Y1 - 2001 A1 - Carolyn L. Turvey A1 - Schultz, Susan K. A1 - Arndt, Stephan A1 - Ellingrod, Vicki A1 - Robert B Wallace A1 - A. Regula Herzog KW - Aged KW - Aged, 80 and over KW - Aging KW - Caregivers KW - Cognition Disorders KW - Cohort Studies KW - Delusions KW - depression KW - Female KW - Follow-Up Studies KW - Hallucinations KW - Humans KW - Male KW - Marital Status KW - Paranoid Disorders KW - Risk Factors KW - Stroke KW - Surveys and Questionnaires KW - United States KW - Vision Disorders AB -

This study examined the demographic, medical, and psychiatric correlates of hallucinations and paranoid delusions reported by proxy informants for 822 elders aged 70 or older. This sample comprised people who were deemed unable to complete a direct interview in a large nationwide study of aging. Marital status, trouble with vision, and cognitive impairment were associated with report of both paranoid delusions and hallucinations. Depressive symptoms and stroke were associated with hallucinations only. These results suggest that inadequate external stimulation in the elderly leads to psychotic experiences.

PB - 13 VL - 13 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/11495398?dopt=Abstract U4 - Caregivers/Dementia/Elderly ER - TY - JOUR T1 - Changes in driving patterns and worsening depressive symptoms among older adults. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2001 A1 - Stephanie J. Fonda A1 - Robert B Wallace A1 - A. Regula Herzog KW - Activities of Daily Living KW - Adaptation, Psychological KW - Aged KW - Aged, 80 and over KW - Automobile Driving KW - depression KW - Female KW - Humans KW - Male KW - Quality of Life KW - Risk Factors KW - Social Environment AB -

OBJECTIVES: This study examined whether changes in driving patterns-driving cessation and reduction-have negative consequences for the depressive symptoms of older Americans and whether these consequences are mitigated for people with a spouse who drives.

METHODS: The project used data from 3 waves of the Asset and Health Dynamics Among the Oldest Old (AHEAD) study. Depressive symptoms were assessed with an abbreviated Center for Epidemiologic Studies-Depression scale. Using 2 models, the project examined how driving cessation and reduction that occurred between Waves 1 and 2 contributed to increases in depressive symptoms between Waves 2 and 3. The first model included the entire sample (N = 5,239), and the second model focused on drivers only (n = 3,543). A third model added interaction terms to the analysis to consider whether respondents who stopped driving but had a spouse who drove were less at risk of worsening depressive symptoms.

RESULTS: Respondents who stopped driving had greater risk of worsening depressive symptoms. Drivers who restricted their driving distances before the study began also had greater risk of worsening depressive symptoms, but seemingly less so than the respondents who stopped driving altogether. For respondents who stopped driving, having a spouse available to drive them did not mitigate the risk of worsening symptoms.

DISCUSSION: Changes in driving patterns can be deleterious for older people's depressive symptoms. Initiatives for assisting older people should focus on strategies that help them retain driving skills, that prepare them for the possible transition from driver to ex-driver, and that ensure that they have access to mental health therapies if driving changes are imminent.

PB - 56B VL - 56 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/11682595?dopt=Abstract U4 - Health Status/Depressive Symptoms/Driving Patterns/Basic Demographics ER - TY - JOUR T1 - Childlessness and the psychological well-being of older persons. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2001 A1 - Zhang, Zhenmei A1 - Mark D Hayward KW - Aged KW - Aged, 80 and over KW - depression KW - Family Planning Services KW - Female KW - Geriatric Assessment KW - Humans KW - Loneliness KW - Male KW - Marital Status KW - Risk Factors KW - Sex Factors AB -

OBJECTIVES: Rapid growth in the size of the childless elderly population has prompted concerns about the negative effects of childlessness on psychological well-being. This study adds to this line of inquiry by examining the effects of childlessness on two important dimensions of elderly persons' psychological well-being: loneliness and depression.

METHODS: Using the 1993 Asset and Health Dynamics Among the Oldest Old data set, the authors estimated logistic and ordinary least squares regression models of psychological well-being for a nationally representative sample of people aged 70 and older (N = 6,517).

RESULTS: Childlessness per se did not significantly increase the prevalence of loneliness and depression at advanced ages, net of other factors. There also was no statistical evidence for the hypothesis that childlessness increases loneliness and depression for divorced, widowed, and never married elderly persons. Sex, however, altered how childlessness and marital status influenced psychological well-being. Divorced, widowed, and never married men who were childless had significantly higher rates of loneliness compared with women in comparable circumstances; divorced and widowed men who were childless also had significantly higher rates of depression than divorced and widowed women.

DISCUSSION: The findings suggest that it is important to understand the consequences of childlessness in the context of marital status and sex.

PB - 56B VL - 56 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/11522813?dopt=Abstract U4 - Aged, 80 and Over/Depression/Family Planning/Gender/Geriatric Assessment/Loneliness/Marital Status/Risk Factors/Sex Factors/Support, U.S. Government--PHS ER - TY - JOUR T1 - Estimating the cost of informal caregiving for elderly patients with cancer. JF - J Clin Oncol Y1 - 2001 A1 - Hayman, James A. A1 - Kenneth M. Langa A1 - Mohammed U Kabeto A1 - Steven J. Katz A1 - DeMonner, Sonya M. A1 - M.E. Chernew A1 - Slavin, Mitchell B. A1 - A. Mark Fendrick KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Caregivers KW - Cost of Illness KW - Family KW - Female KW - Home Nursing KW - Humans KW - Male KW - Multivariate Analysis KW - Neoplasms KW - Regression Analysis KW - United States AB -

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

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

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

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

PB - 19 VL - 19 IS - 13 U1 - http://www.ncbi.nlm.nih.gov/pubmed/11432889?dopt=Abstract U4 - Activities of Daily Living/Aged, 80 and Over/Caregivers/Cost of Illness/Family/Psychology/Female/Home Nursing/Economics/Statistics and Numerical Data/Human/Multivariate Analysis/Neoplasms/Complications/Therapy/Regression Analysis/United States ER - TY - JOUR T1 - The explosion in paid home health care in the 1990s: who received the additional services? JF - Med Care Y1 - 2001 A1 - Kenneth M. Langa A1 - M.E. Chernew A1 - Mohammed U Kabeto A1 - Steven J. Katz KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Chronic disease KW - Family Characteristics KW - Female KW - Financing, Government KW - Frail Elderly KW - Geriatric Assessment KW - Health Care Surveys KW - Health Expenditures KW - health policy KW - Home Care Services KW - Home Nursing KW - Humans KW - Longitudinal Studies KW - Male KW - Marital Status KW - Multivariate Analysis KW - Social Support KW - Socioeconomic factors KW - Surveys and Questionnaires KW - United States KW - Utilization Review AB -

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

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

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

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

PB - 39 VL - 39 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/11176552?dopt=Abstract U4 - Activities of Daily Living/Classification/Aged, 80 and Over/Chronic Disease/Family Characteristics/Female/Financing, Government/Frail Elderly/Geriatric Assessment/Health Care Surveys/Health Expenditures/Health Policy/Home Care Services/Home Nursing/Longitudinal Studies/Marital Status/Multivariate Analysis/Questionnaires/Social Support/Socioeconomic Factors/Support, Non U.S. Government/United States/Utilization Review ER - TY - JOUR T1 - Life events and alcohol consumption among mature adults: a longitudinal analysis. JF - J Stud Alcohol Y1 - 2001 A1 - Perreira, Krista M. A1 - Frank A Sloan KW - Adaptation, Psychological KW - Aged KW - Alcohol Drinking KW - Employment KW - Family KW - Health Status KW - Humans KW - Life Change Events KW - Longitudinal Studies KW - Middle Aged KW - Social Support KW - Stress, Psychological AB -

OBJECTIVE: Four waves of the Health and Retirement Study were used to examine changes in alcohol consumption co-occurring and following stress associated with major health, family and employment events.

METHOD: The final sample consisted of 7,731 (3,907 male) individuals between the ages of 51 and 61 at baseline. We used multinomial logit analysis to study associations between important life events and changes in alcohol consumption over a 6-year study period. Interactions between stressful life events, gender and problem drinking were also evaluated.

RESULTS: Most persons (68%) did not change their use of alcohol over the entire 6 years. Hospitalization and onset of a chronic condition were associated with decreased drinking levels. Retirement was associated with increased drinking. Widowhood was associated with increased drinking but only for a short time. Getting married or divorced was associated with both increases and decreases in drinking, with a complex lag structure. A history of problem drinking influenced the association between certain life events (e.g., divorce and retirement) and changes in drinking. Gender modified the association between losing a spouse and changes in drinking.

CONCLUSIONS: Even after controlling for problem drinking history, social support and coping skills, changes in drinking behavior were related to several life events occurring over a 6-year period for a national cohort of individuals in late middle-age. The magnitude of these relationships, however, varied by gender and problem drinking history.

PB - 62 VL - 62 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/11513228?dopt=Abstract U4 - Stress/Drinking Behavior/Family Relations/Adults/Life Events/Alcohol Abuse ER - TY - JOUR T1 - Long-term care and nursing home coverage: are adult children substitutes for insurance policies? JF - J Health Econ Y1 - 2001 A1 - Jennifer M Mellor KW - Adult KW - Aged KW - Caregivers KW - Family KW - Female KW - Home Nursing KW - Humans KW - Insurance Coverage KW - Insurance, Long-Term Care KW - Intergenerational Relations KW - Long-term Care KW - Male KW - Models, Statistical KW - Nursing homes AB -

Recent theoretical work suggests that in some cases, parents will forego the purchase of long-term care insurance and rely on child-provided care in old age. This paper uses data from the Asset and Health Dynamics survey and the Panel Study of Income Dynamics to examine whether the availability of children and other potential caregivers explains why so few elderly persons have long-term care insurance. In contrast to the notion that family members serve as substitutes for long-term care insurance, variables measuring the availability of informal caregivers have no statistically significant effect in models of insurance ownership and models of intentions to purchase insurance.

PB - 20 VL - 20 IS - 4 N1 - RDA 1999-001 U1 - http://www.ncbi.nlm.nih.gov/pubmed/11463187?dopt=Abstract U4 - Adult/Caregivers/Family/Female/Home Nursing/Economics/Human/Insurance Coverage/Statistics and Numerical Data/Insurance, Long Term Care/Utilization/Intergenerational Relations/Long Term Care/Economics/Models, Statistical/Nursing Homes/Economics/Support, U.S. Government--PHS ER - TY - JOUR T1 - National estimates of the quantity and cost of informal caregiving for the elderly with dementia. JF - J Gen Intern Med Y1 - 2001 A1 - Kenneth M. Langa A1 - M.E. Chernew A1 - Mohammed U Kabeto A1 - A. Regula Herzog A1 - Mary Beth Ofstedal A1 - Robert J. Willis A1 - Robert B Wallace A1 - Mucha, L.M. A1 - Walter L. Straus A1 - A. Mark Fendrick KW - Aged KW - Aged, 80 and over KW - Caregivers KW - Cost of Illness KW - Dementia KW - Female KW - Health Care Costs KW - Humans KW - Male KW - Multivariate Analysis KW - Regression Analysis KW - Severity of Illness Index KW - Time Factors KW - United States AB -

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

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

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

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

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

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

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

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

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

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

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

PB - 11 VL - 11 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/11454494?dopt=Abstract U4 - Age Factors/Depressive Disorder/Diagnosis/Epidemiology/Female/Follow up Studies/Geriatric Assessment/Human/Least Squares Analysis/Longitudinal Studies/Mood Disorders/Diagnosis/Epidemiology/Regression Analysis/Risk Factors/Severity of Illness Index/Somatoform Disorders/Diagnosis/Epidemiology/Support, Non U.S. Government/Support, U.S. Government--PHS/United States/Epidemiology ER - TY - JOUR T1 - Predictors of transitions in disease and disability in pre- and early-retirement populations. JF - J Aging Health Y1 - 2001 A1 - Namkee G Choi A1 - Schlichting-Ray, L. KW - Activities of Daily Living KW - Aged KW - Black or African American KW - Chronic disease KW - Disabled Persons KW - Female KW - Health Status KW - Hispanic or Latino KW - Humans KW - Male KW - Middle Aged KW - Retirement KW - Risk Factors KW - Sex Factors KW - Socioeconomic factors KW - United States KW - White People AB -

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

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

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

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

PB - 13 VL - 13 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/11813732?dopt=Abstract U4 - Activities of Daily Living/Blacks/Chronic Disease/Epidemiology/Disabled Persons/Female/Health Status/Hispanic Americans/Human/Middle Age/Retirement/Risk Factors/Sex Factors/Socioeconomic Factors/Support, U.S. Government--PHS/United States/Whites ER - TY - JOUR T1 - Prevalence and outcomes of comorbid metabolic and cardiovascular conditions in middle- and older-age adults. JF - J Clin Epidemiol Y1 - 2001 A1 - Oldrige, Neil B. A1 - Timothy E. Stump A1 - Nothwehr, F. A1 - Daniel O. Clark KW - Age Distribution KW - Aged KW - Aged, 80 and over KW - Cardiovascular Diseases KW - Cohort Studies KW - Diabetes Complications KW - Diabetes Mellitus KW - Female KW - Health Services for the Aged KW - Humans KW - Hypertension KW - Male KW - Middle Aged KW - Obesity KW - Odds Ratio KW - Outcome Assessment, Health Care KW - Prevalence KW - Prospective Studies KW - Quality of Life KW - United States AB -

UNLABELLED: To estimate age group differences in the prevalence and outcomes of three common and often comorbid metabolic conditions (i.e., obesity, hypertension, and diabetes) and heart disease.

DESIGN: Nationally representative prospective cohort study.

SETTING: PARTICIPANTS' homes.

PARTICIPANTS: 9825 adults aged 51 to 61 years (middle-age) in 1992, and 7370 adults aged 70 years and over (older-age) in 1993.

MEASUREMENTS: Two-year dichotomous outcomes included: doctor visits, hospitalization, mobility difficulty, activity of daily living limitation, poor perceived health, and mortality. Odds ratios (OR) were adjusted for sociodemographic characteristics and history of cancer or lung disease.

RESULTS: Those with one condition represented 80% and 70% of the middle- and older-age groups, respectively, while just 1-2% of each age group reported all three metabolic conditions. Thirteen percent and 32%, respectively, reported heart disease with or without metabolic conditions. Diabetes comorbid with other metabolic conditions, and particularly with heart disease, substantially elevated the risk of adverse outcomes such as health-related quality of life deficits, health services use, and mortality in both middle- and older-age adults. In the middle-age group, the OR was 6.81 for mortality in patients with a combination of obesity and diabetes and 6.10 in those with a combination of heart disease and diabetes. There also were significant ORs for mortality in middle-aged patients with heart disease (OR = 2.40), diabetes (OR = 2.63) and for those with a combination of obesity, hypertension, and diabetes (OR = 3.26).

CONCLUSION: The impact of these often comorbid conditions underscores the importance of targeted and aggressive prevention, particularly among middle-age adults.

VL - 54 IS - 9 ER - TY - JOUR T1 - Proportional treatment effects for count response panel data: effects of binary exercise on health care demand. JF - Health Econ Y1 - 2001 A1 - Lee, Myoung Jae A1 - Satoru Kobayashi KW - Adult KW - Aged KW - Aged, 80 and over KW - Bias KW - Cost Control KW - Cross-Sectional Studies KW - Data Interpretation, Statistical KW - Effect Modifier, Epidemiologic KW - Exercise Therapy KW - Female KW - Health Promotion KW - Health Status KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Needs Assessment KW - Regression Analysis KW - Research Design KW - Treatment Outcome KW - United States AB -

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

PB - 10 VL - 10 IS - 5 N1 - ProCite field 3 : Sungkyunkwan U; Mitsubishi Trust and Banking Corp, Tokyo U1 - http://www.ncbi.nlm.nih.gov/pubmed/11466803?dopt=Abstract U4 - Exercise/Econometric Methods: Single Equation Models: Models with Panel Data/Health Care/Health Status/Hospitalization/Panel Data ER - TY - JOUR T1 - Self-restriction of medications due to cost in seniors without prescription coverage. JF - J Gen Intern Med Y1 - 2001 A1 - Michael A Steinman A1 - Laura Sands A1 - Kenneth E Covinsky KW - Aged KW - Aged, 80 and over KW - Cohort Studies KW - Cross-Sectional Studies KW - Female KW - Humans KW - Insurance, Pharmaceutical Services KW - Male KW - Prescription Fees KW - Risk Factors KW - Socioeconomic factors KW - Treatment Refusal KW - United States AB -

OBJECTIVE: Little is known about patients who skip doses or otherwise avoid using their medications because of cost. We sought to identify which elderly patients are at highest risk of restricting their medications because of cost, and how prescription coverage modifies this risk.

DESIGN AND PARTICIPANTS: Cross-sectional study from the 1995-1996 wave of the Survey of Asset and Health Dynamics Among the Oldest Old, a population-based survey of Americans age 70 years and older.

MEASUREMENTS: Subjects were asked the extent of their prescription coverage, and whether they had taken less medicine than prescribed for them because of cost over the prior 2 years. We used bivariate and multivariate analyses to identify risk factors for medication restriction in subjects who lacked prescription coverage. Among these high-risk groups, we then examined the effect of prescription coverage on rates of medication restriction.

MAIN RESULTS: Of 4,896 seniors who regularly used prescription medications, medication restriction because of cost was reported by 8% of subjects with no prescription coverage, 3% with partial coverage, and 2% with full coverage (P <.01 for trend). Among subjects with no prescription coverage, the strongest independent predictors of medication restriction were minority ethnicity (odds ratio [OR], 2.9 compared with white ethnicity; 95% confidence interval [95% CI], 2.0 to 4.2), annual income <$10,000 (OR, 3.8 compared with income > or =$20,000; 95% CI, 2.4 to 6.1), and out-of-pocket prescription drug costs >$100 per month (OR, 3.3 compared to costs < or =$20; 95% CI, 1.5 to 7.2). The prevalence of medication restriction in members of these 3 risk groups was 21%, 16%, and 13%, respectively. Almost half (43%) of subjects with all 3 risk factors and no prescription coverage reported restricting their use of medications. After multivariable adjustment, high-risk subjects with no coverage had 3 to 15 times higher odds of medication restriction than subjects with partial or full coverage (P <.01).

CONCLUSIONS: Medication restriction is common in seniors who lack prescription coverage, particularly among certain vulnerable groups. Seniors in these high-risk groups who have prescription coverage are much less likely to restrict their use of medications.

PB - 16 VL - 16 IS - 12 U1 - http://www.ncbi.nlm.nih.gov/pubmed/11903757?dopt=Abstract U4 - Aged, 80 and Over/Cohort Studies/Cross Sectional Studies/Female/Insurance, Pharmaceutical Services/Prescription Fees/Risk Factors/Socioeconomic Factors/Support, U.S. Government--non PHS/Support, U.S. Government--PHS/Treatment Refusal ER - TY - JOUR T1 - The effect of smoking on health using a sequential self-selection model. JF - Health Econ Y1 - 2000 A1 - Kajal Chatterji Lahiri A1 - Song, Jae G. KW - Adult KW - Aged KW - Aged, 80 and over KW - Attitude to Health KW - Decision making KW - Health Behavior KW - Health Status KW - Health Surveys KW - Humans KW - Middle Aged KW - Models, Econometric KW - Predictive Value of Tests KW - Reproducibility of Results KW - Risk Factors KW - Risk-Taking KW - Selection Bias KW - Smoking KW - Smoking cessation KW - Surveys and Questionnaires KW - United States AB -

We estimate a structural model of individual smoking behaviour emphasizing the role of individual risk belief on smoking choices. Our model consists of five equations: two selection equations for initiation and cessation decisions, and three switching outcome regressions for nonsmokers, ex-smokers, and current smokers. The presence of significant self-selectivity implies that the health effects of smoking based on sample proportions do not correctly indicate the true risk of cigarette smoking. Further, our evidence suggests that the self-selection in the cessation decision, but not in the initiation decision, is consistent with economic rationality. We estimate the model by full information maximum likelihood (FIML) with starting values from heteroskedasticity corrected Heckman-Lee two-step method using newly released Health and Retirement Study (HRS) data.

PB - 9 VL - 9 IS - 6 N1 - ProCite field 3 : SUNY, Albany; SUNY, Albany U1 - http://www.ncbi.nlm.nih.gov/pubmed/10983003?dopt=Abstract U4 - Economic Status/Health Production/Nutrition/Mortality/Morbidity/Disability/Disability/Economic Behavior/Smoking ER - TY - JOUR T1 - Expectations among the elderly about nursing home entry. JF - Health Serv Res Y1 - 2000 A1 - Richard C Lindrooth A1 - Hoerger, Thomas J. A1 - Edward C Norton KW - Activities of Daily Living KW - Aged KW - Attitude to Health KW - Data Interpretation, Statistical KW - Effect Modifier, Epidemiologic KW - Female KW - Geriatric Assessment KW - Health Care Surveys KW - Health Services Research KW - Health Status KW - Homes for the Aged KW - Humans KW - Least-Squares Analysis KW - Longevity KW - Male KW - Medicaid KW - Nursing homes KW - Patient Admission KW - Probability KW - Risk Factors KW - Surveys and Questionnaires KW - United States AB -

OBJECTIVE: To assess whether the covariates that explain expectations of nursing home entry are consistent with the characteristics of those who enter nursing homes.

DATA SOURCES: Waves 1 and 2 of the Assets and Health Dynamics Among the Oldest Old (AHEAD) survey.

STUDY DESIGN: We model expectations about nursing home entry as a function of expectations about leaving a bequest, living at least ten years, health condition, and other observed characteristics. We use an instrumental variables and generalized least squares (IV-GLS) method based on Hausman and Taylor (1981) to obtain more efficient estimates than fixed effects, without the restrictive assumptions of random effects.

PRINCIPAL FINDINGS: Expectations about nursing home entry are reasonably close to the actual probability of nursing home entry. Most of the variables that affect actual entry also have significant effects on expectations about entry. Medicaid subsidies for nursing home care may have little effect on expectations about nursing home entry; individuals in the lowest asset quartile, who are most likely to receive these subsidies, report probabilities not significantly different from those in other quartiles. Application of the IV-GLS approach is supported by a series of specification tests.

CONCLUSIONS: We find that expectations about future nursing home entry are consistent with the characteristics of actual entrants. Underestimation of risk of nursing home entry as a reason for low levels of long-term care insurance is not supported by this analysis.

PB - 35 VL - 35 IS - 5 Pt 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/11130816?dopt=Abstract U4 - Long-Term Care/Nursing Homes/Medicaid/Health Insurance ER - TY - JOUR T1 - Gender disparities in the receipt of home care for elderly people with disability in the United States. JF - JAMA Y1 - 2000 A1 - Steven J. Katz A1 - Mohammed U Kabeto A1 - Kenneth M. Langa KW - Activities of Daily Living KW - Aged KW - Disabled Persons KW - Family KW - Female KW - Geriatrics KW - Home Care Services KW - Home Nursing KW - Humans KW - Male KW - Regression Analysis KW - Sex Distribution KW - United States AB -

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

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

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

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

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

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

PB - 284 VL - 284 IS - 23 U1 - http://www.ncbi.nlm.nih.gov/pubmed/11122589?dopt=Abstract U4 - Activities of Daily Living/Disabled Persons/Family/Female/Geriatrics/Home Care Services/Utilization/Home Nursing/Utilization/Regression Analysis/Sex Distribution/Support, Non U.S. Government/Support, U.S. Government--PHS/United States/Epidemiology ER - TY - JOUR T1 - Health insurance and retirement behavior: evidence from the health and retirement survey. JF - J Health Econ Y1 - 2000 A1 - Jeannette Rogowski A1 - Lynn A Karoly KW - Aged KW - Career Mobility KW - Data collection KW - Decision making KW - Employment KW - Health Services Accessibility KW - Humans KW - Insurance, Health KW - Male KW - Retirement KW - Social Class KW - United States AB -

This paper studies the role of health insurance in the retirement decisions of older workers. As policymakers consider mechanisms for how to increase access to affordable health insurance for the near elderly, considerations of the potential labor force implications of such policies will be important to consider--potentially inducing retirements just at a time when the labor force is shrinking. Using data from the 1992 and 1996 waves of the Health and Retirement Survey, this study demonstrates that access to post-retirement health insurance has a large effect on retirement. Among older male workers, those with retiree health benefit offers are 68% more likely to retire (and those with non-employment based insurance are 44% more likely to retire) than their counterparts who would lose employment-based health insurance upon retirement. In addition, the study demonstrated that in retirement models, when retiree health benefits are controlled for, the effects of pension coverage are reduced, suggesting that these effects may have been overestimated in the prior literature.

PB - 19 VL - 19 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/11010239?dopt=Abstract U4 - Retirement/Retirement Policies/Analysis of Health Care Markets/Insurance/Insurance Companies/Elderly/Health Insurance/Health/Insurance/Older Workers/Retirement ER - TY - JOUR T1 - Implications of asking "ambiguous" difficulty questions: an analysis of the second wave of the asset and health dynamics of the oldest old study. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2000 A1 - Vicki A Freedman KW - Activities of Daily Living KW - Aged KW - Cognition KW - Female KW - Health Status KW - Humans KW - Male KW - Prospective Studies KW - Surveys and Questionnaires AB -

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

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

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

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

PB - 55B VL - 55 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/10985300?dopt=Abstract U4 - Activities of Daily Living/Cognition/Female/Health Status/Prospective Studies/Questionnaires/Support, U.S. Government--PHS ER - TY - JOUR T1 - Measuring morbidity: disease counts, binary variables, and statistical power. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2000 A1 - Kenneth F Ferraro A1 - Janet M Wilmoth KW - Adult KW - Aged KW - Chronic disease KW - Cross-Sectional Studies KW - Female KW - Geriatric Assessment KW - Health Surveys KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Models, Statistical KW - United States AB -

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

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

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

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

PB - 55B VL - 55 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/11833985?dopt=Abstract U4 - Disease/Morbidity/Subjective Probabilities ER - TY - JOUR T1 - Memory complaint in a community sample aged 70 and older. JF - J Am Geriatr Soc Y1 - 2000 A1 - Carolyn L. Turvey A1 - Schultz, Susan K. A1 - Arndt, Stephan A1 - Robert B Wallace A1 - A. Regula Herzog KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Cognition KW - Depressive Disorder KW - Educational Status KW - Female KW - Geriatric Assessment KW - Humans KW - Longitudinal Studies KW - Male KW - Marital Status KW - Memory KW - Self-Assessment AB -

OBJECTIVES: The ability of older people to estimate their own memory, often referred to as "metamemory," has been evaluated in previous studies with conflicting reports regarding accuracy. Some studies have suggested that an older person's metamemory is mostly accurate, whereas others have demonstrated little relationship between memory complaint and actual impairment. This study examines memory complaint in a large national sample of older people aged > or = 70.

DESIGN: A longitudinal cohort study with two waves of data collection spaced 2 years apart.

SETTING: A nationwide random sample of community-dwelling older persons.

PARTICIPANTS: A total of 5,444 community-dwelling persons aged > or = 70 and their spouses.

MEASUREMENTS: Participants were asked if they believed their memory was excellent, very good, good, fair, or poor. They were then administered a cognitive assessment derived from the Mini-Mental Status Exam.

RESULTS: In general, people's assessment of their memory corresponded with their actual performance on cognitive measures. However, large portions of the sample inaccurately assessed their memory skills. People who reported depressive symptoms and had impairment in activities of daily living were more likely to state that their memory was impaired, although they performed very well on cognitive measures.

CONCLUSIONS: The conditions that skew people's self-assessment are the ones most likely to bring them into contact with healthcare professionals. This may give clinicians the general impression that older people cannot assess their own cognitive skills. However, poor metamemory appears to be a characteristic of a specific subgroup of older persons, not necessarily characteristic of the general population.

PB - 48 VL - 48 IS - 11 U1 - http://www.ncbi.nlm.nih.gov/pubmed/11083320?dopt=Abstract U4 - Aged, 80 and Over/Cognition/Depressive Disorder/Educational Status/Gender/Geriatric Assessment/Longitudinal Studies/Marital Status/Memory/Self Assessment (Psychology)/Support, U.S. Government--PHS ER - TY - JOUR T1 - Nativity and older women's health: constructed reliance in the health and retirement study. JF - J Women Aging Y1 - 2000 A1 - Cynthia J. Buckley A1 - Jacqueline L. Angel A1 - Donahue, Dennis KW - Aged KW - Emigration and Immigration KW - ethnicity KW - Female KW - Florida KW - Health Status KW - Humans KW - Middle Aged KW - Retirement KW - Social Support KW - Socioeconomic factors KW - Women's Health AB -

Gender and nativity are known risk factors for physical and economic dependency. Immigrant women are particularly disadvantaged because of their greater lack of social and economic resources. In this study, we investigate how women immigrants coordinate and utilize various support systems as they approach retirement age, as well as how choices and constraints affect their physical wellbeing. Experiences throughout the life course play a role in the maintenance of health, but the pre-retirement years are particularly crucial to the establishment of patterns of reliance to be used in later life. We examine the effects of economic resources, social support, and family ties (as well as several exogenous variables) on women's physical health using data from the Health and Retirement Survey. For the women in this study, demographic characteristics, such as Hispanic ethnicity and low education are strong risk factors for poor health. Findings also indicate that reliance patterns across resource domains do not differ significantly by nativity and that both economic and familial resource access significantly lessens the risk of poor health for both native and foreign born women.

PB - 12 VL - 12 IS - 3-4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/11151352?dopt=Abstract U4 - Females/Immigrants/Health/Support Networks/Social Support/Family Relations/Socioeconomic Factors/Retirement 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 - Pathways to retirement: patterns of labor force participation and labor market exit among the pre-retirement population by race, Hispanic origin, and sex. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2000 A1 - Chenoa Flippen A1 - Tienda, Marta KW - Aged KW - Black or African American KW - Cross-Cultural Comparison KW - Employment KW - Female KW - Hispanic or Latino KW - Humans KW - Logistic Models KW - Male KW - Middle Aged KW - Personnel Downsizing KW - Regression Analysis KW - Retirement KW - Sex Factors KW - Socioeconomic factors KW - United States KW - White People AB -

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

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

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

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

PB - 55B VL - 55 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/10728126?dopt=Abstract U4 - Labor Force Participation/Health Status/Economic Status/Retirement Planning/Basic Demographics ER - TY - JOUR T1 - Preferences for surrogate decision makers, informal communication, and advance directives among community-dwelling elders: results from a national study. JF - Gerontologist Y1 - 2000 A1 - Faith P. Hopp KW - Advance directives KW - Aged KW - Aged, 80 and over KW - Black or African American KW - Choice Behavior KW - Communication KW - Educational Status KW - Family KW - Female KW - Health education KW - Health Status KW - Humans KW - Logistic Models KW - Male KW - Needs Assessment KW - Surveys and Questionnaires KW - United States KW - White People AB -

This study, drawing on a nationally representative sample of community-dwelling adults aged 70 and older from the second wave of the Asset and Health Dynamics Among the Oldest Old (AHEAD) survey, addresses the need for greater information on advance care planning among older adults. Older persons expect to draw on a diverse array of persons to make health care decisions for them when they are unable to do so, including spouses, when available, as well as younger generation members such as children and grandchildren. Completion of advance directives such as living wills and durable powers of attorney for health care was more common among White respondents than among African American respondents, and among high school- and college-educated respondents compared with those with less than a high school education. The results suggest the need to develop interventions aimed at strengthening knowledge and understanding of advance directives, particularly for African Americans and persons with lower levels of educational attainment. They further suggest the need for more research on the factors related to informal communication between older adults and their family members on issues related to advance care planning.

PB - 40 VL - 40 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/10961034?dopt=Abstract U4 - Advance Directives/Psychology/Aged, 80 and Over/Blacks/Choice Behavior/Communication/Educational Status/Family/Female/Health Education/Health Status/Logistic Models/Needs Assessment/Whites 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 - Racial variations in end-of-life care. JF - J Am Geriatr Soc Y1 - 2000 A1 - Faith P. Hopp A1 - Sonia A. Duffy KW - Advance care planning KW - Advance directives KW - Aged KW - Aged, 80 and over KW - Attitude to Health KW - Black or African American KW - Cross-Cultural Comparison KW - Decision making KW - Female KW - Follow-Up Studies KW - Humans KW - Logistic Models KW - Male KW - Patient Care Planning KW - Terminal Care KW - United States KW - White People AB -

OBJECTIVES: To identify differences in advanced care planning and end-of-life decision-making between whites and blacks aged 70 and older.

DESIGN: The Asset and Health Dynamics Among the Oldest Old (AHEAD) study is a nationally representative survey of adults who were aged 70 and older in 1993. Relatives (proxy respondents) for 540 persons who died between the first (1993) and second (1995) waves of the study were surveyed about advanced care planning and end-of-life decisions that were made for their family member who died.

SETTING: Respondents were interviewed at home by telephone (n = 444) or in person (n = 95).

PARTICIPANTS: The 540 proxy respondents included 454 whites and 86 blacks.

MEASUREMENTS: Questions were asked about advance care planning and end-of-life decisions.

RESULTS: Whites were significantly more likely than blacks to discuss treatment preferences before death (P = .002), to complete a living will (P = .001), and to designate a Durable Power of Attorney for Health Care (DPAHC) (P = .032). The treatment decisions for whites were more likely to involve limiting care in certain situations (P = .007) and withholding treatment before death (P = .034). In contrast, the treatment decisions for blacks were more likely to be based on the desire to provide all care possible in order to prolong life (P = .013). Logistic regression models revealed that race continued to be a significant predictor of advance care planning and treatment decisions even after controlling for sociodemographic factors.

CONCLUSIONS: These findings suggest that there are important differences between blacks and whites regarding advanced care planning and end-of-life decision-making. Health professionals need to understand the diverse array of end-of-life preferences among various racial and ethnic groups and to develop greater awareness and sensitivity to these preferences when helping patients with end-of-life decision-making.

PB - 48 VL - 48 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/10855602?dopt=Abstract U4 - Advance Directives/Aged, 80 and Over/Attitude to Health/Blacks/Psychology/Comparative Study/Cross Cultural Comparison/Decision Making/Female/Follow up Studies/Logistic Models/Patient Care Planning/Terminal Care/Whites 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 - Financial assistance from middle-aged couples to parents and children: racial-ethnic differences. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 1999 A1 - Rebeca Wong A1 - Capoferro, C. A1 - Beth J Soldo KW - Aged KW - Child KW - ethnicity KW - Family Relations KW - Female KW - Financing, Personal KW - Humans KW - Intergenerational Relations KW - Male KW - Middle Aged KW - Parent-Child Relations KW - Racial Groups AB -

OBJECTIVES: To examine racial-ethnic differences in the allocation of financial transfers to parents, children, and others by middle-aged couples.

METHODS: Multinomial specification of alternative recipients of financial transfers, using data from the 1992 Health and Retirement Survey.

RESULTS: Transfer patterns are sensitive to parental health and wealth, to children being young or in school, as well as to the donors' health and wealth. Controlling for these and other factors, including family size and structure, Blacks and Whites are the most likely, and Hispanics the least likely, to financially help their parents compared to assisting offspring. Black couples are the most likely to sacrifice their own consumption to assist parents financially.

DISCUSSION: Future research on transfers should attempt to capture unmeasured noneconomic sources of variation proxied by the race-ethnicity indicator.

PB - 54B VL - 54 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/10363045?dopt=Abstract U4 - Child/Ethnicity/Gender/Family Relations/Financing, Personal/Intergenerational Transfers/Intergenerational Relations/Middle Age/Parent Child Relations/Support, U.S. Government--PHS ER - TY - JOUR T1 - The influence of personal care and assistive devices on the measurement of disability. JF - Soc Sci Med Y1 - 1999 A1 - Agree, E M KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Disability Evaluation KW - Female KW - Humans KW - Life Expectancy KW - Logistic Models KW - Long-term Care KW - Male KW - Self-Help Devices AB -

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

PB - 48 VL - 48 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/10075170?dopt=Abstract ER - TY - JOUR T1 - Parental marital disruption and intergenerational transfers: an analysis of lone elderly parents and their children. JF - Demography Y1 - 1999 A1 - Liliana E Pezzin A1 - Barbara Steinberg Schone KW - Activities of Daily Living KW - Adult KW - Aged KW - Analysis of Variance KW - Caregivers KW - Chi-Square Distribution KW - Divorce KW - Family KW - Father-Child Relations KW - Female KW - Financial Support KW - Frail Elderly KW - Home Nursing KW - Humans KW - Intergenerational Relations KW - Loneliness KW - Male KW - Marriage KW - Parent-Child Relations KW - Parents KW - Sample Size KW - Sampling Studies KW - Socioeconomic factors AB -

Although one of the most marked demographic trends observed over the twentieth century is the increased rate of divorce, relatively little research has explored the effects of these changing marital patterns in the context of an aging society. Using a sample of lone elderly parents and their adult children, we analyze the direct and indirect effects of marital disruption on four important dimensions of intergenerational transfers: coresidence, financial assistance, adult children's provision of informal care, and parental purchase of paid care. Our findings suggest that divorce has deleterious effects on intergenerational transfers, particularly for elderly fathers. Remarriage further reduces exchange. Our results reveal that parents engage in lower levels of transfers with stepchildren relative to biological children. Moreover, intergenerational transfers are sensitive to characteristics of biological children but not to those of stepchildren. Taken together, these results suggest that exchange at the end of the life course continues to be adversely affected by marital disruption.

PB - 36 VL - 36 IS - 3 N1 - ProCite field 3 : Johns Hopkins U; Agency for Health Care Policy and Research U1 - http://www.ncbi.nlm.nih.gov/pubmed/10472494?dopt=Abstract U4 - Marriage/Marital Dissolution/Family Structure/Economics of the Elderly/Fertility/Child Care/Children/Youth/Aging/Children/Demographics/Divorce/Elderly/Marital/Parent ER - TY - JOUR T1 - Prevalence and severity of urinary incontinence in older African American and Caucasian women. JF - J Gerontol A Biol Sci Med Sci Y1 - 1999 A1 - Fultz, Nancy H. A1 - A. Regula Herzog A1 - Trivellore E. Raghunathan A1 - Robert B Wallace A1 - Diokno, A.C. KW - Aged KW - Aged, 80 and over KW - Black or African American KW - Female KW - Humans KW - Prevalence KW - Risk Factors KW - United States KW - Urinary incontinence KW - White People AB -

BACKGROUND: Few studies have investigated the prevalence and severity of urinary incontinence in older African American women. Comparisons of findings with those for older Caucasian women could provide important clues to the etiology of urinary incontinence and be used in planning screening programs and treatment services.

METHODS: Data are from the first wave of the Asset and Health Dynamics Among the Oldest Old (AHEAD) study. A nationally representative sample of noninstitutionalized adults 70 years of age and older was interviewed. African Americans were oversampled to ensure that there would be enough minority respondents to compare findings across racial groups.

RESULTS: A statistically significant relationship was found between race and urinary incontinence in the previous year: 23.02% of the Caucasian women reported incontinence, compared with 16.17% of the African American women. Other factors that appear to increase the likelihood of incontinence include education, age, functional impairment, sensory impairment, stroke, body mass, and reporting by a proxy. Race was not related to the severity (as measured by frequency) of urine loss among incontinent older women.

CONCLUSION: This study identifies or confirms important risk factors for self-reported urinary incontinence in a national context, and suggests factors leading to protection from incontinence. Race is found to relate to incontinence, with older African American women reporting a lower prevalence.

PB - 54A VL - 54 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/10411017?dopt=Abstract U4 - Aged, 80 and Over/Blacks/Statistics and Numerical Data/Female/Human/Prevalence/Risk Factors/Support, U.S. Government--PHS/United States/Epidemiology/Urinary Incontinence/Ethnology/Whites ER - TY - JOUR T1 - Racial differences in education, obesity, and health in later life. JF - Ann N Y Acad Sci Y1 - 1999 A1 - Christine L Himes KW - Age Distribution KW - Aged KW - Arthritis KW - Black or African American KW - Diabetes Mellitus KW - Educational Status KW - Female KW - Health Status KW - Health Surveys KW - Humans KW - Logistic Models KW - Male KW - Obesity KW - Prevalence KW - Social Class KW - United States KW - White People PB - 896 VL - 896 U1 - http://www.ncbi.nlm.nih.gov/pubmed/10681925?dopt=Abstract U4 - Age Distribution/Arthritis/Ethnology/Blacks/Comparative Study/Diabetes Mellitus/Ethnology/Educational Status/Female/Health Status/Health Surveys/Logistic Models/Obesity/Ethnology/Prevalence/Social Class/United States/Epidemiology/Whites ER - TY - JOUR T1 - The relationship of self-rated vision and hearing to functional status and well-being among seniors 70 years and older. JF - Am J Ophthalmol Y1 - 1999 A1 - Paul P Lee A1 - James P Smith A1 - Raynard Kington KW - Aged KW - Aged, 80 and over KW - Female KW - Health Status KW - hearing KW - Hearing Disorders KW - Humans KW - Male KW - Multivariate Analysis KW - Quality of Life KW - Self Disclosure KW - Surveys and Questionnaires KW - Vision Disorders KW - Vision, Ocular KW - Visual Acuity AB -

PURPOSE: To describe the relationship between self-reported visual and hearing impairment and an index of global functional status among seniors age 70 years or older.

METHODS: A total of 7,320 United States community-dwelling persons aged 70 years or older participating in the 1993 Assets and Health Dynamics of the Oldest Old Survey (AHEAD) completed detailed questionnaires about their demographic, socioeconomic, and health status. Multivariate analyses of functional status (using a global index of functional status based on self-reported limitations in 11 activities) were conducted, controlling for demographic and socioeconomic status and common medical conditions, as well as independently for hearing and vision.

RESULTS: Of the respondents, 27% rated their vision as fair or poor, whereas 25% rated their hearing as fair or poor. Controlling for demographic factors, socioeconomic status, medical conditions, and general health status, limitations in both vision and hearing correlated independently with worsened functional status. Controlling for income, wealth, and education did not greatly reduce the strength of the association between visual and hearing impairment and function.

CONCLUSIONS: Visual and hearing impairment appear to have a significant relationship to overall functioning in the oldest old, regardless of income or wealth. By confirming these findings across income and household wealth groups, adjusted for medical conditions and general health status, in a nationally representative population of Americans age 70 years or older, this study provides a powerful added impetus to efforts for improving vision and hearing for all other Americans, including the oldest old.

PB - 127 VL - 127 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/10218698?dopt=Abstract U4 - Hearing Impaired Persons/Visually Impaired Persons/Old Age ER - TY - JOUR T1 - Retirement patterns and bridge jobs in the 1990s. JF - EBRI Issue Brief Y1 - 1999 A1 - Joseph F. Quinn KW - Aged KW - Attitude KW - Career Mobility KW - Data collection KW - Employment KW - Female KW - Humans KW - Male KW - Middle Aged KW - Multivariate Analysis KW - Retirement KW - United States AB -

During most of the post-World War II period, American men have been leaving the labor force at earlier and earlier ages. Evidence suggests that this trend has been under way for more than a century. However, in the mid-1980s, this trend came to an abrupt halt. Male labor force participation rates have been flat since 1985, and have actually increased over the past several years. Understanding these issues is especially important given the looming increase in the Social Security normal retirement age to 67 and the possibility of even more increases in the ages of eligibility under Social Security and Medicare reform. Because of the influx of married women into the labor market in the post-World War II period, older women's participation rates did not decline as men's did. In contrast, their rates were relatively steady, rising or falling very slowly. Since the mid-1980s, however, older women's participation rates have increased significantly. Many more older men and women are working today than the pre-1986 trends would have suggested. Many older Americans leave the labor force gradually, utilizing "bridge jobs" between employment on a full-time career job and complete labor force withdrawal. These bridge jobs are often part-time, often in a new line of work, and sometimes involve a switch from wage and salary work to self-employment. Estimates suggest that between one-third and one-half of older Americans will work on a bridge job before retiring completely, and for these workers retirement is best viewed as a process, not as a single event. These changes in retirement behavior are consistent with societal changes that have altered the relative attractiveness of work and leisure late in life. Mandatory retirement has been outlawed for most American workers. Social Security has become more age-neutral, no longer penalizing the average worker who wants to continue working after age 65. An increasing proportion of employer pension coverage has been in defined contribution plans, which do not contain the age-specific retirement incentives that many defined benefit plans do. The composition of jobs has shifted from manufacturing to service occupations. Americans are living longer and healthier lives, and many look forward to years to productive activity after age 65. These structural changes have been accompanied by an important cyclical factor: the strength of the American economy over the past decade. This has increased the demand for all types of labor, including older workers. Evidence suggests that there is more than this cyclical factor at work, however, and that new attitudes about work late in life are developing. Labor supply decisions late in life are correlated in expected ways with the individual's health (measured in several ways), age, and pension and health insurance status. Retirement patterns in America are much richer and more varied than the stereotypical one-step view of retirement suggests. Public policy is changing in ways that make continued work late in life more likely. If employers are willing to provide flexible job opportunities to meet the needs of these potential employees, then society can tap a growing pool of older, experienced, and willing workers for years to come.

PB - Employee Benefit Research Institute CY - Washington, D.C. IS - 206 U1 - http://www.ncbi.nlm.nih.gov/pubmed/10387179?dopt=Abstract U4 - Labor Force Participation/Health Status/Health Insurance Coverage/Retirement Planning ER - TY - JOUR T1 - A revised CES-D measure of depressive symptoms and a DSM-based measure of major depressive episodes in the elderly. JF - Int Psychogeriatr Y1 - 1999 A1 - Carolyn L. Turvey A1 - Robert B Wallace A1 - A. Regula Herzog KW - Aged KW - Antidepressive Agents KW - depression KW - Depressive Disorder, Major KW - Diagnosis, Differential KW - Female KW - Humans KW - Male KW - Prospective Studies KW - Psychiatric Status Rating Scales KW - Psychometrics KW - Severity of Illness Index KW - Surveys and Questionnaires AB -

This study examines the psychometric properties of two new abbreviated versions of standard measures of depression, a revised eight-item Center for Epidemiological Studies-Depression Scale (CES-D) and a short-form Composite International Diagnostic Interview (short-form CIDI). A sample of 6,133 elders, age 70 years or older, completed both measures as part of the Asset and Health Dynamics Study of the Oldest Old. The revised CES-D had an internal consistency and factor structure comparable to that of prior versions of the CES-D. The sources of discordance between the two measures were examined and the two measures were compared on self-report of four clinical variables: medical illness, physician diagnosis, psychiatric treatment, and antidepressant or tranquilizer use. Both measures were associated with self-report of physician diagnosis and psychiatric treatment. Respondents positive for depression on the CES-D reported higher rates of antidepressant use. Respondents positive on the short-form CIDI only did not report more antidepressant use than nondepressed respondents.

PB - 11 VL - 11 UR - https://pubmed.ncbi.nlm.nih.gov/11475428/ IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/11475428?dopt=Abstract U4 - Antidepressive Agents/Therapeutic Use/Depression/Depression, Involutional/Gender/Prospective Studies/Psychiatric Status Rating Scales/Psychometrics/Severity of Illness Index/Support, Non U.S. Government/Support, U.S. Government--PHS ER - TY - JOUR T1 - Do medical conditions affect cognition in older adults? JF - Health Psychol Y1 - 1998 A1 - Elizabeth Zelinski A1 - Eileen M. Crimmins A1 - Sandra L Reynolds A1 - Teresa Seeman KW - Aged KW - Aged, 80 and over KW - Aging KW - Cerebrovascular Disorders KW - Cognition KW - Diabetes Complications KW - Diabetes Mellitus KW - Female KW - Health Status KW - Humans KW - Hypertension KW - Male KW - Mental Health AB -

Analyses of a nationally representative sample who completed a list recall task (weighted n = 6,446) and 2 mental status tasks (weighted n = 6,646) were conducted to determine whether specific medical conditions such as high blood pressure and diabetes as well as general health ratings predict cognitive performance in adults aged 70 to 103. Presence of stroke and poorer health ratings predicted poorer performance on the 3 tasks. Presence of diabetes predicted poorer performance on recall and 1 mental status task. Age interacted with medical conditions including high blood pressure and diabetes in predicting mental status, with condition-related deficits confined to the younger end of the age continuum. Global health ratings interacted with age, with poorer ratings associated with worse mental status in the younger participants. Findings suggest that stroke and diabetes are associated with cognitive deficits. Some deficits are more pronounced in younger old adults with high blood pressure and poorer health ratings.

PB - 17 VL - 17 UR - https://pubmed.ncbi.nlm.nih.gov/9848800/ IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/9848800?dopt=Abstract U4 - Aged, 80 and Over/Aging/Psychology/Cerebrovascular Disorders/Cognition/Diabetes Mellitus/Gender/Health Status/Hypertension/Support, U.S. Government--PHS ER - TY - JOUR T1 - Occupational injuries among older workers with disabilities: a prospective cohort study of the Health and Retirement Survey, 1992 to 1994. JF - Am J Public Health Y1 - 1998 A1 - Zwerling, Craig A1 - Nancy L. Sprince A1 - Charles S. Davis A1 - Paul S. Whitten A1 - Robert B Wallace A1 - Steven G Heeringa KW - Accidents, Occupational KW - Age Distribution KW - Aged KW - Aged, 80 and over KW - Analysis of Variance KW - Cross-Sectional Studies KW - Disabled Persons KW - Female KW - Health Surveys KW - Humans KW - Logistic Models KW - Male KW - Middle Aged KW - Odds Ratio KW - Prospective Studies KW - Retirement KW - Risk Factors KW - United States AB -

OBJECTIVES: We tested the hypothesis that among older workers, disabilities in general, and hearing and visual impairments in particular, are risk factors for occupational injuries.

METHODS: Using the first 2 interviews of the Health and Retirement Study, a nationally representative survey of Americans aged 51 to 61 years, we conducted a prospective cohort study of 5600 employed nonfarmers.

RESULTS: Testing a logistic regression model developed in a previous cross-sectional study, we found that the following occupations and risk factors were associated with occupational injury as estimated by odds ratios: service personnel, odds ratio = 1.71 (95% confidence interval = 1.13, 2.57); mechanics and repairers, 3.47 (1.98, 6.10); operators and assemblers, 2.33 (1.51, 3.61); laborers, 3.16 (1.67, 5.98); jobs requiring heavy lifting, 2.05 (1.55, 2.70); self-employment, 0.50 (0.34, 0.73); and self-reported disability, 1.58 (1.14, 2.19). Replacing the general disability variable with specific hearing and visual impairment variables, we found that poor hearing (1.35 [0.95, 1.93]) and poor sight (1.45 [0.94, 2.22]) both had elevated odds ratios.

CONCLUSIONS: Poor sight and poor hearing, as well as work disabilities in general, are associated with occupational injuries among older workers.

PB - 88 VL - 88 UR - https://pubmed.ncbi.nlm.nih.gov/9807538/ IS - 11 U1 - http://www.ncbi.nlm.nih.gov/pubmed/9807538?dopt=Abstract U4 - Labor/Occupational Injury/Health Status/Basic Demographics/Health Behaviors/Risk Factors/Disability/Disability ER - TY - JOUR T1 - Occupational injuries among older workers with visual, auditory, and other impairments. A validation study. JF - J Occup Environ Med Y1 - 1998 A1 - Zwerling, Craig A1 - Paul S. Whitten A1 - Charles S. Davis A1 - Nancy L. Sprince KW - Accidents, Occupational KW - Aged KW - Cohort Studies KW - Disabled Persons KW - Female KW - Health Surveys KW - Humans KW - Logistic Models KW - Male KW - Middle Aged KW - Persons With Hearing Impairments KW - Risk Factors KW - Visually Impaired Persons AB -

This study aims to validate a previously defined model of the risk of occupational injuries among older workers with visual, auditory, or other impairments. That model was based upon the Health and Retirement Study (HRS). The previous logistic regression model was recalculated using data from the 1994 National Health Interview Survey (NHIS). The parameter estimates for impaired hearing (.181 in NHIS, 1.55 in HRS), impaired vision (2.42 in NHIS, 1.48 in HRS), and self-employment (0.22 in NHIS, 0.49 in HRS) were in same direction and of roughly the same magnitude. The previously defined model was confirmed using NHIS data. The data suggest that as the workforce ages, more attention must be paid to the accommodation of disabilities in the workplace, especially sensory impairments-poor vision and hearing.

PB - 40 VL - 40 UR - https://pubmed.ncbi.nlm.nih.gov/9729756/ IS - 8 U1 - http://www.ncbi.nlm.nih.gov/pubmed/9729756?dopt=Abstract U4 - Accidents, Occupational/Cohort Studies/Disabled Persons/Gender/Hearing Impaired Persons/Logistic Models/Middle Age/Risk Factors/Support, Non U.S. Government/Support, U.S. Government--PHS/Visually Impaired Persons ER - TY - JOUR T1 - Asset and Health Dynamics Among the Oldest Old (AHEAD): initial results from the longitudinal study. Introduction. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 1997 A1 - Myers, George C. A1 - Juster, F. Thomas A1 - Richard M. Suzman KW - Aged KW - Aged, 80 and over KW - Data collection KW - Health Status KW - Humans KW - Income KW - Longitudinal Studies KW - Research Design PB - 52B VL - 52 Spec No UR - https://www.ncbi.nlm.nih.gov/pubmed/9215353 U1 - http://www.ncbi.nlm.nih.gov/pubmed/9215353?dopt=Abstract U4 - Aged, 80 and Over/Data Collection/Health Status/Human/Income/Longitudinal Studies/Research Design ER - TY - JOUR T1 - A comparative analysis of ADL questions in surveys of older people. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 1997 A1 - Willard L Rodgers A1 - Baila Miller KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Geriatric Assessment KW - Health Services KW - Health Status KW - Health Surveys KW - Humans KW - Regression Analysis KW - Reproducibility of Results KW - United States AB -

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

PB - 52B VL - 52 Spec No U1 - http://www.ncbi.nlm.nih.gov/pubmed/9215355?dopt=Abstract U4 - Health Status--ADL limitations/Basic Demographics/Method of Questioning/Data Collection Procedures ER - TY - JOUR T1 - Demographic and economic correlates of health in old age. JF - Demography Y1 - 1997 A1 - James P Smith A1 - Raynard Kington KW - Activities of Daily Living KW - Aged KW - Cohort Studies KW - Demography KW - Disabled Persons KW - ethnicity KW - Female KW - Health Status KW - Humans KW - Income KW - Male KW - Models, Econometric KW - Racial Groups KW - Socioeconomic factors KW - United States AB -

In this paper we examine disparities in the ability to function among older Americans. We place special emphasis on two goals: (1) understanding the quantitatively large socioeconomic status-health gradient, and (2) the persistence in health outcomes over long periods. We find that there exist strong contemporaneous and long-run feedbacks from health to economic status. In light of these feedbacks, it is important to distinguish among alternative sources of income and the recipient of income in the household. This research also demonstrates that health outcomes at old age are influenced by health attributes of past, concurrent, and future generations of relatives. Finally, we find that the demographic and economic differences that exist among them explain functional health disparities by race and ethnicity, but not by gender.

PB - 34 VL - 34 UR - https://www.ncbi.nlm.nih.gov/pubmed/9074837 IS - 1 N1 - ProCite field 3 : RAND; UCLA and RAND U1 - http://www.ncbi.nlm.nih.gov/pubmed/9074837?dopt=Abstract U4 - Economics of the Elderly/Health Status/Socioeconomic Status/Ethnicity/Income/Gender/Old Age ER - TY - JOUR T1 - The division of family labor: care for elderly parents. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 1997 A1 - Douglas A. Wolf A1 - Vicki A Freedman A1 - Beth J Soldo KW - Aged KW - Caregivers KW - Family KW - Frail Elderly KW - Humans KW - Models, Theoretical KW - Time Factors AB -

We consider the division of caregiving efforts among the children of older, functionally limited parents. Our model of parental care assumes that care decisions are made in the context of an extended family, with each child taking into account not only the parent's needs and the child's own circumstances, but also the characteristics and actual care behavior of siblings. We propose a simultaneous-Tobit statistical framework that embodies these assumptions. The model is estimated using data from the 1993 Asset and Health Dynamics Among the Oldest Old (AHEAD) study. The findings indicate that a child's hours of parent care are reduced, but on much less than a one-for-one basis, as the parent-care hours of siblings increase. We also find that a child's supply of parent-care hours is reduced by having sisters, holding constant the care efforts of siblings.

PB - 52B VL - 52 Spec No U1 - http://www.ncbi.nlm.nih.gov/pubmed/9215362?dopt=Abstract U4 - Caregivers/Family/Frail Elderly/Human/Models, Theoretical/Time Factors/Transfers 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 - Expectations of nursing home use in the Health and Retirement Study: the role of gender, health, and family characteristics. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 1997 A1 - Karen C. Holden A1 - Timothy D McBride A1 - Maria Perozek KW - Aged KW - Black or African American KW - Female KW - Humans KW - Male KW - Middle Aged KW - Nursing homes KW - Patient Satisfaction KW - Retirement KW - Sex Characteristics KW - White People AB -

Economic models of life cycle behavior suggest that expectations about future events may affect savings, insurance, and retirement planning. This article uses data from the first wave of the Health and Retirement Survey (HRS) to examine how personal characteristics and health conditions influence expectations of nursing home use. Subjective expectations of nursing home use are quite close to known probabilities of lifetime use. There are marked differences in the determinants of expectations for women and men that also conform to actual behavior. There is strong evidence that women and men incorporate what is known about nursing home risk into their own expectations, even many years prior to the time when they are most likely to need long-term care.

PB - 52B VL - 52 UR - https://www.ncbi.nlm.nih.gov/pubmed/9310096 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/9310096?dopt=Abstract U4 - Nursing Homes/Family Characteristics/Gender/Health Status ER - TY - JOUR T1 - Measures of cognitive functioning in the AHEAD Study. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 1997 A1 - A. Regula Herzog A1 - Robert B Wallace KW - Aged KW - Aged, 80 and over KW - Cognition KW - Geriatric Assessment KW - Health Status KW - Health Surveys KW - Humans KW - Longitudinal Studies KW - Memory KW - Mental Status Schedule KW - Psychological Tests KW - Socioeconomic factors KW - United States AB -

Decline in cognitive functioning and onset of cognitive impairment are potentially important predictors of elderly persons needing informal assistance and formal health care. This article describes the measures of cognitive functioning that were developed for the Asset and Health Dynamics Among the Oldest Old (AHEAD) study of some 6,500 Americans aged 70 years and older. The study was designed to investigate the impact of health on disbursement of family and economic resources. Evaluation of the cognitive measures in terms of psychometric properties and missing data, telephone administration, and formation of an aggregate index is encouraging. Their construct validity is evidenced by their correlations with sociodemographic characteristics and health indicators that replicate existing findings as well as by their prediction of IADL and ADL functioning that are consistent with theory.

PB - 52B VL - 52 Spec No UR - https://www.ncbi.nlm.nih.gov/pubmed/9215356 U1 - http://www.ncbi.nlm.nih.gov/pubmed/9215356?dopt=Abstract U4 - Psychological Tests/Survey Methods/Cognitive Functioning ER - TY - JOUR T1 - Medical insurance and the use of health care services by the elderly. JF - J Health Econ Y1 - 1997 A1 - Michael D Hurd A1 - Kathleen McGarry KW - Activities of Daily Living KW - Aged KW - Health Care Surveys KW - Health Services for the Aged KW - Health Status Indicators KW - Hospitalization KW - Humans KW - Insurance, Health KW - Medicare KW - Office Visits KW - Patient Acceptance of Health Care KW - Private Sector KW - Probability KW - United States AB -

The objective of this paper is to find how health insurance influences the use of health care services by the elderly. On the basis of the first wave of the Asset and Health Dynamics Survey, we find that those who are the most heavily insured use the most health care services. Because our data show little relationship between observable health measures and either the propensity to hold or to purchase private insurance, we interpret this as an effect of the incentives embodied in the insurance, rather than as the result of adverse selection in the purchase of insurance.

PB - 16 VL - 16 UR - https://www.ncbi.nlm.nih.gov/pubmed/10169091 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/10169091?dopt=Abstract U4 - Health Status/Health Services/Economic Status ER - TY - JOUR T1 - Patterns of in-home care among elderly black and white Americans. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 1997 A1 - Norgard, T.M. A1 - Willard L Rodgers KW - Aged KW - Aged, 80 and over KW - Black or African American KW - Caregivers KW - Female KW - Home Care Services KW - Humans KW - Male KW - Socioeconomic factors KW - United States KW - White People AB -

This study examines the use of informal and formal sources of care by elderly Black and White Americans (n = 2,847) who are functionally impaired and noninstitutionalized. The data are from the Asset and Health Dynamics Among the Oldest Old (AHEAD) study. Detailed baseline characteristics are provided and logistic regressions are used to assess the likelihood of (a) receiving in-home assistance from any source, (b) using any informal sources of in-home care, (c) using any formal sources, and (d) using formal sources of in-home care with informal sources of home care. Results of the logistic regressions indicate that, compared to Whites, Black elders were less likely to receive assistance and to use informal sources of home care.

PB - 52B VL - 52 Spec No UR - https://www.ncbi.nlm.nih.gov/pubmed/9215361 U1 - http://www.ncbi.nlm.nih.gov/pubmed/9215361?dopt=Abstract U4 - Aged, 80 and Over/Blacks/Caregivers/Female/Home Care Services/Socioeconomic Factors/Support, U.S. Government--PHS/United States/Whites ER - TY - JOUR T1 - Prevalence and impact of risk factors for lower body difficulty among Mexican Americans, African Americans, and whites. JF - J Gerontol A Biol Sci Med Sci Y1 - 1997 A1 - Daniel O. Clark A1 - Mungai, S.M. A1 - Timothy E. Stump A1 - Frederic D Wolinsky KW - Aged KW - Aged, 80 and over KW - Black or African American KW - Chronic disease KW - Cohort Studies KW - Disabled Persons KW - Disease KW - Female KW - Health Behavior KW - Humans KW - Male KW - Memory Disorders KW - Mexican Americans KW - Middle Aged KW - Prevalence KW - Risk Factors KW - Socioeconomic factors KW - White People AB -

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

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

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

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

PB - 52A VL - 52 UR - http://biomed.gerontologyjournals.org/contents-by-date.0.shtml IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/9060977?dopt=Abstract U4 - Aged, 80 and Over/Blacks/Chronic Disease/Cohort Studies/Disabled Persons/Disease/Female/Health Behavior/Human/Memory Disorders/Mexican Americans/Middle Age/Prevalence/Risk Factors/Socioeconomic Factors/Support, Non U.S. Government/Support, U.S. Government--PHS/Whites ER - TY - JOUR T1 - Cross pressures on middle-aged adults: a broader view. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 1996 A1 - Beth J Soldo KW - Adult KW - Age Distribution KW - Aged KW - Aged, 80 and over KW - Family KW - Female KW - Humans KW - Male KW - Middle Aged PB - 51B VL - 51 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/8931626?dopt=Abstract U4 - Adult/Age Distribution/Aged, 80 and Over/Family/Psychology/Female/Caregiving ER - TY - JOUR T1 - The extent of private and public health insurance coverage among adult Hispanics. JF - Gerontologist Y1 - 1996 A1 - Ronald J. Angel A1 - Jacqueline L. Angel KW - Adult KW - Aged KW - Employment KW - Female KW - Health Services Accessibility KW - Hispanic or Latino KW - Humans KW - Insurance, Health KW - Male KW - Medical Assistance KW - Middle Aged KW - Multivariate Analysis KW - United States AB -

Data from the Health and Retirement Survey reveal extremely low levels of health insurance coverage among Hispanics and, especially, among Mexican Americans. The data reveal that this lack of insurance is associated with lower rates of employer-based and privately purchased coverage. Even after controlling for a large number of insurance-related factors, Hispanics have rates of health insurance coverage that are lower than those of either non-Hispanic blacks or whites. This serious lack of health insurance coverage among preretirement-age Hispanics has serious implications both for health, because the lack of insurance represents a major barrier to health care, and for the adequacy of retirement coverage, because private insurance represents an important supplement to Medicare.

PB - Vol. 36 VL - 36 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/8682331?dopt=Abstract U4 - Health Services--type of insurance coverage/Labor/Economic Status/Health Status/Minorities/Health Insurance Coverage/Basic Demographics ER - TY - JOUR T1 - Minority perspectives from the Health and Retirement Study. Introduction: health and retirement among ethnic and racial minority groups. JF - Gerontologist Y1 - 1996 A1 - James S Jackson A1 - Lockery, Shirley A. A1 - Juster, F. Thomas KW - Aged KW - Health Status KW - Humans KW - Minority Groups KW - Prospective Studies KW - Quality of Life KW - Retirement KW - United States PB - 36 VL - 36 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/8682326?dopt=Abstract U4 - Health Status/Human/Minority Groups/Prospective Studies/Quality of Life/Retirement/United States ER - TY - JOUR T1 - Who takes early Social Security benefits? The economic and health characteristics of early beneficiaries. JF - Gerontologist Y1 - 1996 A1 - R.V. Burkhauser A1 - Kenneth A. Couch A1 - John W R Phillips KW - Aged KW - Eligibility Determination KW - Female KW - Health Status KW - Health Surveys KW - Humans KW - Income KW - Male KW - Middle Aged KW - Pensions KW - Retirement KW - Social Security KW - United States AB -

Using the 1992 and 1994 Waves of the Health and Retirement Survey, we compare individuals who first take Social Security benefits at age 62 with those who don't and find that the income and net assets of these two groups are similar in the years just prior to eligibility. However, there is great diversity within the groups, so that poor health appears to be more closely related to lower economic well-being than is early Social Security acceptance status. Our results suggest that raising the Social Security retirement age is not likely to dramatically lower the economic well-being of the typical person aged 62 since only 3% of men aged 62 are receiving Social Security retirement benefits, are in poor health, and have Social Security retirement benefits as their only source of pension income.

PB - 36 VL - 36 IS - 6 N1 - RDA U1 - http://www.ncbi.nlm.nih.gov/pubmed/8990591?dopt=Abstract U4 - Comparative Study/Eligibility Determination/Female/Health Status/Health Surveys/Human/Income/Statistics and Numerical Data/Middle Age/Pensions/Statistics and Numerical Data/Retirement/Statistics and Numerical Data/Social Security/Economics/Statistics and Numerical Data/Support, U.S. Government--PHS/United States ER - TY - JOUR T1 - Effect of recall period on the reporting of occupational injuries among older workers in the Health and Retirement Study. JF - Am J Ind Med Y1 - 1995 A1 - Zwerling, Craig A1 - Nancy L. Sprince A1 - Robert B Wallace A1 - Charles S. Davis A1 - Paul S. Whitten A1 - Steven G Heeringa KW - Accidents, Occupational KW - Adult KW - Aged KW - Bias KW - Cross-Sectional Studies KW - Data collection KW - Female KW - Humans KW - Incidence KW - Linear Models KW - Male KW - Mental Recall KW - Middle Aged KW - Models, Statistical KW - Reproducibility of Results KW - Retirement KW - Risk Factors KW - Time Factors KW - United States AB -

Studies of injury morbidity often rely on self-reported survey data. In designing these surveys, researchers must chose between a shorter recall period to minimize recall bias and a longer period to maximize the precision of rate estimates. Using data from the Health and Retirement Study, which employed a recall period of 1 year, we examined the effect of the recall period on rates of occupational injuries among older workers as well as upon rate ratios of these injuries for nine risk factors. We fit a stochastic model to the occupational injury rates as a function of time before the interview and used this model to estimate what the injury rates would have been had we used a 4-week recall period. The adjusted occupational injury rate of 5.9 injuries per 100 workers per year was 36% higher than the rate based on a 1-year recall period. Adjustment for recall period had much less effect on rate ratios, which typically varied by < 10%. Our work suggests that self-reported surveys with longer recall periods may be used to estimate occupational injury rates and also may be useful in studying the associations between occupational injuries and a variety of risk factors.

PB - 28 VL - 28 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/8561168?dopt=Abstract U4 - Accidents, Occupational/Adult/Bias (Epidemiology)/Morbidity/Gender/Incidence/Middle Age/Models, Statistical/Recall/Reproducibility of Results/Retirement/Risk Factors/Support, U.S. Government--PHS/Time Factors ER - TY - JOUR T1 - Physician perspectives on the role of religion in the physician-older patient relationship. JF - J Fam Pract Y1 - 1989 A1 - Koenig, H G A1 - Bearon, L B A1 - Dayringer, R KW - Aged KW - Attitude of Health Personnel KW - Cross-Sectional Studies KW - Humans KW - Illinois KW - Middle Aged KW - Physician-Patient Relations KW - Physicians, Family KW - Religion and Medicine AB -

A study of 160 family physicians and general practitioners found that the majority of physicians believed that religion has a positive effect on the mental health of older patients, and many believed that religion has a positive effect on physical health. While more than one half reported that patients only rarely, if ever, mentioned religious issues during a medical visit, a significant proportion of the physicians felt they should address religious issues when an older person indicates religion's importance and that religious issues should not be reserved completely for the clergy. Nearly two thirds of the physicians felt that prayer with patients was appropriate under certain circumstances, and over one third reported having prayed with older patients during extreme physical or emotional distress. Older physicians were less likely than younger to have positive attitudes toward addressing religious issues. The strongest predictors of physicians' belief in the appropriateness of addressing religious concerns were two attitudinal variables that indicated an understanding of the importance of religion in the lives of older adults and an awareness that patients might desire to engage in prayer with them. Hence, the beliefs and attitudes of the physician appear to be important factors in determining their receptivity to discussion of religious issues, which in turn may influence whether patients mention such issues in the context of the medical visit.

VL - 28 UR - http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=1883437991andFmt=7andclientId=17822andRQT=309andVName=PQD IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/2784826?dopt=Abstract U3 - 2784826 U4 - depression/risk Factors/health Status/Composite International Diagnostic Interview ER -