%0 Journal Article %J Journal of Aging and Health %D Forthcoming %T Childhood Disadvantage and Adult Functional Status: Do Early-Life Exposures Jeopardize Healthy Aging? %A Patricia M Morton %K Activities of Daily Living %K Childhood adversity %K cumulative disadvantage %K life course epidemiology %K Successful aging %X

OBJECTIVES: To examine whether childhood disadvantage is associated with later-life functional status and identify mediating factors.

METHODS: Unique and additive effects of five childhood domains on functional status were assessed at baseline (2006) and over time (2006-2016) in a sample of 13,894 adults from the Health and Retirement Study (>50 years). Adult health behaviors and socioeconomic status (SES) were tested as mediators.

RESULTS: Respondents exposed to multiple childhood disadvantages (OR = .694) as well as low childhood SES (OR = .615), chronic diseases (OR = .694), impairments (OR = .599), and risky adolescent behaviors (OR = .608) were less likely to be free of functional disability by baseline. Over time, these unique and additive effects of childhood disadvantage increased the hazard odds of eventually developing functional disability (e.g., additive effect: hOR = 1.261). Adult health behaviors and SES mediated some of these effects.

DISCUSSION: Given the enduring effects of childhood disadvantage, policies to promote healthy aging should reduce exposure to childhood disadvantage.

%B Journal of Aging and Health %G eng %R 10.1177/08982643211064723 %0 Journal Article %J Journal of Applied Gerontology, Series B, Psychological Sciences and social sciences %D 2024 %T The Potential of Informal Care for Self-Perceptions of Aging Among Older Community-Dwelling Adults: Longitudinal Findings From the Health and Retirement Study. %A Zwar, Larissa %A König, Hans-Helmut %A Hajek, André %K Activities of Daily Living %K Aged %K Humans %K Independent Living %K Longitudinal Studies %K Patient Care %K Retirement %K Self Concept %K United States %X

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.

%B Journal of Applied Gerontology, Series B, Psychological Sciences and social sciences %V 79 %G eng %N 3 %R 10.1093/geronb/gbad189 %0 Journal Article %J BMC Medicine %D 2024 %T Trajectories of health conditions and their associations with the risk of cognitive impairment among older adults: insights from a national prospective cohort study. %A Du, Min %A Tao, Liyuan %A Liu, Min %A Liu, Jue %K Activities of Daily Living %K Cognitive Dysfunction %K multimorbidity %K Sleep Wake Disorders %X

BACKGROUND: The associations between trajectories of different health conditions and cognitive impairment among older adults were unknown. Our cohort study aimed to investigate the impact of various trajectories, including sleep disturbances, depressive symptoms, functional limitations, and multimorbidity, on the subsequent risk of cognitive impairment.

METHODS: We conducted a prospective cohort study by using eight waves of national data from the Health and Retirement Study (HRS 2002-2018), involving 4319 adults aged 60 years or older in the USA. Sleep disturbances and depressive symptoms were measured using the Jenkins Sleep Scale and the Centers for Epidemiologic Research Depression (CES-D) scale, respectively. Functional limitations were assessed using activities of daily living (ADLs) and instrumental activities of daily living (IADLs), respectively. Multimorbidity status was assessed by self-reporting physician-diagnosed diseases. We identified 8-year trajectories at four examinations from 2002 to 2010 using latent class trajectory modeling. We screened participants for cognitive impairment using the 27-point HRS cognitive scale from 2010 to 2018 across four subsequent waves. We calculated hazard ratios (HR) using Cox proportional hazard models.

RESULTS: During 25,914 person-years, 1230 participants developed cognitive impairment. In the fully adjusted model 3, the trajectories of sleep disturbances and ADLs limitations were not associated with the risk of cognitive impairment. Compared to the low trajectory, we found that the increasing trajectory of depressive symptoms (HR = 1.39; 95% CI = 1.17-1.65), the increasing trajectory of IADLs limitations (HR = 1.88; 95% CI = 1.43-2.46), and the high trajectory of multimorbidity status (HR = 1.48; 95% CI = 1.16-1.88) all posed an elevated risk of cognitive impairment. The increasing trajectory of IADLs limitations was associated with a higher risk of cognitive impairment among older adults living in urban areas (HR = 2.30; 95% CI = 1.65-3.21) and those who smoked (HR = 2.77; 95% CI = 1.91-4.02) (all P for interaction < 0.05).

CONCLUSIONS: The results suggest that tracking trajectories of depressive symptoms, instrumental functioning limitations, and multimorbidity status may be a potential and feasible screening method for identifying older adults at risk of cognitive impairment.

%B BMC Medicine %V 22 %P 20 %G eng %N 1 %R 10.1186/s12916-024-03245-x %0 Journal Article %J Zhonghua Liu Xing Bing Xue Za Zhi %D 2023 %T [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]. %A Hou, X D %A Luo, Y N %A Jin, Y Z %A Zheng, Z J %K Activities of Daily Living %K Aged %K China %K European Union %K Female %K Healthy life expectancy %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Socioeconomic factors %K United States %X

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.

%B Zhonghua Liu Xing Bing Xue Za Zhi %V 44 %P 1006-1012 %8 2023 Jun 10 %G eng %N 6 %R 10.3760/cma.j.cn112338-20221031-00924 %0 Journal Article %J Journal of Applied Gerontology %D 2023 %T Comparison of Cognitive and Physical Decline as Predictors of Depression Among Older Adults. %A Scher, Clara %A Nepomnyaschy, Lenna %A Amano, Takashi %K Activities of Daily Living %K Cognitive Dysfunction %K depression %K Retirement %K Risk Factors %X

Activities of daily living (ADL) limitations and cognitive impairment have been identified as key risk factors for depression among older adults. However, little has been done to compare the strength of these relationships. The current study describes the prevalence and compares the independent and joint associations of ADL and cognitive limitations with depression among older adults in the US. Analyses are based on a sample of 30,923 observations on 13,545 unique respondents from three waves (2012, 2014, and 2016) of the Health and Retirement Study. Linear and logistic multivariate regression models with random and individual fixed effects were estimated. Findings indicate that both cognitive and ADL limitations are associated with depression; however, across all models, ADL limitations have a much stronger association. Further, in our most rigorous models, having both limitations is not significantly different from having just ADL, and not cognitive, limitations.

%B Journal of Applied Gerontology %V 42 %P 387-398 %G eng %N 3 %R 10.1177/07334648221139255 %0 Journal Article %J J of the American Geriatric Society %D 2023 %T The devil's in the details: Variation in estimates of late-life activity limitations across national cohort studies. %A Ankuda, Claire K %A Covinsky, Kenneth %A Freedman, Vicki A %A Kenneth M. Langa %A Aldridge, Melissa D %A Yee, Cynthia %A Kelley, Amy S %K Activities of Daily Living %K Cohort Studies %K Disabled Persons %K Medicare %K Self Care %X

BACKGROUND: Assessing activity limitations is central to aging research. However, assessments of activity limitations vary, and this may have implications for the populations identified. We aim to compare measures of activities of daily living (ADLs) and their resulting prevalence and mortality across three nationally-representative cohort studies: the National Health and Aging Trends Study (NHATS), the Health and Retirement Survey (HRS), and the Medicare Current Beneficiary Survey (MCBS).

METHODS: We compared the phrasing and context of questions around help and difficulty with six self-care activities: eating, bathing, toileting, dressing, walking inside, and transferring. We then compared the prevalence and 1-year mortality for difficulty and help with eating and dressing.

RESULTS: NHATS, HRS, and MCBS varied widely in phrasing and framing of questions around activity limitations, impacting the proportion of the population found to experience difficulty or receive help. For example, in NHATS 12.4% [95% confidence interval (CI) 11.5%-13.4%] of the cohort received help with dressing, while in HRS this figure was 6.4% [95% CI 5.7%-7.2%] and MCBS 5.3% [95% CI 4.7%-5.8%]. When combined with variation in sampling frame and survey approach of each survey, such differences resulted in large variation in estimates of the older population of older adults with ADL disability.

CONCLUSIONS: In order to take late-life activity limitations seriously, we must clearly define the measures we use. Further, researchers and clinicians seeking to understand the experience of older adults with activity limitations should be careful to interpret findings in light of the framing of the question asked.

%B J of the American Geriatric Society %V 71 %P 858-868 %G eng %N 3 %R 10.1111/jgs.18158 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2023 %T Everyday Discrimination, Neighborhood Perceptions, and Incidence of Activity Limitations Among Middle-Aged and Older African Americans. %A Qin, Weidi %A Nguyen, Ann W %A Wang, Yi %A Hamler, Tyrone C %A Wang, Fei %K Activities of Daily Living %K Aged %K Black or African American %K Humans %K Incidence %K Middle Aged %K Residence Characteristics %K Retirement %X

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.

%B J Gerontol B Psychol Sci Soc Sci %V 78 %P 866-879 %G eng %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/36661210?dopt=Abstract %R 10.1093/geronb/gbad001 %0 Journal Article %J Maturitas %D 2023 %T Examining racial and ethnic differences in disability among older adults: A polysocial score approach. %A Tang, Junhan %A Chen, Ying %A Liu, Hua %A Wu, Chenkai %K Activities of Daily Living %K Aged %K Cohort Studies %K Disabled Persons %K ethnicity %K Health Status Disparities %K Humans %K Racial Groups %K United States %X

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.

%B Maturitas %V 172 %P 1-8 %G eng %R 10.1016/j.maturitas.2023.03.010 %0 Journal Article %J JAMA Network Open %D 2023 %T History of Incarceration and Its Association With Geriatric and Chronic Health Outcomes in Older Adulthood. %A Garcia-Grossman, Ilana R %A Cenzer, Irena %A Steinman, Michael A %A Williams, Brie A %K Activities of Daily Living %K Chronic disease %K Diabetes Mellitus %K Health Care %K Lung Diseases %K Outcome Assessment %X

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

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

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

EXPOSURES: Self-reported history of incarceration.

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

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

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

%B JAMA Network Open %V 6 %P e2249785 %G eng %N 1 %R 10.1001/jamanetworkopen.2022.49785 %0 Journal Article %J Population Research and Policy Review %D 2023 %T Life, Longevity, and the Pursuit of Happiness: The Role of Disability in Shaping Racial and Sex Disparities in Living a Long and Happy Life %A Bardo,Anthony R. %A Cummings,Jason L. %K Activities of Daily Living %K Black People %K Black white differences %K Black women %K Business And Economics–Economic Situation And Conditions %K Data quality %K Demographers %K Demography %K Disability %K Disadvantaged %K Gender Differences %K Happiness %K health %K Inequality %K Intersectionality %K Life Expectancy %K Life span %K limitations %K Longevity %K Marital Status %K Men %K Older people %K Peers %K Quality of Life %K race %K Racial differences %K Racial inequality %K Retirement %K Severity %K Sex differences %K Subjective well-being %K Wealth %K women %X Disability-free life expectancy is a common measure used by demographers to gauge quantity and quality of life. Yet, the extent to which positive dimensions of quality of life differ by disability status remains unexplored. Using data from the Health and Retirement Study (N = 16,614), we estimated happy life expectancy by age, race, sex, and severe Activities of Daily Living (ADL) limitations. First, results show that happy life expectancy differed substantially by disability status, as older adults with severe ADL limitations experienced 50–60% fewer remaining years of their life happy compared to their more able-bodied peers. Second, healthy Black women and men at age fifty can expect to live five fewer years of their remaining life happy compared to their White peers, but there were no significant race or sex differences among individuals with severe ADL limitations. Finally, the racial gap in Happy Life Expectancy between Black and White women was largely accounted for by group differences in marital status, education, and wealth, but Black men continued to be disadvantaged compared to their White peers. Implications of this study point to a need to critically examine the intersections of race and sex to develop a clearer portrait of the pattern and underlying factors associated with social disparities in longevity and quality of life. Findings highlight the importance of considering positive dimensions of quality of life alongside measures of illness, disability, or disease when determining whether we are adding life to years or just years to life. %B Population Research and Policy Review %V 42 %P 72 %@ 01675923 %G eng %U https://proxy.lib.umich.edu/login?url=https://www.proquest.com/scholarly-journals/life-longevity-pursuit-happiness-role-disability/docview/2849184861/se-2 %0 Journal Article %J Alzheimers Dement %D 2023 %T Measurement differences in the assessment of functional limitations for cognitive impairment classification across geographic locations. %A Nichols, Emma %A Ng, Derek K %A Hayat, Shabina %A Kenneth M. Langa %A Lee, Jinkook %A Steptoe, Andrew %A Deal, Jennifer A %A Gross, Alden L %K Activities of Daily Living %K Aged %K Cognitive Dysfunction %K Dementia %K England %K Humans %K Surveys and Questionnaires %K United States %X

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.

%B Alzheimers Dement %V 19 %P 2218-2225 %8 2023 May %G eng %N 5 %R 10.1002/alz.12994 %0 Journal Article %J Gerontology %D 2023 %T Multimorbidity and Functional Disability among Older Adults: The Role of Inflammation and Glycemic Status - An Observational Longitudinal Study. %A Botoseneanu, Anda %A Markwardt, Sheila %A Quiñones, Ana R %K Activities of Daily Living %K Aged %K Arthritis %K C-reactive protein %K Diabetes Mellitus %K Disabled Persons %K Female %K Glycated Hemoglobin %K Heart Diseases %K Humans %K Hypertension %K Inflammation %K Longitudinal Studies %K Male %K multimorbidity %K Prospective Studies %K Stroke %X

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.

%B Gerontology %V 69 %P 826-838 %G eng %N 7 %R 10.1159/000528648 %0 Journal Article %J J Patient Rep Outcomes %D 2023 %T Structural equation model of coping and life satisfaction of community-dwelling older people during the COVID-19 pandemic. %A Lalani, Nasreen %A Dongjuan, Xu %A Cai, Yun %A Arling, Greg W %K Activities of Daily Living %K Adaptation, Psychological %K Aged %K Child %K COVID-19 %K Female %K Frailty %K Humans %K Independent Living %K Male %K Pandemics %K Personal Satisfaction %X

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.

%B J Patient Rep Outcomes %V 7 %P 46 %G eng %N 1 %R 10.1186/s41687-023-00583-x %0 Journal Article %J Am J Occup Ther %D 2023 %T Subjective Memory Complaints Predict Decline in Memory, Instrumental Activities of Daily Living, and Social Participation in Older Adults: A Fixed-Effects Model. %A Lee, Chang Dae %A Foster, Erin R %K Activities of Daily Living %K Aged %K Aging %K Female %K Humans %K Independent Living %K Longitudinal Studies %K Male %K Memory Disorders %K Social participation %X

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.

%B Am J Occup Ther %V 77 %G eng %N 4 %R 10.5014/ajot.2023.050151 %0 Journal Article %J Front Endocrinol %D 2022 %T Association Between Long-Term HbA1c Variability and Functional Limitation in Individuals Aged Over 50 Years: A Retrospective Cohort Study. %A Shao, Di %A Wang, Shuang-Shuang %A Sun, Ji-Wei %A Wang, Hai-Peng %A Sun, Qiang %K Activities of Daily Living %K Blood Glucose %K Cohort Studies %K Diabetes Mellitus %K Glycated Hemoglobin A %K Retrospective Studies %K Type 2 %X

Background: As mean HbA1c provides incomplete information regarding glycemic variability, there has been considerable interest in the emerging association between glycemic variability and macrovascular events and with microvascular complications and mortality in adults with and without diabetes. However, the association between long-term glycemic variability, represented by visit-to-visit HbA1c variability, and functional limitations has not been clarified in previous literature. The present study aimed to explore the longitudinal association between long-term glycemic variability, represented by visit-to-visit HbA1c variability and functional limitations.

Methods: This cohort study included adults aged over 50 years who participated in the 2006 to 2016 waves of the Health and Retirement Study. Physical functions, including mobility, large muscle function, activities of daily living (ADLs), and instrumental ADLs (IADLs), were assessed at baseline and every 2 years, and HbA1c levels were assessed at baseline and every 4 years. Visit-to-visit HbA1c variability was calculated using the HbA1c variability score (HVS) during the follow-up period. Generalized estimating equation models were used to evaluate the longitudinal association between HbA1c variability and functional limitations with adjustment for a series of confounders.

Results: A total of 5,544 participants having three HbA1c measurements from 2006 to 2016, having two or more physical function measures (including one at baseline), and age over 50 years were included in this analysis. The mean age at baseline was 66.13 ± 8.39 years. A total of 916 (16.5%) participants had an HVS = 100, and 35.1% had an HVS = 50. The highest HVS category (HVS =100) was associated with increased functional status score (β = 0.093, 95% CI: 0.021-0.165) in comparison with the lowest HVS category (HVS = 0). Sensitivity analyses using the CV and SD of HbA1c as measures of variability showed similar associations between HbA1c variability and functional limitation. An incremental increase in HbA1c-CV (β = 0.630, 95% CI: 0.127-1.132) or HbA1c-SD (β = 0.078, 95% CI: 0.006-0.150) was associated with an increase in functional limitation in the fully adjusted model.

Conclusions: HbA1c variability was associated with heightened difficulty in performing functional activities over time after adjusting for mean HbA1c levels and multiple demographics and comorbidities. This study provides further evidence regarding the detrimental effect of HbA1c variability and highlights the significance of steady glycemic control.

%B Front Endocrinol %V 13 %P 847348 %G eng %R 10.3389/fendo.2022.847348 %0 Journal Article %J Journal of Alzheimer's Disease %D 2022 %T Associations Between Midlife Functional Limitations and Self-Reported Health and Cognitive Status: Results from the 1998-2016 Health and Retirement Study. %A Wu, Benson %A Toseef, Mohammad Usama %A Stickel, Ariana M %A González, Hector M %A Tarraf, Wassim %K Activities of Daily Living %K Age Factors %K Cognitive Dysfunction %K ethnicity %K Female %K Health Status %K Humans %K Male %K Middle Aged %K Mobility Limitation %K Neuropsychological tests %K Psychomotor Performance %K Retirement %K Risk Factors %K Self Report %K Surveys and Questionnaires %X

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

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

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

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

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

%B Journal of Alzheimer's Disease %V 85 %P 1621-1637 %G eng %N 4 %R 10.3233/JAD-215192 %0 Journal Article %J Circulation. Heart Failure %D 2022 %T Challenges for Patients Dying of Heart Failure and Cancer. %A Orlovic, Martina %A Mossialos, Elias %A Orkaby, Ariela R %A Joseph, Jacob %A Gaziano, J Michael %A Skarf, Lara M %A Nohria, Anju %A Warraich, Haider J %K Activities of Daily Living %K Heart Failure %K Hospice Care %K Neoplasms %K Palliative care %K Terminal Care %X

BACKGROUND: Hospice and palliative care were originally implemented for patients dying of cancer, both of which continue to be underused in patients with heart failure (HF). The objective of this study was to understand the unique challenges faced by patients dying of HF compared with cancer.

METHODS: We assessed differences in demographics, health status, and financial burden between patients dying of HF and cancer from the Health and Retirement Study.

RESULTS: The analysis included 3203 individuals who died of cancer and 3555 individuals who died of HF between 1994 and 2014. Compared with patients dying of cancer, patients dying of HF were older (80 years versus 76 years), had poorer self-reported health, and had greater difficulty with all activities of daily living while receiving less informal help. Their death was far more likely to be considered unexpected (39% versus 70%) and they were much more likely to have died without warning or within 1 to 2 hours (20% versus 1%). They were more likely to die in a hospital or nursing home than at home or in hospice. Both groups faced similarly high total healthcare out-of-pockets costs ($9988 versus $9595, =0.6) though patients dying of HF had less wealth ($29 895 versus $39 008), thereby experiencing greater financial burden.

CONCLUSIONS: Compared with patients dying of cancer, those dying from HF are older, have greater difficulty with activities of daily living, are more likely to die suddenly, in a hospital or nursing home rather than home or hospice, and had worse financial burden.

%B Circulation. Heart Failure %V 15 %P e009922 %G eng %N 12 %R 10.1161/CIRCHEARTFAILURE.122.009922 %0 Journal Article %J The Journals of Gerontology, Series A %D 2022 %T Changes in the Hierarchy of Functional Impairment from Middle Age to Older Age. %A Brown, Rebecca T %A L Grisell Diaz-Ramirez %A W John Boscardin %A Anne Cappola %A Lee, Sei J %A Michael A Steinman %K Activities of Daily Living %K functional impairment %X

BACKGROUND: Understanding the hierarchy of functional impairment in older adults has helped illuminate mechanisms of impairment and inform interventions, but little is known about whether hierarchies vary by age. We compared the pattern of new-onset impairments in activities of daily living (ADLs) and instrumental ADLs (IADLs) from middle age through older age.

METHODS: We conducted a cohort study using nationally representative data from 32486 individuals enrolled in the Health and Retirement Study. The outcomes were new-onset impairment in each ADL and IADL, defined as self-reported difficulty performing each task, assessed yearly for 9 years. We used multi-state models and competing risks survival analysis to estimate the cumulative incidence of impairment in each task by age group (ages 50-64, 65-74, 75-84, and 85 or older).

RESULTS: The pattern of incident ADL impairments differed by age group. Among individuals ages 50-64 and 65-74 who were independent at baseline, over 9 years' follow-up, difficulties dressing and transferring were the most common impairments to develop. In individuals ages 75-84 and 85 or older who were independent at baseline, difficulties bathing, dressing, and walking were most common. For IADLs, the pattern of impairments was similar across age groups; difficulty shopping was most common followed by difficulty managing money and preparing meals. Complementary analyses demonstrated a similar pattern.

CONCLUSIONS: These findings suggest that the hierarchy of ADL impairment differs by age. These findings have implications for the development of age-specific interventions to prevent or delay functional impairment.

%B The Journals of Gerontology, Series A %V 77 %P 1577-1584 %G eng %N 8 %R 10.1093/gerona/glab250 %0 Journal Article %J The Journal of Gerontology, Series A %D 2022 %T COVID-19 pandemic impact on trajectories in cardiometabolic health, physical activity and functioning among adults from the 2006-2020 Health and Retirement Study. %A Beydoun, Hind A %A Beydoun, May A %A Gautam, Rana S %A Alemu, Brook T %A Weiss, Jordan %A Hossain, Sharmin %A Zonderman, Alan B %K Activities of Daily Living %K COVID-19 %K lifestyle %K Obesity %K Statistical models %X

BACKGROUND: The aim of this study was to evaluate the impact of the COVID-19 pandemic on trajectories in cardiometabolic health, physical activity and functioning among U.S. older adults, overall and according to selected baseline socio-demographic characteristics.

METHODS: We performed secondary analyses using longitudinal data on 1,372 participants from the 2006-2020 Health and Retirement Study. Pre-post COVID-19 pandemic onset was examined in relation to body mass index (BMI), number of cardiometabolic risk factors and/or chronic conditions, physical activity, Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) using mixed-effects regression models and group-based trajectory models.

RESULTS: The COVID-19 pandemic was associated with significantly increased BMI (β=1.39, 95% CI: 0.74, 2.03). Furthermore, the odds of having at least one cardiometabolic risk factor and/or chronic disease increased pre-post COVID-19 onset (OR 1.16, 95% CI: 1.00, 1.36), whereas physical functioning worsened pre-post COVID-19 onset (ADL: β=1.11, 95% CI: 0.94, 1.28; IADL: β=0.59, 95% CI: 0.46, 0.73). The pre-post COVID-19 period (2018-2020) showed a stable group of trajectories, with low, medium and high levels of the selected health indicators. Health disparities according to sex, race/ethnicity, educational level, work status and total wealth are highlighted.

CONCLUSIONS: The COVID-19 pandemic onset appears to worsen cardiometabolic health and physical functioning among U.S. older adults, with clusters of individuals defined by selected socio-demographic characteristics experiencing distinct trajectories pre-post COVID-19 pandemic onset.

%B The Journal of Gerontology, Series A %V 77 %P 1371-1379 %G eng %N 7 %R 10.1093/gerona/glac028 %0 Journal Article %J BMJ Open %D 2022 %T Decreasing rates of cost-related medication non-adherence by age advancement among American generational cohorts 2004-2014: a longitudinal study. %A Zhang, James %A Bhaumik, Deepon %A Meltzer, David %K Activities of Daily Living %K Drug Costs %K Medicare %K Medication Adherence %X

OBJECTIVES: The access barrier to medication has been a persistent and elusive challenge in the US healthcare system and around the globe. Cost-related medication non-adherence (CRN) is an important measure of medication non-adherence behaviours that aim to avoid costs. Longitudinal study of CRN behaviours for the ageing population is rare.

DESIGN: Longitudinal study using the Health and Retirement Study to evaluate self-reported CRN biennially.

SETTING: General population of older Americans.

PARTICIPANTS: Three cohorts of Americans aged between 50 and 54 (baby boomers), 65-69 (the silent generation) and 80 or above (the greatest generation) in 2004 who were followed to 2014.

INTERVENTION: Observational with no intervention.

PRIMARY AND SECONDARY OUTCOME MEASURES: Longitudinal CRN rates for three generational cohorts from 2004 to 2014. Population-averaged effects of a broad set of variables including sociodemographics, income, insurance status, limitations in activities of daily living (ADLs) and instrumental activities of daily living (IADLs), and comorbid conditions on CRN were derived using generalised estimating equation by taking into account repeated measurements of CRN over time for the three cohorts, respectively.

RESULTS: The three cohorts of baby boomer, the silent generation and the greatest generation with 1925, 2839 and 2666 respondents represented 12.3 million, 8.2 million and 7.7 million people in 2004, respectively. Increasing age was associated with decreasing likelihood of reporting CRN in all three generational cohorts (p<0.05), controlling for demographics, income, insurance status, functional status and comorbid conditions. All three generational cohorts had a higher prevalence of diabetes, cancer, heart conditions, stroke, a higher percentage of respondents with Medicare-Medicaid dual eligibility and lower percentage with private insurance in 2014 compared with 2004 (p<0.05).

CONCLUSION: The paradox of decreasing CRN rates, independent of disease burden, income and insurance status, suggests populations' CRN behaviours change as Americans age, bearing implications to social policy.

%B BMJ Open %V 12 %P e051480 %G eng %N 5 %R 10.1136/bmjopen-2021-051480 %0 Journal Article %J Nutrients %D 2022 %T Diet Quality and Health in Older Americans. %A Zhao, Hang %A Andreyeva, Tatiana %K Activities of Daily Living %K Aged %K diet %K Eating %K Healthy %K Nutritional Status %X

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.

%B Nutrients %V 14 %P 1198 %G eng %N 6 %R 10.3390/nu14061198 %0 Journal Article %J Journal of Alzheimer's Disease %D 2022 %T Difficulties with Activities of Daily Living and Receipt of Care Among Older Adults with Cognitive Impairment: Differences Between Those Living Alone and Those Living with Others. %A Yang, Yulin %A Swinnerton, Kaitlin %A Portacolone, Elena %A Allen, Isabel Elaine %A Torres, Jacqueline M %A Duchowny, Kate %K Activities of Daily Living %K Cognitive Dysfunction %K home environment %K Independent Living %K Prevalence %X

We compared the prevalence of reporting difficulty with basic and instrumental activities of daily living without help received for persons with cognitive impairment living alone versus those living with others. We used data on 13,782 community-dwelling participants aged 55+ with cognitive impairment in the Health and Retirement Study (2000-2016). Models were stratified by gender and race/ethnicity. Among cognitively impaired older adults, those living alone were more likely to report difficulty without help received than those living with others. Results were similar by gender and race/ethnicity. Providers and policymakers might focus their efforts on ensuring the adequate provision of home and community-based services for older adults living alone with cognitive impairment.

%B Journal of Alzheimer's Disease %V 89 %P 31-37 %G eng %N 1 %R 10.3233/JAD-220172 %0 Journal Article %J BMC Geriatrics %D 2022 %T Difficulty and help with activities of daily living among older adults living alone during the COVID-19 pandemic: a multi-country population-based study. %A Chen, Shanquan %A Jones, Linda A %A Jiang, Shan %A Jin, Huajie %A Dong, Dong %A Chen, Xi %A Wang, Dan %A Zhang, Yun %A Xiang, Li %A Zhu, Anna %A Cardinal, Rudolf N %K Activities of Daily Living %K COVID-19 %K Domiciliary care %K Living Alone %X

BACKGROUND: Older adults who live alone and have difficulties in activities of daily living (ADLs) may have been more vulnerable during the COVID-19 pandemic. However, little is known about pandemic-related changes in ADL assistance (such as home care, domiciliary care) and its international variation. We examined international patterns and changes in provision of ADL assistance, and related these to country-level measures including national income and health service expenditure.

METHODS: We analysed data covering 29 countries from three longitudinal cohort studies (Health and Retirement Study, English Longitudinal Study of Aging, and Survey of Health, Ageing and Retirement in Europe). Eligible people were aged ≥50 years and living alone. Outcomes included ADL difficulty status (assessed via six basic ADLs and five instrumental ADLs) and receipt of ADL assistance. Wealth-related inequality and need-related inequity in ADL assistance were measured using Erreygers' corrected concentration index (ECI). Correlations were estimated between prevalence/inequality/inequity in ADL assistance and national health-related indicators. We hypothesized these measures would be associated with health system factors such as affordability and availability of ADL assistance, as well as active ageing awareness.

RESULTS: During COVID-19, 18.4% of older adults living alone reported ADL difficulties (ranging from 8.8% in Switzerland to 29.2% in the USA) and 56.8% of those reporting difficulties received ADL assistance (ranging from 38.7% in the UK to 79.8% in Lithuania). Females were more likely to receive ADL assistance than males in 16/29 countries; the sex gap increased further during the pandemic. Wealth-related ECIs indicated socioeconomic equality in ADL assistance within 24/39 countries before the pandemic, and significant favouring of the less wealthy in 18/29 countries during the pandemic. Needs-related ECIs indicated less equity in assistance with ADLs during the pandemic than before. Our hypotheses on the association between ADL provision measures and health system factors were confirmed before COVID-19, but unexpectedly disconfirmed during COVID-19.

CONCLUSION: This study revealed an unequal (and in some countries, partly needs-mismatched) response from countries to older adults living alone during the COVID-19 pandemic. The findings might inform future research about, and policies for, older adults living alone, particularly regarding social protection responses during crises.

%B BMC Geriatrics %V 22 %P 181 %G eng %N 1 %R 10.1186/s12877-022-02799-w %0 Book Section %B New Models for Managing Longevity Risk: Public-Private Partnerships %D 2022 %T Disability-free life trends at older ages: Implications for longevity risk management %A Douglas A. Wolf %A Olivia S. Mitchell %K Activities of Daily Living %K Disability %B New Models for Managing Longevity Risk: Public-Private Partnerships %I Oxford University Press %@ 978–0–19–285980–8 %G eng %& 3 %R 10.1093/oso/9780192859808.001.0001 %0 Journal Article %J Journal of Applied Gerontology %D 2022 %T Handgrip Strength Asymmetry Is Associated With Limitations in Individual Basic Self-Care Tasks. %A Mahoney, Sean J %A Kyle J Hackney %A Donald A Jurivich %A Lindsey J Dahl %A Johnson, Carol %A Ryan P McGrath %K Activities of Daily Living %K Disability %K Frailty %K self-care %X

This investigation sought to determine the associations between handgrip strength (HGS) asymmetries and limitations in individual activities of daily living (ADL). The analytic sample included 18,468 participants from the 2006 to 2016 waves of the Health and Retirement Study. Those with HGS >10% stronger on either hand had any HGS asymmetry. Individuals with HGS >10% stronger on their dominant or non-dominant hand had dominant or non-dominant HGS asymmetry, respectively. ADL abilities were self-reported. Those with any HGS asymmetry had 1.21 (95% confidence interval [CI] = [1.01-1.46]) greater odds for a toileting limitation and 1.25 (CI = [1.03-1.52]) greater odds for a transferring limitation. Individuals with dominant HGS asymmetry had 1.24 (CI = [1.01-1.53]) greater odds for a transferring limitation. Those with non-dominant HGS asymmetry had 1.39 (CI = [1.01-1.93]) and 1.44 (CI = [1.05-1.96]) greater odds for a bathing and toileting limitation, respectively. HGS asymmetries could help to identify future limitations in specific ADLs.

%B Journal of Applied Gerontology %V 41 %P 450-454 %G eng %N 2 %R 10.1177/0733464820982409 %0 Journal Article %J JAMA Network Open %D 2022 %T Importance of Asking Older Adults Whether They Are Having Difficulty Managing Finances. %A Karlawish, Jason %K Activities of Daily Living %K cognitive impairment %B JAMA Network Open %V 5 %P e2231442 %G eng %N 9 %R 10.1001/jamanetworkopen.2022.31442 %0 Journal Article %J BMC Geriatrics %D 2022 %T Multimorbidity and long-term disability and physical functioning decline in middle-aged and older Americans: an observational study. %A Aubert, Carole E %A Kabeto, Mohammed %A Kumar, Navasuja %A Wei, Melissa Y %K Activities of Daily Living %K Hand Strength %K multimorbidity %K Retirement %K walking speed %X

BACKGROUND: Multimorbidity is highly prevalent and associated with several adverse health outcomes, including functional limitations. While maintaining physical functioning is relevant for all adults, identifying those with multimorbidity at risk for faster rates of physical functioning decline may help to target interventions to delay the onset and progression of disability. We quantified the association of multimorbidity with rates of long-term disability and objective physical functioning decline.

METHODS: In the Health and Retirement Study, we computed the Multimorbidity-Weighted Index (MWI) by assigning previously validated weights (based on physical functioning) to each chronic condition. We used an adjusted negative binomial regression to assess the association of MWI with disability (measured by basic and instrumental activities of daily living [ADLs, IADLs]) over 16 years, and linear mixed effects models to assess the association of MWI with gait speed and grip strength over 8 years.

RESULTS: Among 16,616 participants (mean age 67.3, SD 9.7 years; 57.8% women), each additional MWI point was associated with a 10% increase in incidence rate of disability (IRR: 1.10; 95%CI: 1.09, 1.10). In 2,748 participants with data on gait speed and grip strength, each additional MWI point was associated with a decline in gait speed of 0.004 m/s (95%CI: -0.006, -0.001). The association with grip strength was not statistically significant (-0.01 kg, 95%CI: -0.73, 0.04). The rate of decline increased with time for all outcomes, with a significant interaction between time and MWI for disability progression only.

CONCLUSION: Multimorbidity, as weighted on physical functioning, was associated with long-term disability, including faster rates of disability progression, and decline in gait speed. Given the importance of maintaining physical functioning and preserving functional independence, MWI is a readily available tool that can help identify adults to target early on for interventions.

%B BMC Geriatrics %V 22 %P 910 %G eng %N 1 %R 10.1186/s12877-022-03548-9 %0 Journal Article %J JAMA Network Open %D 2022 %T Racial and Ethnic Differences in Hospice Use and Hospitalizations at End-of-Life Among Medicare Beneficiaries With Dementia. %A Lin, Pei-Jung %A Zhu, Yingying %A Olchanski, Natalia %A Cohen, Joshua T %A Neumann, Peter J %A Jessica Faul %A Fillit, Howard M %A Freund, Karen M %K Activities of Daily Living %K Death %K Dementia %K Female %K Hospice Care %K Hospices %K Hospitalization %K Medicare %X

Importance: The pool of studies examining ethnic and racial differences in hospice use and end-of-life hospitalizations among patients with dementia is limited and results are conflicting, making it difficult to assess health care needs of underresourced racial and ethnic groups.

Objective: To explore differences in end-of-life utilization of hospice and hospital services among patients with dementia by race and ethnicity.

Design, Setting, and Participants: This cohort study used national survey data from the Health and Retirement Study linked with Medicare and Medicaid claims that reflected a range of socioeconomic, health, and psychosocial characteristics. Eligible participants were Medicare fee-for-service beneficiaries aged 65 years or older diagnosed with dementia who died between 2000 and 2016. Analyses were performed from June to December 2021.

Exposures: Race and ethnicity.

Main Outcomes and Measures: We examined the frequency and costs of hospice care, emergency department (ED) visits, and hospitalizations during the last 180 days of life among Medicare decedents with dementia. We analyzed the proportion of dementia decedents with advance care planning and their end-of-life care preferences.

Results: The cohort sample included 5058 beneficiaries with dementia (mean [SD] age, 85.5 [8.0] years; 3038 women [60.1%]; 809 [16.0%] non-Hispanic Black, 357 [7.1%] Hispanic, and 3892 non-Hispanic White respondents [76.9%]). In adjusted analysis, non-Hispanic Black decedents (odds ratio [OR], 0.65; 95% CI, 0.55-0.78), nursing home residents (OR, 0.81; 95% CI, 0.71-0.93), and survey respondents represented by a proxy (OR, 0.84; 95% CI, 0.71-0.99) were less likely to use hospice, whereas older decedents (age 75-84 vs 65-74 years: OR, 1.39; 95% CI, 1.12-1.72; age ≥85 vs 65-74 years: OR, 1.39; 95% CI, 1.13-1.71), women (OR, 1.19; 95% CI, 1.05-1.35), and decedents with higher education (high school vs less than high school: OR, 1.17; 95% CI, 1.01-1.36; more than high school vs less than high school: OR, 1.32; 95% CI, 1.13-1.54), more severe cognitive impairment (OR, 1.51; 95% CI, 1.02-2.23), and more instrumental activities of daily living limitations (OR, 1.07; 95% CI, 1.01-1.12) were associated with higher hospice enrollment. A higher proportion of Black and Hispanic decedents with dementia used ED (645 of 809 [79.7%] and 274 of 357 [76.8%] vs 2753 of 3892 [70.7%]; P < .001) and inpatient services (625 of 809 [77.3%] and 275 of 357 [77.0%] vs 2630 of 3892 [67.5%]; P < .001) and incurred roughly 60% higher inpatient expenditures at the end of life compared with White decedents (estimated mean: Black, $23 279; 95% CI, $20 690-$25 868; Hispanic, $23 471; 95% CI, $19 532-$27 410 vs White, $14 609; 95% CI, $13 800-$15 418). A higher proportion of Black and Hispanic than White beneficiaries with dementia who were enrolled in hospice were subsequently admitted to the ED (56 of 309 [18.1%] and 22 of 153 [14.4%] vs 191 of 1967 [9.7%]; P < .001) or hospital (48 of 309 [15.5%] and 17 of 153 [11.1%] vs 119 of 1967 [6.0%]; P < .001) before death. The proportion of dementia beneficiaries completing advance care planning was lower among Black (146 of 704 [20.7%]) and Hispanic (66 of 308 [21.4%]) beneficiaries compared with White beneficiaries (1871 of 3274 [57.1%]). A higher proportion of Black and Hispanic decedents with dementia had written instructions choosing all care possible to prolong life (30 of 144 [20.8%] and 12 of 65 [18.4%] vs 72 of 1852 [3.9%]), whereas a higher proportion of White decedents preferred to limit care in certain situations (1708 of 1840 [92.8%] vs 114 of 141 [80.9%] and 51 of 64 [79.7%]), withhold treatments (1448 of 1799 [80.5%] vs 87 of 140 [62.1%] and 41 of 62 [66.1%]), and forgo extensive life-prolonging measures (1712 of 1838 [93.1%] vs 120 of 138 [87.0%] and 54 of 65 [83.1%]).

Conclusions and Relevance: The results of this cohort study highlight unique end-of-life care utilization and treatment preferences across racial and ethnic groups among patients with dementia. Medicare should consider alternative payment models to promote culturally competent end-of-life care and reduce low-value interventions and costs among the population with dementia.

%B JAMA Network Open %V 5 %P e2216260 %G eng %N 6 %R 10.1001/jamanetworkopen.2022.16260 %0 Journal Article %J Journal of Applied Gerontology %D 2022 %T The Role of Optimism on the Relationship Between Activity Limitations and Life Satisfaction Among Middle-Aged and Older Adults in the United States: A Growth Curve Model of Changes Over Time. %A Cheng, Kent Jason Go %A McMaughan, Darcy Jones Dj %A Smith, Matthew Lee %K Activities of Daily Living %K Activity limitation %K instrumental activities of daily living %K Leave Behind Survey %K Life Satisfaction %K Optimism %X

Activity limitations can diminish life satisfaction. This study explored the role of optimism on the relationship between changes in activities of daily living and instrumental activities of daily living (ADL/IADL) limitations and life satisfaction over time among middle-aged and older adults. Growth curve modeling accounting for intra- and inter-individual changes in life satisfaction was applied to the 2008-2018 waves of the Health and Retirement Study Leave Behind Survey subsample ( = 39,122 person-years). After controlling for sociodemographic factors, physical functioning decline adversely affected life satisfaction ( = -0.12, = -0.13, 0.001), but the negative consequences reduced slightly through optimism ( = -0.11, = -0.12, = 0.47, 0.001). Increasing optimism could reduce the negative consequences of ADL/IADL limitations on life satisfaction among middle-aged to older adults.

%B Journal of Applied Gerontology %V 41 %P 993-1001 %G eng %N 4 %R 10.1177/07334648211056638 %0 Journal Article %J American Journal of Epidemiology %D 2022 %T Testing Black-White Disparities in Biological Aging Among Older Adults in the United States: Analysis of DNA-Methylation and Blood-Chemistry Methods. %A Graf, Gloria H %A Crowe, Christopher L %A Kothari, Meeraj %A Kwon, Dayoon %A Jennifer J Manly %A Turney, Indira C %A Valeri, Linda %A Belsky, Daniel W %K Activities of Daily Living %K Cross-Sectional Studies %K DNA %K DNA Methylation %X

Biological aging is a proposed mechanism through which social determinants drive health disparities. We conducted proof-of-concept testing of 8 DNA-methylation (DNAm) and blood-chemistry quantifications of biological aging as mediators of disparities in healthspan between Black and White participants in the 2016 wave of the Health and Retirement Study (n = 9,005). We quantified biological aging from 4 DNAm "clocks" (Horvath, Hannum, PhenoAge, and GrimAge clock), a DNAm pace-of-aging measure (DunedinPoAm), and 3 blood-chemistry measures (PhenoAge, Klemera-Doubal method biological age, and homeostatic dysregulation). We quantified Black-White disparities in healthspan from cross-sectional and longitudinal data on physical performance tests, self-reported limitations in activities of daily living, and physician-diagnosed chronic diseases, self-rated health, and survival. DNAm and blood-chemistry quantifications of biological aging were moderately correlated (Pearson's r = 0.1-0.4). The GrimAge clock, DunedinPoAm, and all 3 blood-chemistry measures were associated with healthspan characteristics (e.g., mortality effect-size hazard ratios were 1.71-2.32 per standard deviation of biological aging) and showed evidence of more advanced/faster biological aging in Black participants than in White participants (Cohen's d = 0.4-0.5). These measures accounted for 13%-95% of Black-White differences in healthspan-related characteristics. Findings suggest that reducing disparities in biological aging can contribute to building health equity.

%B American Journal of Epidemiology %V 191 %P 613-625 %G eng %N 4 %R 10.1093/aje/kwab281 %0 Journal Article %J The Journals of Gerontology: Series B %D 2022 %T Trends in the Use of Residential Settings Among Older Adults. %A Toth, Matt %A Palmer, Lauren %A Lawren E. Bercaw %A Voltmer, Helena %A Sarita Karon %K Activities of Daily Living %K Aged %K Comorbidity %K Cross-Sectional Studies %K Dementia %K Female %K Health Status Disparities %K Health Transition %K Homes for the Aged %K Humans %K Independent Living %K Male %K Medicare %K Nursing homes %K United States %X

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.

%B The Journals of Gerontology: Series B %V 77 %P 424-428 %G eng %N 2 %R 10.1093/geronb/gbab092 %0 Journal Article %J Journal of Alzheimers Disease %D 2022 %T Undiagnosed Dementia Is Associated with Poor Physical Function in Older Adults. %A McGrath, Ryan %A Robinson-Lane, Sheria G %A Klawitter, Lukus %A Rhee, Yeong %A Hamm, Jeremy M %A McCourt, Mark E %A Parker, Kelly %A Hackney, Kyle J %K Activities of Daily Living %K Cognitive Dysfunction %K Dementia %K Hand Strength %K walking speed %X

BACKGROUND: Older adults with a cognitive impairment, including those not yet diagnosed, may have deficits in their physical function.

OBJECTIVE: We sought to determine the associations of cognitive impairment consistent with dementia (CICD) diagnosis status on handgrip strength, gait speed, and functional disability in older adults.

METHODS: The analytical sample included 8,383 adults aged ≥65-years without history of stroke, cancers, neurological conditions, or brain damage who participated in at least one-wave of the 2010-2016 waves of the Health and Retirement Study. A handgrip dynamometer measured handgrip strength. Men with handgrip strength <26 kg and women <16 kg were weak. Gait speed was timed across a 2.5-m course and those with slowness had gait speed <0.8 m/s. Participants with difficulty or an inability in completing any basic activities of daily living had a functional disability. The adapted Telephone Interview of Cognitive Status evaluated cognitive function. Persons with scores <7 had a CICD. Healthcare provider dementia-related diagnosis was self-reported. Undiagnosed CICD was defined as no reported dementia-related diagnosis but had CICD, while diagnosed CICD was classified as reporting a dementia-related diagnosis. Covariate-adjusted logistic models were used for the analyses.

RESULTS: Persons with undiagnosed CICD had 1.37 (95% confidence interval (CI): 1.04-1.80) greater odds for weakness and 2.02 (CI: 1.39-2.94) greater odds for slow gait speed. Older adults with diagnosed CICD had 2.29 (CI: 1.32-3.97) greater odds for slowness and 1.85 (CI: 1.19-2.90) greater odds for functional disability.

CONCLUSION: Screening for CICD could be recommended when defects in physical function are observed in older adults.

%B Journal of Alzheimers Disease %V 89 %P 473-482 %8 2022 %G eng %N 2 %R 10.3233/JAD-220257 %0 Journal Article %J The Journals of Gerontology: Series B %D 2021 %T Activity Limitations and Depressive Symptoms Among Older Couples: The Moderating Role of Spousal Care. %A Sae Hwang Han %A Kim, Kyungmin %A Jeffrey A Burr %K Activities of Daily Living %K Caregiving %K Disability %K instrumental support %X

OBJECTIVES: Limitations in performing basic daily activities, as well as spousal caregiving that arises from activity limitations, are important factors that have ramifications for mental health among couples. The objective of this study was to investigate the interplay of these factors by focusing on whether the associations between activity limitations and depressive symptoms among coupled-individuals were moderated by receipt and provision of spousal care.

METHODS: Longitudinal household data from the Health and Retirement Study (2004-2014; dyad N = 6,614) were analyzed to estimate within-person associations between one's own and spousal activity limitations, receipt and provision of spousal care, and depressive symptoms.

RESULTS: Findings showed a consistent link between one's own activity limitations and depressive symptoms for both spouses, whereas spousal activity limitations were associated with depressive symptoms for wives only. We also found moderating effects of spousal care in the link between one's own and spousal activity limitations and depressive symptoms.

DISCUSSION: Receipt and provision of activities of daily living-related assistance may contextualize the association between activity limitations and depressive symptoms among older coupled-individuals in a direction that could alleviate or aggravate the risk of depression.

%B The Journals of Gerontology: Series B %V 76 %P 360-369 %G eng %N 2 %R 10.1093/geronb/gbz161 %0 Journal Article %J American Journal of Epidemiology %D 2021 %T The Association Between Cytomegalovirus and Disability by Race/Ethnicity and Gender: Results from the Health and Retirement Study. %A Kate A Duchowny %A Grace A Noppert %K Activities of Daily Living %K Cytomegalovirus %K Disability %K Health Disparities %K social epidemiology %X

Recent studies have documented a decline in the overall prevalence of disability in the United States, however racial/ethnic and gender disparities continue to persist. Cytomegalovirus (CMV), a socially patterned exposure, may be a key mechanism in understanding these previously documented disparities. Using data from the nationally-representative 2016 Health and Retirement Study, we employed Poisson log-binomial models to estimate the prevalence of disability comparing CMV seropositive versus seronegative adults and investigated effect modification by race/ethnicity and gender. Among the 9,029 participants (55% women, mean age: 67.4), 63% were CMV seropositive and 15% were disabled. CMV seropositivity was highest among non-Hispanic Black (88%) and Hispanic adults (92%) compared to non-Hispanic White adults (57%). We found evidence for effect modification of the CMV-disability by gender but not race/ethnicity. While the confidence intervals in the fully-adjusted models included the null value, compared to seronegative women, our results suggest a greater prevalence of disability among CMV seropositive women (PR= 1.16, 95% CI= 0.97, 1.39) but not among men (PR= 0.85, 95% CI= 0.69, 1.06). Results provide initial support that CMV may be an important determinant of gender disparities in disability.

%B American Journal of Epidemiology %V 190 %P 2314-2322 %G eng %N 11 %R 10.1093/aje/kwab152 %0 Journal Article %J BMC Geriatrics %D 2021 %T Association of late-life depression with cognitive impairment: evidence from a cross-sectional study among older adults in India. %A Muhammad, T %A Meher, Trupti %K Activities of Daily Living %K Cognitive Dysfunction %K Cross-Sectional Studies %K depression %K LASI %X

BACKGROUND: Late-life depression (LLD) is considered as a prodrome to dementia and plays a major role in the development of long-term cognitive disabilities. We aimed to estimate the prevalence and correlates of LLD and cognitive impairment and to explore their associations among older adults in India.

METHODS: Data for this study was derived from the Longitudinal Ageing Study in India (LASI) Wave 1 (2017-18). The total sample included 31,464 (15,098 male and 16,366 female) older individuals aged 60 years and above. Cognitive impairment measured from various domains derived from the cognitive module of the Health and Retirement Study (HRS), and major depression measured by the CIDI-SF (Composite International Diagnostic Interview- Short Form) were the outcome variables. Descriptive, bivariate, and multivariable analyses were performed to fulfill the objectives of the study.

RESULTS: The overall prevalence of LLD and cognitive impairment for the current sample was 8.7% and 13.7 % respectively. Among older individuals who have rated their health status as poor were 2.59 times more likely to suffer from LLD [OR: 2.59, CI: 2.24-2.99] as compared to their counterparts. The older adults who had difficulty in activities of daily living (ADL) and instrumental activities of daily living (IADL) were 74% and 69 % more likely to suffer from LLD. Similarly, older adults who were depressed had higher odds of cognitive impairment [OR: 1.22, CI: 1.01-1.48] compared to their counterparts. Also, older adults who were depressed and belonged to rural areas were 2.58 times [AOR: 2.58, CI: 1.95-3.41] more likely to be cognitively impaired than those who were not depressed and resided in urban areas.

CONCLUSIONS: Depression is linked to an increased risk of cognitive decline and dementia; therefore, failing to diagnose and treat LLD in later life may have significant health implications. Moreover, treatment under the care of a cognitive neurologist or geriatric psychiatrist is recommended for people with LLD and cognitive disability due to both the disorders' complex existence.

%B BMC Geriatrics %V 21 %P 364 %G eng %N 1 %R 10.1186/s12877-021-02314-7 %0 Conference Paper %B ISEE Conference Abstracts %D 2021 %T Associations of Long-term Air Pollution Exposure and Incident Late-Life Disability in Older U.S. Adults: The Health Retirement Study %A Gao, Jiaqi %A Carlos F. Mendes de Leon %A D'Souza, Jennifer %A Zhang, Boya %A Szpiro, Adam %A Young, Michael %A Weuve, Jennifer %A Kenneth M. Langa %A Jessica Faul %A Kaufman, Joel %A Richard A Hirth %A Sara Dubowsky Adar %K Activities of Daily Living %K Air Pollution %K Long-Term Exposure %X Late-life disability is of critical concern to older adults and can reflect the cumulative burden of chronic disease over the lifespan. Although air pollution has been associated with many common chronic conditions, associations with disability are understudied. We aimed to quantify associations between long-term exposures to air pollution and late-life disability. METHODS: We used biennial data between 2000 and 2016 on self-reported Activities of Daily Living (ADL) from participants 65 years from the nationally representative Health and Retirement Study. Using a spatiotemporal prediction model, we estimated 10-year PM2.5, PM10-2.5, NO2, and O3 concentrations at participant residences. We then estimated the risk of incident ADL disability as a function of time-varying air pollution, adjusting for individual and area-level confounders and sampling weights in a Cox model. We fitted single- and two-pollutant models. RESULTS:Our study population of 16,927 adults (70+6.4 years) was predominantly non-Hispanic White (76%), Non-Hispanic Black (14%), and Hispanic White (8%) and 32% reported a new disability during follow-up. Overall, we found some evidence that air pollution was associated with an increased risk of ADL disability. After adjustment for place and PM2.5, we found that interquartile increases in PM10-2.5 and NO2 were associated with 8% (HR: 1.08 per 5 µg/m3, 95% CI: 1.01, 1.17) and 9% (HR: 1.09 per 6 ppb, 95% CI: 1.00, 1.19) greater hazards of ADL, respectively, with similar findings in the single pollutant models. PM2.5 and O3 were not associated with higher hazards of ADL in single or multipollutant models after detailed adjustment for place. CONCLUSIONS:This prospective study in a nationally representative sample of older adults found some evidence that higher levels of some but not all long-term air pollutants assessed are associated with increased risk of late-life disability. %B ISEE Conference Abstracts %V 2021 %G eng %U https://ehp.niehs.nih.gov/action/doSearch?AllField=Associations+of+Long-term+Air+Pollution+Exposure+and+Incident+Late-Life+Disability+in+Older+U.S.+Adults%3A+The+Health+Retirement+Study %N 1 %0 Journal Article %J Journal of General Internal Medicine %D 2021 %T Development, Validation, and Performance of a New Physical Functioning-Weighted Multimorbidity Index for Use in Administrative Data. %A Wei, Melissa Y %A Luster, Jamie E %A Ratz, David %A Mukamal, Kenneth J %A Kenneth M. Langa %K Activities of Daily Living %K multimorbidity %B Journal of General Internal Medicine %V 36 %P 2427-2433 %G eng %N 8 %R 10.1007/s11606-020-06486-7 %0 Journal Article %J The Journals of Gerontology, Series A %D 2021 %T Disability Incidence Rates for Men and Women in 23 Countries: Evidence on Health Effects of Gender Inequality. %A Jinkook Lee %A Erik Meijer %A Drystan F. Phillips %A Hu, Peifeng %K Activities of Daily Living %K CHARLS %K Cross-Country %K ELSA %K health disparity %K KLoSA %K Longitudinal analysis %K MHAS %K SHARE %X

BACKGROUND: Inequality in gender varies across social contexts, which may influence the health of both men and women. Based on theories of gender as a social system, we examine whether systematic gender inequality at the macro level influences health of men and women.

METHODS: Using harmonized panel data from the Gateway to Global Aging Data in 23 high and middle income countries (N=168,873), we estimate disability prevalence and incidence for men and women ages 55 to 89 (2000-2016). Within each country or geographic region, we also investigate gender differences in age gradients of the probability of disability onset. We, then, pool data from all countries and test the hypothesis that gender inequality increases the probability of disability onset.

RESULTS: We found substantial cross-country variation in disability incidence rates, and this variation is greater for women than for men. Among ages 65-69, disability incidence rates ranged from 0.4 to 5.0 for men and from 0.5 to 9.4 for women. Our within-country analysis showed significant gender differences in age gradients of the probability of disability onset in the U.S., Korea, Southern Europe, Mexico, and China, but not in Northern, Central, and Eastern Europe, England and Israel. Testing hypothesized effects of gender inequality, we find that gender inequality is significantly associated with the probability of disability onset for women, but not for men.

CONCLUSIONS: Macro-level societal gender inequality is significantly associated with the probability of disability onset for women. Reducing and eliminating gender inequality is crucial to achieving good health for women.

%B The Journals of Gerontology, Series A %V 76 %P 328-338 %G eng %N 2 %R 10.1093/gerona/glaa288 %0 Journal Article %J The Journals of Gerontology: Series B %D 2021 %T Family caregiving and place of death: Insights from cross-national analysis of the Harmonized End of Life Data. %A Jennifer A Ailshire %A Osuna, Margarita %A Wilkens, Jenny %A Jinkook Lee %K Activities of Daily Living %K Aging %K Disability %K family caregivers %K Nursing homes %K SHARE %K spouse %K Terminally Ill %X

OBJECTIVES: Family is largely overlooked in research on factors associated with place of death among older adults. We determine if family caregiving at the end of life is associated with place of death in the United States and Europe.

METHODS: We use the Harmonized End of Life data sets developed by the Gateway to Global Aging Data for the Survey of Health, Ageing and Retirement in Europe (SHARE) and the Health and Retirement Study (HRS). We conducted multinomial logistic regression on 7,113 decedents from 18 European countries and 3,031 decedents from the United States to determine if family caregiving, defined based on assistance with activities of daily living, was associated with death at home versus at a hospital or nursing home.

RESULTS: Family caregiving was associated with reduced odds of dying in a hospital and nursing home, relative to dying at home in both the United States and Europe. Care from a spouse/partner or child/grandchild was both more common and more strongly associated with place of death than care from other relatives. Associations between family caregiving and place of death were generally consistent across European welfare regimes.

DISCUSSION: This cross-national examination of family caregiving indicates that family-based support is universally important in determining where older adults die. In both the United States and in Europe, most care provided during a long-term illness or disability is provided by family caregivers, and it is clear families exert tremendous influence on place of death.

%B The Journals of Gerontology: Series B %V 76 %P S76-S85 %G eng %N Supplement_1 %R 10.1093/geronb/gbaa225 %0 Journal Article %J Age and Ageing %D 2021 %T Life satisfaction among older adults with impairment in activities of daily living. %A Boccaccio, Dominic E %A Irena Cenzer %A Kenneth E Covinsky %K Activities of Daily Living %K functional impairment %K Life Satisfaction %X

BACKGROUND: Many older adults experience decline in function, but maintain high levels of life satisfaction. The factors associated with high life satisfaction among those with functional impairment are not well understood.

OBJECTIVE: Examine the proportion of older adults with functional impairment reporting high life satisfaction and the predictors of high life satisfaction.

DESIGN: Cross-sectional cohort study.

SETTING: Health and Retirement Study.

SUBJECTS: A total of 7,287 community-dwelling participants, 65 years or older, who completed the leave-behind questionnaire in 2014 or 2016.

METHODS: The main predictor was having difficulty or needing help in performing Activities of Daily Living (ADL). The primary outcome was reporting high life satisfaction, defined using a three-item Diener scale. Significant factors were identified using modified Poisson regression models adjusted for demographic characteristics.

RESULTS: Those with no ADL impairment were more likely to report high levels of life satisfaction than those with ADL difficulty or ADL dependence (54.4 vs 38.6 vs 27.6%, P < 0.001). Among those with ADL dependence, we identified several factors associated with high life satisfaction, including: not being lonely (38.2 vs 23.2%, ARR = 1.6 (1.2, 2.2)), satisfied with family life (35.1 vs 12.8%, ARR = 2.7 (1.6, 4.4)), and satisfied with financial situation (40.8 vs 16.6%, ARR = 2.5 (1.8, 3.6)). Similar associations were present among those with ADL difficulty.

CONCLUSIONS: A substantial proportion of older adults with ADL impairment report high life satisfaction, and it is associated with social and economic well-being. Understanding the factors associated with high life satisfaction can lead to clinical practices and policy guidelines that promote life satisfaction in older adults.

%B Age and Ageing %V 50 %P 2047-2054 %G eng %N 6 %R 10.1093/ageing/afab172 %0 Journal Article %J The Lancet Healthy Longevity %D 2021 %T Sex differences in functional limitations and the role of socioeconomic factors: a multi-cohort analysis %A Mikaela Bloomberg %A Aline Dugravot %A Benjamin Landré %A Annie Britton %A Andrew Steptoe %A Archana Singh-Manoux %A Séverine Sabia %K Activities of Daily Living %K ELSA %K Functional limitations %K Sex differences %K SHARE %K Sister studies %K Socioeconomic factors %K TILDA %X Summary Background Women are more likely to have functional limitations than are men, partly because of greater socioeconomic disadvantage. However, how sex differences vary by severity of functional limitations remains unclear. We examined sex differences in functional limitations, with attention to socioeconomic factors and severity of limitations. Methods Longitudinal data on limitations in basic activities of daily living (ADL) and instrumental activities of daily living (IADL) and mobility activities were drawn from 62 375 participants from 14 countries. For ADL, IADL, and mobility, participants were categorised based on number of limited activities (0, 1, 2, or ≥3). Sex differences in limitations in four birth cohorts (1895–1929, 1930–38, 1939–45, and 1946–60) were analysed before and after adjustment for socioeconomic factors (education and labour force status). Findings The prevalence of IADL and ADL limitations was higher in women than in men. After adjustment for socioeconomic factors, this sex difference was attenuated. The sex difference in IADL limitations at age 75 years (in the 1895–1929 cohort) was 3·7% before adjustment for socioeconomic factors (95% CI 2·6–4·7) and 1·7% (1·1–2·2) after adjustment. For ADL, the sex difference in limitations at age 75 years (in the 1895–1929 cohort) was 3·2% (2·3–4·1) before adjustment for socioeconomic factors and 1·4% (0·9–1·8) after adjustment. Sex differences in mobility limitations (16·1%, 95% CI 14·4–17·7) remained after adjustment for socioeconomic factors (14·3%, 12·7–15·9). After age 85 years, women were more likely to have three or more IADL or mobility limitations and men were more likely to have one or two limitations. Interpretation Socioeconomic factors largely explain sex differences in IADL and ADL limitations but not mobility. Sex differences in mobility limitations in midlife are important targets for future research and interventions. Funding National Institute on Aging, UK National Institute for Health Research, European Commission, and US Social Security Administration. %B The Lancet Healthy Longevity %V 2 %P e780-e790 %G eng %N 12 %R https://doi.org/10.1016/S2666-7568(21)00249-X %0 Journal Article %J Journal of Applied Gerontology %D 2020 %T Caregiving, recovery, and death after incident ADL/IADL disability among older adults in the United States %A Claire K. Ankuda %A Deborah A Levine %A Kenneth M. Langa %A Katherine A Ornstein %A Amy Kelley %K Activities of Daily Living %K Caregiving %K Disabilities %X This study assesses patterns of caregiving, death, and recovery after incident disability in older adults. We used the Health and Retirement Study to follow of a cohort of adults age ≥65 years in the United States with incident disability in activities of daily living (ADLs) or instrumental activities of daily living (IADLs; n = 8,713). Rates of care and function state were assessed biennially: deceased, nursing home dwelling, at home with paid help, at home with both paid and unpaid help, at home with unpaid help, at home with no assistance and recovered. In the 2 years after incident disability, 22.1% recovered and 46.8% died. Transitions between care and function states occurred frequently, with more than 20% of the cohort living at home with no assistance despite disability at least once. This study demonstrates the high levels of care and function state fluctuation and unmet needs after functional disability. %B Journal of Applied Gerontology %V 39 %G eng %U https://journals.sagepub.com/doi/10.1177/0733464819826842 %N 4 %9 Journal %! J Appl Gerontol %R 10.1177/0733464819826842 %0 Journal Article %J Alzheimer's & DementiaAlzheimer's & DementiaAlzheimer's Dement. %D 2020 %T Difficulty and help with activities of daily living among older adults living alone with cognitive impairment %A Ryan D. Edwards %A Willa D Brenowitz %A Portacolone, Elena %A Kenneth E Covinsky %A Bindman, Andrew %A M. Maria Glymour %A Jacqueline M Torres %K Activities of Daily Living %K Aging in place %K CIND %K Dementia %K Disability %K limitations %K Living arrangement %K population-based study %K service gaps %X Abstract Introduction There is limited research on difficulties with activities of daily living (I/ADLs) among older adults living alone with cognitive impairment, including differences by race/ethnicity. Methods For U.S. Health and Retirement Study (2000?2014) participants aged 55+ living alone with cognitive impairment (4,666 individuals; 9,091 observations), we evaluated I/ADL difficulty and help. Results Among 4.3 million adults aged 55+ living alone with cognitive impairment, an estimated 46% reported an I/ADL difficulty; 72% reported not receiving help with an I/ADL. Women reported more difficulty than men. Compared to white women, black women were 22% more likely to report a difficulty without help, and Latina women were 36% more likely to report a difficulty with help. Among men, racial/ethnic differences in outcomes were not significant. Patterns of difficulty without help by race/ethnicity were similar among Medicaid beneficiaries. Discussion Findings call for targeted efforts to support older adults living alone with cognitive impairment. %B Alzheimer's & DementiaAlzheimer's & DementiaAlzheimer's Dement. %8 2020/06/26 %@ 1552-5260 %G eng %R 10.1002/alz.12102 %0 Journal Article %J Journal of Aging and Health %D 2020 %T Exploring racial and ethnic differences in recovery maintenance from mobility limitation %A Kenzie Latham-Mintus %K Activities of Daily Living %K Disabilities %K Racial/ethnic differences %X Objective: This research examines whether racial and ethnic minorities experience less recovery maintenance (i.e., maintaining their recovery status 2 years later). Method: Using Waves 4-12 (1998-2014) of Health and Retirement Study (HRS), this research examines recovery maintenance among a group of older adults who have previously recovered from mobility limitation. Outcomes included newly acquired mobility limitation (reference), recovery maintenance, and death/attrition. Additional analyses examined whether recovery maintenance predicted disability onset. Results: Analyses used multinomial logistic regression to estimate the odds of recovery maintenance 2 years later. After adjusting for socioeconomic status, there were no significant differences in recovery maintenance among older White and minority adults. Recovery maintenance was a robust predictor of subsequent disability onset; there was suggestive evidence that the effect of recovery maintenance on disability onset varied by race. Discussion: This research provides evidence that the higher rates of recovery among minorities is a form of physical resilience. %B Journal of Aging and Health %V 32 %G eng %U https://pubmed.ncbi.nlm.nih.gov/30698483/ %N 5-6 %9 Journal %! J Aging Health %& 384-393 %R 10.1177/0898264319826790 %0 Journal Article %J Journal of General internal Medicine %D 2020 %T Impact of Instrumental Activities of Daily Living Limitations on Hospital Readmission: an Observational Study Using Machine Learning %A Nicholas K Schiltz %A Dolansky, Mary A. %A David F Warner %A Kurt C Stange %A Gravenstein, Stefan %A Siran M Koroukian %K Activities of Daily Living %K Health Services Research %K multimorbidity %K Patient Readmission %K supervised machine learning %X Background Limitations in instrumental activities of daily living (IADL) hinder a person’s ability to live independently in the community and self-manage their conditions, but its impact on hospital readmission has not been firmly established. Objective To test the importance of IADL dependency as a predictor of 30-day readmissions and quantify its impact relative to other morbidities. Design A retrospective cohort study of the population-based Health and Retirement Study linked to Medicare claims data. Random forest was used to rank each predictor variable in terms of its ability to predict readmission. Classification and regression tree (CART) was used to identify complex multimorbidity combinations associated with high or low risk of readmission. Generalized linear regression was used to estimate the adjusted relative risk of readmission for IADL limitations. Subjects Hospitalizations of adults age 65 and older (n = 20,007), from 6617 unique subjects. Main Measures The main outcome was 30-day all-cause unplanned readmission. The main predictor of interest was self-reported IADL limitation. Other key predictors were self-reported complex multimorbidity including chronic diseases, geriatric syndromes, and activities of daily living (ADL) limitations, along with demographic, socioeconomic, and behavioral factors. Key Results The overall 30-day readmission rate in the study was 16.4%. Random forest analysis ranked ADLs and IADL limitations as the two most important predictors of 30-day readmission. CART identified hospitalizations of patients with IADL limitations and diabetes as a subgroup at the highest risk of readmission (26% readmitted). Multivariable regression analyses showed that ADL limitations were associated with 1.17 (1.06–1.29) times higher risk of readmission even after adjusting for other patient covariates. Risk prediction was modest though for even the best model (AUC = 0.612). Conclusions IADL limitations are key predictors of 30-day readmission as demonstrated using several machine learning methods. Routine assessment of functional abilities in hospital settings could help identify those most at risk. %B Journal of General internal Medicine %@ 1525-1497 %G eng %R https://doi.org/10.1007/s11606-020-05982-0 %0 Journal Article %J European Journal of Public Health %D 2020 %T Life-course risk factors are associated with activity of daily living disability in older adults. %A Macinko, James %A Vaz de Melo Mambrini, Juliana %A Bof de Andrade, Fabíola %A Drumond Andrade, Flavia Cristina %A Lazalde, Gabriela E %A Lima-Costa, Maria Fernanda %K Activities of Daily Living %K Aging %K Child %K Disability %K Educational Status %K human development index %K multimorbidity %K Older adult %K Socioeconomic factors %X

BACKGROUND: Multiple risk factors accumulate over the life-course and contribute to higher rates of disability at older ages. This study investigates whether three life-course risk factors (low educational attainment, poor health in childhood and multimorbidity) are associated with increased risk of disability [defined as any limitation in basic activities of daily living (BADL)] in older adults and whether this relationship is moderated by the national socioeconomic context, measured by the Human Development Index (HDI).

METHODS: Data include 100 062 adults (aged 50 and over) participating in longitudinal studies of aging conducted in 19 countries. Analyses include multivariable Poisson models with robust standard errors to assess the associations between HDI, life-course risk factors and other individual-level control variables (sex and age) with any BADL disability.

RESULTS: In country-specific analyses, both educational attainment and multimorbidity are independently associated with disability in nearly every country. The interaction between these risk factors further increases the magnitude of this association. In pooled regression analyses, the relationship between life-course risk factors and disability is moderated by a country's HDI. For individuals with all three life-course risk factors, the predicted probability of disability ranged from 36.7% in the lowest HDI country to 21.8% in the highest HDI country.

CONCLUSIONS: Social and health system policies directed toward reducing the development of life-course risk factors are essential to reduce disability in all countries, but are even more urgently needed in those with lower levels of socioeconomic development.

%B European Journal of Public Health %G eng %R 10.1093/eurpub/ckaa156 %0 Journal Article %J The Journals of Gerontology: Series A %D 2020 %T Living Longer, With or Without Disability? A Global and Longitudinal Perspective %A Jinkook Lee %A Lau, Samuel %A Erik Meijer %A Hu, Peifeng %K Activities of Daily Living %K CHARLS %K Cross-country comparison %K Disability %K ELSA %K KLoSA %K MHAS %K SHARE %K Trends %X Background Significant gains in life expectancy have been achieved, but living longer does not necessarily mean the years gained are productive and healthy. Different theories predict different patterns of time trends in old-age disability prevalence. Methods Using the Gateway to Global Aging Data, which provides internationally harmonized longitudinal data from the Health and Retirement Study and its sister surveys, we compare time trends (from 2004 to 2014) in disability prevalence across countries. Results Disability prevalence varies greatly across countries, and divergent time trends are observed across countries. For countries such as Belgium, Czechia, and Mexico, we observe an increase of disability prevalence, whereas in countries such as Denmark, England, Greece, Korea, Poland, and Sweden, we observe a substantial decrease in disability prevalence. Looking further into the severity of disability, we often observe differential trends in prevalence, but there is no evidence supporting the dynamic equilibrium hypothesis that predicts increased prevalence of modest disability but a decrease in severe disability prevalence. Conclusions Significant gains in life expectancy have translated into different gains in healthy years of life across different countries. Diverse time trends in disability prevalence across countries reaffirm that the expansion of late-life disability is not inevitable. %B The Journals of Gerontology: Series A %V 75 %P 162-167 %G eng %U https://pubmed.ncbi.nlm.nih.gov/30629214/ %N 1 %R 10.1093/gerona/glz007 %0 Journal Article %J Ethnicity & Disease %D 2020 %T Racial Disparities in Stroke Recovery Persistence in the Post-Acute Stroke Recovery Phase: Evidence from the Health and Retirement Study %A Buie, Joy %A Zhao, Yujing %A Burns, Suzanne %A Magwood, Gayenell %A Adams, Robert %A Sims, Catrina %A Lackland, Daniel %K Activities of Daily Living %K Blacks %K Epidemiology %K Motor Skills %K Risk Factors %X Background and Purpose: Blacks have a higher burden of post-stroke disability. Factors associated with racial differences in long-term post-stroke disability are not well-understood. Our aim was to assess the long-term racial differences in risk factors associated with stroke recovery.Methods: We examined Health and Retire­ment Study (HRS) longitudinal interview data collected from adults living with stroke who were aged >50 years during 2000- 2014. Analysis of 1,002 first-time, non- Hispanic, Black (210) or White (792) stroke survivors with data on activities of daily liv­ing (ADL), fine motor skills (FMS) and gross motor skills (GMS) was conducted. Ordinal regression analysis was used to assess the impact of sex, race, household residents, household income, comorbidities, and the time since having a stroke on functional outcomes.Results: Black stroke survivors were young­er compared with Whites (69 ± 10.4 vs 75 ± 11.9). The majority (~65%) of Black stroke survivors were female compared with about 54% White female stroke survivors (P=.007). Black stroke survivors had more household residents (P<.001) and comor­bidities (P<.001). Aging, being female, being Black and a longer time since stroke were associated with a higher odds of hav­ing increased difficulty in ADL, FMS and/or GMS. Comorbidities were associated with increased difficulty with GMS. Black race increased the impact of comorbidities on ADL and FMS in comparison with Whites.Conclusion: Our data suggest that the effects of aging, sex and unique factors associated with race should be taken into consideration for future studies of post-stroke recovery and therapy. %B Ethnicity & Disease %V 30 %P 339-348 %G eng %U https://www.ncbi.nlm.nih.gov/pubmed/32346280 %N 2 %9 Journal %R 10.18865/ed.30.2.339 %0 Journal Article %J The Journals of Gerontology: Series B %D 2020 %T Use of Informal Support as a Predictor of Home- and Community-Based Services Utilization %A Kristen N Robinson %A Menne, Heather L %A Gaeta, Raphael %K Activities of Daily Living %K Living Alone %K Social Support %X Home- and community-based services (HCBS) help older adults remain living safely in their homes by delaying or preventing the need for institutionalization. This analysis is guided by the Andersen Behavioral Model of Health Services Use to examine the association between informal support and use of HCBS.Health and Retirement Study data from 2011 and 2012 are used in the bivariate analyses and multivariate logistic regression models to examine differences in HCBS utilization among extremely vulnerable older adults who have informal caregivers and those who do not.For extremely vulnerable older adults who report difficulties with any instrumental or basic activities of daily living, use of HCBS is not strongly associated with access to informal caregivers. However, for this same population of extremely vulnerable older adults, those who live alone have roughly three times the odds of using any HCBS compared to those who do not live alone.Among already vulnerable older adults, this study revealed that living alone is an important enabling factor of the Andersen model as applied in HCBS research. Further investigation is needed to see if more resources should be allocated to senior centers and local providers to identify vulnerable older adults who live alone and may have unmet needs. %B The Journals of Gerontology: Series B %V 76 %P 133-140 %G eng %N 1 %R 10.1093/geronb/gbaa046 %0 Journal Article %J The Journal of Nutrition, Health & Aging %D 2019 %T The burden of functional disabilities for middle-aged and older adults in the United States %A Ryan P McGrath %A Soham Al Snih %A Kyriakos S Markides %A Kyle J Hackney %A Bailey, R. %A Mark D Peterson %K Activities of Daily Living %K Disabilities %K IADLS %X Understanding the role of functional capacity on longevity is important as the population in the United States ages. The purpose of this study was to determine the burden of instrumental activities of daily living (IADL) and activities of daily living (ADL) disabilities for a nationally-representative sample of middle-aged and older adults in the United States. %B The Journal of Nutrition, Health & Aging %V 23 %P 172-174 %G eng %N 2 %! J Nutr Health Aging %R 10.1007/s12603-018-1133-2 %0 Journal Article %J SSM - Population Health %D 2019 %T Educational differences in the compression of disability incidence in the United States %A Chi-Tsun Chiu %A Mark D Hayward %A Chan, Angelique %A Matchar, David B. %K Activities of Daily Living %K Disabilities %K Education %X Objective: To examine educational differences in the compression of disability incidence in the United States. Method: We use the Health and Retirement Study and techniques of microsimulation and bootstrap to estimate the distribution of mortality and disability incidence for major education groups. Results: Higher education is associated with a right shift in the age distributions of both mortality and disability incidence, and more compressed distributions above the modal ages (p<0.05). Our study also points to gender differences in the association between education and compression of mortality and disability incidence (p<0.05). Discussion: To our knowledge, no prior studies have examined educational difference in compression of disability incidence and conducted formal tests for statistical significance. Educational differences in life span variation in mortality correspond closely with life span variation in disability incidence. One long-range implication of this work is growing inequality in life-span variation in disability incidence given trends in educational differences in life-span variation in mortality. %B SSM - Population Health %V 7 %P 100347 %G eng %! SSM - Population Health %R 10.1016/j.ssmph.2018.100347 %0 Journal Article %J Journal of Aging and Health %D 2019 %T From Snapshots to Movies: The Association Between Retirement Sequences and Aging Trajectories in Limitations to Perform Activities of Daily Living. %A Azar, Ariel %A Ursula M. Staudinger %A Slachevsky, Andrea %A Madero-Cabib, Ignacio %A Calvo, Esteban %K Activities of Daily Living %K Disabilities %K Policy %K Retirement Planning and Satisfaction %X

OBJECTIVE: This study analyzes the dynamic association between retirement sequences and activities of daily living (ADLs) trajectories between ages 60 and 70.

METHOD: Retirement sequences previously established for 7,880 older Americans from the Health and Retirement Study were used in hierarchical linear and propensity score full matching models, analyzing their association with ADL trajectories.

RESULTS: Sequences of partial retirement from full- or part-time jobs showed higher baseline and slower decline in ADL than sequences characterized by early labor force disengagement.

DISCUSSION: The conventional model in which people completely retire from a full-time job at normative ages and the widely promoted new conventional model of late retirement are both associated with better functioning than early labor force disengagement. But unconventional models, where older adults keep partially engaged with the labor force are also significantly associated with better functioning. These findings call attention to more research on potential avenues to simultaneously promote productive engagement and health later in life.

%B Journal of Aging and Health %V 31 %P 293-321 %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/29952242?dopt=Abstract %R 10.1177/0898264318782096 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2019 %T How Does Employment-Based Insurance Coverage Relate to Health After Early Retirement? %A Ben Lennox Kail %K Activities of Daily Living %K Age Factors %K Aged %K depression %K Employment %K Female %K Health Benefit Plans, Employee %K Humans %K Male %K Middle Aged %K Retirement %K United States %B J Gerontol B Psychol Sci Soc Sci %V 74 %P 1211-1212 %8 2019 Sep 15 %G eng %U http://psychsocgerontology.oxfordjournals.org/content/early/2016/03/17/geronb.gbw020.short %N 7 %1 http://www.ncbi.nlm.nih.gov/pubmed/26988867?dopt=Abstract %4 retirement planning/public policy/transitions/insurance Coverage/employee benefits %$ 999999 %R 10.1093/geronb/gbw020 %0 Journal Article %J Journal of the American Medical Directors Association %D 2019 %T Impairments in Individual Autonomous Living Tasks and Time to Self-Care Disability in Middle-Aged and Older Adults %A Ryan P McGrath %A Brian C Clark %A Erlandson, Kristine M. %A Stephen D. Herrmann %A Brenda Vincent %A Orman T Hall %A Kyle J Hackney %K Activities of Daily Living %K Caregiving %K Cognitive Ability %K Disabilities %X Objectives: Impairments in specific tasks that are necessary for independent living may identify future self-care limitations, and the use of time-varying covariates can better capture the fluidity in functional capacity trajectories over time. The purpose of this study was to determine the associations between individual instrumental activities of daily living (IADL) impairments and time to activities of daily living (ADL) disability for middle-aged and older adults in the United States. Design: Longitudinal panel. Setting: Detailed interviews that included physical, biological, and psychosocial measures were completed in person. The core interview was typically completed over the telephone. Participants: A nationally representative sample of 15,336 adults aged at least 50 years from the 2006 wave of the Health and Retirement Study was followed for 8 years. Measures: Ability to perform IADL and ADL were self-reported at each wave. Separate covariate-adjusted Cox models were used to examine the time-varying associations between individual IADL impairments and time to ADL disability. Results: The presence of each IADL impairment was associated with a higher hazard ratio for an ADL disability for the following functions: 2.52 [95% confidence interval (CI) 2.35, 2.70] for grocery shopping, 1.91 (CI 1.77, 2.06) for preparing hot meals, 1.55 (CI 1.37, 1.76) for taking medications, 1.48 (CI 1.36, 1.61) for managing money, 1.41 (CI 1.27, 1.57) for using a telephone, and 1.38 (CI 1.29, 1.48) for using a map. Conclusions/Implications: Our findings provide insights into the disabling process by revealing how impairments in each IADL are differentially associated with time to ADL disability. Interventions aiming to retain function during aging should be informed by fluctuations in IADL performance and how specific IADL impairments may exacerbate functional capacity declines more so than others. %B Journal of the American Medical Directors Association %V 20 %P 730-735 %G eng %U https://linkinghub.elsevier.com/retrieve/pii/S1525861018305875https://api.elsevier.com/content/article/PII:S1525861018305875?httpAccept=text/xmlhttps://api.elsevier.com/content/article/PII:S1525861018305875?httpAccept=text/plain %9 Journal %! Journal of the American Medical Directors Association %R 10.1016/j.jamda.2018.10.014 %0 Journal Article %J Western Journal of Nursing Research %D 2019 %T Interdependence in Health and Functioning Among Older Spousal Caregivers and Care Recipients. %A Geoffrey J Hoffman %A Sarah A. Burgard %A Carolyn A Mendez-Luck %A Joseph E Gaugler %K Activities of Daily Living %K Caregiving %K Marriage %K Physical Ability %X Older spousal caregiving relationships involve support that may be affected by the health of either the caregiver or care recipient. We conducted a longitudinal analysis using pooled data from 4,632 community-dwelling spousal care recipients and caregivers aged ⩾50 from the 2002 to 2014 waves of the Health and Retirement Study. We specified logistic and negative binomial regression models using lagged predictor variables to assess the role of partner health status on spousal caregiver and care recipient health care utilization and physical functioning outcomes. Care recipients' odds of hospitalization, odds ratio (OR): 0.83, p<.001, decreased when caregivers had more ADL difficulties. When spouses were in poorer versus better health, care recipients' bed days decreased (4.69 vs. 2.54) while caregivers' bed days increased (0.20 vs. 0.96). Providers should consider the dual needs of caregivers caring for care recipients and their own health care needs, in adopting a family-centered approach to management of older adult long-term care needs. %B Western Journal of Nursing Research %V 41 %P 685-703 %G eng %N 5 %R 10.1177/0193945918781057 %0 Journal Article %J Health Affairs %D 2019 %T Spousal caregivers are caregiving alone in the last years of life %A Katherine A Ornstein %A Jennifer L. Wolff %A Bollens-Lund, Evan %A Rahman, Omari-Khalid %A Amy Kelley %K Activities of Daily Living %K Caregiving %K Community-dwelling %K Couples %X Caregiving in the last years of life is associated with increased depression and negative health outcomes for surviving spouses, many of whom are themselves in poor health. Yet it is unclear how often spouses are caregiving alone, how they differ from supported spouses, and whether lack of support affects postbereavement outcomes. We hypothesized that spouses who were solo caregivers—that is, the only caregivers (paid or unpaid) who provided assistance with a spouse’s self-care or household activities—would experience more depression after bereavement than supported spouses would. Using information from the Health and Retirement Study, we found that 55 percent of the spouses of community-dwelling married people with disability were solo caregivers. Solo caregiving was even common among people who cared for spouses with dementia and those with adult children living close by. Bereavement outcomes did not differ between solo and supported caregiving spouses. Caregiving spouses are often isolated and may benefit from greater support, particularly during the final years before bereavement. While some state and federal policy proposals aim to systematically recognize and assess caregivers, further innovations in care delivery and reimbursement are needed to adequately support seriously ill older adults and their caregivers. Ultimately, the focus of serious illness care must be expanded from the patient to the family unit. %B Health Affairs %V 38 %P 964-972 %G eng %U http://www.healthaffairs.org/doi/10.1377/hlthaff.2019.00087 %N 6 %! Health Affairs %R 10.1377/hlthaff.2019.00087 %0 Journal Article %J Work, Aging and Retirement %D 2018 %T Activities Matter: Personality and Resource Determinants of Activities and their Effect on Mental and Physical Well-being and Retirement Expectations %A Beier, Margaret E. %A Torres, W. Jackeline %A Gilberto, Jacqueline M. %K Activities of Daily Living %K Health Conditions and Status %K Personality %K Psychosocial %K Retirement Planning and Satisfaction %K Well-being %X Remaining active throughout the lifespan is central to healthy aging. The current study tests a model derived from investment and resource theories that examines the extent to which activities mediate the relationship between individual differences in personality and resources on mental and physical well-being and retirement expectations. A subsample (N = 400; 58% women) of participants from the nationally representative Health and Retirement Study (HRS) was used. Self-reported activities were grouped into 4 broad categories: productive, physical, social, and leisure. Activity variety, operationalized as the number of different activity categories in which a person reported participating over a specified period of time, was also examined. Correlations and path analysis results suggest small but significant effects between personality traits and activity participation, and more consistent effects of personality for predicting activity variety. Personality was also significantly correlated with well-being and retirement expectations as was activity variety. There was limited evidence, however, that activity variety mediated the relationship between personality and resources and mental and physical well-being and retirement expectations as would be predicted by investment theory. %B Work, Aging and Retirement %V 4 %P 67-78 %G eng %U https://academic.oup.com/workar/article-abstract/4/1/67/2660320?redirectedFrom=fulltext %N 1 %! WORKAR %R 10.1093/workar/waw034 %0 Journal Article %J British Journal of Anaesthesia %D 2018 %T The association between obesity and disability in survivors of joint surgery: analysis of the Health and Retirement Study. %A Timothy G. Gaulton %A L.A. Fleisher %A Mark D Neuman %K Activities of Daily Living %K Disabilities %K Hospitalization %K Obesity %X

BACKGROUND: Obesity is associated with osteoarthritis and the need for joint surgery. Obese patients who undergo joint surgery may have a higher risk of morbidity compared with normal or overweight patients but less is known about their risk of postoperative disability. The primary objective of our study was to determine the association between obesity and the development of new dependence in activities of daily living within 2 years after joint surgery.

METHODS: We obtained data from the Health and Retirement Study, a longitudinal survey of older Americans. We included participants who indicated having joint surgery for arthritis. We defined obesity as a BMI ≥30 kg m. Our outcome was a new or increased dependence in one or more activities of daily living after surgery.

RESULTS: We analysed data on 2519 respondents who underwent joint surgery for arthritis. Respondents had a median age of 69yr, 65.5% were female, 66.6% had joint replacement surgery and 45.3% were obese. The overall incidence of a new dependence within 2 years was 22.1%. Obese respondents had a higher incidence of new dependence compared with non-obese respondents (25.4% vs 19.4%, P<0.001). In adjusted analysis, obese respondents had increased odds of developing dependence [odds ratio 1.35 (95% CI 1.09-1.68), P=0.007].

CONCLUSIONS: Obesity is associated with an increased risk of developing dependence in the 2 years after joint surgery. Our study findings identify a high-risk group that may benefit from targeted interventions and allocation of perioperative resources to optimize recovery and minimize longer-term disability.

%B British Journal of Anaesthesia %V 120 %P 109-116 %8 01/2018 %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/29397117?dopt=Abstract %R 10.1016/j.bja.2017.11.011 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2018 %T Differences in the Progression of Disability: A U.S.-Mexico Comparison. %A Díaz-Venegas, Carlos %A Timothy A Reistetter %A Rebeca Wong %K Activities of Daily Living %K Age Factors %K Aged %K Disabled Persons %K disease progression %K Female %K Humans %K Male %K Mexico %K MHAS %X

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.

%B J Gerontol B Psychol Sci Soc Sci %V 73 %P 913-922 %8 2018 06 14 %G eng %U https://www.ncbi.nlm.nih.gov/pubmed/27436102 %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/27436102?dopt=Abstract %R 10.1093/geronb/gbw082 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2018 %T Education and Psychosocial Functioning Among Older Adults: 4-Year Change in Sense of Control and Hopelessness. %A Uchechi A Mitchell %A Jennifer A Ailshire %A Lauren L Brown %A Morgan E. Levine %A Eileen M. Crimmins %K Activities of Daily Living %K Aged %K Educational Status %K Female %K Humans %K Internal-External Control %K Male %K Middle Aged %K Psychology %K Sadness %K Social participation %K Social Support %X

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.

%B J Gerontol B Psychol Sci Soc Sci %V 73 %P 849-859 %8 2018 Jun 14 %G eng %U http://psychsocgerontology.oxfordjournals.org/content/early/2016/03/23/geronb.gbw031.abstract %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/27013537?dopt=Abstract %4 Health and Retirement Study/Longitudinal analysis/Mastery/Perceived constraints %$ 999999 %R 10.1093/geronb/gbw031 %0 Journal Article %J Medicine and Science in Sports and Exercise %D 2018 %T Handgrip Strength, Function, and Mortality in Older Adults: A Time-Varying Approach. %A Ryan P McGrath %A Brenda Vincent %A Lee, I-Min %A William J Kraemer %A Mark D Peterson %K Activities of Daily Living %K Mortality %K Physical Ability %K Physical measures %X

PURPOSE: To determine the time-varying associations between 1) decreased handgrip strength and disabilities in each activity of daily living (ADL) function, and 2) disaggregated ADL limitations and time to mortality in older adults.

METHODS: A United States nationally-representative sample of 17,747 older adults from the Health and Retirement Study were followed for eight-years. Maximal handgrip strength was measured with a hand-held dynamometer. Ability to perform ADLs were self-reported. Date of death was identified by the National Death Index and exit interviews. Separate covariate-adjusted hierarchical logit models were used to examine the time-varying associations between decreased handgrip strength and each ADL outcome. Distinct covariate-adjusted Cox models were used to analyze the time-varying associations between disaggregated ADL limitations and time to mortality.

RESULTS: Every five-kilogram decrease in handgrip strength was associated with increased odds for the following ADL limitations: 20% for eating, 14% for walking, 14% for bathing, 9% for dressing, 8% for transferring, and 6% for toileting. The presence of a bathing, walking, toileting, eating, and dressing ADL disability was associated with a 47%, 43%, 32%, 30%, and 19% higher hazard for mortality, respectively. A transferring ADL disability was not significantly associated with mortality.

CONCLUSIONS: Decreased handgrip strength was associated with increased odds for each ADL limitation, and in turn, most individual ADL impairments were associated with a higher hazard for mortality in older adults. These findings provide insights into the disabling process by identifying which ADL limitations are most impacted by decreased handgrip strength and the subsequent time to mortality for each ADL disability.

%B Medicine and Science in Sports and Exercise %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/29933349?dopt=Abstract %R 10.1249/MSS.0000000000001683 %0 Journal Article %J The Journal of Nutrition, Health and Aging %D 2018 %T Latent Profiles of Macronutrient Density and their Association with Mobility Limitations in an Observational Longitudinal Study of Older U.S. Adults. %A Nicholas J Bishop %A Krystle E Zuniga %A Lucht, A. L. %K Activities of Daily Living %K Nutrition %K Physical limitations %X

OBJECTIVES: Our first objective was to estimate empirically-derived subgroups (latent profiles) of observed carbohydrate, protein, and fat intake density in a nationally representative sample of older U.S. adults. Our second objective was to determine whether membership in these groups was associated with levels of, and short term change in, physical mobility limitations.

DESIGN AND SETTING: Measures of macronutrient density were taken from the 2013 Health Care and Nutrition Study, an off-year supplement to the Health and Retirement Study, which provided indicators of physical mobility limitations and sociodemographic and health-related covariates.

PARTICIPANTS: 3,914 community-dwelling adults age 65 years and older.

MEASUREMENTS: Percent of daily calories from carbohydrate, protein, and fat were calculated based on responses to a modified Harvard food frequency questionnaire. Latent profile analysis was used to describe unobserved heterogeneity in measures of carbohydrate, protein, and fat density. Mobility limitation counts were based on responses to 11 items indicating physical limitations. Poisson regression models with autoregressive controls were used to identify associations between macronutrient density profile membership and mobility limitations. Sociodemographic and health-related covariates were included in all Poisson regression models.

RESULTS: Four latent subgroups of macronutrient density were identified: "High Carbohydrate", "Moderate with Fat", "Moderate", and "Low Carbohydrate/High Fat". Older adults with the lowest percentage of daily calories coming from carbohydrate and the greatest percentage coming from fat ("Low Carbohydrate/High Fat") were found to have greater reported mobility limitations in 2014 than those identified as having moderate macronutrient density, and more rapid two-year increases in mobility limitations than those identified as "Moderate with Fat" or "Moderate".

CONCLUSION: Older adults identified as having the lowest carbohydrate and highest fat energy density were more likely to report a greater number of mobility limitations and experience greater increases in these limitations than those identified as having moderate macronutrient density. These results suggest that the interrelation of macronutrients must be considered by those seeking to reduce functional limitations among older adults through dietary interventions.

%B The Journal of Nutrition, Health and Aging %V 22 %P 645-654 %G eng %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/29806853?dopt=Abstract %R 10.1007/s12603-017-0986-0 %0 Journal Article %J The Journal of Nutrition, Health & Aging %D 2018 %T Muscle weakness and physical disability in older Americans: Longitudinal findings from the U.S. Health and Retirement Study %A Kate A Duchowny %A Philippa J Clarke %A Mark D Peterson %K Activities of Daily Living %K Disabilities %K Muscle Weakness %X Importance: Muscle weakness is an important indicator of disability, chronic disease and mortality. While we recently proposed sex/race specific grip strength cutpoints for clinical muscle weakness in a diverse, nationally representative sample of older Americans, the extent to which these cutpoints predict physical disability remains unknown. Objective: To examine whether sex/race specific muscle weakness cutpoints predict physical disability status in a nationally representative sample of Americans age 65+. Design: We used data from the 2006-2010 Health and Retirement Study. Fully-adjusted, weighted multinomial logistic regression models were used to quantify the odds of experiencing the onset, progression or persistence of disability in activities of daily living (ADL) among weak versus non-weak individuals over a 2-year period. Setting: General community, nationally representative sample of older Americans. Participants: Population-based, community dwelling sample of older American adults aged 65-years+; 57 percent were women, 91% were White and the mean age was 75 years. Main Outcome(s) and Measure(s): The primary outcome of interest was disability dynamics, defined by changes in ADL status across at 2- year period. The primary exposure was clinical muscle weakness as defined by previously identified cutpoints. Hypotheses were formulated before analyses were conducted. Results: In this nationally representative sample (n= 8,725), 44% of individuals were classified as weak at baseline. At follow-up, 55% remained independent with no change in their ADL status, 11% had an onset of disability and 4% progressed in their disability status. The odds of experiencing an onset of ADL disability was 54% higher among weak individuals compared those who were not weak at baseline (OR= 1.54, 95% CI= 1.54, 1.5, p<.0001); the odds of experiencing a progression in physical disability status was 2.16 times higher among those who were weak at baseline compared to non-weak individuals (OR= 2.16, 95% CI= 2.15, 2.16, p<.0001). Conclusions: This is the first study to use grip strength weakness cut-points to identify those who may be at greatest risk for experiencing physical disability in later life. Results underscore the importance of using population-specific cutpoints for clinical weakness in order to identify individuals at greatest risk for adverse health outcomes. %B The Journal of Nutrition, Health & Aging %V 22 %8 04/2018 %G eng %U http://link.springer.com/10.1007/s12603-017-0951-yhttp://link.springer.com/content/pdf/10.1007/s12603-017-0951-y.pdfhttp://link.springer.com/content/pdf/10.1007/s12603-017-0951-y.pdfhttp://link.springer.com/article/10.1007/s12603-017-0951-y/fulltext.html %N 4 %! J Nutr Health Aging %R 10.1007/s12603-017-0951-y %0 Journal Article %J J Gerontol A Biol Sci Med Sci %D 2017 %T Associations Between Arthritis and Change in Physical Function in U.S. Retirees. %A Nancy A. Baker %A Kamil E Barbour %A Charles G Helmick %A Matthew M. Zack %A Soham Al Snih %K Activities of Daily Living %K Age Factors %K Aged %K Arthritis %K Case-Control Studies %K Female %K Health Status %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Muscle Strength %K Retirement %K United States %X

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.

%B J Gerontol A Biol Sci Med Sci %V 72 %P 127-133 %8 2017 Jan %G eng %U http://biomedgerontology.oxfordjournals.org/content/early/2016/04/26/gerona.glw075.abstract %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/27121962?dopt=Abstract %R 10.1093/gerona/glw075 %0 Journal Article %J Journal of Gerontology, Series B %D 2017 %T Back to Work? Not Everyone. Examining the Longitudinal Relationships Between Informal Caregiving and Paid Work After Formal Retirement. %A Gonzales, Ernest %A Lee, Yeonjung %A Brown, Celeste %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Caregivers %K Employment %K Family %K Female %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Retirement %K return to work %X

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.

%B Journal of Gerontology, Series B %V 72 %P 532-539 %G eng %N 3 %R 10.1093/geronb/gbv095 %0 Journal Article %J J Women Aging %D 2017 %T Caregiver stressors and depressive symptoms among older husbands and wives in the United States. %A Kim, Min Hee %A Ruth E Dunkle %A Amanda J Lehning %A Shen, Huei-Wern %A Sheila Feld %A Angela K Perone %K Activities of Daily Living %K Aged %K Caregivers %K depression %K Female %K Humans %K Independent Living %K Longitudinal Studies %K Male %K Middle Aged %K Multivariate Analysis %K Prospective Studies %K Regression Analysis %K Sex Factors %K Spouses %K Stress, Psychological %K United States %X

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.

%B J Women Aging %V 29 %P 494-504 %8 2017 Nov-Dec %G eng %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/27673406?dopt=Abstract %R 10.1080/08952841.2016.1223962 %0 Journal Article %J BMC Geriatr %D 2017 %T Control beliefs and risk for 4-year mortality in older adults: a prospective cohort study. %A Wei Duan-Porter %A Susan Nicole Hastings %A Brian Neelon %A Courtney Harold Van Houtven %K Activities of Daily Living %K Age Factors %K Aged %K Diabetes Mellitus %K Female %K Heart Failure %K Humans %K Internal-External Control %K Lung Diseases %K Male %K Middle Aged %K Neoplasms %K Prospective Studies %K Risk Factors %K Self Concept %K Survival Analysis %X

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.

%B BMC Geriatr %V 17 %P 13 %8 2017 01 11 %G eng %U https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/28077089/ %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/28077089?dopt=Abstract %R 10.1186/s12877-016-0390-3 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2017 %T Foundations of Activity of Daily Living Trajectories of Older Americans. %A Linda G Martin %A Zachary Zimmer %A Jinkook Lee %K Activities of Daily Living %K Age Factors %K Aged %K Aged, 80 and over %K Chronic pain %K cognitive aging %K Disability Evaluation %K disease progression %K Female %K Humans %K Individuality %K Male %K Middle Aged %K Socioeconomic factors %K Statistics as Topic %K United States %X

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.

%B J Gerontol B Psychol Sci Soc Sci %V 72 %P 129-139 %8 2017 Jan %G eng %U http://psychsocgerontology.oxfordjournals.org/content/early/2015/09/01/geronb.gbv074.abstract %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/26333820?dopt=Abstract %4 Disability/Disability/Functional health status/Health disparities/Mortality/Transition models %$ 999999 %R 10.1093/geronb/gbv074 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2017 %T From Noise to Signal: The Age and Social Patterning of Intra-Individual Variability in Late-Life Health. %A Lin, Jielu %A Jessica Kelley-Moore %K Activities of Daily Living %K Aged %K cognitive aging %K Cognitive Dysfunction %K Disability Evaluation %K Female %K Health Behavior %K Health Status Disparities %K Humans %K Individuality %K Male %K Middle Aged %K Minority Groups %K Models, Statistical %K Multilevel Analysis %K Reference Values %K Sex Characteristics %K Sex Factors %K Socioeconomic factors %X

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.

%B J Gerontol B Psychol Sci Soc Sci %V 72 %P 168-179 %8 2017 Jan %G eng %U http://psychsocgerontology.oxfordjournals.org/content/early/2015/08/26/geronb.gbv081.abstract %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/26320123?dopt=Abstract %4 Health disparities/Intra-individual variability/Multilevel growth curves/Residuals %$ 999999 %R 10.1093/geronb/gbv081 %0 Journal Article %J Annals of Internal Medicine %D 2017 %T Functional Impairment and Decline in Middle Age: A Cohort Study. %A Rebecca T Brown %A L Grisell Diaz-Ramirez %A W John Boscardin %A Sei J. Lee %A Michael A Steinman %K Activities of Daily Living %K Functional limitations %K Memory %K Older Adults %X

Background: Difficulties with daily functioning are common in middle-aged adults. However, little is known about the epidemiology or clinical course of these problems, including the extent to which they share common features with functional impairment in older adults.

Objective: To determine the epidemiology and clinical course of functional impairment and decline in middle age.

Design: Cohort study.

Setting: The Health and Retirement Study.

Participants: 6874 community-dwelling adults aged 50 to 56 years who did not have functional impairment at enrollment.

Measurements: Impairment in activities of daily living (ADLs), defined as self-reported difficulty performing 1 or more ADLs, assessed every 2 years for a maximum follow-up of 20 years, and impairment in instrumental ADLs (IADLs), defined similarly. Data were analyzed by using multistate models that estimate probabilities of different outcomes.

Results: Impairment in ADLs developed in 22% of participants aged 50 to 64 years, in whom further functional transitions were common. Two years after the initial impairment, 4% (95% CI, 3% to 5%) of participants had died, 9% (CI, 8% to 11%) had further ADL decline, 50% (CI, 48% to 52%) had persistent impairment, and 37% (CI, 35% to 39%) had recovered independence. In the 10 years after the initial impairment, 16% (CI, 14% to 18%) had 1 or more episodes of functional decline and 28% (CI, 26% to 30%) recovered from their initial impairment and remained independent throughout this period. The pattern of findings was similar for IADLs.

Limitation: Functional status was self-reported.

Conclusion: Functional impairment and decline are common in middle age, as are transitions from impairment to independence and back again. Because functional decline in older adults has similar features, current interventions used for prevention in older adults may hold promise for those in middle age.

Primary Funding Source: National Institute on Aging and National Center for Advancing Translational Sciences through the University of California, San Francisco, Clinical and Translational Sciences Institute.

%B Annals of Internal Medicine %V 167 %P 761-768 %G eng %N 11 %1 http://www.ncbi.nlm.nih.gov/pubmed/29132150?dopt=Abstract %R 10.7326/M17-0496 %0 Journal Article %J Res Aging %D 2017 %T Gender Differences in Spousal Care Across the Later Life Course. %A Glauber, Rebecca %K Activities of Daily Living %K Aged %K Caregivers %K Cross-Sectional Studies %K Employment %K Female %K Home Care Services %K Humans %K Male %K Marriage %K Middle Aged %K Sex Factors %K Spouses %X

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.

%B Res Aging %V 39 %P 934-959 %8 2017 09 %G eng %U http://www.ncbi.nlm.nih.gov/pubmed/27193046 %N 8 %1 http://www.ncbi.nlm.nih.gov/pubmed/27193046?dopt=Abstract %R 10.1177/0164027516644503 %0 Journal Article %J J Gerontol A Biol Sci Med Sci %D 2017 %T Hierarchy and Speed of Loss in Physical Functioning: A Comparison Across Older U.S. and English Men and Women. %A Bendayan, Rebecca %A Cooper, Rachel %A Elizabeth G Wloch %A Scott M Hofer %A Andrea M Piccinin %A Graciela Muñiz Terrera %K Activities of Daily Living %K Aged %K Aging %K Cross-Cultural Comparison %K Disability Evaluation %K Female %K Geriatric Assessment %K Health Status Disparities %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Mobility Limitation %K Self Report %K Statistics, Nonparametric %K United Kingdom %K United States %X

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.

%B J Gerontol A Biol Sci Med Sci %V 72 %P 1117-1122 %8 2017 Aug 01 %G eng %N 8 %1 http://www.ncbi.nlm.nih.gov/pubmed/27753610?dopt=Abstract %R 10.1093/gerona/glw209 %0 Journal Article %J Disabil Health J %D 2017 %T Identifying adults aging with disability using existing data: The case of the Health and Retirement Study. %A Caitlin E. Coyle %A Putnam, Michelle %K Activities of Daily Living %K Adolescent %K Age of Onset %K Aged %K Aged, 80 and over %K Aging %K Child %K Child Health %K Chronic disease %K Disabled Persons %K Female %K health %K Health Status %K Health Surveys %K Humans %K Male %K Middle Aged %K Retirement %K Self Report %K Work %X

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.

%B Disabil Health J %V 10 %P 611-615 %8 2017 Oct %G eng %U https://linkinghub.elsevier.com/retrieve/pii/S1936-6574(16)30191-1 %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/28082002?dopt=Abstract %R 10.1016/j.dhjo.2016.12.016 %0 Journal Article %J Health Serv Res %D 2017 %T Identifying Older Adults with Serious Illness: A Critical Step toward Improving the Value of Health Care. %A Amy Kelley %A Kenneth E Covinsky %A Rebecca Jean Gorges %A McKendrick, Karen %A Bollens-Lund, Evan %A R Sean Morrison %A Christine S Ritchie %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Critical Illness %K Early Diagnosis %K Female %K Health Care Costs %K Hospitalization %K Humans %K Male %K Medicare %K Nursing homes %K Prospective Studies %K Quality Improvement %K United States %X

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.

%B Health Serv Res %V 52 %P 113-131 %8 2017 02 %G eng %U http://www.ncbi.nlm.nih.gov/pubmed/26990009 %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/26990009?dopt=Abstract %4 Medicare; geriatrics; palliative medicine; population health %R 10.1111/1475-6773.12479 %0 Journal Article %J Med Care %D 2017 %T Identifying Specific Combinations of Multimorbidity that Contribute to Health Care Resource Utilization: An Analytic Approach. %A Nicholas K Schiltz %A David F Warner %A Jiayang Sun %A Paul M Bakaki %A Avi Dor %A Charles W Given %A Kurt C Stange %A Siran M Koroukian %K Activities of Daily Living %K Age Factors %K Aged %K Aged, 80 and over %K Comorbidity %K Female %K Health Behavior %K Health Expenditures %K Health Status %K Humans %K Machine learning %K Male %K Medicare %K Retrospective Studies %K Self Report %K Socioeconomic factors %K United States %X

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.

%B Med Care %V 55 %P 276-284 %8 2017 03 %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/27753745?dopt=Abstract %R 10.1097/MLR.0000000000000660 %0 Journal Article %J J Gen Intern Med %D 2017 %T The Impact of Disability and Social Determinants of Health on Condition-Specific Readmissions beyond Medicare Risk Adjustments: A Cohort Study. %A Meddings, Jennifer %A Reichert, Heidi %A Shawna N Smith %A Theodore J Iwashyna %A Kenneth M. Langa %A Timothy P Hofer %A Laurence F McMahon %K Activities of Daily Living %K Cognitive Dysfunction %K Comorbidity %K Disability Evaluation %K Female %K Heart Failure %K Humans %K Logistic Models %K Male %K Myocardial Infarction %K Patient Readmission %K Pneumonia %K Retrospective Studies %K Risk Adjustment %K Social determinants of health %X

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

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

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

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

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

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

%B J Gen Intern Med %V 32 %P 71-80 %8 2017 01 %G eng %U http://link.springer.com/10.1007/s11606-016-3869-xhttp://link.springer.com/content/pdf/10.1007/s11606-016-3869-x.pdfhttp://link.springer.com/content/pdf/10.1007/s11606-016-3869-x.pdfhttp://link.springer.com/article/10.1007/s11606-016-3869-x/fulltext.html %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/27848189?dopt=Abstract %! J GEN INTERN MED %R 10.1007/s11606-016-3869-x %0 Journal Article %J J Gen Intern Med %D 2017 %T Rates of Recovery to Pre-Fracture Function in Older Persons with Hip Fracture: an Observational Study. %A Victoria L. Tang %A Rebecca L. Sudore %A Irena Cenzer %A W John Boscardin %A Alexander K Smith %A Christine S Ritchie %A Margaret Wallhagen %A Finlayson, Emily %A Petrillo, Laura %A Kenneth E Covinsky %K Activities of Daily Living %K Age Factors %K Aged %K Aged, 80 and over %K Comorbidity %K Dementia %K Female %K Geriatric Assessment %K Hip Fractures %K Humans %K Longitudinal Studies %K Male %K Mobility Limitation %K Recovery of Function %K Walking %X

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.

%B J Gen Intern Med %V 32 %P 153-158 %8 2017 Feb %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/27605004?dopt=Abstract %R 10.1007/s11606-016-3848-2 %0 Journal Article %J Med Care %D 2017 %T Receipt of Caregiving and Fall Risk in US Community-dwelling Older Adults. %A Geoffrey J Hoffman %A Hays, Ron D %A Steven P Wallace %A Martin F Shapiro %A Yakusheva, Olga %A Susan L Ettner %K Accidental Falls %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Caregivers %K Female %K Geriatric Assessment %K Humans %K Independent Living %K Longitudinal Studies %K Male %K Middle Aged %K Risk Assessment %K Risk Factors %K United States %X

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.

%B Med Care %V 55 %P 371-378 %8 2017 04 %G eng %U http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00005650-900000000-98801 %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/27875481?dopt=Abstract %! Medical Care %R 10.1097/MLR.0000000000000677 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2017 %T Successful Aging as the Intersection of Individual Resources, Age, Environment, and Experiences of Well-being in Daily Activities. %A Shannon T. Mejia %A Lindsay H Ryan %A Gonzalez, Richard %A Jacqui Smith %K Activities of Daily Living %K Adult %K Aged %K Aged, 80 and over %K Aging %K environment %K Female %K Follow-Up Studies %K Health Status %K Humans %K Male %K Middle Aged %K Personal Satisfaction %K Social Support %K United States %X

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.

%B J Gerontol B Psychol Sci Soc Sci %V 72 %P 279-289 %8 2017 Mar 01 %G eng %U http://psychsocgerontology.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=28077430 %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/28077430?dopt=Abstract %R 10.1093/geronb/gbw148 %0 Journal Article %J J Psychosom Res %D 2016 %T Antidepressant use and functional limitations in U.S. older adults. %A An, Ruopeng %A Lu, Lingyun %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Antidepressive Agents %K depression %K Drug Utilization %K Female %K Health Surveys %K Humans %K Longitudinal Studies %K Male %K Mobility Limitation %K Muscle, Skeletal %K Prevalence %K Risk Factors %K Socioeconomic factors %K United States %X

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.

%B J Psychosom Res %I 80 %V 80 %P 31-6 %8 2016 Jan %G eng %U http://www.sciencedirect.com/science/article/pii/S0022399915300167 %1 http://www.ncbi.nlm.nih.gov/pubmed/26721545?dopt=Abstract %R 10.1016/j.jpsychores.2015.11.007 %0 Journal Article %J J Epidemiol Community Health %D 2016 %T Are self-reported neighbourhood characteristics associated with onset of functional limitations in older adults with or without memory impairment? %A Thu T Nguyen %A Rist, Pamela M %A M. Maria Glymour %K Activities of Daily Living %K Aged %K Female %K Humans %K Independent Living %K Interviews as Topic %K Longitudinal Studies %K Male %K Memory Disorders %K Middle Aged %K Mobility Limitation %K Residence Characteristics %K Risk Factors %K United States %X

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.

%B J Epidemiol Community Health %V 70 %P 1017-23 %8 2016 Oct %G eng %U http://jech.bmj.com/content/early/2016/05/06/jech-2016-207241.abstract %N 10 %1 http://www.ncbi.nlm.nih.gov/pubmed/27154180?dopt=Abstract %R 10.1136/jech-2016-207241 %0 Journal Article %J J Gen Intern Med %D 2016 %T Combinations of Chronic Conditions, Functional Limitations, and Geriatric Syndromes that Predict Health Outcomes. %A Siran M Koroukian %A Nicholas K Schiltz %A David F Warner %A Jiayang Sun %A Paul M Bakaki %A Kathleen A Smyth %A Kurt C Stange %A Charles W Given %K Activities of Daily Living %K Age Distribution %K Aged %K Aged, 80 and over %K Chronic disease %K Comorbidity %K Female %K Geriatric Assessment %K Health Status %K Health Status Indicators %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Mobility Limitation %K Prognosis %K Risk Factors %K Self Report %K Sex Distribution %K Socioeconomic factors %K Syndrome %K United States %X

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.

%B J Gen Intern Med %V 31 %P 630-7 %8 2016 Jun %G eng %U http://dx.doi.org/10.1007/s11606-016-3590-9 %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/26902246?dopt=Abstract %& 630 %R 10.1007/s11606-016-3590-9 %0 Journal Article %J J Aging Health %D 2016 %T A Comparison of Educational Differences on Physical Health, Mortality, and Healthy Life Expectancy in Japan and the United States. %A Chi-Tsun Chiu %A Mark D Hayward %A Saito, Yasuhiko %K Activities of Daily Living %K Age Distribution %K Aged %K Cause of Death %K Cross-Cultural Comparison %K Educational Status %K Employment %K Family Characteristics %K Female %K Health Status %K Health Surveys %K Healthy Lifestyle %K Humans %K Japan %K Life Expectancy %K Life Tables %K Longitudinal Studies %K Male %K Middle Aged %K Regression Analysis %K Retirement %K Sex Distribution %K United States %X

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.

%B J Aging Health %V 28 %P 1256-78 %8 2016 10 %G eng %N 7 %1 http://www.ncbi.nlm.nih.gov/pubmed/27590801?dopt=Abstract %R 10.1177/0898264316656505 %0 Journal Article %J Lancet Diabetes Endocrinol %D 2016 %T Compression of disability between two birth cohorts of US adults with diabetes, 1992-2012: a prospective longitudinal analysis. %A Barbara H. Bardenheier %A Ji Lin %A Zhuo, Xiaohui %A Mohammed K. Ali %A Theodore J Thompson %A Yiling J. Cheng %A Edward W Gregg %K Activities of Daily Living %K Aged %K Diabetes Mellitus %K Disabled Persons %K Female %K Health Status %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Prospective Studies %K United States %X

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.

%B Lancet Diabetes Endocrinol %V 4 %P 686-694 %8 2016 08 %G eng %U http://www.ncbi.nlm.nih.gov/pubmed/27298181 %N 8 %1 http://www.ncbi.nlm.nih.gov/pubmed/27298181?dopt=Abstract %R 10.1016/S2213-8587(16)30090-0 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2016 %T Depression and Frailty in Late Life: Evidence for a Common Vulnerability. %A Matthew C. Lohman %A Dumenci, Levent %A Briana Mezuk %K Activities of Daily Living %K Aged %K Aged, 80 and over %K depression %K Female %K Frail Elderly %K Geriatric Assessment %K Humans %K Independent Living %K Interview, Psychological %K Male %X

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.

%B J Gerontol B Psychol Sci Soc Sci %V 71 %P 630-40 %8 2016 07 %G eng %U http://www.ncbi.nlm.nih.gov/pubmed/25617399 %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/25617399?dopt=Abstract %4 Depression Frailty Older adults Psychology %R 10.1093/geronb/gbu180 %0 Journal Article %J Gerontologist %D 2016 %T Do Higher Levels of Resilience Buffer the Deleterious Impact of Chronic Illness on Disability in Later Life? %A Lydia K Manning %A Dawn C Carr %A Ben Lennox Kail %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Aging %K Chronic disease %K Disability Evaluation %K Disabled Persons %K Female %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Resilience, Psychological %K Retirement %K Surveys and Questionnaires %X

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.

%B Gerontologist %V 56 %P 514-24 %8 2016 06 %G eng %U https://www.ncbi.nlm.nih.gov/pubmed/25063353 %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/25063353?dopt=Abstract %R 10.1093/geront/gnu068 %0 Journal Article %J Am J Obstet Gynecol %D 2016 %T Functional status in older women diagnosed with pelvic organ prolapse. %A Tatiana V D Sanses %A Nicholas K Schiltz %A Bruna M. Couri %A Sangeeta T Mahajan %A Holly E Richter %A David F Warner %A Jack M. Guralnik %A Siran M Koroukian %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Aging %K Cross-Sectional Studies %K Female %K Health Status %K Health Surveys %K Humans %K Medicare %K Middle Aged %K Mobility Limitation %K Muscle Strength %K Pelvic Organ Prolapse %K United States %K Upper Extremity %X

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.

%B Am J Obstet Gynecol %I 214 %V 214 %P 613.e1-7 %8 2016 May %G eng %U http://www.sciencedirect.com/science/article/pii/S0002937815024783 %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/26704893?dopt=Abstract %2 PMC4851569 %4 activities of daily living/functional status/limitations/mobility/pelvic organ prolapse/strength %$ 999999 %R 10.1016/j.ajog.2015.11.038 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2016 %T Functioning, Forgetting, or Failing Health: Which Factors Are Associated With a Community-Based Move Among Older Adults? %A Esther M Friedman %A Margaret M Weden %A Regina A Shih %A Stephanie Kovalchik %A Singh, Reema %A José J Escarce %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Aging %K Cognitive Dysfunction %K Female %K Health Status %K Health Surveys %K Humans %K Male %K Middle Aged %K Population Dynamics %K Residence Characteristics %K United States %X

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.

%B J Gerontol B Psychol Sci Soc Sci %V 71 %P 1120-1130 %8 2016 Nov %G eng %U http://psychsocgerontology.oxfordjournals.org/content/early/2015/10/07/geronb.gbv075.abstract %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/26450960?dopt=Abstract %4 Activities of daily living/Aging/Cognition/Health/HEALTH STATUS/health condition/Migration %$ 999999 %R 10.1093/geronb/gbv075 %0 Journal Article %J J Pain Symptom Manage %D 2016 %T High Levels of Geriatric Palliative Care Needs in Hip Fracture Patients Before the Hip Fracture. %A Christine S Ritchie %A Amy Kelley %A Irena Cenzer %A Margaret Wallhagen %A Kenneth E Covinsky %K Activities of Daily Living %K Aged, 80 and over %K Dementia %K depression %K Female %K Hip Fractures %K Humans %K Interviews as Topic %K Male %K multimorbidity %K pain %K Palliative care %K Patient Acceptance of Health Care %K Prodromal Symptoms %K Vulnerable Populations %X

CONTEXT: Most hip fracture care models are grounded in curative models where the goal is to return the patient to independent function. In many instances, however, hip fractures contribute to continued functional decline and mortality. Although the negative impact of hip fractures is appreciated once they have occurred, what is less understood is what proportion of older adults have high illness burden before experiencing hip fracture and might benefit from geriatric palliative care.

OBJECTIVES: Using data from the Health and Retirement Study linked to Medicare claims (January 1992 through December 2010), we sought to understand the extent of premorbid illness burden before hip fracture.

METHODS: Characteristics were based on the interview before hip fracture. Features used to indicate need for geriatric palliative care included evidence of functional and medical vulnerability, pain, and depression.

RESULTS: Eight hundred fifty-six older adults who experienced a hip fracture were compared to 851 age-, gender-, and race-matched controls. Older adults with hip fractures had significantly more premorbid functional vulnerability (activities of daily living dependent 25.7% vs. 16.1% [P < 0.001]; dementia 16.2% vs. 7.3% (P < 0.001); use of helpers 41.2% vs. 28.7% [P < 0.001]). They also experienced more medical vulnerability (multimorbidity 43% vs. 29.8% [P < 0.001]; high health care utilization 30.0% vs. 20.9% [P < 0.001]; and poor prognosis 36.1% vs. 25.4% [P < 0.001] in controls). There was no difference in premorbid pain and depression between subsequent hip fracture patients and controls.

CONCLUSIONS: A significant proportion of older adults have evidence of functional and medical vulnerability before hip fracture. For these individuals, integration of geriatric palliative care may be particularly important for optimizing quality of life and addressing the high morbidity experienced by this population.

%B J Pain Symptom Manage %V 52 %P 533-538 %8 2016 10 %G eng %U http://www.sciencedirect.com/science/article/pii/S0885392416302214 %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/27521282?dopt=Abstract %R 10.1016/j.jpainsymman.2016.07.003 %0 Journal Article %J J Gerontol A Biol Sci Med Sci %D 2016 %T Life Expectancy With and Without Pain in the U.S. Elderly Population. %A Zachary Zimmer %A Rubin, Sara %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Aging %K Disabled Persons %K Female %K Health Status Indicators %K Humans %K Incidence %K Life Expectancy %K Life Tables %K Male %K Middle Aged %K pain %K Quality of Life %K Risk Factors %K Surveys and Questionnaires %K United States %X

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.

%B J Gerontol A Biol Sci Med Sci %V 71 %P 1171-6 %8 2016 Sep %G eng %U http://biomedgerontology.oxfordjournals.org/content/early/2016/03/17/gerona.glw028.abstract %N 9 %1 http://www.ncbi.nlm.nih.gov/pubmed/26988661?dopt=Abstract %4 Aging/Longevity/Demography/Health and Retirement Survey/Multistate life tables/Interpolative Markov Chains/Quality of life %$ 999999 %R 10.1093/gerona/glw028 %0 Journal Article %J Int J Aging Hum Dev %D 2016 %T Longitudinal Relationships Between Productive Activities and Functional Health in Later Years: A Multivariate Latent Growth Curve Modeling Approach. %A Choi, Eunhee %A Tang, Fengyan %A Turk, Phillip %K Activities of Daily Living %K Aged %K Aging %K Employment %K Female %K Health Status %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Volunteers %X

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.

%B Int J Aging Hum Dev %V 83 %P 418-40 %8 2016 10 %G eng %U http://ahd.sagepub.com/content/early/2016/07/21/0091415016657557.long %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/27461262?dopt=Abstract %R 10.1177/0091415016657557 %0 Journal Article %J Journal of Aging Research %D 2016 %T Muscle Strength, Physical Activity, and Functional Limitations in Older Adults with Central Obesity. %A Cassandra M Germain %A John A. Batsis %A Elizabeth Vasquez %A Douglas R McQuoid %K Activities of Daily Living %K BMI %K Disabilities %K Obesity %X Background. Obesity and muscle weakness are independently associated with increased risk of physical and functional impairment in older adults. It is unknown whether physical activity (PA) and muscle strength combined provide added protection against functional impairment. This study examines the association between muscle strength, PA, and functional outcomes in older adults with central obesity. Methods. Prevalence and odds of physical (PL), ADL, and IADL limitation were calculated for 6,388 community dwelling adults aged ≥ 60 with central obesity. Individuals were stratified by sex-specific hand grip tertiles and PA. Logistic models were adjusted for age, education, comorbidities, and body-mass index and weighted. Results. Overall prevalence of PL and ADL and IADL limitations were progressively lower by grip category. Within grip categories, prevalence was lower for individuals who were active than those who were inactive. Adjusted models showed significantly lower odds of PL OR 0.42 [0.31, 0.56]; ADL OR 0.60 [0.43, 0.84], and IADL OR 0.46 [0.35, 0.61] for those in the highest grip strength category as compared to those in the lowest grip category. Conclusion. Improving grip strength in obese elders who are not able to engage in traditional exercise is important for reducing odds of physical and functional impairment. %B Journal of Aging Research %V 2016 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/27034833?dopt=Abstract %R 10.1155/2016/8387324 %0 Journal Article %J J Am Geriatr Soc %D 2016 %T One-Year Mortality After Hip Fracture: Development and Validation of a Prognostic Index. %A Irena Cenzer %A Victoria L. Tang %A W John Boscardin %A Christine S Ritchie %A Margaret Wallhagen %A Espaldon, Roxanne %A Kenneth E Covinsky %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Cause of Death %K Cohort Studies %K Comorbidity %K Disability Evaluation %K Female %K Hip Fractures %K Humans %K Incidence %K Longitudinal Studies %K Male %K Prognosis %K Retrospective Studies %K Risk Assessment %K Survival Analysis %K United States %X

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.

%B J Am Geriatr Soc %V 64 %P 1863-8 %8 2016 09 %G eng %U http://www.ncbi.nlm.nih.gov/pubmed/27295578 %N 9 %1 http://www.ncbi.nlm.nih.gov/pubmed/27295578?dopt=Abstract %R 10.1111/jgs.14237 %0 Journal Article %J BMC Health Serv Res %D 2016 %T A pilot study among older adults of the concordance between their self-reports to a health survey and spousal proxy reports on their behalf. %A Frederic D Wolinsky %A Ayres, Lioness %A Michael P Jones %A Yiyue Lou %A George L Wehby %A Fred A Ullrich %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Epidemiologic Methods %K Female %K Health Status %K Hospitalization %K Humans %K Iowa %K Male %K Medicare %K Middle Aged %K Patient Acceptance of Health Care %K Physicians %K Proxy %K Spouses %K United States %X

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.

%B BMC Health Serv Res %V 16 %P 485 %8 2016 09 09 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/27612571?dopt=Abstract %R 10.1186/s12913-016-1734-6 %0 Journal Article %J J Am Geriatr Soc %D 2016 %T Prevalence and Outcomes of Breathlessness in Older Adults: A National Population Study. %A David C. Currow %A Amy P Abernethy %A Miriam J Johnson %A Yinghui Miao %A W John Boscardin %A Christine S Ritchie %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Anxiety %K Chronic disease %K Comorbidity %K depression %K Dyspnea %K Female %K Geriatric Assessment %K Hospitalization %K Humans %K Male %K Prevalence %K Proportional Hazards Models %K Risk Assessment %K Risk Factors %K Symptom Assessment %K United States %X

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.

%B J Am Geriatr Soc %V 64 %P 2035-2041 %8 2016 10 %G eng %N 10 %1 http://www.ncbi.nlm.nih.gov/pubmed/27603500?dopt=Abstract %R 10.1111/jgs.14313 %0 Journal Article %J Eur J Clin Nutr %D 2016 %T 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. %A John A. Batsis %A Cassandra M Germain %A Elizabeth Vasquez %A Bartels, S. J. %K Activities of Daily Living %K Aged %K Aging %K Cross-Sectional Studies %K Databases, Factual %K Female %K Humans %K Male %K Middle Aged %K Muscle Weakness %K National Institutes of Health (U.S.) %K Retirement %K sarcopenia %K Surveys and Questionnaires %K United States %X

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.

%B Eur J Clin Nutr %V 70 %P 1168-1173 %8 2016 10 %G eng %U http://www.ncbi.nlm.nih.gov/pubmed/27245209 %N 10 %1 http://www.ncbi.nlm.nih.gov/pubmed/27245209?dopt=Abstract %R 10.1038/ejcn.2016.90 %0 Journal Article %J J Am Geriatr Soc %D 2016 %T Self-Reported Hearing in the Last 2 Years of Life in Older Adults. %A Christine S Ritchie %A Yinghui Miao %A W John Boscardin %A Margaret Wallhagen %K Activities of Daily Living %K Aged %K Aged, 80 and over %K California %K Demography %K Female %K Hearing aids %K Hearing loss %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Prevalence %K Quality of Life %K Risk Factors %K Self Report %K Vulnerable Populations %X

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.

%B J Am Geriatr Soc %V 64 %P 1486-91 %8 2016 07 %G eng %U http://www.ncbi.nlm.nih.gov/pubmed/27341383 %N 7 %1 http://www.ncbi.nlm.nih.gov/pubmed/27341383?dopt=Abstract %R 10.1111/jgs.14145 %0 Journal Article %J J Am Geriatr Soc %D 2016 %T Skin Cancer in U.S. Elderly Adults: Does Life Expectancy Play a Role in Treatment Decisions? %A Linos, Eleni %A Chren, Mary-Margaret %A Irena Cenzer %A Kenneth E Covinsky %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Carcinoma, Basal Cell %K Carcinoma, Squamous Cell %K Comorbidity %K Cost-Benefit Analysis %K Cross-Sectional Studies %K Curettage %K Decision Support Techniques %K Disability Evaluation %K Electrosurgery %K Female %K Humans %K Keratinocytes %K Life Expectancy %K Male %K Mohs Surgery %K Prognosis %K Skin Neoplasms %X

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.

%B J Am Geriatr Soc %V 64 %P 1610-5 %8 2016 08 %G eng %U http://www.ncbi.nlm.nih.gov/pubmed/27303932 %N 8 %1 http://www.ncbi.nlm.nih.gov/pubmed/27303932?dopt=Abstract %R 10.1111/jgs.14202 %0 Journal Article %J J Gerontol A Biol Sci Med Sci %D 2015 %T Becoming centenarians: disease and functioning trajectories of older US Adults as they survive to 100. %A Jennifer A Ailshire %A Hiram Beltrán-Sánchez %A Eileen M. Crimmins %K Activities of Daily Living %K Aged, 80 and over %K Aging %K Chronic disease %K Cognition %K Disability Evaluation %K Educational Status %K Female %K Geriatric Assessment %K Health Status %K Health Surveys %K Humans %K Longevity %K Longitudinal Studies %K Male %K Marital Status %K Prospective Studies %K Sex Factors %K United States %X

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

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

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

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

%B J Gerontol A Biol Sci Med Sci %I 70 %V 70 %P 193-201 %8 2015 Feb %G eng %U http://biomedgerontology.oxfordjournals.org/content/70/2/193.abstract %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/25136001?dopt=Abstract %R 10.1093/gerona/glu124 %0 Journal Article %J J Gerontol A Biol Sci Med Sci %D 2015 %T Comorbidity and functional trajectories from midlife to old age: the Health and Retirement Study. %A Stenholm, Sari %A Westerlund, Hugo %A Head, Jenny %A Hyde, Martin %A Ichiro Kawachi %A Pentti, Jaana %A Mika Kivimäki %A Vahtera, Jussi %K Activities of Daily Living %K Age Factors %K Aged %K Aged, 80 and over %K Chronic disease %K Comorbidity %K Female %K Health Status %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Retirement %K Socioeconomic factors %K United States %X

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.

%B J Gerontol A Biol Sci Med Sci %I 70 %V 70 %P 332-8 %8 2015 Mar %G eng %U http://biomedgerontology.oxfordjournals.org/content/early/2014/07/23/gerona.glu113.abstract %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/25060316?dopt=Abstract %2 PMC4336333 %4 Aging/Comorbidity/Physical functioning/Disability/Disability %$ 999999 %R 10.1093/gerona/glu113 %0 Journal Article %J Am Heart J %D 2015 %T Cost of informal caregiving for patients with heart failure. %A Heesoo Joo %A Fang, Jing %A Jan L Losby %A Wang, Guijing %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Caregivers %K Cost of Illness %K Heart Failure %K Humans %K Linear Models %K Male %K Middle Aged %K Models, Econometric %X

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.

%B Am Heart J %I 169 %V 169 %P 142-48.e2 %8 2015 Jan %G eng %U 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 %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/25497259?dopt=Abstract %2 PMC4392718 %4 Caregivers/Chronic illnesses/Costs/Cardiovascular Diseases/Mortality/Older people/Informal caregiver/Health Care Costs %$ 999999 %R 10.1016/j.ahj.2014.10.010 %0 Journal Article %J Health Serv Res %D 2015 %T Disaggregating activities of daily living limitations for predicting nursing home admission. %A Joelle H Fong %A Olivia S. Mitchell %A Benedict S K Koh %K Activities of Daily Living %K Age Factors %K Aged %K Aged, 80 and over %K Female %K Geriatric Assessment %K Homes for the Aged %K Humans %K Male %K Middle Aged %K Nursing homes %K Patient Admission %K Residence Characteristics %K Risk Factors %K Sex Factors %K Socioeconomic factors %X

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.

%B Health Serv Res %I 50 %V 50 %P 560-78 %8 2015 Apr %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/25256014?dopt=Abstract %2 PMC4369222 %4 ADL/IADL/Long Term Care/Nursing home placement %$ 999999 %R 10.1111/1475-6773.12235 %0 Journal Article %J J Gen Intern Med %D 2015 %T Discrimination in Healthcare Settings is Associated with Disability in Older Adults: Health and Retirement Study, 2008-2012. %A Stephanie E Rogers %A Angela D Thrasher %A Yinghui Miao %A W John Boscardin %K Activities of Daily Living %K Aged %K Ageism %K Aging %K Disabled Persons %K Female %K Follow-Up Studies %K Health Status %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Retirement %K Surveys and Questionnaires %X

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.

%B J Gen Intern Med %I 30 %V 30 %P 1413-20 %8 2015 Oct %G eng %U http://www.scopus.com/inward/record.url?eid=2-s2.0-84924662760andpartnerID=40andmd5=4aaf0227e962a58fb0e6670d3d3c6bff %N 10 %1 http://www.ncbi.nlm.nih.gov/pubmed/25773918?dopt=Abstract %2 PMC4579241 %4 health Care Use/discrimination/health outcomes/health care discrimination/Cox proportional hazards model %$ 999999 %R 10.1007/s11606-015-3233-6 %0 Journal Article %J Health Serv Res %D 2015 %T Explaining Disability Trends in the U.S. Elderly and Near-Elderly Population. %A Chen, Yiqun %A Frank A Sloan %K Activities of Daily Living %K Age Distribution %K Aged %K Aged, 80 and over %K Alcohol Drinking %K Chronic disease %K Disabled Persons %K Female %K Health Behavior %K Health Surveys %K Humans %K Male %K Middle Aged %K Mobility Limitation %K Obesity %K Prevalence %K Sex Distribution %K Smoking %K Socioeconomic factors %K United States %X

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.

%B Health Serv Res %I 50 %V 50 %P 1528-49 %8 2015 Oct %G eng %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/25655273?dopt=Abstract %2 PMC4600360 %4 ADL/IADL/Disabilities/sociodemographic factors/sociodemographic factors/Chronic Disease/Smoking/Alcohol/obesity %$ 999999 %R 10.1111/1475-6773.12284 %0 Journal Article %J JAMA Intern Med %D 2015 %T Functional impairment and hospital readmission in Medicare seniors. %A S. Ryan Greysen %A Irena Cenzer %A Andrew D. Auerbach %A Kenneth E Covinsky %K Activities of Daily Living %K Age Factors %K Aged %K Aged, 80 and over %K Cohort Studies %K Comorbidity %K Female %K Heart Failure %K Humans %K Income %K Logistic Models %K Male %K Medicare %K Myocardial Infarction %K Patient Readmission %K Pneumonia %K Risk Assessment %K Risk Factors %K Sex Factors %K United States %X

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.

%B JAMA Intern Med %I 175 %V 175 %P 559-65 %8 2015 Apr %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/25642907?dopt=Abstract %2 PMC4388787 %4 Medicare/Functional impairment/hospital readmission/ADL and IADL Impairments %$ 999999 %R 10.1001/jamainternmed.2014.7756 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2015 %T How do race and Hispanic ethnicity affect nursing home admission? Evidence from the Health and Retirement Study. %A Thomeer, Mieke Beth %A Mudrazija, Stipica %A Jacqueline L. Angel %K Activities of Daily Living %K African Continental Ancestry Group %K Disability Evaluation %K European Continental Ancestry Group %K Hispanic Americans %K Homes for the Aged %K Humans %K Nursing homes %K Proportional Hazards Models %K Socioeconomic factors %K United States %X

OBJECTIVES: This study investigates how health- and disability-based need factors and enabling factors (e.g., socioeconomic and family-based resources) relate to nursing home admission among 3 different racial and ethnic groups.

METHOD: We use Cox proportional hazard models to estimate differences in nursing home admission for non-Hispanic whites, non-Hispanic blacks, and Hispanics from 1998 to 2010 in the Health and Retirement Study (N = 18,952).

RESULTS: Racial-ethnic differences in nursing home admission are magnified after controlling for health- and disability-based need factors and enabling factors. Additionally, the degree to which specific factors contribute to risk of nursing home admission varies significantly across racial-ethnic groups.

DISCUSSION: Our findings indicate that substantial racial and ethnic variations in nursing home admission continue to exist and that Hispanic use is particularly low. We argue that these differences may demonstrate a significant underuse of nursing homes for racial and ethnic minorities. Alternatively, they could signify different preferences for nursing home care, perhaps due to unmeasured cultural factors or structural obstacles.

%B J Gerontol B Psychol Sci Soc Sci %I 70 %V 70 %P 628-38 %8 2015 Jul %G eng %U http://psychsocgerontology.oxfordjournals.org/content/early/2014/09/08/geronb.gbu114.abstract %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/25204311?dopt=Abstract %2 PMC4462672 %4 Hispanic ethnicity/Long-term care/Nursing homes/ethnicity/race/ethnic differences %$ 999999 %R 10.1093/geronb/gbu114 %0 Journal Article %J J Appl Gerontol %D 2015 %T Improving the validity of activity of daily living dependency risk assessment. %A Daniel O. Clark %A Timothy E. Stump %A Tu, Wanzhu %A Douglas K Miller %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Cognition %K Cognition Disorders %K Female %K Gait %K Geriatric Assessment %K Humans %K Independent Living %K Interviews as Topic %K Male %K Quality Improvement %K Reproducibility of Results %K Risk Assessment %X

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.

%B J Appl Gerontol %I 34 %V 34 %P 329-42 %8 2015 Apr %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/24652867?dopt=Abstract %2 PMC4597469 %4 ADL/IADL/Cognitive measures/Cognitive measures/ADL dependency %$ 999999 %R 10.1177/0733464812471894 %0 Journal Article %J J Am Geriatr Soc %D 2015 %T Increase in Disability Prevalence Before Hip Fracture. %A Irena Cenzer %A W John Boscardin %A Christine S Ritchie %A Margaret Wallhagen %A Kenneth E Covinsky %K Activities of Daily Living %K Age Factors %K Aged %K Aged, 80 and over %K Dementia %K Disability Evaluation %K Disabled Persons %K Educational Status %K Female %K Health Surveys %K Hip Fractures %K Humans %K Income %K Male %K Mobility Limitation %K Prevalence %K United States %X

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.

%B J Am Geriatr Soc %I 63 %V 63 %P 2029-35 %8 2015 Oct %G eng %N 10 %1 http://www.ncbi.nlm.nih.gov/pubmed/26480970?dopt=Abstract %2 PMC4699653 %4 medicare/ADMINISTRATIVE DATA/Disabilities/Hip Fractures/ADL/IADL %$ 999999 %R 10.1111/jgs.13658 %0 Journal Article %J Aging Ment Health %D 2015 %T The Paulson-Lichtenberg Frailty Index: evidence for a self-report measure of frailty. %A Daniel Paulson %A Peter A Lichtenberg %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Aging %K Fatigue %K Female %K Frail Elderly %K Geriatric Assessment %K Health Status %K Health Surveys %K Humans %K Longitudinal Studies %K Male %K Self Report %K Socioeconomic factors %K Walking %X

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.

%B Aging Ment Health %I 19 %V 19 %P 892-901 %8 2015 %G eng %N 10 %1 http://www.ncbi.nlm.nih.gov/pubmed/25537004?dopt=Abstract %2 PMC4480217 %4 aging/decline/health outcomes/measurement/ADL and IADL Impairments %$ 999999 %R 10.1080/13607863.2014.986645 %0 Journal Article %J J Gerontol Soc Work %D 2015 %T The prevalence of older couples with ADL limitations and factors associated with ADL help receipt. %A Shen, Huei-Wern %A Sheila Feld %A Ruth E Dunkle %A Tracy Schroepfer %A Amanda J Lehning %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Cross-Sectional Studies %K Female %K Health Services Accessibility %K Humans %K Male %K Social Support %K Socioeconomic factors %X

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.

%B J Gerontol Soc Work %I 58 %V 58 %P 171-89 %8 2015 %G eng %U http://dx.doi.org/10.1080/01634372.2014.944248 %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/25036802?dopt=Abstract %2 PMC4297741 %4 health/functional limitations/care needs/spousal caregiving/marital dyad %$ 999999 %R 10.1080/01634372.2014.944248 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2015 %T Spouse and Child Availability for Newly Disabled Older Adults: Socioeconomic Differences and Potential Role of Residential Proximity. %A Choi, Hwajung %A Robert F. Schoeni %A Kenneth M. Langa %A Michele M Heisler %K Activities of Daily Living %K Adult children %K Aged %K Aged, 80 and over %K Aging %K Disabled Persons %K Female %K Home Nursing %K Humans %K Male %K Middle Aged %K Nursing homes %K Residence Characteristics %K Social Class %K Spouses %X

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.

%B J Gerontol B Psychol Sci Soc Sci %I 70 %V 70 %P 462-9 %8 2015 May %G eng %U http://psychsocgerontology.oxfordjournals.org/content/early/2014/03/06/geronb.gbu015.abstract %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/24607786?dopt=Abstract %4 Disability/Disability/Geographic proximity/Informal care/Socioeconomic status/community-based care/activities of daily living %$ 999999 %R 10.1093/geronb/gbu015 %0 Journal Article %J J Manipulative Physiol Ther %D 2014 %T The comparative effect of episodes of chiropractic and medical treatment on the health of older adults. %A Paula A Weigel %A Jason Hockenberry %A Suzanne E Bentler %A Frederic D Wolinsky %K Activities of Daily Living %K Aged, 80 and over %K Back Pain %K Episode of Care %K Female %K Humans %K Male %K Manipulation, Chiropractic %K Treatment Outcome %X

OBJECTIVES: The comparative effect of chiropractic vs medical care on health, as used in everyday practice settings by older adults, is not well understood. The purpose of this study is to examine how chiropractic compares to medical treatment in episodes of care for uncomplicated back conditions. Episodes of care patterns between treatment groups are described, and effects on health outcomes among an older group of Medicare beneficiaries over a 2-year period are estimated.

METHODS: Survey data from the nationally representative Survey on Assets and Health Dynamics among the Oldest Old were linked to participants' Medicare Part B claims under a restricted Data Use Agreement with the Centers for Medicare and Medicaid Services. Logistic regression was used to model the effect of chiropractic use in an episode of care relative to medical treatment on declines in function and well-being among a clinically homogenous older adult population. Two analytic approaches were used, the first assumed no selection bias and the second using propensity score analyses to adjust for selection effects in the outcome models.

RESULTS: Episodes of care between treatment groups varied in duration and provider visit pattern. Among the unadjusted models, there was no significant difference between chiropractic and medical episodes of care. The propensity score results indicate a significant protective effect of chiropractic against declines in activities of daily living (ADLs), instrumental ADLs, and self-rated health (adjusted odds ratio [AOR], 0.49; AOR, 0.62; and AOR, 0.59, respectively). There was no difference between treatment types on declines in lower body function or depressive symptoms.

CONCLUSION: The findings from this study suggest that chiropractic use in episodes of care for uncomplicated back conditions has protective effects against declines in ADLs, instrumental ADLs, and self-rated health for older Medicare beneficiaries over a 2-year period.

%B J Manipulative Physiol Ther %V 37 %P 143-54 %8 2014 Mar-Apr %G eng %U https://www.ncbi.nlm.nih.gov/pubmed/24636108 %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/24636108?dopt=Abstract %R 10.1016/j.jmpt.2013.12.009 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2014 %T Cumulative inequality and racial disparities in health: private insurance coverage and black/white differences in functional limitations. %A Ben Lennox Kail %A Miles G Taylor %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Black or African American %K Cross-Sectional Studies %K Female %K Health Status Disparities %K Hispanic or Latino %K Humans %K Insurance Coverage %K Insurance, Health %K Longitudinal Studies %K Male %K Medicare %K Socioeconomic factors %K United States %X

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.

%B J Gerontol B Psychol Sci Soc Sci %I 69 %V 69 %P 798-808 %8 2014 Sep %G eng %U http://psychsocgerontology.oxfordjournals.org/content/early/2014/02/24/geronb.gbu005.abstract %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/24569001?dopt=Abstract %2 PMC4189650 %4 Cumulative inequality/Insurance/Functional limitations/Private insurance %$ 999999 %R 10.1093/geronb/gbu005 %0 Journal Article %J J Gerontol A Biol Sci Med Sci %D 2014 %T The disability burden associated with stroke emerges before stroke onset and differentially affects blacks: results from the health and retirement study cohort. %A Benjamin D Capistrant %A Nicte I Mejia %A Sze Y Liu %A Qianyi Wang %A M. Maria Glymour %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Aging %K Black or African American %K Cohort Studies %K Disabled Persons %K Female %K Humans %K Male %K Prospective Studies %K Stroke %K United States %K White People %X

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.

%B J Gerontol A Biol Sci Med Sci %I 69 %V 69 %P 860-70 %8 2014 Jul %G eng %U http://biomedgerontology.oxfordjournals.org/content/early/2014/01/19/gerona.glt191.abstract %N 7 %1 http://www.ncbi.nlm.nih.gov/pubmed/24444610?dopt=Abstract %2 PMC4067116 %4 Minority aging/Disablement process/Stroke/Cardiovascular/Epidemiology. %$ 999999 %R 10.1093/gerona/glt191 %0 Journal Article %J Circ Cardiovasc Qual Outcomes %D 2014 %T Functional disability and cognitive impairment after hospitalization for myocardial infarction and stroke. %A Deborah A Levine %A Dimitry S Davydow %A Catherine L Hough %A Kenneth M. Langa %A Mary A M Rogers %A Theodore J Iwashyna %K Activities of Daily Living %K Cognition %K Cognition Disorders %K Disability Evaluation %K Disabled Persons %K Female %K Follow-Up Studies %K Hospitalization %K Humans %K Incidence %K Male %K Middle Aged %K Myocardial Infarction %K Odds Ratio %K Retrospective Studies %K Stroke %K Time Factors %K United States %X

BACKGROUND: We assessed the acute and long-term effect of myocardial infarction (MI) and stroke on postevent functional disability and cognition while controlling for survivors' changes in functioning over the years before the event.

METHODS AND RESULTS: Among participants in the nationally representative Health and Retirement Study with linked Medicare data (1998-2010), we determined within-person changes in functional limitations (basic and instrumental activities of daily living) and cognitive impairment after hospitalization for stroke (n=432) and MI (n=450), controlling for premorbid functioning using fixed-effects regression. In persons without baseline impairments, an acute MI yielded a mean acute increase of 0.41 functional limitations (95% confidence interval [CI], 0.18-0.63) with a linear increase of 0.14 limitations/year in the following decade. These increases were 0.65 limitations (95% CI, 0.07-1.23) and 0.27 limitations/year afterward for those with mild-to-moderate impairment at baseline. Stroke resulted in an acute increase of 2.07 (95% CI, 1.51-2.63) limitations because of the acute event and an increase of 0.15 limitations/year afterward for those unimpaired at baseline. There were 2.65 new limitations (95% CI, 1.86-3.44) and 0.19/year afterward for those with baseline mild-to-moderate impairment. Stroke hospitalization was associated with greater odds of moderate-to-severe cognitive impairment (odds ratio, 3.86; 95% CI, 2.10-7.11) at the time of the event, after adjustment for premorbid cognition but MI hospitalization was not.

CONCLUSIONS: In this population-based cohort, most MI and stroke hospitalizations were associated with significant increases in functional disability at the time of the event and in the decade afterward. Survivors of MI and stroke warrant screening for functional disability over the long-term.

%B Circ Cardiovasc Qual Outcomes %I 7 %V 7 %P 863-71 %8 2014 Nov %G eng %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/25387772?dopt=Abstract %4 activities of daily living/cognitive impairment/myocardial infarction/stroke/functional decline/functional decline/Transient Ischemic Attack/Coronary Artery Disease/quality of life/medicare %$ 999999 %R 10.1161/HCQ.0000000000000008 %0 Journal Article %J J Behav Med %D 2013 %T Adults with cardiovascular disease who help others: a prospective study of health outcomes. %A Michele M Heisler %A Choi, Hwajung %A John D Piette %A Ann Marie Rosland %A Kenneth M. Langa %A Stephanie Brown %K Activities of Daily Living %K Aged %K Cardiovascular Diseases %K depression %K Female %K Health Status %K Helping Behavior %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Prospective Studies %K Time Factors %X

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.

%B J Behav Med %I 36 %V 36 %P 199-211 %8 2013 Apr %G eng %U http://search.proquest.com.proxy.lib.umich.edu/docview/1318045378?accountid=14667 %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/22481214?dopt=Abstract %4 Psychology/Cardiovascular disease/Chronic conditions/caregivers/Depressive Symptoms/health care policy %$ 68988 %R 10.1007/s10865-012-9414-4 %0 Journal Article %J J Gen Intern Med %D 2013 %T BMI change patterns and disability development of middle-aged adults with diabetes: a dual trajectory modeling approach. %A Chiu, Ching-Ju %A Linda A. Wray %A Lu, Feng-hwa %A Elizabeth A Beverly %K Activities of Daily Living %K Body Mass Index %K Diabetes Mellitus, Type 2 %K Disability Evaluation %K Disabled Persons %K Female %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Models, Statistical %K Obesity %K Obesity, Morbid %K Overweight %K Retrospective Studies %K United States %K Weight Gain %K Weight Loss %X

BACKGROUND: Few longitudinal studies have examined associations between body mass index (BMI) changes in adults with diabetes and the development of disability.

OBJECTIVE: To investigate association patterns between BMI and disability in middle-aged adults with diabetes.

DESIGN AND SETTING: Retrospective cohort design with data from the 1992-2006 Health and Retirement Study (HRS). A group-based joint trajectory method identified distinct BMI change trajectories and their link to subsequent disability trajectories.

PARTICIPANTS: U.S. nationally representative adults aged 51-61 who reported a diagnosis of diabetes in the 1992 HRS (N = 1,064).

MEASUREMENTS: BMI and self-reported disability score were the main variables. Sociodemographic, clinical, behavioral, and diabetes-related factors were also examined.

RESULTS: Four distinct weight trajectories (stable normal weight, 28.7 %; stable overweight, 46.2 %; loss and regain obese, 18.0 %; weight cumulating morbidly obese, 7.1 %) and three disability trajectories (little or low increase, 34.4 %; moderate increase, 45.4 %; chronic high increase, 20.2 %) best characterized the long-term patterns of BMI and disability change in middle-aged adults with diabetes. Adults in stable normal weight had the highest probability of being in the little/low increase disability group; however, one in five adults in that group progressed into chronic high disability, a higher proportion compared to the stable overweight group.

CONCLUSIONS: Although there were various ways in which the two trajectories were linked, the beneficial impacts of optimizing weight in adults with diabetes were supported. In addition, the complexity of diabetes control in those with relatively normal weight was highlighted from this study.

%B J Gen Intern Med %I 28 %V 28 %P 1150-6 %8 2013 Sep %G eng %N 9 %1 http://www.ncbi.nlm.nih.gov/pubmed/23463456?dopt=Abstract %2 PMC3744313 %4 Medical Sciences/Body fat/Disability/Disability/Middle age/Diabetes/Models %$ 69104 %R 10.1007/s11606-013-2399-z %0 Journal Article %J J Manipulative Physiol Ther %D 2013 %T Chiropractic use and changes in health among older medicare beneficiaries: a comparative effectiveness observational study. %A Paula A Weigel %A Jason Hockenberry %A Suzanne E Bentler %A Frederic D Wolinsky %K Activities of Daily Living %K Age Factors %K Aged %K Aged, 80 and over %K Cohort Studies %K Databases, Factual %K Disability Evaluation %K Female %K Geriatric Assessment %K Humans %K Low Back Pain %K Male %K Manipulation, Chiropractic %K Medicare %K Mobility Limitation %K Musculoskeletal Diseases %K Patient Satisfaction %K Quality of Life %K Risk Assessment %K Sex Factors %K Treatment Outcome %K United States %X

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.

%B J Manipulative Physiol Ther %V 36 %P 572-84 %8 2013 Nov-Dec %G eng %U https://www.ncbi.nlm.nih.gov/pubmed/24636108 %N 9 %1 http://www.ncbi.nlm.nih.gov/pubmed/24144425?dopt=Abstract %R 10.1016/j.jmpt.2013.08.008 %0 Journal Article %J JAMA Intern Med %D 2013 %T Disability during the last two years of life. %A Alexander K Smith %A Louise C Walter %A Yinghui Miao %A W John Boscardin %A Kenneth E Covinsky %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Disability Evaluation %K Disabled Persons %K Educational Status %K Female %K Frail Elderly %K Humans %K Income %K Longitudinal Studies %K Male %K Marital Status %K Middle Aged %K Prospective Studies %K Sex Distribution %K Socioeconomic factors %K United States %X

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.

%B JAMA Intern Med %I 173 %V 173 %P 1506-13 %8 2013 Sep 09 %G eng %N 16 %1 http://www.ncbi.nlm.nih.gov/pubmed/23836120?dopt=Abstract %2 PMC3773297 %4 Medical Sciences/Older people/Disability/Disability/Palliative care/Aging/United States--US %$ 69096 %R 10.1001/jamainternmed.2013.8738 %0 Journal Article %J J Am Geriatr Soc %D 2013 %T Fall-associated difficulty with activities of daily living in functionally independent individuals aged 65 to 69 in the United States: a cohort study. %A Nishant K. Sekaran %A Choi, Hwajung %A Rodney A. Hayward %A Kenneth M. Langa %K Accidental Falls %K Activities of Daily Living %K Aged %K Aging %K Disability Evaluation %K Disabled Persons %K Female %K Follow-Up Studies %K Geriatric Assessment %K Health Status %K Humans %K Male %K Odds Ratio %K Retrospective Studies %K Risk Factors %K United States %K Wounds and Injuries %X

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.

%B J Am Geriatr Soc %I 61 %V 61 %P 96-100 %8 2013 Jan %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/23311555?dopt=Abstract %4 falls/Fall prevention/disability/disability/older adults/ADL/IADL/activities of daily living/Mobility/functional impairment/health Status %$ 69762 %R 10.1111/jgs.12071 %0 Journal Article %J Am J Med %D 2013 %T Functional disability, cognitive impairment, and depression after hospitalization for pneumonia. %A Dimitry S Davydow %A Catherine L Hough %A Deborah A Levine %A Kenneth M. Langa %A Theodore J Iwashyna %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Cognitive Dysfunction %K depression %K Hospitalization %K Humans %K Logistic Models %K Longitudinal Studies %K Middle Aged %K Myocardial Infarction %K Pneumonia %K Stroke %X

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.

%B Am J Med %V 126 %P 615-24.e5 %8 2013 Jul %G eng %N 7 %1 http://www.ncbi.nlm.nih.gov/pubmed/23499326?dopt=Abstract %2 PMC3690157 %4 Functional decline/Functional decline/cognitive Impairment/Depression/myocardial Infarction/Stroke/pneumonia/ADL/IADL/depressive symptoms/HOSPITALIZATION %$ 68966 %R 10.1016/j.amjmed.2012.12.006 %0 Journal Article %J J Geriatr Psychiatry Neurol %D 2013 %T Functional limitations in older adults who have cognitive impairment without dementia. %A Tanya R Gure %A Kenneth M. Langa %A Gwenith G Fisher %A John D Piette %A Brenda L Plassman %K Activities of Daily Living %K Age Factors %K Aged %K Aged, 80 and over %K Cognitive Dysfunction %K Dementia %K Female %K Humans %K Male %K Neuropsychological tests %K Severity of Illness Index %K Surveys and Questionnaires %X

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.

%B J Geriatr Psychiatry Neurol %V 26 %P 78-85 %8 2013 Jun %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/23559664?dopt=Abstract %2 PMC3726208 %4 ADAMS/Cognitive Impairment/ADL and IADL Impairments/Physical health/Dementia/Functional limitation %$ 68962 %R 10.1177/0891988713481264 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2013 %T Heterogeneity in multidimensional health trajectories of late old years and socioeconomic stratification: a latent trajectory class analysis. %A Kandauda Wickrama %A Jay A. Mancini %A Kwag, Kyunghwa %A Kwon, Josephine %K Activities of Daily Living %K Age Factors %K Aged %K Aged, 80 and over %K depression %K Female %K Health Status %K Health Transition %K Humans %K Longitudinal Studies %K Male %K Marriage %K Memory Disorders %K Middle Aged %K Socioeconomic factors %X

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.

%B J Gerontol B Psychol Sci Soc Sci %I 68 %V 68 %P 290-7 %8 2013 Mar %G eng %U http://psychsocgerontology.oxfordjournals.org/content/68/2/290.full.pdf html %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/23197341?dopt=Abstract %3 23197341 %4 health trajectories/health trajectories/Socioeconomic Differences/life Course/life Events/prevention/Public Policy/social Welfare %$ 69816 %R 10.1093/geronb/gbs111 %0 Journal Article %J J Am Geriatr Soc %D 2013 %T Pain as a risk factor for disability or death. %A James S Andrews %A Irena Cenzer %A Yelin, Edward %A Kenneth E Covinsky %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Cohort Studies %K Disabled Persons %K Female %K Geriatric Assessment %K Health Status %K Humans %K Life Style %K Male %K Middle Aged %K pain %K Prevalence %K Prognosis %K Prospective Studies %K Severity of Illness Index %K Sex Distribution %K Sex Factors %K United States %X

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.

%B J Am Geriatr Soc %I 61 %V 61 %P 583-9 %8 2013 Apr %G eng %U http://search.proquest.com.proxy.lib.umich.edu/docview/1356928876?accountid=14667 %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/23521614?dopt=Abstract %2 PMC3628294 %4 Demography/Risk Abstracts/Mortality/Mobility/Risk factors/Disabilities/Survival %$ 68992 %R 10.1111/jgs.12172 %0 Journal Article %J Adv Life Course Res %D 2013 %T The socioeconomic origins of physical functioning among older U.S. adults. %A Jennifer Karas Montez %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Educational Status %K Female %K Health Behavior %K Health Status %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Obesity %K Sex Factors %K Socioeconomic factors %K United States %X

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.

%B Adv Life Course Res %I 18 %V 18 %P 244-56 %8 2013 Dec %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/24796709?dopt=Abstract %4 Education/Functional limitations/Gender/Health/Life course %$ 999999 %R 10.1016/j.alcr.2013.08.001 %0 Journal Article %J J Am Geriatr Soc %D 2013 %T Stroke-associated differences in rates of activity of daily living loss emerge years before stroke onset. %A Benjamin D Capistrant %A Qianyi Wang %A Sze Y Liu %A M. Maria Glymour %K Activities of Daily Living %K Age of Onset %K Aged %K Aged, 80 and over %K Bayes Theorem %K Disability Evaluation %K Disabled Persons %K Female %K Follow-Up Studies %K Geriatric Assessment %K Humans %K Male %K Middle Aged %K Morbidity %K Prospective Studies %K Risk Assessment %K Risk Factors %K Socioeconomic factors %K Stroke %K Stroke Rehabilitation %K Survival Rate %K Survivors %K Time Factors %K United States %X

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.

%B J Am Geriatr Soc %I 61 %V 61 %P 931-938 %8 2013 Jun %G eng %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/23668393?dopt=Abstract %4 Gerontology And Geriatrics/ADL and IADL Impairments/Stroke/Self assessed health/risk Factors %$ 69008 %R 10.1111/jgs.12270 %0 Journal Article %J Demography %D 2013 %T Trends in late-life activity limitations in the United States: an update from five national surveys. %A Vicki A Freedman %A Brenda C Spillman %A Patricia Andreski %A Jennifer C. Cornman %A Eileen M. Crimmins %A Kramarow, Ellen %A Lubitz, James %A Linda G Martin %A Sharon S. Merkin %A Robert F. Schoeni %A Teresa Seeman %A Timothy A Waidmann %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Disabled Persons %K Female %K Health Surveys %K Humans %K Male %K Mobility Limitation %K Models, Statistical %K United States %X

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.

%B Demography %I 50 %V 50 %P 661-71 %8 2013 Apr %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/23104207?dopt=Abstract %2 PMC3586750 %4 methodology/Meta-analysis/ADL and IADL Impairments/Public Policy/health Care Costs/PREVALENCE %$ 68982 %R 10.1007/s13524-012-0167-z %0 Journal Article %J Gerontologist %D 2013 %T Type of high-school credentials and older age ADL and IADL limitations: is the GED credential equivalent to a diploma? %A Sze Y Liu %A Chavan, Niraj R. %A M. Maria Glymour %K Activities of Daily Living %K Adult %K Aged %K Aged, 80 and over %K Aging %K Disabled Persons %K Educational Status %K Female %K Follow-Up Studies %K Humans %K Kaplan-Meier Estimate %K Logistic Models %K Male %K Socioeconomic factors %K United States %X

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.

%B Gerontologist %I 53 %V 53 %P 326-33 %8 2013 Apr %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/22859434?dopt=Abstract %4 EDUCATION/disabilities/ADL/IADL/Activities Of Daily Living/Public Policy %$ 69164 %R 10.1093/geront/gns077 %0 Journal Article %J Aging Ment Health %D 2013 %T Vascular depression: an early warning sign of frailty. %A Daniel Paulson %A Peter A Lichtenberg %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Aging %K Cerebrovascular Disorders %K depression %K Disabled Persons %K Female %K Follow-Up Studies %K Frail Elderly %K Geriatric Assessment %K Health Status %K Humans %K Incidence %K Logistic Models %K Male %K Prevalence %K Psychiatric Status Rating Scales %K Risk Factors %K Socioeconomic factors %K United States %X

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.

%B Aging Ment Health %V 17 %P 85-93 %8 2013 %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/22724516?dopt=Abstract %2 PMC3492543 %4 activities of daily living/depression/cerebrovascular burden/frailty %$ 69584 %R 10.1080/13607863.2012.692767 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2013 %T Is working later in life good or bad for health? An investigation of multiple health outcomes. %A Kandauda Wickrama %A Catherine W. O'Neal %A Kyung H. Kwag %A Lee, Tae K. %K Activities of Daily Living %K Age Factors %K Aged %K depression %K Educational Status %K Employment %K Female %K Health Status %K Humans %K Longitudinal Studies %K Male %K Memory, Short-Term %K Middle Aged %K Neuropsychological tests %K Psychiatric Status Rating Scales %K Sex Factors %X

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.

%B J Gerontol B Psychol Sci Soc Sci %I 68 %V 68 %P 807-15 %8 2013 Sep %G eng %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/23887930?dopt=Abstract %4 Medical Sciences--Psychiatry And Neurology/Employment/Older people/Personal health/Mental depression/Gerontology/Disability/Disability/Memory %$ 69094 %R 10.1093/geronb/gbt069 %0 Journal Article %J Med Care %D 2012 %T Association of chronic diseases and impairments with disability in older adults: a decade of change? %A William W. Hung %A Joseph S. Ross %A Boockvar, Kenneth S %A Albert L Siu %K Activities of Daily Living %K Aged %K Aging %K Cardiovascular Diseases %K Chronic disease %K Cognition Disorders %K Cross-Sectional Studies %K Diabetes Mellitus %K Disabled Persons %K Female %K Health Surveys %K Hearing loss %K Humans %K Hypertension %K Male %K Mobility Limitation %K Residence Characteristics %K Respiratory Tract Diseases %K Self Care %K Socioeconomic factors %K United States %K Vision Disorders %X

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.

%B Med Care %I 50 %V 50 %P 501-7 %8 2012 Jun %G eng %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/22584885?dopt=Abstract %2 PMC3353149 %4 Chronic Disease/DISABILITY/DISABILITY/impairment/impairment/Hypertension/Diabetes/lung disease %$ 69462 %R 10.1097/MLR.0b013e318245a0e0 %0 Journal Article %J J Gerontol A Biol Sci Med Sci %D 2012 %T Clinical complexity and mortality in middle-aged and older adults with diabetes. %A Christine T Cigolle %A Mohammed U Kabeto %A Pearl G. Lee %A Caroline S Blaum %K Activities of Daily Living %K Aged %K Comorbidity %K Diabetes Complications %K Diabetes Mellitus %K Female %K Health Status %K Humans %K Male %K Middle Aged %K Proportional Hazards Models %K Self Care %X

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.

%B J Gerontol A Biol Sci Med Sci %I 67 %V 67 %P 1313-20 %8 2012 Dec %G eng %N 12 %1 http://www.ncbi.nlm.nih.gov/pubmed/22492022?dopt=Abstract %4 Mortality/Diabetes Mellitus/Disease management/Physiological aspects/Prevalence/Demographic aspects/Diabetics/Health aspects/Older people %$ 69726 %R 10.1093/gerona/gls095 %0 Journal Article %J Medical Care %D 2012 %T A comparison and cross-validation of models to predict basic activity of daily living dependency in older adults. %A Daniel O. Clark %A Timothy E. Stump %A Tu, Wanzhu %A Douglas K Miller %K Accidental Falls %K Activities of Daily Living %K Age Factors %K Aged %K Aged, 80 and over %K Aging %K Body Mass Index %K Chronic disease %K Female %K Humans %K Male %K Mobility Limitation %K Models, Statistical %K Risk Assessment %K Sex Factors %X

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.

%B Medical Care %V 50 %P 534-9 %8 2012 Jun %G eng %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/22581013?dopt=Abstract %R 10.1097/MLR.0b013e318245a50c %0 Journal Article %J J Epidemiol Community Health %D 2012 %T Current and long-term spousal caregiving and onset of cardiovascular disease. %A Benjamin D Capistrant %A J Robin Moon %A Lisa F Berkman %A M. Maria Glymour %K Activities of Daily Living %K Adult %K Aged %K Aged, 80 and over %K Cardiovascular Diseases %K Caregivers %K Female %K Follow-Up Studies %K Humans %K Incidence %K Interviews as Topic %K Long-term Care %K Male %K Middle Aged %K Proportional Hazards Models %K Risk Factors %K Self Report %K Socioeconomic factors %K Spouses %K Stress, Psychological %K United States %X

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.

%B J Epidemiol Community Health %V 66 %P 951-6 %8 2012 Oct %G eng %N 10 %1 http://www.ncbi.nlm.nih.gov/pubmed/22080816?dopt=Abstract %3 22080816 %4 Spousal care/cardiovascular disease/Socioeconomic Differences/risk Factors/Activities Of Daily Living/IADLs %$ 62688 %R 10.1136/jech-2011-200040 %0 Journal Article %J J Aging Soc Policy %D 2012 %T Determinants of retirement timing expectations in the United States and Australia: a cross-national comparison of the effects of health and retirement benefit policies on retirement timing decisions. %A K. A. Sargent-Cox %A Kaarin J. Anstey %A Kendig, H. %A Skladzien, E. %K Activities of Daily Living %K Age Factors %K Australia %K Cross-Cultural Comparison %K Florida %K Health Benefit Plans, Employee %K Health Status %K Humans %K Job Satisfaction %K Middle Aged %K Pensions %K Public Policy %K Retirement %K Sex Factors %K Socioeconomic factors %K Time Factors %K United States %X

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

%B J Aging Soc Policy %I 24 %V 24 %P 291-308 %8 2012 %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/22720888?dopt=Abstract %2 PMC in process %4 cross-national comparison/Australian Household Income and Labour Dynamics/retirement planning/Health insurance %$ 69588 %R 10.1080/08959420.2012.676324 %0 Journal Article %J J Gen Intern Med %D 2012 %T Disability and decline in physical function associated with hospital use at end of life. %A Amy Kelley %A Susan L Ettner %A R Sean Morrison %A Qingling Du %A Catherine A Sarkisian %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Chronic disease %K Dementia %K Disability Evaluation %K Disabled Persons %K Female %K Frail Elderly %K Geriatric Assessment %K Hospitalization %K Humans %K Length of Stay %K Longitudinal Studies %K Male %K Medicare %K Socioeconomic factors %K Terminal Care %K United States %X

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.

%B J Gen Intern Med %I 27 %V 27 %P 794-800 %8 2012 Jul %G eng %N 7 %1 http://www.ncbi.nlm.nih.gov/pubmed/22382455?dopt=Abstract %2 PMC3378753 %4 Public Policy/Medicare/end of life/Functional decline/Functional decline/Hospital Care Intensity Index/Hospital Care Intensity Index/end-of-life %$ 69430 %R 10.1007/s11606-012-2013-9 %0 Journal Article %J Health Econ %D 2012 %T Does retirement trigger ill health? %A Stefanie Behncke %K Activities of Daily Living %K Cardiovascular Diseases %K Chronic disease %K England %K Health Status %K Humans %K Longitudinal Studies %K Models, Econometric %K Neoplasms %K Quality of Life %K Retirement %K Risk Factors %X

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

%B Health Econ %I 21 %V 21 %P 282-300 %8 2012 Mar %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/21322085?dopt=Abstract %3 21322085 %4 retirement/health/Cross-national/matching methods/instrumental variable/ELSA_ %$ 69640 %R 10.1002/hec.1712 %0 Journal Article %J J Am Geriatr Soc %D 2012 %T Effect of obesity on falls, injury, and disability. %A Christine L Himes %A Sandra L Reynolds %K Accidental Falls %K Activities of Daily Living %K Aged %K Body Mass Index %K Disability Evaluation %K Disabled Persons %K Female %K Follow-Up Studies %K Humans %K Incidence %K Male %K Obesity %K Odds Ratio %K Prevalence %K Retrospective Studies %K Risk Factors %K United States %K Wounds and Injuries %X

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.

%B J Am Geriatr Soc %I 60 %V 60 %P 124-9 %8 2012 Jan %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/22150343?dopt=Abstract %3 22150343 %4 Obesity/Falls/DISABILITY/DISABILITY/Activities Of Daily Living/Body Mass Index/Self assessed health %$ 62678 %R 10.1111/j.1532-5415.2011.03767.x %0 Journal Article %J J Gen Intern Med %D 2012 %T How safe is your neighborhood? Perceived neighborhood safety and functional decline in older adults. %A Vivien K Sun %A Irena Cenzer %A Helen Kao %A Cyrus Ahalt %A Brie A Williams %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Health Status Disparities %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Perception %K Residence Characteristics %K Safety %K Surveys and Questionnaires %X

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.

%B J Gen Intern Med %V 27 %P 541-7 %8 2012 May %G eng %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/22160889?dopt=Abstract %2 PMC3326109 %4 neighborhood Characteristics/Safety/Functional decline/Functional decline/Activities Of Daily Living/Mobility/HEALTH %$ 62672 %R 10.1007/s11606-011-1943-y %0 Journal Article %J Health Soc Care Community %D 2012 %T The impact of socioeconomic inequalities and lack of health insurance on physical functioning among middle-aged and older adults in the United States. %A Kim, Jinhyun %A Virginia E. Richardson %K Activities of Daily Living %K Aged %K Black or African American %K Female %K Health Status %K Healthcare Disparities %K Humans %K Longitudinal Studies %K Male %K Medically Uninsured %K Middle Aged %K Poverty %K Sex Factors %K Socioeconomic factors %K Time Factors %K United States %K White People %X

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.

%B Health Soc Care Community %I 20 %V 20 %P 42-51 %8 2012 Jan %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/21733029?dopt=Abstract %3 21733029 %4 Socioeconomic Differences/health Insurance/health disparities/economic Status/WOMEN/Physical function %$ 62738 %R 10.1111/j.1365-2524.2011.01012.x %0 Journal Article %J Am J Epidemiol %D 2012 %T Limited lung function: impact of reduced peak expiratory flow on health status, health-care utilization, and expected survival in older adults. %A Melissa H. Roberts %A Douglas W Mapel %K Activities of Daily Living %K Aged %K Chronic disease %K Cohort Studies %K Comorbidity %K Diabetes Mellitus %K Female %K Health Services %K Health Status %K Heart Diseases %K Hospitalization %K Humans %K Incidence %K Logistic Models %K Longitudinal Studies %K Lung Diseases %K Male %K Middle Aged %K Neoplasms %K Odds Ratio %K Peak Expiratory Flow Rate %K Population Surveillance %K Stroke %K United States %X

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.

%B Am J Epidemiol %I 176 %V 176 %P 127-34 %8 2012 Jul 15 %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/22759722?dopt=Abstract %2 PMC3493194 %4 peak expiratory flow/disability/disability/hospitalization/physical fitness %$ 69580 %R 10.1093/aje/kwr503 %0 Journal Article %J Arch Intern Med %D 2012 %T Loneliness in older persons: a predictor of functional decline and death. %A Perissinotto, Carla M %A Irena Cenzer %A Kenneth E Covinsky %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Female %K Humans %K Loneliness %K Longitudinal Studies %K Male %K Middle Aged %K Mortality %K United States %K Upper Extremity %K Walking %X

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.

%B Arch Intern Med %I 172 %V 172 %P 1078-83 %8 2012 Jul 23 %G eng %N 14 %1 http://www.ncbi.nlm.nih.gov/pubmed/22710744?dopt=Abstract %3 22710744 %4 loneliness/functional decline/functional decline/Mortality/psychosocial/Quality of Life/Multivariate Analysis %$ 69670 %R 10.1001/archinternmed.2012.1993 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2012 %T Measurement equivalence in ADL and IADL difficulty across international surveys of aging: findings from the HRS, SHARE, and ELSA. %A Kitty S. Chan %A Judith D Kasper %A Jason Brandt %A Liliana E Pezzin %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Aging %K Bias %K Europe %K Female %K Health Surveys %K Humans %K Internationality %K Longitudinal Studies %K Male %K United States %X

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.

%B J Gerontol B Psychol Sci Soc Sci %V 67 %P 121-32 %8 2012 Jan %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/22156662?dopt=Abstract %2 PMC3267026 %4 measurement/SHARE/ELSA_/Activities Of Daily Living/instrumental activities of daily living/DISABILITY/DISABILITY/differential item functioning/differential item functioning %$ 62674 %R 10.1093/geronb/gbr133 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2012 %T The relationship between body weight, frailty, and the disablement process. %A Mary E Bowen %K Activities of Daily Living %K Aged %K Body Weight %K Cross-Sectional Studies %K Disability Evaluation %K Disabled Persons %K Female %K Frail Elderly %K Geriatric Assessment %K Health Behavior %K Health Surveys %K Humans %K Life Style %K Longitudinal Studies %K Male %K Middle Aged %K Overweight %K Physical Fitness %K Prospective Studies %K sarcopenia %K Socioeconomic factors %K Thinness %K United States %X

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.

%B J Gerontol B Psychol Sci Soc Sci %I 67 %V 67 %P 618-26 %8 2012 Sep %G eng %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/22967933?dopt=Abstract %2 PMC in process %4 Weight/Frailty/Disability/Disability/Older people/Health behavior/Socioeconomic factors/activities Of Daily Living/ADL and IADL Impairments %$ 69624 %R 10.1093/geronb/gbs067 %0 Journal Article %J BMC Geriatr %D 2012 %T Restless legs syndrome and functional limitations among American elders in the Health and Retirement Study. %A Dominic J Cirillo %A Robert B Wallace %K Activities of Daily Living %K Age Factors %K Aged %K Aged, 80 and over %K Body Mass Index %K Cross-Sectional Studies %K Disabled Persons %K Female %K Humans %K Male %K Middle Aged %K Prevalence %K Restless Legs Syndrome %K Risk Factors %K United States %X

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.

%B BMC Geriatr %I 12 %V 12 %P 39 %8 2012 Jul 26 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/22834914?dopt=Abstract %2 PMC3433378 %4 Restless legs syndrome/activities of daily living/ADL/IADL/mobility/Functional Assessment/Quality of Life %$ 69636 %R 10.1186/1471-2318-12-39 %0 Journal Article %J Gerontologist %D 2012 %T Risk factors of falls in community-dwelling older adults: logistic regression tree analysis. %A Takashi Yamashita %A Noe, Douglas A. %A John A. Bailer %K Accidental Falls %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Decision Trees %K Female %K Geriatric Assessment %K Health Surveys %K Humans %K Logistic Models %K Male %K Predictive Value of Tests %K Residence Characteristics %K Risk Assessment %K Socioeconomic factors %K United States %X

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.

%B Gerontologist %I 52 %V 52 %P 822-32 %8 2012 Dec %G eng %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/22437329?dopt=Abstract %4 falls/risk Factors/ADL and IADL Impairments/Methodology/Logistic Models %$ 69782 %R 10.1093/geront/gns043 %0 Journal Article %J Am J Hypertens %D 2012 %T Spousal caregiving and incident hypertension. %A Benjamin D Capistrant %A J Robin Moon %A M. Maria Glymour %K Activities of Daily Living %K Aged %K Cardiovascular Diseases %K Caregivers %K Female %K Follow-Up Studies %K Humans %K Hypertension %K Male %K Memory Disorders %K Middle Aged %K Odds Ratio %K Spouses %K Stress, Psychological %X

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.

%B Am J Hypertens %I 25 %V 25 %P 437-43 %8 2012 Apr %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/22189941?dopt=Abstract %3 22189941 %4 ADL/IADL/caregiving/Spousal death/Spousal death/Hypertension/mortality/Hazard model %$ 69708 %R 10.1038/ajh.2011.232 %0 Journal Article %J J Gen Intern Med %D 2012 %T Subjective social status and functional decline in older adults. %A Bonnie Chen %A Kenneth E Covinsky %A Irena Cenzer %A Nancy E Adler %A Brie A Williams %K Activities of Daily Living %K Aged %K Aging %K Female %K Health Status Disparities %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Mobility Limitation %K Risk Factors %K Self Report %K Social Class %X

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.

%B J Gen Intern Med %V 27 %P 693-9 %8 2012 Jun %G eng %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/22215272?dopt=Abstract %2 PMC3358399 %4 health outcomes/socioeconomic Differences/social status/social status/functional decline/functional decline/ADL and IADL Impairments %$ 62662 %R 10.1007/s11606-011-1963-7 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2011 %T 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. %A Philippa J Clarke %A Jacqui Smith %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Aging %K Cross-Cultural Comparison %K Culture %K Disabled Persons %K England %K Female %K Gait %K Health Status %K Humans %K Internal-External Control %K Longitudinal Studies %K Male %K Mobility Limitation %K Politics %K Social Values %K Socioeconomic factors %K United States %X

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.

%B J Gerontol B Psychol Sci Soc Sci %I 66B %V 66 %P 457-67 %8 2011 Jul %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/21666145?dopt=Abstract %2 PMC3132269 %4 Older people/Disability/Disability/Aging/International comparisons/Self control %$ 62578 %R 10.1093/geronb/gbr054 %0 Journal Article %J J Am Geriatr Soc %D 2011 %T Caring for individuals with dementia and cognitive impairment, not dementia: findings from the aging, demographics, and memory study. %A Gwenith G Fisher %A Melissa M Franks %A Brenda L Plassman %A Stephanie Brown %A Guy G Potter %A David J Llewellyn %A Mary A M Rogers %A Kenneth M. Langa %K Activities of Daily Living %K Aged %K Analysis of Variance %K Caregivers %K Cognition Disorders %K Cross-Sectional Studies %K Dementia %K Female %K Humans %K Linear Models %K Male %K Neuropsychological tests %K Time Factors %K United States %X

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.

%B J Am Geriatr Soc %I 59 %V 59 %P 488-94 %8 2011 Mar %G eng %U http://onlinelibrary.wiley.com/doi/10.1111/j.1532-5415.2010.03304.x/full %N 3 %L newpubs20110418_Fisher.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/21391939?dopt=Abstract %2 PMC3646395 %4 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 %$ 24660 %R 10.1111/j.1532-5415.2010.03304.x %0 Journal Article %J Stroke %D 2011 %T Consequences of stroke in community-dwelling elderly: the health and retirement study, 1998 to 2008. %A Afshin A Divani %A Shahram Majidi %A Anna M Barrett %A Noorbaloochi, Siamak %A Andreas R Luft %K Activities of Daily Living %K Aged %K Case-Control Studies %K Cohort Studies %K Comorbidity %K Female %K Geriatrics %K Humans %K Male %K Quality of Life %K Retirement %K Risk %K Social Environment %K Stroke %X

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.

%B Stroke %I 42 %V 42 %P 1821-5 %8 2011 Jul %G eng %N 7 %1 http://www.ncbi.nlm.nih.gov/pubmed/21597018?dopt=Abstract %2 PMC3125444 %4 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 %$ 62750 %R 10.1161/STROKEAHA.110.607630 %0 Journal Article %J J Behav Health Serv Res %D 2011 %T Depression and the onset of chronic illness in older adults: a 12-year prospective study. %A Mustafa C. Karakus %A Lisa C Patton %K Activities of Daily Living %K Age Distribution %K Aged %K Chronic disease %K depression %K Female %K Follow-Up Studies %K Humans %K Male %K Middle Aged %K Prospective Studies %K Psychiatric Status Rating Scales %K Risk Factors %K Sex Distribution %K Socioeconomic factors %K United States %X

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.

%B J Behav Health Serv Res %I 38 %V 38 %P 373-82 %8 2011 Jul %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/21293976?dopt=Abstract %4 Chronic illnesses/Older people/Correlation analysis/Mental depression/Experiment/theoretical treatment/Health care industry %$ 69350 %R 10.1007/s11414-011-9234-2 %0 Journal Article %J Soc Sci Med %D 2011 %T Differences in health between Americans and Western Europeans: Effects on longevity and public finance. %A Pierre-Carl Michaud %A Dana P Goldman %A Darius Lakdawalla %A Adam Gailey %A Yuhui Zheng %K Activities of Daily Living %K Adult %K Aged %K Body Mass Index %K Cross-Cultural Comparison %K Disabled Persons %K Europe %K Female %K Health Expenditures %K health policy %K Health Status Disparities %K Health Surveys %K Humans %K Internationality %K Life Expectancy %K Male %K Middle Aged %K Models, Economic %K Models, Statistical %K Mortality %K Public Health %K United States %X

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.

%B Soc Sci Med %I 73 %V 73 %P 254-63 %8 2011 Jul %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/21719178?dopt=Abstract %2 PMC3383030 %4 disability/disability/mortality/international comparisons/Cross-national/microsimulation/Europe/SHARE/ELSA_/longevity %$ 69616 %R 10.1016/j.socscimed.2011.05.027 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2011 %T Does informal care attenuate the cycle of ADL/IADL disability and depressive symptoms in late life? %A Lin, I-Fen %A Wu, Hsueh-Sheng %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Caregivers %K Cohort Studies %K Cost of Illness %K depression %K Disability Evaluation %K Female %K Humans %K Longitudinal Studies %K Male %K Models, Psychological %K United States %X

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.

%B J Gerontol B Psychol Sci Soc Sci %I 66B %V 66 %P 585-94 %8 2011 Sep %G eng %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/21746870?dopt=Abstract %2 PMC3155031 %4 Disability/Disability/Mental depression/Older people/Caregivers/Gerontology/Mobility %$ 62618 %R 10.1093/geronb/gbr060 %0 Journal Article %J J Aging Health %D 2011 %T Drinking patterns and the development of functional limitations in older adults: longitudinal analyses of the health and retirement survey. %A James C. Lin %A Guerrieri, Joy Gioia %A Alison A . Moore %K Activities of Daily Living %K Age Factors %K Aged %K Alcohol Drinking %K Female %K Humans %K Logistic Models %K Male %K Middle Aged %K Retirement %X

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.

%B J Aging Health %I 23 %V 23 %P 806-21 %8 2011 Aug %G eng %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/21311049?dopt=Abstract %2 PMC3233258 %4 Risk assessment/Older people/Alcohol use/Aging/Comparative analysis %$ 62592 %R 10.1177/0898264310397541 %0 Journal Article %J Psychol Aging %D 2011 %T Dynamic links between memory and functional limitations in old age: longitudinal evidence for age-based structural dynamics from the AHEAD study. %A Frank J Infurna %A Denis Gerstorf %A Lindsay H Ryan %A Jacqui Smith %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Aging %K Cognition %K depression %K Female %K Health Status %K Humans %K Interviews as Topic %K Longitudinal Studies %K Male %K Memory %K Memory Disorders %K Memory, Episodic %K Models, Statistical %K Neuropsychological tests %X

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.

%B Psychol Aging %I 26 %V 26 %P 546-58 %8 2011 Sep %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/21480716?dopt=Abstract %2 PMC3575140 %4 Memory/Aging/Cognitive ability/Multivariate analysis/Young adults/Personal health %$ 62608 %R 10.1037/a0023023 %0 Journal Article %J Eur J Public Health %D 2011 %T Gender differences in health: results from SHARE, ELSA and HRS. %A Eileen M. Crimmins %A Jung K Kim %A Sole-Auro, Aida %K Activities of Daily Living %K Aged %K Aging %K Body Weights and Measures %K Chronic disease %K Employment %K Female %K Global Health %K Health Behavior %K Health Status %K Humans %K Male %K Middle Aged %K Self Report %K Sex Factors %X

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.

%B Eur J Public Health %V 21 %P 81-91 %8 2011 Feb %G eng %N 1 %L newpubs20101112_Crimmins.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/20237171?dopt=Abstract %2 PMC3023013 %4 cross-national comparison/gender Differences/ELSA_/SHARE/SELF-RATED HEALTH/health Behavior/disease prevalence/DISABILITY/DISABILITY %$ 23770 %R 10.1093/eurpub/ckq022 %0 Journal Article %J J Gerontol Soc Work %D 2011 %T Health and medical services use: a matched case comparison between CCRC residents and national health and retirement study samples. %A Gaines, Jean M %A Judith L Poey %A Marx, Katherine A %A J. M. Parrish %A Resnick, Barbara %K Activities of Daily Living %K Age Factors %K Aged %K Aged, 80 and over %K Aging %K Case-Control Studies %K Chronic disease %K depression %K Female %K Geriatric Assessment %K Health Services %K Health Services for the Aged %K Health Status %K Home Care Services %K Hospitalization %K Humans %K Interview, Psychological %K Male %K Middle Aged %K Multivariate Analysis %K Psychometrics %K Retirement %X

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.

%B J Gerontol Soc Work %I 54 %V 54 %P 788-802 %8 2011 Nov %G eng %N 8 %1 http://www.ncbi.nlm.nih.gov/pubmed/22060005?dopt=Abstract %3 22060005 %4 health Status/Continuing care retirement communities/COMORBIDITY/Self assessed health %$ 62690 %R 10.1080/01634372.2011.595476 %0 Journal Article %J BMC Geriatr %D 2011 %T Long-term declines in ADLs, IADLs, and mobility among older Medicare beneficiaries. %A Frederic D Wolinsky %A Suzanne E Bentler %A Jason Hockenberry %A Michael P Jones %A Maksym Obrizan %A Paula A Weigel %A Kaskie, Brian %A Robert B Wallace %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Cohort Studies %K Disabled Persons %K Female %K Follow-Up Studies %K Geriatric Assessment %K Health Surveys %K Humans %K Insurance Benefits %K Longitudinal Studies %K Male %K Medicare %K Mobility Limitation %K Prospective Studies %K Time Factors %K United States %X

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.

%B BMC Geriatr %I 11 %V 11 %P 43 %8 2011 Aug 16 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/21846400?dopt=Abstract %2 PMC3167753 %4 SELF-RATED HEALTH/Medicare/Functional decline/Functional decline/ADL/IADL/risk Factors %$ 25090 %R 10.1186/1471-2318-11-43 %0 Journal Article %J J Am Geriatr Soc %D 2011 %T Neuropsychiatric symptoms and the risk of institutionalization and death: the aging, demographics, and memory study. %A Okura, Toru %A Brenda L Plassman %A David C Steffens %A David J Llewellyn %A Guy G Potter %A Kenneth M. Langa %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Behavioral Symptoms %K Caregivers %K Cognition Disorders %K Female %K Humans %K Institutionalization %K Male %K Neuropsychological tests %K Proportional Hazards Models %X

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.

%B J Am Geriatr Soc %I 59 %V 59 %P 473-81 %8 2011 Mar %G eng %N 3 %L newpubs20110418_Okura.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/21391937?dopt=Abstract %2 PMC3088883 %4 Mental disorders/Cognition/reasoning/Caregivers/Risk factors/Nursing homes/Mortality/Older people %$ 24670 %R 10.1111/j.1532-5415.2011.03314.x %0 Journal Article %J Gerontologist %D 2011 %T Physical disability trajectories in older Americans with and without diabetes: the role of age, gender, race or ethnicity, and education. %A Chiu, Ching-Ju %A Linda A. Wray %K Activities of Daily Living %K Age Distribution %K Aged %K Aged, 80 and over %K Cross-Sectional Studies %K Diabetes Mellitus %K Disabled Persons %K Educational Status %K ethnicity %K Female %K Health Status %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Models, Theoretical %K Racial Groups %K Sex Distribution %K Time Factors %K United States %X

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.

%B Gerontologist %I 51 %V 51 %P 51-63 %8 2011 Feb %G eng %N 1 %L newpubs20110418_Chiu2.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/20713455?dopt=Abstract %2 PMC3018868 %4 Gerontology/Older people/Diabetes/Gender/Ethnicity/Disability/Disability %$ 24840 %R 10.1093/geront/gnq069 %0 Journal Article %J BMC Geriatr %D 2011 %T Recent trends in chronic disease, impairment and disability among older adults in the United States. %A William W. Hung %A Joseph S. Ross %A Boockvar, Kenneth S %A Albert L Siu %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Chronic disease %K Disabled Persons %K Female %K Health Surveys %K Humans %K Longitudinal Studies %K Male %K United States %K Visually Impaired Persons %X

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.

%B BMC Geriatr %I 11 %V 11 %P 47 %8 2011 Aug 18 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/21851629?dopt=Abstract %2 PMC3170191 %4 PREVALENCE/concurrent prevalence trends/concurrent prevalence trends/Chronic Disease/impairment/impairment/DISABILITY/DISABILITY/ADL and IADL Impairments %$ 62721 %R 10.1186/1471-2318-11-47 %0 Journal Article %J Health Psychol %D 2011 %T Spousal associations between functional limitation and depressive symptom trajectories: Longitudinal findings from the study of Asset and Health Dynamics Among the Oldest Old (AHEAD). %A Christiane A Hoppmann %A Denis Gerstorf %A Anita Hibbert %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Aging %K depression %K Female %K Humans %K Longitudinal Studies %K Male %K Psychometrics %K Spouses %K United States %X

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.

%B Health Psychol %I 30 %V 30 %P 153-62 %8 2011 Mar %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/21401249?dopt=Abstract %2 PMC3078040 %4 Activities of Daily Living/Aging/Longitudinal Studies/Psychometrics/Spouses/marital Status/Functional limitations/Depressive Symptoms %$ 69474 %R 10.1037/a0022094 %0 Journal Article %J J Health Soc Behav %D 2011 %T The urban neighborhood and cognitive functioning in late middle age. %A Carol S Aneshensel %A Michelle J Ko %A Joshua Chodosh %A Richard G Wight %K Activities of Daily Living %K Age Factors %K Aged %K Aging %K Chi-Square Distribution %K Cognition %K Cognition Disorders %K ethnicity %K Female %K Health Status Disparities %K Humans %K Male %K Middle Aged %K Psychometrics %K Residence Characteristics %K Risk Factors %K Socioeconomic factors %K United States %K Urban Population %X

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.

%B J Health Soc Behav %I 52 %V 52 %P 163-79 %8 2011 Jun %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/21673145?dopt=Abstract %2 PMC3152319 %4 Segregation/Cognitive ability/Cognition/reasoning %$ 62634 %R 10.1177/0022146510393974 %0 Journal Article %J J Am Geriatr Soc %D 2011 %T Volunteering, driving status, and mortality in U.S. retirees. %A Sei J. Lee %A Michael A Steinman %A Erwin J Tan %K Activities of Daily Living %K Aged %K Automobile Driving %K Female %K Health Status %K Humans %K Male %K Prospective Studies %K Retirement %K Risk Factors %K Social Behavior %K Survival Rate %K United States %K Volunteers %X

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.

%B J Am Geriatr Soc %I 59 %V 59 %P 274-80 %8 2011 Feb %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/21314648?dopt=Abstract %2 PMC3089440 %4 Activities of Daily Living/Automobile Driving/driving Patterns/Health Status/Prospective Studies/Retirement planning/Risk Factors/Social Behavior/Social Behavior/Survival/volunteering %$ 62776 %R 10.1111/j.1532-5415.2010.03265.x %0 Journal Article %J J Psychol %D 2010 %T Activities of daily living, social support, and future health of older Americans. %A Bozo, Ozlem %A Charles A Guarnaccia %K Activities of Daily Living %K Adaptation, Psychological %K Aged %K Aging %K Caregivers %K Chronic disease %K Female %K Friends %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Personal Satisfaction %K Retirement %K Risk Factors %K Sick Role %K Social Support %K Spouses %X

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.

%B J Psychol %I 144 %V 144 %P 1-14 %8 2010 Jan-Feb %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/20092067?dopt=Abstract %3 20092067 %4 Activities of Daily Living/social Support/health care/families/Transfers %$ 22220 %R 10.1080/00223980903356032 %0 Journal Article %J Am J Public Health %D 2010 %T Childhood socioeconomic position and disability in later life: results of the health and retirement study. %A Mary E Bowen %A Hector M González %K Activities of Daily Living %K Cohort Studies %K Disabled Persons %K Female %K Humans %K Male %K Michigan %K Middle Aged %K Prospective Studies %K Retirement %K Risk Assessment %K Social Class %X

OBJECTIVES: We used a life course approach to assess the ways in which childhood socioeconomic position may be associated with disability in later life.

METHODS: We used longitudinal data from the nationally representative Health and Retirement Study (1998-2006) to examine associations between parental education, paternal occupation, and disabilities relating to activities of daily living (ADLs) and instrumental activities of daily living (IADLs).

RESULTS: Respondents whose fathers had low levels of education and those whose fathers were absent or had died while they were growing up were at increased risk of disability in later life, net of social, behavioral, and pathological health risks in adulthood. Social mobility and health behaviors were also important factors in the association between low childhood socioeconomic position and ADL and IADL disabilities.

CONCLUSIONS: Our findings highlight the need for policies and programs aimed at improving the well-being of both children and families. A renewed commitment to such initiatives may help reduce health care costs and the need for people to use health and social services in later life.

%B Am J Public Health %I 100 %V 100 Suppl 1 %P S197-203 %8 2010 Apr 01 %G eng %N Suppl 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/19762655?dopt=Abstract %2 PMC2837439 %4 ADL and IADL Impairments/Health risk assessment/Children/youth/Tuition/Health behavior/Tobacco smoke/Families/family life/Disease/Retirement/Disability/Disability/Palliative care/Education %$ 22460 %R 10.2105/AJPH.2009.160986 %0 Journal Article %J J Am Med Dir Assoc %D 2010 %T Comparison study on functional outcomes and perceived quality of life between all-inclusive and fee-for-service continuing care retirement communities. %A Young, Yuchi %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Cross-Sectional Studies %K Fee-for-Service Plans %K Female %K Humans %K Male %K New York %K Outcome Assessment, Health Care %K Quality of Life %K Residential Facilities %X

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.

%B J Am Med Dir Assoc %I 11 %V 11 %P 257-62 %8 2010 May %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/20439045?dopt=Abstract %3 20439045 %4 Activities of Daily Living/continuing care retirement communities/Quality of Life/nursing Homes/Home Care Services %$ 22600 %R 10.1016/j.jamda.2009.09.004 %0 Journal Article %J J Am Geriatr Soc %D 2010 %T Depressive symptoms in middle age and the development of later-life functional limitations: the long-term effect of depressive symptoms. %A Kenneth E Covinsky %A Kristine Yaffe %A Lindquist, Karla %A Cherkasova, Elena %A Yelin, Edward %A Dan G. Blazer %K Activities of Daily Living %K depression %K Female %K Humans %K Kaplan-Meier Estimate %K Male %K Middle Aged %K Mobility Limitation %K Proportional Hazards Models %K Prospective Studies %K Risk Factors %K United States %X

OBJECTIVES: To determine whether middle-aged persons with depressive symptoms are at higher risk for developing activity of daily living (ADL) and mobility limitations as they advance into older age than those without.

DESIGN: Prospective cohort study.

SETTING: The Health and Retirement Study (HRS), a nationally representative sample of people aged 50 to 61.

PARTICIPANTS: Seven thousand two hundred seven community living participants in the 1992 wave of the HRS.

MEASUREMENTS: Depressive symptoms were measured using the 11-item Center for Epidemiologic Studies Depression Scale (CES-D 11), with scores of 9 or more (out of 33) classified as significant depressive symptoms. Difficulty with five ADLs and basic mobility tasks (walking several blocks or up one flight of stairs) was measured every 2 years through 2006. The primary outcome was persistent difficulty with ADLs or mobility, defined as difficulty in two consecutive waves.

RESULTS: Eight hundred eighty-seven (12%) subjects scored 9 or higher on the CES-D 11 and were classified as having significant depressive symptoms. Over 12 years of follow-up, subjects with depressive symptoms were more likely to reach the primary outcome measure of persistent difficulty with mobility or difficulty with ADL function (45% vs 23%, Cox hazard ratio (HR)=2.33, 95% confidence interval (CI)=2.06-2.63). After adjusting for age, sex, measures of socioeconomic status, comorbid conditions, high body mass index, smoking, exercise, difficulty jogging 1 mile, and difficulty climbing several flights of stairs, the risk was attenuated but still statistically significant (Cox HR=1.44, 95% CI=1.25-1.66).

CONCLUSION: Depressive symptoms independently predict the development of persistent limitations in ADLs and mobility as middle-aged persons advance into later life. Middle-aged persons with depressive symptoms may be at greater risk for losing their functional independence as they age.

%B J Am Geriatr Soc %I 58 %V 58 %P 551-6 %8 2010 Mar %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/20163486?dopt=Abstract %2 PMC2904810 %4 Mobility/Older Adults/Middle Aged/Depression/Activities Of Daily Living/Geriatrics/Functional Assessment/Aging/FUNCTIONAL loss in older people/disability/disability/functional status/outcomes %$ 22810 %R 10.1111/j.1532-5415.2010.02723.x %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2010 %T Diabetes-related support, regimen adherence, and health decline among older adults. %A Emily J Nicklett %A Jersey Liang %K Activities of Daily Living %K Aged %K Diabetes Mellitus, Type 2 %K Disability Evaluation %K Female %K Health Behavior %K Health Status %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Patient Compliance %K Quality of Life %K Social Support %K Surveys and Questionnaires %K United States %X

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.

%B J Gerontol B Psychol Sci Soc Sci %I 10 %V 65B %P 390-9 %8 2010 May %G eng %N 3 %L newpubs20090908_Nicklett.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/19541672?dopt=Abstract %2 PMC2853599 %4 Chronic Illness/diabetes/Health care management %$ 20640 %R 10.1093/geronb/gbp050 %0 Journal Article %J J Gerontol A Biol Sci Med Sci %D 2010 %T Differences in functional impairment across subtypes of dementia. %A Tanya R Gure %A Mohammed U Kabeto %A Brenda L Plassman %A John D Piette %A Kenneth M. Langa %K Activities of Daily Living %K Aged %K Alzheimer disease %K Dementia %K Dementia, Vascular %K Humans %X

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.

%B J Gerontol A Biol Sci Med Sci %I 65A %V 65 %P 434-41 %8 2010 Apr %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/20018827?dopt=Abstract %2 PMC2844058 %4 Aging/Dementia/Demographics/Memory/Older people/Alzheimers disease/Questionnaires/Disability/Disability %$ 22700 %R 10.1093/gerona/glp197 %0 Journal Article %J Soc Sci Med %D 2010 %T 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? %A Muramatsu, Naoko %A yin, Hongjun %A Hedeker, Donald %K Activities of Daily Living %K Aged %K Cognition %K Community Health Services %K depression %K Disabled Persons %K Female %K Home Care Services %K Humans %K Logistic Models %K Male %K Mental Health %K Multilevel Analysis %K Risk Factors %K Social Support %K Spouses %K State Government %K Stress, Psychological %K United States %X

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.

%B Soc Sci Med %I 70 %V 70 %P 1050-8 %8 2010 Apr %G eng %N 7 %L newpubs20100729_Muramatsu.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/20117865?dopt=Abstract %2 PMC3360961 %4 Stress/Home Care Services/community-based services/mental Health/depression %$ 22990 %R 10.1016/j.socscimed.2009.12.005 %0 Journal Article %J Soc Sci Med %D 2010 %T Health outcomes of Experience Corps: a high-commitment volunteer program. %A S I Hong %A Morrow-Howell, Nancy %K Activities of Daily Living %K Aged %K Aged, 80 and over %K depression %K Female %K Health Promotion %K Health Status %K Humans %K Male %K Middle Aged %K Program Evaluation %K Regression Analysis %K Self Concept %K Volunteers %X

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.

%B Soc Sci Med %I 71 %V 71 %P 414-420 %8 2010 Jul %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/20510493?dopt=Abstract %3 20510493 %4 EDUCATION/academic achievement/Volunteering/Experience Corps/methodology/generational transfers %$ 23230 %R 10.1016/j.socscimed.2010.04.009 %0 Journal Article %J J Aging Health %D 2010 %T Health trajectories among older movers. %A Janet M Wilmoth %K Activities of Daily Living %K Age Factors %K Aged %K Aged, 80 and over %K Aging %K Female %K Health Status %K Humans %K Male %K Middle Aged %K Multivariate Analysis %K Regression Analysis %K Social Class %K Transients and Migrants %X

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.

%B J Aging Health %I 22 %V 22 %P 862-81 %8 2010 Oct %G eng %N 7 %1 http://www.ncbi.nlm.nih.gov/pubmed/20710006?dopt=Abstract %3 20710006 %4 Activities of Daily Living/Health/Migration/Health Care/Nursing Homes/Mobility/Employment %$ 24090 %R 10.1177/0898264310375985 %0 Journal Article %J Gerontologist %D 2010 %T Longitudinal changes in disabled husbands' and wives' receipt of care. %A Claire Noël-Miller %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Caregivers %K Disabled Persons %K Female %K Humans %K Long-term Care %K Longitudinal Studies %K Male %K Marriage %K Middle Aged %K Models, Theoretical %K Sex Factors %K Social Support %K Socioeconomic factors %K Spouses %K Surveys and Questionnaires %K Time Factors %X

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.

%B Gerontologist %I 50 %V 50 %P 681-93 %8 2010 Oct %G eng %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/20382664?dopt=Abstract %2 PMC2937250 %4 Activities of Daily Living/instrumental activities of daily living/DISABILITY/DISABILITY/Handicapped/Sex Differences/spousal care/Home Care Services/gender Differences %$ 23960 %R 10.1093/geront/gnq028 %0 Journal Article %J JAMA %D 2010 %T Long-term cognitive impairment and functional disability among survivors of severe sepsis. %A Theodore J Iwashyna %A E Wesley Ely %A Dylan M Smith %A Kenneth M. Langa %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Case-Control Studies %K Cognition Disorders %K Disabled Persons %K Female %K Health Status %K Hospitalization %K Humans %K Male %K Prospective Studies %K Sepsis %K Severity of Illness Index %K Survivors %K United States %X

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.

%B JAMA %I 304 %V 304 %P 1787-94 %8 2010 Oct 27 %G eng %U http://jama.ama-assn.org/content/304/16/1787.abstract %N 16 %1 http://www.ncbi.nlm.nih.gov/pubmed/20978258?dopt=Abstract %2 PMC3345288 %4 Sepsis/Cognitive psychology/Disability/Disability/Survivor/Inpatient care %$ 25210 %R 10.1001/jama.2010.1553 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2010 %T Military service and men's health trajectories in later life. %A Janet M Wilmoth %A Andrew S London %A Wendy M Parker %K Activities of Daily Living %K Aged %K Aging %K Health Status %K Humans %K Korean War %K Male %K Middle Aged %K Military Personnel %K Multivariate Analysis %K Racial Groups %K Self-Assessment %K Veterans %K Vietnam Conflict %K World War II %X

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.

%B J Gerontol B Psychol Sci Soc Sci %I 65B %V 65 %P 744-55 %8 2010 Nov %G eng %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/20864570?dopt=Abstract %2 PMC2954333 %4 Veterans: statistics/numerical/Models/Mens health/Age differences/MORTALITY %$ 24240 %R 10.1093/geronb/gbq072 %0 Journal Article %J Ann Epidemiol %D 2010 %T Neighborhood disadvantage and self-assessed health, disability, and depressive symptoms: longitudinal results from the health and retirement study. %A M. Maria Glymour %A Mujahid, Mahasin %A Wu, Qiong %A White, Kellee %A Tchetgen Tchetgen, Eric J %K Activities of Daily Living %K Age Factors %K Aged %K Confidence Intervals %K depression %K Disabled Persons %K Female %K Health Status Disparities %K Humans %K Incidence %K Logistic Models %K Longitudinal Studies %K Male %K Middle Aged %K Odds Ratio %K Poverty %K Residence Characteristics %K Risk %K Self-Assessment %K Socioeconomic factors %K Time Factors %X

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.

%B Ann Epidemiol %V 20 %P 856-61 %8 2010 Nov %G eng %N 11 %1 http://www.ncbi.nlm.nih.gov/pubmed/20933193?dopt=Abstract %R 10.1016/j.annepidem.2010.08.003 %0 Journal Article %J J Aging Health %D 2010 %T Obesity, physical activity, and depressive symptoms in a cohort of adults aged 51 to 61. %A Dianna D Carroll %A Heidi M Blanck %A Mary K. Serdula %A David R Brown %K Activities of Daily Living %K Age Factors %K Aging %K Chi-Square Distribution %K Cohort Studies %K Confidence Intervals %K depression %K Female %K Health Status %K Humans %K Logistic Models %K Male %K Middle Aged %K Motor Activity %K Multivariate Analysis %K Obesity %K Odds Ratio %K Psychometrics %K Self Report %K Sex Factors %K United States %X

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

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

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

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

%B J Aging Health %I 22 %V 22 %P 384-98 %8 2010 Apr %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/20164412?dopt=Abstract %3 20164412 %4 Physical Fitness/Health/Problems/Sex Differences/Males/depression/physical activity/obesity/aging/mental and emotional health problems %$ 21970 %R 10.1177/0898264309359421 %0 Journal Article %J J Am Geriatr Soc %D 2010 %T Prevalence of neuropsychiatric symptoms and their association with functional limitations in older adults in the United States: the aging, demographics, and memory study. %A Okura, Toru %A Brenda L Plassman %A David C Steffens %A David J Llewellyn %A Guy G Potter %A Kenneth M. Langa %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Behavioral Symptoms %K Cognition Disorders %K Cross-Sectional Studies %K Dementia %K Female %K Humans %K Male %K Mental Disorders %K Prevalence %K United States %X

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.

%B J Am Geriatr Soc %I 58 %V 58 %P 330-7 %8 2010 Feb %G eng %N 2 %L newpubs20100519_Okura.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/20374406?dopt=Abstract %2 PMC2875937 %4 dementia/functional limitations/Functional Assessment/depression/Neuropsychiatric symptoms %$ 21910 %R 10.1111/j.1532-5415.2009.02680.x %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2010 %T Spousal loss, children, and the risk of nursing home admission. %A Claire Noël-Miller %K Activities of Daily Living %K Adult children %K Aged %K Aged, 80 and over %K Aging %K Bereavement %K Caregivers %K Family Characteristics %K Female %K Gender Identity %K Homes for the Aged %K Humans %K Long-term Care %K Male %K Nursing homes %K Parent-Child Relations %K Patient Admission %K Proportional Hazards Models %K Social Support %K Spouses %K Utilization Review %X

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.

%B J Gerontol B Psychol Sci Soc Sci %I 65B %V 65B %P 370-80 %8 2010 May %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/20371551?dopt=Abstract %2 PMC2853605 %4 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 %$ 22690 %R 10.1093/geronb/gbq020 %0 Journal Article %J J Aging Health %D 2010 %T Trading years for perfect health: results from the health and retirement study. %A Liat Ayalon %A King-Kallimanis, Bellinda L %K Activities of Daily Living %K Age Factors %K Aged %K Aged, 80 and over %K Aging %K Community Participation %K Confidence Intervals %K Culture %K Epidemiologic Methods %K ethnicity %K Female %K Health Surveys %K Humans %K Longevity %K Male %K Multivariate Analysis %K Psychometrics %K Retirement %K Self Report %K Surveys and Questionnaires %K Time Factors %X

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.

%B J Aging Health %I 22 %V 22 %P 1184-97 %8 2010 Dec %G eng %N 8 %1 http://www.ncbi.nlm.nih.gov/pubmed/20660638?dopt=Abstract %3 20660638 %4 SELF-RATED HEALTH/demographics/GENDER/imperfect health %$ 22960 %R 10.1177/0898264310371980 %0 Journal Article %J Am J Epidemiol %D 2009 %T The aftermath of hip fracture: discharge placement, functional status change, and mortality. %A Suzanne E Bentler %A Li Liu %A Maksym Obrizan %A Elizabeth A Cook %A Kara B Wright %A John F Geweke %A Elizabeth A Chrischilles %A Claire E Pavlik %A Robert B Wallace %A Robert L. Ohsfeldt %A Michael P Jones %A Gary E Rosenthal %A Frederic D Wolinsky %K Activities of Daily Living %K Aged %K Aged, 80 and over %K depression %K Female %K Health Status %K Health Status Indicators %K Hip Fractures %K Humans %K Interviews as Topic %K Iowa %K Length of Stay %K Logistic Models %K Medicare %K Patient Discharge %K Prospective Studies %K Psychometrics %K Socioeconomic factors %K Time Factors %K Treatment Outcome %K United States %X

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.

%B Am J Epidemiol %I 170 %V 170 %P 1290-9 %8 2009 Nov 15 %G eng %N 10 %L newpubs20091202_HipFracture.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/19808632?dopt=Abstract %2 PMC2781759 %4 Functional Status/Mortality/Nursing Homes %$ 21300 %R 10.1093/aje/kwp266 %0 Journal Article %J Med Care %D 2009 %T Changes in functional status among persons over age sixty-five undergoing total knee arthroplasty. %A Frank A Sloan %A Ruiz, David %A Alyssa C Platt %K Activities of Daily Living %K Aged %K Arthroplasty, Replacement, Knee %K Attitude to Health %K Geriatric Assessment %K Health Care Surveys %K Health Status %K Health Surveys %K Humans %K Insurance Claim Reporting %K Logistic Models %K Longitudinal Studies %K Medicare %K Mobility Limitation %K Multivariate Analysis %K Muscle Weakness %K Osteoarthritis, Knee %K pain %K Sensitivity and Specificity %K Surveys and Questionnaires %K Treatment Outcome %K United States %X

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.

%B Med Care %I 47 %V 47 %P 742-8 %8 2009 Jul %G eng %N 7 %L newpubs20100921_Sloan.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/19536027?dopt=Abstract %3 19536027 %4 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 %$ 23050 %R 10.1097/MLR.0b013e31819a5ae3 %0 Journal Article %J Soc Sci Med %D 2009 %T Childhood socioeconomic status and racial differences in disability: evidence from the Health and Retirement Study (1998-2006). %A Mary E Bowen %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Black or African American %K Disabled Persons %K Female %K Health Behavior %K Humans %K Male %K Middle Aged %K Models, Statistical %K Prejudice %K Prospective Studies %K Racial Groups %K Social Justice %K Socioeconomic factors %K Statistics as Topic %K United States %K White People %X

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.

%B Soc Sci Med %I 69 %V 69 %P 433-41 %8 2009 Aug %G eng %N 3 %L newpubs20090908_BowenSSM.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/19541400?dopt=Abstract %3 19541400 %4 childhood conditions/socioeconomic status/DISABILITY/DISABILITY/Racial Differences %$ 20690 %R 10.1016/j.socscimed.2009.06.006 %0 Journal Article %J Alzheimers Dement %D 2009 %T Cognitive performance and informant reports in the diagnosis of cognitive impairment and dementia in African Americans and whites. %A Guy G Potter %A Brenda L Plassman %A James R Burke %A Mohammed U Kabeto %A Kenneth M. Langa %A David J Llewellyn %A Mary A M Rogers %A David C Steffens %K Activities of Daily Living %K Age of Onset %K Aged %K Aged, 80 and over %K Black or African American %K Caregivers %K Cognition Disorders %K Cohort Studies %K Culture %K Dementia %K Disability Evaluation %K Female %K Geriatric Assessment %K Health Surveys %K Humans %K Male %K Neuropsychological tests %K Observer Variation %K Population Surveillance %K Predictive Value of Tests %K Prevalence %K Psychiatric Status Rating Scales %K Psychometrics %K Registries %K Sensitivity and Specificity %K Surveys and Questionnaires %K White People %X

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.

%B Alzheimers Dement %I 5 %V 5 %P 445-53 %8 2009 Nov %G eng %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/19896583?dopt=Abstract %2 PMC2805266 %4 CERAD/IQCODE/Cognitive decline/Dementia/African American %$ 25240 %R 10.1016/j.jalz.2009.04.1234 %0 Journal Article %J J Am Geriatr Soc %D 2009 %T Comparing models of frailty: the Health and Retirement Study. %A Christine T Cigolle %A Mary Beth Ofstedal %A Zhiyi Tian %A Caroline S Blaum %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Chronic disease %K Cross-Sectional Studies %K Demography %K Disability Evaluation %K Frail Elderly %K Geriatric Assessment %K Health Surveys %K Humans %K Interviews as Topic %K Logistic Models %K Models, Theoretical %K United States %X

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.

%B J Am Geriatr Soc %I 57 %V 57 %P 830-9 %8 2009 May %G eng %N 5 %L newpubs20090908_Cigolle_etal.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/19453306?dopt=Abstract %3 19453306 %4 FRAILTY/Models, Theoretical %$ 20440 %R 10.1111/j.1532-5415.2009.02225.x %0 Journal Article %J Psychol Sci %D 2009 %T Compensatory conscientiousness and health in older couples. %A Brent W Roberts %A Jacqui Smith %A Joshua J Jackson %A Edmonds, Grant %K Activities of Daily Living %K Adult %K Aged %K Aged, 80 and over %K Aging %K Conscience %K Female %K Health Status %K Humans %K Longevity %K Longitudinal Studies %K Male %K Middle Aged %K Neurotic Disorders %K Personality Inventory %K Social Conformity %K Spouses %X

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.

%B Psychol Sci %I 20 %V 20 %P 553-9 %8 2009 May %G eng %N 5 %L newpubs20090908_Roberts_etal.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/19476589?dopt=Abstract %2 PMC2698025 %4 aging/Couples/Personal relationships %$ 20450 %R 10.1111/j.1467-9280.2009.02339.x %0 Journal Article %J J Am Geriatr Soc %D 2009 %T The co-occurrence of chronic diseases and geriatric syndromes: the health and retirement study. %A Pearl G. Lee %A Christine T Cigolle %A Caroline S Blaum %K Accidental Falls %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Angina Pectoris %K Comorbidity %K Cross-Sectional Studies %K Diabetes Mellitus, Type 2 %K Female %K Geriatric Assessment %K Health Surveys %K Heart Failure %K Humans %K Male %K Myocardial Infarction %K Sick Role %K Syndrome %K United States %K Urinary incontinence %X

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.

%B J Am Geriatr Soc %I 57 %V 57 %P 511-6 %8 2009 Mar %G eng %N 3 %L newpubs20090908/LeeJAG.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/19187416?dopt=Abstract %3 19187416 %4 COMORBIDITY/Chronic Disease/Diabetes Mellitus/Heart Diseases %$ 20340 %R 10.1111/j.1532-5415.2008.02150.x %0 Journal Article %J Health Econ %D 2009 %T Does job loss cause ill health? %A Salm, Martin %K Activities of Daily Living %K Age Factors %K Cohort Studies %K Cross-Sectional Studies %K Employment %K Female %K Health Status %K Humans %K Male %K Mental Health %K Middle Aged %K Sex Factors %K Smoking %K Socioeconomic factors %X

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

%B Health Econ %I 18 %V 18 %P 1075-89 %8 2009 Sep %G eng %N 9 %L newpubs20090908_Salm.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/19634153?dopt=Abstract %3 19634153 %4 Job Loss/Unemployment/health status %$ 20920 %R 10.1002/hec.1537 %0 Journal Article %J J Genet Psychol %D 2009 %T Doing well: a SEM analysis of the relationships between various activities of daily living and geriatric well-being. %A James A Katt %A Speranza, Linda %A Shore, Wendy %A Karen H. Saenz %A E. Lea Witta %K Activities of Daily Living %K Adaptation, Psychological %K Aged %K Cognition %K depression %K Humans %K Models, Psychological %K Socioeconomic factors %K United States %X

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.

%B J Genet Psychol %I 170 %V 170 %P 213-26 %8 2009 Sep %G eng %N 3 %L newpubs20100129_Katt_etal.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/19928315?dopt=Abstract %3 19928315 %4 ADL and IADL Impairments/Cognitive Function/Well Being %$ 21490 %R 10.1080/00221320903218190 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2009 %T Is the effect of reported physical activity on disability mediated by cognitive performance in white and african american older adults? %A Mihaela A. Popa %A Sandra L Reynolds %A Brent J. Small %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Black or African American %K Cognition Disorders %K Cohort Studies %K Disability Evaluation %K Exercise %K Female %K Follow-Up Studies %K Health Status Disparities %K Humans %K Male %K Motor Activity %K Neuropsychological tests %K Socioeconomic factors %K United States %K White People %X

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.

%B J Gerontol B Psychol Sci Soc Sci %I 64 %V 64 %P 4-13 %8 2009 Jan %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/19196688?dopt=Abstract %2 PMC2654991 %4 SELF-RATED HEALTH/DISABILITY/DISABILITY/Cognitive Functioning %$ 19750 %R 10.1093/geronb/gbn030 %0 Journal Article %J J Am Geriatr Soc %D 2009 %T Estimating the quantity and economic value of family caregiving for community-dwelling older persons in the last year of life. %A Rhee, YongJoo %A Howard B Degenholtz %A Anthony T. Lo Sasso %A Linda L Emanuel %K Activities of Daily Living %K Adult %K Aged %K Aged, 80 and over %K Caregivers %K Costs and Cost Analysis %K Disability Evaluation %K Female %K Health Surveys %K Home Health Aides %K Home Nursing %K Humans %K Independent Living %K Male %K Middle Aged %K Retrospective Studies %K Terminal Care %K United States %X

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).

%B J Am Geriatr Soc %I 57 %V 57 %P 1654-9 %8 2009 Sep %G eng %N 9 %L newpubs20090908_Rhee_etal.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/19682115?dopt=Abstract %3 19682115 %4 Caregivers/Costs and Cost Analysis %$ 20940 %R 10.1111/j.1532-5415.2009.02390.x %0 Journal Article %J Soc Work Health Care %D 2009 %T 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. %A Cai, Qian %A J. Warren Salmon %A Mark E. Rodgers %K Activities of Daily Living %K Age Factors %K Aged %K Aged, 80 and over %K Female %K Geriatric Assessment %K Health Status %K Homes for the Aged %K Humans %K Logistic Models %K Male %K Mental Health %K Nursing homes %K Proportional Hazards Models %K Risk Factors %K Sex Factors %K Social work %K Socioeconomic factors %K United States %X

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.

%B Soc Work Health Care %I 48 %V 48 %P 154-68 %8 2009 %G eng %N 2 %L newpubs20090908/Cai_etal.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/19197772?dopt=Abstract %3 19197772 %4 Nursing Homes/Old Age/SELF-RATED HEALTH/ADL and IADL Impairments %$ 20290 %R 10.1080/00981380802580588 %0 Journal Article %J J Aging Health %D 2009 %T Fall risk in older adults: roles of self-rated vision, home modifications, and limb function. %A Bernard A Steinman %A Pynoos, Jon %A Anna Q D Nguyen %K Accidental Falls %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Black or African American %K Disabled Persons %K Educational Status %K Female %K Health Status %K Health Surveys %K Humans %K Logistic Models %K Longitudinal Studies %K Male %K Musculoskeletal Physiological Phenomena %K Risk %K Risk Factors %K Self-Assessment %K Self-Help Devices %K Surveys and Questionnaires %K Vision, Low %K Visual Acuity %K White People %X

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.

%B J Aging Health %I 21 %V 21 %P 655-76 %8 2009 Aug %G eng %N 5 %L newpubs20090908_Steinman.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/19494362?dopt=Abstract %3 19494362 %4 Home Modifications/exercise/Visually Impaired Persons/Falls/risk factors %$ 20680 %R 10.1177/0898264309338295 %0 Journal Article %J J Am Geriatr Soc %D 2009 %T Functional limitations, socioeconomic status, and all-cause mortality in moderate alcohol drinkers. %A Sei J. Lee %A Rebecca L. Sudore %A Brie A Williams %A Lindquist, Karla %A Helen L. Chen %A Kenneth E Covinsky %K Activities of Daily Living %K Aged %K Alcohol Drinking %K Comorbidity %K Education %K Female %K Humans %K Income %K Male %K Obesity %K Risk Factors %K Sex Factors %K Smoking %K Socioeconomic factors %X

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.

%B J Am Geriatr Soc %I 57 %V 57 %P 955-62 %8 2009 Jun %G eng %N 6 %L newpubs20090908_Lee_etal.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/19473456?dopt=Abstract %2 PMC2847409 %4 Alcohol Drinking/socioeconomic status/ADL and IADL Impairments/Mobility/Survival Analysis %$ 20510 %R 10.1111/j.1532-5415.2009.02184.x %0 Journal Article %J J Am Geriatr Soc %D 2009 %T Pain, functional limitations, and aging. %A Kenneth E Covinsky %A Lindquist, Karla %A Dorothy D Dunlop %A Yelin, Edward %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Aging %K Comorbidity %K Cross-Sectional Studies %K Disability Evaluation %K Female %K Geriatric Assessment %K Health Behavior %K Health Surveys %K Humans %K Life Style %K Male %K Middle Aged %K Mobility Limitation %K pain %K Pain Measurement %K Quality of Life %K Risk Factors %X

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.

%B J Am Geriatr Soc %I 57 %V 57 %P 1556-61 %8 2009 Sep %G eng %N 9 %L newpubs20090908_Covinsky.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/19682122?dopt=Abstract %2 PMC2925684 %4 Physical Activity/ADL and IADL Impairments/Mobility %$ 20950 %R 10.1111/j.1532-5415.2009.02388.x %0 Journal Article %J Obesity (Silver Spring) %D 2009 %T Smoking kills, obesity disables: a multistate approach of the US Health and Retirement Survey. %A Mieke Reuser %A Luc G Bonneux %A Frans J Willekens %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Body Mass Index %K Disability Evaluation %K Educational Status %K Female %K Health Surveys %K Humans %K Life Expectancy %K Life Tables %K Male %K Middle Aged %K Obesity %K Proportional Hazards Models %K Prospective Studies %K Smoking %K United States %K White People %X

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.

%B Obesity (Silver Spring) %I 17 %V 17 %P 783-9 %8 2009 Apr %G eng %N 4 %L newpubs20100129 %1 http://www.ncbi.nlm.nih.gov/pubmed/19165165?dopt=Abstract %3 19165165 %4 Obesity/Smoking/Body Mass Index/DISABILITY/DISABILITY/Mortality %$ 21690 %R 10.1038/oby.2008.640 %0 Journal Article %J J Aging Health %D 2008 %T The association between low vision and function. %A Berger, Sue %A Frank Porell %K Activities of Daily Living %K Aged %K Aging %K Disability Evaluation %K Geriatric Assessment %K Humans %K International Classification of Diseases %K Logistic Models %K Vision, Low %K Visual Acuity %X

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.

%B J Aging Health %I 20 %V 20 %P 504-25 %8 2008 Aug %G eng %N 5 %L newpubs20080822_Berger_Porell %1 http://www.ncbi.nlm.nih.gov/pubmed/18436856?dopt=Abstract %3 18436856 %4 ADL and IADL Impairments/Visually Impaired Persons %$ 19180 %R 10.1177/0898264308317534 %0 Journal Article %J Am J Public Health %D 2008 %T Chronic conditions and mortality among the oldest old. %A Sei J. Lee %A Alan S Go %A Lindquist, Karla %A Bertenthal, Daniel %A Kenneth E Covinsky %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Chronic disease %K Female %K Health Behavior %K Health Status %K Humans %K Male %K Middle Aged %K Models, Statistical %K Predictive Value of Tests %K Proportional Hazards Models %K Reproducibility of Results %K Risk Adjustment %K Severity of Illness Index %K Socioeconomic factors %K Survival Analysis %K United States %X

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.

%B Am J Public Health %I 98 %V 98 %P 1209-14 %8 2008 Jul %G eng %N 7 %L newpubs20080822_AJPH1209 %1 http://www.ncbi.nlm.nih.gov/pubmed/18511714?dopt=Abstract %2 PMC2424085 %4 Chronic Disease/Mortality/Age Factors %$ 19110 %R 10.2105/AJPH.2007.130955 %0 Journal Article %J Soc Sci Med %D 2008 %T Declines in late-life disability: the role of early- and mid-life factors. %A Vicki A Freedman %A Linda G Martin %A Robert F. Schoeni %A Jennifer C. Cornman %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Aging %K Chronic disease %K Cross-Sectional Studies %K Disabled Persons %K Female %K Frail Elderly %K Health Behavior %K Health Status %K Health Surveys %K Humans %K Life Style %K Logistic Models %K Male %K Morbidity %K Population Surveillance %K Socioeconomic factors %K United States %X

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.

%B Soc Sci Med %I 66 %V 66 %P 1588-602 %8 2008 Apr %G eng %N 7 %L newpubs20080411_SocSciMed.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/18222580?dopt=Abstract %2 PMC2408829 %4 aging/DISABILITY/DISABILITY/Health Risk %$ 18830 %R 10.1016/j.socscimed.2007.11.037 %0 Journal Article %J J Gen Intern Med %D 2008 %T Degree of disability and patterns of caregiving among older Americans with congestive heart failure. %A Tanya R Gure %A Mohammed U Kabeto %A Caroline S Blaum %A Kenneth M. Langa %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Caregivers %K Coronary Disease %K Cross-Sectional Studies %K Disabled Persons %K Female %K Health Surveys %K Heart Failure %K Hospitalization %K Humans %K Male %K Nursing homes %K United States %X

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.

%B J Gen Intern Med %I 23 %V 23 %P 70-6 %8 2008 Jan %G eng %N 1 %L newpubs20071203_Gure_JGIM.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/18030537?dopt=Abstract %2 PMC2173919 %4 Heart Diseases/DISABILITY/DISABILITY/Caregiving %$ 18210 %R 10.1007/s11606-007-0456-1 %0 Journal Article %J Health Serv Res %D 2008 %T Depression and retirement in late middle-aged U.S. workers. %A Jalpa A Doshi %A Cen, Liyi %A Daniel Polsky %K Activities of Daily Living %K Comorbidity %K depression %K Employment %K Female %K Humans %K Male %K Middle Aged %K Retirement %K Severity of Illness Index %K Sex Factors %K Socioeconomic factors %K United States %X

OBJECTIVE: To determine whether late middle-aged U.S. workers with depression are at an increased risk for retirement.

DATA SOURCE: Six biennial waves (1992-2002) of the Health and Retirement Study, a nationally representative panel survey of noninstitutionalized 51-61-year-olds and their spouses started in 1992.

STUDY DESIGN: Workers aged 53-58 years in 1994 were followed every 2 years thereafter, through 2002. Depression was coded as lagged time-dependent variables measuring active depression and severity of depression. The main outcome variable was a transition to retirement which was measured using two distinct definitions to capture different stages in the retirement process: (1) Retirement was defined as a transition out of the labor force in the sample of all labor force participants (N=2,853); (2) In addition a transition out of full time work was used as the retirement definition in the subset of labor force participants who were full time workers (N=2,288).

PRINCIPAL FINDINGS: In the sample of all labor force participants, the presence of active depression significantly increased the hazard of retirement in both late middle-aged men (adjusted OR: 1.37 [95 percent CI 1.05, 1.80]) and women (adjusted OR: 1.40 [95 percent CI 1.10, 1.78]). For women, subthreshold depression was also a significant predictor of retirement. In the sample of full time workers, the relationship between depression and retirement was considerably weaker for women yet remained strong for men.

CONCLUSIONS: Depression and depressive symptoms were significantly associated with retirement in late middle-aged U.S. workers. Policymakers must consider the potentially adverse impact of these labor market outcomes when estimating the cost of untreated depression and evaluating the value of interventions to improve the diagnosis and treatment of depression.

%B Health Serv Res %I 43 %V 43 %P 693-713 %8 2008 Apr %G eng %N 2 %L newpubs20080528_HlthServRes %1 http://www.ncbi.nlm.nih.gov/pubmed/18370974?dopt=Abstract %2 PMC2442377 %4 Depression/Mental health/RETIREMENT/risk factors/Public health/Labor Market %$ 18960 %R 10.1111/j.1475-6773.2007.00782.x %0 Journal Article %J J Am Geriatr Soc %D 2008 %T Effect of arthritis in middle age on older-age functioning. %A Kenneth E Covinsky %A Lindquist, Karla %A Dorothy D Dunlop %A Thomas M Gill %A Yelin, Edward %K Activities of Daily Living %K Arthritis %K Chronic disease %K Confidence Intervals %K Female %K Follow-Up Studies %K Humans %K Male %K Middle Aged %K Mobility Limitation %K Prognosis %K Prospective Studies %K Risk Factors %K Severity of Illness Index %K Surveys and Questionnaires %K Time Factors %K Walking %X

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

DESIGN: Prospective longitudinal study.

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

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

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

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

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

%B J Am Geriatr Soc %I 56 %V 56 %P 23-8 %8 2008 Jan %G eng %N 1 %L newpubs20080229_Covinsky_etal.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/18184204?dopt=Abstract %2 PMC2875135 %4 arthritis/Activities of Daily Living/Mobility %$ 18620 %R 10.1111/j.1532-5415.2007.01511.x %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2008 %T Gender differences in functional status in middle and older age: are there any age variations? %A Jersey Liang %A Joan M. Bennett %A Benjamin A Shaw %A Ana R Quiñones %A Wen Ye %A Xiao Xu %A Mary Beth Ofstedal %K Activities of Daily Living %K Age Factors %K Aged %K Aged, 80 and over %K Disabled Persons %K Female %K Health Status %K Humans %K Linear Models %K Longitudinal Studies %K Male %K Middle Aged %K Sex Factors %K United States %X

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.

%B J Gerontol B Psychol Sci Soc Sci %I 63B %V 63 %P S282-92 %8 2008 Sep %G eng %N 5 %L newpubs20081205_Liang_etal.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/18818448?dopt=Abstract %2 PMC3454348 %4 GENDER-DIFFERENCES/Health Physical %$ 19500 %R 10.1093/geronb/63.5.s282 %0 Journal Article %J J Aging Health %D 2008 %T Impact of functional limitations and medical comorbidity on subsequent weight changes and increased depressive symptoms in older adults. %A Valerie L Forman-Hoffman %A Kelly K Richardson %A Jon W. Yankey %A Stephen L Hillis %A Robert B Wallace %A Frederic D Wolinsky %K Activities of Daily Living %K Age Factors %K Arthritis %K Comorbidity %K depression %K Depressive Disorder %K Diabetes Complications %K Diabetes Mellitus %K Disabled Persons %K Female %K Health Surveys %K Heart Diseases %K Humans %K Hypertension %K Lung Diseases %K Male %K Mental Disorders %K Middle Aged %K Neoplasms %K Obesity %K Risk Factors %K Sex Factors %K Stroke %K United States %K Weight Gain %X

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

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

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

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

%B J Aging Health %I 20 %V 20 %P 367-84 %8 2008 Jun %G eng %N 4 %L newpubs20080528_JnlAgingHlth.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/18390865?dopt=Abstract %3 18390865 %4 Weight/Depressive Symptoms/COMORBIDITY/Health Physical %$ 18870 %R 10.1177/0898264308315851 %0 Journal Article %J J Women Aging %D 2008 %T Life with and without heart disease among women and men over 50. %A Eileen M. Crimmins %A Mark D Hayward %A Ueda, Hiroshi %A Saito, Yasuhiko %A Jung K Kim %K Activities of Daily Living %K Aged %K Female %K Health Status %K Heart Diseases %K Humans %K Life Expectancy %K Male %K Middle Aged %K Myocardial Infarction %K Patient Education as Topic %K Prejudice %K Risk Factors %K United States %K Women's Health %K Women's Health Services %X

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.

%B J Women Aging %I 20 %V 20 %P 5-19 %8 2008 %G eng %N 1-2 %L newpubs20101112_Crimmins2.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/18581697?dopt=Abstract %2 PMC2994551 %4 Activities of Daily Living/health Status/Heart disease/life Expectancy/EDUCATION/risk factors/WOMEN %$ 23780 %R 10.1300/j074v20n01_02 %0 Journal Article %J J Aging Health %D 2008 %T Parent caregiving choices of middle-generation Blacks and Whites in the United States. %A Shelley I. White-Means %A Rose M. Rubin %K Activities of Daily Living %K Black People %K Caregivers %K Employment %K Family Characteristics %K Financial Support %K Humans %K Intergenerational Relations %K Logistic Models %K Parent-Child Relations %K Parents %K Siblings %K Socioeconomic factors %K United States %K White People %X

OBJECTIVE: This study compares how middle-generation caregivers and non-caregivers differ by race and explores racial differences in activities of daily living (ADL), instrumental activities of daily living (IADL), and financial assistance that middle-generation caregivers provide for their parents.

METHOD: Using 2000 Health and Retirement Study data, racially stratified descriptive analyses and logistic regression models for ADL, IADL, and financial assistance are presented.

RESULTS: Parental need and race influence support, with similar patterns of Black and White ADL support, but racial differences in IADL and financial support. Having more children motivates Whites to increase IADL support and reduce financial support; more children decreases Blacks' IADL support. Sibling caregiver networks influence IADL and financial support in ways that vary by race. The number employed is a key determinant for Blacks for all support, but only influences White ADL support.

DISCUSSION: The findings of this article indicate the importance of sample stratification by race and that employment or other subsidies may aid the expansion of caregiving by middle-generation adults.

%B J Aging Health %I 20 %V 20 %P 560-82 %8 2008 Aug %G eng %N 5 %L newpubs20080822_JnlAgingHlth %1 http://www.ncbi.nlm.nih.gov/pubmed/18448685?dopt=Abstract %3 18448685 %4 Caregivers/sociodemographic differences/sociodemographic differences/Racial Differences/ADL and IADL Impairments/Financial Support %$ 19170 %R 10.1177/0898264308317576 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2008 %T Productive activities and psychological well-being among older adults. %A Hao, Yanni %K Activities of Daily Living %K Aged %K Cohort Studies %K depression %K Employment %K Female %K Health Status %K Humans %K Male %K Mental Health %K Middle Aged %K Models, Psychological %K Psychological Theory %K Psychomotor Performance %K Quality of Life %K Social Environment %K Volunteers %X

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.

%B J Gerontol B Psychol Sci Soc Sci %I 63B %V 63 %P S64-72 %8 2008 Mar %G eng %N 2 %L newpubs20080528_JoG63_2.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/18441271?dopt=Abstract %3 18441271 %4 Work/Work, volunteer/Mental health %$ 18930 %R 10.1093/geronb/63.2.s64 %0 Journal Article %J Arch Phys Med Rehabil %D 2008 %T Racial and ethnic differences in activities of daily living disability among the elderly: the case of Spanish speakers. %A Manasi A. Tirodkar %A Song, Jing %A Rowland W Chang %A Dorothy D Dunlop %A Huan J. Chang %K Acculturation %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Disability Evaluation %K Disabled Persons %K Female %K Geriatric Assessment %K Health Status Indicators %K Hispanic or Latino %K Humans %K Male %K Middle Aged %X

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.

%B Arch Phys Med Rehabil %I 89 %V 89 %P 1262-6 %8 2008 Jul %G eng %N 7 %L newpubs20090908_Tirodkar.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/18534555?dopt=Abstract %2 PMC2740915 %4 ADL and IADL Impairments/hispanics/DISABILITY/DISABILITY %$ 21080 %R 10.1016/j.apmr.2007.11.042 %0 Journal Article %J Gerontologist %D 2008 %T Racial/ethnic differences in the relationship between the use of health care services and functional disability: the health and retirement study (1992-2004). %A Mary E Bowen %A Hector M González %K Activities of Daily Living %K Disabled Persons %K ethnicity %K Female %K Health Services %K Health Status Disparities %K Healthcare Disparities %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Mobility Limitation %K Racial Groups %K Retirement %X

PURPOSE: The purpose of this study was to examine racial/ethnic differences in the relationship between functional disability and the use of health care services in a nationally representative sample of older adults by using the Andersen behavioral model of health services utilization.

DESIGN AND METHODS: The study used 12 years of longitudinal data from the Health and Retirement Study (1992-2004), a nationally representative sample of community-dwelling adults older than 50 in 1992 (N = 8,947). Nonlinear multilevel models used self-reported health care service utilization (physician visits and hospital admissions) to predict racial/ethnic differences in disability (activities of daily living and mobility limitations). The models also evaluated the roles of other predisposing (age and gender), health need (medical conditions and self-rated health), and enabling factors (health insurance, education, income, and wealth).

RESULTS: Blacks and Latinos utilizing physician visits and hospital admissions were associated with significantly more activity of daily living disability than Whites (p <.001). Blacks utilizing physician visits (p <.001) and hospital admissions (p <.05) and Latinos utilizing hospital admissions (p <.05) were associated with more mobility disability than Whites. Other predisposing, health need, and enabling factors did not account for these racial/ethnic differences.

IMPLICATIONS: Nationally, health care use for Blacks and Latinos was associated with more disabilities than for Whites after we accounted for predisposing, health need, and enabling factors. The findings suggest that improving health care quality for all Americans may supersede equal access to health care for reducing ethnic and racial disparities in functional health.

%B Gerontologist %I 48 %V 48 %P 659-67 %8 2008 Oct %G eng %N 5 %L newpubs20081205_Bowen-Gonzales.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/18981282?dopt=Abstract %2 PMC2885453 %4 DISABILITY/DISABILITY/Health Care Utilization/Racial Differences %$ 19550 %R 10.1093/geront/48.5.659 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2008 %T Spousal caregiving in late midlife versus older ages: implications of work and family obligations. %A Julie C Lima %A Susan M Allen %A Goldscheider, Frances %A Intrator, Orna %K Activities of Daily Living %K Age Factors %K Aged %K Aged, 80 and over %K Caregivers %K Employment %K Family Relations %K Female %K Gender Identity %K Health Surveys %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Mobility Limitation %K Spouses %K Time Factors %K United States %X

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.

%B J Gerontol B Psychol Sci Soc Sci %I 63B %V 63 %P S229-S238 %8 2008 Jul %G eng %N 4 %L newpubs20081014_Lima-etal.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/18689772?dopt=Abstract %3 18689772 %4 ADL and IADL Impairments/Marital Status/Caregiving %$ 19390 %R 10.1093/geronb/63.4.s229 %0 Journal Article %J Health Soc Work %D 2007 %T Age group differences in depressive symptoms among older adults with functional impairments. %A Namkee G Choi %A Kim, Johnny S. %K Activities of Daily Living %K Age Factors %K Aged %K Aged, 80 and over %K Demography %K depression %K Disabled Persons %K Female %K Health Status %K Humans %K Interviews as Topic %K Logistic Models %K Male %K Middle Aged %K United States %X

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.

%B Health Soc Work %I 32 %V 32 %P 177-88 %8 2007 Aug %G eng %N 3 %L newpubs20071002_ChoiKim.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/17896674?dopt=Abstract %4 Age Factors/Depression/ADL and IADL Impairments %$ 17930 %R 10.1093/hsw/32.3.177 %0 Journal Article %J J Aging Health %D 2007 %T Does more health care improve health among older adults? A longitudinal analysis. %A Ezra Golberstein %A Jersey Liang %A A. R. Quinones %A Frederic D Wolinsky %K Activities of Daily Living %K Aged %K Health Services %K Health Services for the Aged %K Health Status %K Humans %K Longitudinal Studies %K United States %X

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.

%B J Aging Health %I 19 %V 19 %P 888-906 %8 2007 Dec %G eng %N 6 %L newpubs20080229_888.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/18165287?dopt=Abstract %4 Health Services Research/Health Care Utilization/health status/ADL and IADL Impairments %$ 18660 %R 10.1177/0898264307308338 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2007 %T Educational disparities in the prevalence and consequence of physical vulnerability. %A Daniel O. Clark %A Timothy E. Stump %A Douglas K Miller %A Long, J. Scott %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Chronic disease %K Cohort Studies %K Cross-Sectional Studies %K Educational Status %K Female %K Geriatric Assessment %K Health Surveys %K Humans %K Male %K Mobility Limitation %K Risk Factors %K Socioeconomic factors %K Survival Analysis %K United States %X

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.

%B J Gerontol B Psychol Sci Soc Sci %I 62B %V 62 %P S193-7 %8 2007 May %G eng %N 3 %L newpubs20070611_EdDisparities.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/17507595?dopt=Abstract %4 Mortality/Physical Vulnerability/Education/ADULT HEALTH/DISABILITY/DISABILITY %$ 17800 %R 10.1093/geronb/62.3.s193 %0 Journal Article %J Ann Intern Med %D 2007 %T Geriatric conditions and disability: the Health and Retirement Study. %A Christine T Cigolle %A Kenneth M. Langa %A Mohammed U Kabeto %A Zhiyi Tian %A Caroline S Blaum %K Accidental Falls %K Activities of Daily Living %K Age Factors %K Aged %K Aged, 80 and over %K Body Mass Index %K Chronic disease %K Cognition Disorders %K Comorbidity %K Cross-Sectional Studies %K Disability Evaluation %K Dizziness %K Female %K Geriatric Assessment %K Geriatrics %K Hearing Disorders %K Humans %K Male %K Prevalence %K Retirement %K Urinary incontinence %K Vision Disorders %X

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.

%B Ann Intern Med %I 147 %V 147 %P 156-64 %8 2007 Aug 07 %G eng %N 3 %L newpubs20071002_Cigolle_etal.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/17679703?dopt=Abstract %4 ADL and IADL Impairments/Geriatrics/Chronic Disease/Health care %$ 18010 %R 10.7326/0003-4819-147-3-200708070-00004 %0 Journal Article %J J Gerontol Nurs %D 2007 %T Informal caregiving and Body Mass Index among older adults. %A Kristi Rahrig Jenkins %A Mohammed U Kabeto %A Fultz, Nancy H. %A Kenneth M. Langa %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Body Mass Index %K Body Weight %K Caregivers %K Female %K Geriatric Assessment %K Humans %K Male %K Social Class %X

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.

%B J Gerontol Nurs %I 33 %V 33 %P 42-51 %8 2007 Apr %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/17436868?dopt=Abstract %4 Caregiving/Body Mass Index/Obesity %$ 17390 %R 10.3928/00989134-20070401-06 %0 Journal Article %J J Pain %D 2007 %T Pain in aging community-dwelling adults in the United States: non-Hispanic whites, non-Hispanic blacks, and Hispanics. %A Reyes-Gibby, Cielito C. %A Aday, Lu Ann %A Todd, Knox H. %A Cleeland, Charles S. %A Anderson, Karen O. %K Activities of Daily Living %K Age Factors %K Aged %K Aged, 80 and over %K Aging %K Black People %K Chronic disease %K Data collection %K ethnicity %K Female %K Hispanic or Latino %K Humans %K Insurance, Health %K Logistic Models %K Male %K Middle Aged %K pain %K Pain Measurement %K Population %K Socioeconomic factors %K United States %K White People %X

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.

%B J Pain %I 8 %V 8 %P 75-84 %8 2007 Jan %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/16949874?dopt=Abstract %4 Health Care/Racial Differences/Ethnicity %$ 17190 %R 10.1016/j.jpain.2006.06.002 %0 Journal Article %J Am J Public Health %D 2007 %T Racial/ethnic differences in the development of disability among older adults. %A Dorothy D Dunlop %A Song, Jing %A Larry M Manheim %A Daviglus, Martha L. %A Rowland W Chang %K Activities of Daily Living %K Aged %K Black or African American %K Disabled Persons %K Female %K Health Behavior %K Health Status Disparities %K Health Surveys %K Hispanic or Latino %K Humans %K Male %K Prevalence %K Proportional Hazards Models %K Prospective Studies %K Risk %K Socioeconomic factors %K Survival Analysis %K United States %K White People %X

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.

%B Am J Public Health %I 97 %V 97 %P 2209-15 %8 2007 Dec %G eng %N 12 %1 http://www.ncbi.nlm.nih.gov/pubmed/17971548?dopt=Abstract %4 aging/Chronic Disease/DISABILITY/DISABILITY/Racial Differences %$ 18500 %R 10.2105/AJPH.2006.106047 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2007 %T Urban neighborhoods and depressive symptoms among older adults. %A Carol S Aneshensel %A Richard G Wight %A Miller-Martinez, Dana %A Amanda L. Botticello %A Arun S Karlamangla %A Teresa Seeman %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Comorbidity %K Cross-Sectional Studies %K Depressive Disorder %K Female %K Health Status Indicators %K Health Surveys %K Humans %K Incidence %K Male %K Minority Groups %K Peer Group %K Population Dynamics %K Risk Factors %K Social Environment %K United States %K Urban Population %X

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.

%B J Gerontol B Psychol Sci Soc Sci %I 62 %V 62 %P S52-9 %8 2007 Jan %G eng %N 1 %L newpubs20070403_Aneshensel_etal %1 http://www.ncbi.nlm.nih.gov/pubmed/17284567?dopt=Abstract %4 Depressive Symptoms/Socioeconomic Factors/Urban Population %$ 17280 %R 10.1093/geronb/62.1.s52 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2007 %T Weight and depressive symptoms in older adults: direction of influence? %A Valerie L Forman-Hoffman %A Jon W. Yankey %A Stephen L Hillis %A Robert B Wallace %K Activities of Daily Living %K Age Factors %K Aged %K Aged, 80 and over %K Body Mass Index %K Cohort Studies %K Comorbidity %K Depressive Disorder %K Female %K Health Status Indicators %K Health Surveys %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Models, Statistical %K Odds Ratio %K Prospective Studies %K Sex Factors %K Statistics as Topic %K United States %K Weight Gain %K Weight Loss %X

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.

%B J Gerontol B Psychol Sci Soc Sci %I 62 %V 62 %P S43-51 %8 2007 Jan %G eng %N 1 %L newpubs20070403_Forman-Hoffman_etal %1 http://www.ncbi.nlm.nih.gov/pubmed/17284566?dopt=Abstract %4 Weight/Depressive Symptoms %$ 17260 %R 10.1093/geronb/62.1.s43 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2006 %T Cohabitation among older adults: a national portrait. %A Susan L. Brown %A Lee, Gary R. %A Jennifer R. Bulanda %K Activities of Daily Living %K Demography %K Female %K Health Status %K Humans %K Interpersonal Relations %K Male %K Marriage %K Middle Aged %K Residence Characteristics %K Sexual Partners %K Surveys and Questionnaires %K United States %X

OBJECTIVE: Older adults are increasingly likely to experience cohabitation, or living together unmarried in an intimate, heterosexual union. In order to begin building a conceptual framework, we provide a descriptive portrait of older adult cohabitors, emphasizing how they compare to older remarrieds and unpartnereds.

METHODS: We used data from both Census 2000 and the 1998 Health and Retirement Study ( HRS; Health and Retirement Study, 1998) to estimate the size and composition of the cohabiting population aged 51 and older. Also, using HRS data, we estimated multinomial logistic regression models to identify the correlates associated with cohabitation and remarriage (vs being unpartnered) among women and men who were previously married.

RESULT: More than 1 million older adults, composing 4% of the unmarried population, currently cohabit. About 90% of these individuals were previously married. We identify significant differences among cohabitors, remarrieds, and unpartnereds across several dimensions, including sociodemographic characteristics, economic resources, physical health, and social relationships. Cohabitors appear to be more disadvantaged than remarrieds, and this is especially evident for women.

DISCUSSION: Older cohabitors differ from individuals of other marital statuses, and therefore future work on marital status should explicitly incorporate cohabitation.

%B J Gerontol B Psychol Sci Soc Sci %I 61 %V 61 %P S71-9 %8 2006 Mar %G eng %N 2 %L pubs_2006_Cohabitation.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/16497963?dopt=Abstract %4 Couples %$ 16010 %R 10.1093/geronb/61.2.s71 %0 Journal Article %J Int J Aging Hum Dev %D 2006 %T Expansion of elderly couples' IADL caregiver networks beyond the marital dyad. %A Sheila Feld %A Ruth E Dunkle %A Tracy Schroepfer %K Activities of Daily Living %K Aged %K Caregivers %K Female %K Humans %K Logistic Models %K Male %K Marriage %K Multivariate Analysis %K Self-Help Groups %X

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.

%B Int J Aging Hum Dev %I 37 %V 63 %P 95-113 %8 2006 %G eng %N 2 %L pubs_2005_Feld_etal.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/17137029?dopt=Abstract %4 Caregivers/Couples/ADL and IADL Impairments %$ 13382 %R 10.2190/CW8G-PB6B-NCGH-HT1M %0 Journal Article %J J Am Geriatr Soc %D 2006 %T Functional impairment, race, and family expectations of death. %A Brie A Williams %A Lindquist, Karla %A Sandra Y. Moody-Ayers %A Louise C Walter %A Kenneth E Covinsky %K Activities of Daily Living %K Aged %K Attitude to Death %K Black or African American %K Cross-Sectional Studies %K Disabled Persons %K Family %K Female %K Hispanic or Latino %K Humans %K Male %K White People %X

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.

%B J Am Geriatr Soc %I 54 %V 54 %P 1682-7 %8 2006 Nov %G eng %N 11 %L newpubs20101112_Willams2.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/17087694?dopt=Abstract %4 Activities of Daily Living/Minorities/Hispanic/African Americans/functional impairment/expectations/death %$ 23640 %R 10.1111/j.1532-5415.2006.00941.x %0 Journal Article %J J Prev Med Public Health %D 2006 %T A longitudinal study of the relationship between health behavior risk factors and dependence in activities of daily living. %A Sang-Hyuk Jung %A Truls Ostbye %A Kyoung-Ok Park %K Activities of Daily Living %K Alcohol Drinking %K Body Mass Index %K ethnicity %K Exercise %K Female %K Health Behavior %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Risk Factors %K Smoking %K United States %X

OBJECTIVES: The purpose of this study was to shed further light on the effect of modifiable health behavior risk factors on dependence in activities of daily living, defined in a multidimensional fashion.

METHODS: The study participants were 10,278 middle aged Americans in a longitudinal health study, the Health and Retirement Survey (HRS). A multi-stage probability sampling design incorporating the effect of population sizes (Metropolitan and non-metropolitan), ethnicity (the non-Hispanic White, the Hispanic, and the Black), and age (age 51-61) was utilized. Basic Activities of Daily Living (ADL) were measured using five activities necessary for survival (impairment in dressing, eating, bathing, sleeping, and moving across indoor spaces). Explanatory variables were four health behavior risk factors included smoking, exercise, Body Mass Index (BMI), and alcohol consumption.

RESULTS: Most participants at baseline were ADL independent (1992). 97.8% of participants were independent in all ADL's at baseline and 78.2% were married. Approximately 27.5% were current smokers at baseline, and the subjects reported moderate or heavy exercise were 74.8%. All demographic characteristics and behavioral risk factors were significantly associated with the ADL status at Wave 4 except alcohol consumption. Risk behaviors such as current smoking, sedentary life style and high BMI at Wave 1 were associated with ADL status deterioration; however, moderate alcohol consumption tended to be more related to better ADL status than abstaining at Wave 4. ADL status at Wave 1 was the strongest factor and the next was exercise and smoking affecting ADL status at Wave 4. People who were in ADL dependent at Wave 1 were 15.17 times more likely to be ADL dependent at Wave 4 than people who were in ADL independent at Wave 1. Concerning smoking cigarettes, people who kept only light exercise or sedentary life style at Wave 1 were 1.70 times more likely to be died at Wave 4 than the people who did not smoke at Wave 1.

CONCLUSIONS: All demographics and health behaviors at wave 1 had consistently similar OR trends for ADL status to each other except alcohol consumption. Smoking and exercise in health behaviors, and age and gender in demographics at Wave 1 were significant factors associated with ADL group separation at Wave 4.

%B J Prev Med Public Health %I 39 %V 39 %P 221-8 %8 2006 May %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/16764496?dopt=Abstract %4 Health Behavior/risk factors/Activities of Daily Living %$ 16820 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2005 %T Disparities among older adults in measures of cognitive function by race or ethnicity. %A Frank A Sloan %A Wang, Jingshu %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Black or African American %K Case-Control Studies %K Cognition %K Cognition Disorders %K Cross-Sectional Studies %K Female %K Hispanic or Latino %K Humans %K Linear Models %K Longitudinal Studies %K Male %K Racial Groups %K United States %X

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.

%B J Gerontol B Psychol Sci Soc Sci %I 60B %V 60 %P P242-50 %8 2005 Sep %G eng %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/16131618?dopt=Abstract %4 Racial disparities/Cognitive Function/Elderly %$ 13852 %R 10.1093/geronb/60.5.p242 %0 Journal Article %J Neurourol Urodyn %D 2005 %T Functional impairment as a risk factor for urinary incontinence among older Americans. %A Kristi Rahrig Jenkins %A Fultz, Nancy H. %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Chronic disease %K Disability Evaluation %K Female %K Humans %K Longitudinal Studies %K Male %K Motor Activity %K Risk Factors %K Socioeconomic factors %K Urinary incontinence %X

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.

%B Neurourol Urodyn %I 24 %V 24 %P 51-5 %8 2005 %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/15578629?dopt=Abstract %4 WOMEN/Epidemiology/DISABILITY/DISABILITY %$ 16060 %R 10.1002/nau.20089 %0 Journal Article %J Psychol Sci %D 2005 %T Health, wealth, and happiness: financial resources buffer subjective well-being after the onset of a disability. %A Dylan M Smith %A Kenneth M. Langa %A Mohammed U Kabeto %A Peter A. Ubel %K Activities of Daily Living %K Cross-Sectional Studies %K Disability Evaluation %K Female %K Follow-Up Studies %K Happiness %K Health Status %K Humans %K Male %K Middle Aged %K Quality of Life %K Socioeconomic factors %X

We examined the hypothesis that the relationship between financial status and subjective well-being, typically found to be very small in cross-sectional studies, is moderated by health status. Specifically, we predicted that wealth would buffer well-being after the onset of a disability. Using data from the Health and Retirement Study, a longitudinal study of people at and approaching retirement age, we employed within-subjects analyses to test whether wealth measured prior to the onset of a disability protected participants' well-being from some of the negative effects of a new disability. We found support for this hypothesis: Participants who were above the median in total net worth reported a much smaller decline in well-being after a new disability than did participants who were below the median. We also found some evidence that the buffering effect of wealth faded with time, as below-median participants recovered some of their well-being.

%B Psychol Sci %I 16 %V 16 %P 663-6 %8 2005 Sep %G eng %N 9 %L pubs_2005_HealthWealth.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/16137249?dopt=Abstract %4 Health Status/Subjective/Wealth/Disability/Disability %$ 15230 %R 10.1111/j.1467-9280.2005.01592.x %0 Journal Article %J Gerontologist %D 2005 %T The impact of obesity on active life expectancy in older American men and women. %A Sandra L Reynolds %A Saito, Yasuhiko %A Eileen M. Crimmins %K Activities of Daily Living %K Aged %K Female %K Health Status %K Health Surveys %K Humans %K Life Expectancy %K Life Tables %K Logistic Models %K Male %K Markov chains %K Obesity %K Risk Factors %K United States %X

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.

%B Gerontologist %I 45 %V 45 %P 438-44 %8 2005 Aug %G eng %N 4 %L pubs_2005_obesity_ale.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/16051906?dopt=Abstract %4 Disability/Disability/Obesity/Life Expectancy %$ 15170 %R 10.1093/geront/45.4.438 %0 Journal Article %J Gerontologist %D 2005 %T Predictors of perceptions of involuntary retirement. %A Maximiliane E Szinovacz %A Adam Davey %K Activities of Daily Living %K Choice Behavior %K Demography %K Humans %K Retirement %K Social Perception %K Socioeconomic factors %K United States %X

PURPOSE: Retirement is often treated as a voluntary transition, yet selected circumstances can restrict choice in retirement decision processes. We investigated conditions under which retirees perceive their retirement as "forced" rather than "wanted."

METHODS: Analyses relied on Waves 1-4 of the Health and Retirement Survey (N=1,160; 572 men and 588 women). Logistic regression models estimated the effects of background factors, choice and restricted choice conditions, and retirement contexts on perceptions of forced retirement.

RESULTS: Nearly one third of older workers perceived their retirement as forced. Such forced retirement reflects restricted choice through health limitations, job displacement, and care obligations. Other predictors include marital status, race, assets, benefits, job tenure, and off-time retirement.

IMPLICATIONS: Future research should establish personal and policy implications of forced retirement. Programs are needed to help older workers forced into retirement find alternative employment opportunities and to reduce the conditions leading to forced retirement.

%B Gerontologist %I 45 %V 45 %P 36-47 %8 2005 Feb %G eng %N 1 %L pubs_2004_szinovacz_DaveyGeron.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/15695416?dopt=Abstract %4 Retirement %$ 12432 %R 10.1093/geront/45.1.36 %0 Journal Article %J Arch Phys Med Rehabil %D 2005 %T Racial differences in activities of daily living limitation onset in older adults with arthritis: a national cohort study. %A Shih, Vivian C. %A Song, Jing %A Rowland W Chang %A Dorothy D Dunlop %K Activities of Daily Living %K Aged %K Arthritis %K Black or African American %K Female %K Geriatric Assessment %K Health Behavior %K Health Services Needs and Demand %K Hispanic or Latino %K Humans %K Longitudinal Studies %K Male %K Predictive Value of Tests %K Prospective Studies %K Risk Factors %K United States %K White People %X

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.

%B Arch Phys Med Rehabil %I 86 %V 86 %P 1521-6 %8 2005 Aug %G eng %N 8 %L pubs_2005_APMR.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/16084802?dopt=Abstract %4 Activities of Daily Living/African-Americans/Hispanics %$ 15240 %R 10.1016/j.apmr.2005.02.009 %0 Journal Article %J J Am Geriatr Soc %D 2005 %T Setting eligibility criteria for a care-coordination benefit. %A Christine T Cigolle %A Kenneth M. Langa %A Mohammed U Kabeto %A Caroline S Blaum %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Case Management %K Chronic disease %K Cognition Disorders %K Comorbidity %K Cross-Sectional Studies %K Disability Evaluation %K Disease Management %K Eligibility Determination %K Female %K Geriatric Assessment %K Health Surveys %K Humans %K Longitudinal Studies %K Male %K Medicare %K Middle Aged %K Retirement %K United States %X

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.

%B J Am Geriatr Soc %I 53 %V 53 %P 2051-9 %8 2005 Dec %G eng %N 12 %L pubs_2005_Cigolle_etal.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/16398887?dopt=Abstract %4 Chronic Disease/Cognition Disorders/ADL and IADL Impairments/Caregiving %$ 15640 %R 10.1111/j.1532-5415.2005.00496.x %0 Journal Article %J Gerontologist %D 2005 %T Use of complementary medicine in older Americans: results from the Health and Retirement Study. %A Ness, Jose %A Dominic J Cirillo %A David R Weir %A Nisly, Nicole L. %A Robert B Wallace %K Activities of Daily Living %K Aged %K Chi-Square Distribution %K Complementary Therapies %K Female %K Humans %K Male %K Middle Aged %K Regression Analysis %K Surveys and Questionnaires %K United States %X

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.

%B Gerontologist %I 45 %V 45 %P 516-24 %8 2005 Aug %G eng %N 4 %L pubs_2005_cam.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/16051914?dopt=Abstract %4 Medicine/Chiropractic/Dietary Supplements %$ 15180 %R 10.1093/geront/45.4.516 %0 Journal Article %J Med Care %D 2005 %T What is perfect health to an 85-year-old?: evidence for scale recalibration in subjective health ratings. %A Peter A. Ubel %A Jankovic, Aleksandra %A Dylan M Smith %A Kenneth M. Langa %A Angela Fagerlin %K Activities of Daily Living %K Age Factors %K Aged %K Aged, 80 and over %K Analysis of Variance %K Attitude to Health %K Calibration %K Female %K Geriatric Assessment %K Health Status %K Humans %K Interviews as Topic %K Male %K Prospective Studies %K Psychometrics %K Self Concept %X

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.

%B Med Care %I 43 %V 43 %P 1054-7 %8 2005 Oct %G eng %N 10 %1 http://www.ncbi.nlm.nih.gov/pubmed/16166876?dopt=Abstract %4 Subjective phenomena/Methodology %$ 15390 %R 10.1097/01.mlr.0000178193.38413.70 %0 Journal Article %J J Aging Health %D 2004 %T Body-weight change and physical functioning among young old adults. %A Kristi Rahrig Jenkins %K Activities of Daily Living %K Aged %K Body Weight %K Demography %K Exercise %K Health Behavior %K Humans %K Movement Disorders %K Socioeconomic factors %X

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.

%B J Aging Health %I 16 %V 16 %P 248-66 %8 2004 %G eng %N 2 %L pubs_2004_Jenkins_JAH.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/15030665?dopt=Abstract %4 Body Mass Index/Health Physical %$ 12832 %R 10.1177/0898264303262626 %0 Journal Article %J J Am Geriatr Soc %D 2004 %T The effect of equipment usage and residual task difficulty on use of personal assistance, days in bed, and nursing home placement. %A Donald H. Taylor Jr. %A Hoenig, H. %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Bed Rest %K Cross-Sectional Studies %K Disability Evaluation %K Female %K Homemaker Services %K Humans %K Least-Squares Analysis %K Logistic Models %K Longitudinal Studies %K Male %K Nursing homes %K Risk Factors %K Self-Help Devices %X

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.

%B J Am Geriatr Soc %I 52 %V 52 %P 72-9 %8 2004 Jan %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/14687318?dopt=Abstract %4 Mobility Difficulty %$ 12852 %R 10.1111/j.1532-5415.2004.52013.x %0 Journal Article %J Am J Psychiatry %D 2004 %T Extent and cost of informal caregiving for older Americans with symptoms of depression. %A Kenneth M. Langa %A Marcia A. Valenstein %A A. Mark Fendrick %A Mohammed U Kabeto %A Sandeep Vijan %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Caregivers %K Comorbidity %K Costs and Cost Analysis %K Depressive Disorder %K Fees and Charges %K Female %K Health Care Costs %K Home Nursing %K Humans %K Longitudinal Studies %K Male %K Personality Inventory %K Workload %X

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.

%B Am J Psychiatry %I 161 %V 161 %P 857-63 %8 2004 May %G eng %N 5 %L pubs_2004_Langa-etal_AJP.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/15121651?dopt=Abstract %4 Depression Symptoms/Caregiving %$ 12252 %R 10.1176/appi.ajp.161.5.857 %0 Journal Article %J Eur J Cardiovasc Prev Rehabil %D 2004 %T Heart disease, comorbidity, and activity limitation in community-dwelling elderly. %A Oldrige, Neil B. %A Timothy E. Stump %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Chronic disease %K Cross-Sectional Studies %K Female %K Health Status %K Heart Diseases %K Humans %K Male %K Middle Aged %K Motor Activity %K Residence Characteristics %K Self Concept %K Socioeconomic factors %X

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.

%B Eur J Cardiovasc Prev Rehabil %I 11 %V 11 %P 427-34 %8 2004 Oct %G eng %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/15616418?dopt=Abstract %4 quality of life/Elderly/COMORBIDITY/risk factors %$ 16190 %R 10.1097/01.hjr.0000140716.25015.b8 %0 Journal Article %J Gerontologist %D 2004 %T Obesity's effects on the onset of functional impairment among older adults. %A Kristi Rahrig Jenkins %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Body Weight %K Chronic disease %K Disabled Persons %K Exercise %K Female %K Humans %K Longitudinal Studies %K Male %K Motor Activity %K Movement %K Obesity %K Risk-Taking %K United States %X

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.

%B Gerontologist %I 44 %V 44 %P 206-16 %8 2004 Apr %G eng %N 2 %L pubs_2004_Jenkins_Geron.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/15075417?dopt=Abstract %4 Obesity/Health Status--ADL limitations %$ 12502 %R 10.1093/geront/44.2.206 %0 Journal Article %J J Aging Health %D 2004 %T Religion and functional health among the elderly: is there a relationship and is it constant? %A Benjamins, Maureen Reindl %K Activities of Daily Living %K Age Factors %K Aging %K Demography %K Health Behavior %K Health Status %K Humans %K Mental Health %K Religion and Psychology %K Socioeconomic factors %K United States %X

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

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

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

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

%B J Aging Health %I 16 %V 16 %P 355-74 %8 2004 Jun %G eng %N 3 %L pubs_2004_Benjamins.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/15155067?dopt=Abstract %4 Religiosity/Aging/Health %$ 14142 %R 10.1177/0898264304264204 %0 Journal Article %J Soc Sci Med %D 2004 %T Religion and preventative health care utilization among the elderly. %A Benjamins, Maureen Reindl %A Brown, Carolyn %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Catholicism %K Diagnostic Tests, Routine %K Female %K Health Services for the Aged %K Health Status %K Humans %K Interviews as Topic %K Jews %K Logistic Models %K Longitudinal Studies %K Male %K Patient Acceptance of Health Care %K Preventive Health Services %K Primary Health Care %K Protestantism %K Religion and Psychology %K Socioeconomic factors %K United States %X

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.

%B Soc Sci Med %I 58 %V 58 %P 109-18 %8 2004 Jan %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/14572925?dopt=Abstract %4 Religiosity/Elderly/Health Care Utilization %$ 13042 %R 10.1016/s0277-9536(03)00152-7 %0 Journal Article %J Demography %D 2004 %T Resolving inconsistencies in trends in old-age disability: report from a technical working group. %A Vicki A Freedman %A Eileen M. Crimmins %A Robert F. Schoeni %A Brenda C Spillman %A Aykan, Hakan %A Kramarow, Ellen %A Land, Kenneth %A Lubitz, James %A Kenneth G. Manton %A Linda G Martin %A Shinberg, Diane %A Timothy A Waidmann %K Activities of Daily Living %K Age Factors %K Aged %K Aged, 80 and over %K Chronic disease %K Disabled Persons %K Female %K Health Surveys %K Homemaker Services %K Humans %K Male %K Models, Statistical %K Self-Help Devices %K United States %X

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.

%B Demography %I 41 %V 41 %P 417-41 %8 2004 Aug %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/15461008?dopt=Abstract %4 Disability/Disability/ADL and IADL Impairments/Elderly/Caregiving %$ 12982 %R 10.1353/dem.2004.0022 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2004 %T Retirement transitions and spouse disability: effects on depressive symptoms. %A Maximiliane E Szinovacz %A Adam Davey %K Activities of Daily Living %K Adaptation, Psychological %K Aged %K Caregivers %K Demography %K depression %K Disabled Persons %K Female %K Follow-Up Studies %K Humans %K Male %K Middle Aged %K Retirement %K Spouses %K Surveys and Questionnaires %X

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.

%B J Gerontol B Psychol Sci Soc Sci %I 59B %V 59 %P S333-42 %8 2004 Nov %G eng %N 6 %L pubs_2004_szinovacz_daveyJoG.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/15576864?dopt=Abstract %4 Retirement Behavior/Spouse/Disability/Disability/Depressive Symptoms %$ 12402 %R 10.1093/geronb/59.6.s333 %0 Journal Article %J J Am Geriatr Soc %D 2004 %T Urinary incontinence and its association with death, nursing home admission, and functional decline. %A Holroyd-Leduc, Jayna M. %A Kala M. Mehta %A Kenneth E Covinsky %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Body Mass Index %K Female %K Follow-Up Studies %K Frail Elderly %K Health Status %K Humans %K Male %K Nursing homes %K Outcome Assessment, Health Care %K Risk Factors %K Smoking %K Socioeconomic factors %K Time Factors %K Urinary incontinence %X

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.

%B J Am Geriatr Soc %I 52 %V 52 %P 712-8 %8 2004 May %G eng %N 5 %L pubs_2004_Holroyd_etal.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/15086650?dopt=Abstract %4 Urinary Incontinence/Mortality/Nursing Homes/Activities of Daily Living %$ 12532 %R 10.1111/j.1532-5415.2004.52207.x %0 Journal Article %J J Aging Health %D 2003 %T Additive and interactive effects of comorbid physical and mental conditions on functional health. %A Fultz, Nancy H. %A Mary Beth Ofstedal %A A. Regula Herzog %A Robert B Wallace %K Activities of Daily Living %K Aged %K Aging %K Black or African American %K Cognition Disorders %K depression %K Diabetes Complications %K Educational Status %K Health Surveys %K Hispanic or Latino %K Humans %K Stroke %K United States %K White People %X

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.

%B J Aging Health %I 15 %V 15 %P 465-81 %8 2003 Aug %G eng %N 3 %L pubs_2003_Fultz_etal.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/12914014?dopt=Abstract %4 Activities of Daily Living/Chronic Disease/Epidemiology/Health Surveys %$ 11682 %R 10.1177/0898264303253502 %0 Journal Article %J J Aging Health %D 2003 %T Asking neutral versus leading questions: implications for functional limitation measurement. %A Vicki A Freedman %A Aykan, Hakan %A Kleban, Morton H. %K Activities of Daily Living %K Aged %K Factor Analysis, Statistical %K Health Surveys %K Humans %K Research Design %K Surveys and Questionnaires %K United States %X

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.

%B J Aging Health %I 15 %V 15 %P 661-87 %8 2003 Nov %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/14594023?dopt=Abstract %4 Method of Questioning/Measurement/Survey Methods %$ 12902 %R 10.1177/0898264303256250 %0 Journal Article %J Int J Aging Hum Dev %D 2003 %T Determinants of self-perceived changes in health status among pre- and early-retirement populations. %A Namkee G Choi %K Activities of Daily Living %K Age Factors %K Female %K Health Behavior %K Health Status %K Humans %K Logistic Models %K Male %K Middle Aged %K Multivariate Analysis %K Retirement %K Self Concept %K United States %X

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

%B Int J Aging Hum Dev %I 56 %V 56 %P 197-222 %8 2003 %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/14661813?dopt=Abstract %4 Health Status/Subjective %$ 12922 %R 10.2190/T8JD-1P30-6MFT-8WHA %0 Journal Article %J Obstet Gynecol %D 2003 %T Urinary incontinence and depression in middle-aged United States women. %A Ingrid E Nygaard %A Carolyn L. Turvey %A Burns, Trudy L. %A Elizabeth A Chrischilles %A Robert B Wallace %K Activities of Daily Living %K Aged %K Comorbidity %K Cross-Sectional Studies %K depression %K Female %K Humans %K Logistic Models %K Middle Aged %K United States %K Urinary incontinence %X

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.

%B Obstet Gynecol %I 101 %V 101 %P 149-56 %8 2003 Jan %G eng %N 1 %L newpubs20091202_Incontinence.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/12517660?dopt=Abstract %4 Depression/Women/Incontinence %$ 21260 %R 10.1016/s0029-7844(02)02519-x %0 Journal Article %J Am J Public Health %D 2002 %T Driving life expectancy of persons aged 70 years and older in the United States. %A Foley, Daniel J. %A Heimovitz, Harley K. %A Jack M. Guralnik %A Brock, Dwight B. %K Accidents, Traffic %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Automobile Driving %K Decision making %K Family Characteristics %K Female %K Frail Elderly %K Humans %K Interviews as Topic %K Licensure %K Life Expectancy %K Logistic Models %K Male %K Risk Factors %K Transportation %K United States %X

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.

%B Am J Public Health %I 92 %V 92 %P 1284-9 %8 2002 Aug %G eng %N 8 %L newpubs20070125_Foley_etal_AJPH %1 http://www.ncbi.nlm.nih.gov/pubmed/12144985?dopt=Abstract %4 Driving Patterns/Life Expectancy/Public Policy %$ 16990 %R 10.2105/ajph.92.8.1284 %0 Journal Article %J Soc Sci Med %D 2002 %T The health capital of families: an investigation of the inter-spousal correlation in health status. %A Sven E. Wilson %K Activities of Daily Living %K Chronic disease %K Decision making %K Female %K Health Behavior %K Health Status Indicators %K Humans %K Interviews as Topic %K Life Style %K Male %K Marital Status %K Middle Aged %K Regression Analysis %K Risk Factors %K Risk-Taking %K Self Efficacy %K Sociology, Medical %K Spouses %K United States %X

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

%B Soc Sci Med %I 55 %V 55 %P 1157-72 %8 2002 Oct %G eng %N 7 %L pubs_2002_Wilson_SSocSciMed.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/12365528?dopt=Abstract %4 Health production/Economics of the family/Marriage markets/Shared risks %$ 11782 %R 10.1016/s0277-9536(01)00253-2 %0 Journal Article %J J Health Soc Behav %D 2002 %T Health in household context: living arrangements and health in late middle age. %A Mary Elizabeth Hughes %A Linda J. Waite %K Activities of Daily Living %K Depressive Disorder %K Family Characteristics %K Family Health %K Female %K Health Status Indicators %K Humans %K Longitudinal Studies %K Male %K Marital Status %K Middle Aged %K Self Efficacy %K United States %X

People living in some arrangements show better health than persons in other living arrangements. Recent prospective studies document higher mortality among persons living in particular types of households. We extend this research by examining the influence of household structure on health using longitudinal data. We theorize that individuals experience role-based household relations as sets of resources and demands. In certain household structures, individuals are more likely to perceive that the demands made on them outweigh the resources available to them. This perceived imbalance poses a risk to individual health. We test our expectations by analyzing the relationship between living arrangements and health using data from waves 1 and 2 of the Health and Retirement Study. We focus on persons ages 51-61 and explore gender differences. We find prospective links between household structure and self-rated health, mobility limitation, and depressive symptoms. Married couples living alone or with children only are the most advantaged; single women living with children appear disadvantaged on all health outcomes. Men and women in other household types are disadvantaged on some health outcomes. Our results suggest that the social context formed by the household may be important to the social etiology of health. In addition, they qualify the well-known link between marital status and health: The effect of marital status on health depends on household context.

%B J Health Soc Behav %I 43 %V 43 %P 1-21 %8 2002 Mar %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/11949193?dopt=Abstract %4 Family Structure/Health/Living Conditions/Middle Aged Adults/Sex Differences/Households %$ 1234 %R 10.2307/3090242 %0 Journal Article %J J Health Soc Behav %D 2002 %T Individual consequences of volunteer and paid work in old age: health and mortality. %A Luoh, M. %A A. Regula Herzog %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Employment %K Female %K Health Status %K Humans %K Male %K Mortality %K Multivariate Analysis %K Prospective Studies %K United States %K Volunteers %X

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.

%B J Health Soc Behav %I 43 %V 43 %P 490-509 %8 2002 Dec %G eng %N 4 %L pubs_2002_Luoh-Herzog.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/12664678?dopt=Abstract %4 Labor Force Participation/Mortality/Work, volunteer %$ 8548 %R 10.2307/3090239 %0 Journal Article %J Arthritis Rheum %D 2001 %T Arthritis prevalence and activity limitations in older adults. %A Dorothy D Dunlop %A Larry M Manheim %A Song, Jing %A Rowland W Chang %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Arthritis %K Data collection %K Humans %K Prevalence %K Racial Groups %K Socioeconomic factors %K Surveys and Questionnaires %X

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.

%B Arthritis Rheum %I 44 %V 44 %P 212-21 %8 2001 Jan %G eng %N 1 %L pubs_2001_Dunlop_DArth.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/11212163?dopt=Abstract %4 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 %$ 4435 %R 10.1002/1529-0131(200101)44:1<212::AID-ANR28>3.0.CO;2-Q %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2001 %T Changes in driving patterns and worsening depressive symptoms among older adults. %A Stephanie J. Fonda %A Robert B Wallace %A A. Regula Herzog %K Activities of Daily Living %K Adaptation, Psychological %K Aged %K Aged, 80 and over %K Automobile Driving %K depression %K Female %K Humans %K Male %K Quality of Life %K Risk Factors %K Social Environment %X

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.

%B J Gerontol B Psychol Sci Soc Sci %I 56B %V 56 %P S343-51 %8 2001 Nov %G eng %N 6 %L pubs_2001_Fonda_SJGSeriesB.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/11682595?dopt=Abstract %4 Health Status/Depressive Symptoms/Driving Patterns/Basic Demographics %$ 8496 %R 10.1093/geronb/56.6.s343 %0 Journal Article %J J Clin Oncol %D 2001 %T Estimating the cost of informal caregiving for elderly patients with cancer. %A Hayman, James A. %A Kenneth M. Langa %A Mohammed U Kabeto %A Steven J. Katz %A DeMonner, Sonya M. %A M.E. Chernew %A Slavin, Mitchell B. %A A. Mark Fendrick %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Caregivers %K Cost of Illness %K Family %K Female %K Home Nursing %K Humans %K Male %K Multivariate Analysis %K Neoplasms %K Regression Analysis %K United States %X

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.

%B J Clin Oncol %I 19 %V 19 %P 3219-25 %8 2001 Jul 01 %G eng %N 13 %L pubs_2001_Hayman_JJClinOnc.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/11432889?dopt=Abstract %4 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 %$ 4250 %R 10.1200/JCO.2001.19.13.3219 %0 Journal Article %J Med Care %D 2001 %T The explosion in paid home health care in the 1990s: who received the additional services? %A Kenneth M. Langa %A M.E. Chernew %A Mohammed U Kabeto %A Steven J. Katz %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Chronic disease %K Family Characteristics %K Female %K Financing, Government %K Frail Elderly %K Geriatric Assessment %K Health Care Surveys %K Health Expenditures %K health policy %K Home Care Services %K Home Nursing %K Humans %K Longitudinal Studies %K Male %K Marital Status %K Multivariate Analysis %K Social Support %K Socioeconomic factors %K Surveys and Questionnaires %K United States %K Utilization Review %X

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.

%B Med Care %I 39 %V 39 %P 147-57 %8 2001 Feb %G eng %N 2 %L pubs_2001_Langa_KMedCare.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/11176552?dopt=Abstract %4 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 %$ 4095 %R 10.1097/00005650-200102000-00005 %0 Journal Article %J J Aging Health %D 2001 %T Predictors of transitions in disease and disability in pre- and early-retirement populations. %A Namkee G Choi %A Schlichting-Ray, L. %K Activities of Daily Living %K Aged %K Black or African American %K Chronic disease %K Disabled Persons %K Female %K Health Status %K Hispanic or Latino %K Humans %K Male %K Middle Aged %K Retirement %K Risk Factors %K Sex Factors %K Socioeconomic factors %K United States %K White People %X

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.

%B J Aging Health %I 13 %V 13 %P 379-409 %8 2001 Aug %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/11813732?dopt=Abstract %4 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 %$ 4035 %R 10.1177/089826430101300304 %0 Journal Article %J Am J Public Health %D 2001 %T Socioeconomic status and the prevalence of health problems among married couples in late midlife. %A Sven E. Wilson %K Activities of Daily Living %K Cohort Studies %K Female %K Health Status %K Humans %K Male %K Marital Status %K Middle Aged %K Odds Ratio %K Risk Factors %K Socioeconomic factors %K Spouses %K United States %X

OBJECTIVES: This study analyzed the association between socioeconomic status (SES) and the prevalence of mutually occurring health problems among married couples in late midlife.

METHODS: Data consisted of 4746 married couples aged 51 to 61 years from the 1992 US Health and Retirement Study. Two health measures were used: (1) self-assessed health status and (2) an index of functional limitations and activity restrictions. SES indicators were household income, education, and insurance coverage.

RESULTS: In general, after adjustment for age cohort, a strong association was found between the health of a married individual and the health of his or her spouse. SES was highly associated with the joint occurrence of health problems among marriage partners.

CONCLUSIONS: Public health policy should pay particular attention to the interaction between health, SES, and interpersonal relationships.

%B Am J Public Health %I 91 %V 91 %P 131-5 %8 2001 Jan %G eng %N 1 %L pubs_2001_Wilson_SAJPH.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/11189807?dopt=Abstract %4 Cohort Studies/Gender/Health Status/Marital Status/Middle Age/Odds Ratio/Risk Factors/Socioeconomic Status/Spouses/Support, Non U.S. Government/Support, U.S. Government--PHS %$ 4345 %R 10.2105/ajph.91.1.131 %0 Journal Article %J Health Serv Res %D 2000 %T Expectations among the elderly about nursing home entry. %A Richard C Lindrooth %A Hoerger, Thomas J. %A Edward C Norton %K Activities of Daily Living %K Aged %K Attitude to Health %K Data Interpretation, Statistical %K Effect Modifier, Epidemiologic %K Female %K Geriatric Assessment %K Health Care Surveys %K Health Services Research %K Health Status %K Homes for the Aged %K Humans %K Least-Squares Analysis %K Longevity %K Male %K Medicaid %K Nursing homes %K Patient Admission %K Probability %K Risk Factors %K Surveys and Questionnaires %K United States %X

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.

%B Health Serv Res %I 35 %V 35 %P 1181-202 %8 2000 Dec %G eng %N 5 Pt 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/11130816?dopt=Abstract %4 Long-Term Care/Nursing Homes/Medicaid/Health Insurance %$ 16200 %0 Journal Article %J JAMA %D 2000 %T Gender disparities in the receipt of home care for elderly people with disability in the United States. %A Steven J. Katz %A Mohammed U Kabeto %A Kenneth M. Langa %K Activities of Daily Living %K Aged %K Disabled Persons %K Family %K Female %K Geriatrics %K Home Care Services %K Home Nursing %K Humans %K Male %K Regression Analysis %K Sex Distribution %K United States %X

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.

%B JAMA %I 284 %V 284 %P 3022-7 %8 2000 Dec 20 %G eng %N 23 %L pubs_2000_Katz_SJAMA.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/11122589?dopt=Abstract %4 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 %$ 4255 %R 10.1001/jama.284.23.3022 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2000 %T Health effects of involuntary job loss among older workers: findings from the health and retirement survey. %A William T Gallo %A Elizabeth H Bradley %A Michele J. Siegel %A Stanislav V Kasl %K Activities of Daily Living %K Adaptation, Psychological %K Aging %K Female %K Geriatric Assessment %K Health Status %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Retirement %K Unemployment %K United States %X

OBJECTIVES: To estimate the health consequences of involuntary job loss among older workers in the United States.

METHODS: Using longitudinal data from the 1992 and 1994 waves of the Health and Retirement Survey, multivariate regression models were estimated to assess the impact of involuntary job loss on both physical functioning and mental health. Our analysis sample included 209 workers who experienced involuntary job loss between survey dates and a comparison group of 2,907 continuously employed workers.

RESULTS: The effects of late-life involuntary job loss on both follow-up physical functioning and mental health were negative and statistically significant (p < .05), even after baseline health status and sociodemographic factors were controlled for. Among displaced workers, reemployment was positively associated with both follow-up physical functioning and mental health, whereas the duration of joblessness was not significantly associated with either outcome.

DISCUSSION: The findings provide evidence of a causal relationship between job loss and morbidity among older workers. This relationship is reflected in both poorer physical functioning and mental health for workers who experience involuntary job loss. In addition to the economic consequences of worker displacement, there may be important health consequences of job loss, especially among older workers.

%B J Gerontol B Psychol Sci Soc Sci %I 55B %V 55 %P S131-40 %8 2000 May %G eng %N 3 %L pubs_2000_Gallo_etal.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/11833981?dopt=Abstract %4 Labor Force/Personnel Downsizing/Health Status/Economic Status %$ 8356 %R 10.1093/geronb/55.3.s131 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2000 %T Implications of asking "ambiguous" difficulty questions: an analysis of the second wave of the asset and health dynamics of the oldest old study. %A Vicki A Freedman %K Activities of Daily Living %K Aged %K Cognition %K Female %K Health Status %K Humans %K Male %K Prospective Studies %K Surveys and Questionnaires %X

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.

%B J Gerontol B Psychol Sci Soc Sci %I 55B %V 55 %P S288-97 %8 2000 Sep %G eng %N 5 %L pubs_2000_Freedman_VJGSeriesB.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/10985300?dopt=Abstract %4 Activities of Daily Living/Cognition/Female/Health Status/Prospective Studies/Questionnaires/Support, U.S. Government--PHS %$ 4490 %R 10.1093/geronb/55.5.s288 %0 Journal Article %J J Am Geriatr Soc %D 2000 %T Memory complaint in a community sample aged 70 and older. %A Carolyn L. Turvey %A Schultz, Susan K. %A Arndt, Stephan %A Robert B Wallace %A A. Regula Herzog %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Cognition %K Depressive Disorder %K Educational Status %K Female %K Geriatric Assessment %K Humans %K Longitudinal Studies %K Male %K Marital Status %K Memory %K Self-Assessment %X

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.

%B J Am Geriatr Soc %I 48 %V 48 %P 1435-41 %8 2000 Nov %G eng %N 11 %1 http://www.ncbi.nlm.nih.gov/pubmed/11083320?dopt=Abstract %4 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 %$ 4335 %R 10.1111/j.1532-5415.2000.tb02634.x %0 Journal Article %J Int J Aging Hum Dev %D 2000 %T Older adults and financial bequests. %A Goetting, Marsha A. %A Peter Martin %A Johnson, Christine %K Activities of Daily Living %K Age Factors %K Aged %K Aged, 80 and over %K Aging %K Attitude %K Female %K Health Care Costs %K Health Status %K Humans %K Male %K Mental Health %K Michigan %K Models, Economic %K Sampling Studies %K Sex Factors %K Socioeconomic factors %K Spouses %K Surveys and Questionnaires %K Wills %X

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.

%B Int J Aging Hum Dev %I 50 %V 50 %P 227-44 %8 2000 %G eng %N 3 %L wp_2000/Goetting.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/10987344?dopt=Abstract %4 Racial Differences Bequests/Inheritance %$ 16270 %R 10.2190/AJJ3-AVG7-QKMW-R21R %0 Journal Article %J J Aging Health %D 2000 %T Race and ethnic variation in the disablement process. %A Zsembik, Barbara A. %A M. Kristen Peek %A Chuck W Peek %K Activities of Daily Living %K Black or African American %K Cognition Disorders %K Disabled Persons %K Hispanic or Latino %K Humans %K Socioeconomic factors %K White People %X

OBJECTIVES: This analysis examines ethnoracial group differences in the transition from health to disability.

METHODS: Using data from the AHEAD study, the authors examine the relative influence of each stage in the disablement process in the evolution of ethnoracial group differences in basic and instrumental disability.

RESULTS: Predisposing factors account for disability differences between Whites and other Latinos, whereas excess disability among African Americans stems from their higher level of cognitive limitation. The excess disability of Mexican Americans arises from their higher level of physical limitations. The data also reveal a larger impact of medical conditions and physical limitations on acquisition of disability among African Americans and Mexican Americans. This article demonstrates the importance of cognitive status in the disablement process, especially in ethnoracial group differences.

DISCUSSION: The authors discuss the practical implications for health care delivery to non-White elders and the theoretical implications for understanding the complexities of disablement.

%B J Aging Health %I 12 %V 12 %P 229-49 %8 2000 May %G eng %N 2 %L pubs_2000_Zsembik.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/11010698?dopt=Abstract %4 Cognition Disorders/Disabled Persons/Ethnicity/Minorities/Socioeconomic Factors %$ 4400 %R 10.1177/089826430001200205 %0 Journal Article %J Demography %D 2000 %T The racial crossover in comorbidity, disability, and mortality. %A Nan E. Johnson %K Activities of Daily Living %K Age Factors %K Aged %K Aged, 80 and over %K Birth Certificates %K Black People %K Chronic disease %K Comorbidity %K Cross-Over Studies %K Death Certificates %K Disabled Persons %K Female %K Humans %K Male %K United States %K White People %X

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.

%B Demography %I 37 %V 37 %P 267-83 %8 2000 Aug %G eng %N 3 %L pubs_2000_Johnson_NanDemog.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/10953803?dopt=Abstract %4 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 %$ 4215 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 1999 %T At risk on the cusp of old age: living arrangements and functional status among black, white and Hispanic adults. %A Linda J. Waite %A Mary Elizabeth Hughes %K Activities of Daily Living %K Aging %K Black or African American %K Cultural Characteristics %K Family Relations %K Female %K Hispanic or Latino %K Housing %K Humans %K Male %K Middle Aged %K Quality of Life %K Retirement %K Risk Factors %K White People %X

OBJECTIVES: We examine the relationship between living arrangements and multiple measures of physical, cognitive, and emotional functioning in late midlife.

METHODS: Using cross-sectional data from the Health and Retirement Study, we first assess the bivariate relationship between living arrangements and functioning; we then take into account demographic characteristics and measures of household resources and demands.

RESULTS: We find evidence of differential functioning among individuals in various living arrangements. Married couples living alone or with children show the highest levels of functioning, whereas single adults living in complex households show the lowest levels. Functional deficits for those in complex households are reduced but not eliminated when we take demographic characteristics and household resources and demands into account. We find few differences by gender and race/ethnicity in the relationship between living arrangements and functioning.

DISCUSSION: We show a pattern of poorer functioning among those in arguably the most demanding and least supportive household environments. This points to a vulnerable and risk-filled transition from middle to old age for these persons. Because Blacks and Hispanics show lower levels of functioning than Whites and are more likely to live in complex households, they may be particularly disadvantaged.

%B J Gerontol B Psychol Sci Soc Sci %I 54B %V 54 %P S136-44 %8 1999 May %G eng %U http://www.ncbi.nlm.nih.gov/pubmed/10363044?dopt=Abstract %N 3 %L pubs_1999_Waite_LJGSeriesB.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/10363044?dopt=Abstract %4 Aging/Ethnicity/Gender/Cultural Characteristics/Family Relations/Housing/Middle Age/Quality of Life/Retirement/Risk Factors/Support, Non U.S. Government/Support, U.S. Government--PHS %$ 4200 %R 10.1093/geronb/54b.3.s136 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 1999 %T A comparison of correlates of cognitive functioning in older persons in Taiwan and the United States. %A Mary Beth Ofstedal %A Zachary Zimmer %A Hui-Sheng Lin %K Activities of Daily Living %K Age Factors %K Aged %K Aged, 80 and over %K Cognition %K Cross-Cultural Comparison %K depression %K Educational Status %K Female %K Geriatric Assessment %K Health Status %K Humans %K Male %K Multivariate Analysis %K Regression Analysis %K Sex Factors %K Socioeconomic factors %K Surveys and Questionnaires %K Taiwan %K United States %X

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.

%B J Gerontol B Psychol Sci Soc Sci %I 54B %V 54 %P S291-301 %8 1999 Sep %G eng %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/10542831?dopt=Abstract %4 Cognitive Functioning %$ 12822 %R 10.1093/geronb/54b.5.s291 %0 Journal Article %J Soc Sci Med %D 1999 %T The influence of personal care and assistive devices on the measurement of disability. %A Agree, E M %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Disability Evaluation %K Female %K Humans %K Life Expectancy %K Logistic Models %K Long-term Care %K Male %K Self-Help Devices %X

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.

%B Soc Sci Med %I 48 %V 48 %P 427-43 %8 1999 Feb %G eng %N 4 %L pubs_1999_Agree_ESocSciandMed.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/10075170?dopt=Abstract %R 10.1016/s0277-9536(98)00369-4 %0 Journal Article %J Disabil Rehabil %D 1999 %T Measuring disability with parsimony. %A Verbrugge, Lois M. %A Merrill, Susan S. %A Xian Li %K Activities of Daily Living %K Disability Evaluation %K Disabled Persons %K Health Status Indicators %K Health Surveys %K Humans %K Surveys and Questionnaires %X

PRIMARY OBJECTIVE: Health surveys, especially those for older persons, include numerous detailed items about disability. There has been little effort to develop a global disability item, that is, one question that covers the concept of disability briefly but well. This article discusses how parsimony can be achieved through a single item, or less desirably by reductions of detailed items.

MAIN OUTCOME AND RESULTS: Results of three analyses on the issue of compact disability indicators, using public-use data sets (AHEAD, HRS, BRFSS), are presented. The analyses study relationships of global disability to both detailed disability items and global health. Overall, the results show that a global disability item has good coverage of specific disabilities and is distinct from self-rated health.

CONCLUSIONS: Routine inclusion of a global disability item in surveys is recommended, and specific suggestions are made to aid its design.

%B Disabil Rehabil %I 21 %V 21 %P 295-306 %8 1999 May-Jun %G eng %U https://pubmed.ncbi.nlm.nih.gov/10381242 %N 5-6 %L pubs_1999_Verbrugge_LDis.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/10381242?dopt=Abstract %4 disability/disability %$ 11792 %R 10.1080/096382899297729 %0 Journal Article %J Demography %D 1999 %T Parental marital disruption and intergenerational transfers: an analysis of lone elderly parents and their children. %A Liliana E Pezzin %A Barbara Steinberg Schone %K Activities of Daily Living %K Adult %K Aged %K Analysis of Variance %K Caregivers %K Chi-Square Distribution %K Divorce %K Family %K Father-Child Relations %K Female %K Financial Support %K Frail Elderly %K Home Nursing %K Humans %K Intergenerational Relations %K Loneliness %K Male %K Marriage %K Parent-Child Relations %K Parents %K Sample Size %K Sampling Studies %K Socioeconomic factors %X

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.

%B Demography %I 36 %V 36 %P 287-97 %8 1999 Aug %G eng %N 3 %L pubs_1999_Pezzin_LDemog.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/10472494?dopt=Abstract %4 Marriage/Marital Dissolution/Family Structure/Economics of the Elderly/Fertility/Child Care/Children/Youth/Aging/Children/Demographics/Divorce/Elderly/Marital/Parent %$ 1094 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 1997 %T A comparative analysis of ADL questions in surveys of older people. %A Willard L Rodgers %A Baila Miller %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Geriatric Assessment %K Health Services %K Health Status %K Health Surveys %K Humans %K Regression Analysis %K Reproducibility of Results %K United States %X

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.

%B J Gerontol B Psychol Sci Soc Sci %I 52B %V 52 Spec No %P 21-36 %8 1997 May %G eng %L pubs_1997_Rodgers_WJGSeriesB.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/9215355?dopt=Abstract %4 Health Status--ADL limitations/Basic Demographics/Method of Questioning/Data Collection Procedures %$ 8072 %R 10.1093/geronb/52b.special_issue.21 %0 Journal Article %J Demography %D 1997 %T Demographic and economic correlates of health in old age. %A James P Smith %A Raynard Kington %K Activities of Daily Living %K Aged %K Cohort Studies %K Demography %K Disabled Persons %K ethnicity %K Female %K Health Status %K Humans %K Income %K Male %K Models, Econometric %K Racial Groups %K Socioeconomic factors %K United States %X

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.

%B Demography %I 34 %V 34 %P 159-70 %8 1997 Feb %G eng %U https://www.ncbi.nlm.nih.gov/pubmed/9074837 %N 1 %L pubs_1997_Smith_JDemog.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/9074837?dopt=Abstract %4 Economics of the Elderly/Health Status/Socioeconomic Status/Ethnicity/Income/Gender/Old Age %$ 1110 %0 Journal Article %J Am J Epidemiol %D 1997 %T Distribution and association of chronic disease and mobility difficulty across four body mass index categories of African-American women. %A Daniel O. Clark %A Mungai, S.M. %K Activities of Daily Living %K Black People %K Body Mass Index %K Chronic disease %K Comorbidity %K Cross-Sectional Studies %K Female %K Health Behavior %K Humans %K Michigan %K Middle Aged %K Obesity %K Prevalence %K Regression Analysis %K Severity of Illness Index %K Socioeconomic factors %X

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

%B Am J Epidemiol %I 145 %V 145 %P 865-75 %8 1997 May 15 %G eng %N 10 %1 http://www.ncbi.nlm.nih.gov/pubmed/9149658?dopt=Abstract %4 Mobility Difficulty/Health Status/Basic Demographics/Economic Status/Labor %$ 8114 %R 10.1093/oxfordjournals.aje.a009046 %0 Journal Article %J J Health Econ %D 1997 %T Medical insurance and the use of health care services by the elderly. %A Michael D Hurd %A Kathleen McGarry %K Activities of Daily Living %K Aged %K Health Care Surveys %K Health Services for the Aged %K Health Status Indicators %K Hospitalization %K Humans %K Insurance, Health %K Medicare %K Office Visits %K Patient Acceptance of Health Care %K Private Sector %K Probability %K United States %X

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.

%B J Health Econ %I 16 %V 16 %P 129-54 %8 1997 Apr %G eng %U https://www.ncbi.nlm.nih.gov/pubmed/10169091 %N 2 %L pubs_1997_Hurd_MJHE.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/10169091?dopt=Abstract %4 Health Status/Health Services/Economic Status %$ 8100 %R 10.1016/s0167-6296(96)00515-2 %0 Journal Article %J Gerontologist %D 1996 %T The role of ethnicity in the disability and work experience of preretirement-age Americans. %A Linda A. Wray %K Activities of Daily Living %K Analysis of Variance %K Disabled Persons %K Employment %K ethnicity %K Female %K Humans %K Male %K Middle Aged %K Odds Ratio %K Regression Analysis %K Risk Factors %K United States %X

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

%B Gerontologist %I 36 %V 36 %P 287-98 %8 1996 Jun %G eng %N 3 %L pubs_1996_Wray_LGer.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/8682327?dopt=Abstract %4 Disabled Persons/Employment/Ethnic Groups/Gender/Middle Age/Odds Ratio/Risk Factors/Support, U.S. Government--PHS/Methodology %$ 4370 %R 10.1093/geront/36.3.287