Previous healthcare-based studies have reported increasing herpes zoster (HZ) incidence over time; however, this could be an artifact of increased healthcare utilization. This study is a cross-sectional analysis of 15,103 respondents in the 2008 wave of the Health and Retirement Study (HRS) to evaluate changes in HZ incidence from 1940 to 2008. Negative binomial regression is used to model the effect of calendar year, age of onset of HZ, gender and race/ethnicity on HZ incidence. A nonparametric method based on B-spline basis expansion is used to model the effect of calendar year to avoid imposing a predetermined functional form and produce flexible and accurate estimates. This study demonstrates increasing HZ incidence from 1940 to 2008 using self-reported HZ. Although the reason for this increase remains unknown, this study supports the assertion that this trend is real and not an artifact of increasing healthcare utilization for HZ over time.

Background. Research identifies isolation (being alone) as a risk factor for cognitive decline— yet it is possible that subjective dimensions of isolation are more critical. Potential risk factors are loneliness (the distress stemming from feeling alone) and cynical hostility (an attitude of distrust and cynicism). The present study examined the relationship between these factors and cognitive functioning and decline. Methods. Data came from the Health and Retirement Study, a nationally representative longitudinal study of US adults over 50. Loneliness was measured using the Hughes Loneliness Scale; cynical hostility was measured using items from the Cook-Medley Hostility Inventory. Cognitive functioning was indexed by the Telephone Interview for Cognitive Status. Regressions were conducted to examine loneliness and cynical hostility as predictors of cognitive function at baseline as well as cognitive decline over four and six-year periods. Models were adjusted for demographic characteristics, health behaviors, and isolation. Results. Loneliness, [f2=.003, t(52)=-3.75; p<.001] and cynical hostility, [f2=.002, t(52)=-2.98, p=.004] predicted cognitive function at baseline. Loneliness and cynical hostility each predicted cognitive decline over four [f2=.001, t(52)=-2.29; p=.026 f2=.003, t(52)=-3.98; p<.001 respectively] but not six years [t(52)= -.78; p=.439; t(52)= -1.29; p=.203 respectively]. Discussion. Loneliness and cynical hostility are correlates of lower cognitive function and risk factors for cognitive decline over four years. The absence of significant effects of loneliness and cynical hostility over six years could be attributed to low statistical power in these analyses. The effect sizes in this study are small, yet meaningful in the context of the personal and social costs associated with cognitive decline.

Using an analysis of secondary data from the Health and Retirement Survey, this thesis provides the groundwork for understanding factors for nursing home placement using matching techniques to understand the differences between those persons with similar health characteristics who are not residents of nursing homes, and who are temporary residents or permanent residents of nursing homes. / Fisher Institute for Wellness and Gerontology

No description available.

Frailty is a well-established indicator of late-life decline and is accompanied by higher rates of comorbidity and disability. Meanwhile, an estimated 41% of adults over the age of 65 report consuming alcohol – an identified health risk and protective factor depending on dosage. Given that the demographic group of older Americans is projected to double by the year 2050, identification of frailty risk and protective factors is imperative. The goals of this thesis are to: (1) identify how varying levels of alcohol consumption relate to frailty, and (2) elucidate a possible mechanism that accounts for the relationship between alcohol consumption and frailty. A sample of stroke-free participants over the age of 65 was identified from the Health and Retirement Study. Study 1 utilized stepwise logistic regression models to identify predictors of prevalent frailty at baseline (2000), and of incident frailty 4, 8, and 12 years later. For both males and females, significant predictors of frailty at all years included age, depressive symptomatology, and medical burden score. In addition, BMI was a significant predictor of frailty for females at all years. With respect to alcohol use, results revealed that drinking 1-7 drinks per week had a protective effect for females at baseline (OR=0.50) and 12 years later (OR=0.75); however, no such protective effects were found for males. Given that extant research has identified CRP as a mediator between the relationship of moderate alcohol use and cardiovascular health benefits, Study 2 used a cross-sectional sample from the 2008 wave to examine the potential mediating role of CRP between moderate alcohol use and reduced frailty risk. Results from structural equation modeling support the hypothesized model that moderate alcohol is associated with less frailty, and that this relationship is partially mediated by CRP levels. Overall findings suggest that moderate alcohol use confers health benefits for females by reducing frailty risk and that CRP is one mechanism by which alcohol use may confer protective effects for frailty. These results provide a starting place in an effort to better understand the protective effects of moderate alcohol use and can assist in improving prevention and treatment efforts for older adults by preventing or prolonging the onset of age-related diseases. Future research should further examine the relationship between alcohol use and frailty and determine if CRP mediates the relationship between moderate alcohol use and other beneficial health outcomes.

No description available.

No description available.

Title from first page of PDF document. Includes bibliographical references (p. 20-21).

Thesis (Ph.D.)--Pardee Rand Graduate School, 2006. / Title from PDF cover. Includes bibliographical references. Issued also in print.

Chapter 1 presents the backgrounds and research questions of the dissertation project. Although everyone hopes to die with dignity, a “good death” is often privileged. Inequality in end-of-life care in the United States is striking; older minorities are 3 times more likely to receive intrusive care and experience hospital readmission and less likely to use hospice care and die at home. With the hope to address disparities in end-of-life outcomes, as part of the Affordable Care Act, Medicare expanded its benefit and started to reimburse end-of-life care planning services from 2016. This dissertation examines the roles of health insurance policy and its advocated intervention in ensuring person-centered dying experiences in the United States and the public readiness for establishing a similar end-of-life care policy in China. The second chapter examines whether physician–patient advance care planning (ACP) discussions, the “intervention” embedded in the policy, is effective at prompting end-of-life care planning behaviors and improving end-of-life experiences. I also studied the heterogenous effects by race and ethnicity. I used exit data about 7,282 deceased Medicare-eligible respondents from the Health and Retirement Study (HRS) from 2012 to 2020, a nationally representative biennial survey of U.S. older adults. I conducted latent class analysis to identify different end-of-life experiences and used multinomial logistic regression models to study the relationship between having ACP discussions with doctors and different end-of-life experiences in full and stratified samples by race and ethnicity. Then I used path analyses to test whether completing legal documentation initiated by ACP services explains the effectiveness of the intervention. The results show three types of end-of-life experiences among White, Black, and Hispanic older adults; significant effects of end-of-life care discussions with doctors on uncomfortable dying experiences and extensive use of invasive treatments in the older White population; and the partial mediating role of completion of legal health care documents on the relationship between ACP discussions and end-of-life outcomes. This study identified the limited effectiveness of physician–patient ACP discussions among minority older adults and emphasizes the importance of quality, content (e.g., to cover legal documentation during the conversation), and cultural appropriateness of ACP consultations led by doctors. The third chapter examines the heterogenous intent-to-treat effect of the Medicare policy on older adults’ motivation to plan for care by exploiting policy intervention as a natural experiment. Taking advantage of the longitudinal nature of the HRS, I used core data with 47,982 observations nested in 15,647 individuals across 9 years (2012–2020). I used two quasi-experimental models—interrupted time series analysis and difference-in-difference—to study the care-planning outcomes before and after the policy implementation between older adults eligible or not eligible for Medicare. I studied the heterogenous effects in stratified samples by race and ethnicity, immigration background, and socioeconomic status proxied by education and wealth. I used coarsened exact matching to address the potential bias of the comparison group not being the ideal counterfactual control unit. I found that in the total population, the Medicare policy was associated with a significant increase in the proportion of older adults who completed a living will and designated a durable power of attorney for health care, but not having an ACP conversation. Furthermore, although there were immediate positive policy effects, the increases in ACP outcomes driven by the ACA Medicare benefit expansion were not sustained. Finally, I found no evidence that the ACA Medicare benefit expansion was effective in improving the rates of ACP among Black, Hispanic, Asian, Native American, or non-U.S.-born older adults. I also identified heterogeneous policy effects by socioeconomic status. I discuss promising recommendations for health care policy and practice to improve the participation rate of end-of-life care planning. Chapter 4 explores the feasibility of encouraging physicians to discuss end-of-life care wishes with older patients in China. Knowledge of a medical diagnosis is critical for end-of-life decision making. However, a patient’s right to know their diagnosis is neither guaranteed nor protected by law in China. Doctors typically inform family members of the patient’s illness diagnosis and prognosis and let them decide whether to disclose this information to the patient. This study examined middle-aged and older Chinese adults’ preferences for disclosing their and significant others’ diagnoses and whether sociodemographic, economic, and cultural factors were associated with these preferences. The research team surveyed 571 adults aged 50 or older in Shanghai from 2021 to 2022. The outcome measures are preferences for diagnosis disclosures, including whether and to whom diagnoses should be disclosed. I characterized preference types using latent class analysis and estimated multinomial logistic regression to identify the covariates associated with each preference type. Three latent classes were identified. The transparent group (34%) believed patients, whether self or a significant other, should be informed of their diagnoses. The contradictory group (50%) held conflicting attitudes; they preferred to know their diagnosis but preferred that significant others not be informed of their diagnoses. The avoidant group (16%) preferred not to know their diagnosis or to disclose significant others’ diagnoses to them. Familism attitudes were positively associated with holding contradictory views. Experiences with hospitalization and medical decision-making for family members were associated with holding transparent views. I discuss the importance of illness disclosure for honoring patients’ autonomous decision-making.