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Imputation or likelihood-based approaches to handle missing data assume the data are missing completely at random (MCAR) or missing at random (MAR). However, little research has examined the missingness pattern before using these imputation/likelihood methods. Three missingness mechanisms -- MCAR, MAR, and not missing at random (NMAR) -- can be tested using information on research design, disciplinary knowledge, and appropriate methods. This study summarized six commonly used statistical methods to test the missingness mechanism and discussed their application conditions. We further applied these methods to a two-wave longitudinal dataset from the Health and Retirement Study (N = 18,747). Health measures met the MAR assumptions although we could not completely rule out NMAR. Demographic variables provided auxiliary information. The logistic regression method demonstrated applicability to a wide range of scenarios. This study provides a useful guide to choose methods to test missingness mechanisms depending on the research goal and nature of the data.

Housing insecurity has been shown to be associated with worse mental health. However, previous studies mostly examined one aspect of housing insecurity (e.g., affordability), and few focused on older adults. This study examined the relationship between perceived housing problems and depressive symptoms among middle-aged and older Americans. Data from the Health and Retirement Study between 2006 and 2018 were used. A total of 7,119 respondents (aged 50+ at baseline in 2006) were followed up every 4 years. Respondents self-reported the status, severity, and duration of their housing problems. Depressive symptoms were assessed by the Center for Epidemiological Studies-Depression Scale. Mixed-effect models examined the association between perceived housing problems and depressive symptoms. Results show about 5%-7% of respondents had housing problems during every study visit and 5.73% of them experienced persistent housing problems over 12 years. Having housing problems was associated with a higher risk of depressive symptoms (incidence risk ratio = 1.29, 95% CI = 1.23, 1.36). A dose–response relationship was observed in the severity and duration of housing problems, with a greater increase of depressive symptoms risk among those experiencing more severe or prolonged housing problems. The dose–response pattern highlighted the importance of early intervention and persistent assistance to those experiencing housing problems. [ABSTRACT FROM AUTHOR]

The decades-long one-child policy in China has led to a growing number of older individuals with only one child. The Elderly Family Planning Subsidy (EFPS) policy was introduced to provide extra financial support to this group and was expanded nationwide in 2012. This study investigated the relationship between EFPS use and health among EFPS-eligible older Chinese using data from the China Health and Retirement Longitudinal Study. A total of 1,981 respondents were eligible for EFPS (i.e. aged 60 and above, had only one child, or were rural residents with two daughters). Respondents self-reported if they received EFPS in 2011, 2013, and 2015 and were followed up to 2018. Propensity score matching was used to match EFPS non-users with users based on their probability of using EFPS. Among the EFPS-eligible respondents, 256 (12.92%) used the benefit. Analysis revealed no significant differences between EFPS users and non-users with respect to mortality and other health outcomes (i.e. self-reported health, cognition, activities of daily living, chronic diseases, and depressive symptoms). Findings do not provide evidence that EFPS improved the short-term health of older Chinese with only one child. [ABSTRACT FROM AUTHOR]

Polysocial risk scores were recently proposed as a strategy for improving the clinical relevance of knowledge about social determinants of health. Our objective in this study was to assess whether the polysocial risk score model improves prediction of cognition and all-cause mortality in middle-aged and older adults beyond simpler models including a smaller set of key social determinants of health. We used a sample of 13 773 individuals aged ≥50 years at baseline from the 2006-2018 waves of the Health and Retirement Study, a US population-based longitudinal cohort study. Four linear mixed models were compared: 2 simple models including a priori–selected covariates and 2 polysocial risk score models which used least absolute shrinkage and selection operator (LASSO) regularization to select covariates among 9 or 21 candidate social predictors. All models included age. Predictive accuracy was assessed via R 2 and root mean-squared prediction error (RMSPE) using training/test split validation and cross-validation. For predicting cognition, the simple model including age, race, sex, and education had an R 2 value of 0.31 and an RMSPE of 0.880. Compared with this, the most complex polysocial risk score selected 12 predictors (R 2 = 0.35 and RMSPE = 0.858; 2.2% improvement). For all-cause mortality, the simple model including age, race, sex, and education had an area under the receiver operating characteristic curve (AUROC) of 0.747, while the most complex polysocial risk score did not demonstrate improved performance (AUROC = 0.745). Models built on a smaller set of key social determinants performed comparably to models built on a more complex set of social "risk factors." [ABSTRACT FROM AUTHOR]

The study compared care source typologies for older adults in China and the United States. Data from the 2014 U.S. Health and Retirement Study and the 2013 China Health and Retirement Longitudinal Study were used. The respondents included community-dwelling older adults aged 65 years or older with at least one limitation in activities of daily living (ADLs) or instrumental ADLs (IADLs) (N China = 2476, N US = 2898). Respondents reported whether they received assistance from spouse, child/grandchild, relatives, others, and formal helpers. Latent class analysis and multinomial logistic regression were applied. Four classes were identified in China and the U.S, separately. In both countries, ADLs and IADLs were strong determinants of care source typologies. Care sources were more diverse and included formal assistance among older Americans. Older Chinese relied largely on their spouses and children/grandchildren for support. Policy efforts are needed to expand formal long-term services and supports, particularly in China. [ABSTRACT FROM AUTHOR]

This study investigates the interdependence of dietary knowledge and preference and potential rural-urban differences among middle-aged and older Chinese couples. Couple-level data from the 2015 China Health and Nutrition Survey were included (N = 2933). Structural Equation Model examined the actor and partner effects of dietary knowledge on dietary preferences. Findings indicated that greater dietary knowledge was associated with one's healthier diet preferences among both rural and urban residents (P <.01). In rural areas, ones' dietary knowledge was associated with their partners' dietary preferences (P <.01). However, in urban areas, husbands' dietary knowledge was not associated with their wives' dietary preferences (P =.58), whereas wives' dietary knowledge was associated with their husbands' dietary preferences (P <.05). The rural-urban difference indicates the greater decision-making power of men in rural households. A couple-based approach is suggested for dietary interventions and guidelines promoting healthy eating in China, particularly in rural regions. [ABSTRACT FROM AUTHOR]

Objective: Mental health issues among older adults have been widely reported during the COVID-19 pandemic. This study examines the relationship between material hardship and three mental health measures among older Americans. Method: Data are from the Health and Retirement Study collected between 2020 and 2021. Respondents ages ≥ 50 years (N = 1,504) reported whether they had experienced seven types of material hardship (e.g., missed rent or mortgage payments) and self-assessed their mental health (i.e., depressive symptoms, anxiety, and loneliness). We used confounder-adjusted regression models to examine the associations of the sum and each specific type of material hardship with mental health. Results: About 26% of respondents (mean age = 69.36 , 65% female, 63% non-Hispanic white) experienced at least one type of material hardship during the pandemic. The number of material hardships was associated with more depressive symptoms and higher levels of anxiety and loneliness. Among the types of difficulties, having trouble buying food was negatively associated with mental health scores. Conclusion: Material hardship during the pandemic, especially food insecurity, was a significant mental health stressor among older Americans. Targeted supportive interventions and services for disadvantaged older adults may mitigate mental health burdens during public health crises, such as pandemics. [ABSTRACT FROM AUTHOR]

This study examined the long-term impact of spouse caregiving on insomnia symptoms, compared to propensity-score matched non-caregivers. Health and Retirement Study data between 2006 and 2018 were used. Caregivers (n = 403) were respondents (aged 50+) who assisted their heterosexual spouses in performing (instrumental) activities of daily living at baseline. Non-caregivers were matched using a propensity score matching procedure based on baseline characteristics. Insomnia symptoms were measured every 4 years for both groups. Poisson mixed-effect models estimated the association between caregiver status and insomnia symptoms. Compared to matched non-caregivers, caregivers had similar severity of insomnia symptoms at baseline (${{\rm{\beta }}_{{\rm{caregiver}}}}$ β caregiver = 0.018, 95% CI = −0.089, 0.124) and reported a similar yearly change rate (${{\rm{\beta }}_{{\rm{caregiver}} \times {\rm{time}}}}$ β caregiver × time = −0.008, 95% CI = −0.017, 0.001). No moderation effects of care-recipients' dementia status and social support were significant. In this study sample, there is no evidence that spouse caregivers, specifically those who performed light duties, experience more severe insomnia symptoms than non-caregivers. Spouse caregiving, especially in a light-duty capacity, may not be detrimental to the caregivers' sleep health. More data are needed regarding insomnia in spouse caregivers with heavy duties of care to fully assess the health impact of the caregiving experience. [ABSTRACT FROM AUTHOR]

Health disparity by race/ethnicity or gender has been well-documented. However, few researchers have examined health outcomes based on the intersection of individuals' race, ethnicity, and gender or investigated various health dimensions. Guided by an intersectionality framework, this study explores racial/ethnic/gender-based differences in trajectories of multiple health outcomes over a ten-year period among American older adults. Longitudinal data from the Health and Retirement Study (2004–2014) were used (N = 16,654). Older adults (65+) were stratified into six mutually-exclusive groups based on their race, ethnicity, and gender: Non-Hispanic (NH) White Men, NH White Women, NH Black Men, NH Black Women, Hispanic Men, and Hispanic Women. Growth curve models examined the trajectories of three health measures, including cognitive function, physical function limitations (i.e. activities of daily living and instrumental activities of daily living), and depressive symptoms. NH White men and women reported significantly better outcomes in cognition and physical function trajectories than racial/ethnic minority groups. Women in all racial/ethnic groups had more depressive symptoms but better cognition than men. Hispanic women reported the most depressive symptoms. Hispanic women and NH Black women had the worst physical function limitations. NH Black men/women were the most disadvantaged in cognition. Racial/ethnic/gender-based differences were stable over time in all health trajectories. Study findings highlight the utility of an intersectional framework in understanding how multiple social identities intersect to generate protective and/or risk effects on cognitive, mental, and physical health. Multilevel intervention strategies are warranted to reduce the persistent health inequity gap. [ABSTRACT FROM AUTHOR]

Objectives Using a dyadic approach, this study examined the mediating effect of depressive symptoms on the longitudinal relationships between husbands' and wives' memory trajectories and their prospective disability status. Methods Longitudinal data from the Health and Retirement Study 2004–2018 were used. Older (aged 50+) heterosexual couples who had no limitations in the activity of daily living at the baseline (2004) were included (N = 1,310). Latent class growth analysis grouped wives and husbands into distinct memory trajectories in 2004–2014. A structural equation model examined the actor and partner effects of memory trajectories on depressive symptoms in 2016 and disability status in 2018. The mediating effect of depressive symptoms was tested. Results A total of 4 distinct memory trajectories were found: persistently high, high and slow decline, moderate and slow decline, and low and rapid decline. Only the wife's low and rapid decline memory trajectory predicted her own more depressive symptoms (β = 0.588, 95% CI: 0.209, 0.967) and her husband's more depressive symptoms (β = 0.326, 95% CI: 0.004, 0.648). Meanwhile, depressive symptoms had strong and significant actor effects on disability (β = 0.046, 95% CI: = 0.036, 0.057 for wives; β = 0.060, 95% CI: = 0.046, 0.074 for husbands). Discussion The wife's low and rapid declin e trajectory was associated with her own and her husband's more depressive symptoms, which in turn increased the disability risk for both partners. Timely identification and treatment of memory decline among wives have the potential to mitigate couples' depressive symptoms and, ultimately, disability risks. [ABSTRACT FROM AUTHOR]

Objectives: Studies on the interdependence of couples' health behaviors and subsequent cognitive outcomes remain limited. Methods: Longitudinal data from the China Health and Retirement Longitudinal Study (2011–2018) were used (N = 1869 heterosexual couples). Latent class analysis identified the dyadic pattern of health behaviors in 2011 (i.e., alcohol consumption, smoking, and physical inactivity). Stratified Cox models examined the association of latent classes with risk of developing memory-related disorders in 2013–2018. Results: Three classes were identified: class 1 (21.25%, only husband smoke, and both active), class 2 (47.55%, both inactive, neither drink nor smoke), and class 3 (31.20%, both drink and smoke, and both active). Couples' sedentary lifestyle was associated with an increased risk of memory-related disorders among both husbands and wives. Conclusion: Couples were moderately concordant in their physical activity but weakly in smoking and drinking. Couple-based interventions, especially promoting physical activity, may reduce cognitive aging among middle-aged and older Chinese couples. [ABSTRACT FROM AUTHOR]

Objectives: We sought to identify trajectories of patient-reported outcomes, specifically physical well-being of the chest (PWBC), in patients who underwent postmastectomy breast reconstruction, and further assessed its significant predictors, and its relationship with health-related quality of life (HRQOL). Methods: We used data collected as part of the Mastectomy Reconstruction Outcomes Consortium study within a 2-year follow-up in 2012–2017, with 1422, 1218,1199, and 1417 repeated measures at assessment timepoints of 0,3,12, and 24 months, respectively. We performed latent class growth analysis (LCGA) in the implant group (IMPG) and autologous group (AUTOG) to identify longitudinal change trajectories, and then assessed its significant predictors, and its relationship with HRQOL by conducting multinomial logistic regression. Results: Of the included 1424 patients, 843 were in IMPG, and 581 were in AUTOG. Both groups experienced reduced PWBC at follow-up. LCGA identified four distinct PWBC trajectories (χ2 = 1019.91, p<0.001): low vs medium high vs medium low vs high baseline PWBC that was restored vs. not-restored after 2 years. In 76.63%(n = 646) of patients in IMPG and 62.99% (n = 366) in AUTOG, PWBC was restored after two years. Patients in IMPG exhibited worse PWBC at 3 months post-surgery than that in AUTOG. Patients with low baseline PWBC that did not improve at 2-year follow up (n = 28, 4.82% for AUTOG) were characterized by radiation following reconstruction and non-white ethnicity. In IMPG, patients with medium low-restored trajectory were more likely to experience improved breast satisfaction, while patients developing high-restored trajectories were less likely to have worsened psychosocial well-being. Conclusion: Although more women in IMPG experienced restored PWBC after 2 years, those in AUTOG exhibited a more favorable postoperative trajectory of change in PWBC. This finding can inform clinical treatment decisions, help manage patient expectations for recovery, and develop rehabilitation interventions contributing to enhancing the postoperative quality of life for breast cancer patients. [ABSTRACT FROM AUTHOR]

Climate warming leads to frequent extreme precipitation events, which is a prominent manifestation of the variation of the global water cycle. In this study, data from 1842 meteorological stations in the Huang–Huai–Hai–Yangtze River Basin and 7 climate models of CMIP6 were used to obtain the historical and future precipitation data using the Anusplin interpolation, BMA method, and a non-stationary deviation correction technique. The temporal and spatial variations of extreme precipitation in the four basins were analysed from 1960 to 2100. The correlation between extreme precipitation indices and their relationship with geographical factors was also analysed. The result of the study indicates that: (1) in the historical period, CDD and R99pTOT showed an upward trend, with growth rates of 14.14% and 4.78%, respectively. PRCPTOT showed a downward trend, with a decreasing rate of 9.72%. Other indices showed minimal change. (2) Based on SSP1-2.6, the intensity, frequency, and duration of extreme precipitation changed by approximately 5% at SSP3-7.0 and 10% at SSP5-8.5. The sensitivity to climate change was found to be highest in spring and autumn. The drought risk decreased, while the flood risk increased in spring. The drought risk increased in autumn and winter, and the flood risk increased in the alpine climate area of the plateau in summer. (3) Extreme precipitation index is significantly correlated with PRCPTOT in the future period. Different atmospheric circulation factors significantly affected different extreme precipitation indices of FMB. (4) CDD, CWD, R95pD, R99pD, and PRCPTOT are affected by latitude. On the other hand, RX1day and RX5day are affected by longitude. The extreme precipitation index is significantly correlated with geographical factors, and areas above 3000 m above sea level are more sensitive to climate change. [ABSTRACT FROM AUTHOR]

This study compared the associations of child–parent relationships with older adults' multidimensional health in the United States and China. Two waves of data from the US Health and Retirement Study and its sister study in China (2012–2015) were used (2174 non-Hispanic [NH] White Americans and 4467 Chinese). Linear regression models were conducted for cross-sectional and longitudinal comparisons. Results showed most child–parent relationships had nonsignificant associations with NH White Americans' health. In contrast, closer child–parent relationships were linked to fewer depressive symptoms and better cognitive function among Chinese. Co-residence was associated with poorer health among older Chinese. Over a 2-year period, living nearby was linked to poorer cognitive function among NH White Americans and fewer depressive symptoms among Chinese. Having weekly contact was predictive of better cognition among Chinese. This study revealed cross-cultural differences in the associations between child–parent relationships and older adults' health. Family relationships in accordance with Chinese culture could improve health. [ABSTRACT FROM AUTHOR]

Black Americans encounter more barriers in the job market and earn less than White Americans. However, the extent to which racial disparities in employment and poverty histories impact health is not fully understood. This study characterized employment‒poverty histories for Black and White middle-aged adults and examined their association with health. Respondents born in 1948–1953 and enrolled in the 2004 Health and Retirement Study (N B l a c k =555, N W h i t e =2,209) were included. Sequence analysis grouped respondents with similar employment‒poverty trajectories from 2004 to 2016, and confounder-adjusted regression analyses estimated the associations between these trajectories and health in 2018. Analyses were conducted in 2021–2022. More than 23% of Black respondents experienced both employment and poverty fluctuations, including bouts of extreme poverty (<50% of the federal poverty threshold), whereas no trajectory for White respondents included extreme poverty. Adversities in employment‒poverty were associated with worse health. For example, among Black respondents, those who experienced both employment and poverty fluctuations had worse cognition than those employed and not poor (β= –0.55 standardized units, 95% CI= –0.81, –0.30). Similarly, among White respondents, those who experienced employment fluctuations had worse cognition than those employed (β= –0.35, 95% CI= –0.46, –0.24). Notably, the employed and not poor trajectory was associated with worse survival among Black respondents than among White respondents. Employment fluctuations were associated with worse health, especially cognitive function, where the association was stronger among Black Americans who experienced both employment fluctuations and poverty. Findings highlight the importance of enhancing employment stability and of antipoverty programs, especially for Black Americans. [ABSTRACT FROM AUTHOR]

Objectives Growing evidence suggests that religiosity is an important social determinant of health, including cognitive health. Yet most prior work focused on older adults or was conducted in racially and denominationally homogeneous regional samples. This study investigates the association of religious service attendance in midlife with cognitive function later in midlife. Methods Using data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, a racially and geographically diverse prospective cohort study, we explored the association of religious service attendance in midlife with cognitive function 5 years later. Cognitive function was measured using four cognitive tests administered by CARDIA technicians. Multivariable linear regression was used for analyses. Primary analyses controlled for sociodemographics, physical health, depression, and prior religious involvement. Sensitivity analyses additionally controlled for baseline cognition and social support. Results Our study population included 2,716 participants (57.2% female, 44.9% Black, and mean age 50). In primary analyses, attending services more than weekly (compared to never) in midlife was associated with better global cognition (β = 0.14 standard deviations, 95% [confidence interval] CI = 0.02, 0.26) and verbal memory (β = 0.17 standard deviations, 95% CI = 0.04, 0.30), but not with processing speed (β = 0.04 standard deviations, 95% CI = −0.08, 0.16). A reverse association was observed with executive function (β = −0.16 standard deviations, 95% CI = −0.30, −0.02). Most findings persisted in analyses accounting for loss to follow-up via inverse probability weighting. Discussion Our findings suggest that frequent involvement in religious services at midlife is associated with better global cognition and verbal memory but worse executive function. There was no association with processing speed. [ABSTRACT FROM AUTHOR]

Objectives: This study examined whether trajectories of depressive symptoms of one spouse are associated with the other spouse's memory. Methods: Longitudinal data from the Health and Retirement Study (2004–2016) were used (N = 5690 heterosexual couples). Latent-class growth analysis and structural equation models examined the actor and partner effects of depressive symptom trajectories on memory. Results: Four depressive symptom trajectories were identified (i.e., persistently low, increasing, decreasing, and persistently high). Compared to the low trajectory group, the increasing and persistently high trajectories were associated with worse memory for both men and women. While none of the wives' depressive symptom trajectories was significantly associated with husbands' memory (p >.05), husbands' decreasing trajectory was linked to wives' better memory (β = 0.498, 95% CI = 0.106, 0.890). Discussion: Older adults with increasing and persistently high depressive symptoms may experience worse memory. Psychosocial interventions targeting depressive symptoms among older men may be beneficial to their spouses' memory. [ABSTRACT FROM AUTHOR]

Key Points: Question: Is a history of sustained low-wage earning during peak midlife earning years associated with elevated mortality risk and excess mortality? Findings: In a longitudinal study of 4002 workers with biennially reported hourly wage, a sustained history of low-wage earning in midlife was associated with significantly earlier and excess mortality, especially for workers whose low-wage earning was experienced in the context of employment instability. Meaning: Social and economic policies that increase hourly wage or improve the financial standing of low-wage workers would likely have beneficial impacts on survival outcomes. Importance: Earning a low wage is an increasingly recognized public health concern, yet little research exists on the long-term health consequences of sustained low-wage earning. Objective: To examine the association of sustained low-wage earning and mortality in a sample of workers with hourly wage reported biennially during peak midlife earning years. Design, Setting, and Participants: This longitudinal study included 4002 US participants, aged 50 years or older, from 2 subcohorts of the Health and Retirement Study (1992-2018) who worked for pay and reported earning hourly wages at 3 or more time points during a 12-year period during their midlife (1992-2004 or 1998-2010). Outcome follow-up occurred from the end of the respective exposure periods until 2018. Exposures: Low-wage—less than the hourly wage for full-time, full-year work at the federal poverty line—earning history was categorized as never earning a low wage, intermittently earning a low wage, and sustained earning a low wage. Main Outcomes and Measures: Cox proportional hazards and additive hazards regression models sequentially adjusted for sociodemographics, and economic and health covariates were used to estimate associations between low-wage history and all-cause mortality. We examined interaction with sex or employment stability on multiplicative and additive scales. Results: Of the 4002 workers (aged 50-57 years at the beginning of exposure period and 61-69 years at the end), 1854 (46.3%) were female; 718 (17.9%) experienced employment instability; 366 (9.1%) had a history of sustained low-wage earning; 1288 (32.2%) had intermittent low-wage earning periods; and 2348 (58.7%) had never earned a low wage. In unadjusted analyses, those who had never earned low wages experienced 199 deaths per 10 000 person-years, those with intermittent low wages, 208 deaths per 10 000 person-years, and those with sustained low wages, 275 deaths per 10 000 person-years. In models adjusted for key sociodemographic variables, sustained low-wage earning was associated with mortality (hazard ratio [HR], 1.35; 95% CI, 1.07-1.71) and excess deaths (66; 95% CI, 6.6-125); these findings were attenuated with additional adjustments for economic and health covariates. Significant excess death and elevated mortality risk were observed for workers with sustained low-wage exposure and employment fluctuations (eg, for sustained low-wage × employment fluctuated, HR, 2.18; 95% CI, 1.35-3.53; for sustained low-wage × stable employment, HR, 1.17; 95% CI, 0.89,-1.54; P for interaction =.003). Conclusions and Relevance: Sustained low-wage earning may be associated with elevated mortality risk and excess deaths, especially when experienced alongside unstable employment. If causal, our findings suggest that social and economic policies that improve the financial standing of low-wage workers (eg, minimum wage laws) could improve mortality outcomes. This longitudinal study involving US workers collected wage information during a portion of peak earning years and examined whether a history of low-wage earning was associated with mortality risk. [ABSTRACT FROM AUTHOR]

Objectives This study examines how nativity, dementia classification, and age of migration (AOM) of older foreign-born (FB) adults are associated with caregiver psychological well-being and care burden. Methods We used linked data from Round 1 and Round 5 of the National Health and Aging Trends Study and Round 5 of the National Study of Caregiving for a sample of nondementia caregivers (n = 941), dementia caregivers (n = 533), and matched care recipients. Ordinary least squares regression models were estimated, adjusting for caregiver characteristics. Results Relative to nondementia caregivers, dementia caregivers were more likely to provide care for an older FB adult (8.69% vs. 26.70%), reported more assistance with caregiving activities, worse quality of relationship with care recipients, and higher care burden than nondementia caregivers. In adjusted models, interactions of nativity status × dementia and AOM × dementia revealed that overall, caregivers of older FB adults with dementia who migrated in late life (50+) reported lower psychological well-being than those caring for older FB older adults who migrated at (20–49 years) and (0–19 years). Moderating effects of AOM on the link between dementia caregiving and care burden were not observed. Discussion Age of migration of older FB adults with probable dementia may have unique effects on the caregiver's psychological well-being. Our results underscore the importance of considering sociocultural factors of FB adults beyond nativity and the need for research to develop culturally appropriate interventions to enhance psychological well-being and reduce the care burden among dementia caregivers. [ABSTRACT FROM AUTHOR]

Little research has investigated the long-term relationship between low wages and memory decline, despite the growing share of low-wage workers in the US labor market. Here, we examined whether cumulative exposure to low wages over 12 years in midlife is associated with memory decline in later life. Using 1992–2016 data from the Health and Retirement Study, we analyzed data from 2,879 individuals born in 1936–1941 using confounder-adjusted linear mixed-effects models. Low-wage work was defined as an hourly wage lower than two-thirds of the federal median wage for the corresponding year and was categorized into "never," "intermittent," and "sustained" based on wages earned from 1992 to 2004. Memory function was measured at each study visit from 2004 to 2016 via a memory composite score. The confounder-adjusted annual rate of memory decline among "never" low-wage earners was −0.12 standard units (95% confidence interval: −0.13, −0.10). Compared with this, memory decline among workers with sustained earning of low midlife wages was significantly faster (βtime×sustained = −0.014, 95% confidence interval: −0.02, −0.01), corresponding to an annual rate of −0.13 standard units for this group. Sustained low-wage earning in midlife was significantly associated with a downward trajectory of memory performance in older age. Enhancing social policies to protect low-wage workers may be especially beneficial for their cognitive health. [ABSTRACT FROM AUTHOR]

Guided by an intersectionality framework, this study examined intersectional discrimination attributions and their associations with health outcomes. Older respondents (aged ≥50) from the Health and Retirement Study in 2014-2015 were included (N = 6286). Their reasons for discrimination (age, gender, sexual orientation, race, national origin, religion, financial status, weight, physical appearance, disability, and others) were examined. Latent class analysis examined the subgroup profiles. Six classes were identified: class 1 (54.52% of the sample) had no/minimal discrimination; Class 2 (21.89%) experienced primarily ageism; class 3 (8.81%) reported discrimination based on age/gender/national origin/race; class 4 (7.99%) attributed discrimination to financial/other reasons; class 5 (5.87%) experienced discrimination based on age/weight/physical appearance/disability; and class 6 (0.92%) perceived high discrimination. Intersectional discrimination was associated with poorer self-rated health and higher depressive symptoms compared to the no/minimal discrimination group. Multiple marginalized identities co-occur and contribute to discrimination. An intersectional approach is recommended to understand discrimination in later life. [ABSTRACT FROM AUTHOR]

(1) Background: Low-income rural residents in China are disadvantaged due to their financial vulnerability and insufficient access to resources, and this situation demands more research effort. This study examined the pattern of outpatient service satisfaction and its determinants among low-income adults in rural China. (2) Methods: Rural low-income respondents who used outpatient services in their local healthcare facilities in Jiangsu, China evaluated the access, cost, environment, doctor–patient interaction, and other topics during their outpatient visit (N = 662). Latent class analysis was used to identify the groups characterized by various dimensions of outpatient satisfaction. Multinomial logistic regression explored the determinants of class membership. (3) Results: Three latent classes were identified: 28.70% had low satisfaction, unsatisfied with every dimension; 20.69% reported medium satisfaction that valued doctor–patient relationships; and 50.60% had high satisfaction but thought that costs were high. Both low and medium satisfaction were associated with a higher proportion of self-paid fees. (4) Conclusions: Healthcare costs were an important determinant of outpatient service satisfaction. Medical social workers are suggested to be included in the medical team to help patients identify financial assistance. Special aid programs may be developed to help relieve rural low-income patients' medical cost-related burden. [ABSTRACT FROM AUTHOR]

Objective Dyadic perspective is scarce in existing advance directive (AD) literature. Particularly, the significance of one's own and/or one's partner's cognitive function on AD remains unknown. This study investigates the relationship of cognitive function and other factors with AD completion within the spousal context. Method Data from the Health and Retirement Study (2014–2015) were used. Older heterosexual couples (age ≥65) married for 10+ years were asked if they had a living will and/or appointed a durable power of attorney for health care (DPAHC). Structural equation models examined the actor and partner effects of sociodemographic, health, and couple-level characteristics on wife's and husband's AD, respectively. Results Moderate spousal interdependence was observed in living will (kappa coefficient, κ =.60) and DPAHC (κ =.53). Older age and higher education were related to both spouses having AD. Less household wealth and being racial/ethnic minority were associated with a lower probability of having AD. Notable gender contrasts in actor and partner effects were found. Wife's higher level of cognitive function was associated with husband's AD completion. Contrarily, husband's lower level of cognitive function was associated with wife's AD completion. Retirement status had primarily actor effects for both husbands and wives. More chronic conditions were linked to husband's AD completion. Discussion The spousal interdependence of AD warrants practitioner efforts to facilitate family-oriented end-of-life planning. Wives and husbands may have different thoughts regarding their spouse's cognitive capacity to surrogate. Facilitating couple-based discussions may be a feasible approach to promote engagement with AD among older adults. [ABSTRACT FROM AUTHOR]

This study compared the United States and China in examining the predictors of community-based residential relocation and its associated mortality risk.Data from the 2010 to 2018 US Health and Retirement Study and from 2011 to 2018 China Health and Retirement Longitudinal Study were used (NUS = 20,292 and NChina = 11,694). Community-dwelling respondents (aged 50+) reported whether they had relocated and were followed up until 2018. Log-binomial regression and Cox survival analysis were used.In both countries, younger age, higher education, urban residence, and being a renter were associated with higher likelihood of relocation. Community-based relocation was associated with a lower mortality risk (US: HR = 0.63, 95% CI = 0.57, 0.70; China: HR = 0.40, 95% CI = 0.31, 0.50), and this association was significantly stronger in China compared to the United States.Common predictors of community-based relocation were found in the United States and China. The relocation-related survival advantages may be attributed to a better post-move adaptation and living environment. [ABSTRACT FROM AUTHOR]

Using a nationally representative sample of U.S. older adults (50+), this study investigates gender-based depression trajectories following heart disease onset and associated risk of disability and mortality over an 8-year period. Six waves of longitudinal data from the Health and Retirement Study (2006–2016) were used (n = 1787). Heart disease onset was defined as self-reporting no heart disease at baseline but reporting a positive diagnosis in a subsequent wave. Growth Mixture Modelling identified depression trajectories. Multinomial logistic regression models determined significant predictors of depression trajectories. Cox proportional-hazards models examined the associated disability and mortality risks. Three distinct depression trajectories were identified, including persistent minimal depression (men: 68.65%; women: 60.17%), moderate depression (women: 29.70%; men: 17.97%), and chronic depression (women: 10.12%) or emerging depression (men: 13.38%). Younger age and depression status at baseline were associated with women's chronic depression and men's emerging depression. Chronic/emerging and moderate depression were associated with higher disability risks than was minimal depression among both women and men (hazard ratios [HR] ranged from 2.12 to 3.92, p < 0.001). Only men's emerging depression was linked to higher mortality risk compared to minimal depression (HR = 2.03, p < 0.001). Longitudinal course of depression following onset of heart disease is heterogeneous in later life. Unfavorable depression trajectories (i.e. moderate, chronic, and emerging) were associated with higher disability risk compared to the minimal depression trajectory. Study findings characterize risk stratification regarding depression after heart disease onset, which can inform the development of interventions to improve health outcomes among older adults with heart conditions. [ABSTRACT FROM AUTHOR]

This study examined the relationship of kinship bereavement with the psychological well-being of Chinese American older women and men. Data from the Population Study of ChINese Elderly were used. Respondents were asked if their spouse, children/grandchildren, siblings, close relatives, and friends had died. Widowhood was associated with more loneliness for both genders. For women, close relative/friend loss was associated with more stress, and children/grandchildren loss was linked to stronger anxiety. Only coefficients for close relative in the stress model were significantly different between genders. The variation in patterns of kinship bereavement may be attributed to Chinese cultural attitudes toward death. [ABSTRACT FROM AUTHOR]

This study applied the theory of planned behavior to examine predictors of U.S. older adults' (65+ years) intention and behavior of moving to a nursing home. Two waves of Health and Retirement Study data were used (N = 9,969). Moving intention was measured by respondents' self-reported probability to move in the next 5 years in Wave 1. Moving behavior was measured by whether they actually moved in Wave 2. Structural equation modeling was used to examine the relationships of demographic and health predictors with moving intention and behavior. For both genders, advanced age, poorer health, having fewer children, and long-term care insurance were associated with higher levels of moving intention and behavior. Men's intention was a significant predictor of subsequent moving behavior. However, women's intention was not associated with moving behavior, probably due to inadequate resources to support their preference. The findings provide meaningful personhood-centered insights into nursing home entry decisions. [ABSTRACT FROM AUTHOR]

Studies have indicated government transfers greatly alleviate poverty among older Americans. Yet recent social policy changes were suggested to increase older Americans' fiscal insecurity. New evidence is needed to expand the evaluation of government transfers. Longitudinal Health and Retirement Study data from 2002 to 2014 were used. We computed individuals' poverty status both when household income included and did not include government transfers. Results indicated the poverty rate dropped dramatically when household income included government transfers. The poverty alleviation effect was significantly greater among people who were female, older, members of a minority group, having fewer years of education, residing in the South, and living in a bigger household. Evidence from this study solidified the overall poverty alleviation effect of government transfers in old age. Differential effects among various demographic groups could be attributed to their initial status and divergent political beliefs about who should receive government transfers. [ABSTRACT FROM AUTHOR]

This study examined the gap between need and provision of community services in China and its association with older adults' life satisfaction over time. Longitudinal data from the Chinese Longitudinal Healthy Longevity Survey from 2008 to 2014 were used (3 waves, N = 16,199). Respondents reported if they needed nine types of community service and if their community provided such service. Growth curve models analyzed whether individual- and/or province-level characteristics predicted the initial level and/or changes of life satisfaction over time. Results indicated the presence of major unmet service needs in China. Available community services were mismatched with older adults' perceived needs. Unmet service needs were associated with decreased life satisfaction at baseline. However, unmet service needs were not associated with changes in life satisfaction over time. Study findings highlighted the urgent need to optimize service design in accordance with older adults' needs, which ultimately could promote older adults' well-being. [ABSTRACT FROM AUTHOR]

The health and social benefits of volunteering behaviours by older adults are well acknowledged. However, few review articles have been concerned with the correlates/dimensions of older adults' volunteerism. Some focused only on the North American context or reviewed studies only up to 2008. This study reviewed the recent global literature in the past decade about the correlates of older adults' volunteerism. We carried out a literature search in PsycINFO, Social Services Abstracts, Sociological Abstracts and Google Scholar to identify empirical journal publications about the correlates of older adults' (age 60+) volunteerism from 2008 to 2019. Among 112 initially eligible papers, 41 were selected. Findings were synthesised using the framework of the Socioecological Model. Existing studies mainly have used quantitative methodologies and were conducted within the context of a single Western country. Motivations included higher education, morale and mentality, previous experiences, social network, community cohesion and organisational management. Major barriers were health and financial constraints. Few studies focused on macro-level correlates. Irrelevant and confounding correlates were also discussed. We suggest practitioners recruit and retain older volunteers by identifying their needs and optimising management within the organisation. Policy makers should create a supportive environment and increase resource accessibility. Future research could conduct cross-cultural comparisons, use diverse methodologies and embrace more correlates, especially at the macro-level. [ABSTRACT FROM AUTHOR]

Objectives: This study investigated the predictors of risk perception and its effect on older adults' preventive behavior and/or medical care avoidance during the COVID-19 pandemic. Methods: Older respondents (age >50 years) from the MIT COVID-19 Preventive Health Survey reported their social distancing, hand washing, mask wearing, and medical care avoidance between July and October 2020 (n = 4395). Structural equation models were used. Results: Significant predictors of higher risk perception were female gender, older age, poorer health, city residency, personally knowing someone who had COVID-19, and correct knowledge of vaccine/treatment. Higher risk perception was subsequently associated with higher frequency/probability of practicing preventive behavior and/or avoiding medical care. Knowledge had the strongest path coefficient with risk perception. Discussion: Disseminating correct information to older adults could help them evaluate infection risk accurately. Educational programs on the precautions implemented at clinical settings to ensure patient safety may encourage older adults to seek timely medical care. [ABSTRACT FROM AUTHOR]

With the rapid growth of the elderly population and public health challenges in China, concerns arise related to disability associated with activities of daily living (ADLs) and alcohol consumption status. This study assesses the relationships of alcohol consumption status with basic daily activities among Chinese older adults. A total of 5,133 participants aged 60 years or above from three waves of the Chinese Longitudinal Healthy Longevity Survey (2009, 2012, and 2014) were analyzed. Independent ADL items included bathing, dressing, toileting, indoor moving, continence, and feeding (without others' assistance). Multilevel ordered logistic regression model estimation was used to examine the results of total scores based on the Katz index. Multilevel logistic regression models also were estimated to study each index item separately to examine differences across each of the six ADLs. Additional confirmatory factor analysis (CFA) was performed to examine the validity of the index. Preliminary CFA showed that most items had good factor loadings (>0.700), except for continence (0.256) and feeding (0.481). Based on the ordered regression model, former (AOR = 0.412, 95% CI: 0.294, 0.579, p < 0.001) and non-alcohol consumption (AOR = 0.598, 95% CI: 0.447, 0.800, p < 0.001) were negatively associated with the total score. Non-alcohol consumption status was negatively associated with ADL items separately (all ps < 0.05), with the exceptions of continence and feeding. Alcohol consumption may be associated with Chinese older adults' better ADLs. However, further clinical or experimental trials are needed to examine the impact of alcohol consumption on older adults' ADLs. [ABSTRACT FROM AUTHOR]

This study re‐examined the poverty cycle among American middle‐aged (45~64) and older (≥65) adults using contemporary data and has expanded the understanding of sociodemographic differences in the poverty cycle. Longitudinal data from the Health and Retirement Study (2002–2014) were used. Life tables examined age‐specific and cumulative percentages of poverty. Mixed‐effect logistic regression models examined the moderation role of sociodemographic characteristics in the relationship between age and poverty. The poverty proportion increased rapidly starting at age 75. The growth rate of poverty risk in late adulthood was found to be greater among women and those who did not receive public pensions. Gender divides in poverty risk in late adulthood could be attributed to the cumulative disadvantages of women's social roles. The beneficial role of Social Security in late adulthood was supported. Policy advocacy efforts should address the needs of those who are financially vulnerable. Policy options such as financial education and retirement planning were recommended. [ABSTRACT FROM AUTHOR]

Compared with policy related to child abuse, older adult protection policy developed later and made slower progress in the United States of America. Few studies have addressed older adult protection policy. This paper compares the two policies and provides implications about how to improve older adult protection policy by emulating child protection policy. The Dimensions of Choice Framework was utilised to illuminate the differences between child protection and older adult protection policies (i.e. allocation, provisions, delivery and finance), while Advocacy Coalition Framework theory was used to explain why these differences exist (i.e. the contentions between ally and opposite coalitions). The Dimensions of Choice Framework refined the descriptive comparison of the two policies while the Advocacy Coalition Framework unfolded the efforts and struggles between advocacy coalitions that result in policy changes; and the conceptual combination further provides a cross-disciplinary link between social work and public policy studies. Findings indicated that, compared to child protection policy, older adult protection policy lacked federal legislative and administrative direction, well-developed diagnosis and evaluation tools, a national data system, sufficient federal funds and a comprehensive response mechanism. This was the case because older adult protection advocates presented a more controversial argument regarding the role of government intervention in protecting victims while respecting individual autonomy, lower public and government awareness, and weaker efforts from ally coalitions. [ABSTRACT FROM AUTHOR]

This study explores the associations of retirement, and of public and private pensions, with older adults' depressive symptoms by comparing differences between countries and age groups. Harmonized data were analyzed from the family of Health and Retirement Study in 2012–2013 from China, England, Mexico, and the United States (n = 97,978). Respondents were asked if they were retired and received public or private pensions. Depressive symptom was measured by the Center for Epidemiologic Studies Depression Scale. Retirement was significantly associated with higher depressive symptoms for the United States and with lower depressive symptoms for Mexico and England. Public pension was significantly associated with lower depressive symptoms for Mexico and with higher depressive symptoms for the United States and China. Private pension was significantly associated with lower depressive symptoms for the United States, China, and England. Our study shows that continuity theory demonstrates cross-national variation in explaining the association between retirement and depressive symptoms. [ABSTRACT FROM AUTHOR]

This study applied the Andersen Model of Health Care Utilization to explore the variables associated with health service use among Chinese adults living in rural low-income households. A survey of 2,429 adults living in 787 low-income households in Jiangsu, China was conducted in 2017. Respondents were asked the presence of outpatient service in the past one month and the amount of hospitalization in the past one year. Mixed effect logistic and negative binomial models were used to examine the relationship of individual-level and household-level characteristics with health service use. Health condition was the predominant determinant of both outpatient and inpatient service use (Odds Ratio [OR] >1, p < .001). Individuals living in a poor household were less likely to use outpatient service (OR = 0.05, 95% confidence interval CI: 0.00, 0.71), and the longer in poverty status the less likely to use outpatient service (OR = 0.92, CI: 0.86, 0.99). Age was associated with a lower likelihood to use outpatient service (OR = 0.93, CI: 0.93, 1.00), and this relationship was stronger for larger households (OR = 1.01, CI: 1.00, 1.01). For inpatient service use, most household-level measures were insignificant. Rural Chinese health service use was influenced primarily by needs variables. Outpatient service use was constrained by household enabling variables. Older adults were at a disadvantage of using outpatient service when the family prioritized younger members in allocating resources. These results suggest the need for policy advocacy to expand insurance reimbursement and improve benefits for poor older adults. [ABSTRACT FROM AUTHOR]

In this article, we explore the subjective well-being of empty nesters who lived in rural eastern China (N = 967). The Memorial University of Newfoundland Scale of Happiness is used to measure subjective well-being. The results indicate that Memorial University of Newfoundland Scale of Happiness is appropriate for empty nesters in rural China due to its reliability and validity. Generally, male empty nesters report greater subjective well-being scores than females. Negative factors include low levels of education, being a widow or widower, or being unmarried. It is argued that the empty nesters' incapability to access adequate social service and home care leads to their poor subjective well-being. [ABSTRACT FROM AUTHOR]

Background: Little research has investigated the long‐term relationship between low wages and memory decline, despite the growing share of low‐wage workers in the US labor market. We examined whether cumulative exposure to low wages over 12 years in midlife is associated with memory decline in later life. Method: We used 1992‐2016 data from the Health and Retirement Study, a biennial longitudinal survey of nationally representative samples of Americans aged 50+. We analyzed data from 3,803 individuals born 1936‐1941 using confounder‐adjusted linear mixed‐effects models. Low‐wage was defined as hourly wage lower than two‐thirds of the federal median wage for the corresponding year. Low‐wage exposure history was categorized into 'never', 'intermittent', and 'sustained' based on wages earned from 1992 to 2004. Memory function was measured at each visit from 2004 to 2016 by a memory composite score; on average, participants completed 4.8 memory assessments from 2004‐2016. Estimates were obtained in the total sample and within strata of sex (Nmales = 1,913, Nfemales = 1,890). Result: At the beginning of cognitive follow‐up (2004) our sample was on average 65 years old with a mean memory score of 1.15 standard units. The confounder‐adjusted annual rate of memory decline among workers who never earned low wages was ‐0.12 standard units, 95% CI: [‐0.14, ‐0.10]. Compared with this, memory decline among workers with sustained earning of low midlife wages was significantly faster (βtime*sustained:‐0.012, 95% CI: [‐0.02, ‐0.01]), corresponding to an annual rate of ‐0.13 standard units for this group. Put into terms of "excess cognitive aging", the cognitive aging experienced by workers with sustained exposure to low midlife wages over a 10‐year period is what workers never earning low‐wages would experience in 11 years. Similar associations were found among males and females. No significant association between intermittent earning of low wages and memory decline was observed. Conclusion: Sustained earning of low wages in midlife was significantly associated with a downward trajectory of memory performance in older age. Enhancing social policies to protect low‐wage workers (e.g., increasing minimum wage) may be especially beneficial for the cognitive health of individuals with sustained low‐wage employment in midlife. [ABSTRACT FROM AUTHOR]

This study provides a cross-national perspective to apply Cumulative Dis/Advantage (CDA) in explaining health inequality between developing and developed countries in the context of Welfare State Theory. Cross-sectional data from the international Health Retirement Study (United States, China, Mexico, and England) in 2013-2014 were used (n = 97,978). Four health indicators were included: self-reported health, depressive symptoms, functional ability, and memory. Regression models were fitted to examine the moderation roles of country and gender. Results indicated older Chinese and Mexican had poorer health status than their British and American counterparts consistently except for Mexicans' memory. Cumulative health gaps between developing and developed countries existed only for functional ability. There is no evidence of a widening gap in health status between genders in late life. CDA explains the increasing gaps of functional ability across age groups between countries. General health and mental health, may however, depend more on individuals' intrinsic capacity and human agency. [ABSTRACT FROM AUTHOR]

The shared resource hypothesis suggests that married couples share the same environmental resources, which shape their health concordance. This study tests its cross‐national applicability. Cross‐sectional 2012–2013 Health and Retirement Study data from China, England, Mexico, and the United States were analyzed. Heterosexual couples (age ≥60) who were married or partnered were studied (N = 20,565 pairs). Dyadic data were analyzed by multilevel models to examine the effect of self and spousal social and physical health statuses on depressive symptoms. Regression models were used to test the relationship between couples' shared resources and depressive symptom concordance. Results indicated both husbands and wives' depressive symptoms were associated with their own and spouses' social and health statuses. Most couple‐level resources were insignificant predictors for Chinese and Mexican couples' concordance, but having more social and financial resources was associated with higher concordance among British and American couples. Self‐reported health was the most consistent predictor in all countries. The shared resource hypothesis was more applicable to depressive symptom concordance within couples in the United States and England, but not in China and Mexico. Couple‐centered intervention is suggested for clinical practice, and the spousal effect should be considered in policymaking. [ABSTRACT FROM AUTHOR]

Background: Studies on the health effect of Supplemental Nutrition Assistance Program (SNAP) on the cognitive health of older adults are scarce. In this study, we examined the associations of SNAP use and memory function trajectories among US older adults. Method: Our sample included 3,555 SNAP‐eligible participants (aged 50+) from the 1996 Health and Retirement Study survey, among whom 559 were SNAP users and 2,996 were non‐users. SNAP eligibility was constructed based on household income and assets compared to the federal criterion. Memory function was assessed biennially from 1996 through 2016. To account for pre‐existing differences in characteristics and variations in survey attrition between SNAP users and non‐users, we modeled the probability of SNAP use and of attrition using pre‐SNAP exposure (i.e., 1994) demographic and health covariates. We then modeled trajectories of memory function across SNAP use using linear mixed effect models weighted by the inverse probability of treatment (i.e. SNAP use) and of attrition. We also cross‐examined the results in a propensity score (PS) matched sample (N = 1,050). Result: SNAP users in 1996 had lower socioeconomic status and worse health at baseline than SNAP non‐users, and were more likely to be lost to follow‐up. Results using IP‐weights suggested SNAP users had worse memory scores at baseline but slower memory decline compared with non‐users (annual decline rate is ‐0.038 standard units [95%CI = ‐0.044, ‐0.033] for non‐users and ‐0.043 [95%CI = ‐0.046, ‐0.040] for users). Results from the PS‐matched sample also showed SNAP users had slower memory declines compared with non‐users (annual decline rate was ‐0.052 units [95%CI = ‐0.055, ‐0.050] for non‐users and ‐0.048 units [95%CI = ‐0.051, ‐0.046] for users). Conclusion: After accounting for pre‐existing differences between eligible SNAP users and non‐users as well as differential loss to follow‐up, our findings suggested that SNAP participation is associated with slower memory decline among eligible older adults. [ABSTRACT FROM AUTHOR]