Chuck W. Peek

Self-Rated Health and Morbidity Onset Among Late Midlife U.S. Adults

OBJECTIVES Although self-rated health (SRH) is recognized as a strong and consistent predictor of mortality and functional health decline, there are relatively few studies examining SRH as a predictor of morbidity. This study examines the capacity of SRH to predict the onset of chronic disease among the late midlife population (ages 51-61 years). METHOD Utilizing the first 9 waves (1992-2008) of the Health and Retirement Study, event history analysis was used to estimate the effect of SRH on incidence of 6 major chronic diseases (coronary heart disease, diabetes, stroke, lung disease, arthritis, and cancer) among those who reported none of these conditions at baseline (N = 4,770). RESULTS SRH was a significant predictor of onset of any chronic condition and all specific chronic conditions excluding cancer. The effect was particularly pronounced for stroke. DISCUSSION This research provides the strongest and most comprehensive evidence to date of the relationship between SRH and incident morbidity.

Race and ethnic variation in the disablement process.

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 andMexican 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.

Race, Aging, and Care Can Differences in Family and Household Structure Account for Race Variations in Informal Care?

There are substantial uncertainties about key dimensions of the caregiving process as it is experienced by older adults from different racial groups. This investigation explores the care received from family members among a stratified random sample of community-dwelling older (65+) African Americans and Whites who reported difficulties performing daily living tasks. Findings support past research indicating that older African Americans are more likely to receive help from family members than are Whites when in need of assistance. However, this advantage does not extend across all types of family members but, rather, is only statistically significant in the final models with regard to the care received from grandchildren. Evidence is presented that indicates that the observed race differences in the receipt of care from children can be attributed to variations between racial groups in family and household structure. The findings suggest that coresidence may be a form of family caregiving among older African Americans.

Patterns of change in self-reported oral health among dentate adults.

BACKGROUND Although self-assessments of oral health have become useful tools in dental research, the use of self-reports to study changes in oral health over time has been limited. The aim of this investigation was to describe how oral disease and tissue damage, pain, functional limitation, disadvantage, and self-rated oral health change over time. METHODS The Florida Dental Care Study (FDCS) (n = 873) is a longitudinal study of oral health among dentate adults (age, > or = 45 years). Incidence rates and transition probabilities were used to describe changes in oral health over a 24-month period. RESULTS The probability of reporting a specific problem during the 24-month study ranged from 0.52 for perceived need for dental care to 0.07 for avoided eating with others. Only dental sensitivity and perceived need for dental care had transition probabilities >0.20. Decomposition of transition probabilities revealed moderate probabilities of onset coupled with relatively high probabilities of recovery. CONCLUSION Although oral health status is clearly dynamic, no individual measure exhibited profound fluctuation. Most oral health problems were episodic rather than chronic. Patterns of change in oral health varied across dimensional lines.

The Changing Caregiving Networks of Older Adults

One of the dominant features of caregiving networks, their propensity to change over time, continues to be incompletely described and inadequately understood. The purpose of this study is to illuminate the complex patterns of change that shape the evolving caregiving networks of older adults. Using data from the Longitudinal Study of Aging (LSOA), a transition matrix approach is used to describe the changes older adults experience in their caregiving arrangements over time. These caregiving networks are characterized by both stability and change. At any given time, most elders are able to live independently without the help of a caregiver. The caregiving network, once activated, appears to be characterized by a great deal of change in care configurations. Finally, beyond a certain threshold off frailty, extensive care is required in either a community or an institutional setting. Variation in transitions by age, gender, race, and place of residence are examined.

Race Differences in the Health of Elders who Live Alone

This investigation was initiated to determine whether older African Americans who live alone are in poorer health than their White counterparts who live under the same circumstances. Data on 5 measures of health were collected in telephone interviews with a stratified random sample of community-dwelling elders (n = 1,189). Analysis of weighted data indicate that there were fewer differences in health by race among older persons who lived alone compared to elders who lived with others. Where racial differences in health did exist among older adults who lived alone, the differences could only sometimes be accounted for by population composition factors that are known to influence health.

Race and Residence Differences in the Use of Formal Services by Older Adults

Using a longitudinal panel that oversampled older (65+) African Americans and rural residents of north Florida, this study examines race and residence differences in the use of four services: two community-based services (senior centers and special transportation) and two home-based services (homemaker and nursing care). Significant differences across race and residence groups in the use of these services were identified. Black elders, especially rural Blacks, had higher odds of using community-based services, net of other sociodemographic, social support, and health characteristics. In contrast, rural elders were most likely to use homemaker services, controlling for other factors including race. Neither race nor residence was a significant predictor of the use of in-home nursing services in this sample. The findings are discussed within the context of the importance of examining both the individual and combined influences of race and residence on formal service use.

Race Comparisons of the Household Dynamics of Older Adults

Longitudinal studies have suggested that households are much more fluid than was once believed. Yet our understanding of changes in household composition is based on limited sets of transitions occurring across relatively long intervals. Furthermore, we know relatively little about ethnoracial variation in household dynamics. Using data from a sample of older Floridians, the authors describe race differences in longitudinal patterns of household change that occurred during four 6-month intervals. Approximately one quarter of respondents experienced some change in composition during the 24-month study. Older African Americans lived in larger and more dynamic households and were more likely to form coresident relationships with grandchildren and nonrelatives. Age, gender, marital status, and disability were also associated with the likelihood of acquiring a new household member. Findings from this research provide additional insight into the processes through which race differences in the composition of households emerge and are maintained over time.

Race and Residence Variation in Living Arrangements among Unmarried Older Adults Findings from a Sample of Floridians

This study examines race and residence differences in the likelihood of unmarried older persons living alone. Using data collected from a stratified, random sample of elderly persons conducted in both rural and urban areas of north Florida (N = 1,200), the investigation demonstrates that among the unmarried (n = 704), African Americans and residents of urban areas are more likely to live with others than are Whites and rural residents, respectively. This study also finds that the effects of race and residence on living alone are additive. Other factors found to significantly influence living arrangements are age, gender, the occurrence of a hospitalization in the past year, and the number of unmarried children. Variation in two additional aspects of the living arrangements of unmarried elders-the proximity of children and the relationship between elders and other members of the household-offer insight into the race and residence differences in living alone that remain unexplained by the multivariate analysis.

THE EFFECT OF ECONOMIC RESTRUCTURING ON PUERTO RICAN WOMEN'S LABOR FORCE PARTICIPATION IN THE FORMAL SECTOR

The joint effort by the U.S. government and the political elite of Puerto Rico to industrialize the island created increased demand for female labor and a decline in the number of jobs traditionally held by men. The authors examine whether womens labor force participation in the formal sector responds to improving opportunities for women, declining opportunities for men, or the households changing opportunity structures. Specifically, they examine a womans return to work after the birth of her first child as the initial point of conflict between productive and reproductive work. The data used in these analyses are from the 1982 Puerto Rican Fertility and Family Planning Assessment (PRFFPA), an islandwide, representative sample of never-married and ever-married women between the ages of fifteen and forty-nine. The authors estimate a series of nested logistic regression models to evaluate the influence of occupational expansion or contraction on the timing of return to work after the first birth. Their findings offer selective support for the idea that womens lives are affected primarily by the occurrence of growing labor demand for womens labor.