Patricia M. Andreski

Trends In Disability And Related Chronic Conditions Among People Ages Fifty To Sixty-Four

Although still below 2 percent, the proportion of people ages 50-64 who reported needing help with personal care activities increased significantly from 1997 to 2007. The proportions needing help with routine household chores and indicating difficulty with physical functions were stable. These patterns contrast with reported declines in disability among the population age sixty-five and older. Particularly concerning among those ages 50-64 are significant increases in limitations in specific mobility-related activities, such as getting into and out of bed. Musculoskeletal conditions remained the most commonly cited causes of disability at these ages. There were also substantial increases in the attribution of disability to depression, diabetes, and nervous system conditions for this age group.

Trends in health of older adults in the United States: Past, present, future

The decline in late-life disability prevalence in the United States was one of the most important developments in the well-being of older Americans in the 1980s and 1990s, but there is no guarantee that it will continue into the future. We review the past literature on trends in disability and other health indicators and then estimate the most recent trends in biomarkers and limitations for both the population aged 65 and older and those aged 40 to 64, the future elderly. We then investigate the extent to which trends in education, smoking, and obesity can account for recent trends in limitations and discuss how these three factors might influence future prospects for late-life health. We find that improvements in the health of the older population generally have continued into the first decade of the twenty-first century. The recent increase in the proportion of the younger population needing help with activities of daily living is concerning, as is the doubling of obesity in the last few decades. However, the increase in obesity has recently paused, and favorable trends in education and smoking are encouraging.

Health and Functioning Among Baby Boomers Approaching 60

OBJECTIVE To investigate whether the health and functioning of the Baby Boom generation are better or worse than those of previous cohorts in middle age. METHODS Trend analysis of vital statistics and self-reports from the National Health Interview Survey for the 40-59 population. Specific outcomes (years of data): mortality (1982-2004); poor or fair health (1982-2006); nine conditions (1997-2006); physical functional limitations (1997-2006); and needing help with personal care, routine needs, or either (1997-2006). RESULTS In 2005, the mortality rate of 59-year-olds, the leading edge of the Baby Boom, was 31% lower than that of 59-year-olds in 1982 (8.3 vs. 12.1 per 1,000). There was a similar proportional decline in poor/fair health, but the decline reversed in the last decade. From 1997 to 2006, the prevalence of reports of four conditions increased significantly, but this trend may reflect improvements in diagnosis and treatment. Functional limitations and need for help with routine needs were stable, but the need for help with personal care, while quite low, increased. DISCUSSION Trends varied by indicator, period, and age. It is surprising that, given the socioeconomic, medical, and public health advantages of Baby Boomers throughout their lives, they are not doing considerably better on all counts.

Response Rates in National Panel Surveys

It has been well documented that response rates to cross-sectional surveys have declined over the past few decades. It is less clear whether response rates to longitudinal surveys have experienced similar changes over time. This article examines trends in response rates in several major, national longitudinal surveys in the United States and abroad. The authors find that for most of these surveys, the wave-to-wave response rate has not declined. This article also describes the various approaches that these surveys use to minimize attrition.

Further evidence on the link between migraine and neuroticism

Epidemiologic studies have demonstrated an association between migraine and neuroticism.In this report, we examine prospectively whether higher levels of neuroticism, measured at baseline by the Eysenck Personality Questionnaire, signaled increased risk for first incidence of migraine during a 5-year follow-up interval. The sample was randomly selected from the list of young adult members of a large Health Maintenance Organization in southeast Michigan. Follow-up data were available on 972 subjects, 97.2% of the initial sample. Neuroticism predicted the first incidence of migraine in females. The relative risk for migraine in females scoring in the highest quartile of the neuroticism scales versus the lowest quartile was 4.0 (95% Cl 1.6, 10.3). Controlling for history of major depression and anxiety disorders at baseline reduced the estimate to 2.9 (95% Cl 1.1, 7.7). Neuroticism did not predict migraine in males, although the results in males were limited greatly by the small number of incidence cases. Neuroticism might be causally related to migraine, or alternatively, might be an early correlate with shared etiologies. NEUROLOGY 1996;47: 663-667

Trends and inequalities in late-life health and functioning in England

Background Recently, late-life disability rates have declined in several countries of the Organisation for Economic Co-operation, but no national-level trend analysis for England has been available. The authors provide such analysis, including measures both early and late in the disablement process, and the authors investigate the extent to which temporal trends are associated with population changes in socioeconomic position (SEP). Methods The authors fit logistic models of trends in self-reports and nurse measures of 16 health indicators, based on cross-sectional data from those aged 65 years and older from the 1992 to 2007 Health Survey for England. Results Overall, prevalence rates of limitations in seeing, hearing and usual activities declined (p<0.05); ever smoking, measured high blood pressure, high cholesterol, and high C reactive protein decreased (p<0.05); and the proportion with limitations in self-care activities remained stable. But obesity and limitations in walking 200 yards and climbing stairs increased (p<0.05). Increases over time in education and non-manual social class membership were associated with declines in smoking, C reactive protein and problems with usual activities. Had the changes in SEP not occurred, the increases in problems walking and climbing would have been greater. People with less education or of manual social classes experienced relatively worse trends for hearing, mobility functions and usual activities. The opposite was true for seeing. Conclusions Recent trends in late-life health and functioning in England have been mixed. A better understanding of which specific activities pose challenges, how the environment in which activities are conducted influences functioning and the causes of relatively worse trends for some SEP groups is needed.

Examining the Association Between Childhood Asthma and Parent and Grandparent Asthma Status: Implications for Practice:

Examination of intergenerational asthma beyond maternal asthma has been limited. The association between childhood asthma and intergenerational asthma status among a national cohort of children was examined. The genealogical sample (2552 children) participating in the Child Development Supplement of the Panel Study of Income Dynamics was studied. Multivariate regression was used to determine intergenerational asthma. Children with a parent with asthma were almost twice as likely (odds ratio [OR] = 1.96) to have asthma compared with those without a parent with asthma. Children with a parent and grandparent with asthma were more than 4 times more likely to have asthma compared with those without a parent and grandparent with asthma (OR = 4.27). Children with a grandparent with asthma were more likely to have asthma (OR = 1.52). A family history of asthma was a significant predictor of physician diagnosed asthma in children regardless of race/ethnicity and socioeconomic status. Findings support the collection of family history, including grandparent asthma status.

Measuring wealth and wealth inequality: Comparing two U.S. surveys

Household wealth and its distribution are topics of broad public debate and increasing scholarly interest. We compare the relative strength of two of the main data sources used in research on the wealth holdings of U.S. households, the Survey of Consumer Finances (SCF) and the Panel Study of Income Dynamics (PSID), by providing a description and explanation of differences in the level and distribution of wealth captured in these two surveys. We identify the factors that account for differences in average net worth but also show that estimates of net worth are similar throughout most of the distribution. Median net worth in the SCF is 6% higher than in the PSID and the largest differences between the two surveys are concentrated in the 1-2 percent wealthiest households, leading to a different view of wealth concentration at the very top but similar results for wealth inequality across most of the distribution.

Challenges in Estimating Trends in Late-Life Disability from the American Community Survey

To the Editor: We read with interest the article by Fuller-Thomson and colleagues (1) and their conclusion that estimates from the American Community Survey (ACS) showed an increase in difficulty with activities of daily living (ADLs) and a plateau in physical activity limitation between 2000 and 2005 for the U.S. population aged 65 years and older. Although the authors provided caveats in their interpretation of their findings, we believe that additional caution is warranted. We recently considered using the 2000–2007 ACS to assess late-life disability trends. However, we decided that because of changes in survey administration over time, we could not reliably estimate trends from the ACS. Our greatest concern was the change in interview mode. The proportion of ACS interviews that were completed via mail declined from 58% in 2000 to 52% in 2005 (and to 48% in 2007), and the proportion completed through computer-assisted interviews concomitantly increased (2–4). For people aged 16–64 years, estimates of limitation are higher using computer-assisted interviews versus mail. For example, in 2003, the differences for ADL limitation (difficulty dressing, bathing, or getting around inside) were 1.9% versus 1.8%, respectively, and for physical functional limitation (substantial limitation in walking, climbing stairs, reaching, lifting, or carrying) were 7.4% versus 6.5%, respectively (5). We were not able to find mode-specific estimates for the older population. However, if the older group experienced similar patterns, the increase in the proportion of computer-assisted interviews would likely account for some of the estimated increase in limitations. Unfortunately, the public ACS micro data sets do not provide an indicator of interview mode to use in modeling trends. Accordingly, we chose not to use the ACS. Another factor that appears to have contributed to an upward bias in the trends found by Fuller-Thompson and colleagues is aging of the population. They mentioned in their discussion the changes in the age distribution within the population aged 65 years and older from 2000 to 2005, especially the rapid increase of those aged 80 years and older. But they were not able to adjust for age in their analyses because they simply fitted regression lines across the published aggregate prevalences of limitations for each of the six survey years. We were not able to access from the internet the prevalence figures that Fuller-Thompson and colleagues used, but based on the micro data sets for each year, we calculated our own estimates of the aggregate prevalences for those aged 65 years and older, which track closely the data points graphed in figure 1 of their article. Indeed, when we fitted trend regression models using our prevalences, we found that ADL limitation increased at a rate of 1.56% per year in comparison to the 1.81% per year found by Fuller-Thomson and colleagues (calculated by dividing their regression coefficient on [year−2000] of .16 by the intercept of 8.84). However, when we calculated age-specific prevalences by 5-year age groups from the micro data, standardized the overall 65+ annual prevalence rates to the 5-year age distribution from various populations (2000, 2005, and an average of 2000–2005), and then estimated models based on these standardized prevalences, we found for ADL limitation that the p value on the trend coefficient was reduced from .005 to a range from .07 to .09, and the estimated annual change was reduced to 0.7%–0.8%. For functional limitations, the results of Fuller-Thomson and colleagues implied an annual increase of 0.37%, and we found annual change of 0.24% in our model of unadjusted prevalences and −0.14% to −0.16% for our models of age-standardized prevalences [none of the trend coefficients for functional limitations significantly different from 0, as in (1)]. As an alternative test of the importance of adjusting for age, we ran logit regressions of individual-level ADL and functional limitations on trend using the micro data set. For ADLs, our results implied an annual change of 1.67% in the unadjusted model and 0.85% in the model with 5-year age group controls. For functional limitations, the estimates were 0.34% and −0.23%, respectively. (All logit trend coefficients were statistically different from 0.) Accordingly, it appears that controlling for age results in a halving of the rate of increase for ADLs and in a trend downward, as opposed to upward, for functional limitations. We applaud Fuller-Thomson and colleagues for their attempt to shed light on the most recent disability trends and especially for their care in accounting for the institutionalized population. We also agree that tracking trends going forward is critical. However, estimated trends may be contaminated by changes over time in a variety of factors, some of which they note, such as survey design and administration, use of proxies, population coverage, question wording, and age distribution (6). Moreover, differences across surveys may also affect comparisons of trends (7). In sum, we do not think that the analysis of the ACS by Fuller-Thomson and colleagues provides sufficient evidence to reach even tentative conclusions about recent late-life disability trends.