William T. Gallo

Factors associated with home versus institutional death among cancer patients in Connecticut

OBJECTIVE: To assess the relationships between home death and a set of demographic, disease‐related, and health‐resource factors among individuals who died of cancer.

The impact of late career job loss on myocardial infarction and stroke: a 10 year follow up using the health and retirement survey.

Background: Involuntary job loss is a major life event associated with social, economic, behavioural, and health outcomes, for which older workers are at elevated risk. Objective: To assess the 10 year risk of myocardial infarction (MI) and stroke associated with involuntary job loss among workers over 50 years of age. Methods: Analysing data from the nationally representative US Health and Retirement Survey (HRS), Cox proportional hazards analysis was used to estimate whether workers who suffered involuntary job loss were at higher risk for subsequent MI and stroke than individuals who continued to work. The sample included 4301 individuals who were employed at the 1992 study baseline. Results: Over the 10 year study frame, 582 individuals (13.5% of the sample) experienced involuntary job loss. After controlling for established predictors of the outcomes, displaced workers had a more than twofold increase in the risk of subsequent MI (hazard ratio (HR) = 2.48; 95% confidence interval (CI) = 1.49 to 4.14) and stroke (HR = 2.43; 95% CI = 1.18 to 4.98) relative to working persons. Conclusion: Results suggest that the true costs of late career unemployment exceed financial deprivation, and include substantial health consequences. Physicians who treat individuals who lose jobs as they near retirement should consider the loss of employment a potential risk factor for adverse vascular health changes. Policy makers and programme planners should also be aware of the risks of job loss, so that programmatic interventions can be designed and implemented to ease the multiple burdens of joblessness.

The Effect of Spousal Mental and Physical Health on Husbands' and Wives' Depressive Symptoms, Among Older Adults: Longitudinal Evidence From the Health and Retirement Survey

Objective: To estimate the effect of spousal depressive symptoms and physical health on respondents’ depressive symptoms in a national sample of older married couples. Method: We used data on 5,035 respondent husbands and wives from the 1992 and 1994 waves of the Health and Retirement Survey. Multivariate regression models were estimated to examine the impact of spousal depressive symptoms and physical health on respondents’ depressive symptoms. Results: Adjusting for respondent mental and physical health and sociodemographic traits, having a spouse with more depressive symptoms was associated with significantly higher follow-up depressive symptoms in the respondent (p< .001). Controlling for spousal depressive symptoms, a decline in the spouses’physical healthwas associated with a significant reduction in respondent depressive symptoms (p< .05). Discussion: Our findings suggest that health care providers treating older adults should be sensitive to the possibility that spouses may be affected when clients suffer poor mental or physical health.

Ownership status and patterns of care in hospice: results from the National Home and Hospice Care Survey.

Background:The number of for-profit hospices increased nearly 4-fold over the past decade, more than 6 times the growth of nonprofit hospices. Despite this growth, the impact of ownership on hospice care is largely unknown. We sought to assess differences in the provision of services to patients of for-profit and nonprofit hospices. Methods:Using the 1998 National Home and Hospice Care Survey, we examined services used by patients (N = 2080) cared for by 422 hospices nationwide. We used multivariable ordered logistic and logistic regression to assess the effect of profit status on service use, adjusting for potentially confounding patient and organizational characteristics. We calculated point estimates adjusted for sampling weights and standard errors adjusted for the clustering of patients within hospices. Results:In ordered logistic models controlling for organizational and patient factors, patients of for-profit hospices received a significantly narrower range of services (adjusted odds ratio [OR], 0.45; 95% confidence interval [CI], 0.22–0.92) than patients of nonprofit hospices. This result is driven by patients of for-profit hospices receiving significantly fewer types of hospice services that federal regulations term “noncore” or more discretionary services (adjusted OR, 0.34; 95% CI, 0.15–0.75). Conclusion:The pattern of care differs in for-profit and nonprofit hospices. As the industry develops a substantial for-profit presence, it is critical for clinicians and other healthcare professionals to be alert to the potential impact of profit status on the care their patients receive.

Effects of Layoffs and Plant Closings on Subsequent Depression Among Older Workers

Job displacement is widely considered a negative life event associated with subsequent economic decline and depression, as established by numerous prior studies. However, little is known about whether the form of job displacement (i.e., layoffs vs. plant closings) differentially affects depression. The authors assessed the effects of different ways in which workers are displaced on subsequent depression among U.S. men and women nearing retirement. They hypothesized that layoffs would be associated with larger effects on depression than plant closings, particularly among men. The findings generally support these hypotheses. The authors found that men had significant increases in depression as a result of layoffs, but not as a result of plant closings, whereas the reverse was true among women.

Effects of retirement voluntariness on changes in smoking, drinking and physical activity among Dutch older workers.

BACKGROUND Although several studies have investigated the association of health behaviors with retirement, none has examined this relationship in the context of retirement voluntariness. METHODS Using data from the 2001 and 2007 waves of a panel study of retirement in the Netherlands, we used multinomial logistic regression models to investigate the impact of retirement voluntariness on changes in smoking, alcohol use, and physical activity. Participants included 1604 individuals, aged 50-64 years, who were employed in 2001. RESULTS During the 6-year follow-up, 884 (55%) sample members retired: 676 (42%) perceived their retirement as voluntary and 208 (13%) perceived their retirement as involuntary. Results of multinomial logistic analyses indicated that, relative to non-retired participants (n = 720), the voluntarily retired had higher risk of increased physical activity [relative risk ratio (RR) = 2.90, 95% confidence interval (CI): 2.19-3.84] and lower risk of decreased physical activity (RR = 0.35, 95% CI: 0.22-0.56). The involuntarily retired had both higher risk of increased smoking (RR = 3.68, 95% CI: 1.45-9.30) and lower risk of decreased smoking (RR = 0.50, 95% CI: 0.25-0.99), lower risk of decreased alcohol use (RR = 0.47, 95% CI: 0.29-0.73), and both higher risk of increased physical activity (RR = 2.14, 95% CI: 1.47-3.13) and lower risk of decreased physical activity (RR = 0.46, 95% CI: 0.23-0.92). CONCLUSION Accounting for the perceived voluntariness of retirement is essential to obtaining a clear assessment of the behavioral effects of this type of labor force departure.

The Impact of Occupation on Self-Rated Health: Cross-Sectional and Longitudinal Evidence from the Health and Retirement Survey

BACKGROUND The objective of this study is to estimate occupational differences in self-rated health, both in cross-section and over time, among older individuals. METHODS We use hierarchical linear models to estimate self-reported health as a function of 8 occupational categories and key covariates. We examine self-reported health status over 7 waves (12 years) of the Health and Retirement Study. Our study sample includes 9,586 individuals with 55,389 observations. Longest occupation is used to measure the cumulative impact of occupation, address the potential for reverse causality, and allow the inclusion of all older individuals, including those no longer working. RESULTS Significant baseline differences in self-reported health by occupation are found even after accounting for demographics, health habits, economic attributes, and employment characteristics. But contrary to our hypothesis, there is no support for significant differences in slopes of health trajectories even after accounting for dropout. CONCLUSIONS Our findings suggest that occupation-related differences found at baseline are durable and persist as individuals age.

Job loss and depression: The role of subjective expectations

Although the importance of expectations is well documented in the decision-making literature, a key shortcoming of the empirical research into effects of involuntary job loss on depression is perhaps its neglect of the subjective expectations of job loss. Using data from the US Health and Retirement Study surveys we examine whether the impact of job loss on mental health is influenced by an individuals subjective expectations regarding future displacement. Our results imply that, among older workers in the age range of 55-65 year, subjective expectations are as significant predictors of depression as job loss itself, and ignoring them can bias the estimate of the impact of job loss on mental health.

Understanding Heterogeneity in Price Elasticities in the Demand for Alcohol for Older Individuals

This paper estimates the price elasticity of demand for alcohol using Health and Retirement Study data. To account for unobserved heterogeneity in price responsiveness, we use finite mixture models. We recover two latent groups, one is significantly responsive to price, but the other is unresponsive. The group with greater responsiveness is disadvantaged in multiple domains, including health, financial resources, education and perhaps even planning abilities. These results have policy implications. The unresponsive group drinks more heavily, suggesting that a higher tax would fail to curb the negative alcohol-related externalities. In contrast, the more disadvantaged group is more responsive to price, thus suffering greater deadweight loss, yet this group consumes fewer drinks per day and might be less likely to impose negative externalities.

Impact of resilience enhancing programs on youth surviving the Beslan school siege

The objective of this study was to evaluate a resilience-enhancing program for youth (mean age = 13.32 years) from Beslan, North Ossetia, in the Russian Federation. The program, offered in the summer of 2006, combined recreation, sport, and psychosocial rehabilitation activities for 94 participants, 46 of who were taken hostage in the 2004 school tragedy and experienced those events first hand. Self-reported resilience, as measured by the CD-RISC, was compared within subjects at the study baseline and at two follow-up assessments: immediately after the program and 6 months later. We also compared changes in resilience levels across groups that differed in their traumatic experiences. The results indicate a significant intra-participant mean increase in resilience at both follow-up assessments, and greater self-reported improvements in resilience processes for participants who experienced more trauma events.