Abstract The United States is both aging and becoming more diverse. To understand the phenomenon of retirement, it is necessary to understand not only the demographic changes that are currently underway but also projections of change in the coming decades. This chapter examines how demography has intersected with public policy, as well as the characteristics of retirees and family dynamics, to shape retirement in the past, present, and future. It focuses on how demographic factors affect retirement patterns and the need for and supply of workers. Combining demographic projections with current knowledge about incentives and disincentives to work or retire allows extrapolation to potential scenarios for the future of retirement.

Racial disparities in COVID-19 exposure, illness, hospitalization and mortality have been well-documented, however, less is known about potential disparities in the pandemic’s effect on social activities. Data from the early release of the 2020 Health and Retirement Study (HRS) were used to examine the relationship between race (White/African American/other) and ethnicity (Hispanic/Non-Hispanic) and COVID-19 disruptions to social activities (N=4,500). Participants were asked, “due to the coronavirus pandemic, did you experience any of these changes in activities: 1) unable to visit a family member in a care facility, nursing home or group home, 2) family celebrations canceled/restricted, 3) unable to visit a close family member in the hospital, 4) unable to attend in-person funeral or religious service for a family member or friend, 5) unable to visit family after birth of a baby (1=yes, 0=no/not relevant) and, “overall, how stressful have changes in contacts with family and friends been for you?” (1=not at all stressful, 5=extremely stressful). Results from logistic regression controlling for age and gender showed that relative to Whites, African Americans had significantly higher odds of all disruptions except for family celebrations and relative to non-Hispanics, Hispanics had significantly higher odds of three types of disruptions. OLS regression results showed that only Hispanics had higher average stress due to these changes. These findings indicate that in addition to the previously documented disparities in COVID-19, older African Americans and Hispanics experienced greater disruptions to social activities. These impacts could further influence both short and long-term physical and mental health.

Abstract Health care is important for maintaining optimal physical and mental health. However, due to the COVID-19 pandemic, many older adults have delayed or postponed care. Data from the special midterm release of the 2020 Health and Retirement Study (HRS) were used to examine the relationship between chronic conditions and delayed care, as well as between delayed care and mental health outcomes and preventative care among Americans aged 50+ (N=3,266). Approximately 30% of respondents said yes when asked “Since March 2020, was there any time when you needed medical or dental care, but delayed getting or did not get it at all?” Of those, 55% said their provider cancelled, closed or suggested rescheduling, 28.5% decided it could wait, and 20.8% were afraid to go. Results from OLS and logistic regression, controlling for sociodemographic characteristics, indicate that those with lung disease and those with a heart condition had significantly higher odds of delaying care. Delaying care was associated with significantly higher odds of poor self-rated health and feeling depressed, as well as significantly higher average hopelessness, loneliness and negative affect and significantly lower average positive affect. Surprisingly, delaying care was not associated with receiving a flu shot, cholesterol test, colonoscopy, mammogram or prostate exam in the previous two years. It is likely that the full effects of delaying health care during the pandemic have yet to be felt and there is a need to study the implications of such delays.

Abstract Racial disparities in COVID-19 exposure, illness, hospitalization and mortality have been well-documented, however, less is known about whether African Americans and other minorities experience greater worry related to the COVID-19 pandemic. Data from the special midterm release of the 2020 Health and Retirement Study (HRS) were used to examine the relationship between race (white, African American, and other) and ethnicity (Hispanic/Non-Hispanic) and COVID-19 related worry among older Americans (N=2,069). Participants were asked, “because of the coronavirus pandemic how worried are you about 1) your own health, 2) the health of others in your family? 3) Your financial situation? 4) Being able to get help if you needed it from family, friends, or others? 5) What will happen in the future?” (0=not at all worried and 10=very worried). Results from OLS regression controlling for age, gender and education showed that compared with whites, African Americans had significantly higher average worry for all items except the last (other race did not differ). On the other hand, Hispanics had significantly lower worry, on average, for each of the five items. In addition, women had significantly higher average worry, while age was negatively associated with all items except the first. These findings indicate that in addition to the previously documented disparities in COVID-19, older African Americans experienced more worry. This has important implications for long-term physical and mental health.

Abstract The COVID-19 pandemic has caused major disruption to society, including education, the economy, daily life, etc. To understand the impact of the pandemic on both short-term and anticipated long-term mental and physical health, as well as potential period and cohort differences, surveys were emailed to all students, faculty and staff at a Florida HBCU. The survey included the GAD-7 anxiety scale, PHQ-9 scale of depression severity and the UCLA Revised Loneliness Scale (3rd revision), as well as questions about the pandemic’s impact on physical and mental wellbeing in the month of April and long-term physical and mental health. Although loneliness did not differ among groups, students reported the highest levels of moderate/severe depression (46.6%), followed by faculty (21.1%) and staff (6.9%). Students also reported the highest levels of moderate/severe anxiety (48.6%) compared with faculty (29.4%) and staff (12.1%). Students were more likely to say the pandemic moderately or very much impacted their overall physical and mental wellbeing in April. However, faculty were more likely to report that their long-term physical and mental health would be somewhat/greatly affected, followed by students, and then staff. Staff reported the highest levels of optimism about the future, followed by students and faculty. Taken together, these findings indicate substantial differences in the perceived impact of the COVID-19 pandemic.

Abstract There were approximately 34.2 million unpaid caregivers of adults age 50+ in the United States in the last 12 months (NAC & AARP, 2015). These individuals provide important care for older adults with physical, psychological and cognitive problems. There is a growing awareness that caregivers are also at risk for physical and mental health problems and therefore also require support to reduce stress and maintain optimal health. Research suggests that engaging in creative and artistic activities may reduce stress and improve physical and mental health among caregivers. Researchers from Bethune-Cookman University partnered with the Atlantic Center for the Arts in New Smyrna Beach, FL to evaluate their Creative Caregiving program. Approximately 10 informal caregivers and their care partners met for 2 hours each week over the course of 6 weeks from February 3-March 9, 2020. Participants learned how to connect mind, body and spirit by using the arts as a tool of self-care, social interaction, and learning. At each session, participants were asked to rate their overall wellbeing on a scale from 1-10. Pre- and post-session data was analyzed using paired samples t-tests. Results indicate that there was significant improvement in wellbeing and participants reported improvements in their stress, mood and relationship with their caregiver or care partner. These findings were observed for both caregivers and care partners, suggesting that arts programs can benefit both. Such programs are a fun and cost-effective way to improve wellbeing, at least in the short-term.

Abstract Experiences of everyday discrimination, such as being treated with less courtesy or respect, are associated with poorer mental and physical health in later life. Yet not much is known about cohort differences in experiences of everyday discrimination, nor how subjective reports of discrimination change over time among older adults. This study assessed cohort differences and 4-year change in everyday discrimination using data from the 2006 and 2010 waves of the Health and Retirement Study (HRS), a nationally-representative study of Americans 50+. In both waves, participants were asked about 5 possible experiences of everyday discrimination: for example, “In your day-to-day life, how often have any of the following things happened to you? You receive poorer service than other people at restaurants and stores” and could respond from 0=never to 5=almost every day. Average everyday discrimination was lower for older cohorts compared with younger cohorts in both 2006 and 2010. Paired-samples t-tests showed that average everyday discrimination declined significantly over the 4-year period. However, it is unclear if changes are due to period or age effects. Implications of these findings will be discussed.

Abstract Older adults are an important demographic group in the tourism sector, particularly in Florida. This study assessed age-group differences in the characteristics and habits of 2019 Daytona Bike Week attendees, as evidence indicates the average age of bike week visitors is rising. Aging Studies and Hospitality undergraduate students at Bethune-Cookman University interviewed 335 participants using Google Forms on their mobile phones. Results from chi-square tests indicate that there were significant differences between younger (20-39 years), middle-aged (40-59 years) and older adults (60+ years) in terms of gender and income, expenditures on accommodations, type of accommodations, nights spent, and first-time attendance. A greater percentage of older bike week attendees were male and higher income, and were less likely to be first-time attendees. Older adults also tended to spend more on accommodation and stayed longer, and were more likely to stay in Air BnBs, rental homes or a second home/condo compared with younger and middle-aged adults, but were less likely to stay in a hotel/motel or with friends/family. No significant differences were found in expenditures on food, alcohol, gas, entertainment or shopping. Findings suggest that older bike week attendees are important contributors to bike week tourism, particularly with respect to accommodations.

Healthcare stereotype threat (HCST) is the fear of confirming negative group-based stereotypes that operates within healthcare settings. Experimental and observational evaluations suggest that experiencing healthcare stereotype threat is linked to lack of trust in physicians and lower satisfaction with healthcare, as well as worse mental and physical health outcomes. The current study examined the relationship between race-based HCST and specific components of affect (feelings of calm, content and upset) among African American adults of all ages in the American Life Panel (N=456) and older adults in the Health and Retirement Study (N=97) using OLS regression. HCST based on race was significantly negatively associated with contentment and calmness (marginally significant) in the ALP sample, and was significantly associated with lower feelings of calm in the HRS sample. Findings suggest that not only are individuals aware of HCST and able to report on it through surveys, but they also experience greater negative affect and lower positive affect.

Objectives:A lifecourse framework was used to examine the association between major and everyday measures of perceived discrimination and depressive symptoms among African American men and to evaluate whether these relationships differed for young, middle-aged, and older men.Method:The association between both major and everyday discrimination and depressive symptoms, as measured by the Center for Epidemiologic Studies Depression (CES-D) scale, was assessed among 296 African American men in the 2011-2014 Nashville Stress and Health Study (NSAHS) using ordinary least squares regression. Interactive associations between major and everyday discrimination and age patterns in the discrimination-depressive symptoms relationship were also investigated.Results:Everyday, but not major discrimination was associated with depressive symptoms among African American men. This relationship was stronger among middle-aged men and diminished among older men. However, major discrimination, but not everyday discrimination, was associated with depressive symptoms of older men (age 55+), with greatest depressive symptomatology among those reporting both forms of discrimination.Discussion:Everyday discrimination is a more consistent predictor, relative to major discrimination, of depressive symptoms among African American men across the lifecourse, although there were age and/or cohort differences. Findings also demonstrate the synergistic, or additive, impact of multiple forms of discrimination on mental health.

Experiences of “major” discrimination, such as being unfairly dismissed from a job, are associated with poorer mental and physical health in later life. However, discrimination is most often measured using subjective and retrospective reports. This study assessed the consistency of such retrospective reports using data from the 2006 and 2010 waves of the Health and Retirement Study (HRS), a nationally-representative study of Americans 50+. In both waves, participants were asked about 6 possible experiences of discrimination: for example, “at any time in your life, have you ever been unfairly denied a bank loan?” and could respond yes or no. When examining both waves, participants fell into one of 4 categories: reporting no discrimination at either time point, reporting discrimination at both time points, reporting discrimination in 2010 only (incident discrimination) or reporting discrimination in 2006 but not 2010 (inconsistent reporting). The last category is problematic because it is clearly not possible to report a discriminatory experience “at any time in your life” in 2006 but not in 2010.While most respondents had not experienced these types of major discrimination, among those who had, the prevalence of “inconsistent reporting” across items ranged from 22.9–38.8% with an average of 33.1% (overall the average was 3.5% with a range of 0.8% to 5.7%). This has important methodological implications for the measurement and study of discrimination among older adults. Also, future work should explore factors associated with inconsistent reporting, such as cognitive impairment.

Healthcare stereotype threat (HCST), or the fear of being judged or personally confirming negative group-based stereotypes in healthcare settings, has been linked to poorer physical and mental health in cross-sectional studies. However, to date no studies have examined whether HCST predicts chronic disease incidence longitudinally. Using data from the 2012 and 2014 waves of the Health and Retirement Study (N=1,479), we examined whether experiences of HCST reported in 2012 were predictive of the development of chronic disease two years later using logistic regression models, which controlled for sociodemographic characteristics. We found that HCST, assessed in 2012, was predictive of development of diabetes and lung disease by the 2014 HRS wave among people who did not previously have these conditions. HCST, assessed in 2012, was not significantly associated with incidence of hypertension, heart conditions, or stroke, nor with mortality in 2014; nevertheless, odds ratios were in the expected direction and the relatively small sample size likely contributed to lack of significance. Findings demonstrate that HCST is negatively associated with poor mental and physical health not just cross-sectionally, but also with the development of certain chronic conditions over time.

Introduction: Healthcare stereotype threat is the threat of being personally reduced to group stereotypes that commonly operate within the healthcare domain, including stereotypes regarding unhealthy lifestyles and inferior intelligence. The objective of this study was to assess the extent to which people fear being judged in healthcare contexts on several characteristics, including race/ethnicity and age, and to test predictions that experience of such threats would be connected with poorer health and negative perceptions of health care.Methods: Data were collected as part of the 2012 Health and Retirement Study (HRS). A module on healthcare stereotype threat, designed by the research team, was administered to a random subset (n = 2,048 of the total 20,555) of HRS participants. The final sample for the present healthcare stereotype threat experiment consists of 1,479 individuals. Logistic regression was used to test whether healthcare stereotype threat was associated with self-rated health, reported hypertension, and depressive symptoms, as well as with healthcare-related outcomes, including physician distrust, dissatisfaction with health care, and preventative care use.Results: Seventeen percent of respondents reported healthcare stereotype threat with respect to one or more aspects of their identities. As predicted, healthcare stereotype threat was associated with higher physician distrust and dissatisfaction with health care, poorermental and physical health (i.e., self-rated health, hypertension, and depressive symptoms), and lower odds of receiving the influenza vaccine.Conclusions: The first of its kind, this study demonstrates that people can experience healthcare stereotype threat on the basis of various stigmatized aspects of social identity, and that these experiences can be linked with larger health and healthcare-related outcomes, thereby contributing to disparities among minority groups. (C) 2016 Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine

ABSTRACTThe objectives were to determine whether women always fare more poorly in terms of physical function and disability across countries that vary widely in terms of their level of development, epidemiologic context and level of gender equality. Sex differences in self-reported and objective measures of disability and physical function were compared among older adults aged 55–85 in the United States of America, Taiwan, Korea, Mexico, China, Indonesia and among the Tsimane of Bolivia using population-based studies collected between 2001 and 2011. Data were analysed using logistic and ordinary least-squares regression. Confidence intervals were examined to see whether the effect of being female differed significantly between countries. In all countries, women had consistently worse physical functioning (both self-reported and objectively measured). Women also tended to report more difficulty with activities of daily living (ADL), although differences were not always significant. In general, sex differences across measures were less pronounced in China. In Korea, women had significantly lower grip strength, but sex differences in ADL difficulty were non-significant or even reversed. Education and marital status helped explain sex differences. Overall, there was striking similarity in the magnitude and direction of sex differences across countries despite considerable differences in context, although modest variations in the effect of sex were observed.

While deleterious consequences of smoking on health have been widely publicized, in many developing countries, smoking prevalence is high and increasing. Little is known about the dynamics underlying changes in smoking behavior. This paper examines socio-economic and demographic characteristics associated with smoking initiation and quitting in Mexico between 2002 and 2010. In addition to the influences of age, gender, education, household economic resources and location of residence, changes in marital status, living arrangements and health status are examined. Drawing data from the Mexican Family Life Survey, a rich population-based longitudinal study of individuals, smoking behavior of individuals in 2002 is compared with their behavior in 2010. Logistic models are used to examine socio-demographic and health factors that are associated with initiating and quitting smoking. There are three main findings. First, part of the relationship between education and smoking reflects the role of economic resources. Second, associations of smoking with education and economic resources differ for females and males. Third, there is considerable heterogeneity in the factors linked to smoking behavior in Mexico indicating that the smoking epidemic may be at different stages in different population subgroups. Mexico has recently implemented fiscal policies and public health campaigns aimed at reducing smoking prevalence and discouraging smoking initiation. These programs are likely to be more effective if they target particular socio-economic and demographic sub-groups.

OBJECTIVE:This study examines sex differences in the association between migration and exposure to an urban environment and overweight, hypertension and diabetes in later life. METHODS:Interviews were conducted with 3,604 adults aged 50 and older in the Mexican Family Life Survey (MxFLS). Logistic regression analyses were used to examine the association between previous migration, urban exposure, and risk of overweight, hypertension, and diabetes. RESULTS:Migration itself was not associated with health outcomes after controlling for urban exposure. The risk of overweight and diabetes associated with urban exposure appeared to be greater for men. Sex differences were found in the covariates that helped explain differences in health between those with high and low urban exposure. DISCUSSION:These findings underscore the need to consider heterogeneity in health by urban exposure and by sex.

Chapter 5 ww w.a sh ga te. co m A Global Perspective on Physiological Change with Age ww w.a sh ga te. co m © Copyrighted Material ww w.a sh ga te. co m ww w.a sh ga te. co m Eileen Crimmins, Felicia Wheaton, Sarinnapha Vasunilashorn, Hiram Beltran-Sanchez, Lu Zhang and Jung Ki Kim ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m ww w.a sh ga te. co m In Western countries, we think of certain physiological changes as part of normal “ageing.” The idea that the levels of blood pressure and cholesterol rise, that weight increases, that functioning decreases is viewed as part of the ageing process. These physiological changes are monitored by physicians and health systems, and are associated with a significant portion of the use of prescription drugs. Physiological changes associated with age not only contribute to chronic disease, but also lead to disability, diminished quality of life and ultimately, mortality. Yet while ageing is inevitable, it is necessary to question whether the physiological changes we associate with ageing are the result of innate human biology and to what extent physiological age changes are shaped by the social environments in which we live. In this chapter, we examine global differences in a number of markers of ageing to show that there are many patterns of physiological differences with age depending on environmental, cultural, economic, medical and historical circumstances. The observed differences highlight that what we regard as the ageing process is not consistent across countries and is very influenced by environmental circumstances. The differences that we observe suggest that these processes may be changing rapidly in much of the world and that much of what we have assumed to be normal physiological changes with ageing may reflect the environmental circumstances in modern Western or American society. These societies have undergone demographic and economic revolutions that are now ongoing in the rest of the world where newly ageing populations have lived through the entire economic and demographic transition. Recently, a number of nationally representative surveys of ageing populations have added biomarkers to their data collections. The inclusion of measured physiology in social surveys allows for the comparison of markers of health which cannot be reported accurately by respondents in many circumstances. The ability to compare these measured indicators across societies allows us to make generalizations about ageing that have, heretofore, not been possible. To investigate whether physiological changes with age are universal, we examine age differences in a number of markers of physiological dysregulation associated with ageing across a range of populations including Japan, the United States (US), England, Taiwan, two provinces in China, Mexico, Indonesia and the Tsimane of © Copyrighted Material

Objective: This study examines sex differences in the association between migration and exposure to an urban environment and overweight, hypertension and diabetes in later life. Methods: Interviews were conducted with 3,604 adults aged 50 and older in the Mexican Family Life Survey (MxFLS). Logistic regression analyses were used to examine the association between previous migration, urban exposure, and risk of overweight, hypertension, and diabetes. Results: Migration itself was not associated with health outcomes after controlling for urban exposure. The risk of overweight and diabetes associated with urban exposure appeared to be greater for men. Sex differences were found in the covariates that helped explain differences in health between those with high and low urban exposure. Discussion: These findings underscore the need to consider heterogeneity in health by urban exposure and by sex.