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Carolina Center for Population Aging and Health (CCPAH)

University of North Carolina, Chapel Hill

CCPAH supports inter-disciplinary research on healthy aging and social and economic productivity in the United States and across the globe. In addition to the U.S. faculty are deeply engaged in research and primary data collection on the demography and economics of aging in China, India, Indonesia, Malawi, the Philippines, Russia, and Sri Lanka. A critical component of CCPAH research is recognition that measurement of biomarkers, genetics, and cognition, but also of relationships and exposure to stressors, are critical for understanding healthy aging.

Research Themes
Aging in Diverse Contexts; Links between health and social and economic productivity; Methods and measurement; Longitudinal data and life-course perspectives; Interventions and natural and policy experiments; Health and economic disparities.

News Archive and Newsletter
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Pilot Projects

  • 2022. Carmen Gutierrez, PhD. Criminal Legal System Connections, Health, and Place Safety.

    Connections to the criminal legal system (CLS) are known to affect health. Indeed, a large body of
    literature documents adverse health consequences associated with being punished by the CLS. However, surprisingly little is known about the ways that the relationship between punishment and health varies across geographic contexts. Even less attention has been dedicated to investigating the health consequences of working for the CLS, although research during the pandemic highlights how
    exposure to jail and prison environments has contributed to elevated levels of COVID-19 cases and
    deaths among detention center staff. Expanding our knowledge on the relationship between health
    and connections to the CLS to include workers and linking these health patterns to spatial contexts will
    contribute to our understanding of place-based and racial inequalities in health. People who are both
    punished and employed by the CLS are disproportionately Black and Latino men who have been shown
    to have worse health and shorter life expectancies compared to people in the general population, and
    recent changes across metropolitan areas have altered the spatial distribution of this population.
    Nowadays, people connected to the CLS—through both punishment and employment—are increasingly
    likely to reside in rural areas. No study to date, however, has examined the health consequences of
    being connected to the CLS through both punishment and employment through a contextual
    framework. To address these important and timely gaps in the literature, the proposed project seeks to generate original data on CLS connections in eastern North Carolina (ENC)—a predominately rural area where jails and prisons are prominent—and link these connections to health outcomes among working-age adults. This data collection effort will contribute to the existing data collection system of the DEEPP project (Dynamics of Extreme Events, People, and Places), led by Elizabeth Frankenberg. The proposed work would therefore build upon DEEPP’s rich data and support my goal of establishing a unique source of data that will be used for future NIH grant submissions. Specific aims of this foundational work are to:

    Aim 1: Map the locations of jails and prisons in ENC and measure their prominence as sites of
    employment and punishment.
    Aim 2: Collect qualitative data on the stressors associated with CLS connections among people in ENC.
    Aim 3: Develop and pilot test a computer-assisted questionnaire to collect information on CLS
    connections, health, and place in ENC.

    Priority Research Areas: Health Trends and Disparities

  • 2022. Margaret Sheridan, PhD. A Dimensional Approach to Assessing the Impact of Adversity on Age-Related Cognitive Decline.

    Exposure to childhood adversity is common, and is associated with risk for numerous negative outcomes in childhood, adolescence, and adulthood. The prevailing approach for examining the developmental consequences of adversity exposure is a cumulative risk model which points to stress as the primary biological pathway through which adversity comes to impact health outcomes. We have articulated an alternative to the cumulative risk model which proposes a set of novel mechanisms explaining how dimensions of adverse experiences, specifically deprivation and threat, influence risk for negative life outcomes and in particular psychopathology (McLaughlin & Sheridan, 2016; McLaughlin, Sheridan, & Lambert, 2014; Sheridan & McLaughlin, 2016; Sheridan & McLaughlin, 2014). Existing data support the hypothesis that exposure to deprivation but not threat disrupts cognitive function and associated neural pathways whereas exposure to threat but not deprivation disrupts emotion regulation in childhood and adolescence (Lambert et al., 2016; Machlin et al., 2019; Manly et al., 1994, 2001; McLaughlin et al., 2019; Sheridan et al., 2017). In addition, these dimensions of adversity are differentially linked with long-term differences in emotion regulation and cognitive function when measured longitudinally from early childhood through late adolescence (Miller et al., 2018, 2020).

    Importantly, a robust body of work has documented associations between early life adversity exposure and aging related health concerns (Midei et al., 2013) and recent work indicates that differential effects of deprivation and threat on cognitive function and emotion reactivity may be observable even into late life (Geoffroy et al., 2016b). Given selective associations between deprivation and cognitive function in childhood, we expect that deprivation, but not threat, will increase the rate of age-related cognitive decline and rates of diseases of cognitive aging such as idiopathic dementia. In contrast, we would expect threat but not deprivation exposure to be associated with increased cardiovascular risk and metabolic dysfunction. However, most work examining associations between adversity and aging to date has not delineated dimensions of adversity. Beginning well-designed and novel studies of the impact of early adversity on aging is a long-term investment, prior to initiating this kind of approach preliminary investigations are needed. Here we propose three avenues through which preliminary data will be obtained.

    Aim1. We propose taking a meta-analytic approach to understanding the differential impact of deprivation and threat on aging processes. In a previous grant we completed a meta-analysis of the differential impact of deprivation and threat on cardiovascular and metabolic disease indicators. Here we proposed building on that dataset to also examine the impact of these forms of adversity on age related cognitive decline.
    Aim2. In an existing dataset (N = 1,252; ages 18-80 years) acquired using the online data collection platform Prolific, Co-Investigator Boettiger assessed adversity and cognitive function via self-report. Utilizing this data we will determine if retrospective reports of exposure to these forms of adversity are differentially linked with age-related decline in self-reported cognitive function.
    Aim3. In an ongoing pilot data collection project of participants between 18-80 years (N = 120) cognitive and neural function are directly assessed using cognitive testing and neuroimaging. This project is funded via a National Science Foundation grant to Co-Investigators Lindquist and Giovanello. In collaboration with PI Sheridan, measures of self-reported exposure to deprivation and threat are being collected in this dataset in an ongoing fashion. Utilizing this data we will determine if retrospective reports of exposure to these forms of adversity are differentially linked with age-related decline in cognitive function and associated neural processes such as functional brain connectivity.

    These preliminary findings will result in (a) up to three publishable empirical papers and (b) preliminary results which will provide a strong foundation for two subsequent planned grants. First, Co-Investigators Giovanello and Lindquist will build on findings from their current study to apply for an R01 from NICHD to examine life-span changes in emotion and cognitive function. With preliminary data from this application, they will be able to work with PI Sheridan to additionally investigate the link between dimensions of adversity stress reactivity and cognitive function across the life span. Second, Co-Investigator Boettiger will apply for funding from the NIAAA to examine the impact of cognitive aging on risk for alcohol use disorder. With preliminary data from this application, she will be able to work with PI Sheridan to additionally investigate the impact of deprivation and threat as moderators of her planned analyses.

    Priority Research Areas: Biology, Genetics and Demography of Aging

  • 2021. Kathleen Mullan Harris, PhD. The Role of Morningness in Sleep Timing and Epigenetic Aging in Young Adulthood.

    Being more of a “night owl” has been linked to increased risk of diabetes, hypertension, and
    mortality. Evidence suggests that diurnal preference for morningness (versus eveningness) is
    affected by both genetic and environmental, as well as developmental factors, with chronotype
    (measured as midpoint of sleep on free days) shifting earlier as people age from young adulthood
    and beyond. However, not only does aging affect diurnal rhythms, but recent research highlights a
    pathway by which diurnal rhythms might affect aging: telomere length (a measure of biological aging,
    which shortens as we age) is shorter in people with moderately late compared to intermediate diurnal
    preference. Much remains to be understood regarding the relationship between chronotype and
    biological aging, and recent epigenetic “clock” measures provide an opportunity to investigate how
    diurnal preference affects biological aging processes reflected in DNA methylation (DNAm).
    We propose leveraging genetic and recently collected epigenetic data in NIA-funded Add Health to
    advance understanding of the relationships between diurnal preference, sleep timing, and epigenetic
    aging. We hypothesize that greater genetic propensity for morningness, reflected in polygenic scores
    (PGSs), is associated with decreased epigenetic age acceleration (EAA), a measure capturing how
    far biological aging reflected in DNAm has progressed beyond levels predicted by chronological age.
    Our aims are:
    Aim 1: Estimate association of morningness PGSs with sleep timing in young adults using
    PGSs constructed from prior morningness GWAS.9 Test whether association changes across young
    Aim 2: Identify whether social and environmental schedules moderate association of
    morningness PGSs with sleep timing. Test whether association differs between work and free
    days and by sunset time, examining extent to which social schedules and sunlight exposure interact
    with morningness PGSs.
    Aim 3: Estimate association of morningness PGSs with EAA in early mid-adulthood and
    identify whether sleep timing moderates this association. Assess whether “mismatch” of
    morningness PGSs and sleep timing (e.g. high on morningness PGSs, late sleep timing) predicts
    greater EAA.

    Priority Research Areas: Biology, Genetics and Demography of Aging

  • 2021. Tonia Poteat, PhD. Meeting the Pandemic Needs of Older Sexual Minority Women: Data to Inform Covid-19 Response.

    Sexual minority women (SMW) face unique COVID-19 pandemic-related challenges. Black SMW ≥ 50 years old, in particular, were already experiencing health inequities at the intersection of racism, sexism, ageism, and homophobia. Our prior research with Black lesbian elders identified a heavy burden of poverty, multimorbidity, and poor mental health – factors that increase COVID-19 vulnerability. We also identified resilience strategies, such as community-building and intergenerational learning. However, social-distancing, income loss, and caregiving demands wrought by the pandemic have interrupted many of these strategies, as described during virtual focus groups discussion (FGDs) completed with 100 older Black SMW in late 2020. Our FGDs explored physical and psychosocial health, experiences with COVID-19 testing, illness and loss, and vaccine attitudes – providing data on the importance of addressing mental health and vaccine hesitancy. However, FGDs were limited to Black SMW, precluding comparisons with other racial groups to determine whether tailored interventions are necessary. The nature of FGDs prevented in-depth explorations of participants’ perspectives on potential interventions. The videoconference platform presented barriers to engaging women with low educational attainment and/or low technology skills; therefore, we lack information from these groups. We must address these limitations in order to design an intervention that is feasible and acceptable to diverse older SMW. To gather the preliminary data necessary to develop and test a mental health intervention, we propose a mixed methods study with the following aims:

    Aim 1: Assess strategies for recruiting racially and educationally diverse older SMW for participation in a
    quantitative survey. These data will inform enrollment approaches for the future intervention.
    Aim 2: Characterize vaccine attitudes and psychosocial effects of the COVID-19 pandemic via a quantitative survey among a sample of diverse older SMW that builds on prior FGD results. Findings will provide comparative data by race, education, and socioeconomic status to inform selection of intervention targets.
    Aim 3: Identify feasible and acceptable strategies to bolster resilience and mitigate pandemic-related harms among diverse older SMW by conducting in-depth interviews with prior FGD participants and a purposive sample of SMW with low educational attainment and/or low technology skills.

    These data will be collected in partnership with ZAMI NOBLA – National Organization of Black Lesbians on Aging, a community-based organization which collaborated on aforementioned FGDs. They will partner on the planned grant application to NIA in February 2022 that will respond to NOT-AG-21-015: Notice of Special Interest: Aging-Relevant Behavioral and Social Research on Coronavirus Disease 2019.

    Priority Research Areas: Health Trends and Disparities

  • 2021. Jeremy Moulton, PhD. Property tax exemptions and senior home affordability.

    Property tax exemptions are often targeted at seniors to improve home affordability and help them
    age in place. In this project, I aim to answer the question of whether these policies affect the
    ownership and location decisions of seniors and what impact this has on their health.

    Specific Aim 1: How have property tax exemptions for seniors affected home prices across the United
    States? Use event study regression analysis and comparative interrupted time series (CITS) methodologies on “big data” from Zillow to estimate the effect of property tax exemptions on home prices.
    Specific Aim 1a: Who are the winners and losers of property tax exemptions? Use merged American Community Survey (ACS) demographic data to estimate which demographic groups (age, race, ethnicity, etc.) are the recipients of the price change by stratifying and/or interacting the above models.

    Specific Aim 2: How have property tax exemptions affected location and ownership decisions for
    seniors? Use spatial methods and amenity location data (such as health facilities) to estimate how seniors
    change their location decisions based on the incentives associated with property tax exemption.
    Specific Aim 2a: Have other major housing policies affected the location decisions and ownership
    decisions of seniors? Use CITS to investigate if major policies like the first-time homebuyer tax credit, that targeted younger buyers, pushed senior homebuyers out of the market.

    Specific Aim 3: How have property tax exemptions affected the health of seniors? Investigate the impact on health for those pushed into less desirable locations due to the exemptions as well as those that expect appreciation and tax exemption using similar analysis to aim 1.

    Priority Research Areas: Population, Economic and Health Forecasting

  • 2021. Joanna "Asia" Maselko. Optimizing wearable sensing technologies for the measurement of social interactions among older adults.

    Social isolation and loneliness are linked with multiple negative mental, cognitive, and physical
    health outcomes, including mortality across the lifecourse, while greater social engagement is
    linked with significant positive health outcomes. Older age is a unique period of the lifecourse
    where social connections undergo a dramatic shift, often characterized by decreases in social
    connectedness, which are in turn, linked with declining mental, cognitive, and physical health.
    Thus, there is enormous need for effective interventions to alleviate the health and social burdens
    associated with social isolation and loneliness among older age persons. Unfortunately,
    interventions aiming to engage older persons in activities that are meaningful, enjoyable, and
    sustainable have yielded decidedly mixed results. One potential area of focus to ameliorate these negative impacts is the increase of positive social interactions within relationships that the individual is already motivated to engage in. A relationship with unique potential to impact the health of older individuals is the
    grandparent-grandchild (GP-GC) relationship. A focus on GP-GC interactions offers a pathway for
    preventative interventions, encouraging safe ways for older persons to remain engaged in meaningful
    interactions as they age, and thereby optimizing years of healthy life. However, research on the
    health implications of grandparenting has been surprisingly inconclusive, even as its positive
    potential is clearly acknowledged.

    A key challenge to understanding the impact of GP-GC interactions on GP health and well-being is
    that measurement of GP-GC interactions has remained coarse, and granular domains of GP-GC
    interactions are not as well understood. For example, most studies assess GP-GC interaction by
    inquiring about the number of hours spent caregiving or co-residence status. It is also important
    to distinguish caregiving burden from GP-GC interactions. A potential area for methodological
    breakthrough is to assess these granular social interaction domains in a continuous, passive, and
    naturalistic manner, while combining with simultaneous data on GC proximity. Wearable technology
    offers such an opportunity. Recent developments in wearable sensing and activity recognition
    technologies are revolutionizing behavioral research with their unique potential to unobtrusively
    gather comprehensive and meaningful data from the real-world contexts in which individuals
    live. However, the feasibility and potential contributions of these approaches to aging
    research has not yet been fully examined. Previous funding submissions from our research team have
    been hindered by a lack of piloting that has left the feasibility of this method in question.
    Our overarching study objective is to pilot the use of a wearable technology-based approach to
    measure how domains related to health among the aging vary in the presence of their grandchild. We
    focus on the measurement of known correlates of health, including heart-rate variability, physical
    activity, and frequency and quality of grandparent speech.

    We have two specific hypotheses, one methodological and one substantive. First, we hypothesize that we can successfully use wearable technology in a natural (non-laboratory) setting to measure heart rate variability, physical activity, and pre-specified speech domains of the older individual, as well as grandchild proximity. Second, we hypothesize that the presence of the grandchild will be correlated with higher heart
    rate variability, higher frequency of domains such as positive affective speech and physical
    activity, and lower frequency of negative affective speech and silence. In our pilot we will obtain data from:
    1) The wearable worn by the grandparent and a proximity beacon worn by the grandchild. These will
    capture data on (a) heart rate variability (b) physical activity, (c) the auditory environment, and
    (d) GC proximity to the GP.
    2) Qualitative interviews focusing on the feasibility and accessibility of the tech package.

    This is a pilot study and is aimed at determining whether this approach for assessing GP-GC social
    actions is feasible; the results will not contribute to generalizable knowledge and do not require
    an IRB review.

    Priority Research Areas: Biology, Genetics and Demography of Aging

  • 2020. Jennifer Lund, PhD. Social Determinants and Adverse Health Outcomes in Older Adults: The role of inappropriate medication use.

    Optimizing medication use in older adults (age 65+ years) is challenging due to the frequent
    co-occurrence of multimorbidity, polypharmacy, and age-related changes in pharmacokinetics and
    pharmacodynamics, which together increase the risk for adverse drug events. Adverse drug events are
    costly, accounting for approximately $3.5 billion in spending in the United States (US) each year.
    Medications whose risks of harm exceed their expected clinical benefits are termed potentially
    inappropriate medications (PIMs). PIM use is common, reaching a one-year prevalence of >30% among
    Medicare beneficiaries, and is associated with an increased risk of adverse health outcomes of
    paramount importance to older adults, including falls, functional and cognitive impairment,
    hospitalization, and mortality. While there are several prescribing tools that can be used to
    identify PIMs (e.g., the Beers Criteria, the Screening Tool for Older People’s Prescriptions
    (STOPP) criteria, and the Drug Burden Index (DBI)), there is a lack of understanding of the
    relative merits of these tools and how best to apply them in the context of longitudinal data. In
    addition, while social disparities in health, particularly those by race/ethnicity, geography, and
    socioeconomic status (SES), are well documented for individuals across the life course, there is
    little mechanistic research describing how disparities in PIM use could potentially impact
    persistent and ever growing health disparities in late life. Our proposed study will leverage a
    novel data resource, the National Health and Aging Trends Study linked with Medicare claims data to
    evaluate and compare the performance of contemporary PIM screening tools, document disparities in
    use by race/ethnicity, geography, and SES, and disentangle associations between longitudinal PIM
    use trajectories and important adverse health outcomes. Our results will inform the development and
    refinement of pharmacy- based interventions using PIM screening tools that are better targeted to
    high-risk populations in greatest need promote safe and effective medication use among older adults, ultimately leading to reductions in health disparities in late life.

    Priority Research Areas: Health Trends and Disparities

  • 2020. Linda Adair, PhD. Effects of health on economic well-being of older adults in the context of rapid modernization.

    The relationship between health and economic status is bi-directional. While many studies document poor health outcomes related to poverty, less attention has been paid to how health affects economic outcomes. Physical, cognitive, and mental health can have profound effects on the economic productivity and security of older adults, with consequences not only for them but also for the next generation who may benefit from their financial support or be burdened by the time and costs of caregiving and support. Health conditions which limit physical mobility and stamina may be of importance for productivity in occupations that require physical strength or endurance while cognitive deficits and poor mental health may be more likely to impact occupations which require cognitive skills. These limitations may develop over long periods of time. However, few longitudinal studies in low- and middle-income country (LMIC) contexts provide the long-term data that allow study of the evolution of poor health and its impact on economic outcomes across the life course.  Even fewer studies have the data needed to document intergenerational effects. We plan to conduct interdisciplinary, comparative research using data from extremely rich cohort studies spanning several decades in China, Indonesia, and the Philippines. The principal investigators represent ESI and senior CPC fellows (Adair, Gordon-Larsen, Frankenberg) from different disciplines and who have collaborated on other projects. The overall goal of this project is to enhance understanding of how economic productivity and security in older adults is influenced by trajectories of physical, mental, and cognitive health beginning earlier in life, and in turn, how the health and economic well-being of older adults affects the next generation. The cohort studies for this project include: The China Health and Nutrition Survey (CHNS) is a multipurpose panel survey following all members of more than 41,000 households in 360 communities throughout China across 10 exams from 1990 to 2019. The 2015 survey includes 19,525 individuals of whom 5,173 were age 60+. The Cebu Longitudinal Health and Nutrition Study (CLHNS) recruited pregnant women from urban and rural communities of Metro Cebu in 1983-4 and followed them and an index child during bimonthly visits for the first 2 years, then in 8 subsequent surveys through 2016, when the women ranged in age from 45-78 (n=1659, 596 age 60+). The Indonesia Study of the Tsunami, Aftermath and Recovery (STAR) includes a representative population from Aceh, Sumatra, first recruited in 2004, with 6 follow-up visits through 2017. The most recent survey includes 9,707 individuals age 40 and above, of whom 2481 were age 60 and older. The three studies span time periods of rapid modernization and concomitant dramatic health and economic changes. Of note in all settings is the transition in types of work and labor markets from more to less physically demanding jobs benefitting from modern technology, and changes in health profiles with the emergence of obesity and chronic diseases. Comparative research across these settings can take advantage of the high diversity, pace of development and level of disparities within and between countries. The aims include: 1) Harmonization and preparation of data for comparative analysis, by harnessing substantial similarities in the questionnaires and data collected in the surveys. This harmonization work will be guided by principles established by Fortier et al in their work with multiple British and European cohorts( ; 2) Estimate the pathways through which disparities in middle adulthood nutritional status represented as underweight, overweight, and obesity affect subsequent development and patterns of cardiometabolic health, impairment in physical and cognitive functioning, and in turn, changes in type of work, work hours, and earnings. We will use longitudinal marginal structural models to address likely bidirectional associations and take advantage of repeated surveys to focus on predictors of changes in economic outcomes subsequent to changes in health status.

    Priority Research Areas: Determinants of Health, Well-Being and Longevity

  • 2020. Robert Hummer, PhD. Life Course Cognition: Multimodal Measurement of Cognitive Functioning among Diverse Midlife Americans.

    Understanding cognitive functioning is a critical national priority as the United States prepares for the rapid aging of its population. Recent scholarship makes it clear, though, that population-based study of cognitive functioning must begin long before old age; focused attention on midlife (i.e., ages 40-49) is essential. The National Longitudinal Study of Adolescent to Adult Health (Add Health) is poised to make a critical contribution to the understanding of midlife cognitive functioning in the United States. Our research team is in the process of developing the application to secure funding for Wave VI of Add Health, which will include in-depth attention to cognitive health in midlife. Add Health is a longitudinal study of a nationally representative sample of Americans that began following 20,000 adolescents in grades 7-12 during the 1994-95 school year. Add Health respondents are now reaching middle-age; as currently scheduled, the average age of Wave VI respondents will be 44. Add Health is thus exceptionally unique in having such a rich, multi-level, longitudinal array of data among a large nationally representative and diverse cohort of Americans as they approach midlife. These data also set the stage for rigorously studying risk and protective factors that occur earlier in the life course prior to the age-related conditions that will begin to affect this cohort, including cognitive decline and—in the future—dementia. This pilot project will assist in our preparation for cognitive data collection in Wave VI. The overall goal of this pilot is to develop, test, and evaluate potential measures of cognitive functioning among a diverse convenience sample of midlife subjects. We will work with our Add Health field contractor (RTI, International), to draw a diverse (by race/ethnicity, gender, and educational attainment) sample of North Carolina residents between the ages of 40-49. Because the plans for Wave VI of Add Health include both in-person and web-based cognitive assessments, this pilot project will develop, test, and evaluate potential measures of cognition in both the in-home and web-based data collection modes. The pilot project will address the following aims: 1) Using available tools (e.g., NIH Toolbox, Harmonized Cognitive Aging Project, Montreal Cognitive Assessment, Mini-Mental State Examination, PhenX Toolkit, and more), develop a range of in-person and web-based cognitive assessments to pilot among our convenience sample. 2) Collect pilot data on a range of cognitive functioning batteries from our convenience sample, using both the in-home and web-based modes of data collection. We will aim to collect data from as many subjects as our budget allows, with the sample balanced according to race/ethnicity (Black, Hispanic, Asian, White), gender (women, men), and educational attainment (high school degree or less, some college, college degree or more). 3) Compare the in-person with the web-based assessments and test for differences across the two modes. We will make these comparisons across both the full sample, as well as within subgroups defined by race/ethnicity, gender, and educational attainment. This pilot project stands to provide innovative and useful information for measuring cognition in middle age in large scale demographic and population-based studies, including Add Health.



    Priority Research Areas: Biology, Genetics and Demography of Aging

Center Administrator/Media Contact: Michael Case

Center for Advancing Sociodemographic and Economic Study of Alzheimer’s Disease and Related Dementias (CEASES-ADRD)

University of Southern California

CeASES-ADRD is a multi-site center at the USC Schaeffer Center, University of Texas, Austin and Stanford University. The Center’s aims are to advance innovative social science ADRD research, broaden and diversify the set of researchers working in the field, and disseminate findings for impact. Goals are accomplished through network meetings, workshops on data and methods, microsimulation and behavioral economics, pilot project support, and the annual Science of ADRD for Social Scientists Program.

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Pilot Projects

  • 2023. Elham Mahmoudi, PhD. fficiency and Equity in Health Care Use and Costs among Older People with Alzheimer’s Disease and Related Dementia: Medicare Advantage Versus Traditional Medicare.

    Alzheimer’s disease and related dementias (ADRD) is a substantial economic, medical, and social burden. Medicare is the primary health insurance for older adults (65+) living in the U.S. Eligible beneficiaries must choose between two different plan types: traditional Medicare (TM) and Medicare Advantage (MA). MA enrollment has doubled in the last decade, currently covering about 45% of all Medicare beneficiaries. This growth has been driven in part by an increasing proportion of Black and Hispanic MA enrollees. While evidence suggests that some MA patient populations have lower health care costs and experience fewer racial/ethnic disparities in care, it is unknown whether this is true for socioeconomically disadvantaged Black and Hispanic Medicare beneficiaries, who are at substantially greater risk of incident ADRD. Racial/ethnic disparity research in health care has been mainly observational and descriptive, thus limiting its usefulness in informing policy. The specific aims of this study are to use innovative econometric causal methods to (1) examine trends and explain differences in health care use and total and out-of-pocket health care costs in MA vs. TM; (2) examine racial/ethnic disparities in health care use and cost between MA and TM. Study results can inform Medicare policies to promote more efficient and equitable health care for Medicare beneficiaries with ADRD. It will also provide preliminary data for an R01 proposal, to be submitted to the NIA, to investigate the same topic using administrative claims data.

    Priority Research Areas: Disability, Health Care and Long-Term Care

  • 2023. Emma Aguila, PhD. Education, Occupation, and Cognition of Vulnerable Older Adults.

    Recent studies have documented decreases in age-specific prevalence of dementia associated with increases in educational attainment and better chronic disease management over time. Also, mental work demands are associated with higher levels of cognitive functioning and lower cognitive decline. However, little is known about the protective factors associated with the prevalence of dementia for populations with low levels of education. We examine the association between education and mental work demands in the lifetime occupations, and their influence on cognition. We focus on Mexican-origin populations in the United States and Mexico using the Health and Retirement Study (HRS) and the Mexican Health and Aging Study (MHAS).

    Priority Research Areas: Cognitive Aging and the Demography of Dementia

  • 2023. Takashi Amano, PhD. Racial/Ethnic disparities in advance care planning among people with dementia.

    Receiving a diagnosis of ADRD may encourage the patient and their family members to initiate ACP since it provides supports and resources. Nevertheless, previous studies have shown that vast majority of people with Alzheimer’s disease and related dementias (ADRD) do not engage in advance care planning (ACP) or start too late. This suggests that there exists variations in the presumed effects of receiving a diagnosis of dementia. The effects may be attenuated for racial/ethnic minorities due to limited and culturally insensitive medical and social resources. However, the effects of receiving a diagnosis on engagement in ACP and its racial/ethnic variations have not been empirically examined. Guided by the NIA Health Disparities Research Framework, this pilot project aims to gain a better understanding of the causal relationship between diagnostic labeling of Alzheimer’s disease and related dementias (ADRD) and the process of advance care planning (ACP) in the context of racial/ethnic disparity. It has two specific aims: (1) it estimates Estimate the effects of receiving a diagnosis of ADRD on ACP and (2) it examines racial/ethnic variations in ACP among people with dementia. This proposed project utilizes a longitudinal design with data from the nationally representative survey of the Health and Retirement Study (HRS) and propensity score analysis to gain higher generalizability and minimize the influence of confounding factors. With the design and method, this study will be able to examine the effects of receiving a diagnosis of ADRD on the process of ACP with a pseudo experimental setting. Results would suggest possible strategies to promote ACP after the diagnosis of ADRD.

    Priority Research Areas: Health Trends and Disparities

  • 2022. Anna Wu, PhD. Risk of ADRD among first-, second-, and third-generation Latinos in the Multiethnic Cohort (MEC).

    The overall objective of this pilot study is to better understand factors driving purported variation in Alzheimer’s disease and related dementia (ADRD) risk across Latino populations.  This prospective analysis will be conducted among 20,093 California Latinos in the well-established Multiethnic Cohort (MEC) Study.  The three specific aims are: (1)  To determine the age and sex-adjusted diagnostic incidence rates of ADRD for 11,413 first-, 6,125 second-, and 2,555 third-generation Latinos. (2) To investigate ADRD risk associations with outdoor air pollution (gaseous and particulate matter pollutants) and to compare associations of established lifestyle factors (education, neighborhood socioeconomic status, marital status, history of hypertension, stroke, diabetes and heart disease, smoking status, physical activity, short/long sleep, body mass index, and diet quality) across first-, second-, and third-generation Latinos. We will also compare hazard ratio (HR) and 95% confidence interval (CI) from Cox regression models for these Latino populations to those of White California MEC participants.  (3)  To estimate the ADRD population attributable risk for lifestyle factors and outdoor air pollution among first-, second-, and third-generation Latinos.  Completion of this pilot project should provide new information on the incidence, as well as lifestyle and environmental determinants of late-onset ADRD for Latinos by generation status.

    Priority Research Areas: Cognitive Aging and the Demography of Dementia

  • 2022. Annie Chen. Dynamic Microsimulation Projections of ADRD and Associated Functional Limitations in Taiwan and the United States.

    This pilot project develops the Taiwan Future Elderly Model (TFEM) to model cognitive function, functional limitations and informal caregiving; validate the model with observed data; and conduct an initial comparison of ADRD disease burden between Taiwan and the US.  It addresses three of the research priorities of the Center for Advancing Sociodemographic and Economic Study of Alzheimer’s Disease and Related Dementias for the 2022-2023 funding cycle: Health, social and economic costs of ADRD for individuals, families and generations; factors driving variation in ADRD risk and outcomes across populations; international and national trends in and projections of ADRD. This pilot adds an additional country to the growing network of international microsimulation models built on local health and retirement surveys and the Future Elderly Microsimulation software.

    Priority Research Areas: Population, Economic and Health Forecasting

  • 2022. Katherine Miller, PhD. The Mediating Role of State Policies Supporting Care Partners of Persons with Dementia on Care Partner Outcomes.

    Over six million persons living with dementia in the U.S received unpaid care from nearly 16 million care partners. Demand for care provided in the home by family care partners is expected to increase. Care partners of persons living with dementia generally report worse physical health and high levels of depressive symptoms and care partner burden. Variation in state policies supporting care partners yields heterogenous access to and generosity of services for care partners. Unpacking the potential mediating role of polices intended to benefit care partners is critical to support and improve the health of care partners of persons living with dementia. Our objectives are to: (1) provide systematic documentation of policies supporting care partners of persons living with dementia; and (2) examine association of policies and care partners’ outcomes. This study leverages an existing dataset of policies supporting care partners to expand upon and survey data of nationally representative sample of care partners. This research will advance our understanding of the effects of dementia caregiving on care partners and persons living with dementia by building a database for future research to examine persons living with dementia and care partner outcomes. Moreover, understanding the pathways by which policies and policy interactions impact these outcomes is essential to inform the policy discussions regarding evidence-based supports for care partners of persons living with dementia.

    Priority Research Areas: Disability, Health Care and Long-Term Care

  • 2021. Bryan Tysinger, Research Assistant Professor, USC. Dynamic Microsimulation Projections of ADRD in Ireland and the United States .

    Projecting the future burden of Alzheimer’s Disease and Related Diseases (ADRD) is of critical importance to understand implications for individuals, families, health systems, and government planning.  Previously, the applicants have developed dynamic microsimulation models in longitudinal panel data to estimate statistical models of aging and predict future outcomes. This pilot has five Aims:  1. Extend and validate the TILDA-based microsimulation to model new outcomes: cognitive function, depressive behavior, functional limitations and time spent in residential care; 2. Extend and validate the HRS-based microsimulation to model the depressive behavioral domain of ADRD; 3. Produce population and subpopulation (gender, education, and race) projections, and compare these projections within and between countries; 4. Recommend best practices for projecting cognition, depressive behavior, functional status, and ADRD to guide other researchers using panel studies similar to HRS and TILDA.  Scope the potential for novel inclusion of biomarkers and laboratory measures in projections; 5. Use the results as a basis for large-scale international study proposal to project future needs, estimate future health and social care costs, and evaluate the effect of different systems and payment models on care, health and economic outcomes. We anticipate three outcomes associated with the pilot aims: (a) Projections of ADRD prevalence, associated depressive symptoms and functional limitations, and associated residential care use in the United States and Ireland, for the population and for subgroups of interest (Aims 1-3); (b) Lessons learned in validating the domains of ADRD will be documented to inform other modelers undertaking similar work, including assessment of how biomarkers and lab data may improve prediction (Aim 4); (c) An R01 proposal for modeling future ADRD prevalence and associated costs in different countries covered by the g2aging family of longitudinal studies (Aim 5).

    Priority Research Areas: Population, Economic and Health Forecasting

  • 2021. Karen Fingerman, Professor, University of Texas at Austin. Young Adult Caregivers of Aging Family Members.

    More than 40 million adults in the U.S. provide caregiving to older adults and 1 in 4 of these caregivers are young adults aged 18 to 34. Research and interventions for Alzheimer’s Disease caregiving have focused on middle aged and older caregivers. Young adults may have distinct experiences in caregiving and providing care for older family members may be detrimental to future goals (e.g., education) with lasting repercussions on well-being throughout the life course. This pilot study will develop survey instruments and research methodologies to examine this under-researched group. Aim 1 Develop research battery to assess young adults’ caregiving experiences. We will assess the frequency and types of tasks young adult caregivers perform, their role in the family caregiving system and cultural beliefs about caregiving. Aim 2 Develop of assessments of young adults’ caregiving burdens and well-being We will assess implications of caregiving (positive and negative), including burden, loss of goal-directed statuses (e.g., educational pursuits) and subjective perceptions of control. Aim 3 Generate methodologies of daily sampling of caregiving. Intensive data collection will provide insights into caregiving close to the time these tasks occur. Across all aims, we will consider race/ethnicity, gender, relationship to care recipient and intergenerational coresidence. We will recruit a sample of 80 Hispanic, African American or Asian young adults (aged 18 to 34) who identify as caregivers for an older relative with ADRD (i.e., aged 65+). They will complete a 30 minute baseline survey to adapt existing measures and develop new ones to assess young adults’ caregiving experiences. Then, participants will complete brief surveys every week for 5 weeks. Our research team has extensive experience analyzing data intensive assessments. The proposed study may fundamentally shift the paradigm for understanding how family caregiving occurs, embedded in cultural and socioeconomic contexts.

    Priority Research Areas: Caregiving

  • 2021. Leah Richmond-Rakerd, Assistant Professor, University of Michigan. Do Mental Disorders Forecast ADRD in Nationwide Administrative Registers?.

    Neurodegenerative conditions, including Alzheimer’s disease and related dementias (ADRD), have an outsized impact on disability and loss of independence in older adults. As such, there is a growing need to identify modifiable factors that drive variation in ADRD risk at the population level. We propose to investigate mental disorders as a potential preventable risk factor for later-life ADRD. Using three decades of nationwide health-register data on 1.7 million New Zealand citizens aged 21-60 at baseline, we will test whether mental disorders forecast the development of ADRD in the subsequent 30 years. We will test whether these associations hold across sex and age, across different types of mental disorders, within pairs of siblings matched on family-level risk factors, and after controlling for pre-existing physical-health conditions. Through this project, we will (1) quantify the degree to which preventing mental-health problems in young people might reduce the health and social burden of neurodegenerative diseases, and (2) create exportable tools, including a new linked-sibling data resource and a method for ascertaining ADRD across multiple health registers, that can be used by other ADRD researchers employing linked administrative data in their work. If results of the proposed project indicate that mental disorders forecast neurodegenerative diseases, this would also suggest novel hypotheses about mechanisms that underlie the development of ADRD and that may drive variation in ADRD risk across populations (e.g., inflammation, low education, poor health behaviors, social isolation, or psychiatric medications), to be tested in future basic-science and administrative-register studies.

  • 2021. Sarah Mawhorter, Assistant Professor, University of Gronigen. Housing Transitions Associated with Cognitive Decline.

    While existing research addresses the suitability of various housing alternatives for persons with dementia (PWD), little is known about PWDs’ housing transitions over the course of cognitive decline. This study investigates PWDs’ housing transitions using Health and Retirement study data from 2002 through 2016. We find that over half (56%) of PWD move in the years around dementia onset: 28% move once, and 28% move twice or more. Examining various types of moves, we see that slightly over a third of respondents move to another home at some point during cognitive decline, just under a third move into nursing homes, and around ten percent move in with relatives, with overlap between these categories since some PWD move more than once. We find strong patterns by educational attainment and race/ethnicity: Black and Hispanic PWD and those with lower education levels are less likely to move to another home or enter a nursing home than White and college-educated PWD. This suggests the importance of providing support for PWD and their families to transition into different living arrangements as their housing needs change.

  • 2020. Alice Chen, Associate Professor, USC. ADRD Care in New Delivery and Payment Methods.

    This study estimates the impact of new payment and delivery models—including accountable care organization models, patient-centered medical care homes, value-based payment modifiers, and merit-based incentive payments – on the health care and drug use and cost for ADRD patients. Results from this research will identify which delivery and payment models are most effective in improving dementia care. They will also inform an R01 proposals that seek to uncover mechanisms for observed improvements in dementia care, such as the restructuring of ADRD care teams, care coordination, and the placement of higher-risk ADRD patients into care management programs.

    Priority Research Areas: Care for Persons Living with Dementia

  • 2020. Bryan Tysinger, Research Assistant Professor, USC; Rebeca Wong, Professor, UT Medical Branch. Harmonized Cognitive Measures for International Microsimulation Modeling of ADRD.

    This project will extend two existing microsimulation models, the United States Future Elderly Model (US-FEM, based on the HRS) and the FEM-Mexico (based on the MHAS) to incorporate measures from the HCAP supplement and produce population and subpopulation estimates of dementia today and in the future. It will inform an R01 proposal for modeling ADRD that will extend the analysis to potentially include microsimulation models for England, India, and China.

  • 2020. Chandra Muller, Professor, University of Texas, Austin. National Longitudinal Study, 1972 (NLS-72) Record Matching to Centers for Medicare and Medicaid Services (CMS) Records.

    This study addresses the social or skill aspects of education that shape cognitive functioning. The study will create new data for analysis of education and early cognition effects on economic security among older people. The matching and analyses will lay the foundation for an R01 proposal to follow-up the NLS-72 cohort to study cognitive aging and AD.

    Priority Research Areas: Determinants of Health, Well-Being and Longevity

  • 2020. Karen Eggleston, Senior Fellow; Jay Bhattacharya, Professor, Stanford. Trends and Projections of ADRD in Asia.

    This project will extend the current Japanese Future Elderly Model (JFEM) microsimulation model to include cognitive function and dementia. It will use this expanded JFEM to study the social and economic burden of ADRD in Japan, and compare to other FEM for North America and Europe. Existing Asia microsimulation models include those for South Korea and Singapore, with a model under development for Taiwan, and in the planning stages for Hong Kong, the rest of China, and India. The study will project the health and cost implications of cognitive decline and ADRD and implications of long-term care insurance (LTCI) programs in Japan and South Korea.

    Priority Research Areas: Population, Economic and Health Forecasting

  • 2020. Mireille Jacobson, Associate Professor; Jason Doctor, Professor; Julie Zissimopoulos, Associate Professor, USC. The Impact of Cognitive Screening on Early ADRD Diagnosis, Treatment and Spending.

    This study examines how Medicare plan type affects the likelihood of an early ADRD diagnosis combining both Traditional Medicare Fee-for-service claims and MA plan encounter files. The study will also fill a gap in our understanding of the impact of ADRD diagnosis on differences in health care utilization and spending in MA and Traditional Medicare. It will inform an R01 proposal to improve screening, diagnosis and care for person living with dementia.

    Priority Research Areas: Cognitive Aging and the Demography of Dementia

Center Administrator/Media Contact: Johanna Thunell

Center for Aging and Policy Studies (CAPS)

Syracuse University

CAPS is a multi-site consortium across Upstate New York, with Syracuse University, Cornell University, and University at Albany. Research at CAPS focuses on two signature themes—health and well-being, and family and intergenerational supports—and three cross-cutting themes of policy, place, and specific populations such as veterans. CAPS fosters innovative and interdisciplinary research, provides topical and methodological training for population-based aging research, and disseminates findings and data resources to scientists and the public.

Research Themes
Health trends, disparities, and determinants; Family and intergenerational supports; Effects of place on health and aging; Effects of social, economic, and healthcare policy on health and aging; Health and aging of specific populations; Disability and long-term care.

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Pilot Projects

  • 2023. Kelly Musick. Family Complexity and Economic Resources Within and Across Households.

    Increases in childbearing outside of marriage, divorce, repartnering, and childbearing across partnerships have increased the complexity and diversity of families (McLanahan, 2004). Changes in family composition and living arrangements raise challenges for measuring family relationships that our study designs are often ill-equipped to address. This is critically important because families provide a vital safety net for their members across the life course, from childhood through older ages. In Judith Seltzer’s recent address to the Population Association of America (2019), she argued that to better understand how families meet the obligations defined by kinship, demographers need to do a better job identifying family ties that extend beyond the household. Our project answers this call.
    Evidence to date shows that family complexity is common, particularly among racialized and less advantaged groups (Amorim & Tach, 2019; Cancian et al., 2011; Carlson & Furstenberg, 2006). Family complexity is associated with reduced resources for children (Brown et al., 2015; Fomby et al., 2016; Halpern-Meekin & Tach, 2008; Harknett & Knab, 2007) and weaker relationships between parents and their adult children (Cherlin & Seltzer, 2014; Furstenberg, 2014). Emerging
    work in this area has shed new light on the prevalence and potential implications of family complexity for children and older adults, but our current accounting is incomplete. Prior research has focused largely on the presence and composition of parents in the household (e.g., Kennedy and Bumpass 2008; Raley and Wildsmith 2004), limiting our understanding of family ties over the life course and missing key components of kinship that make up the private social safety net. We address this gap by leveraging the genealogical design of the Panel Study of Income
    Dynamics (PSID, 1985-2017). Traditional household-based surveys fail to capture relationships and resource flows between children and nonresident parents and siblings, and administrative data have limited measures of family and household characteristics. The PSID is uniquely suited to advancing our understanding of family complexity and its links to resource flows within and across households, and how these resource flows change within and across cohorts. Our project
    follows a conceptual framework in which family complexity has implications for economic resources, which in turn shape the support and well-being of family members from childhood through the older adult years. It advances CAPS research on family and intergenerational supports and reflects the cross-cutting theme of distinctive circumstances of specific populations, as defined by race and social disadvantage. We use multiple waves of data from the PSID 1985-2017. The unique design of the PSID follows “gened” family members even when they leave the original household. This makes it possible to collect detailed information on nonresident parents that is typically not available in household surveys. In particular, we have information on the marriage and fertility histories of these
    nonresident parents; income sources from labor, kin, public, and other sources for all members of their households; and the full set of biological, adoptive, half, and step siblings residing in their households. We follow changes in residential and nonresidential family composition from the perspective of children, as their parents’ relationships evolve and new children are brought into the family. We address four specific aims:

    Aims 1 and 2: We will identify complex parent and sibling relationships within and beyond the household, and we will estimate differences in their prevalence as children age, across cohorts, and by race and socioeconomic status. To do so, we will rely on household roster data collected at each wave, which includes move-in and move-out dates for all new and departed household members; comprehensive marriage and birth histories collected from all sample members ages 15 years and older since 1985; and PSID’s family composition file (early release, 1968-2017) with identifiers for biological, adoptive, half, and step sibling relationships.

    Aims 3 and 4: We will examine the income sources of households linked by nonresidential parent and sibling relationships, and we will estimate differences as children age, across cohorts, and by race and socioeconomic status in the resources potentially available to children in complex families within and beyond the household. For a subset of children (N=3,065), we have a complete
    fertility history for both parents, thus enabling accurate estimates of half and step siblings on the mother’s and father’s side. We will use this subset of children as a starting sample for our analysis of resources within and across households. We will merge information on family composition to information on household income sources at multiple waves from the core PSID family files. Our project makes several innovative contributions to the literature: First, we rely on the unique
    genealogical design of the PSID that follows family members as they leave the household, making it possible to map changes in both residential and nonresidential sibship composition prospectively as children age. Second, we examine change across a broader span of cohorts, including more recent cohorts of children (born 1985-2004) than those included in the 1997 NLSY (born 1980-1984). Third, we provide among the first estimates based on a national sample of
    differences in patterns of change by parents’ union status, education, and race/ethnicity. The inclusion of a low-income oversample in PSID’s original design enables us to evaluate the extent to which social class differences in sibship composition emerged within and between cohorts against the backdrop of rising social inequality. Finally, we provide the first estimates of detailed income sources of households linked by nonresidential parent and sibling relationships, and our
    accounting differentiates by cohort, child age, race/ethnicity, and socioeconomic status. The descriptive work proposed here will inform a larger project proposal to the National Institute on Aging to investigate associations between family complexity, economic resources, and multiple dimensions of parent and child well-being over the life course. We plan to link our detailed file on childhood family composition and economic resources to data from the Child Development
    Supplement, the Transition to Adulthood Supplement, and the Rosters and Transfers module. These links will allow us to map childhood experiences onto indicators of child well-being and relationships between parents and their adult children. For the parent generation, this includes transfers of time and money with their adult children, as well as help given to children for school, a home purchase, or other financial help. This extension directly addresses critical questions
    about family complexity and the functioning of the family as a safety net for their members across the life course. This project is a collaboration between CAPS affiliate Kelly Musick at Cornell University and Paula Fomby at the University of Pennsylvania. The funding will support a Research Assistantship for an emerging aging scholar with interests in family relationships and well-being over the life course. Musick and Fomby have a long record of collaboration on topics related to family investments, child well-being, and family complexity, including a recently completed R01 on the emergence and social patterning of family complexity over historical time. Fomby led PSID data collection and training initiatives for a decade and is an expert in all aspects of PSID design and content required to achieve the study aims.

    Priority Research Areas: Health Trends and Disparities, Determinants of Health, Well-Being and Longevity

  • 2023. Marc Garcia. U.S. State Policy Contexts and Disability Risk Among Older Latino Adults in the United States.

    The main objective of this project is to generate insights into the role of U.S. state policy contexts on disability risks among Latino adults (as a pan-ethnic category) ages 65 and older, and among subgroups of Latino adults (i.e., by nativity status, country of origin, and gender). The project will also provide insights into which domains of state policy (e.g., labor, environment, immigration) appear to be particularly important for disability risk among Latino adults. The findings will provide new evidence on the potential role of state policy contexts on disability
    among the growing and increasingly diverse population of Latino adults in the United States. This project contributes to CAPS’ signature theme of health and well-being and its cross-cutting themes of place and specific populations. It has two specific aims:

    Aim 1: Estimate the associations between U.S. states’ policy contexts and disability risk among older Latino adults and subgroups of Latino adults. The analyses will focus on two measures of disability. One measure assesses difficulty with activities of daily living such as bathing and eating (ADL) or instrumental activities of daily living such as shopping and running errands (IADL). Another measure assesses cognitive difficulty. State policy contexts will be measured with a single, well-established summary score of over 120 state-level policies [5].

    Aim 2: Examine how 16 specific state policy domains, such as labor and immigration, are associated with disability risk among Latino adults in midlife. This aim will analyze the same measures of disability as in Aim 1. The 16 policy domains are components of the overall state policy measure used in Aim 1.

    Priority Research Areas: Cognitive Aging and the Demography of Dementia, Determinants of Health, Well-Being and Longevity

  • 2023. Pinka Chatterji. Consolidation in the Medicare Part D market and racial disparities in access to prescription drugs.

    The Medicare prescription drug program (Part D) was launched in 2006. Since then, the Part D market has experienced significant consolidation, driven by mergers and acquisitions (M&A) and regulatory changes [1]. The overarching goal of this project is to examine how this industry consolidation has affected Part D utilization and out-of-pocket spending, and racial disparities in these outcomes, through reducing plan variety and competition.

    Aim 1:  Document geographic variation in Medicare Part D market characteristics from 2006-2021 using maps and descriptive tables. We will examine Part D market characteristics across geography and time, focusing on Centers for Medicare and Medicaid Services (CMS) markets with the largest shares of minority racial/ethnic elderly populations. This approach will allow us to gauge descriptively whether trends in market consolidation are different in geographic areas with vs. without high minority elderly populations.

    Aim 2:  Formally test whether Part D market consolidation affects market-level plan characteristics (e.g., premiums, quality), as well as racial disparities in prescription drug use and out-of-pocket spending on drugs among elderly individuals.

    Priority Research Areas: Determinants of Health, Well-Being and Longevity, Disability, Health Care and Long-Term Care

  • 2022. Kate Strully . Exclusionary and inclusionary residential zoning laws and health disparities among metropolitan older adults.

    Aim 1: Draws on data from the 2020 Medicare Disparities Database to conduct an ecological-level analysis of how DZ and IZ policies are associated with health disparities in populations 65+ in the 50 most populous core-based statistical areas (CBSAs) in the U.S., and proposes to test for endogeneity in DZ policies using an instrumental variable strategy.
    Aim 2: Uses data on respondents 65+ from the 2020 Behavioral Risk Factor Surveillance Study to conduct a multi-level analysis at the individual and CBSA level of how DZ and IZ policies are associated with health outcomes across racial-ethnic and income groups.
    Aim 3: Involves a review and preliminary analysis of IZ programs within large CBSAs to identify significant policy changes and comparison locations in order to design a longitudinal study of effects of changes in IZ policies on income and racial-ethnic health disparities for individuals 65+.

    Priority Research Areas: Determinants of Health, Well-Being and Longevity, Effects of Policy and Place on Health

  • 2022. Maria Brown . Biological Aging and Functional Limitations: Moderation by Discrimination.

    Aim 1: Examine how accelerated biological aging, as measured by epigenetic clocks, is associated with functional limitations in older adults.
    Aim 2: Evaluate how the relationship between epigenetic clocks and functional limitations is impacted by perceived discrimination in later life among Black, Hispanic, and White older adults.

    Priority Research Areas: Biology, Genetics and Demography of Aging, Health and Aging of Specific Populations

  • 2022. Samantha Friedman. Redlining Policy and Later-Life Mortality: An Exploratory Analysis of the Linked HRS-1940 Census Data.

    Aim 1: To link the HRS-1940 data at the ED level to the redlining data from the digitized HOLC maps. Mapping the HOLC information onto the EDs is an arduous process because a complete set of ED shapefiles is not readily available. Once ED shapefiles are created, we will overlay the HOLC maps and create a redlining score for each neighborhood. Then, we will link these data to the HRS public use data and code the project variables.
    Aim 2: Using the harmonized dataset, we will estimate a hazard model of all-cause mortality as a function of early-life-neighborhood redlined status, control variables, and mediating variables for the full sample and by race to address the following research questions: a) Does residence in a redlined neighborhood in early life contribute directly to mortality in later life, controlling for other factors? b) Is the impact of residence in a redlined neighborhood in early life on mortality in later life mediated by mid-to-late life income, wealth, and education? and c) Does the impact of redlining in early life differ by race?

    Priority Research Areas: Determinants of Health, Well-Being and Longevity, Effects of Policy and Place on Health

  • 2022. Vida Maralani . Marital Sorting and Health Inequalities in Later Life.

    Aim 1: To investigate how couples’ joint education- smoking portfolios established at the time of marriage inform their functional limitations at older ages.
    Aim 2: To examine differences in smoking and exposure to second-hand smoke across the marital years as potential mechanisms linking assortative mating to inequalities in functional limitations at older ages.
    Aim 3: To examine whether the association between assortative mating and health at older ages has changed across birth cohorts. This helps to illuminate one potential family-level mechanism underlying increasing educational disparities in health in the U.S.

    Priority Research Areas: Determinants of Health, Well-Being and Longevity, Health Trends and Disparities

  • 2021. Chun-Yo Ho. Elderly Health in Rural America: Impact of Hospital Closure.

    Specific Aims:
    Rural areas in the U.S. have been experiencing declines in access to hospital care. Since 2005, there has been 176 rural hospital closure, with considerable variation across states (North Carolina Rural Health Research Program, 2020). More than a fifth of all current rural hospitals are at high risk of closing, in which about two-third of them are considered essential to their community (Navigant 2019). Such trend echoes the access to health care is the top health priority among rural population (Bolin et al. 2015).


    Aim 1: To estimate the effect of losing access to hospital care in rural U.S. counties on elderly health outcomes in response to time-sensitive conditions, and to test for disparities by race/ethnicity and by education, using Vital Statistics death certificate records from 2005-2018.

    Aim 2: To estimate the magnitudes of policy-relevant factors affecting rural elder’ health outcomes directly as well as indirectly through loss of access to hospital care; these policy-relevant factors include the state’s ACA Medicaid expansion status, hospital characteristics, and local market characteristics.

    Priority Research Areas: Determinants of Health, Well-Being and Longevity, Disability, Health Care and Long-Term Care

  • 2021. Colleen Heflin. Increasing access to SNAP for older adults through the Standard Medical Deduction.

    Specific Aims: One of the goals of Healthy People 2020 is to identify and address the social and physical environments that promote good health for all. In 2017, food insecurity was present for 7.7 percent of persons aged 60 and older, or 5.5 million persons (Ziliak & Gundersen, 2019). The consequences of elderly persons’ food insecurity are far-reaching, affecting their health and well-being (Gundersen,
    Kreider, and Pepper 2011). The Supplemental Nutritional Assistance Program (SNAP) is the largest food and nutrition assistance program in the United States and has been shown to reduce food insecurity. States have the option to adopt the Standard Medical Deduction (SMD), a provision designed to make it easier
    for older adults to deduct medical expenses from income during the eligibility process which should increases the number of older adults eligible for SNAP as well as the benefit amount for which they qualify. Despite the potential importance of this provision, currently only 21 states adopt the SMD and there are no formal evaluations of its effectiveness.

    Priority Research Areas: 12. Effects of social, economic, and healthcare policy on health and aging

  • 2021. Jun Li . Effect of Medicaid expansion on low-income, aging adults’ use of informal care.

    Specific Aims:
    More than 44 million Americans receive help from informal caregivers at a societal cost of $522 billion annually, which reflects a health care system that provides limited support for formal long-term services and supports. The Affordable Care Act gave states the opportunity to expand Medicaid, which covers medical care and formal long-term services and supports for low-income and disabled adults under 65, with expansion associated with greater use of health care including increased use of formal long-term services and supports. Greater use of formal medical care (including long-term services and supports) has been observed to substitute for or complement informal care depending on the health of the population and availability of family
    and intergenerational supports. Thus, Medicaid expansion could be critical for how low-income, aging adults use informal care.

    Aim 1: Examine the association between Medicaid expansion and informal care use among low-income adults. We will examine changes in the total intensity of care (number of weekly hours) received, the type of informal caregiving including activities of daily living (e.g., dressing, eating, bathing, and toileting) and instrumental activities of daily living (e.g., meal preparation, grocery shopping, making phone calls), and the composition of informal care (number of informal caregivers providing care). We hypothesize that expansion will be associated with reduced informal care and changes in the composition of informal care.

    Aim 2: Estimate the association of Medicaid expansion with unpaid, informal care costs for low-income adults. We will assess the effects of Medicaid expansion on the monthly costs of informal care borne by care recipients and their caregivers, focusing on the indirect costs of informal care computed using the market price of hourly wages of home health care and personal care aides. We hypothesize that costs of informal care will decrease after expansion.

    Aim 3: Examine whether the relationship between Medicaid expansion and informal care use and costs varied by cognitive impairment, heavy informal care use, and low-income status. We will assess whether expansion had a differential effect on individuals who are more disadvantaged and likely to benefit from changes in access to formal long-term services and supports. Specifically, we examine those with cognitive impairment, those with informal care use above the median amount, and individuals in the bottom quartile of the Medicaid expansion-eligible income distribution. We hypothesize that decreases in informal care use and costs will be greater for vulnerable individuals after expansion.

    Priority Research Areas: 12. Effects of social, economic, and healthcare policy on health and aging, Disability, Health Care and Long-Term Care

  • 2021. Adriana Reyes. Extension of Health Shocks and Changes in Spatial Proximity between Parents and Children.

    Summary of existing project. Adult children provide significant amounts of caregiving to their parents, which is facilitated by relatively close geographic proximity. This project utilizes longitudinal data from the Health and Retirement Study (HRS) to understand how families mobilize in response to a health shock, such an ADRD diagnosis. Using data from 2004-2014, we estimate proximity over time between parents and their adult children using parent’s Census tract and children’s zip codes. Analyses will leverage longitudinal data to assess the time-ordering of health shocks and changes in geographic proximity to children using fixed effects models.

    Rationale for broadening existing project. Alzheimer’s disease and related dementias (ADRD) are among the costliest conditions faced by individuals and society [1]. Average out of pocket costs for someone with ADRD is over $10,000, four times as much as for someone without ADRD [2]. Older adults with ADRD are at a greater risk of preventable hospitalizations than those without ADRD, and having higher quality family care may help cut down preventable hospitalizations [2, 3]. Out-of-pocket health care payments for ADRD consumed 32% of household wealth five years before death [4].  Early stage diagnosis of ADRD has been associated with declines in wealth, which may make it difficult to pay for late-stage treatment [5]. Despite the well documented financial toll of ADRD on the families of those living with ADRD, we know less about how family proximity and care may moderate this relationship.

    Specific Aims. This project asks whether changes in parent-child proximity in response to ADRD is associated with wealth. In particular, does the proximity of adult children reduce health care-related spending for adults with ADRD? The overall goal of this work is to understand how family proximity and mobilization are associated with wealth trajectories and health care spending by older adults with ADRD. Having family nearby may help reduce hospitalizations and other forms of health care spending that can enable older adults to maintain wealth.



    Priority Research Areas: Cognitive Aging and the Demography of Dementia, Family and Intergenerational supports

  • 2021. Ben Shaw . Living alone and risk for the development of Alzheimer’s Disease and related dementias: When does solitary living matter and why.

    Background. Existing research shows that living alone in later life is associated with greater risk for the development of ADRD than physical inactivity, hypertension, diabetes, and obesity [53]. Nevertheless, many older adults who live alone are able to maintain high levels of functioning and will not develop ADRD. While some research has identified factors that moderate the mortality risk of living alone [54], more research is needed to understand the circumstances associated with solitary living in later life that are mostly likely to confer, or buffer, ADRD risk. Social isolation is widely regarded as a key explanatory factor [55], but other demographic, behavioral, social, and environmental factors may also play important roles, either independently or jointly with social isolation. In addition, the timing of living alone (e.g., age of onset; duration in living alone status) and the circumstances precipitating a transition to solitary living may also be important in determining risk for ADRD.

    Aims. This study’s aims are: (1) to determine which specific circumstances defining one’s living alone status (i.e., age of transition to living alone; duration in living alone status; event leading to living alone transition) are associated with ADRD incidence among older adults; (2) to determine the key demographic, behavioral, social, and environmental factors related to living alone during later life that are most strongly associated with ADRD incidence among older adults; and (3) to determine what demographic, behavioral, social, and environmental factors buffer the risk of ADRD among older adults living alone.

    Priority Research Areas: Cognitive Aging and the Demography of Dementia, Family and Intergenerational supports

  • 2021. Emily Wiemers . Extension of The Consequences of Disabilities in Late Middle Age for Consumption Well-Being.

    Summary of existing project. The existing project uses the rich consumption and health data in Panel Study of Income Dynamics [PSID] to examine the consequences of disability in late middle age for consumption well-being and to assess whether the decline in consumption at the time an individual becomes disabled is predicted by or mediated by reports of poor health in childhood. The supplement exploits the measures of cognition, consumption, labor supply, wealth, and early childhood health in the Health and Retirement Study [HRS] to answer the same set of questions focusing on the impact of the onset of cognitive limitations and dementia on consumption well-being and its correlation with poor health in early childhood.

    Specific Aim. To use the HRS to examine the impact of cognitive limitation or dementia onset on consumption well-being paying particular attention to the role of spousal labor supply and wealth as sources of consumption smoothing, and to evaluate the role of poor health in childhood in either exacerbating or mediating dementia-related consumption declines.

    Priority Research Areas: Cognitive Aging and the Demography of Dementia, Disability, Health Care and Long-Term Care

  • 2021. Kevin Heffernan. Estimated Arterial Stiffness as a Predictor of Cognitive Decline and Dementia in Middle-Aged and Older Adults.

    Background. With aging, large arteries outside of the brain lose elasticity. Elevated levels of arterial stiffness expose the brain to high blood pressure that causes structural damage [23]. Numerous cross-sectional studies now support a strong association between arterial stiffening and β-amyloid plaque deposition and atrophy of key areas of the brain implicated in the pathogenesis of cognitive aging and ADRD development [24-27]. Arterial stiffness also prospectively predicts cognitive decline [28-30] and transition to dementia in older adults [31-33]. As such, arterial stiffness may be a useful vascular biomarker to predict age-related cognitive decline and transition from mild cognitive impairment (MCI) to more severe dementia in the general population.

    The gold standard method for assessing arterial stiffness, carotid-femoral pulse wave velocity (cfPWV), requires specialized, relatively expensive equipment and considerable technical proficiency, which limits its widespread adoption [34]. cfPWV can be estimated from two commonly measured clinical variables – age and blood pressure – and we have shown this estimated pulse wave velocity (ePWV) is an independent predictor of cardiovascular and cerebrovascular events in the general population [35,36].This pilot project will extend our ongoing work on vascular aging to consider the relationship between ePWV, cognitive decline, and dementia.

    Specific Aims. As the NIA acknowledges that “MCI research is perceived by experts as Alzheimer’s Disease prevention research,” this pilot project will leverage the strong longitudinal study design of the HRS to address two specific aims and associated hypotheses: (1) examine ePWV as a predictor of cognitive decline in middle-aged and older adults. We hypothesize that higher arterial stiffness will predict a steeper age-related decline in cognitive function. (2) Examine ePWV as a predictor of the transition from MCI to dementia in middle-aged and older adults. We hypothesize higher arterial stiffness will be associated with a higher risk of transitioning from MCI to having dementia.

    Priority Research Areas: Cognitive Aging and the Demography of Dementia, Health Trends and Disparities

  • 2021. Scott Landes . Comparing Alzheimer’s Related Mortality Among People with and without Down Syndrome.

    Background and Significance. Over the past 50 years, the age of death for people with Down syndrome in the Unites States has improved markedly, from an average age at death of 25 in 1983, to 49 in 1997, to 56 in 2017 [39,40]. The increase in longevity for this population is typically ascribed to improvements in early intervention efforts, as well as social supports and medical care for people that often coincided with a transition away from institutional and toward community-based supports [41,42]. With the advent of people with Down syndrome now living into and beyond their 40s, research has documented high rates of early onset Alzheimer’s disease among this population, with some researchers claiming that a majority of individual’s with Down syndrome exhibit neuropathological characteristics of Alzheimer’s disease by age 40 [43-47].

    Three studies utilize US death certificate data to document that adults with Down syndrome have higher rates of death from Alzheimer’s disease and or dementia that adults in the general population [40,48,49], with the most recent reporting adults with Down syndrome were 25 times more likely to die from these diseases [49]. While informative, there are limitations to this research that need to be addressed. The first is that all three studies rely on analysis of the underlying cause of death, as opposed to conducting broader analysis of multiple cause of death. Thus, while they accurately identify that people with Down syndrome were more likely to have Alzheimer’s/dementia identified as their underlying cause of death, they do not address whether people with Down syndrome were more/less likely to have been diagnosed with Alzheimer’s disease by their time of death. This is an important distinction. As people with Alzheimer’s disease can die from various other diseases [50], focusing solely on the underlying cause of death leads to underestimates of the prevalence of this disease at time of death that may vary between people with/without Down syndrome. In comparison, utilizing multiple cause of death files, which provide information on comorbidities present at the time of death, would provide a more accurate accounting of the prevalence of Alzheimer’s disease among both populations at the time of death. In addition, analysis of multiple cause of death files would allow for examination of whether causes of death are similar or different among people with and without Down syndrome who have Alzheimer’s disease, an important research question that has not been addressed to date.

    Specific Aims. This project has two aims: (1) to analyze differences in the prevalence of Alzheimer’s disease among people with and without Down syndrome at the time of death; and (2) to document causes of death among people with and without Down syndrome who had Alzheimer’s disease reported on their death certificate.

    Priority Research Areas: Cognitive Aging and the Demography of Dementia, Health and aging of specific populations

  • 2020. Adriana Reyes. Health Shocks and Changes in Spatial Proximity between Parents and Children.

    Background: Over half of caregivers who provide substantial help to older adults are adult children [1]. However, family caregiving is facilitated by relatively close geographic proximity, especially because children provide an average of 77 hours of assistance a month [2]. Living near children enables a wide range of support, and therefore older adults may migrate to be closer to children in response to or in anticipation of health declines [3]. Previous research has found that when adult children move, they are more likely to choose locations close to their parents compared to other locations, especially when parents are very old [4]. Similarly, elderly adults’ migration patterns are motivated by a desire for close geographic proximity to their children [5]. Recent estimates suggest that a majority of parents and children live near each other, especially those with fewer socioeconomic resources [6]. Yet, the number of older adults without an adult child nearby is projected to increase dramatically over the next two decades [7]. As many rural areas experience an out-migration of young people and declining economic opportunities, the ability of older adults to rely on children for caregiving may be compromised in these areas. We know that children play a significant role in caring for their aging parents; however, we know less about how health shocks associated with Alzheimer’s disease and other conditions may alter the geographic location of children and parents. Building on this context, this project will pursue two specific aims:
    Aim 1: Construct a panel dataset of spatial proximity between parents and their adult children. The data will document, at each wave, the distance between parents and their adult children and changes across waves.
    Aim 2: Identify the correlates of changes in proximity and co-residence. The project will examine how changes in proximity evolve relative to changes in health, such as an Alzheimer’s diagnosis.

    Priority Research Areas: Determinants of Health, Well-Being and Longevity, Family and Intergenerational Dynamics

  • 2020. Emily Wiemers. The Consequences of Disabilities in Late Middle Age for Consumption Well-Being.

    Background: This project will use the rich data in the Panel Study of Income Dynamics (PSID) to examine the consequences of disability in late middle age for economic well-being using consumption-based measures (e.g., food, housing, services) rather than income-based measures. It will exploit the long health histories in the PSID to examine whether declines in consumption at the time an adult becomes disabled are predicted by or mediated by reports of poor health earlier in life, particularly in childhood. The project will address two specific aims:
    Aim 1: Examine the impact of the onset of work-limiting disabilities in late middle age on health, non-durable, and non-health service consumption, focusing on spousal labor supply and wealth as sources of smoothing consumption. This aim will recognize that, for married people, there is a tension between providing care to a disabled spouse and increasing labor supply to smooth consumption after the onset of a spouse’s disability.
    Aim 2: Examine whether adverse childhood health conditions explain declines in consumption for those experiencing a work-limiting disability in late middle age. Individuals with poor health in childhood may save to insure their consumption against expected future adverse health shocks. Alternatively, they may be unable to self-insure because poor health in childhood limits earnings. Adverse childhood health conditions may also predict the severity of disabilities later in life, even in the absence of insurance effects.

    Priority Research Areas: Family and Intergenerational Dynamics, Disability, Health Care and Long-Term Care

  • 2020. Pinka Chatterji. 3. Medicare Part D and Disparities in Chronic Disease among the U.S. Elderly Population .

    Background: Health insurance may be a key factor underlying disparities in chronic disease among the U.S. elderly population. Notably, a study that used data from 1999 to 2006 found that racial/ethnic disparities in control of blood pressure and diabetes become smaller after age 65, suggesting that Medicare reduces disparities in chronic disease [13]. Medicare introduced optional prescription drug coverage in 2006 (Part D). The introduction of Part D may have made Medicare an even more important factor in remediating disparities given the important role of prescription drugs in controlling chronic disease. Prior work suggests that there are racial/ethnic differences in medication adherence for chronic diseases [14, 15], and Part D has increased medication usage overall among the elderly population [16, 17]. To our knowledge, however, no studies have investigated the potentially strong effects of Part D on older adults’ awareness and control of chronic disease, or the effects of Part D on racial/ethnic and education-related disparities in chronic disease. The project will address two specific aims:
    Aim 1: Test whether the introduction of Medicare Part D affected disparities in awareness and control of hypertension, diabetes, and hyperlipidemia using national data sets that include biomarkers.
    Aim 2: Test whether Part D affected disparities in prescription drug use and out-of-pocket spending on drugs among elderly individuals with chronic diseases.

    Priority Research Areas: Determinants of Health, Well-Being and Longevity, Effects of Policy and Place on Health

  • 2020. Shannon Monnat. Demographic, Geographic, and Temporal Trends in Co-Occurring Use Disorders and Mortality from Opioids, Other Drugs, and Alcohol among Middle-Age and Older Adults in the United States.

    Background: Opioid use disorders (OUD) and overdose death rates have grown to unprecedented levels [18, 19]. The U.S. has also experienced large increases in cocaine, methamphetamine, and non-opioid prescription (especially benzodiazepines) overdoses over the past decade. Deaths from alcohol use and use disorders (AUD) are also rising, especially among older adults, women, and low-SES individuals [20, 21]. These crises are costly, getting worse, and interdependent. Excessive alcohol use is common among individuals who misuse opioids [22], with more than half of individuals with OUD also meeting criteria for AUD [23]; more than half of opioid-related deaths involve alcohol or another drug [24]. Use disorders and overdose rates are also geographically patterned [25, 26]. Moreover, while drug and alcohol mortality rates have increased across many demographic groups over the past 20 years, increases in the middle-age cohort (35-64 years) have been startling. Thus, we focus on the relationship between drug- and alcohol- use disorders and between drug- and alcohol- related mortality among middle-aged and older adults. The specific aims of this two-year study are to:
    Aim 1: Characterize demographic, geographic, and temporal trends (2000-2017) in the relationships between opioids, other drugs, and alcohol—in terms of use disorders and mortality—among middle-aged and older adults.
    Aim 2: Identify typologies of counties based on use disorders and mortality from opioids, other drugs, and alcohol.
    Aim 3: Compare the county groups found in Aim 2 by sociodemographic, economic, and other characteristics.

    Priority Research Areas: Health Trends and Disparities, Effects of Policy and Place on Health

Center-Supported Publications

Center Administrator/Media Contact: Doris Mahoney

Center for Demography of Health and Aging (CDHA)

University of Wisconsin, Madison

Through the integration of research, training, and teaching, CDHA aims to increase the understanding of behavioral processes related to health and aging. The interdisciplinary research program at CDHA is designed to create links between social demography, biomedical, and epidemiological research.

Research Themes
Aging and the life course; Biodemography; Determinants of disparities of aging trajectories; Health economics and health services research; Impacts of place on aging processes; social genomics.

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Pilot Projects

  • 2022. Corinne Engelman. Identification of Gene–Environment Interactions in Cognitive Decline During the Preclinical Stage of Alzheimer’s.

    The overall objective of this proposal is to use the life-course approach, combined with a novel Alzheimer’s disease (AD) modeling strategy and rich Health and Retirement Study (HRS) and Wisconsin Registry for Alzheimer’s Prevention (WRAP) data, to identify potential interactions between social and behavioral factors, biomarkers, and genetic variants influencing cognitive aging during the preclinical stage of AD. Findings from this research will provide preliminary data for an NIH R01 application to the NIA to evaluate these candidate interactions in other NIA-funded datasets we have access to through collaborators, including expanding this research to African Americans recruited by WRAP, who were targeted in a later phase of WRAP and have just undergone genome-wide genotyping, HRS, and the Washington Heights-Inwood Community Aging Project (WHICAP).

    Priority Research Areas: Biology, Genetics and Demography of Aging

  • 2022. Lauren Schmitz. Assessing Measures of Biological Age in a Low-Income Context: The Malawi Longitudinal Study of Families and Health.

    This pilot supports in-depth research on the creation and evaluation of biological (or phenotypic) aging measures in a low-income countries (LIC) context. This project has two aims: (1) construct measures of biological age (BA) in the Malawi Longitudinal Study of Families and Health (MLSFH) and test whether they are stronger predictors of age-related disease than chronological age (CA) and (2) compare BA measures and related findings with results from high-income countries (HICs) to evaluate the context-dependence of biological aging measures. This project includes the analysis of pilot data for an R01 resubmission or submission of a new R01 as well as collaborative research opportunities for students that are interested in working with the MLSFH data.

    Priority Research Areas: Biology, Genetics and Demography of Aging

  • 2022. Qiongshi Lu. Polygenic Gene-environment Interaction Analysis for Human Complex Traits.

    This study will assess the interaction between genetics and education reform (i.e., a well-known natural experiment on compulsory schooling age reform) in the UK. This project will explore two recent statistical advances as alternative approaches to estimating gene-environment interaction (GxE). This project will pursue the following two aims: (1) estimate GxE using genetic variants associated with trait variability (vQTL) and variance polygenic scores (vPGS) and (2) estimate polygenic GxE interaction using genetic correlation analysis. The analysis conducted in this project will benefit the method paper describing the PIGEON approach and will lead to at least one other manuscript on GxE analysis.

    Priority Research Areas: Biology, Genetics and Demography of Aging

  • 2022. Rebecca Myerson. Informing Health Insurance Policy to Improve Lung Cancer Screening.

    This project aims to: (1) compare the effect of nearly-universal access to Medicare insurance coverage on lung cancer screening by race, sex, and ethnicity to evaluate the impact on disparities and (2) document the characteristics of screened Medicare patients who lack documentation of shared decision-making, including race, sex, and ethnicity. The findings will inform coverage policy as well as policy related to shared decision-making to improve access to lung cancer screening among older adults, women, and racial/ethnic minorities. As such, the project will increase the evidence base to improve diagnosis and make health care more accessible and equitable. Furthermore, this research will open new horizons for R01-level work on shared decision-making policy, including Medicare’s recent shared decision-making mandates for two other conditions.

    Priority Research Areas: Population, Economic and Health Forecasting

  • 2022. Wei Xu. Uncovering the Impact of Birth Place on Mid-Life All-Cause and Cause-Specific Mortality.

    This project aims to provide new evidence of the contribution of early life geographic context to variation in mid-life mortality in the US and potential mechanisms through which the contribution may be realized. Specifically, this project seeks to: (1) determine the magnitude of contribution of birth place to mid-life mortality, (2) determine the influence of birth place on patterns of mid-life cause-specific mortality, and (3) uncover mechanisms linking birth place and mid-life mortality by focusing early life exposures to epidemiologic and socioeconomic contexts and residential mobility. Findings will inform policy interventions aimed at reducing mid-life mortality inequalities.

    Priority Research Areas: Population, Economic and Health Forecasting

  • 2021. Eric Grodsky. The Nation’s High School Class of 1972 at Retirement: Education and Cognitive Aging Among Mid-Cohort Baby Boomers.

    The research team will collect data from the ~14,500 sample members of the precursor to High School and Beyond, the National Longitudinal Study of the High School Class of 1972. Born mainly in 1953-55, sample members are now in their mid to late 60s. This proposed project would collect, analyze and disseminate data about their current cognition and life circumstances as well as their physiological status as indicated by whole blood, plasma, serum, and other biomarkers. The project has four aims:

    1. Estimate the effects of education from adolescence forward
    2. Assess the role of different aspects of education in producing racial and ethnic disparities in cognitive functioning and impairment in the transition from midlife to older ages
    3. Assess the role of different aspects of education in the relationship between physiology and ADRD captured in blood- and saliva-based biomarkers as individuals transition from midlife to older ages
    4. Prepare for distribution the resulting database and associated documentation and metadata to facilitate scholarship on the factors that affect cognitive functioning and cognitive impairment.

    Priority Research Areas: Cognitive Aging and the Demography of Dementia

  • 2021. Jessica Cao. Post-acute Care Access and Disparities among ACO Medicare Beneficiaries during the COVID-19 Pandemic.

    This pilot project aims to gauge the changes and disparities in post-acute care (PAC) access among Medicare beneficiaries in the UW Health system, a local Medicare Accountable Care Organization (ACO), during the COVID-19 pandemic. Results from this pilot project will be used as the baseline for R01- level studies regarding the effects of the pandemic on PAC utilizations, health outcomes and subsequent health care utilizations and costs among Medicare beneficiaries. The ultimate goal is to make recommendations to the local ACO and beyond on how to improve equitable care access and quality of care for older adults.

    Priority Research Areas: Health Trends and Disparities

  • 2021. John Eason. Frailty, Aging, and Cancer Survival.

    The goal of this project is to investigate the role of frailty/aging at the individual level and community level factors in pancreatic ductal adenocarcinoma survival. In addition to measuring the effect of community disadvantage (e.g. poverty and unemployment), researchers will examine how/if the presence of healthcare organizations in a community mitigate the effect of disadvantage incidence and survival. Eason and colleagues will investigate the role of individual level determinants of health disparities, but will also investigate how access to health care may alleviate cancer survival disparities.

    Priority Research Areas: Effects of Interventions on Population Health

  • 2021. Kristen Litzelman. “Jumping through A New Set of Hoops Each Time” – Conceptualization and Assessment of Socioeconomic Disparities in Caregivers’ Access to Resources.

    In order to advance research and intervention efforts focused on resource use among caregivers, this project will conceptualize the process of accessing resources and assess socioeconomic disparities in resource use. The researchers will draw on previous theoretical and conceptual models to frame this work. The project’s overarching hypothesis is that service use is driven not only by need, but by caregivers’ existing resources of time, money, and emotional energy, compounded by sequential challenges in the systems navigation process. Conceptualizing this process and assessing how socioeconomic factors are linked to service utilization is a critical first step to understanding disparities in resource allocation and identifying targets for intervention

    Priority Research Areas: Health Trends and Disparities

  • 2021. Lauren Schmitz and Valentina Duque (University of Sydney). The Impact of Early Life Exposure to Extreme Weather and Temperature Shocks on Late Life Cardiovascular and Cognitive Health: Evidence from the Longitudinal Aging Study in India (LAS).

    This project will contribute to our understanding of how early life conditions affect aging patterns in developing countries. Specifically, since agriculture remains the main source of income for a large fraction of households in these contexts, we will focus on two shocks that largely affect their economic, health, and psychological wellbeing: 1) the occurrence of adverse weather and temperature shocks, and 2) policies aimed at reducing food insecurity, poverty, and promoting economic growth. Understanding life course impacts of extreme weather patterns on aging outcomes is particularly imperative in the modern climate era; the number of record high temperatures and intense rainfall events has been increasing globally and these trends are expected to continue to rise over the next few decades.

    Priority Research Areas: Determinants of Health, Well-Being and Longevity

  • 2020. Jason Fletcher. Deploying Machine Learning Tools to Predict Mortality Outcomes in the General Population.

    Utilizing machine learning to predict mortality outcomes at the population level has thus far proven a tough nut to crack: the existing small samples sizes too small, the large samples lacking the proper type of data. This project aims to find the middle ground between these extremes by linking large population-based data from the National Longitudinal Mortality Study and the American Community Survey (ACS) to data from the National Death Index (NDI) and Medicare claims. Utilizing these linkages, the researchers will look for interactions that lead to mortality, and create risk scores based off of these interactions.

    Priority Research Areas: Determinants of Health, Well-Being and Longevity

  • 2020. Jooyoung Kong. Adverse Childhood Experiences and Physiological, Affective, and Cardiovascular Reactivity to Family Caregiving Stress.

    Longer life spans have helped advent the “sandwich generation” – middle-aged adults who find themselves caring for their children and their own aging parents. This position, stressful for anyone, may be especially stressful for adults who had Adverse Childhood Experiences (ACEs) while growing up. Primarily using the data from the Midlife in the United States (MIDUS) study, this project will explore how caregiving adults with ACES in their histories respond and react to daily stressors.

    Priority Research Areas: Determinants of Health, Well-Being and Longevity

  • 2020. Judith Simcox. Improving Biomarkers of Metabolic Disease in African American Populations.

    Studies have shown that the most widely used clinical markers for diabetes — HDL, LDL, and triglycerides — are not accurate predictors of the disease in African-Americans. This pilot project will examine the promise of two potential alternatives in African-American females: C reactive protein and arachidonic acid containing lipids. African Americans are 60% more likely than Caucasians to have diabetes and twice as likely to die from diabetes-related complications. With better diagnostic tools, healthcare professionals have a better chance of bringing about positive health care outcomes.

    Priority Research Areas: Biology, Genetics and Demography of Aging

  • 2020. Philipp Koellinger. Understanding Socio-economic Influences on Health and Longevity.

    Scientists have already discovered that low socio-economic status (SES) is linked to an array of physical and mental health conditions and reduced longevity, but the mechanisms behind these correlations have proven elusive thus far. If they could be discovered, scientists may be able to predict and prevent some of the poor outcomes associated with low SES. This project will utilize the over 500,000 genomic samples within the UK Biobank to complete analyses.

    Priority Research Areas: Determinants of Health, Well-Being and Longevity

  • 2020. ZhengZheng Tang. Investigating the Interactions between Inflammatory Biomarkers and Gut Microbiome in the Wisconsin Longitudinal Study.

    Persistent inflammation has emerged as a consistent marker of aging and aging-related diseases. This pilot project seeks to investigate the connection between these inflamed biomarkers and changes in the gut microbiome among older adults, using the Wisconsin Longitudinal Study, a rich longitudinal data source that has tracked individuals from the 1957 high school class throughout Wisconsin.

    Priority Research Areas: Biology, Genetics and Demography of Aging

Center-Supported Publications

Center Administrator/Media Contact: Aaron Crandall

Center for Healthy Aging Behaviors and Longitudinal Investigations (CHABLIS)

University of Chicago

The goal of CHABLIS is to promote a sustained research and infrastructure development program that leverages longitudinal data, from both observational and interventional studies, to examine how demographic and economic factors facilitate or suppress individual healthy aging behaviors, and, in turn, influence outcomes among older adults over the life course.

Research Themes
Individual healthy aging behaviors; Family, networks and the life course; Aging in community and larger social contexts; Health outcomes at the hospital, neighborhood, and municipal levels; Measurement and methods for longitudinal studies on aging; Models of care for medically and social complex older adults; Integration of systemic and oral health; Personalized medicine and preemptive pharmacogenetic testing, including in minority populations.

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Pilot Projects

  • 2023. David A. Gallo, PhD. Adaptive Assessment of Cognition and Metacognition in Aging.

    The project has two major goals. The first is to build the first-ever computerized adaptive test to measure global cognitive ability in older adults. This instrument should increase measurement precision and efficiency compared to current gold-standard measures (e.g., MoCA), significantly improving cognitive assessment for basic research and healthcare applications. The second goal is to further develop a measure of metacognitive awareness – or personal insight into one’s own cognitive ability. Metacognitive awareness varies across individuals and can differ from overall cognitive ability. A lack of awareness (“anosognosia”) in the cognitively impaired has been related to risky decisions and behaviors (e.g., financial, or medical decision making, dangerous driving), but these links and how social factors may play a role have been under explored in cognitively normal older adults.

    Priority Research Areas: Cognitive Aging and the Demography of Dementia

  • 2023. Jayant Pinto, MD. Environment Exposures: Behavioral, Social, and Health impacts on older US Adults in the National Social Life, Health, and Aging Project.

    The project goal is to test feasibility of remote collection of direct indoor pollution assessment (airborne and organic compounds), collection of address histories from respondents to aid longer term/life course assessment of exposures, and measurement of airway function (nose and lung) will generate high quality longitudinal indoor pollution data. It is known that air pollution plays a major role in the process of healthy aging, being associated with both physical health and key healthy aging behaviors (mobility, exercise to name two examples). Because of that, our study will be pivotal to understanding and improving the process of healthy aging. Additionally, this pilot project will generate critical practical information setting the foundation for a R01 level project that will collect pollutant exposure data on the entire NSHAP cohort and be useful for other major aging studies.

    Priority Research Areas: Biology, Genetics and Demography of Aging, Determinants of Health, Well-Being and Longevity

  • 2023. Lissette Piedra, PhD, MSW. Language Use within the AD/ADRD Care Networks of Latino Older Adults: A Pilot Test of New NSHAP.

    The project seeks to enhance the “important matters” social network name generator, used by the National, Social Life, Health, and Aging Project (NSHAP), to explore language use within AD/ADRD care networks. NSHAP is a longitudinal study focused on social relationships, physical and mental health, cognitive, sensory, and motor function, and medication use of older adults. Although it amassed a rich set of data in English and Spanish, and interviewed respondents in four rounds (2005, 2010, 2015 and 2021), few NSHAP studies have examined the health and social lives of Latinos. Moreover, NSHAP data collection protocols have not used visual network representations, and recent methodological developments indicate that such visualizations could reduce respondent burden and assist the network data collection of family caregivers. Network visualizations could facilitate the collection of culturally and linguistically sensitive data. Results may reveal enhancements that could be made to the NSHAP instrument or other similar studies.

    Priority Research Areas: Cognitive Aging and the Demography of Dementia

  • 2023. Micah Prochaska, MD, MS. Characterizing Fatigability, Fatigue, and Activity in Hospitalized Older Adults.

    This project will to measure fatigability, fatigue, and activity levels in older adults during hospitalization and after hospital discharge.  The data for this proposal will help advance our scientific and clinical understanding of fatigue, which as a common symptom in older adults is a high priority scientific area of the NIA. Fatigability is an innovative approach to addressing the symptom of fatigue, and this pilot will expand the scientific and clinical application of fatigability to hospitalized older adults with multifactorial fatigue, and longitudinally (hospitalization to post-discharge), both of which have been identified as important to advancing fatigue research. The data collected, analyses conducted, and protocols generated are necessary for and designed to setup future work, specifically longitudinal studies and trials, investigating the effect of hospital-based interventions on fatigability and functional outcomes after hospital discharge.

    Priority Research Areas: Determinants of Health, Well-Being and Longevity, Effects of Interventions on Population Health

  • 2023. Nabiel Mir, MBBS. Examining Geriatric Assessment, Androgen Deprivation and Biomarkers in Prostate Cancer Treatment.

    The project’s goals are to improve risk assessment for adverse outcomes (such as healthcare utilization, disability, cardiovascular disease, and cognitive impairment) and optimize the health of older adults with metastatic hormone-sensitive prostate cancer (mHSPC) needing androgen deprivation. A 2020 Survivorship Research in Prostate Cancer (SuRECaP) working group identified significant knowledge gaps in understanding ADT/ARSI-related toxicity biomarkers, especially among minorities. To address these gaps, we propose a 12-month observational cohort study of vulnerability and adverse events in a sample of n=30 predominantly minority mHSPC patients ≥65 years old planning to undergo ADT/ARSI treatment. Participants will be recruited from the UChicago Cancer Center Network (Hyde Park, Ingalls, and Orland Park). Baseline assessments will include CARG scores, 7-day wrist accelerometry, and initial body composition by wearable bioimpedance analysis (BIA). Serious adverse events will be reported weekly over 12 months.

    Priority Research Areas: Disability, Health Care and Long-Term Care, Biology, Genetics and Demography of Aging

  • 2023. Tom Best, PhD. System Testing Patient-report Periodontal Data Prediction of Mental/other Health.

    The project will develop an innovative analytic system that enhances understanding of how race and Medicaid coverage (as an indicator of low income/assets) may be a structural driver of higher risk of PD and not performing PHABs such as PC (e.g., flossing, professional gum treatment, dental visits), which, in turn, may be associated with higher risk of systemic diseases like cognitive impairment (CI). The analytic system will be used by Early-Stage Investigators who aim to collaborate on oral/systemic health and health care research.

    Priority Research Areas: Determinants of Health, Well-Being and Longevity, Health Trends and Disparities

  • 2022. Alex Tate, PhD. The Effect of the Doctor-Patient Relationship on Advance Care Planning and End of Life Care.

    Improving advance care planning (ACP) and end of life (EOL) care is an important part of efforts to improve population health for those aging in America. Tate investigates how the physician-patient relationship and trust in physicians, as demonstrated by the Comprehensive Care Physician (CCP) Program, may have impact ACP and EOL care delivery among patients who face additional socioeconomic and psychosocial barriers.

    Priority Research Areas: Disability, Health Care and Long-Term Care

  • 2022. Fanghong Dong, PhD, University of Pennsylvania . Sleep Disturbance and Depressive Symptoms in People Living with Mild Dementia: The mechanistic role of cortisol.

    An estimated 6.2 million Americans are affected by Alzheimer’s Disease and Related Dementias and the number is projected to grow to almost 12 million by 2040. Distressing symptoms such as sleep disturbance and depression are commonly reported in people living with mild dementia or mild cognitive impairment (PLwMD). Dr. Dong is investigating the cross-sectional and longitudinal association between sleep disturbances, depressive symptoms, and cognitive decline, and also examining the interrelationships among sleep disturbances, cortisol levels, and depression in PLwMD.

    Priority Research Areas: Determinants of Health, Well-Being and Longevity, Biology, Genetics and Demography of Aging

  • 2022. Francis Balucan, MD, Vanderbilt University. Longitudinal Improvement in Loneliness in the High Need Population Using Group Visits as Support Group Intervention.

    The High Need Population is defined as people who have three or more chronic medical diseases and a functional inability to take care of themselves (such as bathing or dressing) or perform daily tasks. Balucan’s pilot project aims to describe baseline loneliness in this population and their associated health outcomes. The project also seeks to understand the effects of a support group intervention, with the use of group medical visits and understand longitudinal effects in emotional wellbeing and loneliness.

    Priority Research Areas: Effects of Interventions on Population Health, Determinants of Health, Well-Being and Longevity

  • 2022. James Zhang, PhD. Developing a Longitudinal Measurement Metric and Risk Prediction Model to Identify Medicare Patients at High Risk of Hospitalization with Persistent Cost-related Medication Nonadherence (CRN) and Improve Insurance Coverage.

    There is a growing body of evidence in recent years that even after the implementation of Medicare Part D, cost-related medication non-adherence (CRN) has persisted, or even worsened, among the sickest Medicare patients, including those with multiple chronic conditions, depression, and stroke survivors. Zhang’s pilot aims to develop a new measurement metric of persistent, transient, and intermittent CRN over time and create a risk prediction model using a wide range of predictors for persistent and transient CRN. Identifying such patients will enable more effective policy intervention in terms of targeting and costs, improve access to health care and insurance coverage, and ultimately improve health outcomes for millions of Medicare beneficiaries who struggle to pay for critically important medications.

    Priority Research Areas: Health Trends and Disparities, Population, Economic and Health Forecasting

  • 2022. Sanjana Kareti, MD. Assessing Health and Burden Among Caregivers of Older Adults at High Risk for Hospitalization.

    Dr. Kareti’s pilot project has three main goals: to develop practical strategies for identifying and recruiting caregivers of older adults at high risk of hospitalization (OHH), use cognitive interviewing techniques to gain insight about the experiences of caregivers of OHH and refine survey instruments, and to enhance our understanding of their baseline well-being and support needs.

    Priority Research Areas: Disability, Health Care and Long-Term Care, Health Trends and Disparities

  • 2022. Shilpa Iyer, MD, MPH. Piloting the Mind Over Matter Program for Urinary and Bowel Incontinence in Chicago.

    ‘Mind Over Matter: Healthy Bowels, Healthy Bladder (MOM),’ is a community-based behavioral modification workshop for urinary and bowel incontinence. Dr. Iyer (urogynecology) and Dr. Thompson (geriatrics) are piloting the MOM program at 2 south side Chicago locations to improve urinary and bowel incontinence in older women with this community-based intervention focused on healthy aging behaviors.

    Priority Research Areas: Effects of Interventions on Population Health

  • 2021. Erin Hanlon, PhD, Research Assistant Professor of Medicine. Circadian Biology of the Endocannabinoid System in Aging.

    Although the literature shows that aging is associated with well-documented alterations in the circadian system, including reduced exposure to both external and internal synchronizing agents, the impact of circadian misalignment on cardometabolic (CM) rate risk among older adults is unknown. Hanlon is studying whether the 24-hour profile in circulating endocannibinoids (eCBs), which aid in modulation of appetite, glucose metabolism, and reward driven eating, is modified in older adults when compared to middle aged adults. Hanlon further seeks to study whether a dietary intervention may impact eCB rhythm and CM risk.

    Priority Research Areas: Biology, Genetics and Demography of Aging

  • 2021. Ishanu Chattopadhyay, PhD, Assistant Professor of Medicine. Universal Early Screening For Alzheimer’s Disease and Related Dementia (ADRD) Via Automated Deep Pattern Discovery in Past Medical Encounters.

    A barrier to accurate screening for ADRD or cognitive impairment signaling early stage AD is the limitation of current diagnostic and prognostic modalities. Chattopadhyay’s pilot project aims to design a reliable screening tool for ADRD up to 10 years in the future, enabled by novel learning algorithms that analyze deep comorbidity patterns emerging in the longitudinal history of past medical encourages of individual patients.

    Priority Research Areas: Effects of Interventions on Population Health, Cognitive Aging and the Demography of Dementia

  • 2021. Alyssa Goldman, PhD, Assistant Professor, Sociology, Boston College. Sensory Health Trajectories Among Older Adults in the U.S.

    A growing area of research recognizes the significance of declines in olfactory functioning in predicting numerous age-related health conditions and the importance of identification of factors that contribute to the impairment of olfaction. Goldman is using data from the National Social Life, Health and Aging Project (NSHAP) to examine how structural features and dynamics of older adults’ social networks and neighborhoods shape trajectories of olfactory functioning.

    Priority Research Areas: Biology, Genetics and Demography of Aging, Determinants of Health, Well-Being and Longevity

  • 2021. Elvin Price, PharmD, PhD, School of Pharmacy, Virginia Commonwealth University. Using 24-hour Ambulatory Blood Pressure Monitoring (ABPN) to Examine Association Between Blood Pressure Phenotypes and Cognitive Impairment among African Americans.

    Prior studies using 24-hour ambulatory blood pressure (BP) monitoring (ABPM) found that associations between specific BP phenotypes and increased small vessel cerebrovascular disease was linked with cognitive impairment. However, African Americans were largely excluded from these studies. Price aims to understand the prevalence of BP phenotypes among a sample of African American older adults, and determine if these phenotypes are associated with cognitive impairment in this population.

    Priority Research Areas: Cognitive Aging and the Demography of Dementia, Biology, Genetics and Demography of Aging

  • 2021. Maylyn Martinez, MD, Instructor of Medicine. Comparison of Hospital-Associated Disability (HAD) in Elderly Hospitalized Patients Before and During COVID-19 Pandemic.

    For older adults, the effects of hospitalization superimposed on the normal effects of aging can be a powerful accelerator of that path and result HAD. The COVID-19 pandemic is also likely to increase the risk for development of HAD in hospitalized patients with and without COVID-19. Martinez’s work will examine the prevalence of HAD among hospitalized older adults during the pandemic and study the the effectiveness of the implementation of a clinical decision support tool that guides physical therapy (PT) referral decisions on appropriateness of PT in context of the pandemic.

    Priority Research Areas: Disability, Health Care and Long-Term Care, Determinants of Health, Well-Being and Longevity

  • 2020. Dmitri Koustas, PhD, Assistant Professor, Harris School of Public Policy. The Rise and Consequences of Alternative Work Arrangements for the Aging Workforce.

    Koustas’ recent work has found rates of self-employment and gig work to be higher among older workers. As gig workers will not obtain health insurance through their gig employer, documenting whether they obtain health care coverage for themselves and their dependents through other means is important for contextualizing the welfare implications of gig work and for understanding the labor supply of gig workers. The aims of this pilot project are to clean and process new data elements, and to explore and develop new research designs to answer questions around gig work and health insurance in the United States.

    Priority Research Areas: Disability, Health Care and Long-Term Care

  • 2020. Greg Kaplan, PhD, Professor of Economics, UChicago. Health Care Spending, Mortality and the Macroeconomic and Distributional Effects of Health Inequality at Older Ages.

    In existing work, Kaplan and colleagues have analyzed the joint economic and health implications of different polices by integrating an expanded SIR model of virus spread into a macroeconomic model with realistic income and wealth inequality, as well as occupational and sectoral heterogeneity. However, this work has so far not considered the role of age as a dimension of heterogeneity. The aim of this pilot project is to fill this gap by expanding both the epidemiological and economic blocks of the model to include older people.

    Priority Research Areas: Health Trends and Disparities

  • 2020. Ellis Monk, PhD, Associate Professor of Sociology, Harvard University. Perceived discrimination, especially ethnoracial discrimination, is a significant predictor of the incidence and/or severity of a variety of health outcomes. However, most studies that focus on perceptions of discrimination between-groups fail to define what is meant by ‘racism,’ and rarely consider alternative measures of ‘race’ beyond dichotomous self-identification measures. Monk’s prior research shows that disparities in socioeconomic status among blacks associated with their skin tone rival or exceed SES disparities between blacks and whites as a whole. This pilot study uses innovative measures of skin color, perceived discrimination, and ethnoracial identity to examine their role in shaping health and aging among older adults.

    Perceived discrimination, especially ethnoracial discrimination, is a significant predictor of the incidence and/or severity of a variety of health outcomes. However, most studies that focus on perceptions of discrimination between-groups fail to define what is meant by ‘racism,’ and rarely consider alternative measures of ‘race’ beyond dichotomous self-identification measures. Monk’s prior research shows that disparities in socioeconomic status among blacks associated with their skin tone rival or exceed SES disparities between blacks and whites as a whole. This pilot study uses innovative measures of skin color, perceived discrimination, and ethnoracial identity to examine their role in shaping health and aging among older adults.

    Priority Research Areas: Health Trends and Disparities, Determinants of Health, Well-Being and Longevity

Center-Supported Publications

Center Administrator/Media Contact: Kelsey Bogue

Center for Population Health and Aging (CPHA)

Duke University

CPHA at Duke University is a highly interdisciplinary environment for developing faculty and students who study aging. CPHA fosters important research breakthroughs, particularly in the overlapping areas of biodemography (biological and biomedical demography of aging), life course analyses, and intergenerational studies, including the transmission of health and longevity.

Research Themes
Determinants of health, well-being and longevity; Consequences of U.S. and global aging; Population, economic and health forecasting; Health trends and disparities; Disability, health care and long-term care; Cognitive aging and the demography of dementia; Biology, genetics and demography of aging; Population, economic and health forecasting; Economics of aging; Innovations in data collection and measurement in aging research; Determinants of health and aging across social species.

News & Events
Latest News and Events

Pilot Projects

  • 2024. Anna Gassman-Pines. Tracking Trends in Food Insecurity and Psychological Wellbeing over the SNAP Month .

    This project focuses on understanding how children’s and household’s food insecurity varies through the SNAP (formerly Food Stamps) month. This project would not only inform the SNAP program in a meaningful way, but it could reveal how economic strain more broadly affects low-income families. Thus, this project will add to the scientific literature on economic strain and food insecurity in low-income families, an important component of studies of the life course.

    This project will collect pilot data to help our team demonstrate proof of concept that we can successfully gather daily survey reports of food insecurity, and psychological wellbeing (including mood and cognitive functioning) from a large N sample of SNAP recipients recruited through the mobile phone app Providers, which is operated by the company Propel. Propel runs a survey each month with a random subsample of their app users and they have agreed to add a question to that survey asking respondents if they would be willing to participate in an additional research study. We do not know in advance how many respondents will indicate their interest and, subsequently, will participate in our daily data collection. By collecting pilot data in partnership with Propel, we will learn whether this is a successful recruitment strategy and will be able to demonstrate in a potential R21 proposal to the NIH that our recruitment and data collection procedures are feasible and generate important insights. Further, as described in more detail below, we will develop new measures of daily executive functioning that we will gather in this pilot project. Developing and validating these measures of daily use is the second important component of the project that will support a larger NIH application.

    Priority Research Areas: Population, Economic and Health Forecasting, Effects of Interventions on Population Health

  • 2024. Christopher Wildeman. Building the data infrastructure to differentiate prison and jail incarceration in the NLSY79 in order to estimate long-term effects of both on morbidity and mortality.

    Our project directly contributes to DUPRI research on the social foundations of health, health inequalities, and health and family trajectories across the life course by making it possible to disaggregate the long-term health consequences of jail and prison incarceration for the first time at a national level. The project will allow Duke researchers to obtain access to novel data that are likely to have a significant impact on the study of the health consequences of mass incarceration. Given that incarceration and racial health inequalities will also be key research areas in Duke University’s future center grant application, we consider it to be strategically important, and also extremely valuable in terms of research, to have Duke be the place that made it possible to differentiate the effects of prison and jail incarceration in both the NLSY97 data (already done) and the NLSY79 data (proposed here) and that has several proposals in process using both of those datasets.

    Related research by this team has already been funded through one intramural grant (S25,000 from Duke’s Social Science Research Institute) and one extramural grant ($75,000 from the Russell Sage Foundation). These two grants have fully funded essential data infrastructure work using the National Longitudinal Survey of Youth 1997 (NLSY97). The DUPRI grant would partially fund additional data infrastructure work using the longer-running National Longitudinal Survey of Youth 1979 (NLSY79). Having access to both datasets will significantly enhance the likelihood of success for a planned National Institutes of Health (NIH) R01 proposal, which we intend to submit in Fall 2024. Specifically, adding the NLSY79 will allow us to assess the impact of jail and prison confinement on health at midlife, health at retirement, family formation and dissolution, and premature mortality. These are topics of particular concern among the likely NIH reviewer pool, given the age distribution of Americans who have now been exposed to the era of mass incarceration and the near-total lack of studies that can track the health and family consequences of incarceration across several decades.

    Priority Research Areas: Determinants of Health, Well-Being and Longevity, Population, Economic and Health Forecasting

  • 2024. Avshalom Caspi. The links between mental and physical disorders across the life course: A whole nation analysis .

    By launching this project with nationwide registry data we will pave the way for a grant application of a three-nation study that will bring together physical health, mental health, and socioeconomic data across the life span (from birth to age 100) in three nations (New Zealand, Denmark, and Norway) for >14 million people. These three nations have unique nationwide data registries. We have already established the feasibility of working with the New Zealand and the Danish data. Our goal is to become sufficiently familiar with a new data resource from Norway, and to generate an initial publication, that will document feasibility for a grant application of a three-nation study. The three nations offer access to complementary nationwide health records, including prescription records, hospital records, and, in Norway, primary-care encounters.

    Our aim is to identify the links between mental disorders and physical diseases in the population. To do so, we will leverage a unique data resource that to our knowledge is not available anywhere else in the world: every primary care health encounter over a 17-year period from 2006-2022 in Norway, where all residents are assigned a primary-care physician. By exploring the connections between mental disorders and physical diseases within primary care context, we strive to deepen our understanding of the interplay between mental and physical health, from childhood to old age. Using pilot grant funds, we will prepare and code the nationwide data from primary-care records, and also prepare an initial report which will serve as a ‘preliminary study’ for an extramural grant application.

    Priority Research Areas: Determinants of Health, Well-Being and Longevity, Population, Economic and Health Forecasting

  • 2024. Herman Pontzer. Allostatic Load and Cardiometabolic Health in a Rural Population.

    This project directly examines foundations of lifelong health by testing hypotheses linking early life adversity and physiological (dys)regulation (allostatic load) to cardiometabolic health in adults. It also involves biodemography by integrating biological indicators of health into a life course perspective to examine how the interactions between life events and physiology contribute to population health disparities and mortality differentials. Accordingly, this project engages life course studies through focusing on the cumulative effects of early life experiences on long-term health consequences. The project’s goals include advancing our understanding of how chronic stress influences health across an individual’s health and lifespan, and how these relationships impact differences in population health.

    The Great Smoky Mountain Study (GSMS) provides a unique opportunity to investigate longitudinal effects of early life experience and adversity on cardiometabolic health over the life course. Previous work with GSMS has focused on psychosocial and environmental sources of adversity. With banked dried blood spots for all participants beginning at their enrollment into the study, there are numerous opportunities to expand these analyses to examine biomarkers of physiological stress and dysregulation, including allostasis. This project is a first step in this direction. Results will provide pilot data for grant proposals examining physiological measures of early life stress, their changes over the life course, and their association with adult health outcomes.

    Priority Research Areas: Determinants of Health, Well-Being and Longevity, Biology, Genetics and Demography of Aging

  • 2024. M. Giovanna Merli. Data Collection Innovations to Study the Health of African Immigrants in the United States.

    The topics and methods featured in this study are consistent with DUPRI’s support for data innovations and with the signature themes of the P30-funded CPHA and P2C-funded DPRC (demography of health, life course studies, foundations of lifelong health and interconnected social systems and population health). This project is the first in a collaboration among the following teams:
    (1) the Duke-UNC team composed of Giovanna Merli (Professor of Public Policy at Duke), Ted Mouw (Professor of Sociology at UNC) and colleagues, who have invested significant effort in the empirical testing and evaluation of an innovative link-tracing sampling design, Network Sampling with Memory (NSM), which traces the links (social ties) of respondents to recruit subsequent waves of respondents into the sample according to probability sampling principles. Merli and Mouw have successfully tested this approach among Chinese immigrant populations in the US, Africa and Europe as well as Mexican immigrants in the US. They have shown that NSM is able to generate representative samples of immigrant populations, when compared with the American Community Survey, and that peer referral driving sample recruitment increases response rates; (2) the University of Pennsylvania team composed by Irma Elo, Professor of Sociology and Jere Behrman, Professor of Economics (3) the University of Ghana team led by Ayaga Bawah, Associate Professor and Director of the Regional Institute for Population Studies at the University of Ghana.
    The Penn and Ghana teams have significant expertise in the study of immigrant health and mortality, African health, human resources, economic demography, incentive systems and household behaviors, as well as in the design and conduct of longitudinal data collections in Africa and other low and middle income areas. These two teams have already worked together on a small pilot study of a convenience sample of Ghanaian immigrants in Philadelphia.

    The purpose of this collaboration is to extend the NSM methodology to recruit binational samples of Ghanaian migrants to the U.S. to better understand the impact of migration on the health and wellbeing of African migrants and their families at both origin and destination. The Duke-UNC’s team successfully evaluated NSM with support from grants from NICHD and France National Research Council. We are now planning an NIH R01 grant application to apply and extend this tested methodology to recruit a binational sample of Ghanaian migrants that captures the contexts at origin and destination and to use the peer-referral approach embedded in NSM techniques to follow members of the recruited sample over time. A DUPRI pilot award would help us collect preliminary data and test the feasibility of collecting the network data required by the implementation of NSM among Ghanaian migrants. The new R01 grant application will thus follow from previous NIH investments in this methodology, which would increase the probability of success.

    Priority Research Areas: Migration and health

  • 2023. Jen'nan Read. Implications of White Diversity for U.S. Black-White Health Disparities.

    The overarching goal of this project is to examine how demographic changes in the ethnic origins of whites impact knowledge on U.S. racial disparities in health over time. Specifically, the project will decompose non-Hispanic whites by nativity and region of birth using nationally-representative data from the National Health Interview Survey and the American Community Survey and then replicate studies on black-white health disparities. The replication will first use the standard aggregate white category in comparisons to blacks and then substitute alternative definitions of whites that isolate those of western European descent from those of eastern European, Middle Eastern and North African descent.

    Findings from this study will have implications across DUPRI’s priority areas and contribute to ongoing debates on potential revisions to federal standards on race and ethnicity. The common practice across population health sciences is to treat Whites in the aggregate in studies of U.S. racial inequality, particularly research that focuses on gaps in resources and health outcomes between groups. Studies that focus on within-group diversity among Whites, including my own, are illustrative for identifying vulnerable subpopulations that are masked by the aggregate category. However, they do not address whether changes in the composition of whites over time impact knowledge on intergroup racial inequalities between blacks and whites. Answers to this question would inform research on racial inequality and guide policies that seek to alleviate them.

    Priority Research Areas: Health Trends and Disparities

  • 2023. Hanzhang Xu. Characterizing Caregiving Networks among Persons with ADRD in a Global Context.

    The proposed study is consistent with two priority areas at CPHA as indicated above. First, our study will identify the caregiving networks shared by persons with Alzheimer’s disease and related dementia (ADRD). Some of the caregiving networks likely will include family members across different generations. For example, in China, the cultural expectation of caregiving within the home/family (e.g. filial piety) may contribute to the multigenerational living environment. Therefore, the proposed project is consistent with the intergenerational studies priority area. Furthermore, while the current study will focus on the heterogeneity of caregiving networks and factors associated with it, our ultimate goal is to assess whether certain caregiving networks are associated better well-being, personhood, and quality of life among persons with ADRD. As family and friends are vital to the health and well-being of persons with ADRD, this project’s focus on linked lives is also consistent with the life course studies priority area.

    The PI has been working closely with the Worldwide Elements To Harmonize Research In long-term care liVing Environments (WE-THRIVE) consortium since 2018. In brief, this consortium aims to establish common data elements (CDE) that are relevant to person-centered long-term dementia care. Recently this consortium was invited by the NIA to submit a P01 application that focuses on advancing the identification and use of dementia CDEs that can serve as the springboard for numerous additional studies of the structure, functioning, quality, and equity of dementia care. This proposed project will provide much needed preliminary evidence for one of the P01 projects (R01 equivalence) that focuses on profiling dementia caregiving networks using existing data. This line of work is closely aligned with several NIA’s special interests: ADRD, family caregiving, HRS and HRS International Family of Studies.

    Priority Research Areas: Consequences of U.S. and Global Aging, Determinants of Health, Well-Being and Longevity

  • 2023. Matthew Dupre. Racial Differences in Age-Related Hearing Loss in Middle-Aged and Older Adults.

    Decades of research has documented racial differences in the health and well-being of older adults in the United States. However, much less is known about the life course patterning and predictors of racial differences in hearing loss among U.S. older adults. Evidence from population-based studies indicates that Black Americans have a 40-70% lower prevalence of hearing loss and better pure-tone thresholds compared to White Americans. The reasons for these racial differences in hearing sensitivity are not well understood and appear paradoxical in the context of the large literature on racial disparities in health. Drawing on the life course perspective and biodemography, Black adults may have greater age-related hearing loss than previously observed, but these racial differences may be obscured by failing to account for the life course patterning of hearing loss and the accumulation of risks that Black adults face. Research shows that Black adults experience greater lifetime exposure to risk factors for hearing loss than White adults. For example, Black individuals are much more likely to work in jobs that place them at increased risk for noise-induced hearing loss and live in areas exposed to greater levels of environmental noise pollution or infectious diseases associated with hearing loss (e.g., cytomegalovirus). However, previous research has not examined how the accumulation of a wide range of social, behavioral, and/or physiological factors may contribute to age-related patterns of hearing loss among White and Black older adults. Moreover, most studies that have examined hearing loss are primarily limited to White populations or do not disaggregate Black populations from other minority racial/ethnic groups (i.e., focusing on “non-White” groups).

    To date, there is limited and conflicting evidence to inform the development of clinical and public health interventions to address hearing loss among racial minorities. This pilot project will lay the groundwork to begin addressing this gap by leveraging multiple data sources to understand how a wide array of factors may be contributing to age-related patterns of hearing loss among White and Black middle-aged and older adults. Results from this pilot project will be used to develop an NIH Diversity Supplement (PA-21-071) to examine the implications of age-related hearing loss for differences in hospitalizations in older adults and an NIH/R21 proposal to develop the preliminary evidence needed to support a tailored intervention to improve hearing healthcare among racial minorities.

    Priority Research Areas: Cognitive Aging and the Demography of Dementia, Determinants of Health, Well-Being and Longevity

  • 2022. Charles Nunn. Quantifying the gradient of market integration in relation to health across the life course in northeast Madagascar.

    The pilot research engages with (1) “Foundations of Lifelong Health” by investigating the impact of interactions among biological, behavioral and environmental factors on human health throughout the life course, and (2) “Interconnected Social Systems and Population Health” by considering how
    social connections influence aging and health. The pilot research will form a foundation for building a rich understanding of ongoing market integration in the Sava region of northeast Madagascar where people are transitioning from a lifestyle based on subsistence farming to a lifestyle based on
    market activities, including buying and selling goods. This research will further understanding of the effects of economic change on health across the lifecourse.

    The proposed pilot work will help secure external funding in three main ways: (1) by developing methods to quantify market integration that are appropriate for the cultural, economic, and social context of the area (northeast Madagascar); (2) by expanding our existing research to capture a wider spectrum of variation in market integration across villages; and (3) by conducting initial tests that investigate whether market integration covaries with age, health outcomes, and contact patterns in the region. Previous work studying health in three villages has revealed that agriculturalists are
    increasingly farming a key cash crop (vanilla). This work has demonstrated variation in market integration within these villages; we also expect to document variation across villages, which range from subsistence farmers far from transportation networks to hubs of market activity along major
    roadways. In the context of larger grant applications (R21s or R01s), we will propose to investigate how market integration influences infectious disease exposure, cardiovascular disease, sleep and health disparities, social networks and health, and stress across the life course. We anticipate that
    initial funding applications in the next 24 months will focus on the first two of these topics and incorporate interactions between age and market integration.

    Priority Research Areas: Population, Economic and Health Forecasting, Determinants of Health, Well-Being and Longevity

  • 2021. Elizabeth Gifford . Characterizing Accelerated Aging in Veterans of the Gulf War using Epigenetic Biomarkers.

    Gulf War illness (GWI) is a chronic multisymptom illness (CMI) like fibromyalgia, irritable bowel syndrome, and chronic fatigue syndrome. GWI affects an estimated 25-32% of veterans who were deployed in support of the first Gulf War (1990-91) who continue to experience a host of persistent and reoccurring symptoms (e.g., fatigue, pain, rashes, and gastrointestinal issues) that cannot be explained by other diagnosed medical conditions. An unanswered question for Gulf War veterans is whether or not individuals who experience GWI are also at- risk for experiencing accelerated aging as evidenced by older “epigenetic clocks” and younger age of onset for various chronic conditions. The overarching aim of this pilot is to leverage rich data collected on Gulf War era veterans including self-reported survey data, GWAS (genome wide association study) data, and electronic medical records to create generalizable knowledge regarding aging and disease progression. Specifically, utilizing the Gulf War Era Cohort and Biorepository data repository, this pilot will develop four estimates of epigenetic physiologic age for participants of the Gulf War Era Cohort and Biorepository in support of testing the following hypotheses: (1) Epigenetic age estimates will be higher in Veterans with GWI compared to those without GWI; (2) Epigenetic age estimates will be higher in Veterans with chronic health conditions compared to those without chronic health conditions; (3) Epigenetic age estimates will be higher in Veterans with psychosocial stress, as measured by post-traumatic stress disorder (PTSD).


    Priority Research Areas: Biology, Genetics and Demography of Aging, Health Trends and Disparities

  • 2021. Tyson Brown . Structural Racism and Trajectories of Disease and Disability in Later Life.

    Health inequities along racial lines are broad and deep. Black Americans have a greater prevalence and severity of an array of illnesses, including chronic diseases and disability. While the vast majority of research on racial inequalities in health has focused on the role of individual-level factors such as socioeconomic resources (e.g., education, insurance, income, and wealth), a nascent line of research has begun to examine how health inequities are shaped by contextual factors stemming from structural racism (SR)—i.e., systemic racial exclusion from power, resources, opportunities, and well-being due to societal policies, practices, ideologies and institutions. Prior research has not examined whether racialized socioeconomic inequality is a mediating mechanism linking macro-level structural racism and individual-level health trajectories among older adults. This information is critical for understanding and addressing pathways through which SR affects health in later life. To address these critical gaps, this pilot will create and disseminate a dataset on SR, spanning economic, social, political, and judicial domains as well as over time between 2000 and 2020. This data resource will be a valuable tool for the research community to efficiently build the knowledge base on how SR shapes population health and aging processes. Second, the pilot will provide novel information about the longitudinal relationships between SR and trajectories of health. Finally, the pilot will test the following: a) whether higher levels of SR exposure are predictive of worse health trajectories (levels and rates of accumulation of chronic diseases and disability), b) the extent to which cumulative (and changes in) exposure to SR impacts trajectories of health, and c) whether there are lagged effects of SR exposure on chronic disease and disability trajectories.

    Priority Research Areas: Health Trends and Disparities, Determinants of Health, Well-Being and Longevity

  • 2021. Gregory Samanez-Larkin. Adult age differences in learning and decision making related to differences in sensitivity to different types of reward.

    Neuroscientific research on decision making and aging has focused almost exclusively on monetary incentives. Despite evidence for intact processing of and motivation by monetary gains in old age, preserved function does not extend to learning-based decision making where these incentives must be applied. Here older adults learn more slowly from monetary gains and losses compared to younger adults. These age deficits in learning have been linked to the structure and function of frontostriatal brain circuits, and some studies suggest that enhancement of this neural network via pharmacological increases in dopamine levels selectively improves reward learning in older adults. Although age differences in incentive motivation have been suggested to be due to motivation to maximize well-being (i.e., based on socioemotional selectivity theory), almost no studies have examined age differences in social incentive processing. An interesting possibility is that social incentives may provide a non-pharmaceutical and non-invasive enhancement of frontostriatal networks thus improving learning in old age. The goal of the proposed pilot studies is to examine adult age differences in behavioral and neural sensitivity to social and monetary incentives and examine the behavioral and neural effects of these incentives on learning-based decision making. For the proposed studies we have developed cognitive tasks that will investigate subjective emotional responses during anticipation and receipt of social and monetary incentives (Aim 1), neural sensitivity to the anticipation and receipt of social and monetary incentives (Aim 2), and learning from probabilistic social and monetary outcomes during decision making (Aim 3). One behavioral pilot study (Study 1) and one behavioral and neuroimaging pilot study (Study 2) will be conducted.

    Priority Research Areas: Cognitive Aging and the Demography of Dementia, Disability, Health Care and Long-Term Care

  • 2021. Terrie Moffitt . Psychological and mental health determinants of COVID-19 vaccine hesitancy and vaccine resistance.

    This pilot aims to deliver a comprehensive psychological description of groups who differed in their vaccine intentions in the months just before vaccines became available to them utilizing a cohort on all 1037 births (1972-1973) in one city from the Dunedin Study in New Zealand. Public health professionals aspire to tailor pro-vaccination messaging to the values, motives, lifestyles, and background of people who are hesitant or resistant toward vaccination. This tailoring has called for a “marketing approach” to messaging. However, there is a wide social gap between highly-educated public health professionals and most unvaccinated citizens, who tend to be secondary-school educated, or less. This gap impedes effective messaging. For example, prior US surveys report that unvaccinated individuals tend to be Republicans, or southerners, or not college graduates, but these are crude proxies for people’s actual beliefs, attitudes, preferences, cognitive abilities, and motivations. This pilot harnesses psychologically rich prospective data from a 5-decade longitudinal cohort study to provide insights about the personal psychologies associated with vaccine-hesitance and vaccine-resistance, and whether those personal psychologies emerged early in life and are longstanding. Dunedin cohort members have reported whether they definitely or probably intended to be vaccinated ; definitely or probably did not intend to be vaccinated, or did not know enough to decide. The pilot will compare these 3 groups on prospective antecedents of vaccine intentions, including: (1) adverse childhood experiences; (2) adolescent personality and locus of control over health; (3) cognitive abilities and health knowledge and comprehension of health concepts; and (4) detailed mental disorder histories.

    Priority Research Areas: Determinants of Health, Well-Being and Longevity, Health Trends and Disparities

  • 2021. V. Joseph Hotz . Assessing New Data Source for Measuring Income Volatility to Study Its Relationship with Mortality in the U.S.

    This pilot will assess the use of data from a commercial consumer database on all households in the U.S. to construct reliable measures of the volatility of household income. If successful, the resulting data will be used to assess the relationships between income volatility and mortality in the U.S. and how that relationship varies by race/ethnicity, age and gender of heads of households in the U.S. Study of the latter relationship has been hampered by the lack of availability of samples of households in the U.S. that contain longitudinal data on income and that are of sufficient size to form reliable estimates for all or most counties in the U.S. for different race/ethnic, age and gender groups. If this assessment of the measures of income volatility produced by this data source are positive, others will be able to conduct the first large-scale assessment of the role that income volatility may have played in explaining the recent declines in life expectancy for working age adults in the U.S. and may explain differences in mortality rates by regions of the U.S., and disparities in mortality across racial and ethnic groups.

    Priority Research Areas: Determinants of Health, Well-Being and Longevity, Consequences of U.S. and Global Aging

  • 2020. Susan Alberts . Early adversity in a wild primate model: Physiological mediation and social mitigation.

    Adversity in early life has far-reaching effects on health, well-being, and survival in adulthood, especially when multiple adverse events co-occur. This association is seen not only in humans, but also in captive and wild nonhuman primates. Captive primates exposed to nutritional deficits or maternal neglect show decreased survival in adulthood compared to control animals. Wild baboons who experienced multiple forms of early adversity show reduced adult survival compared to unaffected individuals. Studies of humans and captive animals suggest that immune processes may mediate the effects of early adversity on survival. Early social and physical adversity in humans and captive animals is associated with increased risk of cardiovascular disease, diabetes, mental illness, and allostatic load. In several studies of humans, early-life trauma is also associated with chronic inflammation or heightened inflammatory response to an immune threat. Population-based, prospective, longitudinal studies with multiple repeated measures of adult traits are necessary to fully understand the developmental and physiological underpinnings of early adversity. Innovation. This pilot offers a solution to these challenges by using existing prospective, full life-course data, with real-time, direct observations of both early life adversity and adult sociality, as well as repeated noninvasive measures of adult immune function measured in biological samples that have already been collected. Investigators anticipate the development of a novel dataset that will generate a large number of repeated measures of immunity for each subject in our study; this pilot will be one of the first to measure baseline and acute inflammation in serum from wild animals, a method that may be useful for other wild animal and human research. It will also be one of the first to leverage repeated measures within subjects to quantify baseline versus acute inflammation levels

    Priority Research Areas: Determinants of Health, Well-Being and Longevity

  • 2020. Herman Ponzer . The Daasanach pastoralist population of northern Kenya: A model for healthy aging—specifically the avoidance of non-communicable disease and frailty.

    Small-scale subsistence populations like the pastoralist population of northern Kenya, the Daasanach, have remarkably low prevalence of age-related frailty and cardiometabolic disease, diseases strongly associated with aging and responsible for the vast majority of morbidity and mortality in the U.S. and other industrialized populations. This pilot will investigate which aspects of lifestyle (physical activity, diet, etc.) promote healthy aging among the Daasanach. Two aspects of Daasanach life are of particular relevance to the study of aging. First, like many rural populations across the developing world, the Daasanach are moving from active traditional lifestyles to more sedentary, market-integrated village life. Second, the Daasanach have a largely animal- based diet (blood, milk, and meat). The Daasanach are at the epicenter of the epidemiological transition. Understanding lifestyle changes affecting their life course will help shape strategies to promote healthy aging and other positive health outcomes for them and for other populations in transition and post-transition. This pilot takes advantage of a societal transition in a pastoral environment to capture biosocial processes over the life course that lead to differential aging

    Priority Research Areas: Consequences of U.S. and Global Aging

Center-Supported Publications

Center Administrator/Media Contact: Bernard Fischer


Center on Aging and Population Sciences (CAPS)

University of Texas, Austin

The overarching mission of CAPS is to galvanize novel research that illuminates how biological, psychosocial, and environmental factors intersect and cascade throughout the life course to generate disparities in health and well-being at older ages. The Center promotes collaborations among scholars and supports pilot projects to address these complex aging and population health issues, and works to grow the number and diversity of researchers who study aging at all career stages.

Research Themes
Life course precursors of advantage and disadvantage at older ages; Family demography, social engagement, and social isolation; Place, aging, and health.

News Archive and Newsletter
CAPS News | Events

Pilot Projects

  • 2023. Christy Erving. Superwoman Schema Endorsement, Cardiometabolic Risk, and Depressive Symptoms among Black and White Women in Later Life.

    Black women experience elevated risks for cardiovascular disease (CVD) and depressive symptoms compared to White women which are not fully explained by differences in socioeconomic status, healthcare access, healthcare quality, and psychosocial stressors like discrimination. This project addresses a novel psychosocial construct, Superwoman Schema (SWS), contributes to cardiometabolic risk and depressive symptoms for Black women. SWS includes an obligation to present an image of strength, suppress emotions, and to help others at one’s own expense. This project addresses the following three aims: Aim 1) develop and validate a modified measure of SWS among older Black and White women (i.e., 50 years and older) using data from the Health and Retirement Study (HRS), Aim  2) investigate the association between SWS and cardiometabolic risk as well as depressive symptoms among later life Black women and White women, and Aim 3) examine whether SWS explains Black-White differences in cardiometabolic risk and depressive symptoms among mid- to late-life women.

    Priority Research Areas: Life Course Precursors, Disadvantage at Older Ages

  • 2023. Edison Thomáz. Passive Dietary Monitoring Over the Life Span with a Ring Wearable Sensor.

    Individuals become increasingly vulnerable to unhealthy eating habits as they age. A proven strategy for mitigating unhealthy dietary behaviors is through dietary monitoring, but the practice of keep tracking of everything one eats is onerous and subject to biases. This study will focus on development of a novel approach for detecting food intake over the life span using a ring wearable sensor to track finely-grained finger motion in a small sample of older adults. We will complete an evaluation of the feasibility of the ring wearable in controlled and field settings via the following aims. Aim 1) we will conduct a user-centered design analysis of a ring wearable with 3-5 seniors. Aim 2) We will obtain their initial feedback through informal interviews and use 3D-printed mockup designs. Aim 3) we will advance new senior-focused hardware and algorithms for dietary monitoring

    Priority Research Areas: Life Course Precursors, Disadvantage at Older Ages

  • 2023. Mateo Farina. Understanding the Role of Minority Stress on Cognitive Functioning Among Sexual and Gender Minority (SGM) Older Adults.

    Sexual and gender minority (SGM) older adults experience a greater risk of poor aging-related health outcomes, including cognitive decline and dementia. These risks may be partially attributed to minority stress and stigma experienced across the life course. Participants will include 700 individuals who are participating in a larger longitudinal study of SGM older adults.  The pilot project will identify how cognitive functioning varies by sexual orientation and gender identity categories, with attention to how the experience of SGM specific stressors across the life course affect cognitive functioning. This project addresses these issues in the following aims. Aim 1) examine cognitive functioning nd describe differences by sexual orientation (gay, lesbian, and bisexual) and gender identity (cisgender male, cisgender female, and transgender). Aim 2) Assess how the experience of SGM specific stressors across the life course impacts cognitive functioning among SGM older adults.

    Priority Research Areas: Life Course Precursors, Disadvantage at Older Ages

  • 2023. Michael Geruso. The Age Process of Fertility and Fecundity: New Facts and Implications for Population Dynamics.

    The interaction between aging and childbearing and the trend of delaying births to older ages both have important implications for individuals, families, and societies. Certain basic scientific facts about the age-profile of fecundity (the biological ability to conceive a viable pregnancy) remain unknown: How quickly does fecundity decline with age (in males and females)? Does the decline in female fecundity accelerate at age 30? At age 35? The modern consensus on female fecundity decline relies on populations that were almost entirely white Northern Europeans. In this project, we will generate an accurate age-profile of fecundity decline in a diverse, modern sample. The project addresses two aims. Aim 1) Assemble and harmonize the US data and global data necessary to generate an accurate age-profile of fecundity, Aim 2) Estimate the age-profile of infecundity using standard techniques in formal demography and econometrics.

    Priority Research Areas: Life Course Precursors; Disadvantage at Older Ages, Family Demography, Social Engagement, and Social Isolation

  • 2023. Sarah Brayne. Racial Disparities in Life Expectancy: Living and Dying in the Shadow of Mass Incarceration.

    This project bridges two areas of research: racial disparities in mortality and racial disparities in the United States’ criminal legal system. In the United States, structural and institutional racism place individuals racialized as Black at higher risk of death and disease across the life course. Life course exposure to the most severe form of criminal legal contact is highly stratified by race, with Black individuals being nearly five times as likely as White individuals to experience incarceration. This pilot study uses a combination of quantitative (survey and administrative) and qualitative (interview and observational) data to address the following aims. Aim 1) Examine the long-term, individual-level impact of incarceration on mortality and population-level impact of incarceration on racial disparities in life expectancy Aim 2) Identify factors accounting for these disparities including educational attainment and by state Aim 3) Examine mechanisms regarding how incarceration shapes health and mortality.

    Priority Research Areas: Life Course Precursors, Disadvantage at Older Ages; Place, Aging, and Health

  • 2022. Aprile Benner (Associate Professor, Human Development & Family Sciences, UT Austin). Structural Racism, Discrimination, and Health across the Life Course .

    In considering the impacts of racism on health, much is known about how individually-experienced interpersonal discrimination influences health and well-being, yet the impacts of structural racism remain vastly understudied. Moreover, this small base of extant research tends to focus on a single structural racism component, contrary to both theory and the NIMHD framework, which stress the multifaceted and interdependent nature of structural racism. This limitation is likely driven, in part, by challenges with data access, but it ultimately compromises the effectiveness of interventions targeting health and health disparities by providing an incomplete picture of the consequences of structural racism for health. The proposed project will fill this void, linking state-level structural racism data with individual survey data from the NSAL and NLAAS. We will accomplish the following aims. Aim 1) Document the consequences of, and mediating and moderating mechanisms by which, structural racism influences health for those 60 and over. Aim 2) Extend these analyses to consider variation in structural racism’s pathways of influence. These activities and analyses will illustrate proof of concept and feasibility of larger research aims.

    Priority Research Areas: Disadvantage at Older Ages; Place, Aging, and Health, Life Course Precursors

  • 2022. Karen Fingerman (Professor, Human Development & Family Sciences, UT Austin). Daily Experiences and Well-being in Late Life: A Longitudinal Examination of Ecologically Valid Assessments of Older Adults’ Daily Experiences.

    Social engagement theory suggests that encounters with friends, family, and social groups leads to beneficial everyday activities contributing to longer term benefits. Yet processes underlying these associations remain poorly understood, due to a paucity of ecologically-valid data connecting encounters with social partners to experiences throughout the day. This pilot study lays groundwork for a second wave of data collection building on the innovative and highly successful Daily Experiences and Well-Being Study (R01AG046460) addressing these issues via a follow up phone survey. This pilot project addresses the following Aims. Aim 1) To establish contact with prior participants and/or reasons for an inability to establish contact (e.g., mortality, cognitive impairment), Aim 2) To conduct a brief interview including updates on their social networks and cognitive assessment.

    Priority Research Areas: Family Demography, Social Engagement, and Social Isolation

  • 2022. Lauren Gaydosh, (Assistant Professor, Sociology, UT Austin) . Contextual Despair and Risk Behaviors in Midlife: Extending Innovative Measures to Add Health.

    Life expectancy at birth in the United States (US) has declined since 2014 [1], a uniquely American phenomenon that is not observed in any other developed country [2]. Several scholars have suggested that increasing deaths due to drug overdose, alcohol-related diseases, and suicide among middle-aged adults (45-54) may explain declining life expectancy [3-5]. This cluster of causes of death – referred to as “deaths of despair” – have been attributed to community economic distress, social isolation, and other deteriorating social factors that have led individuals to feel a sense of hopelessness, which is alleviated by turning to self-destructive behaviors, such as self-harm, alcohol and drug abuse [3]. Underlying these national trends is wide variation in both levels and trends in life expectancy across place [6]. Indeed, geographically-patterned community decline increases the demand for substance use, which can ultimately lead to premature death [7, 8]. The role of community factors in the deaths of despair research indicates that the geographic context of despair should be integrated into the social etiology of recent life expectancy decline. The successful completion of this project will lead to a better understanding of the causes and consequences of rising midlife mortality in the US that can inform more effect community-level interventions.

    CAPS Themes
    The proposed research fits with all three of the CAPS themes. First, the project will interrogate contextual despair across the life course (from adolescence to mid adulthood) and consider how they influence health at older ages, in line with the CAPS theme of life course precursors. Second, the pilot project will merge measures of family dissolution, social isolation, and social disengagement as aspects of contextual, in line with the CAPS theme of family demography, social engagement, and social isolation. Finally, the project investigates the role of county-level contextual factors in shaping health behaviors and outcomes, in line with the CAPS these of place, aging, and health. The proposed research fits with the UTMB Pepper Center priority
    area of medical effectiveness by including measures of patient treatment facilities and providers as contextual predictors of individual health outcomes. The proposed research fits with the UTMB RCMAR priority area of health and aging in minority populations by expanding the literature on deaths of despair beyond a narrow focus on non-Hispanic White adults to consider heterogeneity in the relationship between despair and health outcomes by race/ethnicity.

    Priority Research Areas: Family Demography, Social Engagement, and Social Isolation, Place, Aging, and Health

  • 2022. Mark Hayward (Professor, Sociology, UT Austin). The Dynamics of Race Differences in Life Course Pathways Associated with the Risk of Alzheimer’s Disease and Related Dementias.

    The goal of the proposed pilot project is to develop a 5-year R01 NIA grant application to investigate race-specific life course pathways of Alzheimer’s disease and related Dementias (ADRD) risk. The project challenges the idea that life course risk factors are static across race groups [1] and over historical time. It considers the changing dynamics of life course pathways without homogenizing across groups, which is necessary when considering the very different lived experiences of older Blacks and Whites in a racially stratified system. The proposed research draws on our prior work showing that race differences in dementia risk are rooted in dramatic differences in the influence of early life development factors as well as adult exposures and behaviors (which we refer to as racialized life course pathways). Drawing on historical longitudinal data from Health and Retirement Study (HRS), we will evaluate cohort changes in the influence of racialized life course pathways of ADRD risk. Over the course of the 20th century, significant shifts in life course experiences occurred in American society with the expansion of education, changes in health behaviors, and shifts in employment opportunities that may have impacted cohort changes in ADRD risk [2]. Unclear is whether this pattern of overall cohort change in ARDR risk and its ties to life course changes pertains to both Blacks and Whites, because most Black Americans were born in the Jim Crow South, where a robust and wide-reaching legal apparatus curtailed economic, social, and political rights. Our project will explore how these dynamics, along with the race stratification system in the US, may have impacted overall cognitive functioning as well as specific components (e.g., memory). We move beyond the typical global measures of ADRD risk to better understand how changes in specific cognitive health domains are linked to historical changes in cohorts’ life course exposures and ultimately tied to changes in ADRD risk for Blacks and Whites.

    Additionally, this project will also leverage HRS sister studies in Brazil, South Africa, and India to develop a macro comparative approach for understanding the dynamics of the racialized pathways through a global lens. While systematic comparisons of specific macro influences are admittedly challenging, these studies allow us to develop similar life course models of ADRD risk which can be compared cross-nationally to better understand how racial caste systems, institutionalized racism, and caste systems not defined by race shape individuals’ life course exposures and ADRD risk. South Africa and the United States are similar in terms of their Black populations living in race-based caste systems. Brazil offers an important counterpoint to examine race differences in life course pathways since, while it lacks a race-based caste system, race has long defined social hierarchy and inequality. The inclusion of India in this analysis allows us to identify the similarities and differences when caste systems are not defined by race, but rather by other sociopolitical factors that also create rigid social groups.

    CAPS Themes
    The proposed project speaks directly to two CAPS themes.

    • Life course precursors of later life health and well-being
    • Place and health including neighborhoods, geographic region, and other indicators of place

    The proposed study will significantly advance current understanding of the racialized pathways associated with Alzheimer’s disease and related dementias, a topic that has received little attention despite the enormous race gap in ADRD prevalence and incidence. ADRD rates are 2.5 to 3 times higher among Blacks compared to Whites and at levels that are epidemic in magnitude. The study also speaks to the often implicit assumption that the association between life course factors and ADRD is static. This study highlights the importance of considering ADRD risk in terms of dynamic changes in the life course and how these life course changes differ for Blacks and Whites. Finally, this study will shed new light on the possible ways in which macro institutional factors come into play across countries. Most research on ADRD risk is focused on the United States and Europe with much less information about the life course influences.

    Priority Research Areas: Life Course Precursors, Place, Aging, and Health

  • 2022. Sae Hwang Han (Assistant Professor, Human Development & Family Sciences, UT Austin). Disability of a Family Member, Caregiving Behavior, and Caregiver Health Outcomes in Middle and Late Adulthood.

    Tens of millions of middle-aged and older persons in the United States live with a disability today, with the numbers projected to grow substantially in the coming decades due to population aging. The trends of late-life disability have placed issues surrounding health of informal family caregivers at the center of political and social discourse. This is in part because many of the challenges posed by the increasing prevalence of disabilities, such fiscal concerns regarding the cost of late-life dependency and dementia care, as well as societal efforts to reduce unmet needs, are closely related to health and well-being of informal caregivers.

    Despite the decades of research on this topic, however, there continues to be a lack of clear understanding of how the act of caregiving influences caregiver’s health and well-being. On the one hand, caregiving has long been studied within a chronic stress exposure paradigm (e.g., stress process model), where the act of caregiving is characterized as a chronic stressor and by extension a significant risk factor for adverse mental health outcomes, such as depression (Schulz et al., 2020). On the other hand, a stream of recent of population studies indicate that informal caregivers of people with serious debilitating conditions, including dementia, experience robust health benefits in the form of extended longevity (Roth et al. 2015), providing a picture inconsistent with the conventional view that characterizes caregiving as a chronic stressor detrimental to health.

    While there have been several attempts to reconcile the seemingly contradictory set of evidence surrounding caregiving and varied health outcomes (Brown & Brown, 2014; Marino et al., 2017; Roth et al., 2013), a conceptual framework that can be used to generate testable hypotheses about when and under what circumstances caregiving behavior promotes or undermines caregiver’s health and well-being is rare. Guided by interdisciplinary research on prosocial helping behaviors and key tenets of the life course perspective, the primary goal of this pilot project is to provide a first step toward establishing a conceptual framework that can be used to test various pathways and contextual factors for explaining the linkages between caregiving and varied health outcomes for the caregiver. This project challenges the dominant research paradigm that characterizes caregiving solely as a chronic stressor detrimental to health, thereby helping to spur a needed course-correction in the public and policy discourse surrounding family caregiving (Brown & Brown, 2014; Roth et al., 2015). To this end, we take advantage of longitudinal data spanning two decades collected from a large national sample of middle-aged and older adults in the Health and Retirement Study (HRS; 1998-2018), which contains rich information on sociodemographic and health characteristics, as well as caregiving behaviors.

    CAPS Themes

    The central theses of the project are framed around key concepts of the life course perspective. This project investigates linked lives and of intertwined trajectories of older individuals and their close family members, where a family member’s experience of disruptions in critical life domains due to disability is also assumed to be experienced by their family member in a number of different life domains. That is, a health trajectory underlying disablement process of one family member not only influences other family members’ mental health trajectory, but it also triggers initiation of their trajectory as a caregiver (i.e., transition into a caregiver role), often described as a “unexpected career” in life course scholarship. Potential mental health outcomes of caregiving are examined through the lens of constrained agency and identity agency. As such, this project speaks to one of the key priority areas of the Center on Aging and Population Sciences, namely, investigating life course precursors of later life health and well-being.

    Priority Research Areas: Life Course Precursors

  • 2022. Stephanie Grasso (Assistant Professor, Speech Language and Hearing Sciences, UT Austin) . Sociodemographic and Neurocognitive Characterization of Mexican-American Bilinguals and Monolinguals Presenting with Typical and Pathological Cognitive Aging.

    Society is facing a global “dementia epidemic” that will intensify with the growing aging population. Mexican-Americans are expected to demonstrate significant increases in dementia cases relative to other race and ethnic groups. The management and treatment of dementia in Mexican-Americans is hindered by the lack of comprehensive models of neural and cognitive decline that reflect the diversity of this population. Hispanics make up the largest group of bilingual speakers in the U.S. Understanding how language dominance (i.e., language preference and use), language proficiency (e.g., mastery of English comprehension and production), and age of dual language exposure (e.g., during or after childhood) influence the structure and function of the aging brain is a critical first step towards developing individualized interventions for this historically minoritized group. There is a growing body of evidence indicating that differences in bilinguals’ proficiency, dominance, and age of dual language exposure might influence executive functions (e.g., working memory, attention, and cognitive control) that can affect the risk, onset, and progression of dementia. However, the individual, family, and community factors that underly differences in dual language behavior and how these differences influence typical and pathological cognitive aging are largely unknown. To bridge this gap, we will provide an exhaustive sociodemographic (Aim 1) and neurocognitive (Aim 2) characterization of monolingual and bilingual Mexican-Americans with typical cognitive aging, MCI, and dementia. We will use these characterizations to identify the sociodemographic, linguistic, and neurobiological markers that best predict individual differences in cognitive decline. We will analyze two longitudinal datasets that include a wide variety of sociodemographic and neurocognitive measures collected from more than 3,500 aging Mexican-Americans. Our approach will combine concepts from cognitive neuroscience, linguistics, sociology, epidemiology, and demography with cutting-edge neuroimaging and machine learning tools. Machine learning models will be used to predict complex non-linear relationships in multidimensional datasets that are not captured by linear regression models. We will use the methodologies developed herein to submit NIH proposals that aim to elucidate the complex relations between the sociodemographic and neurocognitive profiles derived from this pilot project.

    If our aims are realized, we expect to transform theoretical frameworks of neural and cognitive decline in Mexican-Americans. Crucially, this will lead to advances that can have immediate impacts on society and behavioral intervention approaches. For example, this proposal will serve to reduce health disparities in the historically minoritized and two underserved Mexican-American population. Additionally, our results have the potential to enhance the management and treatment of dementia in bilingual and monolingual speakers. From a methodological perspective, the machine learning approaches developed in this project have the potential to advance predictive modeling techniques used in the field.

    CAPS Themes

    The themes of the UTMB Pepper Center and RCMAR both emphasize the importance of conducting research on the health and aging of diverse older adult populations, with a focus on Hispanic populations in the United States. This project is directly related to these themes as we use a life course approach to investigate the role of bilingualism, English proficiency, and language dominance on changes in cognitive functioning and brain structures among older Mexican American adults. This proposal also directly addresses the three main research themes of the Center on Aging and Population Sciences. First, our proposal addresses life course precursors of advantage and disadvantage at older ages. Second, our proposal addresses the relationship between family demography and social engagement in neurotypical and pathological in underrepresented minority groups. Finally, our proposal addresses place, aging, and health in aging Hispanics in the U.S. context. The life course approach informed our decision to focus on variables in the H-EPESE and HABLE for early- (e.g., country of birth, language spoken as a child), mid-(e.g., occupation), and late- (e.g., household composition, language dominance) life characteristics that we hypothesize are associated with cognitive functioning and brain structures.

    Priority Research Areas: Life Course Precursors, Family Demography, Social Engagement, and Social Isolation

  • 2021. Abigail Weitzman. Assessing the Feasibility of Panel Data Collection Among Adult Refugees in Costa Rica.

    The proposed project aims to collect pilot longitudinal data among refugees and other migrants in need of protection (MNP) who have relocated to Costa Rica to evade an imminent threat to their survival. To do so, the project will first conduct a baseline phone survey with MNP from various different Latin American countries who are ages 18 to 95 years and currently residing in Costa Rica. Following, it will then send these same MNP a series of standardized follow-up surveys to complete online either daily, weekly, or monthly. Analyses of the resultant data will provide new information about how the retention of MNP in panel surveys varies as a function of trauma history, age, and other personal characteristics. In addition, they will reveal: (1) how much variation exists in MNPs’ health, wellbeing, and hardship on a daily, weekly, and monthly basis; (2) how trauma histories and former ecological contexts (e.g. country of origin) sort refugees and other MNP onto different health trajectories; and (3) how trauma, age, country of origin, family structure, and attributes of personal networks predict MNP health and hardship on average. The findings promise to advance research and theory on trauma, aging, and international displacement by generating pilot data for an R01 project, adapting methods to track and describe the social and health circumstances of internationally displaced populations, and examining relationships between pre- and post-flight experiences, family dynamics, social incorporation, and MNP health and wellbeing across the adult life course.



    Priority Research Areas: Life Course Precursors, Family Demography, Social Engagement, and Social Isolation

  • 2021. Debra Umberson. How Spouses Influence Each Other’s Health in Same- and Different-Sex Marriages: A Dyadic and Longitudinal Assessment from Mid to Later Life.

    Decades of population research show that married Americans are in better health and live longer than their unmarried peers and that there are gender differences in how spouses influence each other’s health. Until recently, however, this research was entirely based on marriages between women and men. In 2015, with NIA support (R21 AG0445850), we collected dyadic data to conduct the first in-depth analysis of marital processes and health comparing legally married midlife spouses in same-sex and different-sex marriages. Findings have highlighted differences in health-related marital dynamics for women and men in same and different-sex unions. These dynamics likely impact both spouses’ long-term health, but due to a lack of longitudinal and dyadic data, scientists know little about how they do so. The major aim of this pilot project is to design and launch collection of Wave 2 data to construct a longitudinal, dyadic data set that will allow us to examine how same-sex partners influence each other’s health behaviors and mental and physical health over time, and in comparison to different-sex partners.

    Priority Research Areas: Life Course Precursors, Family Demography, Social Engagement, and Social Isolation

  • 2021. Diane Coffey. Gender Disparities in Adult Mortality and Morbidity in India: Understanding Variation and Investigating Mechanisms.

    A large body of research documents health disparities between boys and girls in India.  Gender discrimination leads to skewed sex ratios at birth, and to male-female gaps in child mortality and height that are markedly different from the rest of the world.  Such research highlights the rich complexity of how biology and society interact to produce population-level child health outcomes.  For example, in most countries, girls are more likely to survive childhood and less likely to be stunted than boys (Sawyer, 2012).  Yet, in India, many child health outcomes are similar across sexes, or worse for girls.

    Less research has documented, contextualized, and investigated disparities in morbidity and mortality between adult men and women.  Comparisons of gender differences in life expectancy suggest that the female life expectancy advantage that exists in almost every country is muted in India.  This proposal seeks to understand how and why women in India experience smaller, and sometimes no survival advantages compared to men.  By examining regional variation in gender discrimination, as well as regional variation in gender health gaps, we seek to build a more comprehensive model of disparities in the aging process in India, where one-sixth of people live.

    This project has three aims: 1) to identify gaps in the literature about gender disparities in health in India and compare how these gaps match with NIA funding priorities; 20 to identify how data on adult health and morbidity can be used to fill gaps in the literature; 3) to prepare preliminary analyses to be used in an NIA proposal and prepare a proposal.





    Priority Research Areas: Life Course Precursors, Place, Aging, and Health

  • 2021. Karen Fingerman . Young Adult Caregivers.

    Priority Research Areas: Family demography, social engagement, and social isolation

  • 2021. Lauren Gaydosh. Biological Aging Among Older Sexual and Gender Minority Adults in the US South.

    Older sexual minorities constitute approximately 3 million Americans, a number expected to double by 2030. Moreover, 35% of SGM adults in the US reside in the South, yet many studies focus on SGM samples in coastal metropolitan cities. Sexual and gender minority (SGM) populations experience significantly worse morbidity, mental health, physical disability, and unmet healthcare needs compared with their heterosexual and cisgender counterparts. With smaller kin networks, SGM are also more likely to experience social isolation. These health and social disparities have been exacerbated by the current COVID-19 pandemic. The Vanderbilt University Social Networks, Aging, and Policy Study (VUSNAPS) investigates the health and aging of older SGM residing in four states in the US South (Alabama, Georgia, North Carolina, and Tennessee). This pilot project will collect innovative in-home self-collected blood samples for measurement of biomarkers of aging in a subsample (n=150) of the VUSNAPS cohort. We aim to assess the feasibility of this self-collection technology both in terms of acceptability in our study population and quality of the resulting biomarker measurements. We will construct biomarker-based measures of biological aging and examine variation by sexual orientation and gender identity. Finally, we will investigate the relationship between social isolation and biological age, testing state-level variation. This project will contribute to the fields of biodemography, public health, minority health disparities, and gerontology, all of which will benefit from expanding access to biomarker data among a high-need and understudied population. The collection of biomarkers of aging among this population will be a major advancement in the measurement and study of health inequalities across gender identity and sexual orientation, especially in older age. The study will enable preliminary investigation into the disproportionate burden and lasting implications of the pandemic on health and aging in this vulnerable population.



    Priority Research Areas: Family Demography, Social Engagement, and Social Isolation, Place, Aging, and Health

  • 2021. Robert Crosnoe. Health Disparities among Aging Parents of Adult Children with Serious Conditions.

    This project will involve preliminary analyses and pilot data collection for a R01 proposal to NIA. The parent project—which will go through the NIH review cycle twice over the next year—is a large mixed-methods study investigating the physical and mental health toll on aging parents of children with serious conditions who have reached adulthood and how this toll can be buffered by resources in the family ecology related to marriage/partnership and by resources in the community related to the availability of health and human services. The pilot project’s goals are to conduct preliminary statistical modeling of a nationally representative data set that incorporates community-level measures from outside sources (e.g., Health Resources and Services Administration, National Center for Charitable Statistics), demonstrates feasibility, confirms power, and produces potential results supporting the proposed plan of quantitative analyses; to conduct a small number of pilot semi-structured interviews with local parents that allow refinement and expansion of the proposed qualitative sampling and data collection procedures and experimentation with the proposed textual and grounded theory analytical techniques; and to address, when possible, any suggestions and critiques that arise during the NIH review process related to data and analyses.

    Priority Research Areas: Life Course Precursors, Family Demography, Social Engagement, and Social Isolation

  • 2021. Veronica Garcia Walker. Living into Old Age with Pyschopathology/schizophrenia.

  • 2020. Chandra Muller. Education and Financial Resilience During Economic Recession for Healthy Aging: Record Linkage of High School Education Longitudinal Studies to Consumer Credit Data.

    Priority Research Areas: Life Course Precursors

  • 2020. Elizabeth Munoz. Neighborhood Characteristics Throughout Life and Midlife Cognitive Functioning.

    Aim 1: To determine whether residential neighborhoods can be successfully coded for neighborhood resources and deprivation from childhood to midlife using historical data indicative of neighborhood context.

    In accordance with Aim 1, we were able to successfully code for early childhood neighborhood deprivation. In consultation with a Geographic Information Systems expert, coded age 5, 10, and 15 addresses for the Effects of Stress on Cognitive Aging, Physiology and Emotion study (ESCAPE) database.

    In consultation with Dr. Gabriel Amaro, Interdisciplinary Statistician at the U.S. Census Bureau, we geocoded and linked addresses with harmonized longitudinal Census tract boundaries. Through this process, we discovered that we were only able to link participant data who had age-5 addresses from 1970 or later. Census tracts have been used since about the 1920s but only a small number of areas in the U.S. were tabulated by tracts. It was not until 1940 that tracts were officially adopted as a geographic entity by the Census Bureau and by 1970, tracts started be used in more widespread fashion. Thus, our variables of interest were only available from the 1970 Census, forward. In all, we were able to link data to 56% of the ESCAPE sample, and thus to participants who were 45 years or younger at the time of assessment. We computed an age-five neighborhood deprivation score that included the following variables: Median household income (reversed scored), percent H.S. or less, percent owner occupied units (reversed scores), % poverty rate, % unemployment rate, median contract rent (reversed scored), and percent female headed households. Our results showed that although early neighborhood deprivation was correlated with cognitive performance, this effect was not after accounting for self-reported recollections of early neighborhood environments.

    Age five addresses have currently been coded for the Colorado Adoption/Twin Study of Lifespan behavior and cognitive aging (CATSLIFE). This is a younger sample between the ages of 28 and 48 and because of the dates of data collection, we were able to successfully geocode age-5 addresses for 1,236 participants and computed a composite deprivation score for age 5. Our next step will be to analyze associations with cognitive function to evaluate if results are consistent with results obtained from ESCAPE.

    Priority Research Areas: Place, Aging, and Health

  • 2020. Elliot Tucker-Drob. Large-Scale Genomic Analysis of Aging-Related Cognitive Declines Elliot Tucker-Drob.

    Priority Research Areas: Life Course Precursors

  • 2020. Jennifer Glass. Trajectories of Mothers’ Breadwinning Responsibilities Over the Life Course.

    Our goals were to find, clean, and analyze the best available data on mothers’ financial provisioning in U.S. households to answer two questions:

    (1) What is the probability that mothers today will find themselves the primary economic support for their children, and for how long a duration on average until their first child turns 18?

    (2) where and why is mother’s role in financial provisioning for children growing so remarkably?

    Using longitudinal SIPP panels beginning in 2014, we first created multi-state lifetable estimates of mothers’ duration as primary earner, as well single-decrement lifetable estimates of their chance of ever being the primary earner over the first 18 years of motherhood. Using a conservative threshold of 60% or more of household earnings to determine primary earning status, around 70% of American mothers can reasonably expect to be their household’s primary financial support at some point during their first 18 years of motherhood. Mothers average 4.19 years as their families’ primary earner in the 18 years following first birth. Mothers with some college but no degree spent the most years as primary-earners, about 5.09 years on average, as did mothers with nonmarital first births, about 5.69 years

    To answer the second question , we are currently using the 1996 and 2014 Survey of Income and Program Participation data to identify changes over time in the prevalence of precipitating events [a separation from a partner or other household earner, an increase in their own earnings, or a decrease in the earnings of a partner or household earner] and determine whether any changes in the effects of these events have occurred since the mid-1990s. We then disaggregate these findings by mothers’ educational attainment and race, estimating variation among mothers in the rate of transition into primary-earner status and whether the contribution of each precipitating event varies by race and class. So far, we have found that separation and divorce account for none of the growth in mothers’ financial provisioning, while the combination of ‘his earnings decline and her earnings increase’ in the same year is much more likely to result in her assuming financial provisioning than in the past. We also note that while Black mothers have seen no growth in financial provisioning (over 80% risk in both time periods), White, Hispanic, and Asian mothers have all seen risk grow over time.

    Priority Research Areas: Family Demography, Social Engagement, and Social Isolation

  • 2020. Marika Cabral. Sources of Variation in Private Insurance Coverage Among Medicare Beneficiaries: Decomposing Place-Based and Person-Based Factors.

    During the pilot period, my collaborators and I have conducted the core analysis for the paper.  We have begun presenting the project at conferences and discussing it with colleagues.  We are currently finishing up a first draft of the paper for this project, and we anticipate being able to circulate the paper in late Spring 2021 for wider feedback before submitting to a journal.  In case it is helpful, below is a preliminary abstract for the paper:
    Abstract: In recent years the share of Medicare enrollees obtaining insurance through private Medicare Advantage (MA) plans has increased by 2-3 percentage points per year, ensuring that elderly and disabled beneficiaries will continue to obtain Medicare insurance both through direct government provision and indirectly through private plans for the foreseeable future. But geographic uptake of MA remains highly variable, with essentially no enrollment in some states and well over half in others. In this paper we exploit the MA enrollment decisions of those moving from one MA market (county) to another between the years 2007 to 2017.  This technique decomposes enrollment decisions into a component due to beneficiary attributes and preferences and a component due to market features.  We find that geographic variation in beneficiary preferences and attributes accounts for more than half (~60%) of variation in MA enrollment decisions. This role of market features is somewhat more important in areas with low MA enrollment and in county pairs where the markets are most dissimilar. We then examine predictors of the market component of MA enrollment decisions. Holding beneficiary preferences fixed, MA enrollment is higher in areas with higher MA reimbursements and greater MA advertising and lower in areas with greater physician and hospital market power.
    Other outcomes from the project and plans for the future
    This pilot project is part of a larger and ongoing research agenda of mine on factors that influence health care decisions and health care consumption among elderly and disabled individuals covered by Medicare.  In early stage work, I am exploring the feasibility of using a similar research design to investigate the determinants of health system choice among other groups with choice between different public insurance options.

    Priority Research Areas: Place, Aging, and Health

Center-Supported Publications

Center Administrator/Media Contact: Stacy Brodie

Center on Biodemography and Population Health (CBPH)

University of Southern California & University of California, Los Angeles

CBPH is a multi-site center located at the Andrus Gerontology Center at USC and the Program in Geriatric Medicine at UCLA. The Center’s primary aim is to provide a synergistic research environment for the integration and translation of research findings from a variety of disciplines to better understand population health. It supports the Biomarker Network, which is dedicated to improving measures of biological risk for late-life health outcomes – measures critical in monitoring population health.

Research Themes
Biology, genetics and demography of aging; Cognitive aging and the demography of dementia; Determinants of health, well-being and longevity; Health trends and disparities

CBPH News & Events

Pilot Projects

  • 2022. Cynthia Kusters, Michael Irwin, Judith Carroll . Treatment of Insomnia using Cognitive Behavioral Therapy or Tai Chi Chih and Modification of Metabolomics.

    Although disease morbidity and mortality risk are elevated among those with sleep disturbances, the specific molecular pathways altered by sleep loss, which impact human disease, are poorly defined, and may be particularly magnified in late life. Potential pathways include inflammatory, oxidative stress, metabolic, and (neuro)-endocrinological pathways, each of which modifies biological aging. No research to date has tested whether treatment of insomnia in older adults modifies metabolic profiles. As insomnia is a modifiable behavioral target with established treatment efficacy, whether this treatment also improves metabolic patterns relevant to health would be a valuable addition to our understanding of how poor sleep drives risk. Cognitive Behavioral Therapy for Insomnia (CBT-I) is an effective intervention to treat insomnia. Our prior trial demonstrated the effectiveness of Tai Chi Chih as an alternative intervention successful at improving sleep among older adults with insomnia. Moreover, we observed improvements in inflammation among CBT-I participants pointing to biological shifts because of treatment. In the present proposal we extend this work by investigating additional relevant metabolites for health using novel metabolomic approaches. We hypothesize that treatment of insomnia using either CBT-I or TCC will relate to improvements in concentrations of important metabolites relevant to cardiometabolic health and biological aging, namely improved lipid, amino acid, and oxidative stress profiles. We will use existing stored specimens to complete this work, and will use the results to inform future grant applications to support junior investigator, Dr. Kusters.

  • 2022. Jennifer Ailshire. Colombia HRS Pilot – COSA.

  • 2022. Miriam Mutambudzi, Maria Brown . Biological Age and Chronic Health Trajectories: Moderation by Perceived Discrimination.

    How biological age may prospectively predict differential classification into trajectories of chronic health conditions (CHCs) associated with greater morbidity and mortality in older adults, and how this association may differ based on experiences of perceived discrimination are still unclear. The objective of the proposed research is to fill this gap using 2014-2020 Health and Retirement Study (HRS) data and biological clock data from the HRS Venous Blood Study. We will construct CHCs trajectories using latent class mixture models and regress these on PhenoAge, an epigenetic clock that measures biological age. We will further examine the moderation effects of perceived discrimination on this association in Black, White and Hispanic participants. Exploring differences in vulnerability to health declines by biological age can enhance our understanding of drivers of accelerated health deterioration that have previously been insufficiently identified or quantified. It will also provide insights into subgroups of adults who, due to accelerated biological aging and exposure to negative social determinants of health, may benefit from access to social and medical resources, particularly in cases where such resources (ex. Medicare) are reserved for those of a certain chronological age. Through this seed funding, we can build a foundation for additional research on biological and social contributors to disparities in adverse health trajectories. Our findings would inform the design of a future NIH R01 application focused on understanding factors contributing to differential health declines among diverse adults of similar chronological age and health profiles.

  • 2022. Theresa Andrasfay . Exploring the Role of Occupational Characteristics as Social Determinants of Epigenetic Aging.

    It is thought that adverse working conditions contribute to premature aging, but it is unclear whether this occurs at the molecular level. The objective of this pilot project is to examine how occupational categorizations and specific occupational exposures are associated with accelerated epigenetic aging, and how they contribute to the earlier aging of disadvantaged social groups. This project will utilize data from the Health and Retirement Study’s 2016 Venous Blood Study, complemented with data from the Occupational Information Network (O*NET), to assess how a set of several physical, psychosocial, and environmental occupational characteristics are associated with epigenetic aging as estimated through five epigenetic clocks. The results from this study will contribute to our understanding of the biological processes through which working conditions influence health and the aging process.

  • 2021. Courtney S. Thomas Tobin. Evaluating the Role of Allostatic Load in the Association between Mental and Physical Health among Black and White Adults.

  • 2021. Eric T. Klopack . Epigenetic Signature of Childhood Adversity in Older Adults.

  • 2021. Lauren Schmitz, Teresa Seeman. arly Life Adversity Associations with Later Life Epigenetic Profiles: The Multi- Ethnic Study of Atherosclerosis (MESA).

  • 2021. Marco Angrisani . The Online Memory Training Study in a Population Representative Panel .

  • 2020. Gregory Miller. Pro-inflammatory Gene Pathways Mediating SES Disparities in Population Health across Adult Development.

  • 2020. Jennifer Ailshire. Exposure to Neurotoxins, DNA Methylation, Inflammatory Mechanisms, and Cognitive Aging.

  • 2020. Jennifer Nicoloro-SantaBarbara. Resiliency and Immune Cell Distribution and Aging in HRS.

Center-Supported Publications

Center Administrator/Media Contact: Eileen Crimmins

Center on the Economics and Demography of Aging (CEDA)

University of California, Berkeley

CEDA supports cutting-edge discovery and dissemination of knowledge on the demography of aging by supporting new research via pilot project funding; providing support for programming, computing, and data access; facilitating and encouraging interdisciplinary interactions and innovation; organizing conferences and seminars; supporting junior faculty development; and disseminating research findings.

Research Themes
Biology, genetics and demography of aging; Consequences of U.S. and global aging; Health trends and disparities; Determinants of health, well-being and longevity; Population, economic and health forecasting; Behavioral economics.

News Archive and Newsletter
Population Sciences News | Email with your request to subscribe to PopSci Weekly News.

Pilot Projects

  • 2024. Andrew Kim. Intergenerational effects of maternal prenatal stress on adult offspring glucocorticoid resistance and psychiatric morbidity in Soweto, South Africa: a study of accelerated immunosenescence.

    Priority Research Areas: Biology, Genetics and Demography of Aging

  • 2024. Catalina Amuedo-Dorantes. Immigration Enforcement and Quality of Care Provided by Home Health Agencies.

    Priority Research Areas: Disability, Health Care and Long-Term Care, Determinants of Health, Well-Being and Longevity

  • 2024. Dennis Feehan. Evaluating humanitarian surveys as a potential resource for understanding mortality in Sub-Saharan Africa.

    Priority Research Areas: Population, Economic and Health Forecasting, Mortality Measurement

  • 2024. Ethan Ligon. The Effect of Old Age Pensions on Nutritional Outcomes: Evidence from the Zanzibar Universal Pension Scheme.

    Priority Research Areas: Determinants of Health, Well-Being and Longevity, Population, Economic and Health Forecasting

  • 2024. Layla Kwong. How does heat stress affect telomere length? A pilot randomized controlled trial in urban Bangladesh.

    Priority Research Areas: Determinants of Health, Well-Being and Longevity, Effects of Interventions on Population Health

  • 2024. Magali Barbieri. Improving the measurement mortality at ages 80 years and above in aging populations.

    Priority Research Areas: Mortality Measurements

  • 2023. Lisa Barcellos. Effects of Wildfire Smoke Exposure on the Epigenome and Health in a Multi-Ethnic Cohort.

    Priority Research Areas: Determinants of Health, Well-Being and Longevity, Biology, Genetics and Demography of Aging

  • 2023. Michael Walker. Unconditional cash transfers and aging: experimental evidence from Kenya.

    Priority Research Areas: Determinants of Health, Well-Being and Longevity, Cognitive Aging and the Demography of Dementia

  • 2023. Rebecca Staiger. How does chronic condition care received in Medicaid affect health utilization and outcomes in Medicare?.

    Priority Research Areas: Disability, Health Care and Long-Term Care

  • 2023. Rosemarie de la Rosa. Longitudinal analysis of childhood adversity and epigenetic aging.

    Priority Research Areas: Biology, Genetics and Demography of Aging

  • 2022. Joseph Shapiro, UC Berkeley. Drinking Water Quality, the Health of Older Americans, and Inequality.

    Priority Research Areas: Health Trends and Disparities

  • 2022. Ming Hsu, UC Berkeley. Vulnerability of Older individuals To Financial Fraud: Insights from Behavioral and Neural Evidence.

    Priority Research Areas: Cognitive Aging and the Demography of Dementia

  • 2022. Ned Augenblick, UC Berkeley. Identifying the Effects of Administrative Complexity on Healthcare Provision and Health Outcomes.

    Priority Research Areas: Disability, Health Care and Long-Term Care

  • 2022. Sarah Reynolds, UC Berkeley. Grandparent and grandchild coresidency: Prevalence and impact on grandparents'health, cognitions & well-being.

    Priority Research Areas: Determinants of Health, Well-Being and Longevity, Cognitive Aging and the Demography of Dementia

  • 2022. Shripad Tuljapurkar, Stanford. Spatial and Temporal Variation in Age at Death in the US.

    Priority Research Areas: Mortality Measurements

  • 2021. Amanda Brewster, UC Berkeley. Is Home and Community-Based Services access and quality better when providers have a greater social service focus.

    Priority Research Areas: Disability, Health Care and Long-Term Care

  • 2021. Dennis Feehan, UC Berkeley. Social network methods for estimating adult death rates in the absence of vital registration.

    Priority Research Areas: Mortality Measurements in LMIC

  • 2021. William H. Dow, UC Berkeley. Long-Term Effects of Social Insurance on Adult Mortality in Mexico.

    Priority Research Areas: Disability, Health Care and Long-Term Care

  • 2021. David Levine, UC Berkeley. Can theories of social identity and of nudges increase uptake of a vaccine against COVID-19? .

    Priority Research Areas: Effects of Interventions on Population Health

  • 2021. Magali Barbieri, UC Berkeley. The Mortality Burden of COVID-19 in the U.S. – A Case Study in Minnesota.

    Priority Research Areas: Health Trends and Disparities

  • 2021. Ben Handel, UC Berkeley. Can Tele-Medicine Increase Access and Make Health Care Delivery More Accessible? Understanding the Impact of COVID-19 on Chronic Disease Treatment and Outcomes.

    Priority Research Areas: Determinants of Health, Well-Being and Longevity, Effects of Interventions on Population Health

  • 2021. Paul Gertler, UC Berkeley. Using mHealth Technology to Improve Retention in Care and Health of Chronic Patients .

    Priority Research Areas: Disability, Health Care and Long-Term Care

  • 2020. Gretchen Donehower, UC Berkeley. Population Aging and the demand for paid and unpaid care: the US in international context.

    Dates subject to NOA

  • 2020. Jim Carey, UC Davis. Recording Lifetime Activity, sleep patterns and reproduction to assess health span and predict time-to-death in the Mediterranean fruit fly.

    At UC Davis Dates subject to NOA

  • 2020. Justin White, UC Berkeley . A Pilot Trial of Gamification for Enhancing a Smoking Cessation App.

    At UCSF Dates subject to NOA

  • 2020. Paul Gertler, UC Berkeley. How Excess Sugar Consumption Early in Life Affects Health in Adulthood.

    Dates subject to NOA

Center-Supported Publications

Center Administration/Media Contact:

Center to Accelerate Population Research in Alzheimer’s (CAPRA)

University of Michigan

CAPRA will focus on science that informs government and healthcare organization actions to address the negative impacts of dementia on the health and financial well-being of individuals and the population. The overarching goal is to serve as a national resource to enable and expand research by current and future leaders in the study of healthcare delivery, economics, and policies to reduce the burden of AD/ADRD locally, nationally, and internationally.

Research Themes
Healthcare delivery and policy impact on outcomes and quality of care; Diffusion of new technologies; Disparities in quality and access to care; Innovative applications of population data that inform allocation of resources and program development.

Newsletter & Podcast
Subscribe to CAPRA’s newsletter | Minding Memory podcast

Center Administrator/Media Contact: Jason Mann

Hopkins Economics of Alzheimer’s Disease and Services (HEADS) Center

Johns Hopkins University

The HEADS Center’s overall goal is to advance population-based science that addresses Alzheimer’s Disease and Related Dementias (ADRD) care and its economic consequences. The Center supports novel research that addresses two thematic areas: (1) Identifying and quantifying the range of ADRD care needs and related economic consequences and (2) Examining how the organization, financing, and delivery of services affects accessibility, affordability, quality, and equity of ADRD care. Within each theme, Center research emphasizes family and unpaid caregiving and disparities. The Center seeks to advance the field of ADRD economics and health services research by nurturing emerging and established investigators, developing a new remote data enclave infrastructure, disseminating new knowledge, and forging linkages with policy and practice communities.

Research Themes
Paid and unpaid caregiving; Disparities related to ADRD care and outcomes; Payment and insurance systems related to ADRD care; Delivery system and community-based solutions for those living with ADRD and their care partners; Economic burden of ADRD and ADRD care.

News Archive and Newsletter
Center News and Updates | Subscribe to HEADS Newsletter | Newsletter Archive

Pilot Projects

  • 2023. Jamie Smith, PhD & Jianhui (Frank) Xu, PhD. Home Health Utilization in Older Adults with Dementia in Traditional Medicare and Medicare Advantage.

    Home health care services has provided crucial health services for persons living with dementia (PLWD) living in the community. Prior work has demonstrated that PLWD use more intensive home health and at greater costs than persons without dementia. However much of our understanding of home health use by PLWD is in the context of traditional Medicare. Given the recent growth in Medicare Advantage and the fundamental differences in the reimbursement models, it is critical to understand how PLWD use home health care with Medicare Advantage. The purpose of this project is to explore differences in home health care use by PLWD between traditional Medicare and Medicare Advantage. This pilot will leverage linked traditional Medicare claims, Medicare Advantage encounter data, and clinician assessments in a national sample of PLWD. We will address essential literature gaps by examining details of the home health episodes (e.g. services used, length of stay) and exploring variations across different Medicare Advantage plan types. Findings will provide an important foundation for future research on the accessibility, quality, and equity of home health care for PLWD.

    Priority Research Areas: Disability, Health Care and Long-Term Care, Cognitive Aging and the Demography of Dementia

  • 2023. Jevay Grooms, PhD & John Wright, PhD. Understanding Gaps in Care and Reimbursement for Diverse Populations with Alzheimer’s Disease and Related Dementias: A Claims-Based Analysis.

    This project which will involve diverse methods to analyze claims data from FAIR Health (which holds the nation’s largest collection of private healthcare claims) and Medicare claims (subject to approval by the Centers for Medicare & Medicaid Services [CMS]), will illuminate the economic costs and differences in utilization of the range of healthcare services provided to patients with Alzheimer’s disease and related dementias (ADRD) by geographic area and a host of demographic factors, including race and ethnicity.

    By illuminating salient treatment patterns and costs among different populations, the study will result in innovative, actionable insights that can be used by stakeholders to address gaps in understanding8 regarding the extent to which and how ADRD care is delivered to and paid for among diverse populations. Through a rigorous, innovative claims-based data analysis utilizing Medicare Advantage, private claims and Medicare data to examine services, costs and comorbid conditions associated with ADRD, the study will inform a wide range of new reimbursement, care delivery and payment approaches for a variety of healthcare stakeholders (e.g., clinicians, payors, policy makers, consumers and others) at the micro and macro levels.

    Priority Research Areas: Population, Economic and Health Forecasting, Cognitive Aging and the Demography of Dementia

  • 2023. Judith Vick, MD. Examining trends in mechanical ventilation among veterans living with dementia and the role of palliative care.

    Among non-veteran persons living with dementia, the use of mechanical ventilation has doubled in recent years. This growth occurred without an increase in survival and despite evidence that surrogate decision makers of persons with advanced dementia almost universally desire comfort, rather than life prolongation, to be the patient’s goal of care. Trends in mechanical ventilation have not been studied among veterans living with dementia, despite the high prevalence of dementia among veterans over the age of 65. In addition, no study has investigated the association of palliative care use and mechanical ventilation for veterans living with dementia, though prior work has shown that use of palliative care is associated with decreased critical care resource use. In this study, we will construct a national cohort of veterans living with dementia to examine trends in mechanical ventilation and explore the association between receipt of palliative care and mechanical ventilation in this population.

    Priority Research Areas: Cognitive Aging and the Demography of Dementia, Effects of Interventions on Population Health

  • 2023. Kelly Gleason, PhD. Smart Rep: Smart Automation to REspond to Patient portal messages.

    Care partners, unpaid family or friends who partner with patients to manage care, are at the forefront of Alzheimer’s disease and related dementias care. Yet, care partners often go unidentified and unsupported by healthcare systems, which compounds the demands of Alzheimer’s disease and related dementias on patients, clinicians, and care partners. In response to this need, we will develop and test “Smart Rep”, Smart Automation to REspond to Patient portal messages, which sends messages in response to patient portal messages to both increase documentation of care partners in the electronic health record, and support care partners with content and resources relevant to their messaged concerns.

    Priority Research Areas: Cognitive Aging and the Demography of Dementia, Disability, Health Care and Long-Term Care

  • 2023. Mariana Socal, MD. Mail order versus retail pharmacy use among Medicare Part D beneficiaries with Alzheimer’s disease and related dementias.

    The Medicare program is the primary source of health care spending for the 6.5 million Americans with Alzheimer’s disease and related dementias (ADRD), accounting for 45% of all ADRD health care-related cost, or $146 billion, in 2022. Patients with ADRD require several pharmacologic treatments to maintain their health and quality of life, as well as to treat underlying comorbidities. This study will examine how the use of pharmaceutical treatments through mail order and retail pharmacies affects drug accessibility and affordability for Medicare beneficiaries with ADRD.

    Priority Research Areas: Cognitive Aging and the Demography of Dementia, Population, Economic and Health Forecasting

  • 2023. Ravi Gupta, MD. Comparison of Claims-Based Identification of Alzheimer Disease and Related Dementias Between Traditional Medicare and Medicare Advantage.

    Accurate claims-based identification of ADRD diagnoses is important for clinical care, population health management, and risk adjustment. In Medicare Advantage, capitated payments may lead to greater care coordination, chronic care management, and lower utilization of care, including for patients with ADRD. However, capitated payments also strongly incentivize MA insurers to increase coding intensity for prospective risk-adjusted payment levels. In this project, we aim to compare the accuracy of diagnostic codes in Medicare Advantage and Traditional Medicare to identify ADRD in the period between the removal and reintroduction of Medicare risk adjustment for ADRD. Our study will help to develop more accurate diagnostic coding and risk adjustment, which are essential to improving clinical care for patients with ADRD.

    Priority Research Areas: Population, Economic and Health Forecasting, Cognitive Aging and the Demography of Dementia

  • 2022. Danielle Powell, AuD, PhD. Care Partners and Support of Older Adults with Hearing Loss and Dementia.

    The purpose of this project is to understand the role of care partners in health care in the context of caring for an older adult with hearing loss and dementia. Caring for the growing number of older adults with dementia presents complex medical and communication challenges. These challenges may be compounded in the context of hearing loss where the additional burden of hearing loss among older adults with dementia may place added stressors on cognitive reserve, hinder communication further, and create additional emotional/social burdens on care partners. With this work, we aim to understand how care partners influence health management of older adults with hearing loss and/or dementia to inform future work to improve communication between older adults with dementia, care partners, and clinicians — critical for the health and social/emotional support of older adults and their care partners.

    Priority Research Areas: Cognitive Aging and the Demography of Dementia, Disability, Health Care and Long-Term Care

  • 2022. Lisa Reider, PhD. Health Care Service Utilization and Cost of Hip Fracture Care in Older Adults with Dementia.

    Hip fractures are a significant cause of morbidity and mortality in older adults and have a substantial impact on health care service utilization and cost. Each year over 300,000 older adults are hospitalized for hip fracture in the United States with an estimated annual direct cost of $17 billion dollars. Given the increase in older adults nationally, these numbers are expected to grow. The risk of hip fracture is nearly three times higher in older adults with dementia owing to higher rates of osteoporosis and a greater propensity for falls. Nearly 40% of older adults with hip fracture are cognitively impaired and are more likely to experience post-operative complications, longer lengths of hospital stay, hospital readmission and greater loss of independent function. This is a vulnerable group that require a higher treatment focus and more resources to meet their complex needs, though little is known about the incremental service utilization and cost associated with dementia for hip fracture. Therefore, we will compare health care service utilization and cost for hip fracture among older adults with versus without dementia using 20% Medicare FFS claims and will determine if dementia is predictive of higher cost independent of standard risk adjustment variables. This research has important implications for future bundled payment policy and the provision of value-based care for these individuals.

    Priority Research Areas: Cognitive Aging and the Demography of Dementia, Disability, Health Care and Long-Term Care

  • 2022. Michael Darden, PhD. An Economic Approach to Mental Health and Cognitive Ability in the Elderly.

    My research seeks to improve our understanding of the determinants of cognitive decline. I propose to use economic modeling to address two fundamental problems in this literature: dynamic selection and measurement error. Dynamic selection occurs when the composition of data changes over the age profile due to mortality. For example, dynamic selection biases the relationship between cigarette smoking and cognitive health because smokers experience excess mortality. Measurement error occurs when we use proxy measures (e.g., word recall scores) in the place of latent variables (e.g., cognitive health). Economists have developed statistical models for both dynamic selection and measurement error, but my research is the first to apply these methods to cognitive health and its determinants.

    Priority Research Areas: Cognitive Aging and the Demography of Dementia, Consequences of U.S. and Global Aging

  • 2022. Onur Altindag, PhD (Bentley University). ADRD, Family Caregiving and Children's labor supply in Denmark.

    A significant share of long-term care needs related to ADRD are met informally by family members, many of whom also work, and the increasing demand for care has potential to impede economic growth by reducing formal employment among the working-age population. A full accounting of the economic burden of ADRD must include the substantial spillovers in the form of reduced labor force participation and lost earnings of family caregivers. In this project, we will study the labor supply response to ADRD-related caregiving among adult men and women in Denmark and document the distribution of economic costs within families based on demographic characteristics. Our study will contribute to a greater understanding of the substantial, but often difficult to measure economic consequences that ADRD imposes on families and on national budgets pointing to targeted policies to mitigate these costs.

    Priority Research Areas: Disability, Health Care and Long-Term Care, Effects of Interventions on Population Health

  • 2021. Megan Shepherd-Banigan, PhD (Duke University). Use of high cost care among Veterans with comorbid mental illness and Alzheimer’s and related dementia.

    We will examine 12-month health care use patterns among Veterans 65+ with pre-existing mental illness and a new Alzheimer’s Disease and Related Dementias (ADRD) diagnosis. Specifically, we will examine the extent to which pre-existing mental illness is a risk factor for poor quality care for individuals with ADRD. The incidence of ADRD is projected to increase exponentially in the coming decades and mental illness is associated with a 2-fold higher risk for developing ADRD. Co-occurrence of ADRD and mental illness likely complicates health care delivery for this population, yet there is little understanding of the implications of this co-occurrence on service utilization patterns which drive Medicare costs. Findings from this study will provide information about the extent to which pre-existing mental illness impedes high quality care for older adults with ADRD, as evidenced by higher ED use, inpatient visits, and 30-day readmissions. This information will provide a foundation upon which to develop health system strategies that improve care coordination and quality for this understudied population.

    Priority Research Areas: Population, Economic and Health Forecasting, Cognitive Aging and the Demography of Dementia

  • 2021. Nicholas W. Papageorge, PhD. Genetic Risk for Alzheimer’s Disease and Later-Life Decisions and Outcomes: Exploring the Role of the Family and Human Capital.

    The purpose of this project is to use data on genetic propensities to develop ADRD to better understand the life course trajectories of people who may eventually develop ADRD, including their educational attainment, work life, income, financial decisions, and wealth accumulation. Of particular interest are individuals who are not diagnosed with ADRD or who do not exhibit significant cognitive decline according to standard measures (either because they lack access to medical care or, alternatively, because their condition is mild enough or their environment protective enough that cognitive decline falls under the radar). Using genetic data to better understand people who may not exhibit cognitive decline using standard measures or who are not diagnosed can help us to better understand the full extent of ADRD. Preliminary results suggest that many people with a genetic propensity for ADRD and who are not diagnosed and who do not exhibit strong cognitive decline according to standard measures still exhibit other negative outcomes (e.g., earlier retirement or less wealth) suggesting that the ways we currently diagnose or recognize illness are not sufficient to capture the full population in need of treatment. Findings will not only help us to recognize more potential patients, but may also help us to understand treatment. If some people with a genetic propensity for ADRD do not exhibit symptoms, it may be by chance, but may also be because policy-modifiable environmental factors are protective. Understanding what these factors are and why they are protecting could eventually be used to inform best treatment practices.

    Priority Research Areas: Biology, Genetics and Demography of Aging, Determinants of Health, Well-Being and Longevity

  • 2021. Stephanie Nothelle, MD. Examining Emergency Department Length of Stay for Older Adults with Dementia.

    Older adults with dementia go to the Emergency Department (ED) more frequently than older adults without dementia. The ED is a potentially overstimulating environment for older adults with dementia given the background noise, large number of unfamiliar people and interrupted opportunities for sleep. Further, the ED is associated with higher costs of care for older adults with dementia compared to those without dementia, placing financial strain on patients, families and society. Given these risks, reducing the time spent in the ED, particularly from long extremes is important for older adults with dementia. In this study we will determine if length of stay in the ED is longer for older adults with dementia and if there are any facility characteristics associated with longer lengths of stay for older adults with dementia. These results will serve as important foundational information that could be used to target ED dementia care interventions.

    Priority Research Areas: Cognitive Aging and the Demography of Dementia, Disability, Health Care and Long-Term Care

  • 2021. Varshini Varadaraj, MD. Dementia and sensory impairment: Economic consequences for patients and caregivers.

    Dementia and sensory impairment are salient features of aging that share common risk factors, and sensory impairment is itself a risk factor for cognitive decline. These commonly co-occurring conditions may be associated with impairment in financial capacity, putting older adults at risk for financial loss and fund mismanagement. In addition, caring for older adults with chronic conditions may be associated with financial difficulties among caregivers. Financial capacity is central to older adults’ independence and well-being, and their caregivers’ welfare and capacity for caregiving. Therefore, a deeper understanding of the interplay between dementia and sensory impairment and the impact of the resultant cumulative risk on financial wellbeing of older adults and their caregivers is required. This project aims to examine the economic impact (income, economic wellbeing, financial literacy) of having co-occurring dementia and sensory impairment (vision and hearing impairments) on older adults, and their family caregivers, using nationally representative data. The resulting findings will highlight gaps and opportunities for the development of supportive services and policies to help older adults with financial management.

    Priority Research Areas: Consequences of U.S. and Global Aging, Population, Economic and Health Forecasting

  • 2020. Chanee Fabius, PhD. Race Differences in Supportive Service Utilization by White and Black Caregivers of Persons with ADRD.

    The purpose of this project is to determine whether the use of supportive services varies by race for black and white caregivers of persons with Alzheimer’s Disease and Related Dementias (ADRD). Persistent health disparities experienced by Black persons living with dementia (PLWD) likely place an added demand on family and unpaid caregivers. There is limited understanding of supportive services accessed by caregivers of PLWD and how utilization may vary by caregiver and care recipient characteristics, particularly across race groups. More information is needed to address the needs of this growing population, inform the design of relevant and effective programs and practices, and increase the capacity of providers and policymakers to serve diverse groups of people impacted by ADRD. Findings from this pilot will provide important information about the current landscape of support for racially diverse ADRD caregivers and better inform strategies to help persons with ADRD and their family and unpaid caregivers.

    Priority Research Areas: Disability, Health Care and Long-Term Care, Health Trends and Disparities

  • 2020. Emmanuel Drabo, PhD. Assessing State Variability in Measures of Dementia Prevalence.

    The purpose of this pilot study is to contribute new and more robust estimates of state-level measures of Alzheimer’s Disease and Related Dementias (ADRD) prevalence and potential variability in prevalence from multiple national datasets (American Community Survey, Behavioral Risk Factor Surveillance System, National Health Interview Survey, and Medicare Claims) with both self-reported measures and diagnosed ADRD. The evidence generated by this research will directly support Drabo’s planned career development application to NIA around ADRD diagnosis and care burden. The anticipated outcome from this proposed training plan and research agenda is to contribute stronger and more robust information regarding state-level estimates of ADRD prevalence to set the stage for further work to quantify ADRD burden, and to permit dementia-related research in various rich, less restrictive, and relatively user-friendly data sources.

    Priority Research Areas: Consequences of U.S. and Global Aging

  • 2020. Hadi Kharrazi, MD. Case-identification of persons with Alzheimer's Disease and Alzheimer's Disease Related Dementia: A methods study to compare diagnoses in structured and unstructured electronic health record data.

    Alzheimer’s Disease Related Dementia (ADRD) is poorly coded in electronic health records (EHRs). To address this gap, this study aims to assess the reliability of ADRD coding in EHRs, and then compare the value of unstructured EHR data in identifying patients with ADRD. Results of this study can enhance our understanding of EHR’s data value in accurately identifying ADRD patients. Study conclusions may improve the use of EHRs to assess patient eligibility in clinical trials and denominator selection for health services research projects targeting the older adults.

    Priority Research Areas: Health Trends and Disparities, Cognitive Aging and the Demography of Dementia

  • 2020. Julia Burgdorf, PhD. Variation in Medicare Home Health Costs Associated with Patient Cognitive Impairment.

    Older adults with Alzheimer’s Disease and Related Dementias (ADRD) have uniquely challenging care needs, large comorbidity burdens, and are heavy users of health care; they comprise an estimated one-third of the patient population in Medicare-funded home health care. Current risk-adjustment models for Medicare home health reimbursement fail to account for whether a patient has ADRD. This omission has the potential to threaten access to care for this vulnerable subpopulation. Using linked survey, patient assessment, and claims data, this pilot will provide the first evidence regarding the relationship between patient cognitive impairment and costs of care during Medicare-funded home health care. Findings will offer a better understanding of the resources needed to provide skilled care at home for older adults with ADRD and may inform future revisions to the Medicare home health reimbursement model.

    Priority Research Areas: Disability, Health Care and Long-Term Care, Population, Economic and Health Forecasting

  • 2020. Lauren Hersch Nicholas, PhD. Quantifying Potentially Avoidable Financial Losses Due to Dementia .

    Dementia represents a threat to retirement security for patients and families because characteristic brain changes make it difficult to remember routine financial characteristics and alter risk perception, increasing susceptibility to fraud and exploitation. Yet little is known about the prevalence and magnitude of financial losses due to dementia and the potential unmet need for assistance with financial management among persons with Alzheimer’s Disease and Related Dementias (ADRD). With no public and/or private sector policies to protect the financial interests of persons with ADRD, there is an urgent need to understand the magnitude of the issue and develop methods to monitor incidence over time so that effective policies can be developed. This pilot project will collect new survey data to assess the prevalence and magnitude of financial losses associated with cognitive impairment and to assess the demographic characteristics of patients and families affected by these losses.

    Priority Research Areas: Consequences of U.S. and Global Aging, Population, Economic and Health Forecasting

Center-Supported Publications

Center Administrator/Media Contact: Nadia Hay

Life Course Center for the Demography and Economics of Aging (LCC)

University of Minnesota

LCC is an incubator for innovative research on the demography and economics of aging. The LCC recruits and fosters connections among researchers across disciplines; develops leading-edge collaborative pilot studies on aging contexts, trends, dynamics, and disparities; provides technical and administrative support for research development; and supports a research network to leverage large-scale population data to advance interdisciplinary scholarship on social determinants and contexts of aging and health.

Research Themes
Later life-course population trends in context; Life-course dynamics as disparity mechanisms; Interrelationships of work, family, community participation, and health.

News & Events
News & Events

Pilot Projects

  • 2023. Jiao Yu. Neighborhood Characteristics and Cognitive Health among Black and White Older Adults: The Mediation Role of Allostatic Load .

    This pilot project aims to generate preliminary data to understand how place-based chronic stressors get under the skin to produce racial disparities in cognitive impairment. One indicator of physiological dysregulation that has received increasing attention is allostatic load (AL). Guided by the “weathering” hypothesis and the stress process theory, this study will develop longitudinal measures of physiological dysregulation (AL) from the Health and Retirement Survey (HRS, 2006–2016). Through linking the HRS to the National Neighborhood Data Archive (NaNDA), it will also investigate the extent to which AL, as an indicator of physiological response to stress, explains neighborhood-driven racial disparities in later life cognitive health. The project has two aims: (1) Develop a longitudinal measure of allostatic load with a range of biomarkers and examine disparities in the allostatic load trajectories by race, gender, education, and their intersections. (2) Identify racial differences in the relationship between neighborhood characteristics (neighborhood disorder and neighborhood cohesion) and cognitive health trajectories among black and white older adults aged 65 years and older.

    Priority Research Areas: Life-Course Dynamics as Disparity Mechanisms

  • 2023. Michael Esposito and Jessica Finlay. Place-Based Determinants of Cognitive Aging Across the Life Course.

    While disparities in Alzheimer’s Disease and Alzheimer’s Disease Related Dementias (AD/ADRD) are well documented, the underlying causal process explaining how and why these inequalities arise is less clear. Evidence suggests that potentially-modifiable individual factors, such as social isolation and physical inactivity, can significantly reduce one’s dementia risk. Much less attention, however, focuses on the upstream, contextual factors that structure people’s access to these risk factors and behaviors. Neighborhood amenities that facilitate socialization, learning, healthy eating, and physical activity may slow rates of cognitive decline, while exposure to highways and polluting sites may increase risk for AD/ADRD. Drs. Finlay and Esposito developed a novel concept of Cognability to identify how neighborhood built and social environments structure opportunities and barriers for later-life cognitive health. This proposal aims to extend Cognability to identify how the accumulation of neighborhood exposures over the adult life course may modify cognitive aging trajectories.

    Priority Research Areas: Life-Course Dynamics as Disparity Mechanisms, Later Life-Course Population Trends in Context

  • 2023. Naomi Thyden. Japanese American Health by Generational Status and Exposure to Structural Racism.

    Although Asian American interest groups have worked against health disparities in their communities for decades, there are now broader calls for more data about Asian Americans, including data disaggregated by ethnicity. At the same time, structural racism has become accepted as a driving force of racial health disparities. There is a long history of discriminatory policies against Asian Americans, and specifically against Japanese Americans. Most notably, the incarceration of Japanese and Japanese Americans during World War II is a racial trauma whose health effects have been insufficiently documented. The effects of indiscriminate incarceration of Japanese residents have implications for today’s federal policies, which include ethnic-based detention centers and blurred lines between criminal and immigration law – termed “crimmigration.” Because Japanese Americans have been in the U.S. since the 1890s, their experiences can offer insights into the long-term effects of being a minoritized immigrant group in the U.S. In this project we aim to (1) understand differences in self-reported discrimination and well-being among Japanese Americans by internment status and how many generations their family lived in the U.S. and (2) investigate social, demographic, and socioeconomic characteristics of Japanese American internees before incarceration.

    Priority Research Areas: Life-Course Dynamics as Disparity Mechanisms

  • 2023. Shekinah Fashaw-Walters and Quinton Cotton. Qualitative Research to Quantify Exposures to Racism among Older Adults.

    The overall objective of this pilot project is to identify through qualitative inquiry the elements of racism across the life course that affect healthy aging and healthcare experiences for Black older adults. Black older adults have worse health outcomes and poorer access to high-quality healthcare services as compared to their white counterparts. Emerging evidence documents the role of community and social factors (i.e., racism, segregation, structural poverty) in healthy aging processes and access to healthcare. However, little is known about the specific impacts of exposure to racism over the life course on healthy aging. Our work will explore and elucidate how multiple systems and institutions of structural discrimination (including within healthcare) can lead to widened racial inequities in healthy aging. Furthermore, we will explore how factors of resistance and resilience (e.g., familial and cultural factors) moderate the impact of racism on healthy aging. We will sample Black older adults ages 50 and above in the Midwest (Minneapolis, Minnesota) and anticipate reaching data saturation with 24 participants.

    Priority Research Areas: Life-Course Dynamics as Disparity Mechanisms

  • 2022. Cindy Vang. Discrimination and Resilience on Health Across the Lifespan: A Mixed-Methods Study of Asian and Asian American Older Adults.

    This project will investigate discrimination, resilience, mental health, and cognitive health across the life course for Asian and Asian American (AAA) older adults using an exploratory sequential mixed methods approach. We will (1) characterize the levels of discrimination, resilience, cognitive health, and mental health of AAA older adults across the life course and (2) provide the context of overcoming discrimination experienced by AAA older adults across the life course.

    Priority Research Areas: Life-Course Dynamics as Disparity Mechanisms

  • 2022. Elizabeth Wrigley-Field. Infectious Disease Exposures in Early Childhood Among Contemporary Old-Age White and African American Cohorts.

    It is well established that early-life infectious disease exposures can be harmful to long-term health. These exposures changed dramatically in the United States during the first half of the twentieth century—and thus, during the critical childhood periods of the cohorts that recently reached, are now reaching, or will soon reach the ages when most deaths happen. Yet we have little systematic information about what this childhood infectious disease exposure burden actually looked like across and within birth cohorts, including its variation by race and place. This project will create a new dataset that will generate a far more comprehensive description of these infectious environments than has ever been previously available and will set up future research into the consequences of those environments for aging trajectories.

    Priority Research Areas: Later-Life Course Population Trends in Context

  • 2022. Frank Heiland. Perceived Workplace Age Discrimination and Racial/Ethnic Disparities in Cognitive Functioning among Older Workers.

    This pilot project will explore the role of perceived workplace ageism in racial/ethnic disparities in cognitive functioning among older workers approaching retirement age. We will examine the differences in cognitive performance between older workers who identify as non-Hispanic white, non-Hispanic Black, Indigenous, and (other) people of color (BIPOC) and Hispanic. Our first goal is to assess the significance, magnitude, and direction of the relationship between perceived workplace ageism and cognitive functioning among older workers. The second and related goal is to investigate whether perceived workplace ageism moderates the relationship between paid work and cognitive health in later life, for example, by increasing the risk of early withdrawal from the labor force or unemployment among older workers.

    Priority Research Areas: Interrelationships of Work, Family, Community Participation, and Health

  • 2022. Renada Goldberg. Work Precarity and the Aging Workforce: Trends in Health Disparity Among Older Service Sector Workers.

    The main objective of this study is to measure the mechanisms by which work precarity contributes to disability and negative health outcomes for older non-college-educated workers in the service sector, measuring racial-ethnic differences in the experience of work precarity. We have three aims: (1) Establish levels of work precarity based on a variety of measures, including wages, hours, work/family conflicts, period of unemployment, or access to health insurance, among older non-college workers (age 50+) in health care, retail, and food service;  (2)  Measure the degree to which the level of work precarity predicts disability and negative health outcomes over time among older non-college workers (age 50+) in health care, retail, and food service; and (3) Measure whether there are differences in levels of work precarity and disability across racial-ethnic groups of older non-college workers (age 50+) in healthcare, retail, and food service.

    Priority Research Areas: Life-Course Dynamics as Disparity Mechanisms

  • 2022. Theresa Andrasfay. Disparities in Inflammation at Older Ages: Exploring the Role of Occupation.

    The objective of this project is to determine which occupational characteristics impact inflammation at midlife and how these are implicated in socioeconomic inequality in midlife inflammation. Because inflammation is a risk factor for many health outcomes—e.g., disability, pain, chronic conditions—and is important for the overall aging process, the results will help clarify the role of work as a social determinant of health and quality of life at older ages and identify potentially modifiable occupational risk factors.

    Priority Research Areas: Interrelationships of Work, Family, Community Participation, and Health

  • 2021. Colleen Peterson. Comparing the Utility of Subjective and Objective Measures of Older Adult Health and Physical Functioning to Predict Long-Term Driving Difficulty and Driving Cessation.

    The proposed exploratory study will identify the simplest and most predictive measures of driving difficulty and driving cessation by identifying relationships between several self-reported subjective and objective physical health measures and long-term incidence of driving difficulty and driving cessation. Limited research has evaluated both objective and subjective mental and physical health indicators to predict only older adult driving cessation over shorter follow-up periods. The more long-range prediction capacity a tool for driving cessation has, the more potential it has for reducing negative older adult health outcomes by linking them earlier to interventions that might delay driving cessation (e.g., rehabilitation to reduce physical difficulties) or support its successful transition (e.g., community-based transportation resources). The proposed study will identify simple, long-range predictors of both driving difficulty and driving cessation to inform evidence-based clinical practice and research.

    Priority Research Areas: Later Life-Course Population Level Trends in Context

  • 2021. Hannah Neprash. Primary Care Exam Length and Potentially Inappropriate Prescribing among Older Adults.

    This project will use a database of national electronic health record (EHR) data from athenahealth, Inc., a large health information technology company, to test for a relationship between exam length and PIP. This database contains detailed information on more than 40 million primary care visits for adults aged 65 and older, including exam length and medications ordered by the clinician during each visit. To quantify exam length, we will use methods developed and deployed by study team members. To define and quantify PIP, we will rely on the 2019 American Geriatric Society Beers Criteria for potentially inappropriate medication use in older adults. This proposed work will contribute much-needed evidence on possible age-related disparities in time use in the form of interaction times between older Americans and their physicians and how that relates to the quality of care that older adults receive. Time use studies typically focus on paid work or family relationships, not community relationships, and yet time spent in medical care is arguably key to healthy aging. We will also promote understanding about how race and gender in combination with being over 65 shape exam times and their health impacts.

    Priority Research Areas: Interrelationships of Work, Family, Community Participation, and Health

  • 2021. Janette Dill. Measuring the supply and turnover of direct care workers in long-term services and supports (LTSS) in the care of adults with AD/ADRD.

    The long-term goals of this project are to assess the supply of the LTSS direct care workforce needed to support the growing demand for AD/ADRD care and to measure the extent to which compensation and resource-related constraints contribute to high turnover and instability in the LTSS direct care workforce. This pilot study will conduct preliminary analyses toward these goals, leading to a rigorous study that will use robust, nationally-representative datasets to measure the supply of the LTSS direct care workforce relative to the AD/ADRD population in local labor markets, identifying areas with relative shortages of this critical workforce. This will be the first study to provide crucial national and regional rates of employer and industry turnover among LTSS direct care workers, including turnover rates across LTSS sectors.

  • 2021. Tom VanHuevelen and Jane VanHuevelen. Intergenerational Health Socialization in Rural America.

    The goal of the proposed study is to investigate health socialization occurring within families that impacts health knowledge, beliefs, and behaviors throughout the life course. We focus on health socialization between retirement aged residents between 65 and 90 of rural areas and their adult children. We seek to identify key factors in the socialization process that influence adoption of health promoting behaviors among retirement-aged rural residents. Because health socialization is necessarily relational, we propose a data collection process that will capture the interconnected nature of health behavior and health socialization.

    Priority Research Areas: Life-Course Dynamics as Disparity Mechanisms and Later-Life Course Population Trends in Context

  • 2021. Wei Duan-Porter. Racial and Ethnic Disparities in Risk for Cognitive Decline and Dementia among Veterans with PTSD.

    Our long-term goal is to address the negative effects of PTSD on cognitive functioning over the life-course, focusing on racial and ethnic minorities. We will meet this objective by building on our prior work with a national cohort of racially and ethnically diverse veterans in VA care who had PTSD and no diagnosis of dementia in 2009 (n=7645). The proposed pilot work will identify surviving respondents and evaluate potentially higher mortality among minority (vs. White) participants. We will update VA data on medical conditions, health care utilization, and participants’ addresses. To examine community-level markers of socioeconomic disadvantage, we will link publicly available Census data on several key measures (e.g., proportion unemployed and proportion of households below the poverty line) using participants’ home zip codes. We will also evaluate the feasibility of recruiting minority participants for cognitive assessments by telephone (using the modified Telephone Interview for Cognitive Status [TICS-M] and telephone-modified Mini-Mental Status Exam [T-3MS]).

    Priority Research Areas: Life-Course Dynamics as Disparity Mechanisms

  • 2020. Carrie Henning-Smith and Julia Drew. Rural-Urban Differences In 5-Year Mortality Among Older Adults In The United States: The Role Of Socio-Demographic And Health Characteristics, Living Arrangements, And Spousal Mortality.

    This project will investigate rural-urban differences in five-year mortality among older adults and variation in mortality risk by individual socio-demographic and health characteristics, living arrangements, and spousal mortality. This demographic research will produce new knowledge about the large number of older adults living in rural areas and deepen our understanding of mortality risks in urban versus rural areas.

    Priority Research Areas: Determinants of Health, Well-Being and Longevity, Later life-course population trends in context

  • 2020. Evan Roberts and Anna Prizment. Do Grandparents Moderate The Association Between Early Life Conditions and Health At Older Ages?.

    Grandparents can be a crucial source of material and social assistance to families and make a significant difference to early-life environments. Because early-life social environments and experiences have an important impact on the life course and aging trajectories, the availability and role of grandparents potentially shapes the aging pattern of subsequent generations. We will expand understanding of how grandparents influence the aging and mortality of their grandchildren by creating a dataset of women observed in childhood in the 1920s, for whom we can objectively measure the presence, proximity, and socio-economic status of grandparents and track health and mortality in recent years. Using these data, we will examine whether the proximity and resources of grandparents during childhood moderates the association between early-life social and economic conditions, and health outcomes at older ages.

    Priority Research Areas: Determinants of Health, Well-Being and Longevity, Later life- course population trends in context

  • 2020. Lynn Blewett. The Budgetary Impact Of Assisted Living Availability On State Medicaid Spending On LTSS.

    This project will document and evaluate Medicaid financing of assisted living services in Minnesota. We have three aims: (1) conduct a preliminary scan of state Medicaid financial support for care in Assisted Facilities; (2) operationalize an assisted living support variable to include in our Minnesota LTSS Projection Model; and (3) provide baseline data on Medicaid coverage of home care services in assisted living facilities. We will develop an initial financial projection model that assesses the impact of the availability of Assisted Living facilities on use and costs of Medicaid spending on LTSS. The model will include both supply information on number and type of Assisted Living, Nursing Facilities, and waivered services as well as demand based on current projections of Minnesota’s aging population and need for LTSS currently available in Minnesota’s LTSS Projection Model.

  • 2020. Rachel Hardeman and Samuel L. Myers, Jr. The Paradox of Racial Disparities in Alzheimer’s Disease.

    This research seeks to resolve a paradox that drives misunderstandings of the impact of Alzheimer’s on African American and white populations. Although research on the diagnosis of Alzheimer’s and other forms of dementia indicates a much higher incidence among African Americans than whites, mortality rates indicate the opposite. The proposed pilot study tests two competing hypotheses for the divergence in the racial gaps in the recorded diagnoses of Alzheimer’s disease and related disorders vs official mortality statistics. The first hypothesis is that there is a pattern of misdiagnosis of African American patients with cognitive deficits possibly due to lower quality medical care or lack of access to expensive modern screening technologies that minimize misdiagnoses. The second hypothesis is that there is a statistical anomaly arising from the fact that relatively few deaths result in autopsies, the definitive assessment of the presence of Alzheimer’s disease.

  • 2020. Sarah Flood, Jesse Berman, Kathryn Grace, and David Van Riper. The Impacts of Extreme Weather on Older Adults’ Time Use.

    This project seeks to understand how older adults’ daily lives are affected by extreme weather and to explore demographic variation in the impact of such events. This project promises to advance our understanding of the effects of different types of extreme weather on daily lived experiences and well-being and speaks directly to NIA’s current “heightened interest in research to understand how extreme weather and disaster events impact older adults” (NIH PAR-19-250). Using novel data linkage, the research team will provide a population-based understanding of older adults’ time allocation and well-being on days when they experience extreme weather events.

Center Administrator/Media Contact: Lesley Schmidt

Michigan Center on the Demography of Aging (MiCDA)

University of Michigan

MiCDA is an interdisciplinary community of scholars from across the University of Michigan with a shared interest in the demography of aging. MiCDA affiliates pioneer the collection of innovative data for study of the demography of aging and lead major surveys on aging. MiCDA affiliates are accelerating understanding of the changing demography of late-life disability and dementia and family caregiving and identifying factors over the life course that shape disparities in health and wellbeing in later life. MiCDA’s activities promote pilot research and bring networks of researchers together to form new collaborations; provide junior faculty with career development opportunities; and make available to researchers data that require secure handling..

Research Themes
Biology, genetics and demography of aging; Cognitive aging and the demography of dementia; Determinants of health, well-being and longevity; Disability, health care and long-term care; Health trends and disparities; Health and well-being in later life; Aging, genetics and social science; Survey measurement and methods; Family caregiving to older adults.


News and Events
MiCDA Updates

Pilot Projects

  • 2023. Crystal Yee To Ng. The Role of Friends in the Lives of Dementia Caregivers: Implications for Daily Cardiovascular Health.

    This study aims to examine the role of friends in the daily experiences of African American (AA) and European American (EA) ADRD caregivers. This pilot study uses data from the Stress and Well-Being in the Everyday Lives of Caregivers study (SWELCare), a study of AA and EA men and women who are primary caregivers and co-reside with their family member or friend who is living with ADRD.2

  • 2023. Jennifer Ailshire. Colombian Survey of Aging (COSA) Biomarker Pilot.

  • 2023. Jessica Faul. Understanding the Speed of Aging Among Adults with Cerebral Palsy.

  • 2023. Kate Duchowny. The Relationship Between Neighborhoods, Muscle Strength and Physical Disability in the National Health & Aging Trends Study (NHATS).

  • 2022. Helen Meier. Immune Aging Phenotypes and COVID-19 Risk in the Health and Retirement Study.

    The goal of this pilot project is to determine if pre-pandemic features of immune aging (i.e., age associated T-cell subsets, inflammation, and epigenetic age) are associated with COVID-19 infection and disease severity.  The pilot draws upon data from the Health and Retirement Study, a nationally representative longitudinal study of adults over 55 years.

    Priority Research Areas: Biology, Genetics and Demography of Aging

  • 2022. Iliya Gutin, University of Texas at Austin. Life Expectancy Trends among U.S. States and Peer Countries, 1980-2020: Estimating the Impact of the 2020 COVID-19 Pandemic on Widening Differences.

    This project uses restricted access state-level vital statistics data from the National Center for Health Statistics as well as national-level data for 18 high-income peer countries in the Human Mortality Database to help point to similarities in key structural advantages and social policies shared by specific states and peer countries that allowed for the COVID-19 pandemic to be managed more effectively and mitigated avoidable deaths at all ages.

    Priority Research Areas: Health Trends and Disparities

  • 2022. Theresa Andrasfay, University of Southern California. Impact of the COVID-19 Pandemic on Physical Functioning, Disability, and Associated Risk Factors among Older Adults in the United States.

    This project assesses the early impact of the COVID-19 pandemic on population-level trends in mobility and ADL limitations and their risk factors among older adults in the United States. Analyses draw upon four nationally representative data sources: the Health and Retirement Study, the National Health Interview Survey, the National Health and Aging Trends Study and the Understanding America Study.

  • 2021. Joelle Abramowitz. Effects of California’s Paid Family Leave on Work and Caregiving of Older Adults.

    Paid family leave laws have the potential to alter older adults’ allocation of time spent in work and caregiving, which can in turn affect their own physical, emotional, and financial wellbeing. In 2004, California became the first state to require that employers provide paid family leave to their employees.  Using data from the Health and Retirement Study, this pilot project examines changes in older adults’ time spent in work and caregiving before and after California’s 2004 paid family leave law.

  • 2021. Joshua Ehrlich. The Synergistic Impact of Late Life Vision Impairment and Genetic Risk on Cognitive Decline and Dementia.

    This pilot study will test the central hypothesis that vision impairments is a “second hit” that potentiates the risk of cognitive decline and dementia among those that carry the APOE ε4 allele. This hypothesis will be tested using data from the nationally-representative Health and Retirement Study and its sub-study, the Aging, Demographics and Memory Study.

  • 2021. Sarah E. Patterson. When Family Care Isn’t Available: Examining Unmet Care Needs of Kinless, Distanced, and Disconnected Older Adults.

    This pilot project will examine unmet care needs across time and related well-being outcomes for older adults among three at-risk groups  – the kinless (no partner or children), the distanced (no partner or children nearby), and the disconnected (partner and children are disengaged).  Analyses will draw upon the 2015-2019 National Health and Aging Trends Study, a panel study of Medicare beneficiaries ages 65 and older.

  • 2021. Yulya Truskinovsky, Wayne State University. The Lasting Impacts of COVID-19 on Long-Term Care Expectations and Outcomes for High-Need Older Adults.

    Documenting changes related to the pandemic in long-term services and supports and family care is crucial in understanding the immediate impact of COVID-19 on vulnerable older adults and for establishing a nationally representative baseline to study longer-run effects.  This pilot project will use data from the Health and Retirement Study to examine the effect of the COVID-19 on long-term services and supports and care decisions among older adults who need help with at least two activities of daily living (ADLs) or with probable dementia (high need older adults).

  • 2021. Mengyao Hu. Dementia Diagnosis Classification Using Deep Learning Neural Networks Based on Clock Drawing Test (CDT) and Medicare claims.

    This pilot study will develop advanced deep learning neural networks to analyze Clock-Drawing Test images to predict dementia diagnosis. The pilot will draw upon Medicare claims linked with a large, publicly available repository of clock images from the 2011-2019 National Health and Aging Trends Study, a panel study of Medicare beneficiaries ages 65 and older.

  • 2020. Hwajung Choi. Care Allocation among Adult Children of Older People with Dementia.

    Adult children often take on central roles in caring for aging parents-especially when a parent develops dementia. How families allocate care among adult children, how this allocation changes over the course of dementia, and implications for the course of the disease remain largely unexplored. Using nearly 20 years of data from the Health and Retirement Study, the proposed pilot project will explore new measures of care allocation among adult children in families in which a parent has dementia.

  • 2020. Jessica Faul, Colter Mitchell. The Effects of Collection Procedures on DNA Methylation Measurement in Population-based Surveys of Aging.

    Epigenetics—the study of gene modifications that do not involve changes to the nucleotide sequence—holds great promise as a potential indicator of molecular change from contextual effects and aging and consequently an early signal of health disparities. Over the last few years aging studies have assayed thousands of genetic samples at great expense. However, despite evidence suggesting sensitivity of epigenetics assays to external stimuli, no research has explored the effects of collection and storage conditions on epigenetic data. This pilot project extends prior work on DNA quality and genomic assay stability to include DNA methylation—the most widely used (and most stable) measure of epigenetics in aging studies.

  • 2020. Lindsay Kobayashi. Investigating Cross-National Variation in Later-Life Cognitive Health Inequalities.

    By 2050, nearly 70% of global dementia cases are projected to occur in lower- and middle-income countries (LMICs). There is an urgent need to build up scientific evidence and resources to understand the etiology of cognitive aging outcomes in LMICs. A first step is to understand the measurement properties of various cognitive tests administered in these countries. This pilot project will use new data from five internationally harmonized longitudinal studies of aging using the Harmonized Cognitive Assessment Protocol (HCAP), including three LMICs and two high-income countries. Psychometric methods will be used to equate cognitive test item scores across countries so that cross-national comparisons may proceed.

  • 2020. Yajuan Si, David S. Johnson. Confidentiality and Privacy Protection after Record Linkage: Laying the Groundwork for Synthetic Record Linkage.

    Augmenting surveys with information about the places sample members have lived can enhance the value of survey data. Restricted enclaves with remote access are valuable for sharing such data, yet barriers to use outside such environments remain because of confidentiality and privacy concerns. The Census Bureau has recently taken steps to create synthetic versions of some of its data products, but the robustness of such data to answer questions not explicitly considered by the synthetic data generation technique has been questioned. Using the Panel Study of Income Dynamics, this pilot project will develop and evaluate procedures to create survey data linked with synthetic geographic data designed to address confidential and privacy as well as analytic concerns.

Center-Supported Publications

Center Administrator / Media Contact: Jana Deatrick

NBER Center for Aging and Health Research

The mission of the NBER Center for Aging and Health Research is to develop, coordinate and advance research by economists on health and aging issues. Center research is conducted through research networks and pilot projects on high-priority themes including those listed here.

Research Themes
Economics of COVID-19; Health Trends and Inequalities; Applications of Machine Learning in Health Care; Economics of Alzheimer’s Disease and Related Dementias; Emerging Challenges in Long-Term Care in the U.S. and Around the World; Dynamics of the Health Care Ecosystem.

Media mentions

Pilot Projects

  • 2022. Amitabh Chandra. How Do Informed Consumers Consume Healthcare? Evidence From Medicare.

    Patients are generally far less knowledgeable about medical conditions, services, and treatment options than their healthcare providers. This project considers how that information asymmetry influences care by comparing the healthcare used by Medicare patients who formerly worked as medical professionals (doctors and nurses) to the healthcare used by socioeconomically similar Medicare patients who did not work in medical professions (lawyers). We will consider differences in the use of many specific healthcare services, such as emergency visits, hospital care, chemotherapy, drug adherence, palliative care, diagnostic testing, and opioid use. We will also compare other aspects of care, such as provider choice (e.g., hospital quality, specialist use, travel time), and Medicare Advantage and Part D plan choice. The study will be the most comprehensive assessment to date of the role of patient expertise, or lack thereof, in healthcare decision making in the United States.

  • 2022. David C. Chan. Beliefs, Self-Interest, and Altruism in COVID-19 Vaccination.

    This project explores the determinants of vaccine take-up among veterans in the United States. Using a combination of observational data, survey data, and informational treatments, we aim to disentangle the economic roots of vaccine hesitancy into self-interested concerns about the benefits and risks of vaccination, altruistic concerns about protecting others, and beliefs that social networks and politics may influence. A new survey will elicit information on political beliefs, social networks and responses to hypothetical benefits and risks of a vaccine. In addition to analyzing the survey data independently, we will explore potential linkages between these data and the VA Corporate Data Warehouse, which contains a wealth of information on veterans’ health care utilization, diagnoses, and health outcomes. We will also explore spillovers of beliefs about COVID-19 vaccination onto beliefs and behavior related to flu vaccination.

  • 2022. Engy Ziedan. Drivers of Racial Segregation in Physician Services: Implications for Health Outcomes Equity.

    This project examines whether segregation by patient race and other demographics occurs in the context of primary care; and then considers the implications of segregation for disparities in health care use and outcomes. It documents the allocation of Medicare beneficiaries and other patients by race across primary care providers and, if we find racial segregation exists, we will explore contributory factors. We will determine the extent to which the delivery of physician services is racially segregated, and whether the degree of segregation has changed over time. We will identify the extent to which racial segregation varies across geographic areas and explore the drivers of those geographic differences. We will then evaluate whether racial segregation in the delivery of primary care is driven by the geographic location of physician practices and patient residences; or whether patient selection across providers, conditional on geographic location, contributes to racial segregation.

  • 2022. Gopi Shah Goda. The Impacts of COVID-19 Illnesses on U.S. Workers.

    This project investigates whether the post-acute sequelae of COVID-19, colloquially referred to as “long COVID” and involving lingering symptoms from COVID-19 illness, has meaningfully depressed labor force participation. To overcome the limited data on long COVID, we construct an indicator of COVID-19 illness, based on the 60 percent increase in work absences due to illness since the start of the pandemic, and the high correlation between illness-related absences and reported cases of COVID-19. Because respondents in the monthly CPS are surveyed on a rotating basis over the course of 16 months, it is possible to follow individuals with illness-related work absences over a period of approximately one year, allowing for a longitudinal analysis of short- and medium-term consequences of suspected COVID-19 illness on labor market outcomes. We aim to quantify the causal link between illness-related work absences and labor market/disability outcomes using an event-study approach that estimates within-person changes in labor market behavior in the periods prior to and following absence.

    Priority Research Areas: The Economics of COVID-19

  • 2021. Jonathan Gruber. Assessing the Impact of The False Claims Act on Healthcare Delivery.

    The US federal government prosecute most health care fraud and abuse cases under a privatized whistleblowing law called the False Claims Act (FCA). Under the FCA, individuals who have private information about misreporting or overbilling to the Medicare program can sue providers directly in federal civil court. The Department of Justice participates in many successful cases, but whistleblowers can also pursue cases on their own. Since the 1986 enactment of the FCA, the FCA has produced over 7,000 healthcare whistleblower lawsuits, from which the government has recovered more than $32 Billion.
    A number of FCA cases have targeted hospices for admitting ineligible patients. Medicare covers hospice for patients with a life expectancy less than 6 months. In 2018, the hospice program served more than 1.5 million Medicare beneficiaries, including more than half of all decedents, spending $19.2 billion. Whistleblowers and the Department of Justice have pursued cases against many for-profit hospice chains for admitting patients who are not terminally ill, including many Alzheimer’s and dementia patients. They charge that administrators pressured clinicians to admit patients and punished or fired those who refused. Long-stay patients may be particularly profitable because they require less ongoing care.
    The objectives of our analysis are to 1) estimate differences in admission patterns between defendant hospices and controls and 2) estimate the impact of hospice admission for the marginal patient on life expectancy and Medicare spending. We will identify estimates based on Medicare beneficiaries’ geographical proximity to a defendant hospice and hospices’ proximity to an annual cap on reimbursements, which is determined in-part by random variation in the length of stays of previously admitted patients.

  • 2021. Kate Bundorf. Health Care System Transformation and COVID-19: The Case of Medically Complex Older Adults.

    This proposed pilot project is part of a broader research agenda examining how the movement toward value-based care in North Carolina impacts low-income, disabled, middle-aged adults (45-64) covered by Medicaid. North Carolina currently has a small number of innovative care models that were implemented through Medicaid waivers with the goal of delivering more patient-centered, coordinated care for this population. In addition, the State is on the cusp of transitioning its Medicaid population to mandatory managed care in July of 2021. Our project will have two aims based on this policy environment, positioning our team for a larger grant.

    Aim 1: To determine the extent to which non-COVID-related care changed during the COVID-19 pandemic for community-based, low-income adults with Medicaid in North Carolina and the implications for health outcomes.

    Aim 2: To evaluate the feasibility of a future study of the effects of the mandatory transition of non-dual Medicaid enrollees to MMC in North Carolina on health care costs, use and outcomes.

  • 2021. Nicholas W. Papageorge. Genes, Alzheimer’s Disease and Related Dementias (ADRD) and Economic Outcomes.

    Recent advances in behavioral genetics have led to the discovery of specific genetic variants that predict complex health outcomes, such as Alzheimer’s disease (AD) (Lambert et al, 2013; Kunkle et al, 2019). We aim to study associations between these variants, summarized as a linear index known as a polygenic score, and economic outcomes. Loosely, a higher polygenic score for AD (henceforth: the AD score) means an individual possesses more of the genetic variants associated with AD. We will also study one particular marker – APOE ε4 – separately given its substantial established links to AD. To examine relationships between genetic measures and individual outcomes, we will use data from the Health and Retirement Study (HRS), which follows a nationally representative sample of U.S. adults above age 50. The data include detailed health and economic variables for older Americans. Moreover, a large portion of the sample has been genotyped, which means the AD score and other genetic measures can be computed for thousands of individuals and paired with detailed lifecycle health and economic information. The overarching goal of the proposed research is to understand how a genetic predisposition for AD affects lifecycle behavior and outcomes; through which particular channels this occurs; and, ultimately, what policies or measures could mitigate the potential detrimental effects of a genetic predisposition for AD. Our study has three specific aims.
    • We will estimate descriptive relationships between our genetic measures for AD, the development of Alzheimer’s disease and related dementias (ADRD), and economic behavior and outcomes, including employment, labor income, retirement age and wealth accumulation.
    • We will explore mechanisms that explain any empirical associations between genetic variants related to AD and economic outcomes. For example, we find a negative relationship between genetic variants for AD and wealth at retirement. Additional analyses can help determine whether this relationship is due to medical expenditures, poor financial and investment decisions, or other factors.
    • We will provide initial evidence on whether policies or institutional features, such as defined benefit pension (DB) schemes or default long-term care insurance (LTCI) provision, could potentially counteract negative consequences of genetic variants related to AD.

  • 2021. Yu-Chu Shen, Renee Y. Hsia. Does the Expansion of Hospitals with Percutaneous Coronary Intervention (PCI) Capacity have Differential Effects on Procedure Volume and Outcomes for Heart Attack Patients in Advantaged and Disadvantaged Communities?.

    Using all-payer patient discharge data from California between 2006 and 2019, we propose to look at the following:
    • Has the probability of being treated at low PCI-volume hospitals changed over time differentially between hospitals serving disadvantaged and advantaged communities?
    • Have disparities in treatment and health outcomes between those treated in low-volume and high-volume PCI hospitals grown over time?
    • Does the extent of disparities in treatment and health outcomes between those treated in low-volume and high-volume PCI depend on whether the patients are in disadvantaged or advantaged communities?

  • 2021. Yu-Chu Shen, Renee Hsia. Access Disparities in the Adoption of Stroke Treatment Technology.

    This pilot project explores geographic variations in the adoption of stroke treatment technology across hospitals,
    and the extent to which more rapid adoption in some hospitals may exacerbate health disparities between
    advantaged and disadvantaged communities. The study focuses on the dissemination of advanced stroke
    treatment capabilities across hospitals between 2008 and 2019; and how race, ethnicity, income, population
    density, and geography relate to a patient’s access to different levels of care.

    Priority Research Areas: Health Trends and Disparities

  • 2020. Kosali Simon. Public Reporting of NH Antipsychotic Use: Changes in the Reporting of Exclusionary Diagnoses?.

    In this proposed pilot study, we aim to examine the use of exclusionary diagnoses around the 20-resident threshold for the long-stay APM quality measure to understand whether NHs have been gaming CMS’ public reporting system for APMs. The ultimate goal is to collect preliminary data in order to write a larger NIH funded grant proposal that will include Medicare/Medicaid claims data that document diagnoses outside of the NH (e.g.
    physicians and hospitals) and to study the issue of gaming for other quality measures reported on NH Compare. We hope to next link both the intended and unintended effects of this policy on APM access to the health outcomes of NH residents, to better understand how these policies affect health at later life.

    Priority Research Areas: The Dynamics of the Health Care Ecosystem

  • 2020. Mireille Jacobson, Julie Zissimopoulos. The Role of Medicare's Annual Wellness Visit in the Assessment of Cognitive Health.

    Dementia and mild cognitive impairment (MCI) are widely considered under-diagnosed, with some estimates suggesting that between 15 and 40% of dementia cases and an even higher share of MCI cases are undiagnosed (Taylor et al., 2009; Amjad et al., 2018). Clinical diagnosis often occurs late in the disease trajectory, hindering timely treatment of reversible causes of memory loss. Late diagnosis also complicates a patient’s need to
    develop clear and consistent medical, legal, and financial plans.
    Medicare payment policy for the routine assessment of cognitive impairment in the primary care setting is a potentially potent tool to improve early detection. As part of a new benefit created under the Affordable Care Act (ACA), Medicare now covers an Annual Wellness Visit (AWV) that requires, among other things, an assessment to detect cognitive impairment. Providers are given little guidance on how to do this assessment beyond “direct observation” and, if appropriate, a “brief validated structured cognitive assessment.”1 This assessment is just one of many required components of the AWV, which should include a health risk assessment, an enumeration of current providers and medications, a depression screening, more routine height and weight measurement,
    and so on. Importantly, providers bill Medicare for the visit as a whole and are not required to submit documentation of specific details of the visit.
    Perhaps not surprisingly, anecdotal evidence suggests that many physicians do not follow the AWV structure. Providers are more inclined to discuss issues such as the management of high blood pressure or vaccinations at the expense of screening for memory loss or depression.2 In addition, most providers, who are reimbursed on a fee-for-service basis and thus get paid irrespective of outcomes, do not face strong incentives to ensure followup
    testing is performed if a cognitive test reveals memory deficits.
    A few recent studies have analyzed take-up of the AWV benefit (Ganguli et al. 2017), its relationship to use of preventive services and depression screening (Jensen et al. 2015; Pfoh et al. 2015), and its correlation with measures of cognitive care (Fowler et al. 2018; 2019 Alzheimer’s Disease Facts and Figures Special Report on Detection in the Primary Care Setting). Yet, our understanding of whether the AWV has increased assessment for cognitive impairment in the Medicare population; how assessments get done; and what happens if someone shows signs of impaired cognition is extraordinarily limited. The proposed pilot will seed a broader project to fill in the gaps in our understanding of the AWV and the required cognitive assessment component of this visit. The specific aims of the broad project are to:
    • Aim 1: Characterize who gets a cognitive assessment in Medicare during an AWV
    • Aim 2: Determine why some beneficiaries get screened while others do not
    • Aim 3: Describe health care service use after a beneficiary screens positive for cognitive impairment
    • Aim 4: Develop and test a nudge to improve take-up and/or targeting of cognitive assessments to appropriate demographic groups

    Priority Research Areas: Cognitive Aging and the Demography of Dementia

  • 2020. William Evans. Evaluating the Ability of a Senior Companion Program to Improve Senior Health.

    This proposal is for a planning grant for a randomized controlled trial that evaluates the effect on health of senior companion services. This study will be a collaboration between researchers at the Wilson Sheehan Lab for Economic Opportunities (LEO) at the University of Notre Dame and a partnering social service agency. The project development team will vet providers interested in conducting a rigorous evaluation and form a research
    partnership with the organization best fit for such an evaluation. The search for potential organizations will be conducted by LEO with the assistance of our partner organizations. LEO coordinates with local social service agencies to conduct random assignment experiments of their innovative programs designed to assist those in poverty. LEO has partnered with three national networks (Catholic Charities USA, Lutheran Services of America and Goodwill Industries) and we plan to work with these organization to help vet potential partners. Organizations will be considered fit to participate in research if they meet the following three criteria. First, the partner must currently operate a large and active SCP geared toward low-SES individuals. Second, the organization’s SCP must exhibit an excess demand for services. This can be gauged by the length of the program’s current waitlist.
    Finally, the organization must be willing to use a lottery to allocate SCP services in place of a waitlist. In our experience, partnering with an organization that meets these three criteria will ensure a successful rigorous study. During this planning stage, our research team will also design and program two surveys that will be used during the full evaluation. The first is the intake survey that will be used during the enrollment process and the
    second is the follow-up survey that will accompany the evaluation.
    The ultimate objective of this project is to provide precise estimates of the impact of SCP programs on seniors’ health status and independent living. For the purposes of this study, independent living and health status will be measured using both self-reported surveys and administrative data on emergency department and in-patient admissions. The randomized controlled trial (RCT) that will provide senior companions to a sample of around 200 predominantly low-SES homebound seniors. An additional 200 seniors will comprise the control group. This study pool will be recruited from the partnering organization’s current waitlist. Following informed consent protocols appropriate to the study, clients choosing to participate will enter a lottery to determine their placement in the treatment versus control group. which will determine if they will receive a study senior companion. Ideally,
    the partnering organization would currently operate a lengthy wait list (e.g., a two-year wait to enter the program); this way, clients selected to the control group can expect a waiting period as long as clients who choose not to participate in the study. LEO has extensive experience working with social service providers. They have 30 active/completed projects in 25 different locations across the country. Their service partners have included social service organizations, county and city governments, and juvenile justice centers.

    Priority Research Areas: Determinants of Health, Well-Being and Longevity

  • 2020. Janet Currie. New Modes of Health Care Delivery—Effects on Patients and Providers.

    We live in an era of rapid changes in the structures and mechanisms of health care delivery. One striking change has been the development of new types of outpatient facilities including retail clinics, urgent care centers, and ambulatory surgical centers. We aim to examine the impact of these non-traditional care settings on the on the utilization of care and on patient outcomes among the elderly. These new care settings may serve as substitutes or complements for care provided in more traditional settings, such as emergency, inpatient, and primary care office settings. They may therefore provide an opportunity to reduce cost and improve access to care. However, they may also make it more likely that a patient seeks care in a setting that is not optimal for their condition,
    which could lead to higher costs and worse outcomes. We will use individual medical histories from longitudinal Medicare claims data to account for underlying differences in patient health status, and we will exploit variation in the closing and opening of facilities in order to study the way that patients are selected into different modes of care, substitution patterns across modes, and impacts on patient outcomes.
    A second related objective will be to study the impact of new modes of medical care delivery on traditional providers. At the facility level, does increased competition from new providers change merger and acquisition patterns or the types of services offered? At the individual physician level, can we see impacts in terms of where they practice, or the quality of medical decision making? Because it has data on patients, physicians, and facility
    type, the Medicare claims data is well suited for this type of analysis. The project should shed light not only on the specific issue of how new care modes help or harm Medicare patients, but also on the more general question of whether increasing competition in a setting that is still far from perfectly competitive improves welfare.

    Priority Research Areas: The Dynamics of the Health Care Ecosystem

Center-Supported Publications

Center Administrator/Media Contact: Janet Stein and Khansa Mahum

Population Aging Research Center (PARC)

University of Pennsylvania

PARC supports highly interdisciplinary research on aging by funding pilot projects, hosting a weekly seminar series and a working paper series, and maintaining a secure data enclave for access to sensitive aging-related data. Research associates conduct research on population and individual processes in the areas of aging, including the determinants and effects of population composition and processes. They are also involved in large data collection projects in the U.S. and abroad.

Research Themes
Health disparities in aging; Early life conditions and older adult health; Behavior and well-being; global aging and health; Health care and long-term care in older adults; Cognition and Alzheimer’s Disease and Related Dementia (ADRD); COVID-19 & Aging.

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Pilot Projects

  • 2023. A. Hamedani. Identifying visual impairment in older adults using administrative claims data.

    Visual impairment is common in older adults and is associated with negative outcomes such as falls,
    depression, anxiety, and cognitive impairment. Because half of all vision loss in the U.S. is
    preventable or treatable, identifying the burden and consequences of age-related visual impairment
    can lead to interventions to promote access to eye care and improve population health.
    Administrative claims data (e.g. Medicare) are an important tool in public health research and have
    been used to study disease prevalence, healthcare utilization, costs, effectiveness, and outcomes
    across many areas of medicine. However, their application to the study of visual impairment and eye
    disease has been limited by the fact that the most important clinical outcomes in ophthalmology
    (namely, visual acuity and vision-related quality of life) are not captured in administrative claims data.
    In this study, we will link Medicare claims data with questionnaire and examination data from the
    National Health and Nutrition Examination Survey (NHANES) to develop and validate a novel visual
    impairment comorbidity index to predict age-related visual impairment using Medicare diagnosis and
    procedure codes. This tool will facilitate a new generation of population-based research on the
    prevalence and health effects of age-related visual impairment using administrative claims datasets.

    Priority Research Areas: Health Trends and Disparities

  • 2023. C. Ma. Understanding the Dynamic Process of Older Adult Behavior Changes for Disaster Preparedness: An Application of the Integrated Transtheoretical Model with Social Cognitive Theory and Protection Motivation Theory.

    Conceptualized as a dynamic process of individual health protective mechanism, disaster
    preparedness is defined as individual behavior changes in this study, from “not prepared” (NP) stage
    to “having an intention to prepare” (IP) stage, and ultimately to “already prepared” (AP) stage.
    Although older adults are much more vulnerable to the health effects of disasters than their middle
    age and young adult counterparts, the extent to which behavioral transitions from one stage to
    another differ across the two groups has not been explored. Integrating the Transtheoretical Model
    (TTM) with Social Cognitive Theory (SCT) and Protection Motivation Theory (PMT), we propose a
    new model to examine a series of specific reasons behind behavior changes for disaster
    preparedness. Using 2022 National Household Survey data (FEMA, 2022), this U.S. population study
    will address the following questions.
    1. Are there disparities in behavior changes for disaster preparedness between older adults and
    non-older adults?
    2. If so, to what extent are these disparities accounted for by income differences between the two
    3. To what extent does personal disaster experience, preparedness awareness, self-efficacy,
    and risk perception each contribute to behavior changes for disaster preparedness, especially when
    people are at different income levels?
    The study also seeks to provide a new statistical method to estimate individual behavior changes in
    departure from the NP stage and in arrival to the AP stage, respectively. To fill the research gap with
    respect to disaster preparedness for older adults (as recently discussed by NIH/NIA [2002]), the
    proposed study aims to identify the specific reasons behind older adults’ decision-making process for
    all-hazards disaster preparedness. We aim to publish our findings from this study in peer-reviewed
    academic journals. Using these results, we will then employ the present process-oriented approach
    and subsequent measurement to study how to support older adults’ preparedness when they are
    exposed in specific hazards (e.g., floodings, wildfires, heatwaves, earthquakes), through extramural
    funding from NIH and/or NSF.

    Priority Research Areas: Consequences of U.S. and Global Aging

  • 2023. I. Elo. Predictors of Cognitive Health in Sub-Saharan Africa: Comparative Perspective from Ghana and Malawi.

    The overall aim of this pilot project is to conduct comparative analyses and generate findings on the
    predictors of cognitive health among older individuals in Ghana and Malawi, two Sub-Saharan African
    countries at different levels of development, Ghana being low-middle-income country and Malawi a
    low-income country. Importantly, these findings will inform planned pilot data collection activities to
    test the Harmonized Cognitive Assessment Protocol (HCAP) in both countries and the integration of
    HCAP in the nationally representative WHO SAGE survey in Ghana. The proposed analyses will
    examine similarities and differences in the association between demographic, socioeconomic, and
    health-related predictors of cognition in Ghana and Malawi. The project activities will also provide an
    opportunity to engage and train a post-doctoral fellow in aging-related research.

    Priority Research Areas: Cognitive Aging and the Demography of Dementia

  • 2023. K. Britt. Spirituality and Brain Health in Older Adults.

    Historically underrepresented populations experience a disproportionate burden of age-related
    cognitive disorders compared to non-White populations. As a salient resource for coping in Black
    communities, spirituality may be associated with better brain health, yet research is limited, especially
    in this population. This study aims to examine: 1) associations between spirituality and cognition, 2)
    identify possible differences across racial groups and, 3) explore the role of spirituality as a
    moderator between AD blood biomarkers and cognition. I hypothesize a relationship exists between
    (a) spirituality and specific cognitive domains including executive function and memory, (b) the
    protective effect of spirituality on cognition will be stronger in Black individuals, and (c) higher
    spirituality will attenuate the association between AD blood biomarkers and cognition. Using
    secondary data from the Penn AD Research Center and Memory Centers, we will use multivariate
    regression with moderation analyses to elucidate spirituality as a potential resilience factor in minority
    brain health.

    Priority Research Areas: Cognitive Aging and the Demography of Dementia

  • 2023. P. Ho. Alcohol Use, Genetics, and Cognitive Decline.

    Alcohol use disorder (AUD) is one of the most pronounced public health concerns in the U.S. and
    cause an enormous burden to the society. In 2019, 14.5 million people of age 12 and older have AUD
    but only 7.2% of them had received treatment in the past year. Moreover, AUD may be correlated with
    cognitive decline and dementia could be a onerous burden to Individuals, family members, and the
    society. Both alcohol consumption and cognitive decline are often correlated to many unoberved
    factors such as genetics, personality traits, and risk perception therefore resulting in endogneity
    concerns. To tackle the endogeneity concerns, this project proposes to study the alcohol consumption
    of individuals of age 50 and older from the genetic perspective, which is pre-determined, and its
    association with cognitive decline. The development in genome-wide association studies (GWAS) in
    past decades provide a straightforward method to summarize the genetic tendency of a certain trait
    (e.g., alcohol consumption) by calculating a Polygenic score (PGS). A higher PGS refers to a higher
    genetic tendency of a trait. We first aim to establish the association between alcohol consumption
    PGS and the rate of cognitive decline to alleviate the endogeneity of drinking behaviors. To further
    characterize the effects of alcohol consumption on cognitive decline, we identify stressful events (e.g.,
    unemployment, divorce) and investigate how individuals respond to stressful events by changing their
    alcohol consumption. The frequencies and spacingof stressful events can facilitate dose response
    analyses. We then explore the genetic correlations between alcohol consumption and other traits
    (e.g., depression, bipolar, smoking behaviors, and personality traits) that often co-exist with AUD to
    obtain a clear picture of AUD, common comorbidities of AUD, and cognitive decline. Alcohol
    consumption, as a risk factor of many diseases, is modifiable via behavior modifications. Thus, we
    next investigate how education and social interactions may interact with alcohol consumption, which
    may shed light on behavior modification targets.

    Priority Research Areas: Biology, Genetics and Demography of Aging

  • 2022. C. Leonard. Effect of outdoor temperature and air pollution on the comparative safety of antihyperglycemic therapies.

    Diabetes exacts a profound societal cost in terms of morbidity, disability, and mortality. As climate
    change progresses and further magnifies the negative impacts of extreme outdoor temperatures and air
    pollution on health, there is urgency in the need for adaptable and personalized diabetes care. Natural
    environmental factors like extreme temperatures and pollution are known to be associated with serious adverse
    health outcomes in persons with type 2 diabetes; these include hypoglycemia (very low blood sugar), diabetic
    ketoacidosis (very high blood ketones), and cardiovascular events (like heart arrhythmias). The most vulnerable
    and disadvantaged populations tend to be hardest hit by climate change and are least equipped to combat its
    effects, and there is substantial overlap between these populations and Medicaid recipients. Furthermore,
    Medicaid recipients are diagnosed with diabetes and hospitalized for diabetes-related adverse health outcomes
    at higher rates than the general US population.
    Personalized diabetes care involves selecting the best therapy based on patient characteristics.
    Unfortunately, clinical trials comparing diabetes drugs have not examined interactions with outdoor temperature
    or air pollution, and are underpowered to do so. This presents a major knowledge gap for efforts to incorporate
    natural environmental factors into personalized diabetes care. While innovative, the inclusion of environmental
    factors in clinical decision-making has precedent, and is even anticipated in the treatment of diabetes.
    To address this knowledge gap, we recently submitted an R01 application to examine the roles of outdoor
    temperature and air pollution on the comparative safety of diabetes drugs in persons with type 2 diabetes. We
    proposed to conduct pharmacoepidemiologic studies by linking federal environmental datasets to Department
    of Health and Human Services healthcare data for the entire US Medicaid (and Medicare) populations residing
    in the conterminous US. We proposed to examine the effects of outdoor temperature and air pollution on rates
    of serious hypoglycemia, diabetic ketoacidosis, and serious arrhythmia, within and among incident users of
    different diabetes drug classes. Our Quartet application proposes to generate pilot data to bolster an R01
    resubmission, recommended by our NIDDK Program Official, by demonstrating proof-of-concept by linking
    environmental to healthcare data for Medicaid beneficiaries with type 2 diabetes, then using this dataset to: a)
    examine temperature and pollution variability by beneficiary ZIP code of residence; b) examine rates of the
    above-named health outcomes by temperature and pollution; and c) demonstrate variability in outcome rates
    among users of different diabetes drug regimens. These pilot data will enable us to directly respond to
    summary statement feedback and improve the fundability of our proposed, innovative R01 that would
    incorporate natural environmental factors to improve health in persons with diabetes.

    Priority Research Areas: Health Trends and Disparities

  • 2022. G. Nave. Biological age and its value for behavioral and decision science.

    The proposed project draws on recent advances in bio-informational research, with an aim to
    investigate how a new type of measurement—called “epigenetic clocks”, which quantifies biological
    processes related to aging (i.e., biological age)—can better our understanding of individuals’
    judgments and decisions. At this time, epigenetic clocks have been previously used in medical
    research to understand the aging process and human lifespan, and such measures have been shown
    to be better at capturing variability in biological aging processes than chronological age. In this
    project, we will partner with one of the largest firms in the US selling epigenetic testing kits,
    TruDiagnostic, and, leveraging their existing customer base (~15,000 individuals with epigenetic
    data), survey participants on a variety of psychological tasks relevant to the aging process, such as
    temporal discounting, risk taking, cognitive reflection, and personality change over the lifespan. Using
    survey measures combined with epigenetic data, we seek to differentiate the contribution of biological
    aging from other non-biological aging-related measures (such as chronological age), and empirically
    disentangle their effects on psychological well-being as well as other meaninful outcomes. Funding
    from this grant will be used for participant incentives.

  • 2022. K. Auriemma. Using hospital-free days to understand the impact of lung allocation policy changes on older lung transplant recipients.

    Background: Changes in US lung allocation policies in 2005 and 2017 increased transplants among
    the sickest and oldest candidates on the waitlist. The impacts of these policy changes on health care
    utilization and quality of life are not known. Assessing hospital-free days (HFDs) among transplant
    recipients will provide a better assessment of the post-transplant survivorship experience than simple
    measures of mortality.
    Objectives: To better understand the consequences of changes in lung allocation policy and inform
    future decision making.
    Specific Aims: (1) To quantify temporal changes in HFDs among lung transplant recipients. (2) To
    determine the impact of May 2005 and November 2017 lung allocation score policy changes on HFDs
    in older relative to younger lung transplant recipients.
    Design: We will create a retrospective cohort of Penn lung transplant recipients from 2000 to 2020 by
    merging Penn data with regional utilization data and data from the Lung Transplant Outcomes Group.
    Methods: Median HFDs, defined as all days alive spent outside of an acute-care hospital, long-term
    acute-care hospital, or emergency department, will be calculated at 365 days post-transplant for each
    year of the study. We will identify patient characteristics associated with greater attainment of HFDs.
    We will use an interrupted time-series design to compare HFDs before and after major lung allocation
    policy changes and determine how these changes differed among older relative to younger patients.
    Impact: This study will generate key preliminary data for a planned NIH R01 proposal to assess the
    impact of previous and future LAS policy changes on HFDs nationally and to assess changes in
    patient function and quality of life. Future work will integrate those measures into quality-weighted

    Priority Research Areas: Disability, Health Care and Long-Term Care

  • 2022. K. Miller. Impacts of the COVID-19 Pandemic on Youth and Young Adult Caregivers.

    A growing proportion of individuals provide unpaid care to family members and friends (i.e., are family
    caregivers). Among younger individuals, an estimated 12.7 million young adults (ages 18-34) and 5.4
    million youth (aged <18) are family caregivers. As the ongoing COVID-19 pandemic has increased
    disability and comorbidities, it follows an increasing number of young adults and youths may
    undertake the role of family caregiver. Potential increases in young adult/youth caregiving
    responsibilities are of major concern because caregiving is associated with adverse mental, physical,
    and financial outcomes. Additionally, because the pandemic has disproportionately impacted
    historically marginalized communities, younger adults/youth of historically marginalized populations
    may disproportionately become family caregivers; thus, existing mental, physical, and financial
    disparities may be exacerbated. Little evidence exists quantifying the impact of the COVID-19
    pandemic on the proportion of young adults/youths acting as caregivers and the intensity of their
    caregiving. The overall objectives of this pilot study are to estimate the prevalence of and describe
    the impact of the COVID-19 pandemic on young adult/youth caregivers. This research will advance
    our understanding of young adult/youths acting as family caregivers.

    Priority Research Areas: Health Trends and Disparities

  • 2022. M. Dougherty. Improving the Outcomes of Older Adult Surgical Patients with Prolonged Surgical Time: Evaluating Modifiable Hospital Nursing Resources.

    More older adults in the United States are undergoing inpatient surgery than ever before. Older age is a risk factor for greater morbidity and mortality following surgery; therefore, improving the surgical care and outcomes of older adults warrants attention. In this proposal, we focus on one concerning adverse surgical event which is particularly threatening to the postoperative recovery of older adults—prolonged surgical time. Prolonged surgical time is associated with complications including a greater risk of death, longer stays in the hospital, and other poor outcomes including venous thromboembolism, anemia, and sepsis. The current literature on outcomes of older adults with prolonged surgical time is limited to descriptive research and offers no evidence about prevention or early intervention of complications should they occur. The proposed study seeks to examine the outcomes of older adult surgical patients that experience prolonged surgical time and modifiable nursing resources within hospitals. Decades of research has shown that when nurses at the bedside are adequately staffed and practice in environments that allow for nurse autonomy and teamwork with physician colleagues, patients are more likely to have favorable postoperative outcomes. The benefits of these good nursing resources are most pronounced among patients with the highest clinical risk, which lends credence to our hypothesis that favorable staffing ratios and supportive work environments will be especially beneficial to older adults with prolonged surgical time. The proposed study addresses the following aims: 1) to evaluate whether and to what extent differences in hospital nursing resources (i.e., patient-to-nurse staffing ratios, work environment) are associated with outcomes of older adult surgical patients with and without prolonged surgical time and 2) to determine whether the effects of hospital nursing resources on older adult surgical patient outcomes are conditional on surgical time. This study will use multiple linked secondary data sources including patient data from the Centers from Medicare and Medicaid Services (CMS), hospital data about nursing resources from the RN4CAST survey of nurses, and data of hospital structural characteristics from the American Hospital Association Annual Survey. Datasets will be linked by hospital identifiers common to all datasets. We anticipate the patient sample will include 800,000 older adult surgical patients, 65 years old or older, which will be representative of approximately 160 surgical procedures and approximately 500 hospitals. Findings obtained from this study will support a burgeoning program of research to inform targeted interventions for improving the care and outcomes of high-risk older adult surgical patients.

    Priority Research Areas: Disability, Health Care and Long-Term Care

  • 2021. C. Boen. Uneven Spillover Effects of Police Violence: Police Shootings and Disparities in Emotional Well-Being.

    In 2018, 992 people were shot and killed by the police in the United States. Black men are at particularly high risk of deadly police violence relative to other groups. In addition to direct consequences of this violence, studies document a host of spill-over effects of police violence, including decreased trust in the police and increased legal cynicism. Given racial disparities in risk of police violence and a broader context of structural racism in the U.S., the collateral consequences of this violence are magnified for Black communities. Now, with the rise of portable video recorders and social media, police violence that was only observed in situ is recorded and broadcast to a global audience, made viral, and viewed repeatedly, broadening the potential reach of these spillover effects. At the same time, forms of social connectivity like Twitter offer individuals platforms for expressing their emotions in real time, offering researchers valuable insight into the effects of widely publicized events, including police violence. A growing body of research aims to identify the spillover effects of police violence, but critical gaps in scientific understanding of the role of police violence in shaping emotional and psychological outcomes—as well as population disparities in well-being—remain. The proposed project improves scientific understanding of the population impacts of police violence by using a corpus of text data from Twitter and computational text analysis to evaluate the emotional spillover effects of police violence and assess racial-ethnic, gender, age, and geographic variation in the associations between police violence and emotional well-being. The project uses longitudinal data, a quasi-natural experiment design, and two cases—the shootings of Michael Brown and Tamir Rice—to assess whether and how police violence affects the emotional well-being of individuals, paying particular attention to the stress-related psychological processes undergirding these links as well as differential vulnerability to these events. This project will expand and shift scholarship on police violence and population disparities in well-being in three key ways. First, this study leverages big data and cutting-edge computational methods to examine the impacts of police violence on population well-being. While most research in this area relies on survey data, our use of Twitter data will allow for improved understanding of how these events shape individual and population well-being in real time. Second, we use a quasi-experimental design and difference-in-difference models to assess the links between police violence and emotional well-being, thereby improving our ability to make causal inferences. Finally, we use a variety of techniques to code sociodemographic characteristics and test for differential vulnerability of exposure to police violence by race, gender, age, and geography, providing new evidence of the role of police violence in shaping inequities in emotional and psychological well-being. Findings from this study will generate new understandings of the spillover effects of police violence, particularly as these events shape individual emotions in ways that relate to individual health and contribute to population health disparities. Results from this project will be inform applications for subsequent extramural funding focused on the links between police violence, emotions, and population disparities in psychological well-being.

    Priority Research Areas: Determinants of Health, Well-Being and Longevity

  • 2021. C. Low. Reproductive Disability: The Link Between Infertility and Economic Well-Being for Women in Zambia.

    It is widely acknowledged that disability results in a permanent downward shift in worker’s incomes, and thus consumption. In other words, workers are not fully insured against these negative shocks in labor market productivity. There is much less attention to another form of disability, that of secondary infertility, which may affect women economically if they are partly dependent on male partners for economic support. In this project, I will test whether infertility materially impacts women’s economic well-being similarly to how worker disability affects their earnings. The long-term plan for this project is to collect longitudinal data over a two-year period on 1,000 women in Zambia to measure how consumption, health, and economic wellbeing co-move with fecundity and spousal expectations of fecundity. The longitudinal data will allow an event study analysis with individual fixed effects to show that the onset of infertility, or “reproductive disability” is associated with a loss of consumption and economic wellbeing. In the initial pilot phase, I will begin enrolling the first 400 women in the survey, as well as analyze existing DHS data in Zambia to demonstrate the connection between infertility and loss of consumption.

    Priority Research Areas: Disability, Health Care and Long-Term Care

  • 2021. R. Greysen. Gamification to Improve Physical Activity in Seniors at Risk for Alzheimer's.

    Increased physical activity by walking further or more vigorously may delay the development of Alzheimer’s Disease and Related Dementias (ADRD) and associated cognitive decline but reaching higher levels of activity and maintaining it as a long-term habit is difficult to do. This project will use concepts from behavioral science to create a mobility game that people at risk for developing ADRD can play in order to increase their levels of activity while having fun doing it. The game is played with a support partner who is a spouse, family member, or close friend who provides feedback and encouragement to help the game-player reach activity goals and maintain them as habits over time. Participants in the game will use their own smartphone and a wristwatch that tracks activity (such as a FitBit, provided by this study) to set goals, get feedback, and play the game for 12 weeks. Participants will be asked to continue wearing the wristwatch for another 6 weeks to track activity after the game is over. To determine the effectiveness of this game, we will randomly assign 50 people to the game and 50 people to only get the wristwatch but no game component. All participants in this study will be recruited from the GeneMatch registry which offers genetic testing on risk for ADRD to all participants. We will recruit participants to our study who have elevated genetic risk as well as those without specific genetic risks to see if either group responds differently to the game. The short-term goal of this study is to determine the feasibility of remotely recruiting and engaging older adults at high risk for developing ADRD from an existing Alzheimer’s cohort study. We hypothesize that we will be able demonstrate the efficacy of gamification to increase physical activity in this pilot population as well as explore differential effects of high-risk genotypes and demonstrate the ability to collect functional and cognitive measures remotely. These results will enable competitive applications for larger studies (NIA R01) immediately after the completion of this pilot. The long-term goal for this project is to launch a successful new line of inquiry into physical activity in patients with ADRD by adapting and applying behavioral economics approaches such as gamification which have been successfully developed for other populations.

    Priority Research Areas: Effects of Interventions on Population Health

  • 2021. W. Roth. How Does Genetic Ancestry Testing Affect Perceptions of Race?.

    The proposed research will evaluate the relative influence of genomic, phenotypic, social attributes, and social context in shaping how individuals perceive other people’s race, to determine how genomic information is influencing societal norms of racial classification. The larger project will conduct a conjoint survey experiment that includes unique morphed photographs, information about genetic ancestry test (GAT) results, and social attributes like racial self-identification before and after testing, to influence the racial classification of others by White, Black, Hispanic, and Asian respondents. The pilot project will develop and test the morphed photographs to be used as the visual stimuli in the experiment. GATs are one of the most common ways that genomic awareness has increased in the public sphere. Many scholars believe GATs will shape individuals’ beliefs about race, including beliefs in essential racial differences and that races are genetically determined. Recent research shows that GATs lead some people to change their racial identity based on the reported genetic information. However, we know little about whether those genetically-influenced identity claims are accepted by others or whether information about an individual’s genetic ancestry influences how their race is perceived. Increased genomic knowledge may be shifting norms of racial classification. This could have significant social implications ranging from demographic shifts and identity-based political mobilization to changing patientprovider interactions and assessments in healthcare settings. In everyday life, people typically rely on phenotype to racially classify others, often using it as a proxy for ancestry. However, we know little about how the perception of phenotype interacts with information about ancestry, which we will test using photographs of human faces and hypothetical GAT results. In addition, an abundant scholarship has shown that race is shaped by social context. Nevertheless, most studies have been observational and may be afflicted by endogeneity. We will provide rigorous experimental evidence for how the social context influences racial classifications: some respondents will be asked to categorize individuals seeking membership in a cultural affinity group; others will be told the individual is applying to college, priming a context of competition for scarce resources; the remainder will be given a neutral context. Last, our nationally representative survey will sample Black, White, Asian, and Hispanic respondents, which will allow us to test how racial perceptions vary across the U.S. and among the nation’s largest ethnoracial groups. This project will develop a research protocol and preliminary data for a larger future study focusing on how genomic information shapes healthcare providers’ racial perceptions and clinical assessments of patients.

    Priority Research Areas: Biology, Genetics and Demography of Aging

  • 2020. I. Kohler. Comparative Cognitive Health Changes in Low-Income Settings.

    This projects overall aim is to lay foundations for a program application to examine for the first time individual variation and age-related changes in cognitive health in mature adults across non-WEIRD (Western, Educated, Industrialized, Rich, Democratic), low-income populations with the ultimate goal to understand if cognitive aging follows universal trajectories and/or is determined by environmentally dependent mechanisms. The project focuses on comparative analysis of longitudinal data on cognition among mature adults using data sets covering substantial segments (at least two decades) of the life-cycle in three very distinct relatively low-income populations in Bolivia, Guatemala, and Malawi.

    Priority Research Areas: Cognitive Aging and the Demography of Dementia

  • 2020. M. Candon. Understanding Nursing Turnover: The Case of Home Health.

    High levels of turnover in professions that rely heavily on skill acquisition is a major source of inefficiency due to productivity loss, termination costs, vacancy, orientation and training, and other spillovers. Turnover among nurses, a bedrock in health care, is a particular concern given the amount of direct care they provide patients – indeed, compromised nursing care has been associated with longer lengths of stay and higher rates of adverse outcomes, including mortality. To date, most studies of nursing turnover have focused on inpatient nurses in hospitals using self-reported survey data and are therefore limited in scope. No projects have been able to cleanly connect nurses to patients, making it impossible to understand the full impact of nursing turnover. This project will leverage a collaborative agreement between the University of Pennsylvania and Encompass Home Health, which is one of the largest home health agencies in the country, currently operating in 30 states. We will acquire a host of different datasets from Encompass to answer two main questions: first, which factors drive nursing turnover in home health; and second, how does nursing turnover in home health affect patient outcomes such as hospitalizations and mortality? Using variables constructed from human resources, payroll, visit logs, and other secondary data sources, we will include a host of potential factors that may drive turnover, e.g., driving time, patient acuity, and outside labor market opportunities, in order to construct an algorithm that can flag nurses at high risk of turnover. This will allow for more tailored personnel interventions to improve retention among home health nurses at Encompass. Next, we will use these unique data to explore the confounded relationship between nursing turnover and patient outcomes. Because home health nurses work alone or in tandem with other provider types, we are able to connect individual nurses to individual patients. That, along with more rigorous statistical approaches, gives us an unprecedented opportunity to pin down the causal pathway between nursing turnover and patient care.

    Priority Research Areas: Disability, Health Care and Long-Term Care

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