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.

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.

Research Themes
Cognitive health and dementia trends and disparities; Population, economic and health forecasting; Behavioral economics; Economics of aging; Disability, health care, unpaid family care and long-term care; Implications of health policy; Cognitive aging and the demography of dementia.

Pilot Projects

  • 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.

Pilot Projects

  • 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: 11. Effects of place on health and aging, 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.

    Aim 1:  To explore if and to what extent SNAP outcomes are higher in states that adopt the Standard Medical Deduction.

    Aim 2:  Because health, out-of-pocket health expenses, and lifetime connection to the SNAP program vary by demographic characteristics, we will document how these effects differ by sex and race/ethnicity.

    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 Administrator/Media Contact: Kathy Forrest

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.

Pilot Projects

  • 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

  • 2019. Jason Fletcher. WLS Digitization.

    The Wisconsin Longitudinal Study (WLS), which started with a state-wide survey of all 30,000 Wisconsin high school seniors in 1957, has become a premier resource for understanding how events and circumstances throughout life shape economic and health trajectories into older ages and can answer questions that no other data resource in the US can answer.  It merges deep social scientific advances with more recent biological assessments, including genetics and the microbiome.

    In this project, we plan to digitize over 20,000 of the original WLS surveys from 1957.  This work will substantially expand the WLS in ways that will allow new research areas to be explored that have not been previously available.  An enhanced WLS can substantially expand our understanding of the connections between early life conditions and experiences and later life outcomes.  Having access to data on the full population of the Wisconsin Class of 1957 seniors thus allows us to contextualize the school and social environments during this time period to a degree not previously available.

    The digitization effort will make possible a number of extensions to the WLS that will also expand the reach of the data.  First, the 20,000 newly digitized surveys can be linked to the 1940 Decennial Census in order to add information on early environments, such as family characteristics and geographic location (the survey respondents were born in 1939).  Second, the surveys can be linked to US Mortality records to create an additional “panel” of respondents. Third, eventually, all WLS respondents could be “PIK”ed and linked with Census data projects (e.g. 2000 Decennial Census) inside an FSRDC.

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

  • 2019. Michal Engelman. Understanding the long-term relationship between Community Health and Voter Turnout in the Midwest.

    Reports of declining life expectancy and rising economic and social anxieties among white Americans (particularly those living outside of major metropolitan areas) captured both popular and scholarly attention in the lead-up to and aftermath of the 2016 election. In attempting to explain the Republican candidate’s victory in a state that had favored Democratic presidential candidates since 1988, early reports stated that white voters – and particularly older, white, working-class voters – were responsible for flipping Wisconsin from blue to red. Subsequent analysis has shown that the story is considerably more complicated, encompassing low voting rates among African Americans (due to unenthusiastic turnout as well as voter ID policies that created barriers for interested voters) and higher-than-predicted support for Trump among white voters of varied socioeconomic backgrounds.

    In this study, we will create a unique linkage between the rich sociodemographic and health data available in the Wisconsin Longitudinal Study (WLS), State Voter Files up to 2019, and aggregate data on population health and economic well-being in order to understand voting patterns among older, largely white adults who grew up in Wisconsin. This study will allow us to identify individual and community level predictors of voting patterns, marshaling longitudinal data to assess the extent to which the 2016 election represented continuity with or a break from prior elections. Our aim in creating this linked data set is to enrich the resources available for future research focused on the interaction of socio-demographic and health characteristics with political participation.

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

  • 2019. Qiongshi Lu. Testing Gene-environment Interactions without Measuring the Environmental Factor.

    Gene-environment interaction studies for late-life health outcomes often have limited sample sizes. While the size of genome-wide association studies (GWAS) grows rapidly for almost all complex diseases and traits, most of these studies have very limited measurements on epidemiological risk factors that are of interest in gene-environment interaction analysis. In this research, we explore the possibility of using PGS as a proxy of the epidemiological/ environmental risk factor (we refer to it as E-PGS) in gene-environment interaction analysis.

    We will conduct simulations to investigate the validity of using E-PGS as a proxy for the ‘E component’ in gene-environment interaction analysis. Then we will conduct a pilot analysis focusing on three prevalent late-life diseases – coronary artery disease, stroke, and breast cancer. The Wisconsin Longitudinal Study (WLS) will be used as the primary discovery cohort, and we will replicate our findings in the Health and Retirement Study (HRS).

    The main goal of the proposed work is to determine the feasibility of identifying gene-environment interactions in late-life health outcomes using E-PGS as a proxy. The successful identification of interactions would provide a strong basis for expanding our analysis to broader phenotypes.

    Priority Research Areas: Biology, Genetics and Demography of Aging

  • 2019. Yang Wang. Medicaid Expansions and Formal and Informal Care for the Elderly.

    The Affordable Care Act has led to substantial increases in health insurance coverage for individuals in the US, and expansions in Medicaid have played a large role in the increased coverage. We explore how these changes have affected the provision and receipt of informal care, as well as changes in the demand for formal (nursing home) care for the elderly.

    We will use the American Time Use Survey (ATUS) and the Health and Retirement Study (HRS). The ATUS provides nationally representative estimates of how, where, and with whom Americans spend their time. The Health and Retirement Study (HRS), focused on providing detailed information on health, health care, work, family and the aging process of Americans, will be used to measure the symmetric informal care receipt by the elderly to validate the results from the ATUS and to measure the effects of Medicaid expansions on actual nursing home use by the elderly.

    Priority Research Areas: Effects of Interventions on Population Health

  • 2018. James Raymo. The Demography of Isolation at Older Ages.

    This project is designed to generate population-based information about the experience of social isolation at older ages and the complex relationships between health and social isolation. It will identify measures of isolation in the Health and Retirement Study (HRS), National Survey of the Japanese Elderly (NSJE) and Survey of Health, Ageing, and Retirement in Europe (SHARE).  How demographic attributes like age, sex, educational attainment, area of residence, marital status, number of children, and health contribute to the prevalence and duration of isolation at older ages in a cross-country frame work.

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

  • 2018. Jason Fletcher. Gene-Environment Interactions Related to Old Age Cognition and Cognitive Decline.

    The restricted Health and Retirement Study (HRS) data will be used to examine interactions between specific environment conditions and polygenic scores related to cognition in old age. HRS is a nationally representative longitudinal study of aging of individuals born 1931-1941 and their spouses. It has collected data on the aging process by focusing on health, work, family, and related domains. HRS’ polygenic scores for cognition, Alzheimer’s disease, education, and other related phenotypes can contribute to our investigation on how genetic predispositions interact with early disease environments, various exposure to pollution, and the Great Depression.

    Priority Research Areas: Biology, Genetics and Demography of Aging

  • 2018. Lindsay Jacobs. Work and Cognition at Older Ages: Do Occupations Matter.

    This pilot will study work patterns on cognition and wellbeing across occupations and over respondents’ life course.  This project plans to connect Job attributes in O*Net data to Wisconsin Longitudinal Study (WLS) respondents’ occupations over the years. WLS is a long-term study of a random sample of 10,317 men and women who graduated from Wisconsin high schools in 1957. The WLS data provides an opportunity to adequately account for selection into occupations earlier in life and any causal effects of occupation on later life outcomes.

    Priority Research Areas: Cognitive Aging and the Demography of Dementia

  • 2018. Stephanie Robert. Social Determinants of Health And Wellbeing at Older Ages.

    This project will examine how SES, race/ethnicity, and neighborhood context impact the health outcomes of older adults, or of adults over the life course. Will associating them with urban/suburban/rural residence predict health trajectories and transitions out of community residence for older adults? Research will be conducted using restricted data from the National Health and Aging Trends Survey (NHATS), a nationally representative sample of Medicare recipients ages 65 and older, with oversamples of black older adults and the oldest old. NHATS includes both community-dwelling older adults and those living in facilities. We will follow respondents’ transitions into nursing home, assisted living, or remaining in the community. In addition, we will link caregivers’ data in the National Study of Caregiving (NSOC), a complementary study for members in NHATS to look at urban/rural/suburban differences in informal and formal support networks in the community and in non-community residences.

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

  • 2017. Jenna Nobles. Aging through a Nutrition Transition: The Effects of Early-Life Scarcity on Later-Life Health.

    In the last few decades, a dietary shift from locally grown staples to mass-produced, shelf-stable calorically dense foods has increased cardiovascular health risk in aging populations around the world. This project uses data from the Indonesian Family Life Survey (IFLS) to measure childhood nutritional conditions and health-trajectories at older ages. It provides an empirical test on the global nutrition transition and the effects of early life scarcity on later life health.

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

  • 2017. Kristen Malecki. The Social Epigenomics of Health Disparities: How Different Dimensions of Disadvantage Get Under the Skin.

    This pilot project uses the Survey of the Health of Wisconsin (SHOW) data to study how individual characteristics and neighborhood-level contextual characteristics operate independently and jointly to shape health disparities through epigenetic mechanisms that accelerate biological aging. It employs DNA methylation array data to test the hypothesis that differences in biological aging exist across socio-demographically matched subpopulations.

    Priority Research Areas: Biology, Genetics and Demography of Aging

  • 2017. Michal Engelman. Who Enjoys An Immigrant Health Advantage? Nativity, Race/Ethnicity, and Population Health Patterns.

    This pilot examines the health of America’s diverse foreign-born population in the context of the nation’s racial/ethnic disparities. The National Health Interview Surveys (NHIS) data is used to study whether and how socioeconomic characteristics, health behaviors, and incorporation experiences of immigrants contribute to their health outcomes.

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

  • 2016. Alberto Palloni. Early Conditions, Delayed Effects and Their Impact on Adult Mortality Patterns Summary.

    This project will conduct an empirical test on conjectures derived from theories of Developmental Origins of Health and Disease (DOHaD). The Latin American Mortality Database (LAMBdA) and the Human Mortality Database (HMD) will be used to generalize a formal model formulated by Palloni and Beltran Sanchez.

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

  • 2016. Federico Rey and Pamela Herd. The Role of Early Life Experiences in Shaping the Gut Microbiome: A Study Incorporating the Microbiome into the Wisconsin Longitudinal Study.

    Microbes in the gut, and their associated genes (the microbiome), affect many aspects of our physiology. A growing body of research emphasizes the key role the microbiome plays in shaping human health. This project uses the Wisconsin Longitudinal Study to explore the role of early life conditions’ and the degree of plasticity in the gut microbiome across the life course.

    Priority Research Areas: Biology, Genetics and Demography of Aging

  • 2016. James Raymo. Living Arrangements at Older Ages: A Cross-National Comparison.

    Living arrangements are closely linked with health, health care, and long-term care in later life. This project will examine transitions in living arrangements among older Europeans, depict their living arrangements as trajectories over a period of nine years. Data will come from the Survey of Health and Retirement in Europe (SHARE), which tracks national samples of men and women 50 years of age or older since 2004 in 20 European countries (and Israel).

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

  • 2016. Michal Engelman. Why Does the Immigrant Health Advantage Disappear over the Life Course?.

    Population aging and immigration from increasingly diverse origins are dramatically transforming America’s demographic profile. This pilot project uses 2014 California Health Interview Survey (CHIS) to examine social structures, policies, and practices affect the health of immigrant populations.

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

  • 2015. Eva Dugof, Michal Engelman, Kevin Look and Amy Kind. Health Trajectories in Older Adults.

    Two out of three older adults in the United States are living with two or more chronic conditions. Research shows that as the number of chronic conditions increases, so too does the complexity of care, health care spending, and adverse health outcomes. Few studies have sought to address how the relationship between multimorbidity and health may vary by the combination of conditions. Our project will examine differences in the order in which conditions are accumulated and study the dynamics of multiple chronic conditions among older adults in the Medicare program and the implications of different health trajectories on health spending and life expectancy. We hope to address an urgent need for better information on the consequences of multiple chronic conditions to inform the development of clinically and culturally tailored interventions, clinical trial design, payment models, and health system planning.

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

  • 2015. Jason Fletcher. Determinants of Telomere Length in the Health and Retirement Study.

    Research findings relating telomere length to longevity and health in general are somewhat contradictory and inconsistent, but most of them are based on small samples of individuals and with limited information. Our project will investigate the relation between telomere length, onset of chronic diseases and mortality in the Health and Retirement Study. This large population study contains rich information on individuals life histories and may help to elucidate aspects that are obscured by inappropriate sample size or ancillary information.

    Priority Research Areas: Biology, Genetics and Demography of Aging

  • 2015. Jennifer Dykema, Dana Garbarski, Nora Cate Schaeffer and Kenneth D. Croes. Uncovering the Relationship between Interviewer-Respondent Interaction and Compliance in the Collection of Anthropometric Measures and Physical Performance AssessmentsUncovering the Relationship between Interviewer-Respondent Interaction and Compliance in the Collection of Anthropometric Measures and Physical Performance Assessments.

    While biomeasures, including anthropometric measures, physical performance assessments, biological materials, and genetic measures, are increasingly collected along with survey responses in household surveys, more research is needed to determine respondents’ willingness to provide these measures, what factors influence participation, and what barriers impeded successful collection. This study aims to understand how the interviewer influences both consent to participate in anthropometric measurement tasks and the mechanisms by which interviewer effects are introduced into the resulting measures. In addition, interaction during the request and the measurement task will be examined to predict compliance with subsequent requests.

    Priority Research Areas: methodology

  • 2014. Barbara Wolfe, Jason Fletcher, Jan S. Greenburg, and Marsha Mailick. Disrupted Family Dynamics: How Children Are Affected by Sibling Death, and Disability.

    There is a large literature on the family determinants of child achievement, development, and life outcomes. One aspect of family determinants that has been the subject of only limited research is the influence of siblings particularly non-normative sibling relationships, such as when a sibling is disabled or dies during childhood. Our project focuses on non-normative sibling relationships by exploring the family as a complex, dynamic, social, and reciprocal setting in which children (and parents) develop. We further explore how family disadvantage may moderate or exacerbate the impacts of sibling relationships and how these sibling relationships affect future family disadvantage.

  • 2014. Craig Atwood. Veteran Health in the WLS.

    The veteran population is exposed to cognitive impacts including post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI; shell-shock). Although these disorders may resolve following return to civilian life, there is little data on the long-term effects of these exposures to cognitive and affective performance with aging in veterans. The central objective of this proposal is therefore to determine if there are disparities in cognitive and affective disorders between the aged veteran population and civilian population within the WLS cohort. In addition, this dataset will be tested for association with genetic and environmental factors. Identification of differences in cognitive and affective disorders in the veteran population would allow better allocation of resources for treatment of veterans at VA hospitals, while identification of genetic and environmental correlates might allow for the development of prognostic/diagnostic tests and the initiation of preventive strategies.

  • 2014. Jason Fletcher. Gene-Environment Interactions in the Health and Retirement Study.

    This pilot project will set up and begin to implement gene-environment interaction research using the restricted (geographic and genetic) Health and Retirement Study (HRS) data. HRS began in 1992 as a nationally representative longitudinal study of aging of individuals born 1931-1941 and their spouses. There are now >10,000 individual with genetic data collected. We plan to use these genetic data in exploring the potential interactions between health policies and genotype in predicting health behaviors. Genetic variants will be examined as potential explanations of heterogeneity in the main effects of environmental effects. In addition, this pilot can help study the potential differences in gene frequency of population stratified by health behaviors.

  • 2014. Katherine Curtis, James Raymo, andJun Zhu. Aging and Place: New Methods to Identify Optimal Spatial Units for Health Outcomes among the Older Population.

    Researchers are becoming increasingly interested in the role of place in shaping various social and health outcomes. Individual characteristics such as age and marital status have strong effects on health, yet researchers argue that health outcomes are also shaped by contextual factors such as local social and economic circumstances and the built environment. Research incorporating contextual factors most often relies on multilevel modeling strategies. While a step in the right direction, such approaches are limited in two important ways. First, existing approaches do not offer an empirically-based test of whether contextual factors are measured at the appropriate spatial scale. Second, existing approaches do not account for the possibility that the effect of contextual factors is not the same in all places. Our project will begin to address these limitations. Our goal is to develop new methods to identify optimal spatial units for the study of health outcomes among the older population.

  • 2014. Leonelo Bautista and Alberto Palloni. Chronic Psychosocial Stress, and Risk of Metabolic Syndrome.

    This project will examine the role of socioeconomic status (SES) on the risk of metabolic syndrome (MetS). SES is a source of chronic psychosocial stress (CPS), which may increase the risk of MetS by increasing blood levels of cortisol. Unfortunately, the roles of SES and CPS are uncertain partly because standard markers of stress (serum, salivary, and urinary cortisol) provide single point in time levels that are subject to major physiological variations. Hair cortisol could be a better biological marker of CPS, as it reflects average blood levels over a period of months. We will assess the usefulness of hair cortisol as a marker of CPS, by quantifying its association with self-reported stress, individual and neighborhood SES, and components of the MetS. Data from this study will be used to design of a cohort study of the effects of SES on CPS and MetS in the Survey of the Health of Wisconsin (SHOW).

  • 2014. Nora Cate Schaeffer. Standardization and Motivation to Provide DNA Samples: Rapport and Motivation in the Standardized Interview.

    The interviewing methods of standardization were developed to support obtaining reliable measurement in large population studies conducted by production interviewers. In addition to the requirements of measurement, contemporary researchers also confront the challenge of motivating respondents to provide the sensitive biological information, such as DNA samples, that forms the foundation of an ambitious research agenda. In this project we examine whether interviewers working under the constraints of standardization introduce responsive behaviors that engage respondents and increase their motivation to comply with sensitive requests. Using pairs of survey respondents matched on their propensity to provide a saliva sample for study of their DNA in response to a request made some time after the interview was completed, we test whether interviews in which behaviors that signal responsiveness by the interviewer and engagement on the part of the respondent increase the odds of complying with the request for a DNA sample.

  • 2013. Corinne Engelman. Identification of Gene Environment Interactions in Cognitive Decline.

    The specific aim of this proposal is to use random forest, a machine learning approach that has worked particularly well in our past research, to identify potential interactions between social and behavioral factors, biomarkers, and genetic variants influencing cognitive decline in the WRAP cohort. We hypothesize that interactions in three main pathways will influence cognitive decline:

    (a) Cholesterol metabolism: interaction between physical activity, obesity, lipids, and the cholesterol metabolism genes. (b) Insulin resistance: interaction between physical activity, obesity, HOMA (a blood measure of insulin resistance), and genetic variants in type 2 diabetes-related genes. (c) Inflammation: interaction between social activity, social support, stress, inflammatory biomarkers, and genetic variants related to immune system function.

    The data for this project comes from the Wisconsin Registry of Alzheimer’s Prevention (WRAP), one of the few studies in the world that is focusing on this preclinical phase in middle-aged adults enriched for parental history of AD. WRAP is a longitudinal study with detailed information on socio-demographic and behavioral factors, biomarkers, and genetic variants.

    This rich dataset is especially important because, as of yet, the only well-established risk factors for AD are increasing age, lower education, family history of AD, the APOE 4 allele, most of which are not modifiable. Nine additional genes of very small effect have recently been confirmed and additional suspected factors include cardiovascular disease risk factors (e.g., high cholesterol and hypertension in midlife and diabetes) and social and cognitive engagement [Alzheimer’s Association].

  • 2013. Donald Moynihan, Barry Burden, and Jason Fletcher. Political Participation of Older Americans: the Role of Social and Genetic Factors.

    We propose to identify how three factors (genetics, personality, and health) each affect the political participation of older Americans. We plan to pursue these questions by using an expanded version of the Wisconsin Longitudinal Survey. The survey already includes self-reported items on voting, plus other variables we hope to explore, including measures of health, political ideology, personality, socioeconomic status, biomarkers, and other important contextual predictors of voting. We plan to draw on three additional sources that will offer a more reliable and comprehensive account of the political participation of older Americans. First, we will add in individual registration and voting histories for approximately the last 10 years. This will be provided by a private firm that collects such data from state records. Second, we will add campaign contribution data from the state of Wisconsin and the federal government. These public files report on campaign contributions made to candidates, parties, and groups in recent election cycles. Third, we will add a list of Wisconsin residents who signed petitions to recall the governor in 2011. This public document records the name, address, and signing date for each person who added their name to the recall petition.

    Priority Research Areas: Biology, Genetics and Demography of Aging

  • 2013. F. Javier Nieto and Alberto Palloni. The Impact of the Economic Recession on the Health and Wellbeing of Elderly Adults.

    This proposal leverages resources from the Survey of the Health of Wisconsin (SHOW), established in 2008 by a University of Wisconsin endowment as a statewide geographically-linked examination survey and biorepository. With funding from an NHLBI Grand Opportunities (RC2) grant, the Network for Health Equity in Wisconsin (NHEW) was established, linking SHOW with contextual data on the social, built-in, and health care environments, while developing strong partnerships with community organizations engaged in multi-modal health improvement initiatives. We propose to use the entire cross-sectional data set collected from 2008 to 2011 (N~2479) plus the (new, not yet released) data corresponding to 2012 to assess the effects of the economic recession on older adults’ behaviors and health markers, health care behaviors, residential patterns, and intra-family transfers as well as on the differential impacts by race and migration status. The two main goal of the pilot project are:

    1. To assess the effects that drastic shifts in economic conditions induced by the 2008 economic recession influence markers and determinants of health status, including self-reported health and conditions; indicators of mental health and cognitive impairment, body mass and biomarkers including cortisol levels, blood pressure, CRP and other markers of inflammation; and, finally, mortality.
    2. To estimate the degree to which the magnitude of the influence of the recession varies across social groups, particularly among disadvantaged groups, including low income, ethnic minorities and immigrants.

    In particular we will focus on the following health outcomes: self-reported health, self-reported conditions (from health histories including CVD, diabetes, stroke), cognitive function and depression, dental health, sleep habits and sleep problems, respiratory function, blood pressure, obesity and weight gain (loss). In addition we will examine behaviors such as physical activity, diet, smoking and alcohol consumption prevention and prevention and safety habits. Finally, we will investigate adherence to treatment and preventative behaviors.

    Priority Research Areas: Population, Economic and Health Forecasting

  • 2013. Hiram Beltrán-Sánchez. Biological Risk Profiles in the Elderly Mexican Population at the Turn of the 21st Century.

    The main goal of this study is to examine the association between socioeconomic factors associate and biological indicators of health within the elderly Mexican population. We expect differences in the physiological profile of the Mexican population to vary by age, gender, education, and rural residence. We also conjecture that older persons will have experienced suboptimal development as evidenced by their being shorter in total height and having more stunting resulting from worse levels of infection and nutrition while growing up. Due to likely increases in over-nutrition across all ages due to recent changes in nutrition we also expect differences in the cardiovascular and lipid profiles by age with a larger number of high-risk factors among the old. We will use data from all three waves of MHAS, the Mexican Health and Aging Survey. The third wave includes clinically relevant health indicators estimated from blood samples which were collected on fasting individuals We will study four sets of indicators representing physiological dysregulation: a) physical development and nutrition; b) indicators of metabolic dysregulation; c) indicators of cardiovascular dysregulation; and d) a summary risk indicator.

    Priority Research Areas: Biology, Genetics and Demography of Aging

  • 2013. Marsha Mailick. Genotype-Phenotype Associations and Genetic Risk of Aging: Health, Reproductive, Mental Health and Cognitive Phenotypes.

    The proposed project will use WLS genetic biomarkers to provide an unbiased assessment of the phenotype of the “premutation” condition of the disorder known as Fragile X-Associated Disorder (FXS), an inherited form of intellectual disability that results from large expansions of a trinucleotide (CGG) repeat in the 5 unstranslated region of the FMR1 gene. This is a highly prevalent but undiagnosed condition. The goal of this new project is to conduct a deep phenotyping analysis to ascertain whether clinical observations of the symptoms associated with the permutation are in fact evident in an unbiased population sample. We will study the physical, reproductive and mental health as well as cognitive phenotypes associated with gray zone and permutation alleles in WLS respondents and determine whether or not the CGG repeat pattern influences the effects of stressful life events on the physical and mental health and cognitive functioning of respondents.

    Priority Research Areas: Biology, Genetics and Demography of Aging

  • 2012. Alberto Palloni. Trends and Determinants of Mortality Disparities between the U.S. and Other High-Income Countries: 1980-2010.

    A 2011 National Research Council report offers compelling evidence supporting the idea that the US life expectancy at age 50 has fallen behind levels attained by peer countries in Western Europe and North America, both among males and females. The most important contributors to the gap between the US and other countries are associated with mortality due to very specific chronic conditions, including cancers and cardiovascular diseases. In turn, the ultimate determinants of these are less associated with medical technology and health care than with concrete individual behaviors, such as smoking, diet and exercise. This project has two objectives. The first is purely descriptive and entails to estimate the size of mortality gaps at various ages between the US and selected peer countries for the period 1975 and 2010. The second objective is to identify determinants of time trends in the gap between the US and other high-income countries. Results from this project on health status across the life cycle appear in chapter 2 of this study called, “U.S. Health in International Perspective: Shorter Lives, Poorer Health”. This study has received extensive media coverage in The New York Times, USA Today, and National Public Radio among other outlets. Alberto Palloni and graduate student Jay Yonker gathered and analyzed the information in Chapter 2 and wrote sections on health status across the life cycle. This study can be downloaded at this National Academy Press site.

    Priority Research Areas: Health Trends and Disparities

  • 2012. Felix Elwert. Proximity to Kin in Old Age and Ill Health.

    Kin continues to be the primary caregivers of elderly and chronically ill Americans. Spouses, children, siblings, and parents offer support with the activities of daily living, maintain contact with healthcare professionals and the wider community, and execute nursing tasks for post-operative home care, disability, or long-term terminal illness. Kin caregiving, especially for long-term support, is greatly aided by physical proximity. Greater physical distance between kin likely hampers kin caregiving and may lead to increased health care expenses as the elderly and infirm are forced to contract caregiving on the open market. This project investigates the determinants of proximity to kin in old age and ill health. It draws on newly geocoded and network-coded data from the Framingham Heart Study (FHS) to examine the determinants of proximity over time.

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

  • 2012. John D. DeLamater. Is There a Hormonal Component to Sexual Functioning in Later Life.

    There have been occasional studies of the relationship between levels of hormones and sexual desire and sexual behavior in men and women. The hormones most frequently studied have been dehydroepiandrosterone (DHEA and DHEA-S), estradiol, progesterone, and testosterone. The results of these studies have been mixed, due in part to the use of small samples and variation in the measurement protocols for the hormonal assays. Few studies have analyzed hormonal levels and sexual functioning in later life. Pollet, et al., (2011) reported that, among persons over 57 years of age, testosterone was significantly associated with lifetime number of partners among men but not women. Spark (2002) suggested, based on limited data, that DHEAS levels are associated with libido and sexual satisfaction in women over 60.
    The National Social Life, Health and Aging Project (NSHAP) provides for the first time the opportunity to analyze these relationships in a large, representative sample of older Americans. The sample includes 3005 men and women ages 57 to 85. The face-to-face interview obtained data on current sexual expression and relationship status, as well as retrospective relation and sexual history data. The interviewer requested that each participant provide a salivary specimen; 2, 721 agreed, and 2,640 were able to produce one. Salivary testing was carried out according to accepted protocols (Waite, et al., nd). The samples were assayed for cotinine, DHEA, estradiol, progesterone and testosterone.
    I will begin by looking at correlations between hormone levels and measures of sexual desire, frequency of kissing and hugging, frequency of “sex” (broadly defined by NSHAP), frequency of vaginal intercourse, and frequency of oral sex. These analyses will be carried out separately by gender, race/ethnicity, and age group; in the case of age, various groupings or “cut-offs” have been used in prior work. We will progress to the use of more complex statistical analyses which will enable us to control for various potentially confounding factors. An important one appears to be relationship status and quality.

    Priority Research Areas: Biology, Genetics and Demography of Aging

  • 2012. Pamela Herd. Veteran Status and Later-Life Health: Evidence from Sibling Fixed-Effects Models.

    There are numerous reasons to posit that veteran status is associated with health in later life. However, very few longitudinal studies of health or military service and health are able to disentangle age, period, and cohort effects or follow cohort members over very long periods of time. This pilot project plans to use data from the Wisconsin Longitudinal Study (WLS) to estimate sibling fixed-effects models of the association between veteran status and various mid- and later-life health outcomes among men, as well as among their spouses and children. We plan to expand this pilot project for a R01 grant application to NIA.

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

  • 2011. Alberto Palloni. Early Childhood Conditions, Reproduction of Socioeconomic Inequalities and the Persistence of Health Disparities.

    This project assesses the influence that early life conditions exert on adult outcomes and on adult health disparities. It opens up two new avenues of research, one substantive and the other methodological. On the substantive front we are attempting to account for the education health gradient using information on early childhood. The second path of research is purely methodological: we are utilizing combined data sets (WLS, NLSY-C, ECLS-K, NCDS58 and British Cohort 197) to carry out a fully comparative, cross country analysis.

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

  • 2011. James R. Walker. Meta–Analysis of the Effect of Education on Mortality.

    Abstract: For at least four reasons education is commonly used to proxy for socioeconomic status. First, education is an omnibus variable that influences alternative measures of socioeconomic status such as income, wealth, and occupation. Second, education is determined early into adulthood and before the onset of most chronic diseases. Therefore, education is less susceptible to problems of reverse causality as are income and wealth. Third, educational attainment is easier to measure than are say occupation or concepts such as social status or prestige. Fourth, there is an array of public policies designed to increase educational attainment. Consequently, identifying link between education and health and mortality offers direct, concrete and constructive guidance on beneficial public interventions to increase health or longevity. Nevertheless, education is heterogeneous and many different measures appear in the literature. This project will use a meta analysis of the educational gradient of mortality over the life course. The protective effects of education on health and the inverse relationship between education and (the timing of) mortality are among the most stable and most common findings in the broad literature investigating the relationship between socioeconomic status and mortality. The meta analysis will summarize effects of the quantity of education and of the effects of quality of education. There is a burgeoning literature on the effect of early life investments and adult health outcomes. Understanding and assessing these studies will be an important part of the meta analysis.

    Priority Research Areas: Methodology

  • 2011. Whitney P. Witt. The Impact of Preconception Health, Social Support, and Stress on Pregnancy and Birth Outcomes.

    There is a dearth of research examining the effects of health, social support, and stress prior to pregnancy and subsequent obstetric outcomes. The purpose of this study will be to evaluate the impact of preconception health, social support, and stress on pregnancy and birth outcomes among a nationally-representative sample of women and their babies. Multivariate logistic regression models will be developed to examine obstetric outcomes using the Early Childhood Longitudinal Study-Birth Cohort (ECLS-B).

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

Center-Supported Publications

Center Administrator/Media Contact: Janet Clear

Center for Health 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.

Pilot Projects

  • 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

  • 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, Population, Economic and Health Forecasting

  • 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: Population, Economic and Health Forecasting

  • 2020. Peter O'Donnell, MD, Associate Professor of Medicine, UChicago. Impact of Pharmacogenetics in a High Utilizer Program for Older Adults at Increased Risk of Hospitalization.

    Progress in pharmacogenomics (PGx) has led to identification of genetic variants that impact response or toxicity for hundreds of drugs. To address barriers to implementation, O’Donnell has developed a genomic prescribing system (GPS), which incorporates preemptive PGx test results and translates patient-specific genotypes into concise, real-time guidance integrated into the University of Chicago Medical Center’s (UCM) EPIC electronic health record. This pilot will evaluate whether the Comprehensive Care Physician (CCP) Program, designed to improve care for older adults at increased risk of hospitalization by giving them a physician who will care for them in and out of the hospital, may provide a stronger setting in which to assess the effect of the GPS system for PGx.

    Priority Research Areas: Biology, Genetics and Demography of Aging, Effects of Interventions on Population Health

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.

Pilot Projects

  • 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. 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

  • 2019. William Pan. Sarcopenia and Sarcopenic Obesity Assessment in the US Population.

    Project nearing completion.

  • 2018. Jenny Tung, Daniel Belsky. Biological Age in Rhesus Monkeys: Causal Effects of Early Development Stress and Social Status.

    Project completed.

  • 2018. Susan Alberts. Effects of Early Life Adversity on Maternal Care and Offspring Survival in Wild Baboons.

    Project nearing completion.

  • 2018. Terrie Moffitt. A Segment of the Population with Large Economic Burden: The New Zealand Integrated Data Infrastructure (NZ-IDI).

    Project Completed. Manuscript published Nature-Human Behavior.

  • 2018. Gregory Samanez-Larkin. Optimizing physical activity-related health promotion across adulthood using neuroimaging.

    Project completed.

  • 2017. Jen'nan Read. Disaggregating Ethnic Diversity in the Non-Hispanic White and Black Populations: Implications for Disability across the Life Course.

    Project completed. Manuscript under review.

  • 2017. Lynch, Scott. Cognitive and Happy Life Expectancy in the US.

    Project completed. Manuscript published Jo of Gerontology-Psychological Sciences

  • 2016. Jenny Tung. DNA methylation age in primate models of aging.

    R01 from NICHD recently awarded; R24 awarded January 2020.

  • 2016. Tyson Brown. Systematic investigation of racial/ethnic disparities in health among older adults.

    Manuscripts completed in Journal of Gerontology, Health and Social Behavior and Social Forces; NIA proposal in preparation.

  • 2016. Kenneth Land, Patrick J. Eric Stallard. Duke Alzheimer's Progress Index: Development of Software for Clinical Applications.

    Project completed. P30 Administrative Supplement awarded in 2018 for continuation of project now nearing completion. R01 in preparation.

  • 2016. Daniel Belsky. Advancing Translation of Molecular Signatures of Biological Aging.

    R21 awarded.

  • 2015. Elizabeth Frankenberg, Duncan Thomas. Computer-based Cognitive Testing of Adults following a Disaster.

    Project completed. R01 pending award.

  • 2015. V. Joseph Hotz, Candace Odgers. Pilot Study on Connectedness & Mobile Technology .

    Renewal proposal for CPHA includes Core D that extends this project to rural areas.

Center-Supported Publications

Center Administrator/Media Contact: Mimi Davis 


Center on Aging & 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.

Pilot Projects

  • 2020. Elliot Tucker-Drob. Faculty Research Associate — Ph.D., University of Virginia.

  • 2020. Chandra Muller. Professor, Alma Cowden Madden Centennial Professorship, Ashbel Smith Professorship.

  • 2020. Elizabeth Munoz. Assistant Professor Department of Human Development and Family Sciences, The University of Texas at Austin.

  • 2020. Jennifer Glass. Professor, Centennial Commission Professorship in the Liberal Arts #4, The University of Texas at Austin.

  • 2020. Marika Cabral. Associate Professor, Department of Economics, The University of Texas at Austin.

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

Pilot Projects

  • 2019. Andrew J. Fuligni. Family Stress and Inflammation-Related Gene Expression in Parent-Adolescent Dyads.

  • 2019. Elizabeth Zelinski. Understanding the role of subjective cognitive decline in determining risk of cognitive impairment cognitive impairment.

  • 2019. Jinkook Lee. Age, Literacy, and Magnetic Resonance Markers of Brain Integrity in LASI-DAD.

  • 2019. Kelly E. Rentscher. Chronic Stress and Accelerated Biological Aging: Social Support as a Protective Factor.

  • 2018. Catalina Zavala. Teasing Apart the Basis for Genetic and Environmental Associations Between Resources in Adolescence, Educational Attainment, and Occupational Complexity in Adulthood.

  • 2018. Kelly E. Rentscher. Stress and Aging Biology: Couples' Relationship Quality as a Protective Factor.

  • 2018. Kia Skrine Jeffers. Unfair Treatment within Employment, Criminal Justice, Education and Housing and Cardiometabolic Risk in the Multi-Ethnic Study of Atherosclerosis (MESA).

  • 2018. Thalida E. Arpawong. Characterizing the dynamic relationship between cardiovascular disease risk factors and cognitive ability over time.

  • 2017. Kelvin Yen. Modulation of cognitive decline by genetic variation in the mitochondrial humanin gene.

  • 2017. Margie Lachman. Physiological dysregulation as a predictor of cognitive decline.

  • 2017. Rebecca Melrose; Suzie El-Saden; David Sultzer. Neural markers of post-traumatic stress disorder (PTSD) in dementia: A VA medical chart review study.

  • 2017. Thalida E. Arpawong. Processing speed in aging: Mechanisms for ability and change related to genes and sex.

  • 2016. Arie Kapteyn. Devices to measure multiple physiological parameters in survey populations.

  • 2016. Deena Goldwater. Evaluating allostatic load as a predictor or cardiovascular disease risk relative to the ACC/AHA pooled cohort risk equation: Multi-Ethnic Study of Atherosclerosis (MESA).

  • 2016. Emma Aguila. Measuring the Effects of an Experimental Social Security Program for Poor Older Adults using Biomarkers Data.

  • 2016. Hiram Beltran-Sanchez. Estimating the Impact of Obesity on Adult Mortality: Assessment of Errors with Applications to the U.S., Costa Rica, Mexico and Puerto Rico.

  • 2015. Arun S Karlamangla. System dynamics in aging physiological systems: Implications of burnout, reactivity, and recovery.

  • 2015. Carol Prescott, Tara Gruenewald, Margaret Gatz & Jack McArdle. Development and Validation of Self-Administered Tablet Computer Cognitive Assessment.

  • 2015. David S. Black. Gene Transcription Profiling of Fatigue in Hispanic Colorectal Cancer Survivors: Targeting Residual Symptoms after Completion of Cancer Treatment in and Aging Probability Sample.

  • 2015. Patrick Heuveline. Launching a New Study of the Long-Term Health and Wellbeing Consequences of Malnutrition: A Feasibility Study and Rapid Assessment.

  • 2014. Steve Cole & Morgan Levine. Genome-wide Transcriptome Profiling in an HRS Pilot Sample.

  • 2014. Jennifer Ailshire, Sharon Merkin & Brian Finch. Economic Conditions & Social Disparities in Biological Risk among US Adults.

  • 2014. Keyonna King, Pinchas Cohen & Teresa Seeman. Assessing Biological Mechanisms Underlying Psycho-social & Cognitive Benefits of a Multi-Factorial Inter-Generational Intervention for Older Adults .

  • 2014. Peifeng Hu & Jinkook Lee. SES Gradients of Metabolic Syndrome in China and India.

  • 2012. John Strauss. Measuring Cognitive Function in Developing Countries.

  • 2012. Susan Enguidanos. Relationship and Timing of Advance Directives and Stated Care Preference on Frequency and Type of Care Setting Transitions in the Last Six Months of Life.

  • 2011. Thomas McDade. Dried blood spot methods for evaluating the regulation of inflammation.

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.

Pilot Projects

  • 2020. Dennis Feehan. Social network methods for estimating adult death rates in the absence of vital registration.

    Dates subject to NOA

  • 2020. Gretchen Donehower and Ron Lee. Population Aging and the demand for paid and unpaid care: the US in international context.

    Dates subject to NOA

  • 2020. Jim Carey. 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. A Pilot Trial of Gamification for Enhancing a Smoking Cessation App.

    At UCSF Dates subject to NOA

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

    Dates subject to NOA

  • 2019. Andres Cardenas. Resilient Epigenomes; DNA Methylation Signatures of "Blue-Zone" Residents.

  • 2019. Hilary Hoynes. The Effects of Employment Incentives and Cash Transfers on Adult Mortality: Evidence from the Long Run Effects of Welfare Reform Experiments.

  • 2019. Ming Hsu. Memory based choices and its neural substrates.

  • 2018. Daniel Schneider. Job loss and health among U.S. manufacturers: using Facebook to augment existing data sources.

  • 2018. Ellen Eisen. Deaths of Despair and Job Loss in a Cohort of Autoworkers.

  • 2018. Gretchen Donehower. Integrating care, age, and health: a database for hypothesis testing and generation.

  • 2018. James Carey. Lineage and Longevity.

  • 2018. Leora Lawton. Assessing Relationships Between Social Networks and Well-being.

  • 2018. Stephanie Child. Use of Redirected Inbound Call Sampling for Increasing Access to Research Participation among Black Americans.

  • 2017. Dow, William H. Health and Aging in Cuba.

  • 2017. Goldstein, Joshua. Towards a new, public data set for studying mortality inequality: Matching the 1940 U.S. Census with Social Security death records, 1963-2011.

  • 2017. Jagust, William. The Influence of Aging on Neural Systems Mediating Behavioral Responses to Financial Rewards.

  • 2017. Kariv, Shachar. Predicting Elderly Health Behaviors and Outcomes Using Decision-making Quality and Risk Attitudes.

  • 2016. Jonathan Kolstad and Benjamin Handel. Preventive Care Utilization and Health Effects of Physician Incentives and Information.

  • 2016. Joshua Goldstein. Hispanic Names, Acculturation, and Health.

  • 2016. Magali Barbieri. Beyond the HMD: Developing a Mortality Database for the Rest of the World.

  • 2016. Ronald Lee. The socioeconomic gradient in US Age-related transfers, health and mortality.

  • 2015. Ming Hsu. Tracking Decision-Making Capacities Across the Lifespan: New experimental approaches.

  • 2015. Alexander Gelber. The Effect of Social Security Benefits on Retirement: Evidence from the Notch Cohorts.

  • 2015. Luis Rosero-Bixby. Population Aging and Socioeconomic Inequality in National Transfer Accounts.

  • 2015. Ming Hsu. Game-Based Approaches to Measuring Decision-Making.

  • 2015. Rucker Johnson. Interlocking Pathways of Mobility from Education to Adult Health.

  • 2015. Stefano Dellavigna. Expert Forecasts: An Exploration on Health and Aging Experiments.

  • 2015. James Carey. Aging in Wild Drosophila Fruitfly Populations.

  • 2014. Emilio Zagheni. Empirical Bayes Approaches for Imperfect Human Mortality Data.

    Original pilot award through June 30, 2015. Carryforward request will be made in July 2015

  • 2014. William Dow. Epigenetic Characteristics of the High Longevity Nicoyan Population of Costa Rica.

  • 2014. Kenneth Wachter. Alleles Affecting Longevity as a Genome-Wide Statistical Ensemble".

    Original pilot award through June 30, 2015. Carryforward request will be made in July 2015

  • 2014. Ulrike Malmendier. Experiences and Expectations.

    Original pilot award through June 30, 2015. Carryforward request will be made in July 2015

  • 2014. Don Moore. Overconfidence Over the Lifespan.

  • 2014. Ming Hsu. Decline in monoamine turnover and its effects on decision-making in older adults.

  • 2014. Shachar Kariv. The quality of the economic decision-making of the elderly: A Combined Survey and Field experiment.

  • 2013. Ming Hsu. Decline in monoamine turnover and its effects on decision-making in older adults.

  • 2011. Ken Wachter. Genetic Markers in the Health and Retirement Study: Risk Aversion, Height, and Health.

  • 2010. Shachar Kariv. The Consistency and Heterogeneity of Individual Behavior under Uncertainty: A Combined Survey and Field Experiment.

  • 2009. William Dow. Using Group Commitment To Promote Smoking Cessation in Thailand.

  • 2009. Claude Fischer. Changes in Social Networks over the Later Life Cycle.

  • 2007. Ivry, Richard. The benefit of sleep on reward-based learning of gains and losses in older adults.

  • 2006. William Satariano. Environmental Correlates of Disability in an Older Population.

  • 2006. William Dow. Costa Rican Census Mortality Linkage.

  • 1999. John Wilmoth. Measurement of Mortality Differentials for the US.

  • 1999. Ronald Lee. Intergenerational transfers among the Maya of Yucatan.

  • 1998. Kenneth Wachter. Multivariate Indices of Short-term Risk of Death, Heart Failure, and Stroke in Elderly Persons.

Center Administrator/Media Contact: Maria Teresa Hernandez

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.

Center Administrator/Media Contact: Jason Mann

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

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.

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.

Pilot Projects

  • 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.

  • 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.

  • 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: Gina Rumore

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.

Pilot Projects

  • 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.

  • 2019. Frederick Conrad. Surveying Older Populations using Video Communication Technologies.

    This research project will examine age-related differences in data quality, participation, respondent experience, and costs in two types of interviews: video-mediated (live two-way communication via platforms like Skype) and video self-administered (video-recorded interviewers asking questions and respondents answering by typing or clicking). These two survey modes are promising because they use off-the-shelf video technology and are less costly than face to face interviews, but they are not yet widely deployed. The project will provide new insights regarding how video-based interviewing affects respondent behavior and experience in surveys, in particular, for older populations.

  • 2019. Neika Sharifian. The Cognitive Costs and Benefits of Social Technology use in Older Adulthood.

    Social engagement is an important protective factor for age-related cognitive decline and dementia. However, it is unclear whether social engagement through social technologies (i.e., texting, social media, video chat, email) demonstrate the same protective effects as face-to-face social interactions. The proposed study will assess whether previously-established social technology measures demonstrate measurement equivalence across younger and older adult populations and are psychometrically sound for use in older adults.

  • 2019. Noah J. Webster. Housing Context and Functional Health Among Lower Income Older Adults: The Mediating Role of Social Resources.

    Housing characteristics and disability in later life are closely tied, but whether housing can positively influence functioning through social resources is unclear. Using data from the National Health and Aging Trends Study (NHATS), this pilot study will determine if and which social resources are a pathway through which housing is related to functional health in later life.

  • 2018. Joshua Ehrlich. Vision Impairment, Participation and Subjective Wellbeing in Older Adults.

    Blindness and vision impairment affects 1 in 11 adults over age 65 in the United States. Among older adults, vision impairment is associated with loss of independence, decreased quality of life and increased morbidity and mortality. In this study, we explore the pathways through which vision impairment influences poorer subjective wellbeing and whether this association is mediated through participation or activity limitations.

  • 2018. Kristine Ajrouch. Measuring Alzheimer's Disease in Arabic-Speaking Populations.

    The incidence of mild cognitive impairment (MCI) and Alzheimer’s Disease and Related Dementias (ADRD) is higher among many racial/ ethnic minorities, but rates among Arab Americans, who exhibit more cardiovascular and other risk factors than whites, are unknown.  The first of its kind, this pilot study translates and validates established measures of cognition, function and behavior commonly used in MCI and ADRD diagnosis so they may be used with aging Arab Americans.

  • 2018. Sela Panapasa. The prevalence, distribution and correlates of disability and comorbidity in the Native Hawaiian and Pacific Islander aging population: results of a population-based study.

    This project undertakes the first systematic analysis of the 2014 Native Hawaiian Pacific Islander-National Health Interview Survey (NHPI-NHIS) to understand the burden of disease and disability among the aging NHPI population. This project will provide important baseline information on the aged NHPI population and inform future directions for research, intervention, and policy.

  • 2017. Roshanak Mehdipanah. Examining the Role of Housing Tenure and Health on the Aging Population in the U.S.

    This pilot study examines the relationship between housing characteristics and health among older Americans. Using the Health and Retirement Study, we hypothesize that, homeownership will have a protective effect over negative health outcomes in disinvested neighborhoods and that affordable housing and good housing conditions protect against negative health outcomes.

  • 2017. Courtney Polenick, Kira Birditt, Helen Kales. Multimorbidity Patterns in Aging Couples: Longitudinal Associations with Functional Disability.

    Using data from ten waves (1996 to 2014) of the Health and Retirement Studies, this study examines patterns of multi-morbidity both within and between spouses, focusing on concordance in the management activities required by multiple conditions.

  • 2017. Laura Zahodne. Cognitive resilience to depressive symptoms in diverse older adults.

    Significant knowledge gaps regarding the depression-dementia link include modifiable factors that attenuate this link and reasons for differences in resilience across racial groups. This pilot addresses these gaps by recruiting a racially diverse, population-representative sample of older adults for psychosocial, cognitive, and functional assessment and by examining how modifiable psychosocial resources that differ across race promote cognitive resilience to depressive symptoms.

  • 2017. Melissa Wei. Chronic diseases and physical functioning: development and validation of an ICD-coded multimorbidity indext.

    This pilot study uses patient-reported outcomes in the nationally-representative Health and Retirement Study and Medicare claims to develop and internally validate a multimorbidity index for International Classification of Diseases (ICD)-coded chronic conditions weighted to physical functioning. The study will yield a validated multimorbidity measure that captures the impact of coexisting chronic diseases on physical functioning in aging adults relevant for clinical care, research, and policy.

  • 2017. Neil Mehta. How do socioeconomic status, behaviors, and age interact to produce death risks?.

    This research evaluates the nature of interactions between two key socio-demographic variables (educational attainment, race/ethnicity) and two key behavioral risk factors (obesity and smoking) to determine whether the two sets of risk factors operate additively or multiplicatively with each to influence the chance of dying.

  • 2016. Christine Cigolle. Rural Older Adults with Cognitive Impairment and Chronic Disease: A Mixed Methods Study of Social and Health Factors in Their Care.

    This pilot undertakes a mixed-methods study of older adults with dementia in rural Michigan. The pilot addresses how rural older adults with dementia are cared for in their communities, as viewed by primary care physicians in those communities.

  • 2016. Cindy Lustig. Cholinergic genetic effects on health and cognition in older adults: Longitudinal analysis.

    Using the HRS representative sample of approximately 20,000 Americans over the age of 50, this pilot examines how limits in cholinergic function are related to changes in measurements of attention, memory, and cognitive status and physiological health across multiple time points.

  • 2016. Lauren Schmitz, Erin Bakshis Ware. Demographic and socioeconomic differences in polygenic risk of cardiovascular health in the Health and Retirement Study.

    This pilot examines the extent to which polygenic scores (PGSs) are associated with cardiovascular risk factors (i.e. systolic and diastolic blood pressure, body mass index, smoking, and alcohol use) and how these associations are modified by key demographic (i.e. sex, age) and socioeconomic factors across the life course.

  • 2016. Philippa J. Clarke. Muscle weakness among older adults: A silent epidemic.

    This pilot project charts new territory in investigating the long-term health consequences of dynapenia to: 1) predict whether individuals who fall below these proposed cut-points are at risk for developing future negative health outcomes; 2) examine proposed cut-points in predicting future health risks above and beyond traditional indicators of morbidity and mortality; and 3) understand the role obesity may play in exacerbating future negative health outcomes among those who are considered weak.

  • 2015. Jessica Faul, Colter Mitchell. The Effects of Collection Procedures on Telomere Length.

    Telomeres serve an important role in the protection of chromosomal DNA and the regulation of cellular senescence. The goal of this project is to examine the stability of salivary telomere length when stored at room temperature for periods of up to 1 year.

  • 2015. Martha J. Bailey, C. Hoyt Bleakley. Changes in Health and Longevity over the 20th Century: Evidence from North Carolina.

    This pilot demonstrates the feasibility of creating large-scale linked vital records to study changes in health and longevity over the 20th century. The pilot lays the groundwork for a multi-state resource called The Longitudinal, Intergenerational Family Electronic Micro-Database Project (LIFE-M), a large scale longitudinal database to cover men and women born 1881-1930.

  • 2015. Pamela Giustinelli. Understanding Uncertainty in Older Adults' Reports of Expectations: An Application to Long-Term Care Preferences.

  • 2014. Helen Levy, Kenneth M. Langa. Cognitive ability and awareness of hypertension in older Americans.

  • 2014. Colter Mitchell. Applying Whole Genome data to Common Social Science Issues.

  • 2014. Sarah Burgard. Understanding Recent Change in Gender Differences in Life Expectancy among Adults in Wealthy Countries.

  • 2013. Amelia Karraker, Robert F. Schoeni. Psychological Human Capital and Mortality across the Life Course: Evidence from the Panel Study of Income Dynamics.

  • 2013. Fabian T. Pfeffer. Do Grandma And Grandpa Matter? Uncovering the importance of the elderly for the socio-economic wellbeing of descendants.

  • 2013. Pearl Lee. Physical Activity among U.S. Adults with Diabetes and Prediabetes, 2006-2010.

  • 2013. Vicki Freedman. Translating a telephone instrument to the web: development of best practices.

  • 2012. Carey Sherman. Intergenerational Support and Caregiving in Late Life: The Role of Stepfamily.

  • 2012. Kenzie Latham, Philippa J. Clarke. Socioeconomic Disparities of Participation and Time Use among Disabled Older Americans.

  • 2012. Lauren Nicholas. Patient Long-Term Outcomes and Public Reporting of Hospital Quality.

  • 2012. Mary McEniry. Early Life Family and Community Environment and Older Adult Health: Linking US Census Data from the Early 20th Century with Puerto Rican Survey Data.

  • 2011. Arline T. Geronimus. Is the error in telomere length measurement introduced by EBV-immortalization of DNA random or systematic?: A Pilot Feasibility Study.

  • 2011. Lauren Nicholas, Cassandra Dorius. Will Changing Trends in Marriage Hurt Medicare?.

  • 2011. Melvin Stephens. Caloric Intake Changes at Retirement: Evolution Over Time.

  • 2011. Robert Stawski. Stressful Experiences in the Health and Retirement Study: Prevalence and Associations with Mental and Physical Health.

  • 2010. Amy M. Pienta, George C. Alter, James McNally. Retirement in the 1950s: Rebuilding a Longitudinal Database.

  • 2010. Christine T. Cigolle. Cognitive Impairment and Frailty in the Older Adult Population: Do the Outcomes Differ?.

  • 2010. David Lam, Rebecca L. Thornton. Living Arrangements of the Elderly and HIV/AIDS in Sub-Saharan Africa.

  • 2010. Deborah Lowry. Management of Old-Age Chronic Illness/Disease in Rural and Urban China.

  • 2010. Gwenith Fisher. Work Ability Among Older Workers in the HRS.

  • 2010. Lauren Nicholas. Economic Effects of Treatment Intensity: Elective Surgery, Paid and Unpaid Work.

  • 2010. Mary Beth Ofstedal, John Bound. Comparative Study of Physical Measures and Biomarkers in HRS and Its Sister Studies.

  • 2009. Arline T. Geronimus, Jay Pearson. Gender Differences in Stress-Mediated Wear and Tear with Age among Mexican Immigrants to the U.S.

  • 2008. David Lam, Murray Leibbrandt, Cally Ardington. The Impact of Illness and Death of Adult Children on the Elderly in South Africa.

  • 2008. John E. Knodel. Older-age Parents and AIDS in the ERA of ART, the Case of Thailand.

  • 2008. Kathleen Ford. HIV testing and Sexual Behavior among Older Thai Adults.

  • 2008. Mark Padilla, Haile Rhawa. Illness Narratives among Aging PLWHA in New York City.

  • 2008. William Axinn, Dirgha Ghimire. Social Change, HIV/AIDS, and Elderly Health and Well-Being in Nepal.

  • 2007. Toni Antonucci, Hiroko Akiyama, Kristine Ajrouch. Gender and Social Relations Across the Life Course in a Middle Eastern Cultural Context.

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.

Pilot Projects

  • 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

  • 2019. Adler-Milstein, Handel, Kolstad. Electronic Medical Records, Provider Behavior and Health Outcomes among the Elderly.

  • 2019. Aparna Soni. Pharmaceutical Access, Functional Outcomes and Implications for Caregiver.

  • 2019. J. Abaluck, P. Hull, A. Starc. Differential Mortality in Medicare Advantage.

  • 2019. R. Abramitzky, H. Williams, D. Fetter. End-of-Life Care in U.S. History.

    Priority Research Areas: The Dynamics of the Health Care Ecosystem

  • 2019. T. Gross, T. Layton, D. Prinz. Liquidity and Healthcare Consumption.

    Priority Research Areas: The Dynamics of the Health Care Ecosystem

  • 2019. Nicolai Kuminoff. Who Bears the Damage from Air Pollution's Effect on Dementia?.

    Priority Research Areas: Cognitive Aging and the Demography of Dementia

  • 2018. David Silver. Early Life Origins of Intergenerational Mobility.

  • 2018. Jessica Van Parys. Does Internet Access Affect Provider Choice and Health Outcomes of Medicare Beneficiaries.

  • 2018. Leila Agha. Provider Organizations and Care Coordination: Effects on Utilization, Quality and Outcome.

  • 2018. Molly Schnell, E. Meara, N. Morden. Understanding Opioid Prescribing Practice.

  • 2017. Amitabh Chandra, Doug Staiger, Maurice Dalton. Predicting the Impact of Hospital Closures on Patient Outcomes.

  • 2017. Bruce Weinberg. Measuring the Impact of Scientific Research on Health.

  • 2017. Jeffrey Clemens, Joshua Gottlieb. Financial Incentives and Long-Run Health Sector Capacity.

  • 2017. Nicole Maestas, David Grabowski, Brian McGarry. Improving Decision-Making by Older Adults in the Medicare Part D Program.

  • 2017. Timothy Layton. The Effect of Medicaid Managed Care on the Health of Aging Individuals with Disabilities.

  • 2017. Joseph Doyle, P.Gulur, M.Jacobsen. Pain Management for Opioid Tolerant Patients: A Randomized Controlled Trial.

  • 2015. David Chan. The Impact of Local Coverage Determinations on Costs and Patient Outcomes.

Center Administrator/Media Contact: Joan Stillwell 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.

Pilot Projects

  • 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

  • 2019. P. Gonalon Pons. The Persistent Feminization and Devaluation of Elder Care.

    Care work, both paid and unpaid, is currently under unprecedented pressure. Population aging and the lengthening of life expectancy are increasing demand for care labor, at the same time that existing social arrangements to meet care needs for the elderly are falling short. The pool of both paid and unpaid caregivers is compressing, in part due to the high economic penalties to specializing in caregiving, either in the family or in the market. This project argues that the feminization and devaluation of caregiving are central to understand shortages in caregiving labor supply and thus central, too, to imagine solutions to the current care crisis. To test this argument, I propose the first comprehensive and comparative analysis about the feminization and devaluation of elder caregiving across countries and care domains –paid and unpaid caregiving. I will use data from the Luxembourg Income Study (LIS) on paid care workers and data from the Multinational Time Use Survey (MTUS) on unpaid caregiving. Both datasets compile and harmonize nationally representative surveys and cover 30 countries and span over 4 decades. These data will be combined with a social policy dataset that will compile policy tools that shape the distribution and penalties of paid and unpaid caregiving (i.e. care leave, care allowances, pension regimes, etc.). This will build an unprecedented map on the political economy of elder care that will serve as a springboard for a novel research agenda on the origins and implications of devaluation and feminization of eldercare. This project contributes to the theme on economics and financing of health and aging by offering a gender and labor perspective that integrates and highlights the interdependency between paid and unpaid caregiving. This perspective will be developed to empirically interrogate how and why the feminization and devaluation persists over time and how it can be undone. This project also fills key gaps in sociological literature about paid and unpaid care work. This project presents the first large-N cross-national study of elder caregiving, it will integrate scholarship on unpaid and paid caregiving, and it will systematically examine the relationship between feminization and devaluation. Taken together, this project will offer a birds’ eye view on the political economy of elder care and why it matters for the future of caregiving, the well-being of the elderly, population health, and the economy at large.

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

  • 2019. S. Stites. Study Partners: Who are the research partners of persons with Alzheimer's disease and does it matter?.

    Alzheimer’s disease (AD) is the most common cause of dementia, affecting 5 million older adults in United States and causing cognitive and functional impairments that limit the ability to carry out activities of daily living.1 As a result, other individuals usually become involved in the care of persons with AD (PwAD). These individuals serve as “study partners” who report on cognitive function and other outcomes of PwAD in research studies, including clinical trials, and as “caregivers” assisting PwAD with IADLs and BADLs and informing on the functioning and wellbeing of PwAD during medical visits. They have powerful roles in the safety, health, and quality of life of PwAD and in the feasibility and integrity of AD trials. Many prior studies have examined the characteristics and outcomes of caregivers of PwAD but little is known about study partners. Who are they and how does who they are impact how reliably they report on the cognition of PwAD? It is crucial we learn the answers to these questions.  In this proposed study, we focus on characterizing study partners (N=532) of community-dwelling PwAD who were age 70 or older at the time of initial interview in Aging, Demographics, and Memory Study (ADAMS), a subsample of the Health and Retirement Study (HRS) that is nationally representative of older adults 70 and older. The purpose is to characterize study partners in nationally representative samples [specific aim (SA) #1], examine how being a study partner corresponds to caregiving duties (SA#2), and evaluate how characteristics of study partners correspond to how they report on cognition of PwAD (SA#3). Descriptive statistics and 95% confidence intervals will be used to describe and compare the demographic characteristics of study partners. Bivariate and multivariable generalized linear models will be used to examine the cross-sectional and longitudinal associations between study partner characteristics and each their engagement in caregiving duties and how they report on the cognition of PwAD.  This study advances what is known about SPs of PwAD by describing their characteristics in a population-based subsample and how, if all, their characteristics associate with patterns between being an SP and caregiver for PwAD and how they report on the cognitive function of PwAD. What’s discovered will inform design of AD clinical trials and also inform education materials for use in clinical care. The findings from this study will develop important pilot data to be used in submission of multi-site cohort study to NIH NIA that will build upon the existing HRS framework in order to study the experiences of both persons with “preclinical AD” (cognitively unimpaired persons with biomarker evidence of AD) and their study partners.

    Priority Research Areas: Cognitive Aging and the Demography of Dementia

  • 2018. I. Kohler. Social Networks, NCDs and Aging: Leveraging Social Dynamics for Efficient Health Interventions among Older Persons in Low-Income Countries.

  • 2018. K. Lasater. Evaluating A Hospital Intervention to Improve Care for Older Adults at the End of Life.

  • 2017. A. E. Curry, PI. Examination of population-based driver licensing and motor vehicle crash rates among older adults.

  • 2017. C. Boen. Biological Risk, Physical Functioning, and Psychosocial Stress among Older Age Hispanics.

  • 2017. M. Ryerson. Towards an Accessible Healthcare Travel Chain for Elderly Populations Through User-Centered Anthropologic Approach.

  • 2016. M. McHugh. The Effect of Nursing Work Environments on Alzheimer's Disease Patient Outcomes.

  • 2016. S. Preston. The Contribution of Diabetes to Mortality in the US.

  • 2016. HP Kohler. Mental Health, Migration and Mortality among Mature Adults in Malawi.

  • 2016. J.V. Ríos-Rull. Health Status and Consumption Growth.

  • 2015. C. Flippen. Transnational Aging: The Link Between Migration and Aging in Mexico.

  • 2014. L. Aiken/H. Smith. Healthcare Workforce and Quality Outcomes: Lessons from Chile, United States, and Europe.

  • 2014. J. Behrman. Early Life to Mature Adulthood: Guatemalan INCAP Health and Socioeconomic Data.

  • 2014. C. Flippen. Transnational Elder Care and the Financial Security of Low Income Mexican Immigrants in the US: A Case Study of Philadelphia, PA.

  • 2014. A. Starc. Pass-Through in a Highly Regulated Supply Chain - The Who, What, and Where of the US Drug Market.

  • 2013. I. Elo. Health and Well-being of African Migrants in the US and in their Country of Origin.

  • 2013. M Guillot. Study of Adult and Old-Age Mortality among Migrants and Their Descendants in France.

  • 2012. C. Valeggia. Metabolic Profiles of Female Reproductive Aging: A Comparative Study.

  • 2012. E. Fernandez-Duque. Sex Differences in the Life-History and Demography of Socially Monogamous Primates.

  • 2012. I. T. Elo. The Health of Black Immigrants in the United States and Comparisons with Countries of Origin.

  • 2012. IV Kohler/HP Kohler. Mental Health, Cognition and Aging in a Poor High-Risk Disease Environment.

  • 2012. J. Thompson Kolstad. Understanding Health Insurance and Policy Using the Massachusetts Health Reform.

  • 2012. O. Mitchell/K. Peijnenberg. Ambiguity Attitudes and Retirement Preparedness (Japan data).

  • 2012. S. Tishkoff. Biomarkers of Aging in Ethnically Diverse Africans: An Integrative Genomics Analysis.

  • 2011. C. Flippen. Relative Social Position and U.S. Internal Migration: Patterns by Race and Ethnicity.

  • 2011. F. Cunha. Health and Human Capital accumulation.

  • 2011. J. Kable/G. Zauberman. Neural Substrates of Anticipatory Time Perception and Time Discounting.

  • 2010. S. Preston. Sources of Aging in US States.

  • 2010. I. Elo/I.V.Kohler. Do parents in developing countries benefit from their children's education at old age?.

  • 2010. J. Schnittker. The Centrality of Schooling in Gene x Environment Interactions for Health.

  • 2009. C. Valeggia. Hormonal and cultural correlates of physical discomforts during the menopausal transition.

  • 2009. J. Kable/L.W. Chao. Neuroeconomics of Intergenerational Sacrifice: Why Mothers Eat Burnt Toast.

  • 2008. I. T. Elo. Early life conditions and familial correlations in cause-specific mortality.

  • 2008. R. Cnaan. Personal Attributes and the Financial Well-Being of Older Adults: The Effects of Control Beliefs.

  • 2008. S. Cnaan. Personal Attributes and the Financial Well-Being of Older Adults: The Effects of Control Beliefs.

  • 2008. Watkins, S. Aging in a Time of AIDS: The Impact of the Epidemic on Elderly in Rural Malawi.

  • 2007. A. DePaula. An Empirical Study on Behavioral Responses to AIDS.

  • 2007. D. Ewbank. Development of Methods for Applying Demographic Synthesis to Large Genome Scans.

  • 2007. H P Kohler/B. Soldo. Biomarkers in Malawi: Inflammation and CRP.

  • 2007. H. P. Kohler/S. Helleringer. A Population-based Study of the Transmission and Diversification of HIV-1 Using Molecular Genetic and Complete Sexual Network Data.

  • 2007. H. Park. Age Variation in the Relationship between Health Literacy and Self-Rated Health.

  • 2007. H. Park. Age Variation in the Relationship between Health Literacy and Self-Rated Health.

  • 2007. H.P. Kohler/LW Chao. HIV/AIDS and Intergenerational Transfers in Malawi.

  • 2007. K. Jedrziewski. Is Physical Activity a Viable Intervention to Lower the Risk of Dementia.

  • 2007. O. Mitchell/J.L. Ruiz. New Evidence on Annuity Choices in Chile: A Dynamic Programming Approach.

  • 2007. P. Todd. Retirement Savings and Unemployment Insurance.

  • 2007. S. Preston. The Effects of Nutrition and Disease on Child Growth and Adult Health.

  • 2007. S. Preston/R. Margolis. The Effects of Nutrition and Disease on Child Growth and Adult Health.

  • 2007. S. Watkins. Aging in a Time of AIDS: The Impact of the Epidemic on Elderly in Rural Malawi.

  • 2007. Soldo, B/Kohler, HP. Biomarkers in Malawi: Inflammation and CRP.

  • 2006. H. Park. The Literacy Gap between Those with High Levels and Low Levels of Educational Attainment among Older Adults: A Comparative Study of 20 Countries.

  • 2006. K. Volpp. Financial Incentives for Weight Loss.

  • 2006. C. Valeggia. Demographic Changes in Toba Villages in Transition.

  • 2006. H.P. Kohler/L.W. Chao. Trust and Transfers in South Africa: Linking Surveys.

  • 2006. I. T. Elo. Race/Ethnic and Immigrant Differences in Disability: What Can We Learn From the 2000 Census of Population?.

  • 2006. L. W. Chao. Does Poor Health Induce Myopia? An Investigation of Mortality, Morbidity, Aging, and Time Preference.

  • 2006. O. Mitchell. Contribution Patterns Under the Chilean Retirement Survey.

  • 2006. O. Mitchell. The Efficiency and Characteristics of Investment Choices Offered by 401(k) Pension Plans.

  • 2006. S. Preston/I.V. Kohler. The Muslim Mortality Puzzle in Bulgaria.

  • 2005. H.P. Kohler/S. Helleringer. HIV/AIDS and Complete Sexual and Social Networks in Rural Malawi.

  • 2005. O. Mitchell. Understanding Pension Literacy.

  • 2005. S. Preston. Factors Responsible for the Changing Sex Differentials in Mortality at Older Ages in US.

  • 2005. J. Behrman. Resource Flows Among Three Generations in Guatemala: Supplementary Analysis and Data Collection to (R01 HD 045627).

Center-Supported Publications

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