Trading years for perfect health: results from the health and retirement study

Aging-related fears and their associations with ideal life expectancy

Fears regarding various aspects tend to stimulate individuals to escape or to avoid the sources of the threat. We concluded that fears associated with the future aging process, like the fear of aging-related diseases, the fear of loneliness in old age, and the fear of death, would stimulate patterns of avoidance when it comes to ideal life expectancy. We expected fear of aging-related diseases and fear of loneliness in old age to be related to lower ideal life expectancies. We expected fear of death to be related to higher ideal life expectancies. In two adult lifespan samples [N₁ = 1065 and N₂ = 591; ages ranging from 18 to 95 years, M (SD)₁ = 58.1 (17.2) years, M (SD)₂ = 52.6 (18.1) years], we were able to support our hypothesis regarding fear of death. We furthermore found significant interactions among the fears, indicating that individuals fearing diseases or loneliness but being unafraid of death opted for the shortest lives. Our results indicate that fears regarding life in very old age might be associated with the wish to avoid this age period; the fear of death was however associated with the wish for particularly long lives, and thus, with distancing oneself from the dreaded event of death. We conclude that fears seem to be associated with how individuals approach old age and with what they wish for in their own future as aged people.

Preferred life expectancy and the association with hypothetical adverse life scenarios among Norwegians aged 60

BACKGROUND

how long older individuals prefer to live given hypothetical adverse changes in health and living conditions has been insufficiently studied.

OBJECTIVES

the objective of this study is to investigate the relationship between six adverse health and living conditions and preferred life expectancy (PLE) after the age of 60 years.

DESIGN

cross-sectional face-to-face interviews.

SETTING

population-based sample.

PARTICIPANTS

825 community dwellers aged 60 years and older in Norway.

METHODS

logistic regression models were used to analyse PLE, measured with a single question: 'If you could choose freely, until what age would you wish to live?' The impact on PLE of several hypothetical scenarios, such as being diagnosed with dementia, spousal death, becoming a burden, poverty, loneliness and chronic pain was analysed by age, sex, education, marital status, cognitive function, self-reported loneliness and chronic pain.

RESULTS

average PLE was 91.4 years (95% CI 90.9, 92.0), and there was no difference between men and women, but those at older ages had higher PLE than those at younger ages. The scenarios that had the strongest negative effects on PLE were dementia, followed by chronic pain, being a burden to society, loneliness, poverty and losing one's spouse. PLE among singles was not affected by the prospect of feeling lonely. The higher educated had lower PLE for dementia and chronic pain.

CONCLUSION

among Norwegians 60+, the desire to live into advanced ages is significantly reduced by hypothetical adverse life scenarios, with the strongest effect caused by dementia and chronic pain.

Investigation of the Predictors of Self-rated Health of Economically Disadvantaged African American Men and Women: Evidence for Sponge Hypothesis

Background and aims

According to the sponge hypothesis, compared to men's self-rated health (SRH), women's SRH is more likely to reflect conditions other than chronic medical conditions (CMCs) such as psychiatric disorders (PDs). As a result, poor SRH is a weaker predictive factor for mortality risk for women than men. Most of this literature, however, is done in samples that are predominantly middleclass White. To test the sponge hypothesis among economically disadvantaged African Americans (AAs), this study compared low-income AA men and women for the effects of the number of PDs and CMCs on SRH.

Materials and Methods

This cross-sectional study recruited a non-random sample (n = 150) of economically disadvantaged AA adults with PD(s). Structured face-to-face interviews were used to collect data. SRH was measured using a single-item measure. PDs and CMCs were also self-reported. We applied linear regression models to test the interactions between SRH and the number of PDs and CMC as well as gender.

Results

The number of PDs and CMCs were associated with SRH in the pooled sample of low-income AA adults with PD(s). However, we found a significant interaction between the number of PDs and gender. This interaction suggested a stronger association between PDs and SRH for AA women than AA men. Gender did not alter the association between the number of CMCs and SRH.

Conclusion

The number of PDs is a determinant of SRH for low-income AA women but not AA men, supporting the sponge hypothesis.

Motivation for Longevity Across the Life Span: An Emerging Issue

Over the past decades, increases in life expectancy in most modern societies have raised questions about whether and to what extent individuals value possible extensions of their personal lifetime. In this vein, a new field of research emerged that investigates the determinants, concomitants, and consequences of longevity values and personal preferences for an extended lifetime across adulthood. Based on a review of available theoretical and empirical work, we identified 3 mindsets on the challenges and potentials of human longevity common in research as well as personal views: (a) an essentialist mindset that builds on ideal principles of an infinite life, aimed at conquering or significantly postponing a biologically determined aging process, (b) a medicalist mindset that appraises aging as being primarily based on quality of health, and (c) a stoicist mindset that associates longevity and lifetime extension with the experience of grace and meaning. In this regard, we submit that motivation for longevity and its behavioral consequences differ depending on what mindsets individuals adopt in a given developmental context. We suggest that mindsets of longevity motivation are embedded in personal belief systems (e.g., death acceptance) that may depend on health, and on context influences (e.g., culture). Mindsets of longevity motivation may be related to differences in health behavior and late-life preparation. We illustrate such ideas with an exploratory analysis from a cross-cultural data set. We discuss the possible implications of these mindsets of longevity motivation for the aging sciences, and with regard to individual ways of approaching old age.

A (Latent) Class of Their Own: Response Patterns in Trading Off Quantity and Quality of Life in Time Trade-Off Exercises

BACKGROUND

Conflicting results regarding associations of time trade-off (TTO) valuations with respondent characteristics have been reported, mostly on the basis of regression analyses. Alternative approaches, such as the latent class analysis (LCA), may add to the further understanding of variations in TTO responses.

OBJECTIVES

To identify whether subgroups of respondents can be identified on the basis of their responses to TTO exercises and to investigate which respondent characteristics are associated with membership of the identified subgroups.

METHODS

Members of the Dutch general public, aged 18 to 65 years, completed a Web-based questionnaire concerning sociodemographic characteristics, three TTO exercises valuing health states described using the domains of the EuroQol five-dimensional questionnaire, and preference for quality versus quantity of life. LCA was used to identify patterns in the responses. Predictive variables were included in the final LCA model to identify the particular respondent characteristics that predict subgroup membership.

RESULTS

The sample consisted of 1067 respondents. Four latent classes were identified in the responses to TTO exercises. Two were high traders, focusing on quality of life and trading off a relatively high number of years. The other two were low traders, focusing on length of life. Predictive analyses revealed significant differences between subgroups in terms of age, sex, subjective life expectancy, and preference for quantity over quality of life.

CONCLUSIONS

We showed that distinct classes of respondents can be discerned in TTO responses from the general public, distinguishing subgroups of low and high traders. More research in this area should confirm our findings and investigate their implications for health state valuation exercises.

Old age expectations are related to how long people want to live

How long do people want to live? Why do some people want to live a very long time, and others would rather die relatively young? In the current study we examine the extent to which the preference to die young (<80 years, less than average life expectancy) or to live somewhat longer or much longer than average life expectancy (90-99 years or 100+ years, respectively) is related to a person's positive and negative expectations of what their life will be like in old age. We use multinomial regression analysis based on survey data from a large sample of younger and middle-aged adults in the United States of America (USA) (N = 1,631, age 18-64 years). We statistically control for socio-demographic characteristics as well as self-reported happiness and health. We find that having fewer positive expectations for their own old age distinguishes people who prefer to die relatively young, while having fewer negative expectations distinguishes people who want to live beyond current levels of life expectancy. The results provide evidence that pessimistic expectations of life in old age can undermine the desire to live up to and beyond current average life expectancy. The study also provides descriptive data about how young and middle-aged adults in the USA anticipate their own ageing.

"Back to the future": Influence of beliefs regarding the future on TTO answers

Background

A common approach to obtain health state valuations is the time-tradeoff (TTO) method. Much remains unknown regarding the influence of responder characteristics on TTO answers. The objective of this study is to increase understanding of the influence that beliefs regarding future health and death, as well as desires to witness certain life events, have on respondents’ health state valuations.

Methods

An online survey was designed, including three TTO questions using a 10 year timeframe. Moreover, respondents completed demographic questions, the Health-Risk Attitude Scale (HRAS), the Expectations Regarding Aging (ERA) questionnaire, questions about beliefs regarding future health (i.e. life expectancy) and death (i.e. fear of death, belief in life after death and opinion about euthanasia), and about important life events taking place within the TTO timeframe. Regression analyses were performed in order to assess the influence of these different variables.

Results

One thousand sixty-seven respondents were included in the analyses. The following variables were significantly associated with years traded off: ERA mental health (decrease), ERA physical health (increase), HRAS (increase), support for euthanasia (increase), fear of death (decrease) and consideration of an important life event (decrease). The explained variance of the final model was low (0.08).

Conclusion

TTO responses may be influenced by considerations of future health, including life events and attitudes regarding health risks and death. Further investigation of TTO responses remains warranted.

Electronic supplementary material

The online version of this article (doi:10.1186/s12955-015-0402-6) contains supplementary material, which is available to authorized users.

Cohort differences in the marriage-health relationship for midlife women

The present study aimed to identify potential cohort differences in midlife women's self-reported functional limitations and chronic diseases. Additionally, we examined the relationship between marital status and health, comparing the health of divorced, widowed, and never married women with married women, and how this relationship differs by cohort. Using data from the Health and Retirement Study (HRS), we examined potential differences in the level of functional limitations and six chronic diseases in two age-matched cohorts of midlife women in the United States: Pre-Baby Boomers, born 1933-1942, N = 4574; and Early Baby Boomers, born 1947-1956, N = 2098. Linear and logistic regressions tested the marital status/health relationship, as well as cohort differences in this relationship, controlling for age, education, race, number of marriages, length of time in marital status, physical activity, and smoking status. We found that Early Baby Boom women had fewer functional limitations but higher risk of chronic disease diagnosis compared to Pre-Baby Boom women. In both cohorts, marriage was associated with lower disease risk and fewer functional limitations; however, never-married Early Baby Boom women had more functional limitations, as well as greater likelihood of lung disease than their Pre-Baby Boom counterparts (OR = 0.28). Results are discussed in terms of the stress model of marriage, and the association between historical context and cohort health (e.g., the influence of economic hardship vs. economic prosperity). Additionally, we discuss cohort differences in selection into marital status, particularly as they pertain to never-married women, and the relative impact of marital dissolution on physical health for the two cohorts of women.

Modelling disparities in health services utilisation for older Blacks: a quantile regression framework

With the on-going ageing of the United States population, resolving health disparities continues to be a prominent and worthwhile goal, particularly in the areas of promoting minority health and reducing racial/ethnic disparities. This analysis employs the 2004 and 2005 Household Component records from the Medical Expenditures Panel Survey, which correspond to data files H89 and H97, to examine utilisation by race across the entire distribution function; more specifically, applying the behavioural model of health services utilisation and employing a Quantile Regression (QR) framework. This is a noteworthy contribution because the conditional mean may not be the best approximation for a skewed-location distribution. In contrast, QR is robust to outliers and scale effects since the estimation minimises least absolute deviation. The sample consists of 2,525 older adults at least 65 years of age with 303 corresponding to Black and 2,222 corresponding to White. Results suggest older Blacks continue to utilise health services (i.e. office or clinic visits with a physician or medical provider) at lower levels and this is more pronounced at and below the median quantile (i.e. below the 50th cut-off). Usual source of care (USC) continues to play an important role. Beliefs surrounding the need for insurance and medical intervention are also significant and explain some of the racial disparities. Although utilisation disparities persist for older Blacks, collaborative and flexible models of care can reach this group.

Demographic differences in health preferences in the United States

BACKGROUND

The United States has a culturally and demographically diverse populace, and the aim of this study was to examine differences in health preferences by sex, age, ethnicity, and race.

METHODS

We assessed preferences for health outcomes defined by the PROMIS-29 survey in a sample of the US population. On the basis of the survey's 540 paired-comparisons trading off lifespan and 7 domains of health-related quality of life (HRQoL), we compared the choices between men and women, adults age 18-54 years and 55 years and older, Hispanics and non-Hispanics, and non-Hispanic blacks and whites. For each subgroup, we estimated the value of 122 HRQoL outcomes on a quality-adjusted life year scale and tested for subgroup differences.

RESULTS

Compared with men, women preferred reduced lifespan over losses in HRQoL, particularly for depression. Compared with the younger adults, older adults preferred reduced lifespan over the symptoms of depression, anxiety, and fatigue. Compared with non-Hispanic whites, Hispanics preferred reduced lifespan over depression and sleep disturbance, but held similar values on losses in physical functioning. Among non-Hispanics, blacks preferred reduced lifespan over losses in ability to climb stairs and to fall asleep compared with whites, but held similar values on mental health outcomes.

CONCLUSIONS

With the growing emphasis on patient-centeredness and culturally sensitive treatment, it is important to recognize the diversity in values placed on potential losses in HRQoL, particularly mental health outcomes. Demographic differences in preferences may influence comparative or cost effectiveness of treatments as perceived by one or another subgroup.