Dynamics of Financial Hardship in the United States: Health and Retirement Study 2006-2016

The purpose of this study was to examine the temporal trends and dynamics of financial hardship among older adults in the U.S. between 2006 and 2016 using the Health and Retirement Study. Sample included a total of 13,537 eligible person observations with a median age of 68 years. Financial hardship included measures of difficulty paying bills, food insecurity, taking less medication due to cost, and ongoing financial strain. Regression analyses were performed using a three-wave quadrennial model to estimate the prevalence of financial hardship over time, to explore temporal patterns and identify persistent hardship. Findings reveal that 51% of respondents who experienced food insecurity at one or more waves were transient. This pattern was similar to respondents who experienced ongoing financial strain (52% transient). Respondents who reported difficulty paying bills (68%) and reduced medications due to cost (62%) were also transient. Significant predictors across all four domains of financial hardship include age, years of education, marital status, self-rated health. Being African American was positively associated with reduced medication use and food insecurity. This study provides insight into the temporal dynamics of financial hardship in later life. It also highlights the contiguous, intermediate and transient nature of financial hardship among older adult populations.

Modeling the impact of financial hardship and age on self-rated health and depressive symptoms pre/post the great recession

Stressful life events such as a recession, could be devastating on a macro and micro level. Although there have been a number of articles written examining the health effects of the recession, little is known about age differences in the relationship between financial stressors and health pre and post the 2008 recession. Using the Health and Retirement study, we investigated the relationship between two forms of financial hardships, mental and physical health among middle aged (N = 4403) and older adults) (N = 2709). Our findings indicate that with regard to financial hardships experienced pre/post recessionary periods there are differences by age. Specifically, older adults tend to report having less financial hardship than their younger counterparts. Additionally, reduced medication use due to costs was a significant predictor of poor self-rated health among middle aged participants compared to older adults. These results highlight the selective impact of recessions on certain age groups. They also suggests that economic recessions may also produce short-term procyclical health effects. Future research should focus on the relationship between other sources of financial hardship among middle-aged and older adults pre/post-recession at shorter time intervals.

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This is a longitudinal study using the Health and Retirement Study data from 2006-2016.

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Examines the relationship between financial hardships and health outcomes before, during and after the great recession.

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Few studies have explored age differences and financial-related stressors pre and post the 2008 recession.

Examining the Association of Pain and Financial Hardship Among Older Men by Race in the United States

Pain associated with financial hardship among older men varies by race. The purpose of this study was to examine the association of financial hardship with the presence of pain in men 50 years and older by race. Using the Health and Retirement Study (HRS) 2010 wave, bivariate and multivariate logistic regression models were used to assess the association between four financial hardship indicators and total financial hardship as a composite score, and the presence of pain by race. Among White men, the association between the presence of pain and hardship controlling for demographic factors was statistically significant across four indicators and one composite score: ongoing financial hardship (OR = 1.29, 95% CI [1.02, 1.64]), food insecurity (OR = 2.55, 95% CI [1.51, 4.31]), taking less medication due to cost (OR = 2.12, 95% CI [1.40, 3.22]), difficulty paying bills (OR = 1.36, 95% CI [1.07, 1.73]), and total financial hardship (OR = 1.27, 95% CI [1.12, 1.44]). Among African American men, the association between the presence of pain and taking less medication due to cost (OR = 2.99, 95% CI [1.31, 6.85]) was significant. With increasing comorbidities among older adults, particularly African Americans, it is imperative to fully understand the mechanisms of this underexplored area in both the pain and financial hardship literature.

The price of mental well-being in later life: the role of financial hardship and debt

OBJECTIVE

This study investigated the associations between various financial hardship and debt indicators and mental health status among older adults.

METHODS

Using data from the Health and Retirement Study (HRS), we considered the association between different forms of financial hardship and debt of those who were identified as having high levels of depressive symptoms (N = 7678) and anxiety (N = 8079). Financial hardship indicators: difficulty paying bills, food insecurity, and medication need; debt indicators: credit card and medical debt. Associations were tested using multiple logistic regression analyses and are reported as relative risk (RR) ratios and 95% confidence intervals (CIs).

RESULTS

Participants who had difficulty paying bills were more likely to have high levels of depressive symptoms (RR = 2.06, CI = 1.75-2.42, p < 0.001) and anxiety (RR = 1.46, CI = 1.02-2.05, p < 0.001) compared to those who did not have financial difficulty. Similarly, medical debt was associated with depressive symptoms (RR = 1.43, CI = 1.14-1.74, p < 0.01) and anxiety (RR = 1.20, CI = 0.96-1.50, p < 0.01). Credit card debt was not significantly associated with either mental health outcome.

CONCLUSION

Indicators of financial hardship and medical debt were associated with depressive symptoms and anxiety in a cohort of older adults. In contrast, the influence of credit card debt appeared to be more complex and vary by individual. These findings indicate that doing without meeting personal salient needs has a particularly adverse effect on psychological well-being.

Interactive Effects of Chronic Health Conditions and Financial Hardship on Episodic Memory among Older Blacks: Findings from the Health and Retirement Study

Previous research links chronic health conditions and financial hardship to cognitive outcomes among older Blacks. However, few studies have explored the moderating effect of financial hardship on chronic disease burden and specific cognitive domains. This study examined whether financial hardship (as measured by difficulty paying monthly bills) modifies the impact of self-reported chronic health conditions (e.g., diabetes, stroke) on episodic memory among 871 older Blacks (50+ years) in the Health and Retirement Study (2006). Financial hardship modified the association between chronic disease burden and episodic memory performance such that individuals who reported very little difficulty paying their monthly bills had significantly lower memory scores at high levels of disease burden compared to those reporting high financial difficulty after controlling for age, gender and education (F 2, 49 = 5.03, p= 0.010). This cross-sectional study suggests that both financial and physical wellbeing may have joint effects on cognitive health in older Blacks.

The Moderating Effect of Social Support and Social Integration on the Relationship Between Involuntary Job Loss and Health

Background:

Job loss is a stressful life event that is associated with changes in somatic, behavioral, and affective well-being. This cohort study investigates whether social support and social integration moderate the relationship between job loss and mental health.

Methods:

Data from four waves of the Americans’ Changing Lives data set were collapsed into three wave-pairs. Our sample comprised 1,474 observations, from which we identified 120 job losses. We applied longitudinal regression models in benchmark moderation analysis; finite mixture modeling was then applied to investigate complex heterogeneity.

Results:

Our findings suggest that social support, and not social integration, buffered the involuntary job loss–depressive symptoms relationship among a subgroup of individuals who were more likely to be White, higher educated, and have higher social support prior to job loss.

Conclusion:

Policies that incentivize education, promote financial and health literacy, and strengthen families may reduce vulnerability to the mental health effects of job loss.

Gender differences in the association between modifiable risk factors and financial hardship among middle-aged and older adults

Objective

To identify associations between modifiable risk factors (cigarette smoking, alcohol consumption, and obesity) and financial hardship (difficulty paying bills, food insecurity and medication need) among middle-aged and older Americans in a nationally representative sample.

Methods

This was a cross-sectional study of 8212 persons age 50 years and older who completed the core 2010 Health and Retirement Study survey and the psychosocial questionnaire. We ran separate multinomial logistic regressions to assess the association of three modifiable risk factors and three different financial hardship indicators.

Results

Adjusting for all covariates, compared to men of normal weight, men who were obese had a 1.4 greater odds of difficulty paying their bills (95% CI: 1.08–1.76); former smokers had a 1.8 greater odds of being food insecure (95% CI: 1.05–2.95); current smokers were twice as likely to be food insecure (95% CI: 1.21–3.73); Compared to women who never smoked, current smokers had a 1.5 greater odds of having difficulty paying their bills (95% CI: 1.11–2.02); current smokers had a 1.8 greater odds of being food insecure (95% CI: 1.13–2.91); and women who were obese had a 1.5 greater odds of reducing medication due to cost (95% CI: 1.11, 2.02).

Conclusion

Our findings contribute to the literature on health behaviors and financial hardship by highlighting the cyclical nature between different indicators of socioeconomic status, modifiable risk factors, and poor health outcomes among middle-aged and older adults. Furthermore, findings highlight how modifiable risk factors may culminate in financial hardship in later life.

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This study contributes to the literature by describing the connection between health and individual and family finances.

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More than 60% of women in our sample had difficulty paying bills

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Close to 70% of women were food insecure, and 70% reduced medication use due to cost

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Modifiable risk behaviors – often socioeconomically patterned, may culminate in financial hardship in later life.

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This study highlights the importance of ongoing efforts to improve income equity between the genders.

Community engagement with African American clergy: faith-based model for culturally competent practice

OBJECTIVE

The intent of this exploratory qualitative study was to examine African American Baptist clergy's pastoral care to older congregants with mental disorders. Critical Race Theory was the guiding framework in this study.

METHOD

A purposive sample of 18 African American clergy participated in one-on-one interviews.

RESULTS

Collectively, all participants were active in the provision of mental health to older congregants with mental disorders. The primary emergent theme 'shepherding the flock' the central phenomenon uncovered in the data, was used to organize a model of pastoral care, which is presented in this paper. Findings from this study supported results from previous studies on the integral role of the Church and clergy in the African American community.

CONCLUSION

Moreover, this study highlights the importance of internal ministries in the Church and the need for further study and potential partnership opportunity.

Pain and Hardship Among Older Men: Examining the Buffering Effect of Medicare Insurance Coverage

To better understand the health status of men in the United States, this study aimed to assess the association of hardship on the presence of and pain severity among men 50 years of age and older. Cross-sectional multivariate logistic regression analyses were conducted using the 2010 wave of the Health and Retirement Study (N = 3,174) to assess the association between four hardship indicators and the presence of pain and pain severity among this sample of older men.

Results suggest that the association between the presence of pain and hardship was statistically significant across all four indicators: ongoing financial hardship (CI [1.05, 1.63], p < .05), difficulty paying bills (CI [1.42, 3.02], p < .001), food insecurity (CI [1.46, 3.15], p < .001), and not taking medication due to cost (CI [1.06, 1.66], p < .05), even after adjusting for all demographic factors.

The associations between pain severity and ongoing financial strain (CI [1.23, 2.83], p < .01) and difficulty paying bills (CI [1.02, 3.18], p < .05) were statistically significant. Results also indicate that education was a buffer at all levels. In addition, the interactive effect of hardship and Medicare insurance coverage on pain severity was significant only for ongoing financial strain (CI [1.74, 14.33], p > .001) and difficulty paying bills (CI [1.26, 7.05], p < .05). The evidence is clear that each hardship indicators is associated with the presence of pain and across some of the indicators in pain severity among men aged 50 and older. In addition, these findings stress the importance that Medicare insurance plays in acting as a buffer to alleviate some of the hardships experienced by older men. These findings also highlight the association between the presence of pain and pain severity for the overall quality of life, health outcomes, and financial position of men in later life.

The association between hardship and self-rated health: does the choice of indicator matter?

PURPOSE

The purpose of this study was to investigate the association between four specific forms of hardship (difficulty paying bills, ongoing financial stress, medication reduction due to cost, and food insecurity) and self-rated health among older men and women.

METHODS

Cross-sectional logistic regression analysis was conducted using the 2010 wave of the Health and Retirement Study Leave-Behind Questionnaire (N = 7619) to determine the association between four hardship indicators and self-rated health. Hardship indicators (difficulty paying bills, ongoing financial stress, medication reduction due to cost, and food insecurity) were dichotomized (0 = no hardship, 1 = yes hardship) for this analysis.

RESULTS

After adjusting for sociodemographic factors, participants reporting difficulty paying bills had an 1.8 higher odds of reporting poor self-rated health (95% confidence intervals [CI]: 1.57, 2.15) and those reporting taking less medication due to cost had a 2.5 times higher odds of poor self-rated health (95% CI: 1.97, 3.09) compared to those not reporting these hardships. When stratified by gender, and adjusting for sociodemographic factors, men who took less medication due to cost had a 1.93 higher odds of low self-rated health (95% CI: 1.39, 2.67) and women who took less medications due to cost had a 2.9 higher odds of reporting poor self-rated health (95% CI: 2.23, 2.70) compared to women not reporting these hardships.

CONCLUSIONS

Research in this area can provide greater conceptual and measurement clarity on the hardship experience and further elucidate the pathway between specific hardships and poor health outcomes to inform intervention development.

Older adults rate their mental health better than their general health

Background.

Self-rated health (SRH) shows strong associations with measures of health and well-being. Increasingly, studies have used self-rated mental health (SRMH) as a predictor of various outcomes, independently or together with SRH. Research has not firmly established if and how these two constructs differ. We sought to characterize the relationship between SRH and SRMH, and to determine how this relationship differed across subgroups defined by sociodemographic and health-related characteristics.

Design and methods.

We analyzed data from the 2012 CAHPS Medicare Advantage Survey. SRH and SRMH ratings were crosstabulated to determine the distribution of responses across response categories. The expected joint probability distribution was computed and compared to the observed distribution. A constructed variable indicated whether SRMH was better, the same, or worse than SRH. We analyzed the distribution of this variable across various subgroups defined by sociodemographic and health-related factors.

Results.

A total of 114,905 Medicare Advantage beneficiaries responded to both the SRH and SRMH questions. Both in general and within all subgroups, SRMH was usually rated as better than SRH, and rarely as worse.

Conclusions.

Within a large group of Medicare recipients, the overwhelming trend was for recipients to rate their mental health as at least as good as their overall health, regardless of any sociodemographic and health-related factors. This finding of a shifted distribution encourages caution in the analytic use of selfrated mental health, particularly the use of both SRH and SRMH for adjustment. Additional research is needed to help clarify the complex relationship between these variables.

Material Hardship and Self-Rated Mental Health among Older Black Americans in the National Survey of American Life

This article examines the association between material hardships and self-rated mental health (SRMH) among older black Americans and determines whether the effect varies by race and ethnicity. Using data from the National Survey of American Life, multiple logistic regression models were specified on a sample of older white Americans (n = 289), African Americans (n = 1,135), and black Caribbean Americans (n = 377). Material hardship was measured as an index of seven items that occurred within the past year. Material hardship (odds ratio = 0.48; 95 percent confidence interval = 0.29-0.79) was associated with SRMH for both groups. None of the interactions were significant. The study concludes that material hardship may contribute to poorer SRMH among older African Americans and black Caribbean Americans. Future studies should examine these associations by using longitudinal designs, which may be better designed to confirm these results.

Patient Planning and Initiative Enhances Physician Recommendations for Cancer Screening and Prevention

BACKGROUND

The growing population of older adults is at the highest risk for cancer, yet they are underserved in terms of cancer prevention and care. Discussions between patients and physicians that result in tailored recommendations are now called for by the U.S. Preventive Services Task Force.

AIMS & METHOD

The current study explored the role of physician-patient relationships and of patient initiatives in health communication on primary care physicians' recommendations of cancer prevention and screening. Our data was collected from baseline questionnaires from elderly patients 60 years of age or older (N=360) who attended an adult community center where an educational intervention was administered.

RESULTS

Our findings demonstrate the importance of elderly patients' advocacy, shown through planning and initiative in communication for eliciting doctor's cancer screening and cancer prevention recommendations in primary care settings.

Association of socio-demographic factors and parental education with depressive symptoms among older African Americans and Caribbean Blacks

OBJECTIVE

The purpose of this study was to examine ethnic variation in the relationship between individual socio-demographic factors, parental educational level, and late-life depressive symptoms in older African Americans and Caribbean Blacks.

METHOD

This cross-sectional study used data from the National Survey of American Life. A subsample of older African Americans (N = 837) and Caribbean Blacks (N = 271) was analyzed using multiple regression analysis.

RESULTS

Findings suggest differences in predictors of depressive symptoms for the two ethnic groups. Among older African Americans, lower educational attainment and lower income were predictive risk factors for higher depressive symptoms. Findings among older Caribbean Blacks suggest that nativity and income were significantly associated with depressive symptoms. This study did not find support for any association between parental education and late-life depressive symptoms.

CONCLUSION

This study adds new information by considering ethnic variation in an examination of depressive symptoms in older Black Americans. The results contribute to the growing awareness of the older Caribbean Black population in the United States.

Perceived discrimination and social networks among older African Americans and Caribbean blacks

The relationship between perceived discrimination and depressive symptoms among older black American populations is poorly understood. Although a small number of studies have examined the relationship between stress and social support, few have examined the association between perceived discrimination, social networks, and depressive symptoms among a representative sample of older racial and ethnic groups. This study examines (a) the relationship between sociodemographic factors, perceived discrimination and depressive symptoms and (b) social networks as a potential moderator in the perceived discrimination and depressive symptom relationship between 2 groups of older black Americans. This was a cross-sectional study using data from the National Survey of American Life with a sample of older African Americans (N = 837) and Caribbean blacks (N = 271). Depressive symptoms were assessed using the 12-item Center for Epidemiological Studies Depression scale. Linear regression analyses were used to predict depressive symptoms. The relationship between perceived discrimination and depressive symptoms was significant in both groups. Social networks contributed as a protective factor for depressive symptoms for both groups. However, there was no significant moderation effect. Results suggest that regardless of ethnic affiliation, the experience of perceived discrimination is similar in both groups and is a risk factor for depressive symptoms. Future research is needed in this area to better understand the associations between sociodemographic factors, perceived discrimination, social networks, and their impact on depressive symptoms.

Rural African American clergy: an exploration of their attitudes and knowledge of Alzheimer's disease

Rural African American clergy's ability to recognize Alzheimer's Disease (AD) and their capacity to provide support to elders with this illness has been neglected in the literature. Using a mental health literacy framework, the purpose of this research was to explore rural African American clergy knowledge and beliefs of AD. In-depth interviews were conducted with 9 African American clergy who oversaw churches in central Kentucky. Although few had direct experience with providing pastoral care to elders with AD, all clergy were literate and aware of the need for additional training. This study seeks to further clarify the role of African American clergy and their understanding of AD to inform the future development of appropriate interventions and establish better collaborative community treatment relationships.

Evidence for decreased transport of tryptophan hydroxylase in Alzheimer's disease

Tryptophan hydroxylase (TPH) is the rate-limiting enzyme in the synthesis of serotonin and a specific marker for serotonergic neurons. These neurons are affected in Alzheimer's disease (AD) in several ways: serotonin is decreased in axon terminals, serotonin neurons accumulate neurofibrillary protein, and these neurons are lost in AD brains. One subcellular mechanism which may underlie degeneration of neurons in AD is decreased axonal transport with accumulation of enzymes and their potentially toxic metabolites in the cell body. To determine whether there is a defect in axonal transport in serotonin neurons in AD we measured TPH activity, serotonin and its oxidative metabolite 5-hydroxyindoleacetic acid (5-HIAA) in dorsal raphe cell bodies from Alzheimer and control cases. TPH activity is increased 4.7-fold in raphe neuron cell bodies in Alzheimer brains. Serotonin and 5-HIAA are increased by 4.0- and 2.0-fold, respectively in Alzheimer compared to control raphe cell bodies. In contrast, in synaptic terminals of the amygdala 5-HT and 5-HIAA were decreased by 41% and 50%, respectively in the same AD cases. We propose that the accumulation of TPH and its products in the raphe perikarya in AD results from a diminished transport of TPH to axon terminals. The accumulation of oxidative metabolites of serotonin may contribute to the degeneration of serotonergic neurons in AD.

Evidence for decreased transport of PNMT protein in advanced Alzheimer's disease

Phenylethanolamine N-methyltransferase (PNMT) is the rate-limiting enzyme in the synthesis of epinephrine and a specific marker for adrenergic neurons. PNMT protein is decreased in axon terminals in brains from patients with Alzheimer's disease due to retrograde degeneration of epinephrine neurons. To determine the subcellular mechanism underlying retrograde degeneration, the distribution of PNMT between axon terminal and cell body was calculated in early and advanced Alzheimer cases compared with age-matched controls. In early Alzheimer's disease there is a decrease in PNMT in axon terminals and in total PNMT in epinephrine cell bodies and terminals compared with control values. There is no difference in the ratio of PNMT in cell body/axon terminal compared with controls. In contrast, in advanced Alzheimer's disease, PNMT activity increases by 124% in epinephrine neuronal cell bodies compared with controls. Immunochemical titration shows that this increased enzyme activity is due to an increase in PNMT protein. The cell body/axon terminal ratio of PNMT is increased 2.5-fold in advanced Alzheimer's disease compared with controls. These findings are consistent with the hypothesis that in early Alzheimer's disease there is a decreased synthesis or increased degradation of PNMT. However, in advanced Alzheimer's disease we propose that the accumulation of this enzyme in the perikarya results from a diminished transport of PNMT to axon terminals. We further postulate that epinephrine, the product of PNMT, and its further metabolites are endogenous neurotoxins. Therefore, the accumulation of PNMT in epinephrine cell bodies may contribute to the degeneration of these neurons in Alzheimer's disease.

Detection of 3,4-dihydroxyphenylglycolaldehyde in human brain by high-performance liquid chromatography

The monoamine oxidase A metabolite of noradrenaline, 3,4-dihydroxyphenylglycolaldehyde, is the precursor of 3,4-dihydroxymandelic acid, and 3,4-dihydroxyphenylglycol, metabolites of noradrenaline. Owing to difficulties in purifying this aldehyde, it has not been previously characterized or identified in biological sources. This paper describes an enzymatic synthesis, purification, and characterization of 3,4-dihydroxyphenylglycolaldehyde. The aldehyde metabolite is identified in postmortem human brain using high-performance liquid chromatography and electrochemical detection. We estimate the concentration in human hippocampus to be 0.164 +/- 0.05 nmol/g. The importance of this aldehyde metabolite of noradrenaline is discussed.

Evidence for retrograde degeneration of epinephrine neurons in Alzheimer's disease

Alzheimer's disease (AD) is associated with a progressive loss of locus ceruleus neurons. These noradrenergic neurons receive a major afferent projection from epinephrine neurons in epinephrine cell groups in the brainstem. The epinephrine neurons have a specific enzymatic marker, phenylethanolamine N-methyltransferase (PNMT), which allows them to be identified chemically and immunohistochemically. We have previously reported a decrease in PNMT in brains of patients with AD. We now report that the decrease in PNMT activity in projections to the locus ceruleus is not due to the loss of epinephrine neurons, although up to 33% of these neurons are atrophic. The decrease in presynaptic PNMT does, however, correlate with the loss of postsynaptic locus ceruleus neurons in brains from AD patients. The percentage of degenerating neurons in the epinephrine nuclei also correlates significantly with the amount of loss of locus ceruleus neurons in AD. In addition, there is a 55% decrease in mitogen activity, a nonspecific measure of growth or maintenance factors, in dialysed locus ceruleus extracts from the AD patients compared to those from control subjects. The mitogen activity in the locus ceruleus was significantly correlated with PNMT activity and with the density of locus ceruleus neurons in all cases examined. These findings provide evidence for the hypothesis that retrograde degeneration is a mechanism of neuronal degeneration in AD and suggest that trophic factors may play a role in this process.

Fluorinated phenytoin anticonvulsant analogs

Six ring-fluorinated phenytoin analogs were synthesized, and their anticonvulsant activity in the maximal electroshock seizure and subcutaneous pentylenetetrazol assays was determined. 5-(4-Fluorophenyl)-5-phenylhydantoin, 5-(3-fluorophenyl)-5-phenylhydantoin, and 5,5-bis(4-fluorophenyl)hydantoin were active in the maximal electroshock seizure assay. The compounds were much less potent than phenytoin but showed an extremely long duration of action.

Short-term consumption effects of a lower minimum alcohol-purchasing age

Multiple-regression analysis revealed that apparent short-term increases in consumption of distilled spirits after reductions in minimum legal purchasing ages were not statistically significant.