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The National Institute on Aging (NIA), the newest of the 11 National Institutes of Health, is dedicated to improving the quality of life of the old in America through biomedical, social, and behavioral research. Aging is viewed as more than just decline and deterioration; it is also a process of continued development and accumulated knowledge. The NIA will encourage innovative research but will not support the delivery of health services, as that is the domain of the other agencies. In areas of overlap, such as diseases common to the old, the NIA will collaborate with other Institutes. A good target area for collaboration is senile dementia. Other areas of interest to the NIA are: encouraging the incorporation of geriatric medicine as a subspecialty, developing retirement test patterns, and investigating drug-drug and drug–age interactions, personality and social processes, and immunocompetence. [ABSTRACT FROM AUTHOR]

Objective: To review and synthesise research related to the ageing farming workforce influence on the health and sustainability of agricultural communities. Design: Using the PRISMA framework as a guide, the CINHAL and Medline databases were searched. Search 1 used the key search terms of ageing OR aging, farm*, workforce. Search 2 used health, sustainability and 'agricultural OR farm communit*. Search 3 combined Searches 1 and 2. Search 4 followed journal citations to identify other relevant articles. A process of narrative synthesis was applied to the results through the prism of rural social capital that described the current state of knowledge and understanding under four themes. Result: Database searches and searching of citations identified 16 contemporary articles. Seven of the papers were from Australia, and the balance from five other high‐income countries. The four that themes emerged are: vulnerabilities of ageing farmers; economic and climatic drivers; social capital and sustainability; and integrative strategies, that might offer a way forward. Conclusion: Integrating these forces of nature, economics and sociology to address the ageing farming workforce and the associated health and sustainability of agricultural communities remains a major challenge for researchers, governments, the agricultural sector and rural communities. [ABSTRACT FROM AUTHOR]

Family quality of life (FQOL) is a multidimensional social construct that can be used to enhance a family's well‐being by providing a framework to plan interventions and evaluate outcomes. Although researchers and policymakers see value in the FQOL domains and dimensions, families and practitioners are often skeptical of lengthy evaluations and aggregate scores. Furthermore, many practitioners find that family caregivers who require support and services overwhelmingly focus on the family member needing the most care. In doing so, they perceive their situations in a "spaghetti‐like" way. This strong focus on one aspect of the situation, or one "spaghetti" strand, can result in conversations about planning and implementing interventions becoming cyclical, like a messy tangle of strands. The FQOL lens can be used in intervention planning to transform overlapping spaghetti‐like thoughts into a waffle‐like system of interconnected and compartmentalized thoughts. The purpose of this paper was to describe the individual‐level application of the FQOL theory to plan and evaluate the benefits of a peer‐mediated family empowerment project for aging caregivers of adults with intellectual/ developmental disabilities in Michigan, USA. The study provides examples of how individual‐level FQOL evaluation at pretest informed the development of individualized action plans that focused on the strengths, desires, and challenges of 100 aging families in this statewide project. [ABSTRACT FROM AUTHOR]

As populations in the United States and around the world continue to age, it has become increasingly important to understand how organizations can create working conditions that attract, support, and retain workers across the lifespan. In this paper, we provide a primer on current theory and research on age in the workplace. We briefly describe lifespan theories that have guided recent advances in the field, discuss the implications of these theories for an aging workforce, and provide an overview of current research streams that address the work and nonwork factors affecting performance, well‐being, and workforce participation among mature workers. Based on this review, we provide recommendations for future research and practice. [ABSTRACT FROM AUTHOR]

BACKGROUND: The need for mentorship in aging research among postdoctoral trainees and junior faculty across medical disciplines and subspecialties is increasing, yet senior personnel with expertise in aging are lacking to fulfill the traditional dyadic mentorship role. Facilitated peer mentorship is grounded in collaborative work among peers with the guidance of a senior mentor. METHODS AND RESULTS: We evaluated the Columbia University Mentor Peer Aging Research (CoMPAdRE) program, an interprofessional facilitated peer mentorship program for early stage investigators, using the Reach Effectiveness Adoption Implementation and Maintenance framework (RE‐AIM). Reach: A total of 15 participants, of which 20% were women, from five states and across six medical specialties participated. Effectiveness: Participants published 183 papers, of which more than 20% were collaborative papers between CoMPAdRE mentees or mentees‐mentor. Participants reported developing skills in negotiation, navigating the academic role, organizing a seminar, management, and leadership over the course of the program. According to the qualitative findings, the most important components of the program included alignment around the aging, learning from national leaders, developing leadership skills and career networking. Adoption: Individual‐level factors included selecting participants with a research track record, willingness to sign a compact of commitment and involvement in shaping the program. An institutional‐level factor that facilitated program adoption included strong commitment from department leaders. Implementation: The program cost $3,259 per participant. Maintenance: CoMPAdRE is being maintained and currently incorporating a second cohort of mentees. CONCLUSION: This RE‐AIM evaluation provides lessons learned and strategies for future adoption, implementation, and maintenance of an aging‐focused facilitated peer mentorship program. J Am Geriatr Soc 67:804–810, 2019. See related editorial by High et al. in this issue. [ABSTRACT FROM AUTHOR]

Family care provision is the norm for adults with intellectual and developmental disabilities (I/DD), even as they and their support networks grow older. As families age together, the role of primary carer frequently transitions from the parent to a sibling, as aging parents die or become too frail to provide continued support. The purpose of this paper is to explore the transition in care from the perspective of a sibling who has replaced parents as the primary carer for an individual aging with I/DD. Data are drawn from semi-structured, in-depth interviews with a sample of adults over age 40, living in the United States, and caring for a sibling with I/DD (n = 15). Data were analyzed using a constant comparative qualitative approach. Results reveal themes impacting the adjustment to the role of primary carer, the extent to which aging transformed the content of care needs, the importance of planning, and the availability of supplementary support. Findings from this study underscore the need to develop long-term services and supports as well as educational resources that accommodate this population of carers as they age together with their sibling with I/DD. [ABSTRACT FROM AUTHOR]

The aging of the American population has significantly changed medical practice over the last century. As is well known, life expectancy first began to increase dramatically in the late 19th century, but at the same time that the numbers of older people have been increasing, the social and cultural meanings of growing old have also changed. It is likely that different cohorts of older people have had different experiences with old age because of the time periods they lived through. This paper offers one way to look at some of the historical changes that have affected the public and the medical profession on the subject of old age by looking at old age through American popular literature in the first half of the 20th century in three overlapping time periods. In the first three decades of the century, the concept of old age was widely defined, and older people (rather than physicians) were the principal authorities in describing the qualities of old age. In the third and fourth decades of the century, the idea of old age was starting to acquire increasing negative connotations, but chronological age itself did not signal the beginning of old age. However, by the late 1930s and 1940s, old age became widely viewed as a specific social and medical problem to be addressed by professionals, and older people had become a recognizable population, with a variety of groups organized around their care. This paper illustrates changes in American understandings of old age within and without the medical profession and suggests ways in which popular conceptions of old age might continue to shift and affect how physicians take care of their older patients in the future. [ABSTRACT FROM AUTHOR]

This paper examines the roots and consequences of the "medicalization" of aging in America. The present set of programs under Medicare, Medicaid and Title XX are described, with particular attention given to the unproductive "dichotomy" created between health and medical needs (addressed primarily under Medicare and Medicaid) and the interrelated social needs of the elderly, provided for, albeit inadequately through Title XX. The present medically and institutionally based approach to care for the elderly in America is contrasted with approaches that seek to create environments that increase self-reliance for the elderly. Programmatic redesign strategies providing a full continuum of care are premised on such concepts as "normalization" and the "least restrictive alternative." Particular attention is focused on the area of community based home health and social services. The experiences of several states in providing more comprehensive community based services are explored. One such program-California's recently initiated Multi-Purpose Senior Services Project is described. It potentially provides a wide range of services that previously were unavailable through more narrowly designed categorical programs. The importance of broader programs of community based care for the elderly, and important research directions, are examined. [ABSTRACT FROM AUTHOR]

The article presents information on recent developments related to rural sociology in the U.S. Homer L. Hitt resigned as head of the Departments of Sociology and Rural Sociology and as associate dean of the Graduate School to become dean of Louisiana State University at New Orleans, Louisiana. On April 28-29, 1958, the first annual "Louisiana Conference on the Aging" was held on the campus. This conference was sponsored jointly by the Department of Sociology and the Louisiana Commission on the Aging. Outstanding scholars in gerontology were brought to the campus for the two-day session. Evan T. Peterson has joined the staff of the Division of Sociology and Rural Life, Mississippi State University, as assistant sociologist and assistant professor of sociology and rural life. The twentieth annual meeting of the Ohio Valley Sociological Society was held on May 1-2, 1958, in Cincinnati, Ohio. Host for the meeting was the Department of Sociology, University of Cincinnati. The 1959 meeting of the Society will be held in Columbus, Ohio.

Policy PointsCountries have adopted different strategies to support aging populations, which are broadly reflected in social, economic, and contextual environments. Referred to as "societal adaptation to aging," these factors affect countries' capacity to support older adults.Results from our study show that countries with more robust societal adaptation to aging had lower depression prevalence. Reductions in depression prevalence occurred among every investigated sociodemographic group and were most pronounced among the old‐old.Findings suggest that societal factors have an underacknowledged role in shaping depression risk. Policies that improve societal approaches to aging may reduce depression prevalence among older adults. Context: Countries have adopted various formal and informal approaches to support older adults, which are broadly reflected in different policies, programs, and social environments. These contextual environments, broadly referred to as "societal adaptation to aging," may affect population health. Methods: We used a new theory‐based measure that captured societal adaptation to aging, the Aging Society Index (ASI), which we linked with harmonized individual‐level data from 89,111 older adults from 20 countries. Using multi‐levels models that accounted for differences in the population composition across countries, we estimated the association between country‐level ASI scores and depression prevalence. We also tested if associations were stronger among the old‐old and among sociodemographic groups that experience more disadvantage (i.e., women, those with lower educational attainment, unmarried adults). Findings: We found that countries with higher ASI scores, indicating more comprehensive approaches to supporting older adults, had lower depression prevalence. We found especially strong reductions in depression prevalence among the oldest adults in our sample. However, we did not find stronger reductions among sociodemographic groups who may experience more disadvantage. Conclusions: Country‐level strategies to support older adults may affect depression prevalence. Such strategies may become increasingly important as adults grow older. These results offer promising evidence that improvements in societal adaptation to aging—such as through adoption of more comprehensive policies and programs targeting older adults—may be one avenue to improve population mental health. Future research could investigate observed associations using longitudinal and quasi‐experimental study designs, offering additional information regarding a potential causal relationship. [ABSTRACT FROM AUTHOR]

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Objectives To prioritize research topics relevant to the care of the growing population of older adults with multiple chronic conditions ( MCCs). Design Survey of experts in MCC practice, research, and policy. Topics were derived from white papers, funding announcements, or funded research projects relating to older adults with MCCs. Setting Survey conducted through the Health Care Systems Research Network ( HCSRN) and Claude D. Pepper Older Americans Independence Centers ( OAICs) Advancing Geriatrics Infrastructure and Network Growth Initiative, a joint endeavor of the HCSRN and OAICs. Participants Individuals affiliated with the HCSRN or OAICs and national MCC experts, including individuals affiliated with funding agencies having MCC-related grant portfolios. Measurements A 'top box' methodology was used, counting the number of respondents selecting the top response on a 5-point Likert scale and dividing by the total number of responses to calculate a top box percentage for each of 37 topics. Results The highest-ranked research topics relevant to the health and healthcare of older adults with MCCs were health-related quality of life in older adults with MCCs; development of assessment tools (to assess, e.g., symptom burden, quality of life, function); interactions between medications, disease processes, and health outcomes; disability; implementation of novel (and scalable) models of care; association between clusters of chronic conditions and clinical, financial, and social outcomes; role of caregivers; symptom burden; shared decision-making to enhance care planning; and tools to improve clinical decision-making. Conclusion Study findings serve to inform the development of a comprehensive research agenda to address the challenges relating to the care of this 'high-need, high-cost' population and the healthcare delivery systems responsible for serving it. [ABSTRACT FROM AUTHOR]

Biological aging is the main driver of age‐associated chronic diseases. In 2014, the United States National Institute of Aging (NIA) sponsored a meeting between several investigators in the field of aging biology, who identified seven biological pillars of aging and a consensus review, "Geroscience: Linking Aging to Chronic Disease," was published. The pillars of aging demonstrated the conservation of aging pathways in diverse model organisms and thus represent a useful framework with which to study human aging. In this present review, we revisit the seven pillars of aging from the perspective of exercise and discuss how regular physical exercise can modulate these pillars to stave off age‐related chronic diseases and maintain functional capacity. [ABSTRACT FROM AUTHOR]

Workforces are aging rapidly and older workers are typically assumed to take more sickness absence. However, the relationship between age and sickness absence is not well understood, as research has yielded mixed findings and has neglected broader societal factors that cascade to shape the age‐sickness absence relationship. To advance the literature, we adopted a resource‐based perspective and investigated the relationship between employee age and sickness absence as mediated by two countervailing mechanisms: physical health issues and work engagement. We also highlighted two country‐level boundary conditions (health expenditure per capita and labor force participation rate) for these mechanisms. We tested our hypotheses with two archival datasets. In Study 1, using a sample of 28,553 employees from 35 European countries, we tested a multilevel model and found that age was positively related to the number of physical health issues, which in turn was positively associated with sickness absence. Country‐level health expenditure per capita was found to mitigate this relationship. We also found that age was positively related to work engagement, which was negatively related to sickness absence, and country‐level labor force participation rate strengthened this relationship. In Study 2, using a multi‐wave dataset (N = 304) from the Health and Retirement Study (HRS) in the United States, we found further support for the two hypothesized mechanisms (physical health issues and work engagement) between age and sickness absence. Our findings have cross‐national implications for understanding and managing sickness absence by helping workers stay healthier and be more engaged in the context of population aging. [ABSTRACT FROM AUTHOR]

Background and aims: Smoking is associated with increased risk for brain aging/atrophy and dementia. Few studies have examined early associations with brain aging. This study aimed to measure whether adult men with a history of heavier smoking in early mid‐life would have older than predicted brain age 16–28 years later. Design Prospective cohort observational study, utilizing smoking pack years data from average age 40 (early mid‐life) predicting predicted brain age difference scores (PBAD) at average ages 56, 62 (later mid‐life) and 68 years (early old age). Early mid‐life alcohol use was also evaluated. Setting: Population‐based United States sample. Participants/cases: Participants were male twins of predominantly European ancestry who served in the United States military between 1965 and 1975. Structural magnetic resonance imaging (MRI) began at average age 56. Subsequent study waves included most baseline participants; attrition replacement subjects were added at later waves. Measurements Self‐reported smoking information was used to calculate pack years smoked at ages 40, 56, 62, and 68. MRIs were processed with the Brain‐Age Regression Analysis and Computation Utility software (BARACUS) program to create PBAD scores (chronological age—predicted brain age) acquired at average ages 56 (n = 493; 2002–08), 62 (n = 408; 2009–14) and 68 (n = 499; 2016–19). Findings In structural equation modeling, age 40 pack years predicted more advanced age 56 PBAD [β = −0.144, P = 0.012, 95% confidence interval (CI) = –0.257, −0.032]. Age 40 pack years did not additionally predict PBAD at later ages. Age 40 alcohol consumption, but not a smoking × alcohol interaction, predicted more advanced PBAD at age 56 (β = −0.166, P = 0.001, 95% CI = –0.261, –0.070) with additional influences at age 62 (β = −0.115, P = 0.005, 95% CI = –0.195, –0.036). Age 40 alcohol did not predict age 68 PBAD. Within‐twin‐pair analyses suggested some genetic mechanism partially underlying effects of alcohol, but not smoking, on PBAD. Conclusions: Heavier smoking and alcohol consumption by age 40 appears to predict advanced brain aging by age 56 in men. [ABSTRACT FROM AUTHOR]

Policy PointsThe focus of successful aging is on the social contexts that enable individuals to be productively engaged and secure, with an emphasis on equity. There is currently no index to measure progress towards this goal at the US state level.We developed an empirical index for the evaluation of US state adaptation to societal aging across five critical domains that support successful population aging: (1) productivity and engagement, (2) security, (3) equity, (4) cohesion, and (5) well‐being.Our index shows substantial variability over time and is not overly influenced by the performance of an individual domain. This suggests that it can be used to monitor state progress over time toward the goal of supporting successful aging.Rather than a major national trend, there are large between‐state differences and changes in our index over time. This suggests individual US state policies and programs, as well as local economic conditions, may have a substantial impact on adaptations to societal aging. Context: Although it is recognized that aspects of US state environments impact the likelihood that older adults age successfully, there is currently no reliable and comprehensive measure of contexts that best support successful aging at a state level. The current project adapts a multidimensional index previously used to assess adaptation to successful aging in developed countries and applies it to the 50 US states and the District of Columbia. Methods: We obtained data from multiple sources for all 50 US states and the District of Columbia from 2003 to 2017 in order to measure five distinct domains that define successful population aging: (1) productivity and engagement, (2) security, (3) equity, (4) cohesion, and (5) well‐being. We created a ranking of states for the year 2017 based on these domains, and also examined how individual US state rankings changed over time from 2003 to 2017. Findings: The level of adaptation to successful aging varied substantially between states and over time. The highest‐ranked states in 2017 were Vermont, Hawaii, Iowa, Colorado, and New Hampshire, and the lowest‐ranked states were Louisiana, Arkansas, Kentucky, West Virginia, and Mississippi. Mississippi, South Carolina, Iowa, Arizona, and Delaware had the greatest improvement in their ranking over the period of 2003 to 2017. Our findings were generally robust to the weighting scheme used and were not overly influenced by any particular domain. Conclusions: The US State Index of Successful Aging can be used to monitor US state progress in promoting the well‐being and health of aging populations. Factors driving the changes in the index remain to be elucidated. [ABSTRACT FROM AUTHOR]

All industrialized countries are grappling with a common problem-how to provide assistance of various kinds to their rapidly aging populations. The problem for countries searching for models of efficient and high-quality long-term care (LTC) policies is that fewer than a dozen countries have government-organized, formal LTC policies. Relatively new surveys focused on the elderly populations of about 25 countries could become the basis for research on which LTC policy design choices have desired outcomes for individuals and society and might be replicable in other countries. As in earlier decades when U.S. researchers created the Current Population Survey (CPS) modules and the Survey of Income and Program Participation to answer policy questions, researchers and policy analysts are now at a point where a concerted effort is needed to generate questions that international comparative research on LTC could answer as well as the data needed to address the questions. © 2011 by the Association for Public Policy Analysis and Management. [ABSTRACT FROM AUTHOR]

Introduction: The overarching goal of research on physical settings for individuals livingwith dementia is to identify associations between designed features within the built environment and outcomes of interest. Over the past three decades numerous environmental assessment tools have been developed in several countries, responding to a changing set of care industry values that increasingly prioritize a holistic, quality-of-life-driven person-centered care (PCC) model over a biomedical approach to long-term care (LTC) provision. This article reviews the diversity, constructs, strengths, and limitations of existing environmental assessment tools and identifies gaps for future tool development. Methods:Asystematic literature search was conducted using four databases (Medline, CINAHL, PsycInfo, and Avery Index) and terms related to health-care environments and assessment tools. Results: A total of 13 environmental assessment tools for people living with dementia within shared residential settings were identified. Evaluation of the environmental assessment tools includes a synthesis of published data for each tool's reliability, validity, ease of use, interpretability, strengths and weaknesses, as well as a comparison of various tool characteristics including date of development, country of origin, applicable care setting(s), number and variety of measures and underlying constructs, format, and descriptive versus evaluative content. Discussion: While the shift to person-centered values encompasses all aspects of care and care settings, the majority of person-centered definitions exclude the important role of the designed, physical environment. However, this review of environmental assessment tools clearly demonstrates that newer tools are embracing the full array of PCC values. In the United States, this is shown in the shift from tools designed to assess segregated dementia care settings to tools that integrate the needs and preferences both of individuals livingwith and without dementia. Next-generation tools need to specifically address the household model of design. [ABSTRACT FROM AUTHOR]

Purpose: Nonmetropolitan communities are faced with health care professional shortages and prior reports suggest that general surgeons are no exception. The purpose of this brief is to evaluate the age difference and distribution of rural versus urban general surgeons to highlight the growing need to recruit medical students and residents for rural practice. Methods: A secondary data analysis of residency graduated general surgeon demographics at the county level was performed using data from the Area Health Resource File. General surgeon demographic data were compared between nonmetropolitan and metropolitan areas. Findings: The number of general surgeons practicing in rural communities is decreasing by a rate of approximately 0.5%‐1.0% annually. Moreover, the entry of younger (<35 years of age) general surgeons into rural counties (8.7%) was less than urban regions (12.1%). Rural general surgeons tended to be older than their urban peers, and on average, rural general surgeon age exhibits a negative skewed, platykurtic distribution. Conclusions: Immediate action must be taken to generate more surgeons for rural practice. A failure to increase recruitment and retention of rural surgeons may have severe consequences on the health status of rural communities. [ABSTRACT FROM AUTHOR]

The characteristics of a nation's demographic metabolism have a profound and direct impact upon the nature and future of the country's politics and public policy. This article suggests that the dramatic increases in the proportion of older persons in the United states is one such area of profound and direct political and policy impact. The article also summarizes a number of recent findings which contradict the view that the aged and the issue of aging are not increasingly salient aspects of politics in the United States.

I compare the extent of food hardships in the United States among adults and seniors before and during the COVID‐19 pandemic. Food insufficiency increased threefold compared to 2019, and more than doubled relative to the Great Recession. Food insufficiency among seniors increased 75% during the COVID period, but more than doubled when including reduced intake of food varieties. Receipt of charitable foods among disadvantaged adults spiked 50% in the COVID period, but the initial response among seniors was a sharp reduction, before rising. These patterns are consistent with strong social distancing measures enacted in response to the pandemic. [ABSTRACT FROM AUTHOR]

Introduction: It is unclear whether the association between Mediterranean-type Diet (MeDi) and cognition is similar across different racial/ethnic groups or between women and men. Methods: The current study included 2435 participants (≥60 years of age) of the National Health and Nutrition Examination Survey (NHANES) 2011-2014. Linear regression models were applied to examine the association between diet and cognition, adjusted for multiple demographic variables. Interaction between MeDi and race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic, other), and between MeDi and gender, were examined, followed by stratified analyses. Results: One score increase in MeDi was associated with 0.039 (95%confidence interval [CI] = 0.016-0.062) higher global cognitive z-score. Significant associations between MeDi and global cognition and between MeDi and immediate recall were found in the non-Hispanic Whites only (P-interaction = 0.057 and 0.059, respectively). MeDi was associated with increased score of animal fluency score in men but not in women (P-interaction = 0.082). Discussion: The positive association between MeDi and cognition might be dependent on race/ethnicity and gender. [ABSTRACT FROM AUTHOR]

Examines how aging research is covered in U.S. print media. Dependence of media coverage of aging and aging research on scientists who conduct the research; Developments in the publishing business that impacted what kind of research gets covered and on how it is framed; State of the art in translating recent aging research into an accessible, practical health story.

Where does the supposed shame of older women's bodies come from? In this essay, I suggest that such shame is not a natural response to aging; rather, it is a culturally conditioned reaction to the patriarchal fantasy of female physical perfection. While certain norms and narratives within Christianity tacitly encourage women to pursue this fantasy, there are also resources within this tradition that can help us challenge the stigma assigned to older female flesh and affirm the goodness of bodies that have lived a long time. Simultaneously, aging itself can provide a lens for fruitfully rethinking some central Christian ideas. [ABSTRACT FROM AUTHOR]

Policy PointsFundamental changes are needed in how complex chronic illness conditions are conceptualized and managed.Health management plans for chronic illness need to be integrated, adaptive, contextual, technology aided, patient driven, and designed to address the multilevel social environment of patients' lives.Such primary care–based health management plans are feasible today but will be even more effective and sustainable if supported by systems thinking, technological advances, and policies that create and reinforce home, work, and health care collaborations. Context: The current health care system is failing patients with chronic illness, especially those with complex comorbid conditions and social determinants of health challenges. The current system combined with unsustainable health care costs, lack of support for primary care in the United States, and aging demographics create a frightening probable future. Methods: Recent developments, including integrated behavioral health, community resources to address social determinants, population health infrastructure, patient‐centered digital‐health self‐management support, and complexity science have the potential to help address these alarming trends. This article describes, first, the opportunity to integrate these trends and, second, a proposal for an integrated, patient‐directed, adaptive, contextual, and technology‐aided support (ACTS) system, based on a patient's life context and home/primary care/work‐setting "support triangle." Findings: None of these encouraging trends is a panacea, and although most have been described previously, they have not been integrated. Here we discuss an example of integration using these components and how our proposed model (termed My Own Health Report) can be applied, along with its strengths, limitations, implications, and opportunities for practice, policy, and research. Conclusions: This ACTS system builds on and extends the current chronic illness management approaches. It is feasible today and can produce even more dramatic improvements in the future. [ABSTRACT FROM AUTHOR]

The symposium was held at the University of Texas Health Science Center on Aging at Houston, Texas, USA. Approximately 20 participants attended from three different counties: Japan, Canada and the USA. The goal of the symposium was to present current research and to discuss possibilities for future collaborative international research. Eleven papers were presented in three categories: research studies, research methodology and mechanisms for future collaboration. [ABSTRACT FROM AUTHOR]

Using data from the 1995, 1998, and 2001 panels of Aging, Status, and Sense of Control ( ASOC) Survey, we examine gender differences in the relationship between self-rated physical health and mental health over time (n = 2,543). Gender-stratified path models highlight how the nature of the mental-physical health relationship changes when we use indicators of mental health that have traditionally been labeled as female sensitive (depression) or male sensitive (heavy drinking). Results show that women and men are similar in that mental health has a stronger effect on physical health than the reverse. However, this is only the case when we use gender-sensitive measures of mental distress: Men who drink heavily and women who are depressed report poorer self-rated physical health over time, while heavy drinking for women and depression for men have no significant effects on their self-rated physical well-being. These results provide evidence of a health process that is gendered in its expression but more universal in its outcome-the exact measure might vary, but men and women alike are physically harmed by mental health problems. [ABSTRACT FROM AUTHOR]

Women constitute the majority of the aging United States ( US) population, and this has substantial implications on cancer population patterns and management practices. Breast cancer is the most common women's malignancy, while ovarian cancer is the most fatal gynecological malignancy in the US. In this review, we focus on these subsets of women's cancers, seen more commonly in postmenopausal and elderly women. In order to systematically investigate the complexity of cancer progression and response to treatment in breast and ovarian malignancies, we assert that integrated mathematical modeling frameworks viewed from a systems biology perspective are needed. Such integrated frameworks could offer innovative contributions to the clinical women's cancers community, as answers to clinical questions cannot always be reached with contemporary clinical and experimental tools. Here, we recapitulate clinically known data regarding the progression and treatment of the breast and ovarian cancers. We compare and contrast the two malignancies whenever possible in order to emphasize areas where substantial contributions could be made by clinically inspired and validated mathematical modeling. We show how current paradigms in the mathematical oncology community focusing on the two malignancies do not make comprehensive use of, nor substantially reflect existing clinical data, and we highlight the modeling areas in most critical need of clinical data integration. We emphasize that the primary goal of any mathematical study of women's cancers should be to address clinically relevant questions. WIREs Syst Biol Med 2016, 8:337-362. doi: 10.1002/wsbm.1343 For further resources related to this article, please visit the . [ABSTRACT FROM AUTHOR]

Background The aging of the workforce, coupled with the changing nature of career tenure has raised questions about the impact of these trends on work disability. This study aimed to determine if age and tenure interact in relating to work disability duration. Methods Relationships were investigated using random effects models with 239,359 work disability claims occurring between 2008 and 2012. Results A 17-day difference in the predicted length of disability was observed from ages 25 to 65. Tenure moderated the relationship between age and length of disability. At younger ages, the length of disability decreased as tenure increased, but at older age, the length of disability increased as tenure increased. Discussion Results indicate that although there is a relationship between length of disability and tenure, age makes a greater unique contribution to explaining variance in length of disability. Future research is needed to better understand why specifically age shows a strong relationship with length of disability and why that relationship varies with age. Am. J. Ind. Med. 58:974-987, 2015. © 2015 The Authors. American Journal of Industrial Medicine Published by Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

This study aimed to confirm whether the well-known income disparities in oral health seen over the life course are indeed absent in 9- to 11-yr-old children, and to explore the role of access to dental care in explaining the age-profile of the income gradient in child oral health. We used data from the 2007 United States National Survey of Children's Health. Income gradients in parental reports of children's decayed teeth or cavities, toothache, broken teeth, bleeding gums, and fair/poor condition of teeth were assessed in stratified analyses according to age of child (1-5, 6-8, 9-11, 12-14, and 15-17 yr), using survey logistic regression to control for family-, parental-, and child-level covariates. Health insurance status and use of preventive dental care were the indicators for children's access to dental care. The adjusted ORs for the effect of family income on having decayed teeth or cavities, toothache, and fair/poor condition of teeth were not significant in 9- to 11-yr-old children. Different age-patterns were found for broken teeth and bleeding gums. The attenuation of the income gradients in having decayed teeth or cavities, toothache, and fair/poor condition of teeth, previously seen in 9- to 11-yr-old children, was also seen in 15- to 17-, 12- to 14-, and 6- to 8-yr-old children, respectively, after controlling for children's access to dental care. This study supports the attenuation of income inequalities in oral health in 9- to 11-yr-old children. Access to dental care could attenuate income gradients in oral health in other age groups. [ABSTRACT FROM AUTHOR]

Context An aging population leads to a growing demand for long-term services and supports (LTSS). In 2002, France introduced universal, income-adjusted, public long-term care coverage for adults 60 and older, whereas the United States funds means-tested benefits only. Both countries have private long-term care insurance (LTCI) markets: American policies create alternatives to out-of-pocket spending and protect purchasers from relying on Medicaid. Sales, however, have stagnated, and the market's viability is uncertain. In France, private LTCI supplements public coverage, and sales are growing, although its potential to alleviate the long-term care financing problem is unclear. We explore whether France's very different approach to structuring public and private financing for long-term care could inform the United States' long-term care financing reform efforts. Methods We consulted insurance experts and conducted a detailed review of public reports, academic studies, and other documents to understand the public and private LTCI systems in France, their advantages and disadvantages, and the factors affecting their development. Findings France provides universal public coverage for paid assistance with functional dependency for people 60 and older. Benefits are steeply income adjusted and amounts are low. Nevertheless, expenditures have exceeded projections, burdening local governments. Private supplemental insurance covers 11% of French, mostly middle-income adults (versus 3% of Americans 18 and older). Whether policyholders will maintain employer-sponsored coverage after retirement is not known. The government's interest in pursuing an explicit public/private partnership has waned under President François Hollande, a centrist socialist, in contrast to the previous center-right leader, President Nicolas Sarkozy, thereby reducing the prospects of a coordinated public/private strategy. Conclusions American private insurers are showing increasing interest in long-term care financing approaches that combine public and private elements. The French example shows how a simple, cheap, cash-based product can gain traction among middle-income individuals when offered by employers and combined with a steeply income-adjusted universal public program. The adequacy of such coverage, however, is a concern. [ABSTRACT FROM AUTHOR]

By tracing the transformations of troubling exchanges in paid home care, this article examines how differently positioned individuals strive to build caring relations within potentially restrictive regimes of care. In paid home care in Chicago, older adults and their workers regularly participate in exchanges of money, time, and material goods. These gifts play a crucial role in building good care relationships that sustain participants' moral personhood. Amid widespread concern about vulnerable elders, home care agencies compete in a crowded marketplace by prohibiting these exchanges, even as they depend on them to strengthen relationships. Supervisors thus exercise discretion, sometimes reclassifying gift exchanges as punishable thefts. In this context, the commodification of care did not lead to the actual elimination of gift relations, but rather transformed gift relations into a suspicious and troublesome source of value. [ABSTRACT FROM AUTHOR]

Context The cost of late-life dependency is projected to grow rapidly as the number of older adults in the United States increases in the coming decades. To provide a context for framing relevant policy discussions, we investigated activity limitations and assistance, care resources, and unmet need for a national sample of older adults. Methods We analyzed the 2011 National Health and Aging Trends Study, a new national panel study of more than 8,000 Medicare enrollees. Findings Nearly one-half of older adults, or 18 million people, had difficulty or received help in the last month with daily activities. Altogether, 1 in 4 older adults receiving help lived in either a supportive care (15%) or a nursing home (10%) setting. Nearly 3 million received assistance with 3 or more self-care or mobility activities in settings other than nursing homes, and a disproportionate share of persons at this level had low incomes. Nearly all older adults in settings other than nursing homes had at least 1 potential informal care network member (family or household member or close friend), and the average number of network members was 4. Levels of informal assistance, primarily from family caregivers, were substantial for older adults receiving help in the community (164 hours/month) and living in supportive care settings (50 hours/month). Nearly all of those getting help received informal care, and about 3 in 10 received paid care. Of those who had difficulty or received help in settings other than nursing homes, 32% had an adverse consequence in the last month related to an unmet need; for community residents with a paid caregiver, the figure was nearly 60%. Conclusions The older population-especially those with few economic resources-has substantial late-life care needs. Policies to improve long-term services and supports and reduce unmet need could benefit both older adults and those who care for them. [ABSTRACT FROM AUTHOR]

The World Health Organization's report, D ementia: A P ublic H ealth P riority, noted that the number of people worldwide affected by dementia is significant and will continue to increase. The report called on nations to address dementia by developing national plans and undertaking public health initiatives. Special mention was made of the situation of people with intellectual disability, some of who manifest high risk for dementias. In the United States, the National Task Group on Intellectual Disabilities and Dementia Practices (the ' NTG') was created to ensure that the needs and interests of adults with intellectual and developmental disability who are affected by Alzheimer's disease and related dementias-as well as their families and friends-are taken into account as part of general-population dementia health and public policy efforts, particularly as noted in the U. S. National Plan to Address Alzheimer's Disease. To this end, the NTG's multifaceted advocacy efforts have included (1) identifying best practices for providing care and services to affected adults with intellectual disability; (2) developing and identifying a functional workable administrative dementia early detection and screening instrument; (3) producing educational materials useful to families, adults with intellectual disability, and nongovernmental organizations; and (4) furthering public policy initiatives on dementia as they affect adults with intellectual disability. This article describes the origins of this group, its functions and accomplishments, as well its role with respect to national dementia advocacy, as a prototype for other national efforts that can be used to promote the interests of adults with intellectual disability affected by dementia and improve the quality of their lives. Suggested are means for replication of such an effort in other national environments. [ABSTRACT FROM AUTHOR]

Abstract: Outcomes from a partially integrated model of managed long‐term care—The VNS CHOICE program (VCP)—were compared to those from a fully capitated model—the Program of All‐Inclusive Care for the Elderly (PACE). A retrospective cohort design examined discharge, morbidity, and functional status for 3,200 individuals over 18 months. Although the two populations were close in average functional status, the PACE sample was sicker and more cognitively impaired. Higher rates of death were found in the PACE program (22 percent vs. 10 percent over 18 months) and a greater likelihood of decline in instrumental activities of daily living; higher functional disability scores (ADLs) predicted discharge in PACE but not in VCP. When propensity score stratification was used to compare like populations, the impact of program enrolment on outcomes became statistically insignificant, suggesting that a partially capitated model performs at least as well as the fully capitated PACE model. [ABSTRACT FROM AUTHOR]

Context Adults aged sixty-five and over account for a large fraction of all surgeries performed in the United States each year. While historical growth in rates of surgery in this population is commonly attributed to financial incentives and technological innovations, the shifts in thought that underpinned the spread of surgery among the U.S. elderly remain largely unexplored. We examined changing perspectives on aging over time in American surgery through two case studies: the expansion of general surgical procedures among older U.S. adults between 1945 and 1965, and the spread of coronary artery bypass grafting (CABG) among the U.S. elderly between 1975 and 1995. Methods For this article, we used close readings of historical journal articles, textbook excerpts, survey reports, and government documents related to surgery and aging. Findings Similar perspectives on aging informed the spread of both general surgical procedures among older adults after World War II and CABG in the elderly from the mid-1970s onward. In each case, surgeons argued against earlier views that surgery was contraindicated in old age using rhetoric that negated the relevance of age to medical decisions. Furthermore, surgeons elevated other types of information-such as the presence or absence of chronic diseases-to supplant age as an explanation for the high operative mortality rates seen among older patients. By stressing the modifiability of operative risk in the elderly, surgeons' arguments positioned old age itself as a new surgical 'frontier.' Conclusions Surgeons' arguments for the expansion of surgery among the U.S. elderly over time worked to negate the relevance of age to medical decisions and to portray the wider use of surgery in the elderly as uniformly beneficial. While potentially promoting broader access to surgical care, such perspectives may also have contributed to ongoing health policy challenges by normalizing surgery at any stage in the life-course, with implications for current patterns of surgical utilization and medical spending. [ABSTRACT FROM AUTHOR]

Clinical metabolic studies have demonstrated that insulin action declines progressively with age in humans. In addition to its close association with Type 2 diabetes, which reduces life expectancy in older people, age-related insulin resistance is implicated in pathogenesis of several highly prevalent disorders for which ageing is a major risk factor. These include atherosclerotic cardiovascular disease, dementia, frailty and cancer. Accordingly, insulin resistance may be viewed as biomarker of age-related ill health and reduced lifespan. The rapidly rising number of older people, coupled with a high prevalence of insulin resistance resulting from obesity and sedentary lifestyles, presents unprecedented public health and societal challenges. Studies of centenarians have shown that preserved whole-body sensitivity to insulin is associated with longevity. The mechanisms through which insulin action is associated with age-related diseases remain unclear. Changes in body composition, i.e. sarcopenia and excess adiposity, may be more potent than age per se. Moreover, the impact of insulin resistance has been difficult to disentangle from the clustering of vascular risk factors that co-segregate with the insulin resistance-hyperinsulinaemia complex. Potentially modifiable mediators of age-related changes in insulin sensitivity include alterations in adipocytokines, impaired skeletal myocyte mitochondrial function and brown fat activity. The hypothesis that improving or maintaining insulin sensitivity preserves health and extends lifespan merits further evaluation. Practical non-pharmacological interventions directed against age-related insulin resistance remain underdeveloped. Novel metabolically active pharmacological agents with theoretical implications for some age-related disorders are entering clinical trials. However, recent adverse experiences with the thiazolidinediones suggest the need for a cautious approach to the use of insulin sensitizing drugs in older people. This could be particularly important in the absence of diabetes where the risk to benefit analysis may be less favourable. [ABSTRACT FROM AUTHOR]

The role social network structure plays in facilitating flows of support between spouses is often overlooked. This study examined whether levels of support between spouses depended on the degree of overlap between spouses' networks. Network overlap may enhance spouses' support capacities by increasing their understanding of each other's support needs and their ability to coordinate support for each other. Data on 1,490 married older adults from the National Social Life, Health, and Aging Project were examined. Analyses revealed that when one's spouse had more contact with one's other network members, one was more likely to (a) view the spouse as a reliable source of support, (b) open up to the spouse, and (c) discuss health issues with the spouse. These results suggest that spousal support is not only a function of relationship quality or obligations-it also is a structural phenomenon that depends on spouses' connectedness to each other's networks. [ABSTRACT FROM AUTHOR]

An adult child's provision of care to an unmarried elderly mother varies both within and between families. Within-family differences address the variation in different children's behavior within in a family. Between-family differences refer to the propensities that members of a family-the children of one mother-share and that differentiate them from other families. Previous research suggests 5 hypotheses affecting either within-family or between-family differences. Data from multiple waves of the Asset and Health Dynamics Among the Oldest Old (AHEAD) cohort of the Health and Retirement Study (HRS; 16,719 observations on 5,607 mother-child dyads in 1,925 families) are used to estimate a multilevel model with a binary outcome. Results indicate substantial differences between families. Mother's characteristics, family composition, and family history account for about half the between-family differences. [ABSTRACT FROM AUTHOR]

In contrast to a previous study we conducted and other evidence, a recent study found no significant effects of Medicare coverage after age 65 on overall health for previously uninsured adults and significant adverse effects on survival for some of these adults. We discuss explanations for these inconsistent findings, particularly the different ways in which deaths were handled, a key methodological challenge in longitudinal analyses of health. We demonstrate that analytic approaches suitable for examining effects of coverage on health measures may not be suitable for effects on mortality. Thus, estimates may be misleading when these different outcomes are jointly modeled. We also present new survival analyses that suggest Medicare coverage significantly attenuated the rising risk of death for previously uninsured adults. [ABSTRACT FROM AUTHOR]

There are differences of intent and impact between short-term and long-term engagement of U.S. academic institutions with communities of need in developing nations. Global health programs that produce long-term transformative change rather than transient relief are more likely to be sustainable and in ethical harmony with expressed needs of a region or community. This article explores characteristics of successful ethical partnerships in global health and the challenges that threaten them, introducing a consensus community engagement model as a framework for building relationships, evolving an understanding of needs, and collaboratively developing solutions and responses to priority health needs in underserved regions of the world. The community engagement model is applied to a case study of an initiative by a U.S. school of nursing to establish long-term relationships with the nursing community in the Caribbean region with the goal of promoting transformative change through collaborative development of programs and services addressing health care needs of the region's growing elderly population and the increasing prevalence of noncommunicable chronic diseases. Progress of this ongoing long-term relationship is analyzed in the context of the organizational, philosophical, ethical, and resource commitments embodied in this approach to initiation of transformative and sustainable improvements in public health. [ABSTRACT FROM AUTHOR]

Context: The aging of the baby boom generation, the extension of life, and progressive increases in disability-free life expectancy have generated a dramatic demographic transition in the United States. Official government forecasts may, however, have inadvertently underestimated life expectancy, which would have major policy implications, since small differences in forecasts of life expectancy produce very large differences in the number of people surviving to an older age. This article presents a new set of population and life expectancy forecasts for the United States, focusing on transitions that will take place by midcentury. Methods: Forecasts were made with a cohort-components methodology, based on the premise that the risk of death will be influenced in the coming decades by accelerated advances in biomedical technology that either delay the onset and age progression of major fatal diseases or that slow the aging process itself. Findings: Results indicate that the current forecasts of the U.S. Social Security Administration and U.S. Census Bureau may underestimate the rise in life expectancy at birth for men and women combined, by 2050, from 3.1 to 7.9 years. Conclusions: The cumulative outlays for Medicare and Social Security could be higher by $3.2 to $8.3 trillion relative to current government forecasts. This article discusses the implications of these results regarding the benefits and costs of an aging society and the prospect that health disparities could attenuate some of these changes. [ABSTRACT FROM AUTHOR]

Aims The aim of this study was to identify changes in patterns of alcohol consumption over a 20-year interval among older women and men, and to examine the associations between guideline-defined excessive drinking and late-life drinking problems. Design, participants and measures A community sample of 719 adults between 55 and 65 years of age who consumed alcohol at or prior to baseline participated in a survey of alcohol consumption and drinking problems and was followed 10 years and 20 years later. Findings The likelihood of excessive drinking declined over the 20-year interval as adults matured into their 70s and 80s. However, at ages 75–85, 27.1% of women and 48.6% of men consumed more than two drinks per day or seven drinks per week. At comparable guideline levels of alcohol consumption, older men were more likely to have drinking problems than were older women. Consumption of more than two drinks per day or seven drinks per week was identified as a potential conservative guideline for identifying excessive drinking associated with an elevated likelihood of drinking problems. Conclusions A substantial percentage of older adults who consume alcohol engage in guideline-defined excessive drinking and incur drinking problems. The finding that older men may be more likely than older women to experience problems when they drink beyond guideline levels suggests that alcohol guidelines for men should not be set higher than those for women. [ABSTRACT FROM AUTHOR]

The article focuses on the opportunities for and barriers to research for cancer screening among older population aged 65 years old and above in the U.S. The cancer screening is an effective way to reduce morbidity and mortality among elderly, while it is considered as the second leading cause of death among them. The 3-level of taxonomy of barriers including macro, patient contact and individual patient levels are mentioned, along with the proposed agenda for cancer screening research.

Pyrethroids are insecticides commonly used in both agricultural and urban environments. Residues of pyrethroids frequently are found in bed sediments of regions such as California (USA), and as such, sediment toxicity from pyrethroid contamination is an emerging concern. Pyrethroids are highly hydrophobic, and toxicity from sediment-borne pyrethroids is expected to depend closely on their desorption rate. In the present study, we evaluated the effect of aging on desorption kinetics of sedimentborne pyrethroids. Two sediments spiked with four pyrethroids were incubated for 7, 40, 100, and 200 d at room temperature. Desorption measured using sequential Tenax® extractions was well described by a three-compartment model. The estimated rapid desorption fraction (Frapid) decreased quickly over time and was accompanied by an increase of the very slow desorption fraction. The aging effect on desorption kinetics followed a first-order model, with half-lives for the decrease in Frapid for all four pyrethroids in both sediments ranging from two to three months. When coupled with degradation, the estimated half-lives of the rapidly desorbing fraction (and, thus, the potentially bioavailable concentration) were two months or less for all four pyrethroids. Two field-contaminated sediments displayed distinctively different desorption kinetics. The sediment with fresh residues exhibited rapid desorption, and the sediment containing aged residues was highly resistant to desorption. The observation that desorption of pyrethroids decreased quickly over contact time implies that the bioavailability of sediment-borne pyrethroids may diminish over time and that use of nonselective extraction methods may lead to overestimating the actual sediment toxicity from pyrethroid contamination. [ABSTRACT FROM AUTHOR]

Forensic science is a fundamental transitional justice issue as it is imperative for providing physical evidence of crimes committed and a framework for interpreting evidence and prosecuting violations to International Humanitarian Law (IHL). The evaluation of evidence presented in IHL trials and the outcomes various rulings by such courts have in regard to the accuracy or validity of methods applied in future investigations is necessary to ensure scientific quality. Accounting for biological and statistical variation in the methods applied across populations and the ways in which such evidence is used in varying judicial systems is important because of the increasing amount of international forensic casework being done globally. Population variation or the perceived effect of such variation on the accuracy and reliability of methods is important as it may alter trial outcomes, and debates about the scientific basis for human variation are now making their way into international courtrooms. Anthropological data on population size (i.e., the minimum number of individuals in a grave), demographic structure (i.e., the age and sex distribution of victims), individual methods applied for identification, and general methods of excavation and trauma analysis have provided key evidence in cases of IHL. More generally, the question of population variation and the applicability of demographic methods for estimating individual and population variables is important for American and International casework in the face of regional population variation, immigrant populations, ethnic diversity, and secular changes. The reliability of various skeletal aging methods has been questioned in trials prosecuted by the International Criminal Tribunal for the Former Yugoslavia (ICTY) in The Prosecutor of the Tribunal against Radislav Krstiċ (Case No. IT-98-33, Trial Judgment) and again in the currently ongoing trial of The Prosecutor of the Tribunal against Zdravko Tolimir, Radivolje Miletiċ, Milan Gvero, Vinko Pandureviċ, Ljubisa Beara, Vujadin Popoviċ, Drago Nikoliċ, Milorad Trbiċ, Ljubomir Borovcanin (IT-05-88-PT, Second Amended Indictment). Following the trial of General Krstiċ, a collaborative research project was developed between the Forensic Anthropology Center at The University of Tennessee (UT) and the United Nations, International Criminal Tribunal for the Former Yugoslavia, Office of the Prosecutor (ICTY). The purpose of that collaboration was to investigate methods used for the demographic analysis of forensic evidence and where appropriate to recalibrate methods for individual estimation of age, sex, and stature for specific use in the regions of the former Yugoslavia. The question of “local standards” and challenges to the reliability of current anthropological methods for biological profiling in international trials of IHL, as well as the performance of such methods to meet the evidentiary standards used by international tribunals is investigated. Anthropological methods for estimating demographic parameters are reviewed. An overview of the ICTY-UT collaboration for research aimed at addressing specific legal issues is discussed and sample reliability for Balkan aging research is tested. The methods currently used throughout the Balkans are discussed and estimated demographic parameters obtained through medico-legal death investigations are compared with identified cases. Based on this investigation, recommendations for improving international protocols for evidence collection, presentation, and research are outlined. [ABSTRACT FROM AUTHOR]

Context: Late-life disability has been declining in the United States since the 1980s. This study provides the first comprehensive investigation into the reasons for this trend. Methods: The study draws on evidence from two sources: original data analyses and reviews of existing studies. The original analyses include trend models of data on the need for help with daily activities and self-reported causes of such limitations for the population aged seventy and older, based on the National Health Interview Surveys from 1982 to 2005. Findings: Increases in the use of assistive and mainstream technologies likely have been important, as have declines in heart and circulatory conditions, vision, and musculoskeletal conditions as reported causes of disability. The timing of the improvements in these conditions corresponds to the expansion in medical procedures and pharmacologic treatment for cardiovascular disease, increases in cataract surgery, increases in knee and joint replacements, and expansion of medications for arthritic and rheumatic conditions. Greater educational attainment, declines in poverty, and declines in widowhood also appear to have contributed. Changes in smoking behavior, the population's racial/ethnic composition, the proportion of foreign born, and several specific conditions were eliminated as probable causes. Conclusions: The substantial reductions in old-age disability between the early 1980s and early 2000s are likely due to advances in medical care as well as changes in socioeconomic factors. More research is needed on the influence of health behaviors, the environment, and early- and midlife factors on trends in late-life disability. [ABSTRACT FROM AUTHOR]

This article discusses findings of a study which determined body mass index (BMI) distribution in the U.S. population along with demographic changes based on past race-, sex-, and birth cohort-specific secular trends. The study, using data from four National Health and Nutrition Examination Surveys, has suggested that a framework to combine BMI and demographic trends is needed to evaluate the burden and disparity associated with the epidemic in the aging U.S. population.

The decline in sleep quality that often accompanies aging is thought to be the consequence of alterations in both circadian and homeostatic processes widely assumed to be responsible for sleep/wake regulation. A number of experimental approaches have been used to examine various aspects of age-related sleep changes, but none has examined spontaneous sleep across the entire 24-h day. Using the ‘disentrainment’ protocol, we studied such sleep in young, middle-aged and older adults. All subjects exhibited polyphasic sleep patterns, characterized by relatively short intervals of both sleep and waking. Whereas, the average duration of major nighttime sleep was significantly shorter in middle-aged and older subjects than in young adults, daytime napping was essentially unaffected by age. Comparisons of sleep and circadian variables between age groups suggest differential effects on sleep of the two regulatory processes, with changes in homeostatic drive preceding those of the circadian component. These findings add to a surprisingly scant literature on the longitudinal decline in sleep quality associated with aging. [ABSTRACT FROM AUTHOR]

Objective. To project the impact of population aging on total U.S. health care per capita costs from 2000 to 2050 and for the range of clinical areas defined by Major Practice Categories (MPCs). Data Sources. Secondary data: HealthPartners health plan administrative data; U.S. Census Bureau population projections 2000–2050; and MEPS 2001 health care annual per capita costs. Study Design. We calculate MPC-specific age and gender per capita cost rates using cross-sectional data for 2002–2003 and project U.S. changes by MPC due to aging from 2000 to 2050. Data Collection Methods. HealthPartners data were grouped using purchased software. We developed and validated a method to include pharmacy costs for the uncovered. Principal Findings. While total U.S. per capita costs due to aging from 2000 to 2050 are projected to increase 18 percent (0.3 percent annually), the impact by MPC ranges from a 55 percent increase in kidney disorders to a 12 percent decrease in pregnancy and infertility care. Over 80 percent of the increase in total per capita cost will result from just seven of the 22 total MPCs. Conclusions. Understanding the differential impact of aging on costs at clinically specific levels is important for resource planning, to effectively address future medical needs of the aging U.S. population. [ABSTRACT FROM AUTHOR]