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A Center for Interdisciplinary Research and Training in Population Aging and Health at University of Wisconsin - Madison |
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Project Database
Development and Support for the Elderly in Indonesia
Researchers: Victoria A. Beard (Assistant Professor, Planning, Policy and Design, University of California at Irvine)Abstract: In the last 30 years, Indonesian society has undergone profound social changes related to economic development. Despite speculation about the effects of these changes on support for the elderly, this study is the first to focus on how the development-related characteristics of adult children affect the type and level of support provided to elderly parents. The objectives of this study are: (1) To discover how the characteristics of adult children affect whether they give support in the form of co-resident living arrangements or in the form of money, time or goods provided to elderly parents living separately, and (2) to see how these characteristics affect the amount of money, time or goods given. Support has traditionally been provided in the form of co-residence with elderly parents because most elderly Indonesians do not receive a pension or any other form of social or economic support from outside of the family.
Funding Institutions: NIH-NIA (R03 AG2065203: 2003-2006)
Status: Complete
Publications: Yes (Search Project Bibliography)
Aging and the Family over the Life Course
Researchers: Larry Bumpass (Professor-emeritus, Sociology, University of Wisconsin - Madison)Abstract: This is a proposal for an addition to the longitudinal data from the National Survey of Families and Households (NSFH). NSFH occupies a unique niche defined by the great depth of data on family interactions (up, down, and across the generational ladder) in the context of a holistic approach that includes measurement across a wide range of substantive domains. Approximately 10,907 subjects would be surveyed, including 6072 main respondents, 2948 original spouse/partners, 1072 new spouse/partners at NSFH-2, and 815 new spouse/partners at NSFH-3. This sample will range in age from the thirties to the nineties. Previous NSFH data collection has accumulated considerable information about the respondent's parents and their childhood (including childhood socioeconomic status). Complete life event history information is available for respondent's living arrangements in childhood, cohabitation, marriage and union stability, fertility, and employment. Proximity, contact, caregiving, relationship quality, co-residence, and the exchange of financial, instrumental, and emotional support with adult children and parents (and parents-in-law) have been tracked. Relationship quality with spouse, contact and support (including caregiving) exchange with siblings, other relatives, and friends has been assessed. Information on social integration in community and religious activities as well as about a wide range of social psychological attitudes, including attitudes about intergenerational obligations and orientations toward retirement is available. Detailed information about income, wealth, physical health, and psychological well being was included at both prior waves of the survey. The new wave will extend these observations for another 8 years, more than doubling the number of transitions observed between the first two waves.
Funding Institutions: NIH-NIA (R02 AG010266: 5/15/1992-3/31/2005)
Status: Complete
Publications: Yes (Search Project Bibliography)
Health and Well-being of Families in Transition
Researchers: Larry Bumpass (Professor-emeritus, Sociology, University of Wisconsin - Madison)Abstract: With joint funding from NIH, this NIA project has supported the design and content of the 1992-94 and 2001-2002 waves of the National Survey of Families and Households (NSFH). The NSFH occupies a unique niche defined by the great depth of data on family interactions (up, down, and across the generational ladder, (as well as individual outcomes with respect to health and well-being)in the context of a holistic approach that includes measurement across a wide range of substantive domains. As a resource for researchers (and policy makers) at large, findings from the NSFH are reported in over 400 articles. An incomplete list is provided at http://www.ssc.wisc.edu/nsfh/bib.htm . A great many of these articles concern research with implications for the elderly and near elderly, for example, the over 70 listed under "Kin contact/Kin relationships." This project has been completed, but analyses continue by researchers from many institutions across the country (and the world) who represent a number of different disciplines.
Funding Institutions: NIH-NICHD (R01 HD021009: 1/1/1986-2/28/2005)
Status: Complete
Publications: Yes (Search Project Bibliography)
Exercise and Physical Activity in Older Adults
Researchers: Richard T. Campbell (Professor, School of Public Health, University of Illinois at Chicago) and Sue HughesAbstract: It is important to increase exercise activity in older adults. This project evaluates effectiveness of Fit and Strong Program in community settings. We have seen an increased number of desirable outcomes in both a laboratory setting and in community settings. We plan to extend the program to other work sites.
Status: Ongoing
Publications: Yes (Search Project Bibliography)
Race, SES and Breast Cancer
Researchers: Richard T. Campbell (Professor, School of Public Health, University of Illinois at Chicago), Richard Warnecke, and Therese DolecekAbstract: We are developing new methods for the analysis of racial, ethnic and socioeconomic disparities in breast cancer outcomes. Our objectives are : 1. Use ordinal regression methods to provide a more comprehensive analysis of stage at breast cancer diagnosis, and 2. Develop better methods of using area-based socioeconomic data from the Census. Ordinal regression methods provide a clearer understanding of health disparities. Census-tract level SES measures tend to conceal substantial within-tract heterogeneity. Empirical Bayes estimates of poverty based on a cross classification of race/ethnicity and age are more appropriate. The current analyses are based on Cook County IL. We are in the process of extending the research to a number of other areas.
Status: Ongoing
Publications: Yes (Search Project Bibliography)
State HCBS Funding and Long Term Care
Researchers: Richard T. Campbell (Professor, School of Public Health, University of Illinois at Chicago) and Naoko MuramatsuAbstract: Funding for home and community based services (HCBS) may delay nursing home placement for disabled elderly. The goal of the research is go access the effects of HCBS. States vary immensely in the provision of HCBS. We first acquired data on each state's expenditures from 1990 to the present and linked these data with a restricted version of the HRS/AHEAD survey. We then used discrete time survival models to evaluate the effect of state level HCBS on the rate of transition to nursing homes. State HCBS delayed nursing home placement for elderly persons who had one or two children but not among those with larger families. There was a clear interaction between family size and the effect of HCBS. We are extending this work to older cohorts and other samples.
Status: Ongoing
Publications: Yes (Search Project Bibliography)
Long Term Outcomes of Childhood Abuse
Researchers: Mary Lindsey Carnes (Professor, Medicine, University of Wisconsin - Madison) and Kristen W Springer (Assistant Professor, Sociology, Rutgers University)Abstract: Childhood abuse and maltreatment are linked to an array of adverse mental and physical health outcomes in early and mid adult life. The contributions of such remote abuse on health as individuals age has not been well studied. Objectives are: 1. To examine the relationship of childhood physical abuse to various mental and physical health measures in the existing WLS data 2. To develop questions capturing multiple domains of childhood abuse and maltreatment in the new WLS wave. To date, we have found that even after controlling for family background variables, education, gender, and age, self reports of experiencing physical violence "some" or "a lot" by either parent significantly increased self-reported somatic symptoms in virtually all organ systems as well as depression, anxiety, and hostility. Plans are: 1. Inclusion of more questions on childhood abuse and maltreatment in the upcoming WLS will enable a more extensive exploration of the long term health outcomes as well as examination of mediating factors.
Funding Institutions: DHHS (10/01/2002-9/30/2003)
Status: Complete
Publications: Yes (Search Project Bibliography)
Late Life Widowhood in the United States
Researchers: Deborah Carr (Associate Professor, Sociology, Rutgers University)Abstract: The death of one's spouse is considered among the most stressful life events. Late-life widowhood may pose important emotional and physical challenges for surviving spouses. This group of studies investigates the psychological, social, and interpersonal consequences of late-life spousal loss. An overarching goal is to explore how pre-loss characteristics, including marital dynamics and psychological traits, affect adjustment to loss in the short- and longer-term. Adjustment to spousal loss is closely tied to marital dynamics and social relations maintained over the life course. Current studies include an examination of couple-level concordance of assessments of marital quality and their implications for the psychological adjustment of bereaved spouses; the extent to which the psychological consequences of spousal loss are moderated by coping style (i.e., problem- or emotion-focused coping); and the extent to which the psychological consequences of spousal loss are contingent upon personality traits, measured with the Big 5 inventory (e.g., agreeableness, neuroticism).
Status: Ongoing
Publications: Yes (Search Project Bibliography)
The Consequence of End-of-Life Planning for Bereaved Family Members: a Prospective Study
Researchers: Deborah Carr (Associate Professor, Sociology, Rutgers University)Abstract: Formal preparations for end-of-life medical care are believed to protect the dying and their family from unwanted pain, psychological distress, and financial burden. Identifying the prevalence and consequences of such preparations has important implications for developing effective interventions among older adults and their family members. We document the sociodemographic and psychological correlates of end-of-life planning; explore the consequences of such planning for older adults who recently lost a parent; and explore the ability of older adults to accurately predict their spouse's preference for end-of-life care The likelihood of engaging in formal end-of-life planning is highest among the well-educated, those who recently experienced the painful death of a loved one, and those with low levels of death anxiety. Whom older adults appoint as a health care proxy varies by family status and gender, where women are more likely than men to appoint a child rather than a spouse to make such decisions. Married persons typically turn to their spouse, and parents typically turn to their children. Unmarried childless persons show great heterogeneity in their appointments of health care proxies. We plan to revise and resubmit a proposal to NIA, which requests funding to do a continuous followup of recently bereaved children, spouses, and siblings of Wisconsin Longitudinal Study graduates and their siblings. The study would enable us to document prospectively the consequences of end-of-life planning, and to obtain multiple reports on conflicts pertaining to end-of-life care.
Status: Ongoing
Publications: Yes (Search Project Bibliography)
Employment in Nonprofit Organizations
Researchers: Martin David (Professor Emeritus, Economics, University of Wisconsin - Madison)Abstract: Employment in nonprofit organizations is measured differently in available sources: Economic Census, IRS Form 990, and BLS/QCEW. Such statistics are badly understated. This project establishes discrepancies in the latter two sources and produces a better understanding of paid employment in nonprofit organizations that serve human population. We combine the BLS/QCEW (a quarterly census of Unemployment Compensation employers) with a census of IRS Forms 990/990-EZ filed by charitable organizations (IRC 501(c)(3). The result increases the coverage of employment data on nonprofit organizations. It also demonstrates major gaps in the coverage of both record systems. We found imputed employment for nonreporters exceeds 0.6 m. Our best estimate of employment in charitable organizations, 11.7 m. in 2003 far exceeds the QCEW. The counting of employees is heavily censored and truncated in available sources. Our comprehensive comparison of nonprofit and for-profit organizations delivering educational, social or health services can be achieved by techniques tested for 2003 data. Presentations of completed research have been given to relevant statistical agencies and professionals.
Status: Complete
Publications: Yes (Search Project Bibliography)
SIPP Survey Redesign
Researchers: Martin David (Professor Emeritus, Economics, University of Wisconsin - Madison)Abstract: Survey of Income and Program Paricipation (SIPP) is a nationwide lognitudianl survey. It has problems on misreporting of income and use of poverty-related programs occurs because of "seam bias". That relates to respondents' using heuristics when direct recovery of information from memory is not possible. The original survey design for SIPP exposed measures of measurement errors in reporting event histories. Proposals for redesigning the survey lose that capacity and replace existing within year measures by an event history approach. The design under discussion may not reduce the level of cognitive errors in reporting income. I propose overlapping panels and related measurement error research. My work examines such methodological problems affecting the quality of measurements of poverty and poverty-related programs for the Census Bureau. It will be used in planning for future data collection from SIPP.
Status: Complete
Publications: Yes (Search Project Bibliography)
The Emotional Brain across the Life Course
Researchers: Richard J. Davidson (Professor, Psychology, University of Wisconsin - Madison)Abstract: The work conducted with this support is designed to examine the neural bases of emotion regulation in individuals selected from the Wisconsin Longitudinal Study. The objectives of this work are to use functional magnetic resonance imaging to examine the neural basis of emotion regulation. The MR signals will then be examined in relation to life history measures and indices of well-being to determine the correlates of individual differences in emotion regulation. We will also examine the relation between skills at emotion regulation and measures of health and immune function. To date, we have found that individuals with greater relative left-sided prefrontal activation exhibit faster recovery from negative emotional stimuli. These individuals also report higher levels of psychological well-being and have a more robust response to influenza vaccination. We plan to continue testing additional subjects.
Funding Institutions: NIH-NIA (P01 AG021079: 9/1/2002-8/30/2007)
Status: Ongoing
Publications: Yes (Search Project Bibliography)
Estimating Union Status for Living Arrangement Research
Researchers: Susan De Vos (Scientist, Sociology, University of Wisconsin - Madison)Abstract: How good internationally is the assumption that elderly married people live together while unmarried elders live without a partner? Can household data be used to estimate union status? My objective is to use recent census data for 10 countries that report marital status and also enable the estimation of union status from household data, this study juxtaposes reported and estimated status to assess the use of either variable when studying the living arrangements of elderly people. Assumptions about marital status for living arrangements are not good in Kenya but make sense elsewhere. Most elders estimated to be in a union are reported to be married except in France. Many elders estimated to be in a union may not be reported married.
Status: Ongoing
Publications: Yes (Search Project Bibliography)
Indicating Socioeconomic Status among Elderly People in Developing Societies: An Example from Brazil
Researchers: Susan De Vos (Scientist, Sociology, University of Wisconsin - Madison)Abstract: Researchers misuse the ill-defined concept of socioeconomic status in social research on the elderly population. The objective of this research is to investigate the relative advantage of using housing information, educational attainment and current household income to indicate social standing in Brazil. The three possible indicators do not provide similar information and need to be identified for what they are. Education may be the best indicator. A report is forthcoming in the journal "Social Indicators Research".
Status: Complete
Publications: Yes (Search Project Bibliography)
Living Arrangements of Elderly People in Brazil Since 1960
Researchers: Susan De Vos (Scientist, Sociology, University of Wisconsin - Madison) and Flavia AndradeAbstract: What are the trends over time in the family life of elderly people of a highly complex, stratified, developing country such as Brazil? Is the traditional co-residence of elderly people with their children giving way to more independent living among elders in all social strata? Objectives are to better identify and explain significant racial, gender and regional differentials in change over time in the independent living of elderly Brazilians. Preliminary results were presented at the CDHA seminar in April 2003. Results indicate that independent living among elderly Brazilians is on the increase, but the increase is not shared in equally by the three major racial groups and the gap between the groups appears to be increasing. This is not consistent with the theoretical view that expects modernization to result in more independent family living among all elderly people. Data from the SABE study can be used to extend the analysis in meaningful ways. Specifically, SABE can be used to explore intergenerational exchanges that are not limited to coresidence.
Status: Complete
Publications: Yes (Search Project Bibliography)
On Classifying Race in Brazil for Health Research
Researchers: Susan De Vos (Scientist, Sociology, University of Wisconsin - Madison)Abstract: The Brazilian census has a category for people of both black and white background but many researchers contend that a dichotomy of white/nonwhite would be sufficient. Is that true for research on the functional ability of older people? I will assess whether using a dichotomous or trichotomous variable is more descriptive of racial differences in functional ability among elders 60+ in Brazil. A trichotomous variable is preferable. Indeed, there is a significant cross-over effect in which brown elders end up having higher functional ability than white elders after controlling for various demographic, geographical and socioeconomic factors, especially education. My research for the situation in 1998 is completed.
Status: Complete
Publications: Yes (Search Project Bibliography)
Paying Household Expenses Among Elders in Latin America and the Caribbean
Researchers: Susan De Vos (Scientist, Sociology, University of Wisconsin - Madison) and Paulo SaadAbstract: Some elders receive financial assistance from others to pay for their household expenses whereas others do not. Why? Is this similar or different throughout the Latin American and Caribbean region? We assessed the importance of demographic characteristics including coresidence and whether had surviving children for the economic well-being of elders. Our research found that living arrangements and whether people had surviving children were conjointly important in predicting whether an elder had any assistance in paying for household expenses. So was the combination of gender and marital status. Whether the elder had enough money to cover daily expenses did not seem to matter however. Present the study as an article in a peer-reviewed journal.
Status: Ongoing
Publications: No
Race and Independent Living Among Elderly Brazilians Since 1980
Researchers: Susan De Vos (Scientist, Sociology, University of Wisconsin - Madison) and Flavia AndradeAbstract: Although there was an overall increase in independent living among Brazilian elders, that increase mainly reflects change among Whites whereas there was little change among Browns or Blacks. Since Whites tend to have higher socioeconomic status than Browns or Blacks in Brazil, one might suppose that a racial disparity merely reflects socioeconomic differences. Is that true? Our objective is to examine the situation empirically with census data from 1980 and 2000. Our findings suggest that social, cultural or minority status factors not captured in our statistical models may explain some of the difference. Additional study is needed that will ideally include information about non-coresident as well as coresident kin. This report was accepted for publication.
Status: Complete
Publications: Yes (Search Project Bibliography)
Race and the Functional Ability of Older People in Brazil
Researchers: Susan De Vos (Scientist, Sociology, University of Wisconsin - Madison) and Luisa SchwartzmanAbstract: Race in Brazil is sometimes dichotomized as white/non-white. Other times, three categories are used--white, brown, black. What is best for health research? Our research objective is to empirically examine the issue with national household survey data of 1998. Our findings show that there is reason to prefer the 3-category measure as real differences can be missed otherwise. This project has been submitted for publication and we will see that through.
Status: Ongoing
Publications: Yes (Search Project Bibliography)
Disparities in Wages by Marital Status
Researchers: Aimée R. Dechter (Assistant Professor, Sociology, University of Wisconsin - Madison) and Tara BeckerAbstract: Much attention has focused on the role of the institution of marriage in perpetuating inequality through assortative mating; however, married men also earn more and receive higher wages than single men. Few studies have explored the mechanisms for the persisting marriage premium and there is little empirical evidence to suggest what about marriage generates this advantage, and whether men's gains come at the expense of their wife's wages and human capital growth. An objective of this study is to find out whether all men benefit from marriage equally or whether some marriages possess characteristics that are more likely to positively affect men's wages than others. Examining the diversity of the effect of marriage will help to uncover some of the mechanisms that may be operating to create the marriage premium. Another objective is to explore the relationship between the marriage premium on wages for men, and the effects of marriage on their wives' wages. We find that previously married men retain a premium even though they are no longer married. Moreover, this lingering premium of marriage is the source of the so-called cohabitation premium. By treating cohabitation as a marital status, the effects of cohabitation in previous research is actually an artifact of the higher wages associated with having been married. We find weak and inconsistent evidence that the marriage premium varies by basis of pay, relationship quality, and spousal education and work, and no evidence that it differs between first and subsequent marriages. We have completed a first draft of a paper focusing on the mechanisms that generate the male marriage premium; however, we are currently evaluating the economic variables and have been developing systematic methods for improving the validity of variables with crosschecks between waves, consistency checks with spousal reports, matching of reported hours worked with a 24-hour time diary for the pervious week, and other means. After completing that paper, we plan to write a paper on the effect of the male premium on women's wages.
Status: Ongoing
Publications: Yes (Search Project Bibliography)
Implications of Services and Environment for Socioeconomic and Racial Differentials in Mortality
Researchers: Aimée R. Dechter (Assistant Professor, Sociology, University of Wisconsin - Madison), Huey-Chi Vicky Chang (Research Scientist, Sociology, University of Wisconsin - Madison), and Hyunjoon ParkAbstract: African Americans and other minority groups experience poorer health and higher mortality than whites, even when economic well-being is taken into account. Some have argued that the disparity is due to differences in where people live; however, empirical studies have focused on mean aggregated population characteristics of the places people live from census summary files. Few have examined the mechanisms through which these characteristics affect racial and ethnic differences in mortality The primary goal of our aggregate analysis is to identify sources of racial/ethnic disparities in mortality that may be more readily modified through policy or other means. We ask the following questions: 1) To what degree does the disproportionate allocation of health care services and related goods and resources across counties explain the mortality disadvantages of African Americans, and Hispanics (at most ages)? 2) To what extent do health care programs geared to low income and other underserved populations intervene? We are first gathering data and have done no analyses. We are completing the allocation of missing data for the death data, and the standardization of county codes for the death and population data. Then we can complete the construction of the numerator and denominator for county level mortality rates from 1990 through 2003. We then plan to move on to completing the construction of the explanatory variables from data such as the Area Resource Files, the census summary files, and administrative data on community health centers. Finally, we will conduct county level analyses.
Funding Institutions: Robert Woods Johnson Foundation (10/21/2002-8/31/2003)
Status: Ongoing
Publications: Yes (Search Project Bibliography)
Relationship Quality Differences between Marriage and Cohabitation
Researchers: Aimée R. Dechter (Assistant Professor, Sociology, University of Wisconsin - Madison), Yan Yu, and Michael SobelAbstract: Empirical studies consistently conclude that married individuals report happier unions than cohabiting individuals; however, they rely exclusively on mean levels even though happiness is typically measured on a categorical scale, with a skewed distribution. Moreover, previous studies do not distinguish among the dimensions of happiness, including magnitude and hedonomic sign of affect, which have been fundamental concepts for understanding how individuals experience their feelings and emotions in the social psychological literature. We estimate adjacent category logit models, developed by Michael Sobel, to parameterize intensity and propensity for being happy or unhappy, among other contrasts. We find that married couples are more likely to report one of the happy categories compared to cohabiting couples. Our results are unweighted and we need to figure out the appropriate sample weights. Moreover, we plan to estimate the models by assorted covariates, including race/ethnicity and childbearing status.
Status: Ongoing
Publications: Yes (Search Project Bibliography)
The Role of Attractiveness and Personality in the Gains to Marriage and Spousal Quality
Researchers: Aimée R. Dechter (Assistant Professor, Sociology, University of Wisconsin - Madison)Abstract: In addition to education, personality, facial attractiveness and healthy weights are attributes that seem to matter in labor markets. These traits are also highly valued in the marriage market. This project will use measures from the Wisconsin Longitudinal Study (WLS) to examine the effects of these traits on marriage and spousal quality. Our goal is to see weather there is a relationship between young adult attractiveness, weight and personality and later life health. In particular, we will study whether spousal quality is an important intervening variable between these typically unmeasured variables and subsequent health. For example, if there is a big effect of these traits on spousal earnings, there may be a large indirect effect on health.
Status: Ongoing
Publications: No
Who Is Privy To Their Partner’s Earnings
Researchers: Aimée R. Dechter (Assistant Professor, Sociology, University of Wisconsin - Madison) and Tara BeckerAbstract: Most theories of marriage presume that spouses know a great deal about one another and most of the data used in social science research rely on the ability of spouses and cohabiting partners to provide reliable information about one another. The use of proxy reports, a cost-effect way to retrieve information about multiple members of a household, is ubiquitous. However, little is known about how well spouses and partners know information about each other's earnings and time allocation. This paper assesses the availability and consistency of earnings reports by individuals and their spouse or partner, and asks if proxy reports from cohabiting partners are as consistent as are those from spouses. We conduct descriptive analyses of four dimensions of consistency: propensity to provide a report, convergence between reports, direction of inconsistency, and magnitude of divergence. The National Survey of Families and Households interviewed both individuals within couples, and asked each to report on assorted financial and work-life information about themselves and their spouse/partner. We find that marriage matters when it comes to knowing one another’s earnings, especially with respect to giving a valid report. However, conditional on providing a report, cohabiting males are comparable to husbands with respect to providing proxy reports that converge with their female partner’s report of her own earnings. Proxy reports on men from female cohabiting partners are more problematic. The National Survey of Families and Households interviewed both individuals within couples, and asked each to report on assorted financial and work-life information about themselves and their spouse/partner. We find that marriage matters when it comes to knowing one another’s earnings, especially with respect to giving a valid report. However, conditional on providing a report, cohabiting males are comparable to husbands with respect to providing proxy reports that converge with their female partner’s report of her own earnings. Proxy reports on men from female cohabiting partners are more problematic.
Status: Ongoing
Publications: Yes (Search Project Bibliography)
Investigating Sexual Dysfunciton Using AARP Data
Researchers: John DeLamater (Professor, Sociology, University of Wisconsin - Madison)Abstract: This research tests the influences of age, biological, and psychosocial factors on sexual expression in later life. We used the American Association of Retired Persons Modem Maturity Sexuality Survey which collected data on diagnosed illnesses, treated illnesses, sexual desire, sexual attitudes, partner circumstances, and sexual behavior from 1,384 persons ages 45 and older. We found that diagnosed illnesses and treatments are generally unrelated to frequency of sexual activity. Sexual attitudes are related to frequency of partnered behavior and sexual desire is related to frequency of masturbation among both women and men. Satisfaction with the physical relationship with a partner is strongly related to behavior. Age remains significant after all other factors are controlled.
Status: Complete
Publications: Yes (Search Project Bibliography)
Sexual Satisfaction in the Seventh Decade of Life
Researchers: John DeLamater (Professor, Sociology, University of Wisconsin - Madison), Janet Hyde (Professor, Psychology and Women's Studies Program, University of Wisconsin - Madison), and Mei-Chia FongAbstract: There is little data on the sexual aspects of the lives of people over 60. This population was estimated in 2005 to be one-sixth of the entire population of the US. The objective of this project is to present and interpret data on the sexual behavior and sexual satisfaction of a cohort of men and women ages 62 to 67. We found that psychological distress (CESD) is significantly and negatively associated with, and physical health and marital satisfaction are positively related to, reported frequency of sexual behavior. Distress is negatively associated with, and frequency of behavior and two measures of relationship quality are positively associated with satisfaction with one's sexual relationship. Analyses are ongoing. We are including an expanded set measures of health and daily functioning to see if they are related to frequency of behavior or satisfaction.
Status: Ongoing
Publications: No
Sociobehavioral Data Analysis and Archiving in Aging
Researchers: Janet Eisenhauer Smith (Data Analyst/Archivist, CDHA, University of Wisconsin - Madison)Abstract: The overall objective of this data archiving project is to maximize the likelihood that researchers will use data that has already been collected with NIA funding for innovative and high risk projects. We aim to improve the probability that a researcher will be able to discover existing data and to minimize the time it takes to determine whether those data can support the anticipated research. We also aim to minimize the time between identification of suitable data and publishable research results by providing user-friendly high-functioning standards-compliant metadata and high-quality anonymized (public-use) data for preliminary analyses.
Status: Ongoing
Publications: No
Marriage and Health: the Interpersonal Transmission of Morbidity and Mortality among Elderly Married Couples
Researchers: Felix Elwert (Assistant Professor, Sociology, University of Wisconsin - Madison)Abstract: This project investigates the health consequences of spousal loss and examines the dimensions of variation in this transmission. The widowhood effect - excess mortality due to the loss of a spouse - varies meaningfully by the race of both spouses, by the causes of death of the predecedent spouse and the surviving spouse, and by characteristics of the residential environment of the couple. A newly developed statistical technique indicates that the widowhood effect is robust to unobserved dimensions of homogamy and shared exposure bias. We will study the contribution of spousal loss to the race crossover in mortality.
Status: Ongoing
Publications: Yes (Search Project Bibliography)
Legal Issues of Aging
Researchers: Howard Erlanger (Professor, Law School, University of Wisconsin - Madison)Abstract: There are a couple of emerging issues important to the aging seniors. The first one is to keep their estate plans coordinated and up to date; the second one is to be aware of the fairly rigid rules regarding will execution. On the first point, a major problem can develop when a person gets divorced but does not remove the former spouse as a beneficiary on all parts of the plan [not just the will, but also any assets that pass outside the will, and often these are a significant part of the assets]. There can also be unfortunate results when a plan does not explicitly take into account the possibility that a child might die before the parent, but the unthinkable in fact occurs. On the second point, many people who try 'do-it-yourself' will might not be aware of many potential mistakes in drafting or in execution of such will. For example, there is currently a case being appealed to the Wisconsin Supreme Court where there seems not to be a dispute over whether the document was intended to be the decedent's will, but where there is a question of whether she 'acknowledged' the will to two witnesses, as required by the statute. The witnesses apparently saw the will in the presence of the testator, but she did not come out and say "that's my will." In March of 2006, Dr. Erlanger completed his work on a piece of legislation approximately 70 pages long. It partly addresses these issues but more needs to be done. There will be resistance by lawyers who prefer traditional approaches and by those who are concerned that if it is too easy to correct 'errors'.
Status: Complete
Publications: No
Pension Plan Termination and Retirement
Researchers: Edward W. Frees (Professor, School of Business, University of Wisconsin - Madison)Abstract: The Society of Actuaries’ Non-Mortality Decrement Task Force organized a data collection effort. Thirty-two contributors provided over 1.7 million life years of pension plan turnover data for years 1994-2000. This research summarizes the results of this data collection effort. The research objective of this report was to assess the effects of pension plan characteristics on plan turnover, while controlling for traditional individual characteristics such as age, service and gender. We document the effect of several plan characteristics: eligibility for post-retirement health benefits, benefit formula, hourly/salary and union status, as well as plan size. To assess the effects of plan characteristics while controlling for age, service and gender, we use multinomial logic analysis, a regression methodology suitable for categorical outcomes. We find that small plans have slightly higher termination probabilities compared to medium and large plans (plan size is our proxy for employer size). Union hourly plans have lower termination probabilities than salaried plans; in turn, salaried plans have lower termination probabilities than non-union hourly plans. Firms that offer richer benefits enjoy lower turnover. This work has been submitted to a referred journal. It is in the revise and resubmission stage.
Status: Complete
Publications: Yes (Search Project Bibliography)
Norms and Performance Comparisons of 5 Health Indexes
Researchers: Dennis G. Fryback (Professor, Industrial Engineering, University of Wisconsin - Madison)Abstract: There are 5 "leading" generic health-related quality of indexes (HRQoL)- questionnaires or instruments - in wide use in research, for national and international databases that document population health, and for tracking clinical outcomes among cohorts of patients. However, data collected with one instrument cannot be directly compared to data collected by the others. The overall goal of this program of research is to begin to remedy this lack of comparability across indexes. The research objectives are as follows: 1. To conduct the National Health Measurement Study (NHMS), a national random digit dial survey of U.S. adults, aged 35-89, using all instruments simultaneously to establish joint age-, race- and gender-specific HRQoL norms. 2. To develop statistical "cross-walks" among the measures. 3. To collect longitudinal data in patient cohorts using these 5 measures simultaneously, to establish joint responsiveness to health changes. 4. To develop methods of statistical adjustment for telephone versus self-administration of all instruments. Results from the NHMS (Objective 1) indicate that the indexes exhibit similar patterns of age-related HRQoL by gender and race; however, absolute means differ across indexes. Females report slightly lower HRQoL across all age groups, compared to men. HRQoL is approximately the same for white and black males in younger age groups, but is substantially lower for black males compared to white males in older age groups. Black females report lower HRQoL than do white females at younger, but not older ages. We will utilize the data collected from the NHMS to pursue research objective 2: developing statistical "cross-walks" among the measures. Data collection remains ongoing for objectives 3 and 4 (longitudinal data in patient cohorts, and the mode of administration study).
Funding Institutions: NIH-NIA (P01 AG020679: 4/1/2004-3/31/2008)
Status: Ongoing
Publications: Yes (Search Project Bibliography)
Exploring Concepts of Population in Human Genetic Studies
Researchers: Joan Fujimura (Professor, Sociology, University of Wisconsin - Madison)Abstract: This project will investigate practices through which biomedical researchers operationalize the concept of "a human population." We will investigate these practices by conducting field observations and interviews in laboratories where researchers study human genetic variation. Researchers typically study genetic variation by assessing the frequencies of genetic markers in a human population, and by comparing marker frequencies among populations. Thus, genetic variation research will provide opportunities for us to observe researchers as they determine which groups to study, how those groups should be described, and how they should be constituted. Human genetic variation is complexly distributed among people around the world. Researchers study this variation for several reasons, including a desire to create tools for finding medically important genes/alleles, and to better understand human demographic history. When studying populations or groups, there are different and nested ways that people can be categorized, including by band, tribe, nation, language group, religious affiliation, geographic location, race, and ethnic group. Commentators have observed that population descriptors often differ within and across genetics studies. No one taxonomic scheme will be best for all purposes, but some might be more informative for particular purposes, some may be easier to implement and validate, and some may produce more or fewer opportunities for confounding. Our project will produce information about how and why scientists choose and institute categorization schemes, and how different concepts of population influence the design, data collection, and analysis of human genetic variation research projects. By making this information explicit we hope to help both scientists and policy makers in planning and evaluating human genetic variation research. Another aim of our project is to examine whether or how laws and regulations pertaining to the inclusion of racial and ethnic minorities in research influence the ways in which populations are constructed. We have already begun and will continue to evaluate published literature on genetic variation as well as laws, recommendations and guidelines that apply to human genetic variation research and that guide scientists in choosing or describing subjects.
Status: Ongoing
Publications: No
The Long Term Impact of Parenting an Adult Child with Bipolar Disorder: a Study of the Wisconsin Longitudinal Cohort
Researchers: Jan S. Greenberg (Associate Professor, School of Social Work, University of Wisconsin - Madison) and Kelly Anne AschbrennerAbstract: The overarching goal of this dissertation research is to investigate the long term impact of parenting an adult child with bipolar disorder. Specifically, this study will use prospective longitudinal data from the Wisconsin Longitudinal Study (WLS) to investigate whether parents of adult children with bipolar disorder differ from parents of unaffected children with respect to parental health and well-being at midlife, and again, ten years later as parents transition to retirement and old age. This study will also examine if and to what extent primary stressors (i.e., child’s illness characteristics), secondary stressors (i.e., work-family strain, marital conflict, child demands), and social resources (i.e., availability of social support) are related to the health and well-being of parents of adult children with bipolar disorder at midlife and in older age. Following a series of screening procedures developed by Seltzer and Greenberg used to identify WLS respondents who are parents of children with a nonnormative condition (i.e., developmental disability or a serious mental health problem), 152 parents of biological or adopted children diagnosed with bipolar disorder have been identified. A comparison group of parents of adult children without disabilities has been drawn to estimate the relative impact of parenting an adult child with bipolar disorder. Results from preliminary analysis reveal that when parents are, on average, in their mid-60s, parents of adult children with bipolar disorder report higher levels of somatic health problems and higher levels of depressive symptoms as compared to parents of adult children without disabilities. There were no differences observed in parental levels of psychological well-being at this time point. The next steps in this dissertation are to investigate whether there were differences in parental health and well-being about ten years earlier when parents were, on average, in their early-50s, and closer to the onset of their child’s bipolar illness. Future analysis will also examine a stress and coping framework used to understand the stress process among parents of adult children with bipolar disorder.
Status: Ongoing
Publications: No
Estimating Health Expectancies from Two Cross-sections
Researchers: Michel Guillot (Associate Professor, Sociology, University of Wisconsin - Madison)Abstract: Health expectancies are key indicators for monitoring the health of populations, as well as for informing debates about compression or expansion of morbidity. However, current methodologies for estimating them are not entirely satisfactory. They are either of limited applicability because of high data requirements (the multistate method), or based on questionable assumptions (the Sullivan method). This project proposes to develop and test a new method for estimating health expectancies which relies on the multistate framework but uses widely available data. The idea is to use age-specific proportions of healthy individuals at two successive but independent cross-sectional surveys and together with information on general mortality, to solve for the set of transition probabilities that produces the observed sequence of proportions healthy. The system is solved by making realistic parametric assumptions about the age patterns of transition probabilities. Using panel data from the Medicare Current Beneficiary Survey (MCBS) and the Survey of Income and Program Participation (SIPP), this project proposes to test the method against both the Sullivan method and the gold-standard multistate method. The intercensal method for estimating health expectancies developed in this project appears to work perfectly when there is no sampling variability and when the parametric assumptions are exactly met. When we introduce sampling variability, the optimization does not perform as well, particularly for recovery transition probabilities. The corresponding conditional health expectancy estimates, however, appear more robust, in particular for the healthy individuals. We are exploring a number of directions for fine-tuning the method. We are hoping to submit an NIA proposal on this project, depending on how promising our results are.
Status: Ongoing
Publications: Yes (Search Project Bibliography)
Ethnic Differentials in Mortality In Kyrgyzstan
Researchers: Michel Guillot (Associate Professor, Sociology, University of Wisconsin - Madison)Abstract: The purpose of this project is to examine mortality by ethnic group in the former Soviet Republic of Kyrgyzstan from 1959 to 1999. There are major uncertainties about ethnic-specific mortality levels and trends for this population which were unable to be addressed previously due to the lack of available data. We intend to narrow substantially the range of uncertainty by using newly-available census and vital registration data from the National Statistical Committee of the Kyrgyz Republic (NatsStatKom) and by applying demographic estimation procedures that are well-suited to these data. Using a variety of demographic techniques, the quality of census and vital registration data will be assessed, and improved estimates of mortality by ethnic group will be produced. These methods include intercensal comparison of cohort size; a procedure based on the reported age distribution of deaths and age-specific growth rates; and a procedure for producing life tables directly from the age distribution of the population and age-specific growth rates. A particular focus of this research is infant and child mortality by ethnic group. Using reported monthly probabilities of dying below age 2 since 1959 and individual census reports of women regarding their number of births and child deaths in 1989 and 1999, improved and independent estimates of infant and child mortality by ethnicity will be produced for the period 1959-1999. These estimates will permit an assessment of the quality of the reported trends and allow a substantive analysis of the differential effect of the post-Soviet transition period on the child mortality conditions of the various ethnic groups. Behavioral and biomedical risk factor distributions among the various ethnic groups will then be estimated using the 1993 Kyrgyzstan Multipurpose Poverty Survey (KMPS), and the extent to which these risk factor distributions could account for the corresponding mortality differentials at the aggregate level will be assessed. We are currently conducting the second phase of the project, which consists of a direct assessment of data quality and which will help confirming or invalidating these preliminary conclusions.
Funding Institutions: NIH-NICHD (R03 HD38752-03: 4/1/2001-3/31/2005)
Status: Ongoing
Publications: Yes (Search Project Bibliography)
Methodology of Estimating Healthy Life Expectancies
Researchers: Michel Guillot (Associate Professor, Sociology, University of Wisconsin - Madison) and Alberto Palloni (Professor, Sociology, University of Wisconsin - Madison)Abstract: In the last few decades, much research has beendevoted to estimating health expectancies as well as fine tunning measures of total expectancies at older ages. The health expectancy is a population health indicator which brings together data on both quantity (through mortality) and quality of life (usually through disability). The health expectancy measures the number of years that one can expect to live in a defined health status. Health expectancies are important indicators because they can monitor the health of populations with a greater level of detail then traditional life expectancies (Murray and Evans 2003). This project plans to develop and test a new method which relies on the multistate framework, but uses widely available data. The idea is to use age-specific proportions of healthy individuals at two successive, but independent, cross-sectional health surveys and together with information on general mortality to solve for the set of transition rates (in-and-out of disability) that produces the observed sequence of proportions healthy.
Status: Ongoing
Publications: No
Mortality and Population Dynamics
Researchers: Michel Guillot (Associate Professor, Sociology, University of Wisconsin - Madison)Abstract: The aim of the project is to design innovative approaches in mortality measurement and its impact on population dynamics, including population aging. This research presents the implications of a summary mortality index, the Cross-sectional Average Length of Life (CAL). By combining the mortality experience of various cohorts in a cross-sectional fashion, CAL complements traditional one-period or one-cohort indexes and enriches our understanding of population processes. First, CAL provides an alternative insight into the analysis of mortality. By taking into account the real mortality conditions to which individuals in a population have been subject, it tends to yield less favorable mortality levels and produces different rankings of mortality levels across countries. Second, CAL is a relevant index for the study of population dynamics. In particular, change in CAL over time shows the direct impact of mortality change on population growth. It illustrates that mortality can play a non-negligible role in future population growth, even in the absence of future mortality improvements. This project will involve a series of papers. The first paper, which appeared in the March 2003 issue of Population Studies, provides an overview of the findings. A second paper, published in 2005, deals specifically with population momentum, and a third paper, published in 2006, discusses tempo effects in mortality.
Status: Complete
Publications: Yes (Search Project Bibliography)
Mortality in Central Asia
Researchers: Michel Guillot (Associate Professor, Sociology, University of Wisconsin - Madison)Abstract: The goal of this project is to improve our knowledge of mortality in former Soviet Central Asia, a region which gained importance recently. Although there is considerable interest in understanding social, economic and cultural change in the area, because of the strategic role that this region is currently playing, very little is known about local mortality processes. In addition to filling these gaps in contextual mortality information, this project will improve our understanding of the relative role that social, economic and cultural factors can play in determining mortality patterns in developing countries. This project plans to gather and analyze unpublished aggregate- and individual-level data from local statistical offices in Uzbekistan, Kazakhstan, Kyrgyzstan, Tajikistan and Turkmenistan. The analysis of these sources will be complemented by the use of data from Demographic and Health Surveys (DHS) and Living Standards Measurement Study (LSMS) household surveys. The implementation of various demographic and statistical methods will permit (a) the assessment of data quality and changes thereof for each of these five republics since 1958; (b) the estimation of ethnic-specific and cause-specific mortality rates for each of these five republics since 1958; and (c) the estimation of biomedical, economic, social and cultural factors associated with recent mortality levels, trends and differentials in Central Asia.
Funding Institutions: NIH-NICHD (R01 HD045531: 4/1/2006-2/28/2011)
Status: Ongoing
Publications: Yes (Search Project Bibliography)
Projecting Cohort Life Expectancy Using CAL
Researchers: Michel Guillot (Associate Professor, Sociology, University of Wisconsin - Madison)Abstract: Methods for projecting mortality typically rely on the extrapolation of trends in period mortality. Yet trends in cohort mortality are much more stable and thus may constitute a stronger basis for the projection of future mortality. In particular, the mortality experience of cohorts up to the present time, even if truncated, may contain useful information for predicting future mortality. A particularly stable mortality indicator is CAL, the "cross-sectional average length of life". This index, first proposed by Brouard (1986) andhrther developed by Guillot (2003), contains the mortality experience of all cohorts present in the population at a given time. This index is even less subject to annual variations than eOc, the cohort life expectancy. Recently, Goldstein (2006) has established that under certain assumptions about the pattern of mortality change, the value of CAL for a given year is equal to the value of the life expectancy at birth for the cohort born CAL years before. The implication of this correspondence is that under these assumptions, the value of the life expectancy at birth for the cohort born CAL years ago can be accurately predicted from the current value of CAL, even though this cohort is not yet extinct. Goldstein established this correspondence in theory. Yet, our preliminary work suggests that the correspondence between CAL(t) and eOc[t-CAL(t)] may in fact exist in a number of contexts, regardless of the level of mortality and the pattern of mortality change. This also suggests that recent trends in CAL could serve as a useful basis for projecting the life expectancy of cohorts which are not yet extinct, even if Goldstein's assumptions are not exactly met. The purpose of this project is to examine the empirical correspondence between CAL and eOc,and to examine the extent to which CAL can be used as a tool for projecting levels of cohort life expectancy. we will 1) calculate CAL and eOc for all countries and all possible years in the human mortality database (www.mortality.org); 2) establish empirical correspondences between CAL(t) and eOc[t-CAL(t)] whenever possible; 3) examine the patterns of changein age-specific mortality that generate these correspondences; 4) Depending on the results of (2) and (3), examine the extent to which CAL(t) can be used as an estimate of the value for the cohort born at time t-CAL(t); 5) Depending on the results of (4), compare the projected values of cohort life expectancy with estimates projected using existing methods (log-linear projection of mortality rates, Lee-Carter model).
Status: Ongoing
Publications: No
Development of a Workshop on Personality, Health, and Aging
Researchers: Robert M. Hauser (Vilas Research Professor, Sociology, University of Wisconsin - Madison)Abstract: Goldberg (2005) argued that "...well-constructed measures of personality traits predict the most important life events e.g., health-related behaviors and outcomes, including morbidity and mortality; job performance, including leadership styles; educational achievement, even after controlling for cognitive test scores; relationship outcomes, including marital failure; and of course virtually all serious mental disorders, including drug and alcohol abuse". However, major NIA-funded longitudinal studies are strikingly absent from the bodies of data on which this recent psychological research is based – and not merely by dint of the absence of appropriate measures of personality. This project will review and assess recent, relevant research in personality psychology and to prepare an overview of the correlates of personality in the past two waves of the Wisconsin Longitudinal Study (WLS) as a complement to other, similar reviews prepared from other bodies of data such as the Health and Retirement Study. This research, more importantly, will lead to improved measures of personality and research on personality in the future waves of the WLS and other longitudinal studies. Three of the NIA P30 Centers for research in the demography of aging will collaborate in a workshop on the measurement and correlates of personality in November 2007.
Status: Ongoing
Publications: No
The Wisconsin Longitudinal Study: As We Age
Researchers: Robert M. Hauser (Vilas Research Professor, Sociology, University of Wisconsin - Madison)Abstract: We propose to continue the Wisconsin Longitudinal Study (WLS) with a major round of data collection, 45 years after the high school graduation of the original 10,317 participants. We want to exploit the unique scientific value of the WLS to pursue a broad agenda of research on social and economic factors in health and aging. We represent diverse scientific fields – sociology, demography, epidemiology, economics, social and cognitive psychology, industrial engineering, neuroscience, social work, psychiatry, nursing, and medicine. Our plan for data collection – of which these proposed surveys are only the first phase – will span many modes: telephone and mail surveys, brain imaging, personal interview, anthropometric measurement, bio-indicators, content analysis of recorded interviews, and linked administrative records. We intend and expect that these new data, along with the rich data presently available from the WLS, will resolve old questions and open new areas of interdisciplinary inquiry about health, aging, and the life course. All WLS data will be released to the research community as soon as they have been collected, cleaned, and documented. We propose one-hour telephone and 48 page mail surveys in 2002-03 of more than 9600 surviving American men and women who were first interviewed as graduating seniors in high school in 1957 and were followed up in 1964, 1975, and 1992; they will be 63-64 years old when they are surveyed. (b) We propose parallel telephone and mail surveys of 7150 randomly selected siblings of the graduates; they vary widely in age and most were first surveyed in 1994; about 2100 were first interviewed in 1977. (c) We propose shorter (30 minute) telephone interviews with spouses (N = 10,150) and widows of graduates and their siblings (N = 850). The WLS is unique as a large scale longitudinal study of adults and their families that will soon cover almost half a century. It is a valuable public resource for studies of aging and the life course, inter-generational transfers and relationships, family functioning, long-term effects of education and of cognitive ability, occupational careers, physical and mental well-being, and morbidity and mortality. Our goal is to extend and enrich our observations of the WLS cohort since their adolescence in ways that will answer important research questions in aging for decades to come. A rewewal application for home interviews, including functional and cognitive assessments, will be submitted on 5 July 2007.
Funding Institutions: NIH-NIA (R01 AG009775: June2002-March2008)
Status: Ongoing
Publications: Yes (Search Project Bibliography)
Income Support Policies and the Health of the Elderly
Researchers: Pamela Herd (Assistant Professor, Sociology, University of Wisconsin - Madison)Abstract: There is over two decades of research demonstrating a link between low incomes and higher rates of morbidity and mortality. If income does have a causal impact on health and mortality, then income support policies, which bolster incomes, should reduce mortality and morbidity rates. Our research objective is to test whether SSI, a means tested income support for elderly Americans, has reduced mortality and morbidity rates among the elderly. When examining changes within state maximum SSI benefits from 1990 to 2000, we find that increases in benefits were correlated with reductions in morbidity rates among the elderly. These findings held even when accounting for the link between SSI eligibility and Medicaid. After having collected mortality data and data on Old Age Assistant and SSI benefits from 1940 through 2000, we will measure the impact of within state changes in benefits over time on mortality rates among the elderly.
Funding Institutions: NIH-NIA (R03 AG027661: 3/15/2006-2/28/2008)
Status: Ongoing
Publications: Yes (Search Project Bibliography)
Onset versus Progression of Health Decline: Understanding Socioeconomic Disparities in Health
Researchers: Pamela Herd (Assistant Professor, Sociology, University of Wisconsin - Madison)Abstract: This paper seeks to elucidate the relationship between socioeconomic position and health by showing how different facets of socioeconomic position (education and income) affect different stages (onset versus progression) of health problems. The biomedical literature has generally treated socioeconomic position as a unitary construct. Likewise, the social science literature has tended to treat health as a unitary construct. To further our understanding of the relationship between socioeconomic position and health, and ultimately foster appropriate policies and practices to improve population health, a more nuanced approach is required that differentiates theoretically and empirically among dimensions of both socioeconomic position and health. We use the American Changing Lives Survey to test whether income and education have differential impacts on the onset of poor health versus declines into worse health. We find that education is a better predictor than income of disease onset, while income is a better predictor than education of disease progression. Education only has an independent effect on disease onset, while income does have independent effects on both onset and progression. The next state of the project will explore the mechanisms between education and income and disease onset and progression.
Status: Ongoing
Publications: Yes (Search Project Bibliography)
Relationship between Early Life Schooling Experiences and Late Life Health Outcomes
Researchers: Pamela Herd (Assistant Professor, Sociology, University of Wisconsin - Madison)Abstract: While the links between education and health are unquestioned, the explanations for what underlies this relationship are not well understood. This project plans to understand how early life schooling experiences (from grades to social activities) impact health outcomes across the life course. Curent findings indicate that high school class rank exerts an independent impact on health outcomes in old age. Future work will explore the links between school quality and health outcomes across the life course.
Status: Ongoing
Publications: Yes (Search Project Bibliography)
Relationship between Income Supports and Health
Researchers: Pamela Herd (Assistant Professor, Sociology, University of Wisconsin - Madison)Abstract: While there is longstanding evidence that poverty negatively affects health, we know little about whether policies targeted at improving the incomes of the poor also affects health. Our project test whether the Supplemental Security Income program affects disability among the elderly. We find that within state changes in maximum SSI benefits are correlated within state changes in disability among the elderly. Increases in the maximum benefit are correlated with reductions in disability among the elderly. Further work is focused on exploring the links between SSI and health in the 1970s. Also, we will explore the links between SSI's predecessor (Old Age Assistance) and its impacts on mortality between 1940 and 1950.
Status: Ongoing
Publications: Yes (Search Project Bibliography)
The Relationship between Education and Health
Researchers: Pamela Herd (Assistant Professor, Sociology, University of Wisconsin - Madison)Abstract: Though the causal link between education and health is largely accepted, much remains unknown regarding the mechanisms that link education to health outcomes. I explore the relationship between 1) IQ and health outcomes and 2) schooling characteristics (school quality) and health outcomes in the Wisconsin Longitudinal Study. Preliminary evidence indicates that IQ is not a confounding factor explaining the relationship between education and health outcomes. Future plans are to further test the link between schooling characteristics and health and mortality outcomes.
Status: Ongoing
Publications: Yes (Search Project Bibliography)
Assessing Savings Sufficiency at the Time of Retirement and Ten Years Later
Researchers: Karen C. Holden (Professor, Consumer Science, University of Wisconsin - Madison), Robert Haveman (Professor Emeritus, Economics, University of Wisconsin - Madison), and Barbara L. Wolfe (Director, La Follette School of Public Affairs, University of Wisconsin - Madison)Abstract: This project has used the New Beneficiary Survey to examine wealth accumulation at retirement and the level of consumption that can be financed with that wealth for the remaining expected years of life of the retiree and, if married, of the surviving spouse. It also, uniquely, asks about the ex post adequacy of the full constellation of resources available to individuals over the course of their retirement years: Is the estimated steady-state retirement consumption level that is possible from wealth accumulation at retirement maintained throughout the years of retirement? In this research, we contribute evidence on the extent to which people who have been retired for a decade have maintained resources at the levels which were estimated to be sustainable at retirement. That is, we compare sustainable consumption during their expected remaining years of retired life at retirement and ten years later, asking for whom this level of potential consumption rises, fall, or remains the same. We are particularly interested in the events that appear to undermine the level of sustainable consumption (e.g., widowhood, inflation, disability) and whether the type of retirement income (e.g., share from Social Security, pensions, own savings) reduce or increase vulnerability of individuals to these events. To our knowledge, the extent to which resources are adequate well into the retirement period has not yet been studied. From this project have come several published papers and conference presentations. With UW Graduate School support we have embarked on a comparative cohort analysis of well-being at retirement using both the NBS and Health and Retirement Survey data and have a proposal (second submission) at NIA for further HRS analysis.
Status: Ongoing
Publications: Yes (Search Project Bibliography)
Changes in Expectations of Nursing Home Use: The Role of Demographic Characteristics, Economic Resources, Health Insurance, and Health Status
Researchers: Karen C. Holden (Professor, Consumer Science, University of Wisconsin - Madison) and Hung-Tai LinAbstract: Out of pocket expenditures on nursing home care is a major financial risk factor for older individuals. Yet nursing home insurance is a product that is purchased by a relatively small proportion of the population. We know little about the role of expected nursing home expenditures on savings and insurance purchase decisions. The objective of this project is to understand the predictors of individuals' expectations of nursing home entry, how these expectations change has the HRS cohort ages, and what appears to be the new information or conditions that affect these expectations. We explore whether and how expectations of nursing home entry, and change in those rates, affect the purchase of nursing home insurance. Even at the still relatively young ages of the HRS cohort, it appears that individuals assess the probability of future nursing home entry taking account of their own probable future risk state rather than current objective risk factors. Probabilities of a future event are expected to become more accurate over time as new information on determinants of nursing home entry become available to individuals. These results suggest that may be the case. Our variables are consistent with hypotheses about who is more likely to search for and take account of new information on actual risks. Thus the effects of higher education and changes in marital status are inconsistent with actual entry risk but are consistent with these individuals being more likely to observe the world around them and reassess what initially may have been fairly uninformed guesses. Our plans include publication of paper in a Consumer Science or Aging Journal.
Status: Ongoing
Publications: Yes (Search Project Bibliography)
Gender Differences in the Labor Force Participation of Older Persons: an International Comparative Study
Researchers: Karen C. Holden (Professor, Consumer Science, University of Wisconsin - Madison) and Jeungkun KimAbstract: This project is a cross-national comparison of the Labor Force Participation (LFPR) of older persons, with focus on gender differences in explanations of work participation across countries. The aim is to examine the relationship among socio-economic factors affecting the LFPRs of older persons in developed countries, attempting to distinguish between the effects of financial variables influencing individual retirement behavior and those that characterize the broader social norms within which individuals make those choices. This is an exploratory study, intended to lead to proposals to refine “social norm” variables in ways that enable exploration of their effects on samples of retirement-age individuals over time, using other data sets for other countries as well as panel data in the U.S. The study has used LIS data from 13 countries, linked to OECD data to provide the country level and institutional factors. It has examined male and female LFPRs, preliminarily distinguishing the effects of factors that are “individual level” from those that may be characterized as modifying individuals’ responses to comparable incentives. This analysis is not longitudinal. We are now exploring the Survey of Health, Ageing and Retirement in Europe (SHARE) in preparation for in an NIA submission, likely in June.
Status: Ongoing
Publications: No
Have Newly Retired Workers in the U.S. Saved Enough to Maintain Well-Being through Retirement Years?
Researchers: Karen C. Holden (Professor, Consumer Science, University of Wisconsin - Madison), Robert Haveman (Professor Emeritus, Economics, University of Wisconsin - Madison), and Barbara L. Wolfe (Director, La Follette School of Public Affairs, University of Wisconsin - Madison)Abstract: There is concern that workers in the U.S. are not saving "enough" for retirement. But study results differ and measures of sufficiency are not standard across studies. Using data for a cohort of newly "retired" workers, we examine several measures of adequacy of retirement resources to estimate whose resources appear sufficient to maintain a prescribed level of consumption over their own and, if married, their spouse's expected lifetimes. In this paper we estimate permanent preretirement earnings over the prime working years of a new retiree and spouse (if married) and measure resource adequacy by comparing the annuitized value of wealth to both the household's own preretirement living standards, and to an absolute national standard of resource adequacy. Our estimates of replacement rates. based on prior earnings suggest a substantial national problem of resource adequacy, with a median replacement rate of about .5. Our results show, however, that resource inadequacy by this measure increases with greater earnings. For this reason we turned also to a measure of absolute inadequacy. About 15 percent of our new beneficiaries have insufficient wealth to allow them to live at an above-poverty line level during all years of retirement, and only half have sufficient resources to enable them to live at a level which is twice their poverty line. We find that those who receive Social Security benefits at younger ages, who do not have private health insurance, employer provided pensions, or an owned home, and who are divorced or separated are at higher risk of having insufficient resources. These estimate suggest that older person enter retirement with resources that are not sufficient to maintain a steady level of "adequate" consumption during their entire remaining lifetimes. Longer lifetimes than those embodied in U.S. life tables would make this situation even worse. Unexpected changes in assets–inflation or lower interest than assumed in our estimates–would also bode poorly for retirement well being. We next turn to estimating resource adequacy among the older SSDI beneficiaries.
Funding Institutions: Social Security Administration, UW Graduate School, and IRP (1/1/1999-3/31/2002)
Status: Ongoing
Publications: Yes (Search Project Bibliography)
Looking beyond Retirement-Patterns and Predictors of Formal End-of-life Planning among Retirement Age Individuals
Researchers: Karen C. Holden (Professor, Consumer Science, University of Wisconsin - Madison) and Yung-ting SuAbstract: EOL health and financial planning are typically considered separate decisions by professionals even though EOL health plans (or lack of) may have financial consequences. This study aims to understand whether individuals' behavior suggests these are thought of as separate or integrated estate planning decisions by individuals. This study uses the 2004 wave of the Wisconsin Longitudinal Study (WLS) to examine the patterns and predictors of formal EOL planning strategies among retirement age individuals and whether EOL health and financial planning are highly correlated planning behaviors. Findings show that EOL health plans appear to be done in combination with financial plans. Females, higher educated persons and those with higher net worth are more likely to have integrated EOL plans containing both EOL health and EOL financial plans. It is suggested that policy makers, health and financial professionals, and educators concerned about the consequences of the absence of EOL health plans, should facilitate the joint planning with finances, especially among those at higher risk of not having such plans (e.g. males, less educated persons, and those who have little net worth). We plan to continue exploring estate planning strategies and consequences among individuals and couples in the WLS (and possibly HRS as well).
Status: Ongoing
Publications: Yes (Search Project Bibliography)
Social Security, Age-of-Retirement, and Economic Wellbeing: Intertemporal and Demographic Patterns Among Retired-Worker Beneficiaries
Researchers: Karen C. Holden (Professor, Consumer Science, University of Wisconsin - Madison), Robert Haveman (Professor Emeritus, Economics, University of Wisconsin - Madison), and Barbara L. Wolfe (Director, La Follette School of Public Affairs, University of Wisconsin - Madison)Abstract: In part because of pending increases in the age of full retirement for Social Security benefits, there is concern about the relative well being of individuals who receive benefits early compared to those who delay receipt. Objective is to examine differences between early and late recipients of Social Security benefits and how timing of benefit receipt influences economic well being in retirement. We examine the economic status of a sample of new recipients of social security retired-worker benefits shortly after first benefit receipt (1982) and ten years later (1991), using longitudinal data on retired-worker beneficiaries surveyed in the Social Security New Beneficiary Survey. We compare differences in economic well-being by age of first benefit receipt, gender, and race. For both 1982 and 1991, the probability that these retired-worker beneficiaries are poor or near poor after taking account of social security benefits is positively and strongly associated with their acceptance of early retired-worker benefits. Early retirees, women who remained single, and women who lost their spouses experienced large declines in economic status over the decade following first receipt of benefits. A multivariate analysis of the risk of remaining or becoming poor or near poor between these two years confirms the continuing disadvantaged status of early benefit recipients. While both women and men who first received benefits at younger ages had lower economic status than did those who became beneficiaries at older ages, this retirement age-related disadvantage increases over the decade for women but not for men. We conclude with policy recommendations. This is part of a larger study of savings for retirement and economic well being in retirement. We hope to submit grant proposals to do this same analysis, using the HRS.
Funding Institutions: Social Security Administration (1/1/1999-2/28/2001)
Status: Complete
Publications: Yes (Search Project Bibliography)
The Financial Risks and Consequences of Early Widowhood
Researchers: Karen C. Holden (Professor, Consumer Science, University of Wisconsin - Madison)Abstract: This project will examine the consequences of relatively early spousal death using WLS data on widows and widowers, who were about 64 years of age when interviewed in 2004-05. At this age couples may be increasingly likely to engage in end-of-life and estate planning as retirement approaches, but not for all will this be the case. For some widowhood would have taken place prior to retirement and to the retirement planning that may have considered widowhood. For widows in the sample we have detailed information on current characteristics that was gathered from all WLS respondents. For individuals widowed in the two years just prior to the interview we have information on the death, duration of final illness, end-of-life planning (i.e., estate planning, having a living will, a DPAHC, and holding discussions) by the respondent and the deceased spouse and the economic and emotional costs of the death. In accord with the SOA RFP, we will focus specifically on financial aspects of a spouse’s death but also explore how financial stress contributes to psychological and emotional well being. We will: 1. Document the income and assets of widows and widowers as well as their psychological well-being, distinguishing surviving spouses by the duration of widowhood. 2. Focus specifically on individuals widowed in the two years just prior to the survey, including data on the death and estate distribution experience. 3. Document changes in subjective assessments of economic security, well-being, and strain among women and men within the first two years following their transition to widowhood; 4. Explore whether a late spouse’s estate planning (reported retrospectively by recently widowed individuals in the 2005 WLS interview) is associated with the objective and subjective economic well-being of widows, within the first two years following spousal death. 5. Explore changes in health insurance coverage in the two years prior to widowhood and the extent to which these are causal or coincident with a spouse’s death. 6.Examine whether age and duration of widowhood is related financial and psychological wellbeing in 2004.
Funding Institutions: Society of Actuaries (1/1/2007-7/31/2008)
Status: Ongoing
Publications: No
The Income Consequences of Widowhood in Britain, U.S., and Germany
Researchers: Karen C. Holden (Professor, Consumer Science, University of Wisconsin - Madison) and Jeungkun KimAbstract: This project looks at how income sources change when married women in Britain, the U.S. and Germany are widowed and draw inferences about the consequences of the different systems of covering retirees and their survivors. Earlier work on this issue was based on the Cross-National Equivalent File (1980-1997) which includes data from the German Socio-Economic Panel (1984-1997), the U.S. Panel Survey of Income Dynamics (1980-1997), and the British Household Panel Survey (1991-1998). Results were published in 2002 and 2003. With Jeungkun Kim, I am currently updating these results with the CNEF (1980-2001) which allows for larger samples of widows and thus a more sophisticated analysis of change.
Status: Ongoing
Publications: Yes (Search Project Bibliography)
ACCESS Study: Assessment of CAncer CarE and SatiSfaction
Researchers: Betty J Kramer (Professor, Social Work, University of Wisconsin - Madison)Abstract: The National Cancer Institute has identified several aspects of cancer care that need to be addressed. Little is know about the quality of cancer care in the state of Wisconsin and the needs of patients and family members. The goals for the larger "Quality of Cancer Care in Wisconsin" study are to identify barriers that affect patient satisfaction, quality of life and treatment options in Wisconsin cancer survivors. Dr. Kramer is adding questions to a survey disseminated to family members of persons who have died, to examine their perceptions of the quality of care provided, and the impact of that care on family conflict at the end of life, and the family member's current psychological and physical well-being (e.g., complicate d grief, depression, health). The survey is currently in the field. This study will provide pilot data for future research by illuminating understanding of how barriers and quality of care impact family members of elders who die from cancer. We hope to uncover strategies to improve cancer care, and information that may be helpful in developing family based interventions at the end of life that could be tested.
Status: Ongoing
Publications: No
Family Caregiving at the End of Life
Researchers: Betty J Kramer (Professor, Social Work, University of Wisconsin - Madison)Abstract: Increasing numbers of family members have been providing care at home for elders who have a terminal illness. Optimal care of the dying is determined, to some extent, by family caregivers and should address strategies to help them in their role. Understanding the unique aspects of end-stage caregiving becomes essential to that effort. This study aimed to understand how caregivers make the transition to end-stage caregiving and to illuminate its unique aspects using a stress process model. End-stage caregiving was characterized in the sample as (1) comprehension of terminality (the interrelationship of information, physical and cognitive decline, and personality change and role losses), (2) near-acute care, (3) executive functions, and (4) final decision making. The comprehension of terminality emerged from three interrelated experiences: receiving and assimilating concrete information about the illness, observing the progression of the disease, and observing the personality change and role loss. The primary stressors (unique end-stage caregiving tasks) were providing near-acute care, assuming an executive function, and beginning and final decision making. The secondary stressors were family role conflict, work conflict, and financial strain. Resources, such as intrinsic and extrinsic religious and faith practices and social support, were identified. Negative outcomes included intense emotional responses, and positive outcomes included heightened development of meaning making. The findings suggest that palliative care professionals have important opportunities to provide information and support to family caregivers during the final stages of the patient's terminal illness.
Status: Complete
Publications: Yes (Search Project Bibliography)
Innovations in End of Life Care for Elders with Advanced Chronic Disease
Researchers: Betty J Kramer (Professor, Social Work, University of Wisconsin - Madison)Abstract: Inadequate care of the dying is emerging as a major concern among health care providers, educators, and policy makers. The field is challenged to develop end of life care models that address the unique needs of low income elders who die with advanced chronic disease and their support network. The Elder Care Partnership program provides comprehensive community-based care for nursing-home-eligible low-income elders with complex chronic illness. As with other fully integrated managed care models, this program has the potential to influence the development of programming as other states seek to replicate and expand on these models. However, there is little known about the phenomenon of end of life care and the challenges of providing this care. The primary objectives of this case study are to 1) determine how end of life care is defined and implemented in this setting according to multiple stakeholders; 2) identify the implicit and explicit outcomes of quality end of life care; 3) identify the structures and processes of care that influence end of life care outcomes; and 4)determine the care dilemmas and challenges to providing end of life care to elders with advanced chronic disease and their family members. Several findings have been explored in this study. First, this project identified seven major themes that characterize primary end of life care challenges including the nature of advanced chronic disease, the incapacity of support systems; barriers to honoring care preferences, challenges with characteristics and needs of participants; needs of complex family systems, barriers with transitions in care; and barriers with culture and language. Second, family conflict emerged as an important phenomenon in this setting. An explanatory matrix of family conflict at the end of life with special attention to contributing factors and consequences was developed. Third, there is substantial incongruence in reports of preferences for the elder's care between the elder and their family member. Future goals of this project are to examine the contributions of the social worker to the interdisciplinary team and congruence in reports of end of life challenges, fears, and care preferences between elders and their family caregivers.
Status: Ongoing
Publications: Yes (Search Project Bibliography)
Palliative Care for Frail Elderly: Integration of Hospice with a Partnership Program
Researchers: Betty J Kramer (Professor, Social Work, University of Wisconsin - Madison)Abstract: Through ongoing research and a continuous quality improvement collaboration between the Primary Investigator (PI, Betty Kramer) and the Elder Care Partnership (ECP) Program of Dane County during the past 2 years, it was revealed that the ECP staff face many challenges, and care dilemmas in providing end of life (EOL) care and that there are several areas in which they feel they could improve the provision of palliative care. The purpose of this descriptive exploratory study is to assess the feasibility of a consultation model, whereby a 25% time hospice nurse (RN) and social worker (SW) would be available to three ECP teams over a year. This pilot seeks to: (a) determine the extent to which and ways in which consultants will be used by the teams; (b) identify the potential outcomes and benefits of consultation from the perspective of the staff, and (c) examine the extent to which consultation will assist ECP team members to enhance perceived success in the provision of palliative care. A total of 30 patient's needs were addressed during the study period; 19 of these (approximately two-thirds) died during the course of the study. Consults occurred primarily during regularly scheduled 2 hour ECP interdisciplinary team meetings as patient care plans were discussed (84% and 77% for nurse and social worker respectively). A larger number of consults were sought from the nurse than the social worker; 140 versus 44 respectively, reflecting greater attention given by the teams to physical care needs. Team members identified nine benefits of the model that were validated by consultant reports that may be translated into measurable outcomes in future research. The feasibility of this consultation model is influenced by several barriers to be addressed in future study. First, early misperceptions that hospice consultants could only be utilized in care situations involving active dying, constrained consultant involvement. Second, although home visits appeared to be a very important method for feedback and modeling, team member's apprehension about introducing consultants to participants as hospice employees limited this form of consultation. Third, scheduling difficulties from both agencies limited planned and impromptu visits. Fourth, the consultants' time was not fully utilized during the weekly team meetings. Fifth, some team members felt defensive receiving suggestions from outsiders and challenged to convey sufficiently the complexity of long-term care plans. Two alternative models are being considered to address the aforementioned barriers.
Status: Complete
Publications: Yes (Search Project Bibliography)
Death of a Sibling and Health of the Survivor Sibling in Later Adulthood
Researchers: H.-H. Daphne Kuo (Researcher, School of Medicine and Public Health, University of Wisconsin - Madison)Abstract: This project is mainly derived from findings of a preliminary study using Wisconsin Longitudinal Study (WLS). I found that experiencing the death of a sibling before age 36 had direct and robust harming effects on many measures of physical health of WLS men and women at age 50 after controlling for childhood family environment (SES, family configuration, and others), socioeconomic attainment in adulthood, and other important life events. This project is to examine the long-term negative consequences of death of a sibling on health of the survivor siblings in later adulthood. My research objectives are : 1. To dissect the effects of the death by the age and the cause of the death. 2. To look into the associations between the sibling's death, early parental death (before age 50), family medical history, and childhood health of the respondents. 3. To examine whether the effect is spurious due to lack of control for unmeasured heterogeneity. 4. To explore sibling data in PSID (and NLSY), national data with detailed information on age, birth, and death of each known biological sibling, for an external grant proposal. Results from my research show 1. Death of a sibling before age 35 only have impact on health at midlife, but not in later adulthood. 2. Respondents who experienced sibling death before age 60 usually report bad health and more medical conditions. 3. The harming effects of sibling death are not moderated by childhood health and early death of mother or father. I plan to use sibling data to study the effect of sibling death, and to analyze data from a national sample hopefully with future external funding.
Status: Complete
Publications: Yes (Search Project Bibliography)
Boston Area Community Health (BACH) Survey
Researchers: Karen LutfeyAbstract: Despite the increasing prevalence of urologic conditions in the US, data assessing the distribution of symptoms across various socioeconomic groups are relatively scant. Boston Area Community Health (BACH) Survey is designed to fill these gaps with community-based epidemiologic data on a wide range of urogynecologic symptoms and risk factors among a random, multi-stage, cluster sample of racially diverse residents between the ages of 30 and 79 (N=5,506 men and women). Manuscripts are ongoing and intended for a range of epidemiologic, health policy, and sociological audiences. Specific papers include the prevalence and correlates of female sexual dysfunction as well as the prevalence of adult and childhood physical, sexual, and emotional abuse. Analysis are ongoing for a series of manuscripts.
Status: Ongoing
Publications: Yes (Search Project Bibliography)
Cognitive Basis of CHD Disparities: a Factorial Experiment
Researchers: Karen LutfeyAbstract: This R01 study is one in a series of 4 generations of video vignette factorial experiments studying non-medical influences on physicians' clinical decision making. Previous and current studies show a significant influence of patient characteristics, provider characteristics, and healthcare system characteristics on clinical diagnostic and treatment decisions. The current study extends previous work by considering a 4th factor, cognitive processing, through the use of priming as a design factor. This study begins data collection in summer 2006. Analyses and manuscripts from the most recently completed experiment are underway while the cognitive priming one prepares to enter the field.
Status: Complete
Publications: No
Medical Error and Chronic Illness Management
Researchers: Karen LutfeyAbstract: Over the course of several decades, this Quality Assurance (QA) movement has developed into a massive, interdisciplinary undertaking with goals of identifying potential sources of error and minimizing their (economic, social, and outcome-related) effects. Implicit in the QA movement, however, is a conflict between (1) efforts from external agents, alarmed by high rates of error and cost-inefficiency, trying to encourage the medical profession to adopt strategies for systematically evaluating and minimizing errors; and (2) the historical entrenchment of notions of uncertainty in medical work (Fox 1957; Light 1972); the indigenous nature of error in such work (Paget 1988); the importance of collegiality in protecting providers from the potential risks associated with such uncertainty (Bosk 1979; Freidson 1970); and the ways in which these processes inhibit the medical profession’s self-regulation in terms of quality assurance (Sharpe & Fadin 1998). To better understand this tension, I focus on questions related to the routine, everyday practicalities of medical work and the ways it is conceptualized, executed, and accounted for by providers. In a work environment necessarily characterized by uncertainty and contingency, how is it that some actions come to be defined as errors? How do providers' conceptualizations of medical error resonate with those offered by QA proponents? To what extent might we expect QA efforts to be integrated into provider behavior? To examine these questions, I use in-depth interviews and ethnographic data from two diabetes clinics in a large, Midwestern, university-based medical center. Findings suggest that there are important limitations to be considered in the application of the “medical error” concept in a chronic care setting. For instance, activities such as measuring error, setting goals for treatment, making sense of unexplained outcomes, and customizing treatments to individual patients operate differently for chronic and acute illness care, and in ways that imply diminishing returns for the concept of “medical error” as a mechanism to improve quality of care in chronic illness management. To be broadly effective in the context of chronic illness management, the QA movement may need to need to attend to mundane internal workings of medical practice by reconceptualizing “medical error” in ways that more accurately capture mundane medical work (e.g., iterative treatment decisions/outcomes, the active role of patients in self-management, the importance of customizing treatment plans according to patients’ social behaviors), as well as identifying potential systematic resistances to QA efforts and mounting interventions in ways that are likely to be effective given nature of the profession.
Status: Complete
Publications: Yes (Search Project Bibliography)
Provider Assessments of Patient Compliance with Diabetes Treatment Regimens
Researchers: Karen LutfeyAbstract: Extensive interdisciplinary research programs on patient compliance offer competing explanations for a relatively narrow range of questions focusing on why patients behave in certain ways, the reasons for their deviant behavior, and the ways such behavior can be changed so it is more commensurate with the needs of the medical system. By contrast, I address the question of how practitioners assess patients in terms of their compliance by evaluating patients' cognitive abilities, talking with patients during consultations, and simultaneously dealing with bureaucratic constraints of clinics. The objective of this study was to use multiple types of ethnographic data (observations, in-depth interviews, videotaped interaction, focus groups, and limited survey data) from two diabetes clinics to examine the processes by which providers try to assess how closely patients are following medical recommendations, and the implications of those assessments for medical care. Findings suggest that the traditional notion that assessing compliance is only a matter of "correctly" determining what patients are doing outside of the clinic oversimplifies what appears to be a much broader undertaking. For example, during in-depth interviews, providers articulated several different roles they assume to help maximize patient compliance--such as educators, detectives, negotiators, salesmen, and motivators--which imply that they are not passive observers of compliance behavior, but active participants in a process that contributes to the very phenomenon they attempt to assess. Based on analyses of videotaped doctor-patient interaction, compliance assessments are not simply a matter of what patients report about their behavior, but also of how they interact with practitioners. Similarly, organizational features of the clinics, such as continuity of care and teaching responsibilities, significantly affect practitioners assessments of and responses to patients independent of how closely patients follow recommendations. Finally, compliance assessments have significant implications for treatment regimens such that patients of high socioeconomic status are more likely than their low SES counterparts to have sophisticated treatment regimens that help ward off long-term and life-threatening diabetes complications; non-medical factors such as individual patient characteristics (income, occupation, age, social support), motivation and willingness, and cognitive ability are critical in this process.
Status: Complete
Publications: Yes (Search Project Bibliography)
Families Manage High-Tech Home Care: the Case of Bone Marrow Transplantation
Researchers: Cameron Macdonald (Assistant Professor, Sociology, University of Wisconsin - Madison)Abstract: The shift of health care from hospital to home has been one of the most dramatic changes over the past decade. Not only are patients moving from inpatient to outpatient care, but families are taking on medical care responsibilities formerly performed by hospital staff and visiting nurses. Nowhere is this change more significant than in bone marrow transplantation. Once held in isolation for up to three months post-transplant, adult transplant recipients are now routinely sent home after as little as three weeks, and that time frame may soon be shrinking. While this development has resulted in increased satisfaction and quality of life for many patients, and reduced cost for hospitals it has also resulted in increased stress and caregiver burden for family members. How do family members manage the tasks delegated to them, including line care, medication management, and monitoring an array of complex symptoms? Because no studies of adult transplant patients have ventured into the home for any period of time, we simply do not know the answers to most of these questions. The world of home care post bone marrow transplant is a "black box" to physicians and medical researchers. Until we understand how families and patients adapt to the challenges of complex health care in the home, we cannot know what, if any interventions might be developed to increase patient safety and treatment efficacy. This prospective study will address this crucial gap in our