Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Page 10 Page 11 Page 12 Page 13 Page 14 Page 15 Page 16 Page 17 Page 18 Page 19 Page 20 Page 21 Page 22 Page 23 Page 24 Page 25 Page 26 Page 27 Page 28 Page 29 Page 30 Page 31 Page 32 Page 33 Page 34 Page 35 Page 36 Page 37 Page 38 Page 39 Page 40 Page 41 Page 42 Page 43 Page 44 Page 45 Page 46 Page 47 Page 48 Page 49 Page 50 Page 51 Page 52 Page 53 Page 54 Page 55 Page 56 Page 57 Page 58 Page 59 Page 60 Page 61 Page 62 Page 63 Page 64 Page 65 Page 66 Page 67 Page 68 Page 69 Page 70 Page 71 Page 72 Page 73 Page 74 Page 75 Page 76 Page 77 Page 78 Page 79 Page 80 Page 81 Page 82 Page 83 Page 84 Page 85 Page 86 Page 87 Page 88 Page 89 Page 90 Page 91 Page 92 Page 93 Page 94 Page 95 Page 96 Page 97 Page 98 Page 99 Page 100 Page 101 Page 102 Page 103 Page 104 Page 105 Page 106 Page 107 Page 10820 CHAPTER 1: HEALTH A central thrust of the Health and Retirement Study (HRS) is to examine the impact of health status on the decision to stop working. A related goal is to understand the longer-term health consequences of the retirement process. The HRS conceptualizes “health” as a multidimensional construct. By combining measures of respondent health, functional status, and health care usage with economic and family variables, the HRS helps us to understand how health influences—and is influenced by—socioeconomic status through the course of life. As the HRS data grow richer over time and as analytic methodologies improve, researchers increasingly will use the data to answer questions of causation that thus far have eluded social scientists and epidemiologists. This chapter offers insight into the physical and mental health status, health insurance coverage, and health care utilization of community-dwelling older adults. It also provides a snapshot of the effects of health and unexpected health events on employment, as well as a look at disability and physical functioning among HRS participants. people who had never smoked, had quit, or were light smokers at the time they were surveyed have a realistic sense of their mortal- ity, their expectations coinciding with actuarial projections. Heavy smokers, however, signifi- cantly underestimate their premature mortality, in denial of the potential effects of their smok- ing habit. Another study found level of educa- tion to be the major positive influence on the decision to quit among heart attack survivors. Cognitive health declines with age. A preliminary study based on HRS data indicates that some 10 percent of people age 70 and older have moderate to severe cognitive impairment, and prevalence rises sharply with age. In the com- munity, an estimated 6 percent of people over 70 have moderate to severe impairment, while some 50 percent of those institutionalized do. The HRS data on cognition are among the first to measure cognitive health at the population level, and these preliminary analyses are being examined further to see how they compare with a number of other estimates, primarily derived from studies in specific communities. 64 reported a health problem that limited their work activity, but one-fifth of those reporting a health limitation were working in some capacity. More than half of men and one-third of women who left the labor force before the Social Security early-retirement age of 62 said that health limited their capacity to work. Longitudinal data from the HRS have shown that the onset of major health problems, such as a stroke or heart attack, frequently leads directly to withdrawal from the labor force. Lifestyle factors influence older adults’ health and physical well-being. One study found that men who were heavy drinkers (five or more drinks per day) but not functionally impaired when first interviewed have a four-fold risk of developing at least one functional impairment (including memory problems) over a 6-year period of time. Among HRS respondents over age 70, overweight and obesity also are factors in functional impairment, having an independent effect on the onset of impairment in strength, lower body mobility, and activities of daily living. Heavy smokers underestimate the mortality effects of smoking. One analysis shows that CHAPTER Highlights There are wide variations in the health of Americans age 50 and older, with differences that vary by age, race/ethnicity, and lifestyle. According to HRS data: Health varies by socioeconomic status. One study found that the pattern of disease at age 50 for people with less than a high school education is similar to that at age 60 for people with college degrees. Older Americans are in reasonably good health overall, but there are striking differences by age and by race and ethnicity. Almost half of HRS participants ages 55 to 64, but only about one quarter of those age 65 and older, say they are in very good or excellent health. White respon- dents report very good or excellent health at a rate almost double that of Blacks and Hispanics. Studies using HRS data have found that part but not all of these racial disparities can be attrib- uted to differences in socioeconomic status. Health has an important influence on older people’s ability to work. In 2002, 20 percent of men and 25 percent of women ages 55 to