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 108CH APTER 1 25 hospitalization and the onset of a chronic condi- tion were associated with decreased drinking; and widowhood was associated with increased drinking, but only for a short time. Ostermann and Sloan (2001) analyzed 8 years of HRS data to examine the effects of alcohol use on disability and income support for people with disabilities. Their analysis demonstrated that a history of problem drinking, especially when combined with recent heavy drinking, was associated with a greater prevalence and inci- dence of limitations in home and work activities. However, despite increased disability, problem drinkers’ higher rates of activity limitations were not associated with a greater likelihood of receiving income support from the Federal Government’s Social Security Disability Insur- ance (SSDI) or Supplemental Security Income (SSI) programs. Obesity HRS data have been used to document an association between obesity and impairments in physical function that will translate into rising disability rates in the future if obesity trends continue (Sturm et al. 2004). A causal analysis of HRS respondents over age 70 suggested that being overweight or obese (using conventional body mass index measures) makes an older per- son more likely to become functionally impaired in the future. While this relationship is often complex, obesity appears to have an independent effect on the onset of impairment in strength, lower body mobility, and activities of daily living (Jenkins 2004). Extra pounds may also be expensive, at least for middle-aged women. Looking at the relationship between weight and financial net worth, Fonda et al. (2004) found that in 1992 the individual net worth of moderately to severely obese women ages 51 to 61 was 40 percent lower than that of normal-weight peers, controlling statistically for health status, education, marital status, and other demographic factors. These individuals’ situation also appears to worsen over time. In 1998, the self-reported individual net worth of moderately to severely obese women in the same cohort (then ages 57 to 67) was 60 percent less than that of their counterparts (an average dif- ference of about $135,000 in 1998). No such pattern could be found for men. While HRS data allow relationships among obesity, gender, and financial status to be measured in new and im- portant ways, researchers caution that the causal mechanisms underlying these findings are still poorly understood. Family characteristics may also play a role in obesity risk and how we might intervene to prevent obesity. After adjusting for age, race, income, and several behavioral factors, research- ers analyzing HRS data found a positive correla- tion between number of children and obesity for both women and men (Weng et al. 2004). The association between obesity and family size is an intriguing finding and suggests the need for fur- ther exploration of the idea that parents of larger families might be an important target population for obesity prevention. Cognitive Function The decline of cognitive function with age is an often-unspoken fear that many people have as they grow older, and the burden of cognitive im- pairment on individuals, families, caregivers, and society at large is enormous. Severe cognitive impairment is a leading cause of insti- tutionalization of older people. Before 2003, es- timates of the prevalence of cognitive impairment had to be derived from local clinic-based studies, typically in urban areas, and extrapo- lated to the larger population. With the advent of the HRS, and more specifically the AHEAD por- tion of the study, researchers could attempt for the first time to tap nationally representative data to assess cognitive function in older people. The HRS is one of the first national health surveys to measure cognitive health at the population level and to examine on a large scale the biological and environmental factors as- sociated with cognition. The HRS measurement of cognition employs two well-tested cognition assessments: the Telephone Interview for Cogni- tive Status (TICS), a brief, standardized test of cognitive functioning that was developed for use in situations where in-person cognitive screening is impractical or inefficient, and the Mini-Mental State Examination (MMSE), a widely used tool for assessing cognitive mental status. In addi- tion, a special assessment tool for third-party observations, the Jorm IQCODE, is used when a proxy reporter provides an interview on behalf of a respondent. This is an essential tool when cog- nitive impairment makes an interview otherwise unobtainable. Initial estimates, while preliminary, indicate that in 1998, approximately 10 percent of the U.S. population age 70 and older had moderate to severe cognitive impairment (Suthers et al. 2003). The prevalence of moderate to severe cognitive impairment among non-institutionalized people was 6 percent, while the level among the institutionalized exceeded 50 percent. On average, the data suggest, a person reaching age 70 with a life expectancy of 14 remaining years will spend 1.5 of those years with moderate or severe cognitive impairment. As the original HRS sample and its additional cohorts age, researchers will be able to update and refine these important data. The analysis also indicated that the prevalence of cognitive impairment increases steeply with advanced age. Among people ages 75 to 79 who participated in the 1998 HRS, fewer than 5 percent had severe