b"CHAPTER 1|WORKING LONGERat the beginning of the study and evaluate the(2010) study HRS participants from 1992 to 2004on changes between 1998 and 2008 in the prev-incidence of mobility limitations and difficultiesto investigate the impact of depressive symptomsalence of disabilityas measured by difficulties with ADLs. Even in this higher functioning group,at the beginning of the study on the risk of devel- with ADLs and IADLsand the prevalence of 29% report a history of arthritis in 1992. Riskoping physical limitations in later life. Those withvarious chronic diseases and cognitive, visual or factors for arthritis include female gender, oldera high level of depressive symptoms at the begin- hearing impairment. Although the prevalence of age, higher BMI, hypertension, diabetes, cancer,ning of the study are 40% more likely to developsome chronic diseases increased between that lung disease, depressive symptoms, and lower so- mobility limitations and difficulties with ADLsperiod, disability prevalence actually decreased. cioeconomic status. Yet even after accounting forover 12 years. Interestingly, Ayyagari (2016a)Stroke, coronary heart failure and arthritis are these differences, those with arthritis in middleshows that the increased access to prescriptionassociated with mobility disability and limita-age are much more likely to develop mobility anddrugs associated with the introduction of thetions in self-care ADLs. Cognitive impairment ADL limitations over 10 years. Medicare Part D program in 2006 improved painhas the strongest and most consistent impact on Another study by this same group of re- management for older adults and reduced pain-a range of ADL difficulties. Eating and dressing searchers looks specifically at the impact of painrelated activity limitations. limitations are especially significant predictors of in middle age on functioning (Covinsky et al.Researchers use the longitudinal data in thenursing home admissions (Fong et al. 2015).2009). Those with significant pain at age 50 to 59HRS to identify racial, ethnic and gender have much higher rates of physical limitationsdifferences in health status trajectoriesDespite having longer life expectancy, than those without pain and are similar to 80- toof middle-aged and older adults. Aswomen have higher frailty index scores 89-year-olds without pain in terms of mobilityexpected, self-rated health worsens at all limitations. Along similar lines, Covinsky et al.ages over the period 1995 to 2006 with athan men at all ages, regardless ofgreater rate of decline for older people andrace or ethnicity.FIGURE 1-5Percent reporting variousfor Black and Hispanic individuals (Liang very important reasons for retiring: 2014 et al. 2010). The poorer rating of health is notOther evidence suggests that older Source: HRS 2014. explained by racial or ethnic differences in socio- Americans may be experiencing greater disease economic status, social networks or prior health.burden in recent times. Beltrn-Snchez et al. 35% Research along similar lines using HRS confirms(2016) show that several chronic diseases actually these racial and ethnic differences in health. Yangincreased in prevalence between 2004 and 2010, 30% and Lee (2010) use HRS data to create a frailtywith 37% higher diabetes prevalence and a 41% 25% index comprised of self-reports of eight chronichigher prevalence of arthritis. These burdens 20% illnesses, difficulties with ADLs and IADLs,appear to be greatest at younger ages suggesting 15% depression and obesity. Black and Hispanic indi- that, as life expectancy continues to increase, viduals score higher than Whites on the frailtythere may not be a compression of morbidity.10%index. Despite having longer life expectancy,A topic of growing interest is the relationship 5% women have higher frailty index scores than menbetween obesity and disability. While excessive 0% at all ages, regardless of race or ethnicity. weight is a well-documented risk factor for cer-Didn't like the work HRS data are also used to study changes intain diseases and disability (Lee and Kim 2008), Poor health the relationship between health and disabilityless attention is paid to the mechanism through Wanted to do other things over time. For example, Hung et al. (2012) reportwhich it might lead to exit from the labor force. Wanted to spend more time with family27"