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 10827 CHAPTER 1 | WORKING LONGER at the beginning of the study and evaluate the incidence of mobility limitations and difficulties with ADLs. Even in this higher functioning group, 29% report a history of arthritis in 1992. Risk factors for arthritis include female gender, older age, higher BMI, hypertension, diabetes, cancer, lung disease, depressive symptoms, and lower so- cioeconomic status. Yet even after accounting for these differences, those with arthritis in middle age are much more likely to develop mobility and ADL limitations over 10 years. Another study by this same group of re- searchers looks specifically at the impact of pain in middle age on functioning (Covinsky et al. 2009). Those with significant pain at age 50 to 59 have much higher rates of physical limitations than those without pain and are similar to 80- to 89-year-olds without pain in terms of mobility limitations. Along similar lines, Covinsky et al. (2010) study HRS participants from 1992 to 2004 to investigate the impact of depressive symptoms at the beginning of the study on the risk of devel- oping physical limitations in later life. Those with a high level of depressive symptoms at the begin- ning of the study are 40% more likely to develop mobility limitations and difficulties with ADLs over 12 years. Interestingly, Ayyagari (2016a) shows that the increased access to prescription drugs associated with the introduction of the Medicare Part D program in 2006 improved pain management for older adults and reduced pain- related activity limitations. Researchers use the longitudinal data in the HRS to identify racial, ethnic and gender differences in health status trajectories of middle-aged and older adults. As expected, self-rated health worsens at all ages over the period 1995 to 2006 with a greater rate of decline for older people and for Black and Hispanic individuals (Liang et al. 2010). The poorer rating of health is not explained by racial or ethnic differences in socio- economic status, social networks or prior health. Research along similar lines using HRS confirms these racial and ethnic differences in health. Yang and Lee (2010) use HRS data to create a frailty index comprised of self-reports of eight chronic illnesses, difficulties with ADLs and IADLs, depression and obesity. Black and Hispanic indi- viduals score higher than Whites on the frailty index. Despite having longer life expectancy, women have higher frailty index scores than men at all ages, regardless of race or ethnicity. HRS data are also used to study changes in the relationship between health and disability over time. For example, Hung et al. (2012) report on changes between 1998 and 2008 in the prev- alence of disability — as measured by difficulties with ADLs and IADLs — and the prevalence of various chronic diseases and cognitive, visual or hearing impairment. Although the prevalence of some chronic diseases increased between that period, disability prevalence actually decreased. Stroke, coronary heart failure and arthritis are associated with mobility disability and limita- tions in self-care ADLs. Cognitive impairment has the strongest and most consistent impact on a range of ADL difficulties. Eating and dressing limitations are especially significant predictors of nursing home admissions (Fong et al. 2015). Other evidence suggests that older Americans may be experiencing greater disease burden in recent times. Beltrán-Sánchez et al. (2016) show that several chronic diseases actually increased in prevalence between 2004 and 2010, with 37% higher diabetes prevalence and a 41% higher prevalence of arthritis. These burdens appear to be greatest at younger ages suggesting that, as life expectancy continues to increase, there may not be a compression of morbidity. A topic of growing interest is the relationship between obesity and disability. While excessive weight is a well-documented risk factor for cer- tain diseases and disability (Lee and Kim 2008), less attention is paid to the mechanism through which it might lead to exit from the labor force. 0% 5% 10% 15% 20% 25% 30% 35% Didn't like the work Poor health Wanted to do other things Wanted to spend more time with family FIGURE 1-5 Percent reporting various “very important” reasons for retiring: 2014 Source: HRS 2014. Despite having longer life expectancy, women have higher frailty index scores than men at all ages, regardless of race or ethnicity.