Susann Rohwedder’s research while affiliated with RAND Corporation and other places

Background Dementia impacts a large and growing number of older adults in the US, and the total impact of disease is costly to individuals and society. Though many risk factors have been identified, accurately predicting future dementia remains difficult. This study aims to identify early predictors of cognitive impairment and dementia using a large US sample. Method We evaluated the predictive power of 181 dementia risk factors using a recently developed and validated probabilistic measure of dementia and cognitive impairment, available on 97,629 person‐year observations in the nationally representative longitudinal Health and Retirement Study in the US (Table 1). The project predicted two types of outcomes: the two‐year or four‐year incidence of dementia or cognitive impairment; and the prevalence of dementia or cognitive impairment at age 80 based on the characteristics of individuals at age 60. Result In line with prior literature, physical health, a prior stroke, cognitive abilities, ADL and IADL functional limitations, and genes strongly predicted future incidence and prevalence of cognitive impairment and dementia. Our statistical models identified additional predictors that have received less attention. For example, dementia prevalence at age 80 was 9.9 percentage points higher (20.5% vs. 10.6%) among those with a BMI above 35 (vs. BMI 0‐25) at age 60, and this differential reduced to 4.2 ppts but remained statistically significant when all other predictors were controlled. Other factors associated with a higher chance of having cognitive impairment or dementia in the future were: being born in the South, not having a private health insurance plan at age 60, working fewer years, diabetes at age 60, never exercising, scoring lower on various physical performance measures (e.g. pulmonary function, grip strength, walking speed, balance tests), being less conscientious, and lower engagement in hobbies and novel information activities (Figures 1 and 2). Conclusion The sharpened list of dementia risk factors can be used to raise awareness and target resources for prevention and early detection in the presence of health system capacity constraints. These results are suggestive that some behavioral changes and interventions might slow cognitive decline.

With an aging population and growing inequality, America is at a crossroads in its approach to work and retirement. Americans live longer and healthier lives than they did 50 years ago and they need income for more years of life. Many policymakers and academics think it is logical – almost inevitable – that Americans will work longer, delay retirement, and spend more of these years in the paid labor force. But as social and economic inequalities have increased over the past four decades in the United States, working-longer policies and expectations that cater to the needs of the “average” American are a poor fit for many. This book calls for a rethinking of the working-longer policy solution. Experts in a wide range of fields examine the evidence and fill in the gaps. Together, they investigate how social and economic inequalities shape people’s capacity to work, the skills and resources they have, the discrimination and other challenges they face, and the benefits that may accrue to them from working longer. And they examine changes across generations or birth cohorts, because the experiences of today’s middle-aged Americans are not the same as the experiences of today’s retirees. This book provides new evidence about the future of working longer in America, drawing on insights from economics, sociology, psychology, organizational behavior, political science, and epidemiology. The final chapter in this volume describes a policy framework to improve the well-being of Americans as they work and retire.

With an aging population and growing inequality, America is at a crossroads in its approach to work and retirement. Americans live longer and healthier lives than they did 50 years ago and they need income for more years of life. Many policymakers and academics think it is logical – almost inevitable – that Americans will work longer, delay retirement, and spend more of these years in the paid labor force. But as social and economic inequalities have increased over the past four decades in the United States, working-longer policies and expectations that cater to the needs of the “average” American are a poor fit for many. This book calls for a rethinking of the working-longer policy solution. Experts in a wide range of fields examine the evidence and fill in the gaps. Together, they investigate how social and economic inequalities shape people’s capacity to work, the skills and resources they have, the discrimination and other challenges they face, and the benefits that may accrue to them from working longer. And they examine changes across generations or birth cohorts, because the experiences of today’s middle-aged Americans are not the same as the experiences of today’s retirees. This book provides new evidence about the future of working longer in America, drawing on insights from economics, sociology, psychology, organizational behavior, political science, and epidemiology. The final chapter in this volume describes a policy framework to improve the well-being of Americans as they work and retire.

This paper presents estimates of the prevalence of dementia in the United States from 2000 to 2016 by age, sex, race and ethnicity, education, and a measure of lifetime earnings, using data on 21,442 individuals aged 65 y and older and 97,629 person-year observations from a nationally representative survey, the Health and Retirement Study (HRS). The survey includes a range of cognitive tests, and a subsample underwent clinical assessment for dementia. We developed a longitudinal, latent-variable model of cognitive status, which we estimated using the Markov Chain Monte Carlo method. This model provides more accurate estimates of dementia prevalence in population subgroups than do previously used methods on the HRS. The age-adjusted prevalence of dementia decreased from 12.2% in 2000 (95% CI, 11.7 to 12.7%) to 8.5% in 2016 (7.9 to 9.1%) in the 65+ population, a statistically significant decline of 3.7 percentage points or 30.1%. Females are more likely to live with dementia, but the sex difference has narrowed. In the male subsample, we found a reduction in inequalities across education, earnings, and racial and ethnic groups; among females, those inequalities also declined, but less strongly. We observed a substantial increase in the level of education between 2000 and 2016 in the sample. This compositional change can explain, in a statistical sense, about 40% of the reduction in dementia prevalence among men and 20% among women, whereas compositional changes in the older population by age, race and ethnicity, and cardiovascular risk factors mattered less.

In countries, where a substantial proportion of retirement income rests on savings, there is much concern that a sizeable fraction of the population reaches retirement with insufficient financial resources. We define saving regret as the wish in hindsight to have saved more earlier in life. We measured saving regret and possible determinants in a survey of U.S. households in which respondents were aged 60-79. We find high levels of saving regret, affirmed by some 58%. Saving regret exhibits significant and plausible correlations with personal characteristics and wealth: Married, older, healthier and wealthier respondents are less likely to report saving regret, suggesting the measure’s validity. We find only weak evidence for correlations between saving regret and measures of procrastination: persons with traits associated with procrastination express saving regret about as often as those without those traits.