Current Awareness in Aging Research (CAAR) Report #25--March 16, 2000

CAAR (Current Awareness in Aging Research) is a weekly email report produced by the Center for Demography of Health and Aging at the University of Wisconsin-Madison that helps researchers keep up to date with the latest developments in the field. For more information, including an archive of back issues and subscription information see:

http://www.ssc.wisc.edu/cdha/caar/caar-index.htm

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I. Data:

1. NACDA SEEKS FEEDBACK ON VALUE OF CREATING HISPANIC HANES 1982-1984 LINK TO NDI:

The National Archive of Computerized Data on Aging (NACDA) is seeking feedback from the research community on the potential value of a data initiative that NACDA has been discussing with the National Center for Health Statistics (NCHS). In brief, we are interested in creating an analysis file that would link the Hispanic Health and Nutrition Examination Survey, (HISPANIC NHANES 1982-1984) to the National Death Index Files and to make this file available to the research community. As you may be aware, the HHANES examined the nutritional practices and physical health of over 11,000 Hispanic persons between 6 months and 74 years of age. Three groups were surveyed: Mexican-Americans, Cuban-Americans, and Puerto Rican Americans. While there was no re-interview of these subjects, NACDA is interested in identifying mortality among survey respondents. Our Resident Scientist, Kenneth Ferraro, has argued that this linked analysis file would provide a valuable resource for researchers interested in the impacts of health and socioeconomic status on mortality outcomes among Hispanic populations. Interested parties are directed to our website:

http://www.icpsr.umich.edu/NACDA

where they can access Study Number 8535 to review data and documentation for the Hispanic Health and Nutrition Examination Survey, 1982-1984. This is the public release version of the data set without NDI links which NACDA has made freely available to the research community for direct download. Overall, the response from NCHS to the proposed NDI linkage has been favorable but there are cost concerns that must be resolved. Linking Hispanic NHANES to the NDI is possible but the composition of the file presents special challenges to obtaining successful matches. Consequently, NACDA has been asked to assess the perceived value of this linked file to the research community so that we can justify a funding request to have this file created and distributed. We are soliciting opinions on this matter so we can report to NCHS and NIA whether or not such a project has potential value to researchers with an ongoing interest in minority issues. As we recognize the value of your time, we are asking two simple questions at present:

1) Would you argue that a file that links the Hispanic NHANES to mortality data from the NDI represents a valuable addition to existing resources on minority research?

2) If NACDA were to make such a file publicly available, is this linked file something you would use for grant development and publications?

Your response to these questions, no matter how brief, would greatly help us evaluate the potential costs and benefits of such a project to the research community. If you feel that it might represent a valuable addition then we can make a more convincing argument for support for this initiative. If not, then we can focus our energies in other more productive arenas.

Thank you so much for your interest and support.

Interested researchers should respond to James W. McNally at NACDA. See this address for more contact information:

http://www.icpsr.umich.edu/NACDA/staff.html

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II. Reports and articles

2. _DEMOGRAPHIC RESEARCH_ ARTICLE: _Demographic Research_, the peer reviewed electronic journal published by the Max Planck Institute for Demographic Research, has released "Mortality Statistics for the Oldest-Old: An Evaluation of Canadian Data," by Robert Bourbeau and Andre Lebel (Vol. 2, No. 2, March 15, 2000, HTML and .pdf formats, 36p.).

>From the Abstract:

The main purpose of this paper is to evaluate the quality of Canadian data among the oldest-old (80+) over the 1951-1995 period, and to compare estimations of Canadian probabilities of death based on the extinct generation method with those of other developed countries in order to ascertain whether Canada experiences a distinct low mortality profile. The evaluation of the data quality suggests that Canadian data are quite good up to the age of 100, and that the main problems concern the centenarians (overstatement of age at death and errors in census age declarations). International comparisons on the basis of two mortality indicators for the 80-99 age-interval lead to the same conclusion: Canadian mortality is lower than in most European countries. The best match is still with the United States.

http://www.demographic-research.org/Volumes/Vol2/2/default.htm

.pdf version is available by clicking on the PDF icon at the bottom of the page.
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3. DHHS OIG REPORTS: The Office of the Inspector General Office of Evaluation and Inspections (OEI) of the Department of Health and Human Services has released the following reports:

A. "Medicare Managed Care: Goals of National Marketing Guide" (OEI-03-98-00270, February 2000, .pdf format, 42p.).

http://www.dhhs.gov/progorg/oei/reports/a432.pdf

B. "Medicare Managed Care: 1998 Marketing Materials" (OEI-03-98-00271, February 2000, .pdf format, 34p.).

http://www.hhs.gov/progorg/oei/reports/a433.pdf

>From the Abstracts:

OEI released two final reports on Medicare managed care marketing materials. In the first report, we found that the 1998 goals of Medicare's National Marketing Guide for managed care, which were to expedite the marketing-material review process, reduce re-submissions of material, ensure uniform review across the nation, and most importantly, provide beneficiaries with accurate and consumer friendly marketing materials to help them make informed health-care choices, were not completely met. In the second report, we found that after the first year of implementation, few marketing materials were in full compliance with the Guide. We made a number of recommendations to address the issues we identified in both reports. The HCFA (Health Care Financing Administration) concurred with the recommendations and is already beginning to implement some of them.

C. "Medicare + Choice HMO Extra Benefits: Beneficiary Perspectives" (OEI-02-99-00030, February 2000, .pdf format, 25p.).

>From the Abstract:

This inspection report looked at the influence of extra benefits on beneficiaries' decisions to join Medicare + Choice HMOs. We found that lower costs, more so than extra benefits, were the main reason for joining an HMO. Once enrolled in an HMO, Medicare beneficiaries value prescription drugs, regular physicals, and vision benefits the most. The prescription drug benefit is least likely to meet their expectations. OEI found that enrollees have a good understanding of their report coverage for regular physicals, but their understanding of other benefits is not as high. The HMO marketing material descriptions of extra benefits coverage were generally easy to understand, but varied greatly. There was potential for confusion in some of the materials. We recommend that HCFA develop mechanisms to assure comparability of Medicare + Choice HMO plan costs and benefits. We recognize that HCFA has been taking steps to develop a standard format for plan benefit summaries and encourage the completion of this task.

http://www.hhs.gov/progorg/oei/reports/a430.pdf
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4. _AMERICAN HEART JOURNAL_ (VIA MEDSCAPE) ARTICLE: "Predictors of Readmission Among Elderly Survivors of Admission With Heart Failure," by Harlan M. Krumholz, Ya-Ting Chen, Yun Wang, Viola Vaccarino, Martha J. Radford, and Ralph I. Horwitz (_American Heart Journal_, January, 2000, Vol. 139, No. 1, p. 72-77). Note: Medscape requires free registration before providing articles.

>From the Abstract:

Background: Readmission rates for patients discharged with heart failure approach 50% within 6 months. Identifying factors to predict risk of readmission in these patients could help clinicians focus resource-intensive disease management efforts on the high-risk patients. Conclusions: Few patient and clinical factors predict readmission within 6 months after discharge in elderly patients with heart failure. Although we were unable to identify a group of patients at very low risk, a group of high-risk patients were identified for whom resource-intensive interventions designed to improve outcomes may be justified.

http://www.medscape.com/mosby/AmHeartJ/2000/v139.n01/ahj1391.06.krum/ahj1391.06.krum-01.html
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5. _JAMA_ ARTICLE AND EDITORIAL:

A. "Systematic Implementation of an Advance Directive Program in Nursing Homes: A Randomized Controlled Trial," by D. William Molloy, Gordon H. Guyatt, Rosalie Russo, Ron Goeree, Bernie J. O'Brien, Michel Bedard, Andy Willan, Jan Watson, Christine Patterson, Christine Harrison, Tim Standish, David Strang, Peteris J. Darzins, Stephanie Smith, and Sacha Dubois (_Journal of the American Medical Association_, Vol. 283, No. 11, Mar. 15, 2000, p. 1437-1444, HTML and .pdf formats).

>From the Abstract:

Context: Although advance directives are commonly used in the community, little is known about the effects of their systematic implementation. Objectives: To examine the effect of systematically implementing an advance directive in nursing homes on patient and family satisfaction with involvement in decision making and on health care costs. Conclusion: Our data suggest that systematic implementation of a program to increase use of advance directives reduces health care services utilization without affecting satisfaction or mortality.

http://jama.ama-assn.org/issues/v283n11/full/joc90890.html

B. "Advance Directives for Nursing Home Residents: Achieving Compassionate, Competent, Cost-effective Care," by Joan M. Teno (_Journal of the American Medical Association_, Vol. 283, No. 11, Mar. 15, 2000, p. 1481, HTML and .pdf formats). Note: This is a _JAMA_ editorial.

http://jama.ama-assn.org/issues/v283n11/full/jed00009.html
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6. _GERIATRICS_ ARTICLE: "Elder abuse: Using clinical tools to identify clues of mistreatment," by Charles E. Marshall, Donna Benton, and Joselynn M. Brazier (_Geriatrics_, Vol. 55, No. 2, February 2000, p. 32-40, .pdf format).

>From the Abstract:

Elder abuse occurs most commonly in residential rather than institutional settings, and the most likely perpetrators are known by the victim. Although a defined set of risk factors has not been developed, careful questioning and assessment can help determine whether a patient is at increased risk. The common types of elder maltreatment include caregiver and self-neglect, emotional and psychological abuse, fiduciary exploitation, and physical abuse. Assessment consists of comprehensive physical examination, including scrutiny of the musculo-skelatal and genito-urinary systems, neurologic and cognitive testing, and detailed social and sexual histories. Clues that cannot be explained medically may signal elder abuse. To properly intervene, clinicians should be familiar with state laws governing reporting procedures and patient privacy.

http://www.geri.com/journal/0200.html

cursor to "Elder Abuse" for abstract and click on "download full text in pdf format" for full text.
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7. _THE REGIONAL ECONOMIST_ (FRB ST. LOUIS) ARTICLE: The Federal Reserve Bank of St. Louis periodical _The Regional Economist_ contains an article: "Working in the Golden Years and Paying for it: The Retirement Earnings Test," by Adam M. Zaretsky (January 2000, HTML format).

http://www.stls.frb.org/publications/re/2000/a/re2000a4.html
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8. CENTER FOR RETIREMENT RESEARCH AT BOSTON COLLEGE ISSUE IN BRIEF: "How Will Sweden's New Pension System Work?" by Annika Sunden (IB#3, March 2000, .pdf format, 16p.).

>From the Executive Summary:

In 1998, the Swedish Parliament passed pension legislation that transformed Sweden's Social Security system to a Notional Defined Contribution (NDC) plan -- that is, a defined contribution plan financed on a pay-as-you-go basis. In addition, the legislature established a second tier of funded benefits. This issue in brief describes the evolution of the new Swedish pension system and discusses its implications for other countries considering pension reform.

http://www.bc.edu/bc_org/avp/csom/executive/crr/issuebriefs/Abstracts/ib3.htm

click on "For full paper in PDF format, click here" for full text.
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9. GAO REPORT: "Medicare Financial Management: Further Improvements Needed to Establish Adequate Financial Control and Accountability" (General Accounting Office Report AIMD-00-66, March 2000, .pdf format, 58p.).

http://www.gao.gov/new.items/ai00066.pdf

Note: GAO Internet addresses are valid for only a limited period of time. After that time, documents can be found by searching the Government Printing Office:

http://www.access.gpo.gov/su_docs/aces/aces160.shtml

and searching on title or report number.
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10. _US NEWS AND WORLD REPORT_ ARTICLES:

A. "The new midlife: short but sweet," by Kim Clark. Note: This article is the Mar. 20, 2000 issue cover article and links to five other articles relevant to the topic.

http://www.usnews.com/usnews/issue/000320/nycu/intro.htm

B. "The cells of immortality," by Joannie Schrof Fischer (_US News and World Report_, Mar. 20, 2000).

http://www.usnews.com/usnews/issue/000320/immortal.htm

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III. Working Papers

11. PENSION RESEARCH COUNCIL (WHARTON SCHOOL, UNIVERSITY OF PENNSYLVANIA): "Holders of the Purse Strings: Governance and Performance of Public Retirement Systems," by Michael Useem and Olivia S. Mitchell (Working Paper 2000-3, March 2000, .pdf format, 22p.).

>From the Abstract:

Public sector pension plans are managed in diverse ways, with governance policies distinguished according to their board composition and size, how the trustees structure their investment decisions, what restrictions are placed on their investments, and whether they have independent performance evaluations. We examine how these governance policies affect pension investment strategies, and how those strategies in turn affect the funds' financial performance. Methods: Drawing on two national surveys of state and local public retirement systems in 1992 and 1993, we ask if pension governance policies affect whether they (1) invest tactically in response to changing conditions; (2) allocate assets between equities and fixed-income holdings; (3) contract for external asset management; and (4) invest outside the U.S. Results: Empirical analysis reveals that governance policies, especially independent performance evaluations predict investment decisions in all four areas. These investment strategies are found in turn to affect subsequent fund performance: preferential investing in equities and abroad increased annual returns on their assets by as much as one to two percentage points. Conclusions: The ways that public pensions are governed have a direct bearing on how they invest their assets, and the investment strategies in turn directly affect the financial performance of their holdings.

http://prc.wharton.upenn.edu/prc/PRC/WP/2000-3.PDF
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12. URBAN INSTITUTE: "The Trade-Off between Hours of Paid Employment and Time Assistance to Elderly Parents at Midlife," by Richard W. Johnson and Anthony T. Lo Sasso (February 2000, .pdf format, 42p.).

>From the Abstract:

Although the family has traditionally been the primary caregiver for the frail elderly, the rising labor force participation rates of married women may interfere with their historical caregiving responsibilities. This paper explores time transfers to elderly parents and their impact on labor supply for persons at midlife. We estimate simultaneous panel data models of annual hours of paid work and the provision of time assistance to parents for a sample of men and women ages 53 to 65 in the Health and Retirement Study. Our results indicate that time help to parents substantially reduces labor supply for both women and men.

http://www.urban.org/retirement/reports/elderly_parents.html

click on "PDF" for full text.
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13. CENTER FOR POLICY RESEARCH (CPR), MAXWELL SCHOOL OF CITIZENSHIP AND PUBLIC AFFAIRS, SYRACUSE UNIVERSITY: "Pharmaceuticals and the Elderly: A Comparative Analysis," by Deborah A. Freund, Don Willison, Grant D. Reeher, Bernie O'Brien, Jarold Cosby, and Amy Ferraro (Working Paper Series No. 17, March 2000, .pdf format, 34p.).

>From the Abstract:

This paper compares and contrasts outpatient pharmaceutical policies for the elderly in seven OECD nations: Australia, Canada, Germany, Japan, New Zealand, the United Kingdom, and the United States. Each country is facing an increasing financial burden due to rapidly growing numbers of elderly citizens, in number and as a percentage of population, and rising drug costs. As a result, they are struggling to balance varying levels of commitment to providing drugs for the elderly with the need to contain costs. Although each country's healthcare systems are unique, the methods that each country is using to control rising pharmaceutical costs are similar. Many countries are gravitating towards the use of last-dollar rather than first-dollar coverage. All provide inpatient pharmaceutical coverage.

http://www-cpr.maxwell.syr.edu/cprwps/wps17abs.htm

click on "Click here for the Adobe Acrobat version of CPR Working Paper 17" for full text.
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14. CENTER FOR RETIREMENT RESEARCH AT BOSTON COLLEGE: "401(k) Investment Decisions and Social Security Reform," by Cori E. Uccello (WP 2000-04, March 2000, .pdf format, 22p.).

>From the Abstract:

This paper uses the 1995 Survey of Consumer Finances to show that 401(k) participants with an underlying defined benefit plan are more likely to invest in equities than are participants whose 401(k) is their primary plan, suggesting that workers with a guaranteed source of retirement income are more likely to invest their other retirement assets more aggressively. Removing this guarantee might result in more conservative investment. Therefore, using current 401(k) asset allocation behavior to project income under a Social Security individual account system with reduced guaranteed benefits could overstate returns to these accounts, thus overstating their attractiveness relative to the current system.

http://www.bc.edu/bc_org/avp/csom/executive/crr/wp/Abstracts/ab00-04.htm

click on "For full paper in PDF format, click here" for full text.

The paper can also be accessed at the Urban Institute's website:

http://www.urban.org/retirement/reports/401k_investment.html

click on "PDF" for full text.

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IV. Journal Tables of Contents (check your library for availability)

15. CARL Uncover Journal Tables of Contents. Follow the instructions below to access tables of contents. CARL Uncover provides fee based document delivery services for selected journals.

A. Point your browser to:

http://uncweb.carl.org:80/

B. click on "Search Uncover"
C. click on "Search Uncover Now"
D. Type the Journal Name in the search box and click the radio button "Journal Title Browse"
E. click on the journal name
F. click on "journal issues"
G. click on the issues identified below

American Journal of Epidemiology (Vol. 151, No. 5, Mar. 1, 2000).

Journal of Women and Aging (Vol. 11, No. 4, 1999).
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V. Books

16. _The Real Deal: The History and Future of Social Security_, by Sylvester J. Schieber and John B. Shoven (Yale University Press, 1999, 480p., cloth ISBN 0300081480 $45.00, paper ISBN 0300081495 $18.95).

http://www.yale.edu/yup/books/schieberF99.html
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17. _True Security: Rethinking American Social Insurance_, by Michael J. Graetz and Jerry L. Mashaw (Yale University Press, 1999, 352p., cloth ISBN 0300081502 $40.00, paper ISBN 0300081944 $16.95).

http://www.yale.edu/yup/books/graetzF99.html

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VI. Legislation Information Updates

18. SENATE APPROPRIATIONS COMMITTEE SUBCOMMITTEE ON LABOR, HEALTH, AND HUMAN SERVICES, EDUCATION HEARING ON MEDICARE WASTE, FRAUD, & ABUSE: a hearing held Mar. 9, 2000.

A. Hearing Testimony:

http://www.senate.gov/~appropriations/labor/hrgtest.htm

scroll to "MARCH 9, 2000; MEDICARE FRAUD, WASTE AND ABUSE." Note: HHS-OIG's referenced report was discussed in last week's (March 10, 2000) CAAR.

B. GAO Testimony: "Medicare: HCFA Faces Challenges to Control Improper Payments," by Leslie G. Aronovitz, Associate Director for Health Financing and Public Health Issues (General Accounting Office T-HEHS-00-74, March 2000, .pdf format, 12p.).

http://www.gao.gov/new.items/he00074t.pdf

Note: GAO Internet addresses are valid for only a limited period of time. After that time, documents can be found by searching the Government Printing Office:

http://www.access.gpo.gov/su_docs/aces/aces160.shtml

and searching on title or report number.
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19. HOUSE COMMITTEE ON GOVERNMENT REFORM SUBCOMMITTEE ON GOVERNMENT MANAGEMENT, INFORMATION, AND TECHNOLOGY: a hearing held Mar. 15, 2000. GAO Testimony: "Medicare Financial Management: Further Improvements Needed to Establish Adequate Financial Control and Accountability," by Gloria Jarmon, Director of Accounting and Financial Management Issues (General Accounting Office T-AIMD-00-118, March 2000, .pdf format, 17p.).

http://www.gao.gov/new.items/ai00118t.pdf

Note: GAO Internet addresses are valid for only a limited period of time. After that time, documents can be found by searching the Government Printing Office:

http://www.access.gpo.gov/su_docs/aces/aces160.shtml

and searching on title or report number.

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VII. Websites of Interest

20. THE URBAN INSTITUTE RETIREMENT PROJECT: The non-partisan Urban Institute's Retirement Project "assesses how current retirement policies, demographic trends, and private sector practices affect the well-being of older Americans and the economy. The project also analyzes proposed retirement policies, with a focus on both the income and health needs of the elderly." The site is highlighted by a series of online reports, briefs and "straight talk on social security" papers. The research is supported by a grant from the Mellon Foundation.

http://www.urban.org/retirement/index.htm

Jack Solock
Data Librarian--Center for Demography and Ecology and Center for Demography of Health and Aging
4470 Social Science
University of Wisconsin-Madison
Madison, WI 53706
608-262-9827
jsolock@ssc.wisc.edu