Current Awareness in Aging Research (CAAR) Report #477 -- March 5, 2009

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:


I. Data:

1. INTER-UNIVERSITY CONSORTIUM FOR POLITICAL AND SOCIAL RESEARCH, NATIONAL ARCHIVE OF COMPUTERIZED DATA ON AGING: "Some researchers have reported a problem with the cross-sectional weights on the 2004 NLTCS public use file produced by Duke University and distributed through the National Archive of Computerized Data on Aging (NACDA) at the University of Michigan ( In response, the Assistant Secretary for Planning and Evaluation/Department of Health and Human Services and the National Institute on Aging/National Institutes of Health/Department of Health and Human Services sponsored a contract with Battelle to examine the cross-sectional sample weights in the 2004 and earlier waves of the NLTCS for accuracy of weighting procedures and their implementation, and for consistency across waves. This effort resulted in the construction of what is considered to be a consistent set of cross-sectional sample weights for all waves of NLTCS except the 1982 wave. The new weights and documentation are available on the NACDA site as of February 27, 2009."

"All registered users of the NACDA supported version of the NLTCS will receive updated copies of the NLTCS public use files which will include the new weights in early March of 2009. If you have an immediate need for the revised weights for publications, research or grant applications contact James McNally the Director of the NACDA Program on Aging at and we will expedite the delivery of the updated copy."


II. Reports and articles:

2. US SOCIAL SECURITY ADMINISTRATION, OFFICE OF POLICY PERIODICAL: Social Security Bulletin (Vol. 68, No. 4, March 2009, .pdf and HTML format).


3. US GOVERNMENT ACCOUNTABILITY OFFICE REPORT: "Debt Management: Treasury's Cash Management Challenges and Timing of Payments to Medicare Private Plans," (GAO-09-118, January 2009, .pdf format, p.).



A. "Comparing Pharmacy Reimbursement: Medicare Part D to Medicaid," (OEI-03-07-00350, February 2009, . pdf format, 26p.).


Nationally, Part D and Medicaid pharmacy reimbursement amounts for most of the single-source drugs that we reviewed were similar; however, Medicaid reimbursement amounts for the multiple-source drugs that we reviewed were typically higher than the Part D amounts. Medicare Part D coverage is provided through private drug plans offered by plan sponsors. Under Federal guidelines, Part D sponsors independently negotiate pharmacy reimbursement and price concessions with manufacturers and pharmacies. Unlike Part D, State Medicaid agencies administer Medicaid and reimburse pharmacies for drugs. States, in conjunction with the Federal Government, determine pharmacy reimbursement under broad Federal guidelines.States also receive federally mandated Medicaid drug rebates and may negotiate with manufacturers for additional rebates. This study compares only the amount reimbursed to pharmacies by Part D and Medicaid; it does not compare total program expenditures and does not examine the impact of rebates or post-point-of-sale price concessions.

We found that within the five States selected for our review, the Medicaid and Part D ingredient cost reimbursement amounts were similar for single-source drugs. In all five States, the average Medicaid ingredient costs exceeded the average Part D ingredient costs for most multiple-source drugs under review. In addition, Medicaid dispensing fees were substantially higher than average Part D dispensing fees for both the single-source and multiple-source drugs under review.

Congress took action to reduce multiple-source drug prices in the Medicaid program through provisions in the Deficit Reduction Act of 2005. These provisions would have expanded the number of drugs subject to Federal upper limits and reduced the Federal upper limit amounts for these multiple-source drugs. These provisions would have also granted States access to average manufacturer price (AMP) data, which, in turn, would have allowed States to base Medicaid drug reimbursement on AMPs. However, a Federal judge issued a preliminary injunction to prevent the implementation of AMP-based Federal upper limits and AMP-based Medicaid reimbursement amounts. In addition, because of the Medicare Improvements for Patients and Providers Act of 2008, CMS is prohibited from establishing Federal upper limit amounts based on AMPs or sharing AMP data with States prior to October 1, 2009. As a result, Federal upper limits and Medicaid reimbursement amounts are still based on published prices, which previous OIG work has found to result in inflated payments for multiple-source drugs.

B. "Effect of the Part D Coverage Gap on Medicare Beneficiaries Without Financial Assistance in 2006," (OEI-05-07-00610, March 2009, .pdf format, 40p.).


Seven percent of Part D beneficiaries entered the coverage gap and did not receive financial assistance with prescription drug costs in 2006. During the coverage gap, drug-purchasing behavior changed for almost all these beneficiaries. Medicare Part D provides an optional drug benefit to Medicare beneficiaries. During the coverage year, the financial responsibilities of beneficiaries, plan sponsors, and CMS vary during four distinct coverage phases: annual deductible, initial coverage, coverage gap, and catastrophic coverage. Some research suggests that beneficiaries who entered the Medicare Part D coverage gap may have changed their prescription drug use behaviors because they were responsible for 100 percent of their drug costs during the coverage gap.

Sixty-nine percent of beneficiaries decreased the average number of drugs they purchased during the coverage gap. This decrease could have represented a strategy that beneficiaries used to reduce their financial burden during the coverage gap, or it could have represented appropriate reductions due to changes in beneficiaries' health status. In addition, the greater the average number of drugs per month that beneficiaries purchased before entering the coverage gap, the more they reduced the average number of drugs per month that they purchased during the coverage gap. Beneficiaries who purchased an average of at least nine drugs per month had the largest decrease at 18 percent.

Based on these findings, we recommend that CMS support outreach and education activities targeted at beneficiaries who make more prescription drug purchases before entering the coverage gap. To do this, CMS could encourage plan sponsors to augment current outreach and beneficiary education efforts and supplement plans' outreach and education efforts by working directly with beneficiaries to explore cost-saving strategies. In addition, CMS should target low-income subsidy outreach to beneficiaries who entered the coverage gap in previous years without financial assistance. CMS concurred with one of our two recommendations. CMS did not agree with our first recommendation. We continue to believe that targeting beneficiaries with more prescription drug purchases before the coverage gap for outreach and education will assist these beneficiaries in identifying cost-saving strategies. CMS concurred with our second recommendation. However, the actions CMS stated it would take may not fully address our recommendation to use drug utilization data to identify potential beneficiaries for the subsidy.


5. MEDICAL EXPENDITURE PANEL SURVEY STATISTICAL BRIEF: "The Top Five Therapeutic Classes of Outpatient Prescription Drugs Ordered by Total Expense for the Medicare Population Age 65 and Older in the U.S. Civilian Noninstitutionalized Population, 2006," by Anita Soni (Statistical Brief No. 238, February 2009, .pdf format, 6p.).


6. CENSUS BUREAU PRESS FACTS FOR FEATURE: "Older Americans Month: May 2009," (CB09-FF.07, March 3, 2009, .pdf and HTML format, 5p.). Note: Link to the .pdf is available at the top of this page.


7. CENTERS FOR MEDICARE AND MEDICAID SERVICES DECISION MEMORANDUM: "Decision Memo for Sleep Testing for Obstructive Sleep Apnea (OSA) (CAG-00405N)," (March 3, 2009).

Related Press Release:



A. "Cash and investment holdings of state and local government employee-retirement systems by level of government: Fiscal years 1993-2007," (March 2009, .pdf and Excel format).



B. "Expenditures of state and local government employee-retirement systems by level of government: Fiscal years 1993-2007," (March 2009, .pdf and Excel format).



C. "Number and membership of state and local government employee-retirement systems: Fiscal years 1993-2007," (March 2009, .pdf and Excel format).



D. "Revenues of state and local government employee-retirement systems by level of government: Fiscal years 1993-2007," (March 2009, .pdf and Excel format).




9. UK OFFICE OF NATIONAL STATISTICS BRIEF: "Pension Analysis 2008," (March 2008, .pdf format). Note: Each of the tables in the .pdf file links to an Excel table.


10. UK HOUSE OF COMMONS REPORT: "Saving Gateway Accounts Bill: Committee Stage Report," by Timothy Edwards (Research Report No. 16, February 2009, .pdf format, 17p.).


11. AUSTRALIAN INSTITUTE OF HEALTH AND WELFARE REPORT: "Hospitalisations due to falls by older people, Australia 2005-06," (Injury research and statistics series no. 50, March 2009, .pdf format, 56p.).


12. CANADIAN POLICY RESEARCH NETWORK REPORT: "Balancing Paid Work and Caregiving Responsibilities: A Closer Look at Family Caregivers in Canada," by Linda Duxbury, Chris Higgins, Bonnie Schroeder (March 2009, .pdf format, 199p.).


13. EMPLOYEE BENEFIT RESEARCH INSTITUTE ISSUE BRIEF: "The Impact of the Recent Financial Crisis on 401(k) Account Balances," by Jack VanDerhei (EBRI Issue Brief No. 326, February 2009, .pdf format, 24p.).


14. CENTER FOR RETIREMENT RESEARCH AT BOSTON COLLEGE ISSUE BRIEF: "An Update on 401(k) Plans: Insights From the 2007 SCF," by Alicia H. Munnell, Francesca Golub-Sass, and Dan Muldoon (IB No.9-5, March 2009, .pdf format, 17p.).



A. "Across the States 2009: Profiles of Long-Term Care and Independent Living," by Ari N. Houser, Wendy Fox-Grage, and Mary Jo Gibson (March 2009, .pdf format, 368p.).

B. "Caregiving and End of Life Issues: A Survey of AARP Members in Florida," by Terri Guengerich (February 2009, .pdf format, 33p.).

C. "Multi-Generational Housing Patterns," by Teresa A. Keenan (February 2009, .pdf format, 20p.).

D. "Need for Low-Income Heating Assistance Continues Despite Recent Drop in Some Home Heating Costs," by Ann McLarty Jackson and Neal Walters (February 2009, .pdf format, 5p.).

E. "Medicare Cost-Sharing Requirements for 2009," by K. Lynn Nonnemaker (February 2009, .pdf format, 3p.).

F. The following Prime Time Radio show (RealPlayer format, running time, between 23 and 30 minutes) has been added to the PTR site:

Revamped Emergency Rooms For Seniors -- Feb. 24, 2009.

Note: this is a temporary address. When new PTR shows are released, these will be available at:


16. METLIFE MATURE MARKET INSTITUTE REPORT: "Boomer Bookends: Insights Into the Oldest and Youngest Boomers," (February 2009, .pdf format, 30p.).


17. KAISER FAMILY FOUNDATION BRIEF: "Retiree Health VEBAs: A New Twist On An Old Paradigm," by Phyllis Borzi (March 2009, .pdf format, 23p.).


18. NELSON A. ROCKEFLLER INSTITUTE OF GOVERNMENT REPORT: "Medicaid and Long-Term Care: New York Compared to 18 Other States," (February 2009, .pdf format, 36p.).


19. CENTER FOR ECONOMIC AND POLICY RESEARCH REPORT: "The Wealth of the Baby Boom Cohorts After the Collapse of the Housing Bubble," by David Rosnick and Dean Baker (February 2009, .pdf format, 23p.).

More information about CEPR:


20. FAMILY CAREGIVER ALLIANCE PERIODICAL: Caregiving PolicyDigest (Vol. 9, No. 5, Mar. 4, 2009).

More information about FCA:


21. SCIENCE ARTICLE ABSTRACT: "Synchronous Hyperactivity and Intercellular Calcium Waves in Astrocytes in Alzheimer Mice," by Kishore V. Kuchibhotla, Carli R. Lattarulo, Bradley T. Hyman, and Brian J. Bacskai (Vol. 323, No. 5918, February 27, 2009, p. 1211-1215).



A. "Protein stability and resistance to oxidative stress are determinants of longevity in the longest-living rodent, the naked mole-rat," by Viviana I. Pez, Rochelle Buffenstein, Venkata Masamsetti, Shanique Leonard, Adam B. Salmon, James Mele, Blazej Andziak, Ting Yang, Yael Edrey, Bertrand Friguet, Walter Ward, Arlan Richardson, and Asish Chaudhuri (Vol. 106, No. 9, March 3, 2009, p. 3059-3064).

B. "Small molecule blockers of the Alzheimer A{beta} calcium channel potently protect neurons from A{beta} cytotoxicity," by Juan Carlos Diaz, Olga Simakova, Kenneth A. Jacobson, Nelson Arispe, and Harvey B. Pollard (Vol. 106, No. 9, March 3, 2009, .pdf and HTML format, p. 3348-3353). Note: PNAS is providing open access to this article.

C. "Reduction of cholesterol synthesis in the mouse brain does not affect amyloid formation in Alzheimer's disease, but does extend lifespan," by Rebekkah W. Halford and David W. Russell (Vol. 106, No. 9, March 3, 2009, p. 3502-3506).



A. "Does My Step Look Big In This? A Visual Illusion Leads To Safer Stepping Behaviour," by David B. Elliott, Anna Vale, David Whitaker, and John G. Buckley (PLoS ONE 4(2): e4577. doi:10.1371/journal.pone.0004577, XML, HTML, and .pdf format, 6p.).

B. "Disruption of Growth Hormone Receptor Prevents Calorie Restriction from Improving Insulin Action and Longevity," by Michael S. Bonkowski, Fernando P. Dominici, Oge Arum, Juliana S. Rocha, Khalid A. Al Regaiey, Reyhan Westbrook, Adam Spong, Jacob Panici, Michal M. Masternak, John J. Kopchick, and Andrzej Bartke (PLoS ONE 4(2): e4567. doi:10.1371/journal.pone.0004567, XML, HTML, and .pdf format, 11p.).

C. "PINK1 Defect Causes Mitochondrial Dysfunction, Proteasomal Deficit and {alpha}-Synuclein Aggregation in Cell Culture Models of Parkinson's Disease," by Wencheng Liu, Cristofol Vives-Bauza, Rebeca Ac-Per-, Ai Yamamoto, Yingcai Tan, Yanping Li, Jordi Magran Mihaela A. Stavarache, Sebastian Shaffer, Simon Chang, Michael G. Kaplitt, Xin-Yun Huang, M. Flint Beal, Giovanni Manfredi, and Chenjian Li (PLoS ONE 4(2): e4597. doi:10.1371/journal.pone.0004597, XML, HTML, and .pdf format, 14p.).

D. "L-DOPA Neurotoxicity Is Mediated by Up-Regulation of DMT1-IRE Expression," by Fang Du, Zhong-ming Qian, Li Zhu, Xiao ei Wu, Wing-ho Yung, Ting-yuk Tsim, and Ya Ke (PLoS ONE 4(2): e4593. doi:10.1371/journal.pone.0004593, XML, HTML, and .pdf format, 12p.).

E. "Normal Aging Modulates the Neurotoxicity of Mutant Huntington," by Elsa Diguet, Fanny Petit, Carole Escartin, Karine Cambon, Nicolas Bizat, Noelle Dufour, Philippe Hantraye, Nicole Deglon, and Emmanuel Brouillet (PLoS ONE 4(2): e4637. doi:10.1371/journal.pone.0004637, XML, HTML, and .pdf format, 13p.).

F. "Molecular Profiling Reveals Diversity of Stress Signal Transduction Cascades in Highly Penetrant Alzheimer's Disease Human Skin Fibroblasts," by Graziella Mendonsa, Justyna Dobrowolska, Angela Lin, Pooja Vijairania, Y.-J. I. Jong, and Nancy L. Baenziger (PLoS ONE 4(2): e4655. doi:10.1371/journal.pone.0004655, XML, HTML, and .pdf format, 22p.).

G. "Mechanism of Neuronal versus Endothelial Cell Uptake of Alzheimer's Disease Amyloid {beta} Protein," by Karunya K. Kandimalla, Olenych G. Scott, Smita Fulzele, Michael W. Davidson, and Joseph F. Poduslo (PLoS ONE 4(2): e4627. doi:10.1371/journal.pone.0004627, XML, HTML, and .pdf format, 20p.).



A. "Vulnerability and access to care for South Asian Sikh and Muslim patients with life limiting illness in Scotland: prospective longitudinal qualitative study," by Allison Worth, Tasneem Irshad, Raj Bhopal, Duncan Brown, Julia Lawton, Elizabeth Grant, Scott Murray, Marilyn Kendall, James Adam, Rafik Gardee, and Aziz Sheikh (BMJ 2009;338:b183, February 28, 2009).

B. "End of life care in ethnic minorities," by Mark R. D. Johnson (BMJ 2009;338:a2989, February 28, 2009).


25. ECONOMIST ARTICLE: "Gilded age," (February 28, 2009).


III. Working Papers:


A. "Do Health Problems Reduce Consumption at Older Ages?" by Barbara A. Butrica, Richard W. Johnson, and Gordon B.T. Mermin (WP No. 2009-9, March 2009, .pdf format, 26p.). Links to the abstract and full-text can be found at:

B. "Evaluating Micro-Survey Estimates of Wealth and Saving," by Barry P. Bosworth and Rosanna Smart (WP No. 2009-4, January 2009, .pdf format, 35p.). Links to the abstract and full-text can be found at:

C. "Labor Supply Elasticity and Social Security Reform," by Selahattin Imrohoroglu and Sagiri Kitao (WP No. 2009-5, January 2009, .pdf format, 25p.). Links to the abstract and full-text can be found at:

D. "Health Care, Health Insurance, and the Relative Income of the Elderly and Nonelderly," by Gary Burtless and Pavel Svaton (WP No. 2009-10, February 2009, .pdf format, 60p.). Links to the abstract and full-text can be found at:


27. NATIONAL BUREAU OF ECONOMIC RESEARCH: "Choice Inconsistencies Among the Elderly: Evidence from Plan Choice in the Medicare Part D Program," by Jason T. Abaluck and Jonathan Gruber (w14759, February 2009, .pdf format, 59p.).


The Medicare Part D Prescription Drug Plan represents the most significant privatization of the delivery of a public insurance benefit in recent history, with dozens of private insurers offering a wide range of products with varying prices and product features; the typical elder had a choice of roughly 40 stand-alone drug plans. In this paper we evaluate the choices of elders across this wide array of Part D options using a unique data set of prescription drug claims matched to information on the characteristics of choice sets. We first document that the vast majority of elders are choosing plans that are not on the "efficient portfolio" of plan choice in the sense that an alternative plan offers better risk protection at a lower cost. We then estimate several discrete choice models to document three dimensions along which elders are making choices which are inconsistent with optimization under full information: elders place much more weight on plan premiums than they do on expected out of pocket costs; they place almost no value on variance reducing aspects of plans; and they value plan financial characteristics beyond any impacts on their own financial expenses or risk.These findings are robust to a variety of specifications and econometric approaches. We develop an "adjusted" revealed preference approach that combines data from consumer choices with ex ante restrictions on preferences, and find that in a partial equilibrium setting, restricting the choice set to the three lowest average cost options would have likely raised welfare for elders under the program.


28. INSTITUTE FOR FISCAL STUDIES [LONDON, UK]: "The value of teachers' pensions," by Richard Disney, Carl Emmerson and Gemma Tetlow (IFS Working Paper No. W09/07, January 2009, .pdf format, 62p.). Links to the abstract and full-text can be found at:


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

29. European Journal of Palliative Care (Vol. 16, No. 2, 2009).

30. Journal of the American Geriatrics Society (Vol. 57, No. 3, March 2009).

31. Medical Care (Vol. 47, No. 3, March 2008).

32. Medical Care Research and Review (Vol. 66, No. 2, April 2009). Note: Full text of this journal is available in the ProQuest Research Library. Check your library for availability of this database and issue.


33. AMEDEO MEDICAL LITERATURE: Note: "AMEDEO has been created to serve the needs of healthcare professionals, including physicians, nurses, pharmacists, administrators, other members of the health professions, and patients and their friends. They can easily access timely, relevant information within their respective fields... All AMEDEO services are free of charge. This policy was made possible thanks to generous unrestricted educational grants provided by AMGEN, Berlex, Eisai, Glaxo Wellcome, Novartis, Pfizer, Roche, and Schering AG."

A. Osteoporosis: Literature for the week of March 4, 2009:

B. Alzheimer's Disease: Literature for the week of March 4, 2009:

C. Parkinson's Disease: Literature for the week of March 4, 2009:

D. Prostate Cancer: Literature for the week of March 4, 2009:

E. Stem Cell Research: Literature for the week of March 4, 2009:

F. Ophthalmology: Literature for the week of March 4, 2009:

AMEDEO Literature Guide:


V. Funding Opportunities:


A. "Manufacturing Processes of Medical, Dental, and Biological Technologies (STTR [R41/R42])," (PA-09-114, is a re-issue of PA-06-012, National Institute on Aging, in conjunction with other agencies, Feb. 26, 2009).

B. "Manufacturing Processes of Medical, Dental, and Biological Technologies (SBIR [R43/R44])," (PA-09-113, is a re-issue of PA-06-013, National Institute on Aging, in conjunction with other agencies, Feb. 26, 2009).


VI. Conferences:

35. WISCONSIN LONGITUDINAL STUDY: "Wisconsin Longitudinal Study Training Workshop at PAA meetings in Detroit," (April 29, 2009).


36. BROOKINGS INSTITUTE: "Financial Literacy in Times of Turmoil and Retirement Insecurity," (March 20, 2009, Washington, DC). Note: Online registration is
available for this event.


37. US ADMINISTRATION ON AGING CONFERENCE UPDATES: The AoA conference page has been updated with the following conferences and events. Scroll to data and place for more information:

Apr. 29-May 5, 2009 -- Chicago, IL.

May 7-9, 2009 -- Orlando, FL

May 27-30, 2009 -- Phoenix, AZ

Jun. 24-26, 2009 -- Atlanta, GA

Jul. 19-22, 2009 -- Minneapolis, MN


38. AMERICAN SOCIETY ON AGING/THE NATIONAL COUNCIL ON AGING: "Aging in America," (March 15-19, 2009, Las Vegas).


VII. Legislation Information Updates:


A. "Boomer Bust? Securing Retirement in a Volatile Economy," a hearing held February 25, 2009 (.pdf format).

B. "Health Reform in An Aging America," a hearing held March 4, 2009 (.pdf format).




Charlie Fiss
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