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This analysis of data from the Health and Retirement Study estimated that the prevalence of dementia among people older than 70 years of age in the United States in 2010 was 14.7% and that the total costs attributable to dementia were between $157 billion and $215 billion. Dementia, a chronic disease of aging characterized by progressive cognitive decline that interferes with independent functioning, 1 affects a large and growing number of older adults in the United States. 2 , 3 Citing the growing effect of dementia on patients, families, and the health care and long-term care systems, President Barack Obama signed the National Alzheimer's Project Act into law in January 2011. One goal of the law is to improve the ability of the federal government to track the monetary costs incurred by individuals and public programs, such as Medicare and Medicaid, that result from dementia. 4 Accurately identifying the monetary costs . . .

Reliable estimates of the lifetime risk of using a nursing home and the associated out-of-pocket costs are important for the saving decisions by individuals and families, and for the purchase of long-term care insurance. We used data on up to 18 y of nursing home use and out-of-pocket costs drawn from the Health and Retirement Study, a longitudinal household survey representative of the older US population. We accumulated the use and spending by individuals over many years, and we developed and used an individual-level matching method to account for use before and after the observation period. In addition, for forecasting, we estimated a dynamic parametric model of nursing home use and spending. We found that 56% of persons aged 57–61 will stay at least one night in a nursing home during their lifetimes, but only 32% of the cohort will pay anything out of pocket. Averaged over all persons, total out-of-pocket expenditures looking forward from age 57 were approximately $7,300, discounted at 3% per year. However, the 95th percentile of spending was almost $47,000. We conclude that the percentage of people ever staying in nursing homes is substantially higher than previous estimates, at least partly due to an increase in nursing home episodes of short duration. Average lifetime out-of-pocket costs may be affordable, but some people will incur much higher costs.

Subjective probabilities are now collected on a number of large household surveys with the objective of providing data to better understand intertemporal decision making. Comparison of subjective probabilities with actual outcomes shows that the probabilities have considerable predictive power in situations where individuals have considerable private information, such as survival and retirement. In contrast, the subjective probability of a stock market gain varies greatly across individuals even though no one has private information and the outcome is the same for everyone. An explanation is that there is considerable variation in accessing and processing information. Further, the subjective probability of a stock market gain is considerably lower than historical averages, providing an explanation for the relatively low frequency of stock holding. An important research objective will be to understand how individuals form their subjective probabilities.

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.

Although expectations, or more precisely subjective probability distributions, play a prominent role in models of decision making under uncertainty, we have had very little data on them. Based on panel data from the Health and Retirement Study, we study the evolution of subjective survival probabilities and their ability to predict actual mortality. In panel, respondents modify their survival probabilities in response to new information such as the onset of a new disease condition. Subjective survival probabilities predict actual survival: those who survived in the panel reported survival probabilities approximately 50% greater at baseline than those who died.

Dementia, defined as a cognitive decline severe enough to require help with daily activities, costs an estimated $159-$215 billion per year in the US. As much as 84% of this amount is attributable to long-term services and supports, many of which are provided by relatives and friends of the person with dementia. However, the reliance on informal care from family members may be unsustainable as the population ages; family sizes shrink; and women, who traditionally bear most of the burden of informal caregiving, increasingly participate in the workforce. To assess whether demographic changes will affect informal caregiving for dementia, policy makers need reliable estimates of the number of informal caregivers and care recipients and of the intensity of care provided. Using data from the 2010 Health and Retirement Study, the authors estimated a significant amount of informal care: Approximately 5.5 million US adults ages seventy and older received informal care, of whom 3.6 million had cognitive impairment or probable dementia.

Objective: We describe the design and methods of the Aging, Demographics, and Memory Study (ADAMS), a new national study that will provide data on the antecedents, prevalence, outcomes, and costs of dementia and ‘cognitive impairment, not demented’ (CIND) using a unique study design based on the nationally representative Health and Retirement Study (HRS). We also illustrate potential uses of the ADAMS data and provide information to interested researchers on obtaining ADAMS and HRS data. Methods: The ADAMS is the first population-based study of dementia in the United States to include subjects from all regions of the country, while at the same time using a single standardized diagnostic protocol in a community-based sample. A sample of 856 individuals age 70 or older who were participants in the ongoing HRS received an extensive in-home clinical and neuropsychological assessment to determine a diagnosis of normal, CIND, or dementia. Within the CIND and dementia categories, subcategories (e.g. Alzheimer’s disease, vascular dementia) were assigned to denote the etiology of cognitive impairment. Conclusion: Linking the ADAMS dementia clinical assessment data to the wealth of available longitudinal HRS data on health, health care utilization, informal care, and economic resources and behavior, will provide a unique opportunity to study the onset of CIND and dementia in a nationally representative population-based sample, as well as the risk factors, prevalence, outcomes, and costs of CIND and dementia.

According to the life-cycle model, mortality risk will influence both retirement and the desire to annuitize wealth. We estimate the effect of subjective survival probabilities on retirement and on the claiming of Social Security benefits because delayed claiming is equivalent to the purchase of additional Social Security annuities. We find that those with very low subjective probabilities of survival retire earlier and claim earlier than those with higher subjective probabilities, but the effects are not large. The great majority of workers claim as soon as they are eligible.

To the Editor: Hurd et al. (April 4 issue) 1 use data from a subgroup of participants in the Health and Retirement Study (HRS) (the Aging, Demographics, and Memory Study subsample) to estimate the annual Medicare cost per person with dementia at $2,752 (in 2010 dollars). This finding closely approximates the results of our earlier study, 2 based on the Medicare Current Beneficiary Survey, in which we estimated an average annual cost of $2,629 (adjusted to 2010 dollars); our findings were within the range of statistical error of the estimate by Hurd et al. We also reported that the average duration of . . .

Along with data about actual, desired, and anticipated job characteristics, this paper uses a novel data element, the subjective conditional probability of working at age 70, to estimate the causal effects of job characteristics on retirement in the United States. Having flexible work hours is the most consistent predictor of retirement preferences and expectations: if all current workers had flexible hours, the fraction working at age 70 would be 0.322, but it would be just 0.172 if none had this option. Job stress, physical, and cognitive job demands, the option to telecommute, and commuting times were additional predictors of retirement expectations.