Depressive Symptoms in Late Life: The Role of Sociodemographic Factors, Retirement Timing, and Post-Acute Care

Abstract

The mental well-being of older Americans is a pressing public health concern given the aging population and recent increases in midlife suicide and substance use. Depressive symptoms specifically are a common cause of poor quality of life in old age, and one of the leading causes of disability. This dissertation uses nationally-representative longitudinal data from the Health and Retirement Study to improve understandings of depressive symptoms in mid- and late life, their social patterning, and their intersection with post-hospital recoveries. In Chapter 2, I used mixed-effect models to characterize population trends in how depressive symptoms change over ages 51-90 by gender, race/ethnicity, educational attainment, and birth cohort. This research highlighted large disparities in depressive symptoms in midlife by educational attainment, pointing to the importance of early life exposures for late life health. Results also reaffirmed mental health concerns about recent birth cohorts. Looking at a key life event for this age group, I next focused on retirement timing. This research examined how expectations about full time work at age 62, reported between ages 51-61, align with realized labor force status to determine whether unmet expectations about retirement timing relate to depressive symptoms across sociodemographic groups. The results revealed that unmet retirement expectations are more common among Hispanic and Black Americans compared to White Americans. In addition, those of low educational attainment were at high risk of unexpectedly not working at age 62. Interestingly, unexpectedly working was not associated with depressive symptoms, pointing to the benefits of work for mental health at older ages and the resilience of those adapting to staying in the labor force. Unexpectedly not working was associated with a small increase in depressive symptoms at age 62, which was explained by health declines between expectations and reaching age 62. Future research attention should be directed at mitigating health-related early labor force departures, which differentially occur among disadvantaged groups in America. Finally, I linked survey data from the Health and Retirement Study to Medicare claims data to consider the role of depressive symptoms in recovering from acute hospitalizations. I tested whether different post-acute care settings might mitigate the association between depressive symptoms and poor health outcomes – hospital readmissions, falls, and mortality. Risk for 30-day hospital readmissions increased with increasing depressive symptoms for those recovering at home with or without home health, but not for patients in inpatient rehabilitation settings such as Skilled Nursing Facilities. Post-acute care settings did not modify the relationships between depressive symptoms and each of falls or mortality; therefore, referring depressed patients to inpatient rehabilitation settings could help hospitals avoid financial penalties for readmissions, but will not improve patients’ risks for falls or mortality. Together, this research provides a rich interdisciplinary look at social factors related to depressive symptoms in the aging population and gives insights into one aspect of health services that may address the harmful repercussions of depressive symptoms on other health outcomes.