Pathways from Health Insurance to Subjective Well-Being and Psychological Health at Older Ages

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Project Summary/Abstract The American population over 65 is growing rapidly, which will lead to a steep rise in the number of dementia cases (Hebert et al. 2003). Cognitive impairment, even in the absence of a dementia diagnosis, is often associated with limitations in an individual's ability to work, manage finances, and deal with routine activities, with possible implications for psychological well-being. Increased uncertainty that harms senior psychological health might, in turn, result in faster cognitive decline (Goveas et al., 2011) and dementia onset. The COVID-19 pandemic, as well as the disruptions caused by measures to slow it, might reinforce the relationship between psychological well-being and dementia. Like individuals with underlying health conditions, older adults are at higher risk of serious reactions to COVID-19 and death. In addition, seniors have steeper cognitive decline that might be accelerated by the increased uncertainty and health risks associated with the pandemic, with implications for the prevalence of dementia. As a result, there is an urgent need to understand the negative cognitive and psychological well-being effects of the pandemic among seniors, which subpopulations are most vulnerable, and what can be done to mitigate such effects. In particular, it is important to understand the role of large social programs such as Medicare in reducing the uncertainty generated by the pandemic and alleviating its consequences. In this administrative supplement, we propose to collect data to investigate the role of Medicare in delaying cognitive decline – and the consequent onset of dementia -- and improving psychological well-being of older Americans. In particular, we will document how the role of Medicare in providing access to health insurance and health care, as well was any consequent effects, changed during the COVID-19 pandemic. In question is whether, by providing access to health insurance, Medicare can reduce the cognition and well-being consequences of the pandemic. This supplement fits in with the overall goal of my K parent grant, which is to understand how health insurance affects the SWB and mental health of the elderly. The aims listed above are closely related to the parent grant's aims, but now use the opportunity to also understand how the pandemic, which greatly increased uncertainty, affected cognition and the onset of dementia. My plan is to develop a long-run panel following this initial cohort of respondents over time in order to capture changes in the cognition, dementia diagnosis, self-reported health and psychological well-being of this important demographic group. To do so, I will apply for a R01. The data collection supported by this supplement will increase my chances of writing a successful R01 application as a PI, one of the few K01 objectives that I still need to achieve. Finally, all collected data will be made publicly available for the research community after the publication of main findings.