{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T00:28:18Z","timestamp":1786321698765,"version":"build-2736575974"},"reference-count":42,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["1RF1AG078262-01A1"],"award-info":[{"award-number":["1RF1AG078262-01A1"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["1R01AG078262-01A1"],"award-info":[{"award-number":["1R01AG078262-01A1"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>There is limited research on whether receiving a dementia diagnosis could prompt later-life migration, particularly among older Medicare beneficiaries in Puerto Rico. Prior research shows older Puerto Ricans are migrating to the mainland United States, which may include those with an Alzheimer\u2019s Disease and Related Dementias (ADRD) diagnosis. This study examined yearly outmigration trends among older Puerto Ricans by exploring their movement patterns in 2011\u20132019.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We used data from the Medicare Master Beneficiary Summary File and the Puerto Rican Community Survey and focused on Medicare Fee-for-Service enrollees aged 65 and older. The Chronic Conditions Warehouse algorithm was used to ascertain ADRD diagnosis, and migration was defined as the change of (end-of-year) residence from one year to the next. A linear probability model was used to calculate differences in the rate of outmigration between beneficiaries with and without ADRD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Across the study period, the sample averaged 53,294 beneficiaries per year (43,819 [2019] to 66,625 [2012]), with 15% having a previous ADRD diagnosis each year. Overall, older Puerto Ricans previously diagnosed with ADRD were slightly more likely to move to the U.S. mainland compared to those without a diagnosis across the years (adjusted differences of b\u2009=\u20090.14%\u20130.42%), though differences were statistically significant in some years. For example, outmigration spiked (over 2.5%) among all older adults in the year of Hurricane Maria, regardless of health status.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Our results suggest that older Puerto Ricans with ADRD are more likely to migrate as they face challenges in aging in place.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/geronb\/gbag116","type":"journal-article","created":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T21:36:07Z","timestamp":1782855367000},"source":"Crossref","is-referenced-by-count":0,"title":["Diagnosis of Alzheimer\u2019s disease and related dementias and outmigration of older Puerto Rican Medicare Fee-for-Service beneficiaries, 2012\u20132019"],"prefix":"10.1093","volume":"81","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3931-5099","authenticated-orcid":false,"given":"Jeung Hyun","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Health Services, Policy, & Practice, School of Public Health, Brown University , Providence, Rhode Island,","place":["United States"]},{"name":"Center for Gerontology & Healthcare Research, School of Public Health, Brown University , Providence, Rhode Island,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoojin","family":"Lee","sequence":"additional","affiliation":[{"name":"Center for Gerontology & Healthcare Research, School of Public Health, Brown University , Providence, Rhode Island,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanru","family":"Liao","sequence":"additional","affiliation":[{"name":"Center for Gerontology & Healthcare Research, School of Public Health, Brown University , Providence, Rhode Island,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0855-5313","authenticated-orcid":false,"given":"Christopher H","family":"Schmid","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, School of Public Health, Brown University , Providence, Rhode Island,","place":["United States"]},{"name":"Center for Evidence Synthesis in Health, School of Public Health, Brown University , Providence, Rhode Island,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daeho","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Health Services, Policy, & Practice, School of Public Health, Brown University , Providence, Rhode Island,","place":["United States"]},{"name":"Center for Gerontology & Healthcare Research, School of Public Health, Brown University , Providence, Rhode Island,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amal","family":"Trivedi","sequence":"additional","affiliation":[{"name":"Department of Health Services, Policy, & Practice, School of Public Health, Brown University , Providence, Rhode Island,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David J","family":"Meyers","sequence":"additional","affiliation":[{"name":"Department of Health Services, Policy, & Practice, School of Public Health, Brown University , Providence, Rhode Island,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyriakos","family":"Markides","sequence":"additional","affiliation":[{"name":"Department of Population Health & Health Disparities, University of Texas Medical Branch at Galveston , Galveston, Texas,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica","family":"Col\u00f3n-Vargas","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, School of Public Health, Brown University , Providence, Rhode Island,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Rosales","sequence":"additional","affiliation":[{"name":"Department of Health Services, Policy, & Practice, School of Public Health, Brown University , Providence, Rhode Island,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7736-4441","authenticated-orcid":false,"given":"Michael","family":"Crowe","sequence":"additional","affiliation":[{"name":"Department of Psychology, University of Alabama at Birmingham , Birmingham, Alabama,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5623-9609","authenticated-orcid":false,"given":"Maricruz","family":"Rivera-Hernandez","sequence":"additional","affiliation":[{"name":"Department of Health Services, Policy, & Practice, School of Public Health, Brown University , Providence, Rhode Island,","place":["United States"]},{"name":"Center for Gerontology & Healthcare Research, School of Public Health, Brown University , Providence, Rhode Island,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,6,30]]},"reference":[{"key":"2026080919350782100_gbag116-B1","volume-title":"Aging in Puerto Rico is a struggle for families fragmented by migration","author":"Acevedo","year":"2023"},{"key":"2026080919350782100_gbag116-B2","doi-asserted-by":"publisher","first-page":"32772","DOI":"10.1073\/pnas.2001671117","article-title":"Quantifying the dynamics of migration after Hurricane Maria in Puerto Rico","volume":"117","author":"Acosta","year":"2020","journal-title":"Proceedings of the National Academy of Sciences of the United States of America"},{"key":"2026080919350782100_gbag116-B3","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1111\/padr.12289","article-title":"The impact of Hurricane Maria on out-migration from Puerto Rico: Evidence from Facebook data","volume":"45","author":"Alexander","year":"2019","journal-title":"Population and Development Review"},{"key":"2026080919350782100_gbag116-B4","author":"Alzheimer\u2019s Association","year":"2020"},{"key":"2026080919350782100_gbag116-B5","first-page":"1","article-title":"2025 Alzheimer\u2019s disease facts and figures","volume":"21","author":"Alzheimer\u2019s Association","year":"2025","journal-title":"Alzheimer\u2019s & Dementia"},{"key":"2026080919350782100_gbag116-B6","doi-asserted-by":"publisher","first-page":"e0280128","DOI":"10.1371\/journal.pone.0280128","article-title":"Healthcare utilization among pre-frail and frail Puerto Ricans","volume":"18","author":"Barba","year":"2023","journal-title":"PloS One"},{"key":"2026080919350782100_gbag116-B7","author":"Carrasquillo","year":"2022"},{"key":"2026080919350782100_gbag116-B8","author":"Citizen Portal","year":"2025"},{"key":"2026080919350782100_gbag116-B9","author":"Centers for Medicare & Medicaid Services","year":"2025"},{"key":"2026080919350782100_gbag116-B10","author":"Centers for Medicare & Medicaid Services","year":"2025"},{"key":"2026080919350782100_gbag116-B11","author":"Centers for Medicare & Medicaid Services","year":"2025"},{"key":"2026080919350782100_gbag116-B12","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1080\/26892618.2020.1858384","article-title":"Later-life migration in the Netherlands: Propensity to move and residential mobility","volume":"36","author":"de Jong","year":"2022","journal-title":"Journal of Aging and Environment"},{"key":"2026080919350782100_gbag116-B13","doi-asserted-by":"publisher","first-page":"e076666","DOI":"10.1002\/alz.076666","article-title":"Negotiating dementia care in networks of care: The effects of compounded disasters on social networks of care in rural Puerto Rico","volume":"19","author":"de Victoria","year":"2023","journal-title":"Alzheimer\u2019s & Dementia"},{"key":"2026080919350782100_gbag116-B14","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1007\/s11111-020-00339-5","article-title":"Out-migration from and return migration to Puerto Rico after Hurricane Maria: Evidence from the consumer credit panel","volume":"42","author":"DeWaard","year":"2020","journal-title":"Population and Environment"},{"key":"2026080919350782100_gbag116-B15","doi-asserted-by":"publisher","first-page":"355","DOI":"10.1111\/j.1747-7379.2002.tb00085.x","article-title":"Mobile livelihoods: The sociocultural practices of circular migrants between Puerto Rico and the United States","volume":"36","author":"Duany","year":"2002","journal-title":"International Migration Review"},{"key":"2026080919350782100_gbag116-B16","doi-asserted-by":"crossref","DOI":"10.5149\/9780807869376_duany","volume-title":"Blurred borders: Transnational migration between the Hispanic Caribbean and the United States","author":"Duany","year":"2011"},{"key":"2026080919350782100_gbag116-B17","doi-asserted-by":"publisher","first-page":"492","DOI":"10.1111\/area.12428","article-title":"Is migration in later life good for wellbeing? A longitudinal study of ageing and selectivity of internal migration","volume":"50","author":"Finney","year":"2018","journal-title":"Area"},{"key":"2026080919350782100_gbag116-B18","doi-asserted-by":"publisher","first-page":"345","DOI":"10.1177\/0164027520958760","article-title":"Internal migration and the health of middle-aged and older persons in China: The healthy migrant effect reconsidered","volume":"43","author":"Gao","year":"2021","journal-title":"Research on Aging"},{"key":"2026080919350782100_gbag116-B19","first-page":"1","article-title":"What is Puerto Rico?","volume":"94","author":"Issacharoff","year":"2019","journal-title":"Indiana Law Journal"},{"key":"2026080919350782100_gbag116-B20","doi-asserted-by":"publisher","first-page":"4011","DOI":"10.1080\/1369183X.2024.2412156","article-title":"The quest for a good old age: Mobility, immobility and Puerto Rican aging in the United States","volume":"51","author":"Jespersen","year":"2025","journal-title":"Journal of Ethnic and Migration Studies"},{"key":"2026080919350782100_gbag116-B21","author":"KFF","year":"2024"},{"key":"2026080919350782100_gbag116-B22","author":"Kramarow","year":"2024"},{"key":"2026080919350782100_gbag116-B23","doi-asserted-by":"publisher","first-page":"801","DOI":"10.3233\/JAD-230505","article-title":"Dementia attributable healthcare utilizations in the Caribbean versus United States","volume":"96","author":"Li","year":"2023","journal-title":"Journal of Alzheimer\u2019s Disease"},{"key":"2026080919350782100_gbag116-B25","doi-asserted-by":"publisher","first-page":"274","DOI":"10.1159\/000539560","article-title":"A systematic review and meta-analysis on the prevalence of mild cognitive impairment and dementia in Mexico","volume":"53","author":"Magall\u00f3n-Zertuche","year":"2024","journal-title":"Dementia and Geriatric Cognitive Disorders"},{"key":"2026080919350782100_gbag116-B26","doi-asserted-by":"publisher","first-page":"964","DOI":"10.1093\/geront\/gnac082","article-title":"Aging and the left behind: Puerto Rico and its unconventional rapid aging","volume":"62","author":"Matos-Moreno","year":"2022","journal-title":"The Gerontologist"},{"key":"2026080919350782100_gbag116-B27","author":"Medicaid and Medicare Advantage Products Association of Puerto Rico","year":"2024"},{"key":"2026080919350782100_gbag116-B28","doi-asserted-by":"publisher","first-page":"649","DOI":"10.3233\/JAD-230729","article-title":"A community-based study of dementia in Mexican American and non-Hispanic White individuals","volume":"97","author":"Morgenstern","year":"2024","journal-title":"Journal of Alzheimer\u2019s Disease"},{"key":"2026080919350782100_gbag116-B29","author":"National Institute on Aging","year":"2023"},{"key":"2026080919350782100_gbag116-B30","author":"National Public Radio","year":"2022"},{"key":"2026080919350782100_gbag116-B31","volume-title":"The near northwest side story: Migration, displacement, and Puerto Rican families","author":"P\u00e9rez","year":"2004"},{"key":"2026080919350782100_gbag116-B32","author":"Perreira","year":"2017"},{"key":"2026080919350782100_gbag116-B33","doi-asserted-by":"publisher","first-page":"e2439499","DOI":"10.1001\/jamanetworkopen.2024.39499","article-title":"Patterns of migration following dementia diagnosis","volume":"7","author":"Rahman","year":"2024","journal-title":"JAMA Network Open"},{"key":"2026080919350782100_gbag116-B34","doi-asserted-by":"publisher","first-page":"igaf122-1500","DOI":"10.1093\/geroni\/igaf122.1500","article-title":"Prevalence of ADRD among Medicare advantage enrollees in Puerto Rico compared to US counterparts","volume":"9","author":"Rivera-Hernandez","year":"2025","journal-title":"Innovation in Aging"},{"key":"2026080919350782100_gbag116-B35","doi-asserted-by":"publisher","first-page":"e0316156","DOI":"10.1371\/journal.pone.0316156","article-title":"\u201cMany old people taking care of old people\u201d: Experiences of older adults after Hurricane Mar\u00eda in Puerto Rico","volume":"20","author":"Santiago-Santiago","year":"2025","journal-title":"PloS One"},{"key":"2026080919350782100_gbag116-B36","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1007\/s11111-020-00355-5","article-title":"Puerto Rico exodus: Long-term economic headwinds prove stronger than Hurricane Maria","volume":"42","author":"Santos-Lozada","year":"2020","journal-title":"Population and Environment"},{"key":"2026080919350782100_gbag116-B85011865","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1111\/j.1749-6632.1992.tb33484.x","article-title":"Transnationalism: a new analytic framework for understanding migration","volume":"645","author":"Schiller","year":"1992","journal-title":"Annals of the New York Academy of Sciences"},{"key":"2026080919350782100_gbag116-B37","author":"StataCorp LLC","year":"2023"},{"key":"2026080919350782100_gbag116-B38","author":"U.S. Census Bureau","year":"2018"},{"key":"2026080919350782100_gbag116-B39","doi-asserted-by":"publisher","first-page":"115888","DOI":"10.1016\/j.socscimed.2023.115888","article-title":"On leaving: Coloniality and physician migration in Puerto Rico","volume":"325","author":"Varas-D\u00edaz","year":"2023","journal-title":"Social Science & Medicine"},{"key":"2026080919350782100_gbag116-B41","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1111\/j.0435-3684.2000.00079.x","article-title":"Types and patterns of later-life migration","volume":"82","author":"Walters","year":"2000","journal-title":"Geografiska Annaler: Series B, Human Geography"},{"key":"2026080919350782100_gbag116-B42","doi-asserted-by":"publisher","first-page":"357","DOI":"10.1093\/geront\/gnr098","article-title":"The meaning of \u201caging in place\u201d to older people","volume":"52","author":"Wiles","year":"2012","journal-title":"The Gerontologist"},{"key":"2026080919350782100_gbag116-B44","doi-asserted-by":"publisher","first-page":"1129","DOI":"10.3233\/JAD-201370","article-title":"Race\/ethnic disparities in mild cognitive impairment and dementia: The Northern Manhattan Study","volume":"80","author":"Wright","year":"2021","journal-title":"Journal of Alzheimer\u2019s Disease"}],"container-title":["The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/psychsocgerontology\/advance-article-pdf\/doi\/10.1093\/geronb\/gbag116\/68663034\/gbag116.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/psychsocgerontology\/article-pdf\/81\/9\/gbag116\/68663034\/gbag116.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/psychsocgerontology\/article-pdf\/81\/9\/gbag116\/68663034\/gbag116.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,9]],"date-time":"2026-08-09T23:35:16Z","timestamp":1786318516000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/psychsocgerontology\/article\/doi\/10.1093\/geronb\/gbag116\/8722722"}},"subtitle":[],"editor":[{"given":"Jason (Jace) D","family":"Flatt","sequence":"additional","affiliation":[{"name":"(Social Sciences Section)"}],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,6,30]]},"references-count":42,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,8,4]]}},"URL":"https:\/\/doi.org\/10.1093\/geronb\/gbag116","relation":{},"ISSN":["1079-5014","1758-5368"],"issn-type":[{"value":"1079-5014","type":"print"},{"value":"1758-5368","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,9]]},"published":{"date-parts":[[2026,6,30]]},"article-number":"gbag116"}}