A revised CES-D measure of depressive symptoms and a DSM-based measure of major depressive episodes in the elderly

Receipt of Emotional Support among Rural South African Adults

As the world undergoes rapid ageing, informal support from friends and relatives is becoming especially important among older adults in middle and low income countries, where formalized social protections may be limited. We use new data from a cohort of adults ages 40 and older in rural South Africa to explore how receipt of emotional support differs by gender and marital status. Our findings suggest that women are more likely to get emotional support than men and have more sources of support. Moreover, women are more likely to get emotional support from relatives, whereas men are more likely to get support from friends. In regard to marital status, married people are more likely to get emotional support and have more sources of support than people who are not married. However, separated/divorced and widowed people are more likely to get emotional support from relatives and have more sources of non-spousal support than married people. These findings point toward gaps in informal systems of support, and the particular importance of considering men and unmarried (especially never married) people when designing policies to offer social protections to older populations.

Association of traumatic brain injury with dementia and memory decline in older adults in the United States

INTRODUCTION

To examine associations of history of traumatic brain injuries (TBIs) with loss of consciousness (LOC) with dementia incidence and memory decline.

METHODS

We studied 2718 participants from the 1992 enrollment cohort of the Health and Retirement Study (HRS) aged 65 years or older in 2000. History of TBI with LOC was self-reported in 1992. Dementia was assessed using four algorithms established in HRS. Participants were followed from 2000 to 2014 with repeated measures of dementia and memory performance. Cox models and linear mixed-effects models were used.

RESULTS

In 1992, 11.9% of the participants reported a history of TBI with LOC. In fully adjusted models for all four algorithms, participants with a history of TBI with LOC had no statistically significant difference in dementia incidence nor in memory decline, compared to participants without TBI history.

DISCUSSION

Our study did not find evidence of a long-term association between history of TBI with LOC (of unknown frequency and severity) and dementia incidence or memory decline.

Handgrip Strength Asymmetry and Weakness Together Are Associated With Functional Disability in Aging Americans

Background

Evaluating handgrip strength (HGS) asymmetry may help to improve the prognostic value of HGS. This study sought to determine the associations of HGS asymmetry and weakness on future activities of daily living (ADL) disability in a national sample of aging Americans.

Methods

The analytic sample included 18,468 Americans aged ≥50 years from the 2006–2016 waves of the Health and Retirement Study. A handgrip dynamometer measured HGS. Those with HGS >10% stronger on either hand were considered as having any HGS asymmetry. Individuals with HGS >10% stronger on their dominant hand were considered as having dominant HGS asymmetry, while those with HGS >10% stronger on their nondominant hand were classified as having nondominant HGS asymmetry. Men with HGS <26 kg and women with HGS <16 kg were considered weak. ADLs were self-reported. Generalized estimating equations were used for analyses.

Results

Relative to those with symmetric HGS and no weakness, each HGS asymmetry and weakness group had increased odds for future ADL disability: 1.11 (95% confidence interval [CI]: 1.02–1.20) for any HGS asymmetry alone, 1.42 (CI: 1.16–1.74) for weakness alone, and 1.81 (CI: 1.52–2.16) for both any HGS asymmetry and weakness. Most weakness and HGS asymmetry dominance groups had increased odds for future ADL disability: 1.30 (CI: 1.13–1.50) for nondominant HGS asymmetry alone, 1.42 (CI: 1.16–1.74) for weakness alone, 1.72 (CI: 1.29–2.29) for both weakness and nondominant HGS asymmetry, and 1.86 (CI: 1.52–2.28) for both weakness and dominant HGS asymmetry.

Conclusions

HGS asymmetry and weakness together may increase the predictive utility of handgrip dynamometers.

Sexual Expression and Cognitive Function: Gender-Divergent Associations in Older Adults

Prior research demonstrates a positive association between sexual activity and cognitive function in later life. However, the relationship between the type of sexual activity and cognitive function in older adulthood remains unclear. This study explored the associations between the frequency of engaging in different types of sexual activities (intercourse, masturbation, and kissing/petting/fondling) and cognitive function in older women and men. Using data from Wave 6 of the English Longitudinal Study of Aging (ELSA), 1915 women and 2195 men (age range 50-89 years; n = 4110) reporting any type of sexual activity over the past 12 months were included in the study. Multiple regression controlling for age, education, satisfaction with sex life, cohabiting, wealth, general health, physical activity, depression, and loneliness was used to explore the associations between the frequency of engagement in intercourse, masturbation, and kissing/petting/fondling, and two measures of cognitive function: word recall and number sequencing. For women, masturbation was linked to better word recall (p = .008), while for men, kissing/petting/fondling was associated with better number sequencing (p = .035). In women (p = .016) and men (p = .018), dissatisfaction with sex life was associated with better number sequencing. The results point to gendered links between sexual activity and cognitive function. These gender-related divergences may reflect differences in biological/neurological mechanisms, or in cognitive lifestyle factors that could influence cognitive reserve in later life. This novel study underscores the need to delineate the underlying mechanisms of the association between sex and cognition in men and women.

Examining Heterogeneity of Outcomes in a Weight Gain Prevention Program for Young Adults

OBJECTIVE

This study aimed to characterize young adults who experienced significant weight gains (> 10%) over 3 years in a weight gain prevention program.

METHODS

Secondary data analysis from the Study of Novel Approaches to Weight Gain Prevention (SNAP), a randomized trial comparing two self-regulation interventions and a control arm in young adults (18-35 years; BMI 21-30.9 kg/m² ), was used. Large Gainers (≥ 10% of their body weight; n = 48), Small Gainers (2.6%-9.9%; n = 149), and Weight Stable participants (± 2.5%; n = 143) were compared on dimensions affecting weight gain.

RESULTS

Differences in weight gain among the three groups were significant by year 1 and subsequently increased. Those who became Large Gainers were heavier at baseline and further below their highest weight, and they reported more weight cycling than Weight Stable, with Small Gainers intermediate. Neither study arm nor pregnancy explained weight change differences among the three groups. Large Gainers reported more depressive symptoms than Weight Stable at years 1 and 2. Large Gainers were less likely to weigh themselves at least weekly at 4 months, before differences in weight gain emerged, and at years 1 and 2.

CONCLUSIONS

Large Gainers (representing almost 10% of participants) could be identified early by greater weight issues at baseline and lower use of weight gain prevention strategies.

An evaluation study of caregiver perceptions of the Ontario's Health Links program

Introduction

In 2012, the Ontario government launched Health Links (HL), which was designed to integrate care for patients with multimorbidity and complex needs who are high users of health services. This study evaluated perceptions of family and friend caregivers of patients enrolled in the HL program. Research questions included: What are (a) characteristics of caregivers of patients enrolled in HL (b) caregivers’ perceptions of the program in relation to HL’s guiding principles (patient and family-centred care, accessibility, coordination of services, and continuity of care and care provider) and (c) caregivers’ perceptions of the impact of HL on themselves and their care recipient?

Methods

This study involved a survey and qualitative, semi-structured interviews. HL guiding principles (patient and family-centered care, accessibility, coordination of services, and continuity) guided the analysis.

Results

Twenty-seven surveys and 16 qualitative interviews were completed. Caregivers reported high levels of strain [Modified Caregiver Strain Index (MCSI) 15.5 (SD 7.03)], mild anxiety [Generalized Anxiety Disorder (GAD 7), 9.6 (SD 6.64)] and depression [Center for Epidemiological Studies Depression Scale (CES-D 10), 11.9 (SD 8.72)]. Regarding the guiding principles, most caregivers had a copy of the HL patient’s care plan, although some caregivers noted that their needs were not included in the plan, nor were they asked for input. Caregivers found the program’s home and phone visits accessible. Despite minimum wait times for community-based services, other access barriers persisted, (i.e., out-of-pocket costs). HL provided well-coordinated patient services, although some perceived that there was poor team communication. Caregiver perceptions varied on the quality of care provided. Provider continuity provided caregiver relief and patient support: A lack of continuity was related to changes in care coordinators and weekend staff and attrition.

Conclusions

Caregivers of HL patients appreciated patient- and family-centred, accessible, consistent, coordinated and team-based approaches in care. Providers and decision-makers are urged to ensure that programs aimed at high system users address these core concepts while addressing caregivers’ needs.

Prolonged grief disorder in Chinese Shidu parents who have lost their only child

Background: China has the largest population of '"loss-of-only-child' parents, that are also known as Shidu parents in Chinese society; however, little is known about their unresolved grief. Objective: This is the first study to examine the grief symptoms, prevalence, comorbidity and potential predictors of prolonged grief disorder (PGD) in such parents, taking into consideration that the new PGD diagnostic criteria ICD-11 will soon be implemented in China. Methods: 149 Shidu parents completed assessments of PGD (PG-13), PTSD (PCL-C), depression (CES-D) and general psychiatric morbidity (GHQ-12) via in-person interviews. Results: Of the 149 Shidu parents, 22.2% met the PGD criteria, with a mean of 7.59 years post-loss, and 62.4% experienced daily longing or yearning. Regression analysis indicated that fewer years since loss, subjective perception of poor economic situation, female gender and more hospital visits were prominent risk factors for the development of PGD. Older age of the parents at the time of child loss was also associated with PGD. Parents with PGD had higher comorbidity of PTSD or depression compared with those without PGD. Conclusions: There is a high prevalence of PGD and a high rate of comorbidity between PGD and PTSD or depression in Shidu parents in China, which highlights the need of timely developing effective assessments and interventions to prevent PGD in this population, particularly in female, recently bereaved, low-income and aged parents who lost their only child.

Smoking Status and Survival Among a National Cohort of Lung and Colorectal Cancer Patients

INTRODUCTION

The purpose of this study was to explore the association of smoking status and clinically relevant duration of smoking cessation with long-term survival after lung cancer (LC) or colorectal cancer (CRC) diagnosis. We compared survival of patients with LC and CRC who were never-smokers, long-term, medium-term, and short-term quitters, and current smokers around diagnosis.

METHODS

We studied 5575 patients in Cancer Care Outcomes Research and Surveillance (CanCORS), a national, prospective observational cohort study, who provided smoking status information approximately 5 months after LC or CRC diagnosis. Smoking status was categorized as: never-smoker, quit >5 years prior to diagnosis, quit between 1-5 years prior to diagnosis, quit less than 1 year before diagnosis, and current smoker. We examined the relationship between smoking status around diagnosis with mortality using Cox regression models.

RESULTS

Among participants with LC, never-smokers had lower mortality risk compared with current smokers (HR 0.71, 95% CI 0.57 to 0.89). Among participants with CRC, never-smokers had a lower mortality risk as compared to current smokers (HR 0.79, 95% CI 0.64 to 0.99).

CONCLUSIONS

Among both LC and CRC patients, current smokers at diagnosis have higher mortality than never-smokers. This effect should be further studied in the context of tumor biology. However, smoking cessation around the time of diagnosis did not affect survival in this sample.

IMPLICATIONS

The results from our analysis of patients in the CanCORS consortium, a large, geographically diverse cohort, show that both LC and CRC patients who were actively smoking at diagnosis have worse survival as compared to never-smokers. While current smoking is detrimental to survival, cessation upon diagnosis may not mitigate this risk.

Food stamps, food insecurity, and health outcomes among elderly Americans

This study examined associations between very low food security and health outcomes in older adults, and tested whether participation in the Supplemental Nutrition Assistance Program (SNAP) mitigates adverse health consequences associated with very low food security. Data were drawn from the 1998-2014 waves of the Health and Retirement Study (N = 148,138 from 27,281 persons). A longitudinal analysis of the relationship between very low food security and health condition depending on SNAP participation was conducted using the individual fixed effects regression. Respondents' health status was assessed by self-rated health, grip strength, and depressive symptoms. The correlations between very low food security and physical health outcomes were negatively significant prior to SNAP enrollment (p < 0.05) but became insignificant upon participation, indicating that SNAP may have prevented poor physical health resulting from very low food security. However, results concerning mental health showed that SNAP enrollment does not modify the association between very low food security and depression; very low food security remained a significant risk factor of depressive symptoms conditional on SNAP enrollment (p < 0.001). Further analyses showed that SNAP participation is correlated with negative self-attitudes (p < 0.05), and that the correlation between SNAP and depression becomes insignificant after controlling for self-attitudes. These results suggest that a stigma effect arising from welfare use may have reduced self-esteem and resulted in depressive moods. Future research needs to delve into whether reforms to the food assistance program aimed at reducing stigma can help alleviate emotional distress among welfare recipients.

Stability of clinically relevant depression symptoms in old-age across 11 cohorts: a multi-state study

AIMS

To study the temporal dynamics of depression symptom episodes in old-age and the related influence of risk factors.

METHODS

Data from 41 362 old adults (54.61% women; mean age = 75.30, SD = 6.20) from the Ageing Trajectories of Health - Longitudinal Opportunities and Synergies (ATHLOS) project were used. Depressive symptoms were followed over an 18-year period. A multi-state model, comprising three statuses (no depression, new clinically relevant episode of symptoms and episode persistence), was fitted. Multinomial regression was used to study the role of risk factors in status transition.

RESULTS

Almost 85% of participants showed no depression, but prevalence became lower over time (B = -0.25, P < 0.001). New episode point prevalence was over 5.30% with a significant probability of moving to persistence status (transition probability = 0.27). Episode persistence became evident in 9.86% of episode status transitions, with increasing rate over time (B = 0.54, P < 0.01). Loneliness was proven to be the strongest predictor of episode emergence (OR = 17.76) and persistence (OR = 5.93).

CONCLUSIONS

The course of depression tends to become chronic and unremitting in old-age. This study may help to plan interventions to tackle symptom escalation and risk factor influence.

Inflammatory and metabolic disturbances are associated with more severe trajectories of late-life depression

Late-life depression is a highly prevalent mental health condition with devastating consequences even from its earliest stages. Alterations in physiological functions, such as inflammatory and metabolic, have been described in patients with depression. However, little is known on the association between depression symptom course and metabolic and inflammation dysregulation. This study aimed to depict the course of depression symptoms while ageing, taking into consideration inter-individual heterogeneity. Moreover, it intended to study the associations between inflammatory and metabolic risk profiles and symptom trajectories. To do so, data from 13,203 adults aged 50-90 years (52.75% women; mean age at baseline = 65.07, SD = 10.00) were used. Blood sample and blood pressure measures were taken from 1536 participants (56.58% women; mean age at baseline = 61.73 years, sd = 7.64). Depression symptoms were assessed every two years across a 10-year follow-up. Trajectories were identified by means of latent class mixed modelling. Inflammation and metabolic risk profile scores were obtained from plasma and diagnostic-based indicators in the follow-up, using a robust latent-factor approach. Multigroup modelling was used to study the associations between the profiles and symptom trajectories. As a result, three heterogeneous trajectories of symptoms were identified (low-symptom, moderate-symptom and high-symptom trajectory). Participants depicting a high-symptom trajectory showed the greatest inflammation profile score and high metabolic risk. Moderate-symptom trajectory was also related to high inflammation and metabolic risk. To sum up, at-risk trajectories of symptoms were associated with high inflammation and risk of metabolic diseases. This study provides valuable evidence to advance personalised medicine and mental health precision, considering person-specific profiles and physiological concomitants.

Gender influence on loneliness and family and nonfamily support among older adults: The confounding role of widowhood

Based on interviews with 465 community elders in Ekiti-State, Nigeria, this study addressed the questions: (a) Do older men and women differ in self-reported loneliness, family and nonfamily support?; and (b) If so, is this relationship maintained when controlling for widowhood, age, social-engagements, extroversion, and neuroticism? Three independent models were tested using one-way MANOVA and MANCOVA. Compared to males, females reported more loneliness and less family support. However, these outcomes became nonexistent after excluding widowhood. Gender maintained significance after excluding other covariates. The study buttresses the primary importance of widowhood in the gender differences found in later-life loneliness and family supports.

Inequalities in elevated depressive symptoms in middle-aged and older adults by rural childhood residence: The important role of education

OBJECTIVES

To quantify inequalities in the prevalence of elevated depressive symptoms by rural childhood residence and the extent to which childhood socioeconomic conditions and educational attainment contribute to this disparity.

METHODS

We identified the prevalence of depressive symptoms among US-born adults ages 50 years and older in the 1998 to 2014 waves of the Health and Retirement Study (n = 16 022). We compared prevalence of elevated depressive symptoms (>4/8 symptoms) by rural versus nonrural childhood residence (self-report) and the extent to which own education mediated this disparity. We used generalized estimating equations and marginal standardization to calculate predicted probabilities of elevated depressive symptoms.

RESULTS

In age, race/ethnicity, and sex-adjusted models, rural childhood residence was associated with elevated depressive symptoms (OR = 1.20; 95% CI, 1.12-1.29; marginal predicted probability 10.5% for rural and 8.9% for nonrural childhood residence). Adjusting for US Census birth region and parental education attenuated this association (OR = 1.07; 95% CI, 0.99-1.15; marginal predicted probability 9.9% for rural and 9.3% for nonrural). After additional adjustment for own education, rural childhood residence was not associated with elevated depressive symptoms (OR = 0.94; 95% CI, 0.87-1.01; marginal predicted probability 9.2% for rural and 9.8% for nonrural).

CONCLUSIONS

Rural childhood residence was associated with elevated depressive symptoms in middle-aged and older adults; birth region, parental education, and own education appear to contribute to this disparity.

Social engagement and loneliness are differentially associated with neuro-immune markers in older age: Time-varying associations from the English Longitudinal Study of Ageing

OBJECTIVES

This study aimed to explore time-varying associations between social engagement, living status and loneliness and neuro-immune markers in older adults, and ascertain whether results are explained by socioeconomic position, health behaviours or depression.

METHODS

We analysed blood samples from 8780 adults aged 50 and above from the English Longitudinal Study of Ageing across three waves of data collection: 2004/5, 2008/9 and 2012/2013. We used fixed effects modelling to estimate the relationship between loneliness, social isolation, living alone and levels of fibrinogen, insulin like growth factor-1 (IGF-1), white blood cell (WBC) count and C-reactive protein (CRP), whilst accounting for all time-invariant and identified time-varying confounders.

RESULTS

Higher levels of social engagement and living with somebody were associated with lower levels of CRP, fibrinogen and WBC, while lower levels of loneliness were associated with higher levels of IGF-1. These associations were found to be independent of time-invariant factors such as gender, medical history, previous patterns of social behaviours, unobserved aspects of social class, and genetics, and time-varying factors such as income, physical health, health behaviours, and depression.

CONCLUSIONS

Aspects of social engagement were associated with lower levels of inflammation whilst loneliness was inversely related to the regulation of inflammation. This suggests there could be different biological pathways involved in objective and subjective aspects of social connections.

Perceived neighborhood social disorder as a predictor of depressive symptoms among unmarried older women and the stress-buffering effect of friends support

The current study examined whether perceived neighborhood social disorder predicted depressive symptoms among unmarried older women (N = 823) drawn from the 2016 Health and Retirement Study. This study also tested the stress-buffering effect of friends support. A negative binomial regression model showed that higher perceived neighborhood social disorder was associated with higher depressive symptoms. The number of close friends was a significant factor, but no stress-buffering effect of friends support was identified. This study highlights the adverse effect of negative perceptions of the neighborhood social environment on unmarried older women's depressive symptoms.

Gender, Depressive Symptoms, Chronic Medical Conditions, and Time to First Psychiatric Diagnosis among American Older Adults

Background:

To test whether gender moderates the effects of baseline depressive symptoms and chronic medical conditions (CMCs) on risk of receiving subsequent psychiatric diagnosis among older adults.

Methods:

Data came from ten waves of the Health and Retirement Study, a nationally representative longitudinal study. We followed 9794 individuals older than 52 years without any diagnosed psychiatric disorder at baseline for up to 18 years. Baseline depressive symptoms and CMC were the predictors, time to receiving an emotional diagnosis was the outcome, baseline demographics and socioeconomics were controls, and gender was the moderator. We used Cox proportional hazards models for data analysis.

Results:

In the pooled sample, female gender increased the effect of baseline depressive symptoms (hazard ratio [HR], 1.58; 95% confidence interval [CI], 1.26–2.00) and reduced the effect of baseline CMC (HR, 0.78; 95% CI, 0.63–0.97) on time to receiving a psychiatric diagnosis. Among men, baseline depressive symptoms (HR, 2.36; 95% CI, 1.87–2.97) increased and baseline CMC (HR, 0.81; 95% CI, 0.69–0.95) decreased time to receiving a psychiatric diagnosis. Among women, depressive symptoms (HR, 1.49; 95% CI, 1.21–1.83) but not CMC (HR, 1.06; 95% CI, 0.91–1.23) were associated with time to receiving a psychiatric diagnosis over time.

Conclusions:

Men and women differ in how depressive symptoms and CMC influence their risk of receiving a psychiatric diagnosis over time. Depressive symptoms are more salient promotor for men than women while CMC is only a barrier for men.

Individualized prediction of depressive disorder in the elderly: A multitask deep learning approach

INTRODUCTION

Depressive disorder is one of the major public health problems among the elderly. An effective depression risk prediction model can provide insights on the disease progression and potentially inform timely targeted interventions. Therefore, research on predicting the onset of depressive disorder for elderly adults considering the sequential progression patterns is critically needed.

OBJECTIVE

This research aims to develop a state-of-the-art deep learning model for the individualized prediction of depressive disorder with a 22-year longitudinal survey data among elderly people in the United States.

METHODS

We obtain the 22-year longitudinal survey data from the University of Michigan Health and Retirement Study, which consists of information on 20,000 elderly people in the United States from 1992 to 2014. To capture temporal and high-order interactions among risk factors, the proposed deep learning model utilizes a recurrent neural network framework with a multitask structure. The C-statistic and the mean absolute error are used to evaluate the prediction accuracy of the proposed model and a set of baseline models.

RESULTS

The experiments with the 22-year longitudinal survey data indicate that (a) machine learning models can provide an accurate prediction of the onset of depressive disorder for elderly individuals; (b) the temporal patterns of risk factors are associated with the onset of depressive disorder; and (c) the proposed multitask deep learning model exhibits superior performance as compared with baseline models.

CONCLUSION

The results demonstrate the capability of deep learning-based prediction models in capturing temporal and high-order interactions among risk factors, which are usually ignored by traditional regression models. This research sheds light on the use of machine learning models to predict the onset of depressive disorder among elderly people. Practically, the proposed methods can be implemented as a decision support system to help clinicians make decisions and inform actionable intervention strategies for elderly people.

Associations Between Vitamin D Levels and Depressive Symptoms in Later Life: Evidence From the English Longitudinal Study of Ageing (ELSA)

Background

A possible role of vitamin D in depression has received considerable attention, especially given the significant disability, mortality, and healthcare costs associated to depression and the high prevalence of vitamin D deficiency.

Methods

We investigated the cross-sectional associations between serum 25-hydroxyvitamin D (25OHD) levels and depressive symptoms (CES-D) in 5,607 older adults from the English Longitudinal Study of Ageing (ELSA).

Results

Overall, there was a significant association between low 25OHD levels and elevated depressive symptoms (odds ratio [OR] = 1.58, 95% confidence interval [CI] = 1.20–2.07 for the lowest quartile; OR = 1.45, 95% CI = 1.15–1.83 for <30 nmol/L cut-off and OR = 1.34, 95% CI = 1.10–1.62 for the ≤50 nmol/L cut-off) after adjustment for a wide range of covariates of clinical significance. Fully adjusted models showed that women in the lowest (OR = 1.67, 95% CI = 1.20–2.34) and second lowest (OR = 1.68, 95% CI = 1.20–2.35) quartiles of 25OHD as well as those with 25OHD levels <30 nmol/L (OR = 1.40, 95% CI = 1.06–1.86) and ≤50 nmol/L (OR = 1.35, 95% CI = 1.07–1.72) were more likely to report elevated depressive symptoms. For men, however, this association only remained significant for those with 25OHD levels of <30 nmol/L (OR = 1.60, 95% CI = 1.06–2.42) in the fully adjusted models.

Conclusions

The independent and inverse association found between low 25OHD levels and elevated depressive symptoms suggests that vitamin D deficiency may be a risk factor for late-life depression, particularly among women. Whether our findings have any clinical meaning or not, additional data are needed from well-designed randomized controlled trials of vitamin D for the prevention and treatment of late-life depression.

Fertility trajectories and later-life depression among parents in England

We examine pathways between indicators of fertility tempo/quantum and depressive symptoms among parents aged 55+ with at least two children, using three waves of the English Longitudinal Study of Ageing. Using standard regression approaches and path analysis within the structural equation framework, we also investigate whether fertility trajectories mediated the association between childhood disadvantage and later-life depression. Results provide limited support for direct influences of fertility trajectories on depression, but indicate indirect linkages for both women and men. Associations are mediated by partnership history, social support, wealth, later-life smoking, and functional limitation. Associations between childhood disadvantage and later-life depression are partially mediated by fertility stressors. Results confirm the influence of life course experiences on depression at older ages and demonstrate the interlinked role of family and other life course pathways on later-life well-being.

Congruent relations between perceived neighbourhood social cohesion and depressive symptoms among older European adults: An East-West analysis

Rationale

Two gaps in the literature arise on the relationship between social cohesion and depressive disorders. Firstly, there is a lack of studies comparing countries with diverse communal bonds and population-level differences in depression. Secondly, most work on explanatory mechanisms has overwhelmingly focussed on social network and social support pathways.

Objectives

We compared the prospective association between perceived neighbourhood social cohesion and depressive symptoms among older adults in England, the Czech Republic, Poland and Russia; and examined whether psychological and health behavioural pathways mediated this association.

Methods

Harmonized data on 26,081 adults from the English Longitudinal Study of Ageing (ELSA), and the Health, Alcohol and Psychosocial factors In Eastern Europe (HAPIEE) studies were analysed. Prospective associations between perceived neighbourhood social cohesion at baseline and depressive symptoms at follow-up were assessed using multivariable negative binomial regression. The psychological (through control of life, and control at home) and health behavioural (through smoking and drinking) pathways were tested using path analysis.

Results

Low cohesion predicted a higher number of depressive symptoms at follow-up among English (b = 0.106, p = 0.001), Czech (b=0.203, p < 0.001), Polish (0.115, p < 0.001) and Russian adults (b = 0.087, p < 0.001). Indirect effects via psychological mechanisms were strong and explained 64% (Poland), 82% (Russia), 84% (England) and 95% (Czech Republic) of the total indirect effects from low cohesion to elevated symptoms in these populations. Indirect effects via health behaviours were much weaker by comparison.

Conclusions

Prospective associations between low social cohesion and increased depressive symptoms were largely congruent among older adults from England and three Central and Eastern European countries. These associations operated via a psychological, but not a health behavioural, pathway among ageing adults living in diverse parts of Europe.

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Social cohesion protects against depressive symptoms in older European adults.

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The association operates via psychological, but not health behavioural, mechanisms.

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Findings were highly consistent between English, Czech, Polish and Russian adults.

Cultural engagement and mental health: Does socio-economic status explain the association?

There is a growing body of literature suggesting that the arts can support mental health. However, both arts participation and cultural engagement are unevenly patterned across the population, with a strong social gradient. This social gradient is also evident in mental health. So it remains unclear whether the relationship between arts engagement and mental health can in fact be explained by socio-economic status (SES). This study explores this question specifically in relation to cultural engagement (e.g. visiting museums/galleries/cinema/theatre/concerts) using data from 8780 adults aged 50 + from the English Longitudinal Study of Ageing. We used a statistical triangulation approach, running three separate sets of analyses that each have different strengths and address different statistical limitations or biases. Using logistic regression, the relationship between cultural engagement and mental health was still present when including covariates relating to SES, and there was no evidence of moderation by SES either through the inclusion of interaction terms or stratification. Using propensity score matching, matching participants based on their SES, we also consistently found evidence of the relationship. Finally, using fixed-effects regression which takes account of all time-invariant factors (which include multiple aspects of SES) even if unobserved, we also found no attenuation of the relationship. Overall, this confirms previous reports that cultural engagement is linked with a lower odds of depression amongst adults aged 50 + by demonstrating a robust association in a nationally-representative sample of older adults. While SES does explain around half of the association between cultural engagement and depression, we found no evidence that it either acts as a moderator or the main explanatory factor, with independent associations maintained across all three approaches. However, the fact that higher SES is associated with more frequent engagement indicates that, in population terms, SES is still an important determinant of the salutogenic impact of culture.

Differential use of emotion regulation strategies when engaging in artistic creative activities amongst those with and without depression

The ability to effectively regulate our emotions has been shown to be impaired in people with depression. Arts activities have been found to improve depression, but whether people with depression make differential use of emotion regulation strategies (ERSs) when engaging in the arts remains unclear. This study analysed data from 11,248 individuals with depression who were matched on demographics, personality and arts experience with a further 11,248 individuals without depression. We found a significantly lower overall use of self-reported ERSs when engaging in arts amongst those with depression; specifically lower use of approach strategies (e.g. reappraisal) and self-development strategies (e.g. improved self-esteem), but the same use of avoidance strategies (e.g. distraction). However, these differences were very slight (very small effect size and <1% difference). This suggests that people with depression still experience benefits for emotion regulation, which could help to explain the beneficial effects of arts interventions reducing symptoms of depression.

Genes, Childhood Trauma, and Late Life Depressive Symptoms

Objectives: Findings on gene-environment correlations suggest childhood “environments” may reflect genetic liabilities. The independent psychosocial influence of childhood trauma is unclear. This study examined such effects on adulthood depressive symptoms. Methods: Data were from the Health and Retirement Study. Trauma items included childhood physical abuse and parental substance abuse. Multinomial logit models examined genetic effects on stable and unstable reports. Linear growth models tested associations of stable trauma responses, genes, and their interaction with current depressive symptoms. Results: Genetic risk predicted both stable and unstable trauma reports. With genes controlled, stable responses were associated with life course variations but not late life change in depression. The exception was women’s physical abuse, which moderated genetic effects but had no independent influence. Discussion: Apparent gene-trauma correlations may be driven by flawed retrospective reports. Research is needed to distinguish true from artifactual genetic effects on other environmental factors and establish psychosocial implications.

Life course socioeconomic position and incidence of mid-late life depression in China and England: a comparative analysis of CHARLS and ELSA

BACKGROUND

Despite the growing prevalence of depression in the Chinese elderly, there is conflicting evidence of life course socioeconomic position (SEP) and depression onset in China, and whether this association is akin to that observed in Western societies. We compared incident risk of mid-late life depression by childhood and adulthood SEP in China and England, a country where mental health inequality is firmly established.

METHODS

Depression-free participants from the China Health and Retirement Longitudinal Study (N=8508) and the English Longitudinal Study of Ageing (N=6184) were studied over 4 years. Depressive symptoms were classified as incident cases using the Center for Epidemiologic Studies Depression Scale criteria. Associations between SEP (education, wealth, residence ownership and childhood/adolescent deprivation) and depression symptom onset were assessed using Cox proportional hazards models. In China, we also investigated children's government employment status as a SEP marker.

RESULTS

Higher education and wealth predicted lower incidence of depression in both countries. The association with non-ownership of residence appeared stronger in England (HR 1.61, 95% CI 1.41 to 1.86) than in China (HR 1.11, 95% CI 0.95 to 1.29), while that with childhood/adolescent deprivation was stronger in China (HR 1.43, 95% CI 1.29 - 1.60) than in England (HR 1.33, 95% CI 0.92 to 1.92). Chinese adults whose children were employed in high-status government jobs, had lower rates of depression onset.

CONCLUSIONS

Consistent findings from China and England demonstrate that SEP is a pervasive determinant of mid-late life depression in very diverse social contexts. Together with conventional measures of SEP, the SEP of children also affects the mental health of older Chinese.

Perceived Weight Discrimination Mediates the Prospective Association Between Obesity and Physiological Dysregulation: Evidence From a Population-Based Cohort

Obesity is thought to cause ill health because of the biological strain that excess fat has on physiological function. We tested an alternative explanation in a population-based sample of 3,609 older English adults-that the pervasive discrimination experienced by individuals with excess weight may in part explain why obesity is associated with subsequent multisystem physiological dysregulation, measured via clinical indicators of cardiovascular, metabolic, and immune function. We found that both obesity and perceived weight discrimination predicted an increase in physiological dysregulation from baseline to follow-up 4 years later. Perceived discrimination because of body weight experienced by individuals with obesity explained more than one quarter of the prospective association between obesity and a deterioration in biomarkers of health status. These findings highlight the possibility that the stigma experienced by individuals with obesity may play an important role in explaining the obesity-related disease burden.

Depressive Symptoms Following Later-life Marital Dissolution and Subsequent Repartnering

The doubling of the divorce rate among individuals over age 50 during the past 20 years underscores the urgency of studying the consequences of gray divorce and subsequent repartnering for adult well-being. We filled this gap by using the 1998-to-2014 Health and Retirement Study to evaluate how the levels of depressive symptoms changed following gray divorce versus widowhood. Individuals who divorced or became widowed already had experienced higher levels of depressive symptoms before dissolution relative to those who remained married. Compared with those who became widowed, those who transitioned to divorce experienced a lower elevation and a shorter time to recovery in depressive symptoms. When repartnering, both groups experienced similar magnitudes of initial reduction and subsequent rates of increase. Both the negative consequences of marital dissolution and the beneficial effects of repartnership for mental health persisted for several years, although ultimately they reverted to their predissolution levels of depressive symptoms.

The Spectrum of Bladder Health: The Relationship Between Lower Urinary Tract Symptoms and Interference with Activities

Background: Little research to date has focused on lower urinary tract symptom (LUTS) prevention and bladder health promotion in women. To address this gap, the Prevention of LUTS Research Consortium developed the following working bladder health definition: "A complete state of physical, mental, and social well-being related to bladder function [that] permits daily activities [and] allows optimal well-being." To begin to inform and quantify this definition, we used data from the Boston Area Community Health Survey, drawing upon its rare collection of information on LUTS and LUTS-specific interference with activities. Methods: At baseline, participants reported their frequency of 15 LUTS and interference with 7 activities. Prevalence ratios (PRs) were calculated by generalized linear models with robust variance estimation, adjusting for LUTS risk factors and individual LUTS. Results: Of the 3169 eligible participants, 17.5% reported no LUTS or interference, whereas the remaining 82.5% reported some frequency of LUTS/interference: 15.1% rarely; 21.7% a few times; 22.6% fairly often/usually; and 22.9% almost always. LUTS independently associated with interference were urgency incontinence, any incontinence, urgency, nocturia, perceived frequency, and urinating again after <2 hours (PRs = 1.2-1.5, all p < 0.05). Conclusions: Our findings suggest that bladder health exists on a continuum, with approximately one in five women considered to have optimal bladder health (no LUTS/interference), the majority to have intermediate health (LUTS/interference rarely to usually), and a further one in five to have worse or poor health (LUTS/interference almost always). These findings underscore the need for LUTS prevention and bladder health promotion.

Longitudinal investigation of the reciprocal relationship between depressive symptoms and glycemic control: The moderation effects of sex and perceived support

AIMS/INTRODUCTION

The present study investigated the longitudinal associations between depressive symptoms and glycemic control in nationally representative adults with type 2 diabetes, and tested the effects of sex and perceived family support in moderating this association.

MATERIALS AND METHODS

In this longitudinal study of middle-aged and older adults who participated in the 2002 and 2006 Health and Retirement Study, and the 2003 and 2006 Diabetes Study (n = 398), we applied a cross-lagged structural equation model to examine the reciprocal relationship between depressive symptoms and glycemic control over a 3-year period.

RESULTS

Men and women were not different in terms of the depressive symptoms and glycemic control relationship, with a stronger association noted for higher depressive symptom scores predicting worse glycemic control (β = 0.22, critical ratio 3.03), as opposed to worse glycemic control predicting higher depressive symptom scores. Family and friend support for diabetes self-management serves as an important buffer. In patients with low family and friend support, more depressive symptoms at baseline were associated with subsequent worse glycemic levels (β = 0.36, critical ratio 4.03). In contrast, in individuals who had strong support, depressive symptoms did not predict subsequent glycemic control.

CONCLUSIONS

The present study provided evidence for the relationship between glycemic control and depression, finding that depressive symptoms predicted poorly controlled glycemic status, especially when the participants perceived inadequate support from their family or friends. A quick survey in clinics to assess the level of family or friend support for diabetes management and depressive symptoms might be an important part of individualized diabetic care.

Changes in depressive symptoms over age among older Americans: Differences by gender, race/ethnicity, education, and birth cohort

Despite concerns about recent trends in the health and functioning of older Americans, little is known about dynamics of depression among recent cohorts of U.S. older adults and how these dynamics differ across sociodemographic groups. This study examined sociodemographic differences in mid- and late-life depressive symptoms over age, as well as changes over time. Using nationally representative data from the Health and Retirement Study (1994–2014), we estimated mixed effects models to generate depressive symptoms over age by gender, race/ethnicity, education, and birth cohort in 33,280 adults ages 51–90 years. Depressive symptoms were measured using the 8-item Center for Epidemiological Studies Depression scale. Women compared to men, low compared to high education groups, and racial/ethnic minorities compared to whites exhibited higher depressive symptoms. The largest disparity resulted from education, with those without high school degrees exhibiting over two more predicted depressive symptoms in midlife compared to those with college degrees. Importantly, war babies and baby boomers (born 1942–1959) exhibited slightly higher depressive symptoms with more decreasing symptoms over age than their predecessors (born 1931–1941) at ages 51–65. We additionally observed an age-as-leveler pattern by gender, whereby females compared to males had higher depressive symptomology from ages 51–85, but not at ages 86–90. Our findings have implication for gauging the aging population's overall well-being, for public health policies aimed at reducing health disparities, and for anticipating demand on an array of health and social services.

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Depressive symptoms in mid- and late-life are higher among socially disadvantaged groups.

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Education levels generated the largest sociodemographic disparity, especially in mid-life.

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Recent birth cohorts had higher symptoms with more declining curves than predecessors ages 51-65.

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Trajectories of depressive symptoms in sociodemographic subgroups converged at higher ages.

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Depressed mood and somatic complaints both rose in late life but men reported lower depressed mood.

Cultural engagement and incident depression in older adults: evidence from the English Longitudinal Study of Ageing

BACKGROUND

There is a recognised need for the identification of factors that might be protective against the development of depression in older adults. Over the past decade, there has been growing research demonstrating the effects of cultural engagement (which combines a number of protective factors including social interaction, cognitive stimulation and gentle physical activity) on the treatment of depression, but as yet not on its prevention.AimsTo explore whether cultural engagement in older adults is associated with a reduced risk of developing depression over the following decade.

METHOD

Working with data from 2148 adults in the English Longitudinal Study of Ageing who were free from depression at baseline, we used logistic regression models to explore associations between frequency of cultural engagement (including going to museums, theatre and cinema) and the risk of developing depression over the following 10 years using a combined index of the Centre for Epidemiological Studies Depression Scale (CES-D) and physician-diagnosed depression.

RESULTS

There was a dose-response relationship between frequency of cultural engagement and the risk of developing depression independent of sociodemographic, health-related and social confounders. This equated to a 32% lower risk of developing depression for people who attended every few months (odds ratio (OR) = 0.68, 95% CI 0.47-0.99, P = 0.046) and a 48% lower risk for people who attended once a month or more (OR = 0.52, 95% CI 0.34-0.80, P = 0.003). Results were robust to sensitivity analyses exploring reverse causality, subclinical depressive symptoms and alternative CES-D thresholds.

CONCLUSIONS

Cultural engagement appears to be an independent risk-reducing factor for the development of depression in older age.Declaration of interestNone.

Time Perspective and All-Cause Mortality: Evidence From the English Longitudinal Study of Ageing

BACKGROUND

Long-term future thinking has been associated with a range of favorable health behaviors. However, it is currently unclear whether this translates into an effect on morbidity and mortality.

PURPOSE

The goal of this study was to study the relationship between time perspective and all-cause mortality and to examine the role of health behavior in explaining this association.

METHODS

Participants (N = 9,949) aged 50 and over from the English Longitudinal Study of Ageing, a representative cohort of older English adults, estimated the length of their time horizon for financial planning (time perspective). Two thousand ninety-two deaths were recorded over a 9-year follow-up period (2002/2003-2012). Smoking, physical activity, and alcohol consumption were examined as factors that may underlie the time perspective-mortality link.

RESULTS

Our prospective survival analyses showed that those who tend to plan for longer periods experienced a significantly reduced risk of all-cause mortality (HR = 0.83; 95% confidence interval [CI]: [0.80, 0.87], p < .001 per 1 SD increase in future time perspective). This association remained after adjusting for baseline socioeconomic status and health (HR = 0.92; 95% CI: [0.88, 0.97], p < .001). The link between time perspective and mortality was observed across the gradient of financial circumstances and did not appear to be due to reverse causality. Healthy behavior among the more future orientated explained 34% of the link between time perspective and mortality.

CONCLUSIONS

Using a simply administered indicator of time perspective, this study suggests that a future-orientated time perspective may be an important predictor of reduced risk of death.

Cognitive function and oral health among ageing adults

OBJECTIVES

There is inconclusive evidence that cognitive function is associated with oral health in older adults. This study investigated the association between cognitive function and oral health among older adults in England.

METHODS

This longitudinal cohort study included 4416 dentate participants aged 50 years or older in the English Longitudinal Study of Ageing during 2002-2014. Cognitive function was assessed at baseline in 2002/2003 using a battery of cognitive function tests. The self-reported number of teeth remaining and self-rated general oral health status was reported in 2014/2015. Ordinal logistic regression was applied to model the association between cognitive function at baseline and tooth loss or self-rated oral health.

RESULTS

Cognitive function at baseline was negatively associated with the risk of tooth loss (per each 1 standard deviation lower in cognitive function score, OR: 1.13, 95% CI: 1.05-1.21). When cognitive function score was categorized into quintiles, there was a clear gradient association between cognitive function and tooth loss (P-trend = 0.003); people in the lowest quintile of cognitive function had higher risk of tooth loss than those in the highest quintile (OR: 1.39, 95% CI: 1.12-1.74). A similar magnitude and direction of association were evident between cognitive function and self-rated oral health.

CONCLUSION

This longitudinal study in an English ageing population has demonstrated that poor cognitive function at early stage was associated with poorer oral health and higher risk of tooth loss in later life. The gradient relationship suggests that an improvement in cognitive function could potentially improve oral health and reduce the risk of tooth loss in the ageing population.

Long-term trajectories of depressive symptoms in old age: Relationships with sociodemographic and health-related factors

BACKGROUND

This study aimed at depicting the course of depression symptoms over the old age, with a special interest in a) uncovering its relationships with sociodemographic and health-related factors; b) analysing its predictive role on healthy-ageing outcomes later in life.

METHODS

The sample comprised 8317 older adults (46.02% men) from the English Longitudinal Study of Ageing. Robust structural equation modelling was used to identify symptom trajectories and their relationships with time-varying factors. Trajectory class and covariates were used to predict outcomes (quality of life, satisfaction with life, and daily living functioning) in a 2-year follow-up.

RESULTS

Three trajectory classes (so-called, normative, subclinical, chronic symptom trajectories) were identified for both sexes. Rising hearing difficulties and history of psychiatric problems were consistently associated with the chronic symptom trajectory. Lower education level, history of psychiatric problems, and increasing visual difficulties were connected with the subclinical trajectories. Finally, participants with either a subclinical or a chronic symptom trajectory showed worse outcomes than the remaining participants in the follow-up.

CONCLUSION

This study highlighted the presence of varying courses of depression symptoms (each showing some distinctive features from other another) over the old age, pointing to some relevant implications for clinical assessment and treatment prescription.

Using Skype to Beat the Blues: Longitudinal Data from a National Representative Sample

OBJECTIVES

This study aimed to determine whether use of certain types of online communication technology is associated with subsequent depressive symptoms.

DESIGN

Nationally representative, population-based prospective cohort.

SETTING

Data were obtained from the 2012 and 2014 waves of the Health and Retirement Study (HRS).

PARTICIPANTS

1,424 community-residing older adults (mean age, 64.8) in the United States.

MEASUREMENTS

We examined associations between use of four communication technologies (email, social networks, video chat, and instant messaging) in 2012 and depressive symptoms (eight-item Center for Epidemiologic Studies Depression scale) at two-year follow-up.

RESULTS

564 participants (39.6%) did not use any communication technologies, 314 (22.1%) used email only, and 255 (17.9%) used video chat (e.g., Skype). Compared to non-users (13.1%, 95% CI: 9.5-16.7%) or those who used only email (14.3%, 95% CI: 10.1-18.5%), users of video chat had approximately half the probability of depressive symptoms (6.9%, 95% CI: 3.5-10.3%, Wald Chi² test, Chi²₍₁₎=13.82, p < 0.001; 7.6%, 95% CI: 3.6-11.6, Wald Chi² test, Chi²₍₁₎=13.56, p < 0.001). Use of email, social media, and instant messaging were not associated with a lower risk of depression.

CONCLUSIONS

Older adults who use video chat such as Skype, but not other common communication technologies, have a lower risk of developing depression.

Handgrip Strength Is Associated with Poorer Cognitive Functioning in Aging Americans

BACKGROUND

Measures of handgrip strength may show promise for detecting cognitive erosion during aging.

OBJECTIVE

To determine the associations between lower handgrip strength and poorer cognitive functioning for aging Americans.

METHODS

There were 13,828 participants aged at least 50 years from the 2006 wave of the Health and Retirement Study included and followed biennially for 8 years. Handgrip strength was assessed with a hand-held dynamometer and cognitive functioning was assessed with a modified version of the Mini-Mental State Examination. Participants aged <65 years with scores 7- 11 had a mild cognitive impairment, ≤6 had a severe cognitive impairment, and ≤11 had any cognitive impairment. Respondents aged ≥65 years with scores 8- 10 had a mild cognitive impairment, ≤7 had a severe cognitive impairment, and ≤10 had any cognitive impairment. Separate covariate-adjusted multilevel logistic models examined the associations between lower handgrip strength and any or severe cognitive impairment. A multilevel ordered logit model analyzed the association between lower handgrip strength and poorer cognitive functioning.

RESULTS

Every 5-kg lower handgrip strength was associated with 1.10 (95% confidence interval (CI): 1.04, 1.15) and 1.18 (CI: 1.04, 1.32) greater odds for any and severe cognitive impairment, respectively. Similarly, every 5-kg lower handgrip strength was associated with 1.10 (CI: 1.05, 1.14) greater odds for poorer cognitive functioning.

CONCLUSIONS

Measurement of handgrip strength is a simple, risk-stratifying method for helping healthcare providers determine poorer cognitive functioning. Interventions aiming to prevent or delay cognitive dysfunction should also implement measures of handgrip strength as an assessment tool for determining efficacy.

The effect of the Winter Fuel Payment on household temperature and health: a regression discontinuity design study

Background

The Winter Fuel Payment (WFP) is a non-NHS population-level policy intervention that aims to reduce cold exposure and enhance the health and well-being of older adults. Labelling this cash transfer as ‘winter fuel’ has been shown to lead to increased household energy expenditure, but it is not known if this expenditure produces warmer homes or health benefits.

Objectives

First, the association between indoor temperature and health was established to identify the outcome measures most likely to be affected by the WFP. Then, whether or not receiving the WFP is associated with raised household temperature levels and/or improved health was assessed.

Design

Random and fixed effects regression models were used to estimate the link between ambient indoor temperature and health. A regression discontinuity (RD) design analysis exploiting the sharp eligibility criteria for the WFP was employed to estimate the potential impact of the payment.

Setting

The sample was drawn from the English Longitudinal Study of Ageing (ELSA), an observational study of community-dwelling individuals aged ≥ 50 years in England.

Participants

Analyses examining the association between household temperature and health had a maximum sample of 12,210 adults aged 50–90 years. The RD analyses drew on a maximum of 5902 observations.

Intervention

The WFP provides households with a member who is aged > 60 years (up to 2010, from which point the minimum age increased) in the qualifying week with a lump sum annual payment, typically in November or December.

Main outcome measures

Differences in indoor temperature were examined, and, following an extensive literature review of relevant participant-reported health indicators and objectively recorded biomarkers likely to be affected by indoor temperature, a series of key measures were selected: blood pressure, inflammation, lung function, the presence of chest infections, subjective health and depressive symptom ratings.

Data sources

The first six waves of the ELSA were drawn from, accessible through the UK Data Service (SN:5050 English Longitudinal Study of Ageing: Waves 0–7, 1998–2015).

Results

Results from both random and fixed-effects multilevel regression models showed that low levels of indoor temperature were associated with raised systolic and diastolic blood pressure levels and raised fibrinogen levels. However, across the RD models, no evidence was found that the WFP was consistently associated with differences in either household temperature or the health of qualifying (vs. non-qualifying) households.

Limitations

The presence of small effects cannot be ruled out, not detectable because of the sample size in the current study.

Conclusions

This study capitalised on the sharp assignment rules regarding WFP eligibility to estimate the potential effect of the WFP on household temperature and health in a national sample of English adults. The RD design employed did not identify evidence linking the WFP to warmer homes or potential health and well-being effects.

Future work

Further research should utilise larger samples of participants close to the WFP eligibility cut-off point examined during particularly cold weather in order to identify whether or not the WFP is linked to health benefits not detected in the current study, which may have implications for population health and the evaluation of the effectiveness of the WFP.

Funding

The National Institute for Health Research Public Health Research programme.

Eating pathology and psychological outcomes in young adults in self-regulation interventions using daily self-weighing

OBJECTIVE

Self-regulation interventions encouraging daily weighing prevent weight gain in young adults; however, concerns have been raised that such interventions may have undesirable effects on eating pathology, depression, and health-related quality of life (HRQL). The present study examined whether self-regulation interventions and self-weighing frequency were associated with these indices in normal weight individuals and those with overweight or obesity.

METHODS

Young adults (n = 599), 18-35 years with a body mass index (BMI) 21.0-30.9 kg/m² were randomized to control, self-regulation with small changes (SC) or self-regulation with large changes (LC). Interventions taught frequent self-weighing to guide behavioral changes. SC prescribed daily small decreases in intake and increases in physical activity. LC prescribed a 5- to 10-lb weight loss to buffer against anticipated gains. Psychological indices were assessed at baseline and periodically over 2 years of follow-up.

RESULTS

There was no evidence that the interventions increased depressive symptoms or compensatory behaviors or decreased HRQL relative to control. LC increased flexible and rigid control and SC decreased disinhibition. Results did not differ by weight status with the exception of rigid control; here, differences between LC and the other conditions were smaller among those with BMI ≥ 25. Greater self-weighing frequency over time was associated with increases in flexible and rigid control, dietary restraint, and improvements in HRQL.

CONCLUSIONS

The self-regulation interventions and increases in self-weighing had no untoward effects. Encouraging weight gain prevention in young adults through frequent weighing and self-regulation appears to be safe for normal weight young adults and those with overweight. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Obesity, perceived weight discrimination, and hair cortisol: a population-based study

BACKGROUND AND PURPOSE

Stigmatization of individuals with obesity is pervasive and may act as a psychological stressor. The present study examined whether perceived weight discrimination mediated the relationship between obesity and cortisol, an objective marker of chronic stress, in a population-based sample.

METHODS

Data were from the English Longitudinal Study of Ageing (n = 1872). Height and weight were objectively measured in 2008/09. Experiences of weight-related discrimination were reported via questionnaire in 2010/11. Hair cortisol concentrations were determined from the scalp-nearest 2 cm hair segment in 2012/13. Mediation analyses tested the role of perceived weight discrimination in the associations between obesity and BMI and hair cortisol concentration, adjusting for age, sex, ethnicity, socio-economic status, smoking status, depression and hair-related factors.

RESULTS

Obesity, BMI and perceived weight discrimination were positively related to hair cortisol (all p <  .01). Perceived weight discrimination significantly mediated associations between obesity and hair cortisol (β = 0.021, SE = 0.007, 95% CI 0.007-0.036) and BMI and hair cortisol (β = 0.001, SE = 0.0004, 95% CI 0.0004-0.002), accounting for 19% of the total effect of obesity and 23% of the total effect of BMI on hair cortisol.

CONCLUSIONS

Perceived weight discrimination is an important mediator of the association between obesity and cortisol. Interventions combating weight stigma and discrimination or promoting strategies for coping with stress could help to lessen the psychological and physiological burden of obesity.

Impairments in Individual Autonomous Living Tasks and Time to Self-Care Disability in Middle-Aged and Older Adults

OBJECTIVES

Impairments in specific tasks that are necessary for independent living may identify future self-care limitations, and the use of time-varying covariates can better capture the fluidity in functional capacity trajectories over time. The purpose of this study was to determine the associations between individual instrumental activities of daily living (IADL) impairments and time to activities of daily living (ADL) disability for middle-aged and older adults in the United States.

DESIGN

Longitudinal panel.

SETTING

Detailed interviews that included physical, biological, and psychosocial measures were completed in person. The core interview was typically completed over the telephone.

PARTICIPANTS

A nationally representative sample of 15,336 adults aged at least 50 years from the 2006 wave of the Health and Retirement Study was followed for 8 years.

MEASURES

Ability to perform IADL and ADL were self-reported at each wave. Separate covariate-adjusted Cox models were used to examine the time-varying associations between individual IADL impairments and time to ADL disability.

RESULTS

The presence of each IADL impairment was associated with a higher hazard ratio for an ADL disability for the following functions: 2.52 [95% confidence interval (CI) 2.35, 2.70] for grocery shopping, 1.91 (CI 1.77, 2.06) for preparing hot meals, 1.55 (CI 1.37, 1.76) for taking medications, 1.48 (CI 1.36, 1.61) for managing money, 1.41 (CI 1.27, 1.57) for using a telephone, and 1.38 (CI 1.29, 1.48) for using a map.

CONCLUSIONS/IMPLICATIONS

Our findings provide insights into the disabling process by revealing how impairments in each IADL are differentially associated with time to ADL disability. Interventions aiming to retain function during aging should be informed by fluctuations in IADL performance and how specific IADL impairments may exacerbate functional capacity declines more so than others.

Memory Decline and Depression Onset in U.S. and European Older Adults

Objectives: We explore the association between different patterns of change in depressive symptoms and memory trajectories in US and European Mediterranean (Spain, France, Italy, and Israel) and non-Mediterranean (Sweden, Denmark, Netherlands, Germany, Belgium, Switzerland, and Austria) older adults. Methods: Samples consisted of 3,466 participants from the Health Retirement Study (HRS) and 3,940 participants from the Survey of Health, Aging and Retirement (SHARE). Individuals were grouped as follows: non-case depression (NO DEP), persistent depression (DEP), depression onset (ONSET), depression recovery (RECOV), and fluctuating (FLUCT). Memory was measured using immediate and delayed recall tests. Linear mixed models were used. Results: DEP and RECOV had significantly lower baseline memory scores compared to NO DEP, at intercept level. At slope level, ONSET had a significantly faster decline in both tasks compared to NO DEP. Discussion: Cross-cohort robust and consistent new empirical evidence on the association between depression onset and faster decline in memory scores is provided.

Assessing Risk for Adverse Outcomes in Older Adults: The Need to Include Both Physical Frailty and Cognition

BACKGROUND

Physical frailty is a powerful tool for identifying nondisabled individuals at high risk of adverse outcomes. The extent to which cognitive impairment in those without dementia adds value to physical frailty in detecting high-risk individuals remains unclear.

OBJECTIVES

To estimate the effects of combining physical frailty and cognitive impairment without dementia (CIND) on the risk of basic activities of daily living (ADL) dependence and death over 8 years.

DESIGN

Prospective cohort study.

SETTING

The Health and Retirement Study (HRS).

PARTICIPANTS

A total of 7338 community-dwelling people, 65 years or older, without dementia and ADL dependence at baseline (2006-2008). Follow-up assessments occurred every 2 years until 2014.

MEASUREMENTS

The five components of the Cardiovascular Health Study defined physical frailty. A well-validated HRS method, including verbal recall, series of subtractions, and backward count task, assessed cognition. Primary outcomes were time to ADL dependence and death. Hazard models, considering death as a competing risk, associated physical frailty and CIND with outcomes after adjusting for sociodemographics, comorbidities, depression, and smoking status.

RESULTS

The prevalence of physical frailty was 15%; CIND, 19%; and both deficits, 5%. In unadjusted and adjusted analyses, combining these factors identified older adults at an escalating risk for ADL dependence (no deficit = 14% [reference group]; only CIND = 26%, sub-hazard ratio [sHR] = 1.5, 95% confidence interval [CI] = 1.3-1.8; only frail = 33%, sHR = 1.7, 95% CI = 1.4-2.0; both deficits = 46%, sHR = 2.0, 95%CI = 1.6-2.6) and death (no deficit = 21%; only CIND = 41%, HR = 1.6, 95% CI = 1.4-1.9; only frail = 56%, HR = 2.2, 95% CI = 1.7-2.7; both deficits = 66%, HR = 2.6, 95% CI = 2.0-3.3) over 8-year follow-up. Adding the cognitive measure to models that already included physical frailty alone increased accuracy in identifying those at higher risk of ADL dependence (Harrell's concordance [C], 0.74 vs 0.71; P < .001) and death (Harrell's C, 0.70 vs 0.67; P < .001).

CONCLUSION

Physical frailty and CIND are independent predictors of incident disability and death. Because together physical frailty and CIND identify vulnerable older adults better, optimal risk assessment should supplement measures of physical frailty with measures of cognitive function. J Am Geriatr Soc 67:477-483, 2019.

Persistent depressive symptoms and cognitive decline in older adults

BACKGROUND

Little is known about the effect of persistent depressive symptoms on the trajectory of cognitive decline.AimsWe aimed to investigate the longitudinal association between the duration of depressive symptoms and subsequent cognitive decline over a 10-year follow-up period.

METHOD

The English Longitudinal Study of Ageing cohort is a prospective and nationally representative cohort of men and women living in England aged ≥50 years. We examined 7610 participants with two assessments of depressive symptoms at wave 1 (2002-2003) and wave 2 (2004-2005), cognitive data at wave 2 and at least one reassessment of cognitive function (wave 3 to wave 7, 2006-2007 to 2014-2015).

RESULTS

The mean age of the 7610 participants was 65.2 ± 10.1 years, and 57.0% were women. Of these, 1157 (15.2%) participants had episodic depressive symptoms and 525 participants (6.9%) had persistent depressive symptoms. Compared with participants without depressive symptoms at wave 1 and wave 2, the multivariable-adjusted rates of global cognitive decline associated with episodic depressive symptoms and persistent depressive symptoms were faster by -0.065 points/year (95% CI -0.129 to -0.000) and -0.141 points/year (95% CI -0.236 to -0.046), respectively (P for trend < 0.001). Similarly, memory, executive and orientation function also declined faster with increasing duration of depressive symptoms (all P for trend < 0.05).

CONCLUSIONS

Our results demonstrated that depressive symptoms were significantly associated with subsequent cognitive decline over a 10-year follow-up period. Cumulative exposure of long-term depressive symptoms in elderly individuals could predict accelerated subsequent cognitive decline in a dose-response pattern.Declaration of interestNone.

Isolation, Not Loneliness or Cynical Hostility, Predicts Cognitive Decline in Older Americans

Objective: To jointly examine isolation, loneliness, and cynical hostility as risk factors for cognitive decline in older adults. Method: Data came from the 2006 to 2012 waves of the Health and Retirement Study (HRS), a longitudinal study of U.S. older adults (age ⩾ 65 years, n = 6,654). Measures included frequency of contact with social network (objective isolation), the Hughes Loneliness Scale (loneliness), a modified version of the Cook-Medley Hostility Inventory (cynical hostility), and a modified version of the Telephone Interview for Cognitive Status (cognitive function). Multilevel modeling (random slope + intercept) was used to examine the association between these factors and trajectories of cognitive function. Results and Discussion: After controlling for demographic characteristics, self-reported health, and functional limitations, loneliness (β = -.34, 95% confidence interval [CI] = [-0.56, -0.11), and cynical hostility (β = -.14, 95% CI = [-0.24, -0.04) correlated with lower cognitive function, but none predicted change in cognitive function. Objective social isolation was associated with lower cognitive function (β = -.27, 95% CI = [-0.41, -0.12]) and steeper decline in cognitive function (β = -.09, 95% CI = [-0.16, -0.01]).

"Crossover" in Depressive Symptoms Among Older Couples: Are Previous Findings Artifactual?

Objective: This study examined effects of a partner's depressive symptoms on those of a focal respondent. Method: Data were from the 2008-through-2014 waves of the Health and Retirement Study. Linear growth modeling was used to distinguish within- from between-person variation, and genetic instrumental variables to take endogeneity into account. Results: A partner's 2008 depressive symptoms had no associations with within-person change in those of a respondent between 2010 and 2014. Corresponding linkages with their between-person variation in 2010 were positive and significant for both genders. Among women, these last estimates remained intact in genetic instrumental variable models restricted to white couples. Discussion: Results indicate that contrary to previous literature, late life relationships are not marked by "crossover" of depressive symptoms. Women's affect may, however, be influenced by such transmission in the relationship's history. Beyond depression, findings suggest current theories of dyadic health effects may partly rest on flawed evidence.

Major Depression and Subthreshold Depression among Older Adults Receiving Home Care

OBJECTIVE

This study aims to estimate the prevalence and correlates of major and subthreshold depression and the extent of treatment utilization in older adults receiving home care.

METHODS

The study sample included 811 community-dwelling adults aged 60 and over who received paid home care during the 2008-2014 waves of the Health and Retirement Study. Depression was assessed using short forms of the Composite International Diagnostic Interview and the Center for Epidemiologic Studies Depression Scale. Logistic regression was used to examine correlates of depression type and treatment utilization.

RESULTS

One in two older home care recipients suffered from probable depression; 13.4% of the sample suffered from major depression and an additional 38.7% met study criteria for subthreshold depression. The majority (72.7%) of participants with major depression and almost half (44.5%) of participants with subthreshold depression reported taking medication for anxiety or depression. One-third (33.2%) of older home care recipients with major depression and 14.2% of those with subthreshold depression reported receiving formal psychiatric or psychological treatment. Males as compared with females and persons with pain problems as compared with no pain complaints had a higher risk of subthreshold and major depression. The receipt of medication or psychiatric treatment declined with age. African Americans were less likely to receive medication for anxiety or depression compared with non-Hispanic whites.

CONCLUSION

Depression affects a substantial proportion of older adults receiving home care and may be inappropriately treated. Future research is needed to develop optimal strategies for integrating depression assessment and treatment into home care.

Weight and Shape Concern Impacts Weight Gain Prevention in the SNAP Trial: Implications for Tailoring Intervention Delivery

OBJECTIVE

The Study of Novel Approaches to Weight Gain Prevention (SNAP) trial demonstrated that two self-regulatory interventions prevented weight gain in young adults. Weight and shape concern (WSC) at baseline was evaluated as a moderator of weight outcomes at 24 months.

METHODS

Young adults (n = 599) were randomized to self-regulation with small changes (to create 200 kcal/day deficit), self-regulation with large changes (to facilitate preemptive weight loss of 5-10 lb), or self-guided control. WSC was assessed by using one item from the Eating Disorders Assessment. ANOVA was used to examine whether the association between baseline level of WSC and percent weight change over 24 months differed across treatment conditions.

RESULTS

Approximately 22% of participants reported high WSC (37% moderate; 41% low). WSC and treatment condition interacted to influence weight change at 24 months (P = 0.03). Individuals with high WSC gained weight in the large changes group (WSC least squares means ± SE, high: + 0.73% ± 1.19%; moderate: -2.74% ± 0.84%; low: -2.41% ± 0.79%). The small changes condition was particularly effective for those with high WSC (high WSC: -2.49% ± 1.16%; moderate: -0.60% ± 0.88%; low: -0.71% ± 0.80%). WSC did not impact weight change among control participants.

CONCLUSIONS

Individuals with high WSC may benefit from a small-changes approach to weight gain prevention. These findings indicate WSC may be used to match individuals to weight gain prevention treatment conditions.