1
|
Zhao X, Jin L, Sun SB. Bidirectional Association Between Internet Use and Episodic Memory Among Older Adults: A Longitudinal Mediation Study. J Appl Gerontol 2024; 43:829-840. [PMID: 38016114 DOI: 10.1177/07334648231214944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023] Open
Abstract
Using nationally representative longitudinal data from three waves of the China Health and Retirement Longitudinal Study (CHARLS), we assessed whether social participation and mental health were channels through which internet use and episodic memory mutually influenced each other. Cross-lagged panel models with multiple mediators were employed for the mediation analysis. The results reveal that social participation and depressive symptoms were mechanisms underlying the internet-cognition interplay. Among men, an increased chance of contacting friends served as a pathway connecting internet use with better episodic memory. Conversely, men with better episodic memory were more likely to use the internet partially due to their higher chances of having contact with friends and engaging in group activities. Among women, engagement in group activities and depressive symptoms were two channels through which internet use and episodic memory positively influenced each other. Our findings provide practical implications for slowing cognitive aging and narrowing the digital divide.
Collapse
Affiliation(s)
- Xiaohang Zhao
- National Institute of Social Development, Chinese Academy of Social Sciences, Beijing, China
| | - Lei Jin
- Department of Sociology, The Chinese University of Hong Kong, Hong Kong, China
| | - Skylar Biyang Sun
- School of International Development and Cooperation, University of International Business and Economics, Beijing, China
| |
Collapse
|
2
|
Luo Y, Zhao D, Pan X, Lingling Z. Household Environments and Cognitive Decline Among Middle-Aged and Older Adults in China: Exploring Gender, Age, and Residential Variations. Int J Aging Hum Dev 2024:914150241260824. [PMID: 38859750 DOI: 10.1177/00914150241260824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
This study examined the relationship between household environments and trajectories of cognitive function among middle-aged and older adults in China and its urban/rural, gender, and age variations. We estimated multi-level linear growth curve models using a representative sample of 16,111 respondents aged 45 years and over from the China Health and Retirement Longitudinal Study (2011-2018). Older people who lived with a spouse, but not with children, and those with higher living expenditures, better housing quality, and indoor clean fuels for cooking had a slower cognitive decline. Living arrangement more strongly predicted men's cognitive decline, while living expenditure, solid fuel use, and housing quality significantly predicted only women's cognitive decline. Only for older adults and rural residents, those living alone had significantly faster cognitive decline than those living with a spouse only. These findings underscore the importance of improving the living conditions of older adults to help alleviate their cognitive decline.
Collapse
Affiliation(s)
- Ye Luo
- Department of Sociology, Anthropology and Criminal Justice, Clemson University, Clemson, SC, USA
| | - Dandan Zhao
- Department of Sociology, Anthropology and Criminal Justice, Clemson University, Clemson, SC, USA
| | - Xi Pan
- Department of Sociology, Texas State University, San Marcos, TX, USA
| | - Zhang Lingling
- Department of Nursing, University of Massachusetts Boston, Boston, MA, USA
| |
Collapse
|
3
|
Xu S, Su YJ, Ehrlich JR, Song Q. Associations Between Self-Reported Visual Difficulty, Age of Onset, and Cognitive Function Trajectories Among Chinese Older Adults. J Aging Health 2024:8982643241247251. [PMID: 38621713 DOI: 10.1177/08982643241247251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
Objectives: This study examined the association between self-reported visual difficulty and age-related cognitive declines among older Chinese adults and how the timing of visual difficulty onset plays a role in cognitive trajectories. Methods: Data were drawn from the 2011-2018 wave of the China Health and Retirement Longitudinal Study, involving 9974 respondents aged 60 years or older (mean age 65.44 years, range 60-101 years). Results: At baseline, 14.16% respondents had self-reported visual difficulty. Growth curve models showed that Chinese older adults with visual difficulty experienced a faster decline in cognitive function compared to those without visual difficulty (β = -0.02, p < .01). Older adults who began experiencing visual difficulty between 61 and 75 years of age had steeper cognitive declines compared to those with earlier or later onset (β = -0.05, p < .01). Discussion: Older adults with self-reported visual difficulty experience faster rates of cognitive decline. Future research should explore potential factors that underlie the association between onset timing of visual difficulty and cognitive function.
Collapse
Affiliation(s)
- Shu Xu
- Department of Gerontology, University of Massachusetts Boston, Boston, MA, USA
| | - Yan-Jhu Su
- Department of Gerontology, University of Massachusetts Boston, Boston, MA, USA
| | - Joshua R Ehrlich
- Department of Ophthalmology and Visual Sciences and Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Qian Song
- Department of Gerontology, University of Massachusetts Boston, Boston, MA, USA
| |
Collapse
|
4
|
Long YQ, Xu QY, Zhao WM, Shan XS, Yang HT, Zhuang K, Liu H, Ji FH, Peng K. Dexmedetomidine Infusion Versus Placebo During Light or Deep Anesthesia on Postoperative Delirium in Older Patients Undergoing Major Noncardiac Surgery: A Pilot Randomized Factorial Trial. Anesth Analg 2024; 138:161-170. [PMID: 37874773 DOI: 10.1213/ane.0000000000006686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
BACKGROUND Postoperative delirium (POD) is common among older surgical patients and may be affected by dexmedetomidine and depth of anesthesia. We designed this pilot study to assess the feasibility of comparing dexmedetomidine with normal saline during light versus deep anesthesia on POD in older patients undergoing major noncardiac surgery. METHODS In this pilot randomized factorial study, 80 patients aged 60 years or older undergoing major noncardiac surgery were randomized (1:1:1:1) to receive dexmedetomidine infusion 0.5 μg/kg/h or normal saline placebo during light (bispectral index [BIS] target 55) or deep (BIS target 40) anesthesia. Feasibility end points included consent rate and dropout rate, timely enrollment, blinded study drug administration throughout surgery, no inadvertent unmasking, achieving BIS target throughout >70% of surgery duration, and the process of twice-daily POD screening. In addition, we estimated the POD incidences in the 2 control groups (placebo and deep anesthesia) and treatment effects of dexmedetomidine and light anesthesia. RESULTS Between November 1, 2021, and June 30, 2022, 78 patients completed the trial (mean [standard deviation, SD] age, 69.6 [4.6] years; 48 male patients [62%]; dexmedetomidine-deep, n = 19; dexmedetomidine-light, n = 20; placebo-deep, n = 19; placebo-light, n = 20). This study had a high consent rate (86%) and a low dropout rate (2.5%). Average recruitment was 5 patients at each center per month. Dexmedetomidine and normal saline were administered in a blinded fashion in all patients. Unmasking did not occur in either group. Approximately 99% of patients received the scheduled study drug infusion throughout the surgery. Approximately 81% of patients achieved the BIS targets throughout >70% of the surgery duration. The scheduled twice-daily POD screening was completed without exception. Overall, 10 of the 78 patients (13%; 95% confidence interval [CI], 7%-22%) developed POD. For the 2 reference groups, POD was observed in 7 of the 39 patients (17.9%; 95% CI, 9%-32.7%) in the placebo group and 7 of the 38 patients (18.4%; 95% CI, 9.2%-33.4%) in the deep anesthesia group. Regarding the treatment effects on POD, the estimated between-group difference was -10% (95% CI, -28% to 7%) for dexmedetomidine versus placebo, and -11% (95% CI, -28% to 6%) for light versus deep anesthesia. CONCLUSIONS The findings of this pilot study demonstrate the feasibility of assessing dexmedetomidine versus placebo during light versus deep anesthesia on POD among older patients undergoing major noncardiac surgery, and justify a multicenter randomized factorial trial.
Collapse
Affiliation(s)
- Yu-Qin Long
- From the Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu, China
| | - Qi-Ya Xu
- From the Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu, China
| | - Wei-Ming Zhao
- From the Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu, China
| | - Xi-Sheng Shan
- From the Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu, China
| | - Hao-Tian Yang
- From the Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu, China
| | - Kai Zhuang
- From the Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu, China
| | - Hong Liu
- Department of Anesthesiology and Pain Medicine, University of California Davis Health, Sacramento, California
| | - Fu-Hai Ji
- From the Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu, China
| | - Ke Peng
- From the Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu, China
| |
Collapse
|
5
|
Lee Y, Jiang Y. Examining sociocultural factors in widowhood and cognitive function among older Chinese immigrants: findings from the PINE study. Aging Ment Health 2023; 27:2144-2152. [PMID: 37116185 PMCID: PMC10592049 DOI: 10.1080/13607863.2023.2205350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 04/11/2023] [Indexed: 04/30/2023]
Abstract
Objectives: Although there is growing evidence on widowhood and cognitive function, existing studies have shown mixed results. Little is known about protective factors that may contribute to resilience, thereby ameliorate the adverse effect of widowhood on cognition among older Asian immigrants. This study explored potential moderators (i.e. social support, acculturation, leisure activities) in the association between widowhood and cognitive function among older Chinese immigrants.Method: The study sample included 2,515 adults aged 60 or older who completed two waves (2011-2013 and 2013-2015) of the Population Study of Chinese Elderly in Chicago. Cognitive function was indexed by global cognitive function and episodic memory. Linear regression analyses were conducted with interaction terms.Results: Our results show that social support moderated the relationship between widowhood and global cognitive function, and acculturation moderated the relationship between widowhood and episodic memory. The adverse effect of widowhood on cognitive function was more pronounced at lower levels of social support and acculturation.Conclusion: Our findings indicate buffering roles of social support and acculturation in cognitive health among older Chinese immigrants who experience widowhood. Providing supportive programs and interventions to increase social support and acculturation is suggested to promote cognitive function in this population.
Collapse
Affiliation(s)
- Yura Lee
- Department of Social Work, Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee, Wi, United States
| | - Yanping Jiang
- institute for Health, Health Care Policy and Aging Research, Department of Family Medicine and Community Health, Rutgers, the State University of new Jersey, new Brunswick, nJ, United States
| |
Collapse
|
6
|
Zhang Y, Chen X, Sun Y, Feng S, Wang F, Gu H, Jia H, Zhang Q, Ding W, Lu H, Zhang J. Relationship of widowhood with pulse pressure, fasting blood glucose, and mental health in older adults: a propensity matching score analysis. Front Public Health 2023; 11:1257133. [PMID: 37954046 PMCID: PMC10634533 DOI: 10.3389/fpubh.2023.1257133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/29/2023] [Indexed: 11/14/2023] Open
Abstract
Background Transitioning from marriage to widowhood presents inevitable and significant challenges for many older adults. This study explored the impact of widowhood on a range of mental health outcomes, including pulse pressure and fasting blood glucose levels, among older adults in nursing homes. Methods This cross-sectional study utilized cluster random sampling to recruit participants, with data analyzed from 388 older Chinese adults. Psychosocial traits were assessed using the Perceived Social Support from Family scale (PSS-Fa) for family support, the Generalized Anxiety Disorder 7-item scale (GAD-7) for anxiety symptoms, and the 9-item Patient Health Questionnaire (PHQ-9) for depressive symptoms and suicidal ideation. Propensity score matching (PSM) was employed to control for confounding factors. A multivariate linear regression analysis was performed to explore the relationship between widowhood, mental health outcomes, pulse pressure, and fasting blood glucose levels. Results After applying PSM, the sample size was refined to 268 (N = 134 for both married and widowed groups) from the initial 388, excluding 120 unmatched cases. Widowed older adults were found to have notably lower family support (β = -0.81, p = 0.002), increased depressive symptoms (β = 1.04, p = 0.043), elevated pulse pressure (β = 8.90, p < 0.001), and higher fasting blood glucose levels (β = 3.22, p = 0.027). These associations exhibited greater beta values compared to pre-matching analysis. Conclusion Our findings revealed that widowed participants had reduced family support, an increased risk of depressive symptoms, heightened pulse pressure, and elevated fasting blood glucose in comparison to their married counterparts. Interventions focusing on social support, mental health, and cardiovascular well-being could be advantageous for this at-risk group.
Collapse
Affiliation(s)
- Yi Zhang
- Department of Science and Education, Nantong First People's Hospital, Nantong, China
| | - Xiangfan Chen
- Department of Biobank, Nantong First People's Hospital, Nantong, China
| | - Yimei Sun
- Finance Department, Nantong First People's Hospital, Nantong, China
| | - Sujuan Feng
- Blood Dialysis Room of Nantong First People’s Hospital, Nantong, China
| | - Fang Wang
- Department of Science and Education, Nantong First People's Hospital, Nantong, China
| | - Haiyan Gu
- Nursing Department of Nantong First People’s Hospital, Nantong, China
| | - Hanyu Jia
- Department of Science and Education, Nantong First People's Hospital, Nantong, China
| | - Quanxing Zhang
- Department of Science and Education, Nantong First People's Hospital, Nantong, China
| | - Wenbin Ding
- The President's Office, Nantong First People's Hospital, Nantong, China
| | - Hongjian Lu
- Department of Science and Education, Nantong First People's Hospital, Nantong, China
| | - Jidong Zhang
- Department of Science and Education, Nantong First People's Hospital, Nantong, China
| |
Collapse
|
7
|
Yang D, Ren Z, Zheng G. The impact of pension insurance types on the health of older adults in China: a study based on the 2018 CHARLS data. Front Public Health 2023; 11:1180024. [PMID: 37333531 PMCID: PMC10272461 DOI: 10.3389/fpubh.2023.1180024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/18/2023] [Indexed: 06/20/2023] Open
Abstract
Introduction Pension insurance is an essential safeguard for the quality of life and health of older adults because it provides a stable and dependable source of income after retirement. China has constructed a multi-level social security system to accommodate the diverse needs of older adults, and offers various levels of pension insurance to maximize their interests. Methods This study uses propensity score matching and ordinary least squares techniques to analyze 7,359 data from the 2018 China Health and Retirement Longitudinal Study (CHARLS) in order to explore the relationship between different pension insurance categories and the health of older individuals. Results The research findings reveal that advanced insurances greatly benefit the health of older adults more than basic pension insurances, and the findings pass the robustness test. In addition, the effect was found to be heterogeneous, depending on the location of retirement and the marital status of older adults.Our findings suggest that both material and non-material consumption may be potential mechanisms by which pension insurance affects the health of older adults, providing new evidence for the causal mechanism between pension insurance and the health of older adults. Discussion This study expands the scope of research on the health effects of pension insurance by covering a large representative sample across the country. The results show the important impact of the level of pension insurance on the health of older adults and can contribute to the development of social policies to promote the physical and mental health of older adults.
Collapse
Affiliation(s)
- Dongliang Yang
- Northeast Asian Research Center, Jilin University, Changchun, China
- Department of Regional Economics, School of Northeast Asian, Jilin University, Changchun, China
| | - Zhichao Ren
- Department of Regional Economics, School of Northeast Asian, Jilin University, Changchun, China
| | - Ge Zheng
- Department of Regional Economics, School of Northeast Asian, Jilin University, Changchun, China
| |
Collapse
|
8
|
Muhammad T, Pai M, Afsal K, Saravanakumar P, Irshad CV. The association between loneliness and life satisfaction: examining spirituality, religiosity, and religious participation as moderators. BMC Geriatr 2023; 23:301. [PMID: 37193948 DOI: 10.1186/s12877-023-04017-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 05/04/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Future cohort of older adults may have to rely on non-family sources and forms of support, religion being one of them. This may be especially so, considering the recent longitudinal evidence that individuals are inclined to become more religious with increasing age. Thus, the purpose of the present study was to assess the association between loneliness and life satisfaction among older adults in India, and the extent to which the association between loneliness and life satisfaction is moderated by spirituality, religiosity, and religious participation. METHODS Data come from the Longitudinal Ageing Study in India, with a sample of 31,464 individuals aged 60 years and above. Multivariable logistic regression models were employed to examine the independent association of loneliness and life satisfaction. Further, an interaction analysis was conducted to examine the extent to which the association between perceived loneliness and life satisfaction is moderated by spirituality, religiosity and religious participation among older Indians. RESULTS The prevalence of low life satisfaction (LLS) was 30.84%; a total of 37.25% of participants reported feeling lonely, 12.54% reported a lack of spiritual experience, 21.24% reported not being religious, and 19.31% reported not participating in religious activities. Older adults who felt lonely had higher odds of LLS relative to peers who were not lonely. Further, the adverse impact of loneliness on LLS among older Indians is moderated by their spirituality, religiosity, and religious participation. Specifically, the adverse impact of loneliness on LLS was less negatively pronounced among older adults who were spiritual, religious, and engaged in religious activities. CONCLUSIONS The study found an independent association between loneliness and lower life satisfaction among older adults in India. It also revealed that religiosity, spirituality and religious participation moderate the association between loneliness and lower life satisfaction. These findings, which underscore the health promoting benefits of religiosity and religious engagement, may be used to build on the interaction between religious and faith-based groups and public health professionals.
Collapse
Affiliation(s)
- T Muhammad
- Department of Family & Generations, International Institute for Population Sciences, Mumbai, 400088, India.
| | - Manacy Pai
- Department of Sociology and Criminology, Kent State University, Kent, OH, 44242, USA
| | - K Afsal
- Department of Migration & Urban Studies, International Institute for Population Sciences, Mumbai, 400088, India
| | - Priya Saravanakumar
- School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, Building 10, Level 7, 235 Jones St, Ultimo, NSW, 2007, Australia
| | - C V Irshad
- School of Social Sciences and Languages, Vellore Institute of Technology, Vellore, 632014, India
| |
Collapse
|
9
|
Handajani YS, Hogervorst E, Schröder-Butterfill E, Turana Y, Hengky A. Memory impairment and its associated risk and protective factors among older adults in Indonesia. Int J Neurosci 2023:1-9. [PMID: 36856553 DOI: 10.1080/00207454.2023.2183788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 01/09/2023] [Accepted: 02/19/2023] [Indexed: 02/24/2023]
Abstract
AIMS This study aimed to evaluate the association between memory impairment and its risk and protective factors, focusing on demographic and health-related variables among older adults in Indonesia. METHOD The data analyzed were the Indonesian Family Life Survey-5 (IFLS-5) using cross-sectional variables of 4236 older adults aged 60 years and over included in the 2015 round. Memory impairment was assessed by immediate word list recall from the Telephone Interview for Cognitive Status (TICS). Sociodemographic factors and multiple health variables were included as predictors. Data were analyzed using frequency analyses bivariate and stepwise logistic regression tests. RESULT Among 4236 older adults, 49.7% were male and 50.3% were female. Stepwise backward analyses showed that memory impairment was independently associated with older age, being female, or not in a union (unmarried, separated, divorced, or widowed), having obtained low levels of education, living in a rural area, reporting low life satisfaction, low social capital, higher dependency, and having clinical depression. Only moderate (but not high or low) physical activity levels were associated with a lower risk. Being underweight increased the risk, but being overweight/obese (as assessed by BMI) protective factors for a lower immediate recall score. CONCLUSION Increasing education and continued engagement of older adults in psychosocial activities, including moderate physical activity, improving mental health, preventing weight loss, and maintaining functional ability to decrease dependency, are associated with increased episodic memory, especially in non-married and older women in rural areas of Indonesia.
Collapse
Affiliation(s)
- Yvonne Suzy Handajani
- School of Medicine and Health Science, Atma Jaya Catholic University of Indonesia, South Jakarta, Indonesia
| | - Eef Hogervorst
- Sport Exercise &Health Sciences, Loughborough University, Loughborough, United Kingdom
| | | | - Yuda Turana
- School of Medicine and Health Science, Atma Jaya Catholic University of Indonesia, South Jakarta, Indonesia
| | - Antoninus Hengky
- Centers of Health Research, Atma Jaya Catholic University of Indonesia, South Jakarta, Indonesia
| |
Collapse
|
10
|
Psychological factors substantially contribute to biological aging: evidence from the aging rate in Chinese older adults. Aging (Albany NY) 2022; 14:7206-7222. [PMID: 36170009 PMCID: PMC9550255 DOI: 10.18632/aging.204264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 08/23/2022] [Indexed: 11/30/2022]
Abstract
We have developed a deep learning aging clock using blood test data from the China Health and Retirement Longitudinal Study, which has a mean absolute error of 5.68 years. We used the aging clock to demonstrate the connection between the physical and psychological aspects of aging. The clock detects accelerated aging in people with heart, liver, and lung conditions. We demonstrate that psychological factors, such as feeling unhappy or being lonely, add up to 1.65 years to one’s biological age, and the aggregate effect exceeds the effects of biological sex, living area, marital status, and smoking status. We conclude that the psychological component should not be ignored in aging studies due to its significant impact on biological age.
Collapse
|
11
|
Jain U, Liu H, Langa KM, Farron M, Kabeto M, Lee J. Widowhood and cognition among older women in India: New insights on widowhood duration and mediators. SSM Popul Health 2022; 19:101242. [PMID: 36193099 PMCID: PMC9525895 DOI: 10.1016/j.ssmph.2022.101242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 09/22/2022] [Accepted: 09/25/2022] [Indexed: 01/10/2023] Open
Abstract
Background Widowhood, a marital status that disproportionately affects older women, has been associated with poorer health compared to married individuals. However, relatively little is known about the association between widowhood in later-life and cognitive health in low- and middle-income countries. Methods To address this research gap, we used data from the Longitudinal Aging Study in India (2017-19) to investigate the widowhood disparity in cognitive health among mid-aged and older women in India, including how this relationship varies by the duration of widowhood. We further examined the extent to which economic, social, and health conditions mediate this association. Results Cognition scores for widowed women were on average lower by almost 0.1 standard deviations compared to married women. Overall, this disparity increased with widowhood duration, with non-linearities in this association. The disparity in cognition scores increased with widowhood duration up to twenty years but did not increase further among those with longer widowhood duration. Worse physical and mental health were found to mediate almost thirty percent of the total association between widowhood and cognition. These mediators were most useful in explaining the association between lower cognition and widowhood among women who experienced widowhood for ten years or longer. Conclusion The study highlights the significant disadvantage in cognitive functioning among older widowed women in India. The study also provides evidence on potential mediators, suggesting differential effects of mediators at different stages of widowhood.
Collapse
Affiliation(s)
- Urvashi Jain
- Department of Economics, Finance and Real Estate, Mitchell College of Business, University of South Alabama, USA
| | - Hui Liu
- Department of Sociology, Michigan State University, USA
| | - Kenneth M. Langa
- Department of Internal Medicine, Institute for Social Research, and VA Center for Clinical Management Research, University of Michigan, USA
| | - Madeline Farron
- Department of Internal Medicine, University of Michigan, USA
| | - Mohammed Kabeto
- Department of Internal Medicine, University of Michigan, USA
| | - Jinkook Lee
- Center for Economic and Social Research, and Department of Economics, University of Southern California, USA
| |
Collapse
|
12
|
Wu-Chung EL, Leal SL, Denny BT, Cheng SL, Fagundes CP. Spousal caregiving, widowhood, and cognition: A systematic review and a biopsychosocial framework for understanding the relationship between interpersonal losses and dementia risk in older adulthood. Neurosci Biobehav Rev 2022; 134:104487. [PMID: 34971701 PMCID: PMC8925984 DOI: 10.1016/j.neubiorev.2021.12.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 11/23/2021] [Accepted: 12/06/2021] [Indexed: 01/18/2023]
Abstract
Accumulating research suggests that stressful life events, especially those that threaten close intimate bonds, are associated with an increased risk of dementia. Grieving the loss of a spouse, whether in the form of caregiving or after the death, ranks among 'life's most significant stressors', evoking intense psychological and physiological distress. Despite numerous studies reporting elevated dementia risk or poorer cognition among spousal caregivers and widow(er)s compared to controls, no review has summarized findings across cognitive outcomes (i.e., dementia incidence, cognitive impairment rates, cognitive performance) or proposed a theoretical model for understanding the links between partner loss and abnormal cognitive decline. The current systematic review summarizes findings across 64 empirical studies. Overall, both cross-sectional and longitudinal studies revealed an adverse association between partner loss and cognitive outcomes. In turn, we propose a biopsychosocial model of cognitive decline that explains how caregiving and bereavement may position some to develop cognitive impairment or Alzheimer's disease and related dementias. More longitudinal studies that focus on the biopsychosocial context of caregivers and widow(er)s are needed.
Collapse
Affiliation(s)
| | | | - Bryan T. Denny
- Department of Psychological Sciences, Rice University, Houston, TX
| | | | - Christopher P. Fagundes
- Department of Psychological Sciences, Rice University, Houston, TX,Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX,Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX
| |
Collapse
|
13
|
Hülür G, Elayoubi J, Nelson ME, Haley WE. Change in Episodic Memory With Spousal Loss: The Role of Social Relationships. J Gerontol B Psychol Sci Soc Sci 2021; 77:683-694. [PMID: 34939648 PMCID: PMC8974325 DOI: 10.1093/geronb/gbab231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES The spousal relationship is one of the most important social contexts in old age, and the loss of a spouse/partner is associated with stress and cognitive decline. In the present study, we examined whether social relationships can buffer potential negative effects of spousal loss on cognition. We examined the role of social network, social activities, and perceived deficiencies in social relationships (loneliness). METHOD We used longitudinal data between 1998 and 2012 from 2,074 participants of the Health and Retirement Study, who had experienced spousal loss during the study period. Multilevel modeling was used to examine how time-varying indicators of social network, social activities, and loneliness were related to age-related trajectories of episodic memory prior to and after spousal loss. Analyses controlled for gender, race/ethnicity, education, time-varying functional health, and being repartnered/remarried. RESULTS Having children living within 10 miles and providing help to others buffered negative effects of widowhood on episodic memory. In addition, within-person increase in providing help to others buffered against decline in episodic memory after spousal loss. Having friends in the neighborhood, more frequent social visits, providing help to others, volunteering, and lack of loneliness were related to higher episodic memory, while having relatives in the neighborhood was related to lower episodic memory. DISCUSSION Our findings suggest that social networks, social activities, and loneliness are related to levels of cognitive function at the time of spousal loss and that social relationships can buffer negative effects of spousal loss on cognitive function. Implications for future research are discussed.
Collapse
Affiliation(s)
- Gizem Hülür
- School of Aging Studies, University of South Florida, Tampa, Florida, USA,Department of Psychology, University of Bonn, Bonn, Germany,Address correspondence to: Gizem Hülür, PhD, Department of Psychology, University Bonn, Kaiser-Karl-Ring 9, 53111 Bonn, Germany. E-mail:
| | - Joanne Elayoubi
- School of Aging Studies, University of South Florida, Tampa, Florida, USA
| | - Monica E Nelson
- School of Aging Studies, University of South Florida, Tampa, Florida, USA
| | - William E Haley
- School of Aging Studies, University of South Florida, Tampa, Florida, USA
| |
Collapse
|
14
|
Wen S, Zou H, Xu H. What doesn't kill you makes you "smarter": The long-term association between exposure to epidemic and cognition. Soc Sci Med 2021; 291:114389. [PMID: 34763133 PMCID: PMC8437674 DOI: 10.1016/j.socscimed.2021.114389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 09/03/2021] [Accepted: 09/07/2021] [Indexed: 12/15/2022]
Abstract
Emerging epidemics have devastating impacts on people's lives and livelihoods. However, acting as a severe health shock, exposure to an epidemic may induce positive changes in health behaviors among survivors, thereby leading to long-lasting improvement in population health. This study examined the long-term association between exposure to the 2002-2004 severe acute respiratory syndrome outbreak and middle-aged and older Chinese adults' cognition assessed in 2011-2015. Drawing on data from the 2011-2015 China Health and Retirement Longitudinal Study, we found that community exposure to the outbreak was associated with significantly higher scores on episodic memory, after adjusting for demographic characteristics, adulthood socioeconomic status and health, and community socioeconomic conditions. No such a significant association was found for mental intactness. Mediation analysis showed that community exposure to the epidemic was associated with increased participation in social activities, maintaining close family relationships with adult children and grandchildren, and increased participation in regular physical exercise, all of which were positively associated with cognitive functioning in middle-aged and older Chinese adults. These findings suggest that positive post-epidemic behavioral changes are possible and may have long-term health benefits for survivors.
Collapse
Affiliation(s)
- Sha Wen
- School of Economics, Southwestern University of Finance and Economics, Chengdu, China
| | - Hong Zou
- School of Economics, Southwestern University of Finance and Economics, Chengdu, China
| | - Hongwei Xu
- Department of Sociology, Queens College, Powdermaker Hall 252, 65-30 Kissena Blvd, Queens, NY, 11367, USA,Corresponding author
| |
Collapse
|
15
|
The Association between Widowhood and Cognitive Function among Chinese Elderly People: Do Gender and Widowhood Duration Make a Difference? Healthcare (Basel) 2021; 9:healthcare9080991. [PMID: 34442128 PMCID: PMC8392527 DOI: 10.3390/healthcare9080991] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/27/2021] [Accepted: 07/29/2021] [Indexed: 12/27/2022] Open
Abstract
Few studies have examined the effects of widowhood on cognitive function in Chinese elderly individuals. We conducted a longitudinal study to assess the association between widowhood and cognitive function and further explored gender differences in this association and the impact of widowhood duration. The analytical sample consisted of 5872 Chinese elderly people who participated in the Chinese Longitudinal Healthy Longevity Survey (CLHLS) and were followed up from 2005 to 2014. We used the Chinese version of the Mini-Mental State Examination (MMSE) to assess cognitive function. Widowhood duration was calculated from the self-reported year at which the spouse passed away. Multilevel growth models were employed to estimate the association between widowhood and cognitive function while adjusting for many demographic and socioeconomic characteristics. Widowhood status was associated with cognitive decline among Chinese elderly individuals after adjusting for covariates (B = −0.440, 95% CI −0.727 to −0.152), and this association was only statistically significant among men (B = −0.722, 95% CI −1.104 to −0.339). Being widowed for 5 years or less (B = −0.606, 95% CI −1.112 to −0.100), 16–20 years (B = −0.937, 95% CI −1.685 to −0.190), and 21+ years (B = −1.401, 95% CI −1.967 to −0.834) predicted worse cognitive function in men, while being widowed for more than 21+ years (B = −0.655, 95% CI −1.186 to −0.124) was associated with cognitive decline in women. More attention should be directed towards widowed men and long-term widowed elderly individuals.
Collapse
|
16
|
Ansari S, Muhammad T, Dhar M. How Does Multi-Morbidity Relate to Feeling of Loneliness among Older Adults? Evidence from a Population-Based Survey in India. JOURNAL OF POPULATION AGEING 2021. [DOI: 10.1007/s12062-021-09343-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
|
17
|
The association of marital status with cognitive function and the role of gender in Chinese community-dwelling older adults: a cross-sectional study. Aging Clin Exp Res 2021; 33:2273-2281. [PMID: 33156506 DOI: 10.1007/s40520-020-01743-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 10/19/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Evidence of the association between marital status and cognitive function in Chinese older adults is limited. AIMS To examine the relationship between marital status and cognitive function and to explore the role of gender amongst older adults from three Chinese communities. METHODS A total of 1376 participants aged 60 years or over were included in this cross-sectional study. Cognitive function was assessed using the Chinese version of the mini-mental state examination (MMSE). Marital status and other variables were collected using a standardized questionnaire. Multiple linear regression models were used to examine associations between marital statuses and cognitive function amongst the target population. The moderating role of gender in these potential associations has also been explored. RESULTS In univariate linear regression models, compared to being married, both being widowed (β [95% CI]: -1.46[-2.78 to - 0.13]) and being single (β [95% CI]: - 4.88[-6.43 to - 3.38]) were associated with lower MMSE scores. After adjustment for confounding factors, the significant association of being widowed with MMSE scores disappeared (β [95% CI: - 0.08[- 1.04 to 0.86]), but the association of being single with MMSE scores still existed (β [95% CI]: - 1.87[- 3.17 to - 0.58]). Furthermore, the association of being single with MMSE scores was statistically significant in men (β [95% CI]: - 5.25[- 7.17 to - 3.33]) but not in women (β [95% CI: 0.88[- 0.87 to 2.64]). DISCUSSION AND CONCLUSIONS Being single was associated with poorer cognitive function compared with their married counterparts in older Chinese men but not in women. More preventive measurements should be implemented for single men to reduce or delay cognitive decline. This is particularly important in the context of an aging population in China.
Collapse
|
18
|
Zhang Z, Liu H, Choi SWE. Marital loss and risk of dementia: Do race and gender matter? Soc Sci Med 2021; 275:113808. [PMID: 33713925 PMCID: PMC8015783 DOI: 10.1016/j.socscimed.2021.113808] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/02/2021] [Accepted: 02/26/2021] [Indexed: 12/22/2022]
Abstract
Recent studies have found that marital loss through divorce or widowhood is associated with a higher risk of dementia for older adults. However, whether these associations vary by race and gender is less clear. To address this gap, we drew upon longitudinal data from the Health and Retirement Study (2000-2016) to investigate the association between marital loss and dementia risk, separately for non-Hispanic Whites and non-Hispanic Blacks. We further examined gender variations in the link between marital loss and dementia risk within each racial group. Results from discrete-time event history models suggested that widowhood is significantly associated with a higher risk of dementia for both Whites and Blacks, controlling for basic demographic characteristics. However, while divorce is significantly associated with a higher risk of dementia for Blacks, the association is marginally significant (p < 0.1) for Whites. There are few significant gender variations in these associations except for the effect of divorce among Whites. Even after controlling for economic and health-related factors, we found that divorce is associated with a higher risk of dementia among White men but not among White women. Economic resources explain a significant portion of the association between widowhood and dementia risk, more so for Whites than for Blacks. Our findings call for more research into the pathways through which marital loss shapes the risk of dementia across racial and ethnic groups.
Collapse
Affiliation(s)
- Zhenmei Zhang
- Department of Sociology, Michigan State University, USA.
| | - Hui Liu
- Department of Sociology, Michigan State University, USA
| | - Seung-Won Emily Choi
- Department of Sociology, Anthropology, and Social Work, Texas Tech University, USA
| |
Collapse
|
19
|
|
20
|
Zhou S, Song S, Jin Y, Zheng ZJ. Prospective association between social engagement and cognitive impairment among middle-aged and older adults: evidence from the China Health and Retirement Longitudinal Study. BMJ Open 2020; 10:e040936. [PMID: 33208332 PMCID: PMC7677353 DOI: 10.1136/bmjopen-2020-040936] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVES Cognitive impairment is a precursor of dementia. This study aimed to examine the association of social engagement with cognitive decline during the process of normal ageing. METHODS We used data from the China Health and Retirement Longitudinal Study. The cognitive functions were tested at baseline, and 2-year and 4-year follow-up visits. Social engagement was constructed as a comprehensive measure including the quantity and frequency of social activities. Activities of social engagement were classified into three types. Multilevel logistic model was fitted to evaluate the prospective association between social engagement and cognitive impairment. RESULTS After 2-year follow-up, compared with participants with the lowest level of social engagement, those with level-2, level-3 and level-4 social engagement had a 12% (OR=0.88, 95% CI 0.71 to 1.09, p=0.242), 17% (OR=0.83, 95% CI 0.71 to 0.97, p=0.020) and 25% (OR=0.75, 95% CI 0.61 to 0.93, p=0.008) lower risk for developing cognitive impairment, respectively. A similar pattern of significantly protective association was found at 4-year follow-up. Combined effect analysis showed that participants who attended one type of social engagement had a lower risk of developing cognitive impairment and the protective effect was even larger with those who attended two or three types of social engagement. CONCLUSIONS Social engagement had a protective effect on cognitive impairment among middle-aged and older adults in China. Given the growing epidemic of dementia and rapid pace of ageing in low-income and middle-income countries, our study shed lights on comprehensive and tailored public health programmes for improving social engagement, to delay cognitive impairment at mid-age and later life.
Collapse
Affiliation(s)
- Shuduo Zhou
- Department of Global Health, Peking University Health Science Centre, Beijing, China
- Institute for Global Health, Peking University, Beijing, China
| | - Suhang Song
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Yinzi Jin
- Department of Global Health, Peking University Health Science Centre, Beijing, China
- Institute for Global Health, Peking University, Beijing, China
| | - Zhi-Jie Zheng
- Department of Global Health, Peking University Health Science Centre, Beijing, China
- Institute for Global Health, Peking University, Beijing, China
| |
Collapse
|
21
|
Chen Z, Ying J, Ingles J, Zhang D, Rajbhandari-Thapa J, Wang R, Emerson KG, Feng Z. Gender differential impact of bereavement on health outcomes: evidence from the China Health and Retirement Longitudinal Study, 2011-2015. BMC Psychiatry 2020; 20:514. [PMID: 33092555 PMCID: PMC7583229 DOI: 10.1186/s12888-020-02916-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 10/13/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Bereavement is the experience of an individual following the death of a person of significance to the individual, most often referring to the spouse. Increased morbidity, health care utilization, and mortality are known to be associated with bereavement. Given China's growing population of older adults, there is a critical need to assess the health consequences of bereavement. METHOD We use data from the China Health and Retirement Longitudinal Study to examine the impact of bereavement on mental health and quality of life among a sample of mid- and older-aged adults. We use propensity score matching to construct a matching sample and difference-in-differences method to estimate the impact of bereavement on mental health and self-assessed health. RESULTS We find bereavement is associated with increased depression symptoms among women (1.542 point or 0.229 standard deviations of Center for Epidemiologic Studies Depression (CES-D) 10 score) but not consistently for men over time. No statistically significant effect of bereavement on self-assessed health is found. CONCLUSIONS Our results show a harmful impact of bereavement on mental health among older women in China and point to the need for a comprehensive policy on survivor benefits in China, particularly for rural older women.
Collapse
Affiliation(s)
- Zhuo Chen
- College of Public Health University of Georgia, Wright Hall 305B, 100 Foster Rd, Athens, GA, 30602, USA.
- University of Nottingham Ningbo China, Ningbo, 315100, Zhejiang, China.
| | - Jiahui Ying
- College of Public Health University of Georgia, Wright Hall 305B, 100 Foster Rd, Athens, GA, 30602, USA
| | - Justin Ingles
- College of Public Health University of Georgia, Wright Hall 305B, 100 Foster Rd, Athens, GA, 30602, USA
| | - Donglan Zhang
- College of Public Health University of Georgia, Wright Hall 305B, 100 Foster Rd, Athens, GA, 30602, USA
| | - Janani Rajbhandari-Thapa
- College of Public Health University of Georgia, Wright Hall 305B, 100 Foster Rd, Athens, GA, 30602, USA
| | - Ruoxi Wang
- Huazhong University of Science and Technology of China, Wuhan, 430074, Hubei, China
| | - Kerstin Gerst Emerson
- College of Public Health University of Georgia, Wright Hall 305B, 100 Foster Rd, Athens, GA, 30602, USA
| | - Zhanchun Feng
- Huazhong University of Science and Technology of China, Wuhan, 430074, Hubei, China
| |
Collapse
|
22
|
Liu H, Zhang Z, Choi SW, Langa KM. Marital Status and Dementia: Evidence from the Health and Retirement Study. J Gerontol B Psychol Sci Soc Sci 2020; 75:1783-1795. [PMID: 31251349 PMCID: PMC7489107 DOI: 10.1093/geronb/gbz087] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES We provide one of the first population-based studies of variation in dementia by marital status in the United States. METHOD We analyzed data from the Health and Retirement Study (2000-2014). The sample included 15,379 respondents (6,650 men and 8,729 women) aged 52 years and older in 2000 who showed no evidence of dementia at the baseline survey. Dementia was assessed using either the modified version of the Telephone Interview for Cognitive Status (TICS) or the proxy's assessment. Discrete-time hazard regression models were estimated to predict odds of dementia. RESULTS All unmarried groups, including the cohabiting, divorced/separated, widowed, and never married, had significantly higher odds of developing dementia over the study period than their married counterparts; economic resources and, to a lesser degree, health-related factors accounted for only part of the marital status variation in dementia. For divorced/separated and widowed respondents, the differences in the odds of dementia relative to married respondents were greater among men than among women. DISCUSSION These findings will be helpful for health policy makers and practitioners who seek to better identify vulnerable subpopulations and to design effective intervention strategies to reduce dementia risk.
Collapse
Affiliation(s)
- Hui Liu
- Department of Sociology, Michigan State University, East Lansing
| | - Zhenmei Zhang
- Department of Sociology, Michigan State University, East Lansing
| | - Seung-won Choi
- Department of Sociology, Anthropology, and Social Work, Texas Tech University, Lubbock
| | - Kenneth M Langa
- Department of Internal Medicine, Institute for Social Research and VA Center for Clinical Management Research, University of Michigan, Ann Arbor
| |
Collapse
|
23
|
Rong H, Lai X, Jing R, Wang X, Fang H, Mahmoudi E. Association of Sensory Impairments With Cognitive Decline and Depression Among Older Adults in China. JAMA Netw Open 2020; 3:e2014186. [PMID: 32990739 PMCID: PMC7525357 DOI: 10.1001/jamanetworkopen.2020.14186] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
IMPORTANCE Sensory impairments may heighten the risk of premature brain aging. Little is known regarding the association of sensory impairments with cognitive function and depression in China. OBJECTIVE To examine the association of visual and/or hearing impairments with cognitive decline and depression. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used the data from 18 038 respondents to the 2015 survey of the China Health and Retirement Longitudinal Study, a nationally representative survey of adults aged 45 years or older and their spouses. EXPOSURES The presence of sensory impairments was identified by self-reported assessment of visual and/or hearing functions. MAIN OUTCOMES AND MEASURES Overall, 3 composite measures were used to assess the respondents' cognitive performance, including episodic memory, mental intactness, and global cognitive function. Depression was examined using the 10-item Center for Epidemiological Studies-Depression scale score. Multiple generalized linear regression models, adjusting for self-reported sociodemographic characteristics, health behaviors, chronic conditions, and participants' overall health, were used. RESULTS Of 18 038 respondents, 9244 (51.2%) were women. The mean (SD) age was 59.9 (9.7) years. Respondents with visual impairment had poorer episodic memory (β = -0.12; 95% CI, -0.19 to -0.05) and global cognition (β = -0.16; 95% CI, -0.31 to -0.02) and a greater risk of depression (odds ratio, 1.78; 95% CI, 1.59 to 1.99) than those without visual impairment. Respondents with hearing impairment had poorer episodic memory (β = -0.24; 95% CI, -0.30 to -0.18), mental intactness (β = -0.19; 95% CI, -0.28 to -0.10), and global cognition (β = -0.43; 95% CI, -0.55 to -0.31) as well as a greater risk of depression (odds ratio, 1.57; 95% CI, 1.44 to 1.70) than those without hearing impairment. People who reported dual sensory impairment performed worse on all of the aforementioned outcome measures (episodic memory: β = -0.23; 95% CI, -0.31 to -0.14; mental intactness: β = -0.13; 95% CI, -0.27 to -0.0003; global cognition: β = -0.37; 95% CI, -0.55 to -0.19; depression: odds ratio, 2.19; 95% CI, 1.90 to 2.52). CONCLUSIONS AND RELEVANCE In this study, visual and hearing impairments were independently and together associated with poorer cognitive and depression outcomes. A more comprehensive and integrated system of care, covering vision, hearing, and cognition, is needed in China's health care system to address age-related sensory impairments.
Collapse
Affiliation(s)
- Hongguo Rong
- China Center for Health Development Studies, Peking University, Beijing, China
- Institute for Excellence in Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Xiaozhen Lai
- China Center for Health Development Studies, Peking University, Beijing, China
- Peking University School of Public Health, Beijing, China
| | - Rize Jing
- China Center for Health Development Studies, Peking University, Beijing, China
- Peking University School of Public Health, Beijing, China
| | - Xiao Wang
- Beijing Key Laboratory of Mental Disorders, The National Clinical Research Center for Mental Disorders, Anding Hospital, Capital Medical University, Beijing, China
| | - Hai Fang
- China Center for Health Development Studies, Peking University, Beijing, China
- Peking University Health Science Center, Chinese Center for Disease Control and Prevention Joint Center for Vaccine Economics, Beijing, China
- Key Laboratory of Reproductive Health, National Health Commission of the People’s Republic of China, Beijing, China
| | - Elham Mahmoudi
- Department of Family Medicine, University of Michigan, Ann Arbor
| |
Collapse
|
24
|
Ying G, Vonk JMJ, Sol K, Brickman AM, Manly JJ, Zahodne LB. Family Ties and Aging in a Multiethnic Cohort. J Aging Health 2020; 32:1464-1474. [PMID: 32600080 DOI: 10.1177/0898264320935238] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objective: Lack of social support is linked to lower cognitive function and cognitive decline. We investigated the effects of a specific type of social relationship, family ties, on cognitive trajectories in non-Hispanic whites, non-Hispanic blacks, and Hispanics. Methods: Using multiple-group latent growth curve models, we analyzed associations between the number of children/grandchildren/siblings/other relatives contacted within the past month at baseline and cognitive trajectories in 1420 older adults who were nondemented at baseline. Language, memory, and visuospatial abilities were assessed at baseline and at 18- and 24-month follow-ups for up to six visits. Inferential analyses assessed the differential effects of sex/gender and race/ethnicity for each family tie. Results: Independent of all covariates, contact with more relatives was associated with better initial memory (b = .01) and language functioning (b = .01) across race/ethnicity and sex/gender. Conclusion: The size of peripheral rather than immediate family networks may be more likely to affect cognitive function in older adults.
Collapse
Affiliation(s)
- Gelan Ying
- 171553Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, NY, USA
| | - Jet M J Vonk
- 171553Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, NY, USA.,168086Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Adam M Brickman
- 171553Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, NY, USA
| | - Jennifer J Manly
- 171553Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, NY, USA
| | | |
Collapse
|
25
|
Biddle KD, Jacobs HIL, d’Oleire Uquillas F, Zide BS, Kirn DR, Properzi MR, Rentz DM, Johnson KA, Sperling RA, Donovan NJ. Associations of Widowhood and β-Amyloid With Cognitive Decline in Cognitively Unimpaired Older Adults. JAMA Netw Open 2020; 3:e200121. [PMID: 32101313 PMCID: PMC7099624 DOI: 10.1001/jamanetworkopen.2020.0121] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
IMPORTANCE To reduce the rising incidence of clinical impairment due to Alzheimer disease, it is essential to define older adults at highest risk. Widowhood may be an unrecognized factor contributing to accelerated clinical progression along the Alzheimer disease pathway among cognitively unimpaired older adults. OBJECTIVE To determine whether widowhood status and level of brain β-amyloid (ie, the Alzheimer disease pathologic protein) are additively or interactively associated with cognitive decline among cognitively unimpaired older adults. DESIGN, SETTING, AND PARTICIPANTS In this cohort study, 257 married, widowed, and unmarried (ie, never married, divorced, or separated) participants from the Harvard Aging Brain Study longitudinal cohort underwent baseline evaluation of neocortical β-amyloid levels using Pittsburgh compound B positron emission tomography and 4 annual cognitive assessments. Data were collected from September 2010 to February 2017 and analyzed from July 2018 to July 2019. MAIN OUTCOMES AND MEASURES Cognitive performance was measured using the Preclinical Alzheimer Cognitive Composite. RESULTS Of the 257 participants, 153 (59.5%) were women, and the mean (SD) age was 73.5 (6.1) years; 145 participants (56.4%) were married (66 [45.5%] women), 77 (30.0%) were unmarried (56 [72.7%] women), and 35 (13.6%) were widowed (31 [88.6%] women). Compared with married participants, widowed participants demonstrated worsening cognitive performance after adjusting for age, sex, socioeconomic status, depression, and β-amyloid levels (β = -0.11; 95% CI, -0.19 to -0.04; P = .002) with no difference observed between married and unmarried participants. Furthermore, widowed participants with higher baseline β-amyloid levels exhibited steeper cognitive decline (β = -0.22; 95% CI, -0.42 to -0.03; P = .02), indicating both independent and interactive associations of β-amyloid levels and widowhood with cognition. In a secondary model using dichotomous β-amyloid-marital status groupings, the rate of cognitive decline among widowed participants with high β-amyloid was nearly 3 times faster than among married participants with high β-amyloid (widowed, high β-amyloid: β, -0.33; 95% CI, -0.46 to -0.19; P < .001; married, high β-amyloid: β, -0.12; 95% CI, -0.18 to -0.01; P < .001). CONCLUSIONS AND RELEVANCE In a sample of cognitively unimpaired older adults, being widowed was associated with accelerated β-amyloid-related cognitive decline during 3 years. Cognitively unimpaired, widowed older adults were particularly susceptible to Alzheimer disease clinical progression, emphasizing the need for increased research attention and evidenced-based interventions for this high-risk group.
Collapse
Affiliation(s)
- Kelsey D. Biddle
- Division of Geriatric Psychiatry, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Heidi I. L. Jacobs
- School for Mental Health and Neuroscience, Alzheimer Centre, Limburg, Maastricht University, Maastricht, the Netherlands
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Federico d’Oleire Uquillas
- Princeton Neuroscience Institute, Princeton, New Jersey
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Benjamin S. Zide
- Division of Geriatric Psychiatry, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Dylan R. Kirn
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Michael R. Properzi
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Dorene M. Rentz
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston
- Department of Neurology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Keith A. Johnson
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston
- Department of Neurology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Reisa A. Sperling
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston
- Department of Neurology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Nancy J. Donovan
- Division of Geriatric Psychiatry, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Neurology, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston
| |
Collapse
|
26
|
Gyasi RM, Phillips DR, David R. Explaining the gender gap in health services use among Ghanaian community-dwelling older cohorts. Women Health 2019; 59:1089-1104. [DOI: 10.1080/03630242.2019.1587666] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Razak M. Gyasi
- African Population and Health Research Center (APHRC), Nairobi, Kenya
| | - David R. Phillips
- Department of Sociology and Social Policy, Lingnan University, Tuen Mun, Hong Kong
| | - Roman David
- Department of Sociology and Social Policy, Lingnan University, Tuen Mun, Hong Kong
| |
Collapse
|