Social environment effects on health and aging: integrating epidemiologic and demographic approaches and perspectives

Preparing the Younger Generation for an Aging Society: Strategies, Challenges, and Opportunities

The global demographic landscape is experiencing a monumental shift as populations age, driven by advances in healthcare and declining birth rates. This transition underscores the need to prepare the younger generation to navigate and contribute effectively to an aging society. This manuscript comprehensively reviews strategies to equip younger generations with the requisite knowledge, skills, and empathy to support an aging population. This study identifies critical challenges and opportunities in fostering intergenerational solidarity and understanding through an extensive analysis of existing literature and innovative educational programs. The review highlights the importance of early education, community engagement, and policy interventions in bridging the generational divide. Additionally, it explores the role of technology and digital media in facilitating awareness and empathy among young people. Key findings suggest that incorporating aging-related content into educational curricula, promoting volunteerism, and implementing supportive policies can significantly enhance the younger generation's readiness to support an aging society. The manuscript concludes with recommendations for future research and practical steps for educators, policymakers, and community leaders to foster a more inclusive and age-friendly environment. By preparing the younger generation today, we can build a more cohesive and supportive society for tomorrow.

Does the community service environment affect the willingness of older adults people to socialize for older adults care?

Population ageing is a significant trend in social development and will remain a fundamental national condition in China for the foreseeable future. Socialized older adults care has become a crucial strategy for China to address population ageing. However, the current levels of acceptance and willingness to seek socialized older adults care among older adults are relatively low. This study focuses on examining how the community environment and services influence older adults people's willingness to engage in social activities related to older adults care. Using data from the China Longitudinal Ageing Social Survey (CLASS) (N = 9,657), this study investigated the impact of the community service environment on older adults people's willingness to participate in social activities related to older adults care through a logit model. The study revealed that 9.15% of older adults (N = 9,657) in China are willing to engage in social activities related to older adults care. Furthermore, the individual characteristics and family support of older adults play a significant role in shaping their willingness to engage in older adults care. The provision of medical services, daily care services, and entertainment venues by the community positively influence older adults people's willingness to participate in social activities related to older adults care (p < 0.01), whereas psychological counselling services have a negative impact (p < 0.01). The impact of community services on older adults people's willingness to engage in social activities related to older adults care varies due to factors such as smoking and chronic diseases. These findings provide valuable insights for improving older adults' social engagement in China.

Cumulative Stress Across the Life Course and Biological Aging in Adulthood

OBJECTIVE

Psychosocial stressors have been linked with accelerated biological aging in adults; however, few studies have examined stressors across the life course in relation to biological aging.

METHODS

In 359 individuals (57% White, 34% Black) from the Child Health and Development Studies Disparities study, economic (income, education, financial strain), social (parent-child relations, caretaker responsibilities) and traumatic (death of a sibling or child, violence exposure) stressors were assessed at multiple time points (birth and ages 9, 15, and 50 years). Experiences of major discrimination were assessed at age 50. Life period stress scores were then assessed as childhood (birth-age 15 years) and adulthood (age 50 years). At age 50 years, participants provided blood samples, and DNA methylation was assessed with the EPIC BeadChip. Epigenetic age was estimated using six epigenetic clocks (Horvath, Hannum, Skin and Blood age, PhenoAge, GrimAge, Dunedin Pace of Aging). Age acceleration was determined using residuals from regressing chronologic age on each of the epigenetic age metrics. Telomere length was assessed using the quantitative polymerase chain reaction-based methods.

RESULTS

In linear regression models adjusted for race and gender, total life stress, and childhood and adult stress independently predicted accelerated aging based on GrimAge and faster pace of aging based on the DunedinPace. Associations were attenuated after adjusting for smoking status. In sex-stratified analyses, greater childhood stress was associated with accelerated epigenetic aging among women but not men. No associations were noted with telomere length.

CONCLUSIONS

We found that cumulative stressors across the life course were associated with accelerated epigenetic age, with differences by sex (e.g., accelerated among women). Further research of this association in large and diverse samples is needed.

Impact of COVID-19 pandemic on mortality and cognitive function of dementia patients: Tochigi Dementia Cohort Study

OBJECTIVES

The coronavirus disease 2019 pandemic significantly affected Japanese society and the health of its population. Despite this, few studies have evaluated the influence of the pandemic on patients with neurological diseases or dementia, which we assessed through the Tochigi Dementia Cohort Study.

METHODS

Participants were divided into two groups. The pre-pandemic group included patients who were enrolled from December 1, 2016 to November 30, 2018, and were followed up until November 30, 2019 (i.e., before the pandemic). The post-pandemic group included patients who were enrolled from December 1, 2019 to November 30, 2021, and were followed up until November 30, 2022 (i.e., during the pandemic). We recorded their age, sex, mortality, and treatment withdrawal during the follow-up period. Furthermore, we examined their cognitive function at the baseline, and after 6 and 12 months.

RESULTS

A total of 384 patients were enrolled in this study, including 199 patients in the pre-pandemic group and 185 in the post-pandemic group. The mortality of dementia patients was significantly higher in the post-pandemic group than in the pre-pandemic group" (5.3% vs. 18.5%, p < 0.05*). The cognitive function scores at 12 months were also significantly lower in the dementia patients of the post-pandemic group than in those of the pre-pandemic group (p < 0.05*).

CONCLUSIONS

This longitudinal cohort study conducted in a local Japanese area revealed that mortality rate and cognitive function worsened in dementia patients during the pandemic.

Social support and cognitive activity and their associations with incident cognitive impairment in cognitively normal older adults

OBJECTIVES

To explore the associations of social support, and cognitive activity with cognitive impairment incidence, and further examine the mediation effect of cognitive activity on the association between social support and cognitive impairment incidence based on a nationwide elderly Chinese cohort.

METHODS

We collected the participants from an ongoing cohort of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). A total of 9394 older adults aged 65 or more years and free of cognitive impairment who participated in the CLHLS between 2008 and 2018 were included. The information on social support and cognitive activity was collected through a questionnaire. The incident cognitive impairment cases were identified through the Mini-Mental State Examination scale (MMSE). Cox proportional hazard regression models were conducted to calculate the hazard ratios (HRs) and 95% confidence interval (CI) of social support and cognitive activity associated with cognitive impairment. We used casual mediation models to assess the indirect association of cognitive activities underlying the association between social support and cognitive impairment.

RESULTS

The adjusted HRs (95% CI) of incident cognitive impairment were 0.956 (0.932 to 0.980), and 0.895 (0.859 to 0.933) associated with per 1 score increase in social support and cognitive activity score, respectively. Better adherence to social support was associated with a higher cognitive activity score (adjusted β = 0.046, 95% CI[0.032-0.060]). The baseline cognitive activity, as well as the mean cognitive activity at baseline and during the first follow-up wave, mediate the association between social support and the incidence of cognitive impairment, accounting for 11.4% and 12.6% of the total association, respectively. The participants who were aged 80 years or older, or those with mild daily functional limitations gained more benefits in the development of cognitive activity related to social support, leading to a reduction in the risks of cognitive impairment.

CONCLUSION

The results of this nationwide cohort provide consistent evidence linking social support, and cognitive activity to reduced risk of subsequent cognitive impairment incidence. These findings provide additional evidence to inform the social strategies to prevent cognitive impairment incidence in elderly people.

Effects of Episodic Food Insecurity on Psychological and Physiological Responses in African American Women With Obesity (RESPONSES): Protocol for a Longitudinal Observational Cohort Study

BACKGROUND

Food insecurity is a risk factor for multiple chronic diseases, including obesity. Importantly, both food insecurity and obesity are more prevalent in African American women than in other groups. Furthermore, food insecurity is considered a cyclic phenomenon, with episodes of food adequacy (ie, enough food to eat) and food shortage (ie, not enough food to eat). More research is needed to better understand why food insecurity is linked to obesity, including acknowledging the episodic nature of food insecurity as a stressor and identifying underlying mechanisms.

OBJECTIVE

The objective of this study is to investigate the episodic nature of food insecurity as a stressor via responses in body weight and psychological and physiological parameters longitudinally and do so in a health-disparate population-African American women.

METHODS

We enrolled 60 African American women (food-insecure cohort: n=30, 50%; food-secure cohort: n=30, 50%) aged 18-65 years with obesity (BMI 30-50 kg/m2) to measure (1) daily body weight remotely over 22 weeks and (2) psychological and physiological parameters via clinic assessments at the beginning and end of the 22-week study. Furthermore, we are assessing episodes of food insecurity, stress, hedonic eating, and appetite on a weekly basis. We hypothesize that food-insecure African American women with obesity will demonstrate increased body weight and changes in psychological and physiological end points, whereas food-secure African American women with obesity will not. We are also examining associations between changes in psychological and physiological parameters and changes in body weight and performing a mediation analysis on the psychological parameters assessed at the study midpoint. Psychological questionnaires are used to assess stress; executive function, decision-making, and motivation; and affect and nonhomeostatic eating. Physiological measurements are used to evaluate the levels of cortisol, dehydroepiandrosterone-sulfate (DHEA-S), C-reactive protein, thyroid hormones, blood glucose, glycated hemoglobin, and insulin, as well as allostatic load.

RESULTS

This study has completed participant recruitment (n=60). At the time of study enrollment, the mean age of the participants was almost 47 (SD 10.8) years, and they had a mean BMI of 39.6 (SD 5.31) kg/m2. All data are anticipated to be collected by the end of 2023.

CONCLUSIONS

We believe that this is the first study to examine changes in body weight and psychological and physiological factors in food-insecure African American women with obesity. This study has significant public health implications because it addresses the cyclic nature of food insecurity to identify underlying mechanisms that can be targeted to mitigate the adverse relationship between food insecurity and obesity and reduce health disparities in minority populations.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05076487; https://clinicaltrials.gov/study/NCT05076487.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/52193.

Model Clinic to Increase Preventive Screenings Among Patients With Physical Disabilities: Protocol for a Mixed Methods Intervention Pilot Study

BACKGROUND

People with physical disabilities often experience premature multimorbidity and adverse health events. A tailored primary care approach for this vulnerable population that also accounts for social and functional risk factors could promote healthier aging and more equitable health care.

OBJECTIVE

This project will evaluate the implementation of a health program designed for people with physical disabilities. The proposed evaluation result is to generate the first best-practice protocol focused specifically on developing primary care to help reduce preventable causes of morbidity and improve functioning among people with physical disabilities.

METHODS

We will design and implement a pilot health program for people with physical disabilities at a primary care clinic within Michigan Medicine. The health program for people with physical disabilities will be an integrated intervention involving a tailored best practice alert designed to prompt family medicine providers to screen and monitor for common, preventable health conditions. The program will also collect social and functional status information to determine the patient's need for further care coordination and support. Adult participants from this clinic with identified physical disabilities will be targeted for potential enrollment. To create a quasi-experimental setting, a separate departmental clinic will serve as a control site for comparison purposes. A quantitative analysis to estimate the treatment effect of implementing this health program will be conducted using a difference-in-differences approach. Outcomes of interest will include the use of preventative services (eg, hemoglobin A1c for diabetes screening), social work assistance, and emergency and hospital services. These data will be extracted from electronic health records. Time-invariant covariates, particularly sociodemographic covariates, will be included in the models. A qualitative analysis of patient and health care provider interviews will also be completed to assess the effect of the health program. Patient Health Questionnaire-9 and Generalized Anxiety Disorder 7-item scores will be assessed to both screen for depression and anxiety as well as explore program impacts related to addressing health and functioning needs related to physical disabilities in a primary care setting. These will be summarized through descriptive analyses.

RESULTS

This study was funded in September 2018, data collection started in September 2021, and data collection is expected to be concluded in September 2023.

CONCLUSIONS

This study is a mixed methods evaluation of the effectiveness of an integrated health program designed for people with physical disabilities, based on a quasi-experimental comparison between an intervention and a control clinic site. The intervention will be considered successful if it leads to improvements in greater use of screening and monitoring for preventable health conditions, increased social worker referrals to assist with health and functioning needs, and improvements in emergency and hospital-based services. The findings will help inform best practices for people with physical disabilities in a primary care setting.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/50105.

Active Aging and Smart Public Parks

The global population is aging, with the percentage of people over 60 expected to rise from 12% to 22% and 33% residing in developed countries. However, most cities lack the appropriate infrastructure to support aging citizens in active aging and traversing the urban landscape, negatively impacting their quality of life. Studies have shown that public parks and green spaces can contribute to a higher quality of life and wellbeing. Also, smart cities are intended to improve the wellbeing and health of their inhabitants. However, most solutions are typically implemented indoors and tend to overlook the needs of older adults. A smart city should consider the increasing rate of aging and give more importance to outdoor environments as a key aspect of quality of life. The article's main purpose is to provide a comprehensive background to understand the current knowledge on smart public parks and highlight the significance of new research in the field to promote active aging. The article is expected to inspire new research ideas by identifying gaps in knowledge. Open and challenging issues in emerging smart park solutions are proposed for further work.

Integrating the social environment with an equity perspective into the exposome paradigm: A new conceptual framework of the Social Exposome

The importance of the social environment and social inequalities in disease etiology is well-known due to the profound research and conceptual framework on social determinants of health. For a long period, in exposome research with its classical orientation towards detrimental health effects of biological, chemical, and physical exposures, this knowledge remained underrepresented. But currently it gains great awareness and calls for innovations in rethinking the role of social environmental health determinants. To fill this gap that exists in terms of the social domain within exposome research, we propose a novel conceptual framework of the Social Exposome, to integrate the social environment in conjunction with the physical environment into the exposome concept. The iterative development process of the Social Exposome was based on a systematic compilation of social exposures in order to achieve a holistic portrayal of the human social environment - including social, psychosocial, socioeconomic, sociodemographic, local, regional, and cultural aspects, at individual and contextual levels. In order to move the Social Exposome beyond a mere compilation of exposures, three core principles are emphasized that underly the interplay of the multitude of exposures: Multidimensionality, Reciprocity, and Timing and continuity. The key focus of the conceptual framework of the Social Exposome is on understanding the underlying mechanisms that translate social exposures into health outcomes. In particular, insights from research on health equity and environmental justice have been incorporated to uncover how social inequalities in health emerge, are maintained, and systematically drive health outcomes. Three transmission pathways are presented: Embodiment, Resilience and Susceptibility or Vulnerability, and Empowerment. The Social Exposome conceptual framework may serve as a strategic map for, both, research and intervention planning, aiming to further explore the impact of the complex social environment and to alter transmission pathways to minimize health risks and health inequalities and to foster equity in health.

Relationship between job stress and impaired fasting glucose in male steel industry workers: a cross-sectional study

Background

The purpose of this study is to investigate the relationship between job stress and impaired fasting glycemia (IFG) of male workers in a manufacturing industry.

Methods

Data were collected from 5,886 male workers in a manufacturing industry who participated in the medical examination from June 19 to August 14, 2020 through self-reported questionnaires. The general characteristics of the subjects, shift work, high blood pressure, dyslipidemia, and job stress were included. Job stress was measured using the Korean Occupational Stress Scale (KOSS) consisting of 8 items and 43 questions. Multivariable logistic regression analysis was used to investigate the IFG association with job stress.

Results

Among the various factors that can cause job stress, only high job demand was associated with a risk of IFG (odds ratio, 1.43; 95% confidence interval, 1.13-1.82) especially in non-shift worker. For all other factors, no statistically significant results were obtained.

Conclusions

In this study of male workers engaged in the Korean steel manufacturing industry, the 'job demand' item among job stress of non-shift worker was related to IFG.

An Examination of the Joint Effect of the Social Environment and Air Pollution on Dementia Among US Older Adults

Evidence suggests exposure to air pollution increases the risk of dementia. Cognitively stimulating activities and social interactions, made available through the social environment, may slow cognitive decline. We examined whether the social environment buffers the adverse effect of air pollution on dementia in a cohort of older adults.

Methods

This study draws from the Ginkgo Evaluation of Memory Study. Participants aged 75 years and older were enrolled between 2000 and 2002 and evaluated for dementia semi-annually through 2008. Long-term exposure to particulate matter and nitrogen dioxide was assigned from spatial and spatiotemporal models. Census tract-level measures of the social environment and individual measures of social activity were used as measures of the social environment. We generated Cox proportional hazard models with census tract as a random effect and adjusted for demographic and study visit characteristics. Relative excess risk due to interaction was estimated as a qualitative measure of additive interaction.

Results

This study included 2,564 individuals. We observed associations between increased risk of dementia and fine particulate matter (µg/m3), coarse particulate matter (µg/m3), and nitrogen dioxide (ppb); HRs per 5 unit increase were 1.55 (1.01, 2.18), 1.31 (1.07, 1.60), and 1.18 (1.02, 1.37), respectively. We found no evidence of additive interaction between air pollution and the neighborhood social environment.

Conclusions

We found no consistent evidence to suggest a synergistic effect between exposure to air pollution and measures of the social environment. Given the many qualities of the social environment that may reduce dementia pathology, further examination is encouraged.

Social support and cognitive function in Chinese older adults who experienced depressive symptoms: is there an age difference?

Objective

This study examined the moderating effect of overall social support and the different types of social support on cognitive functioning in depressed older adults. We also investigated whether the moderating effect varied according to age.

Methods

A total of 2,500 older adults (≥60 years old) from Shanghai, China were enrolled using a multistage cluster sampling method. Weighted linear regression and multiple linear regression was utilized to analyze the moderating effect of social support on the relationship between depressive symptoms and cognitive function and to explore its differences in those aged 60-69, 70-79, and 80 years and above.

Results

After adjusting for covariates, the results indicated that overall social support (β = 0.091, p = 0.043) and support utilization (β = 0.213, p < 0.001) moderated the relationship between depressive symptoms and cognitive function. Support utilization reduced the possibility of the cognitive decline in depressed older adults aged 60-69 years (β = 0.310, p  < 0.001) and 80 years and above (β = 0.199, p  < 0.001), while objective support increased the possibility of cognitive decline in depressed older people aged 70-79 years (β = -0.189, p  < 0.001).

Conclusion

Our findings highlight the buffering effects of support utilization on cognitive decline in depressed older adults. We suggest that age-specific measures should be taken when providing social support to depressed older adults in order to reduce the deterioration of cognitive function.

[Touch, a crucial sense in social interactions to improve homeostasis in aging and promote healthy longevity]

Aging is associated with the generalized deterioration of the organism, being of great relevance experienced by homeostatic systems such as the nervous, immune, and endocrine systems, which increases the risk of morbidity and mortality. Among the lifestyle strategies that have been researched to improve these systems and achieve greater healthy longevity, this review will focus on the social environment. In order to verify the effectiveness of these both in the improvement of homeostasis and in life expectancy, the research carried out with experimental animals that have allowed this to be done will be discussed. In addition, as it has been observed that physical contact is crucial for the positive outcomes of social interaction on homeostatic systems and longevity to occur, we will focus on that mechanism, as well as some of the possible molecular pathways underlying the effects found.

A non-pharmacological multidomain intervention of dual-task exercise and social activity affects the cognitive function in community-dwelling older adults with mild to moderate cognitive decline: A randomized controlled trial

The present study aimed to determine the impact of a 10-month multidomain program using dual-task exercise and social activity conducted at a community-based facility on improved cognitive function in older adults with mild to moderate cognitive decline. The participants included 280 community-dwelling older adults (age 71–91 years) with mild to moderate cognitive decline. The intervention group exercised for 90 min/day, once a week. Their routine included aerobic exercise and dual-task training which cognitive tasks were performed in combination with exercise. The control group attended health education classes thrice. Before and after the intervention, we measured their cognitive function, physical function, daily conversation, and physical activity. The mean adherence rate of the intervention class was 83.0%. According to a repeated-measures multivariate analysis of covariance in an intent-to-treat analysis, logical memory and 6-min walking distance demonstrated a significant time and group interaction effect. Regarding daily physical activities, we observed significant differences in the daily step count and moderate-to-vigorous physical activity in the intervention group. Our non-pharmacological multidomain intervention resulted in a modest improvement in the cognitive or physical function and building health behavior. It may be a helpful program with a potential role in preventing dementia.

Clinical Trial Registration: http://clinicaltrials.gov Identifier ID: UMIN000013097.

The neighborhood context and all-cause mortality among older adults in Puerto Rico

Background

Recent efforts have been made to collect data on neighborhood-level attributes and link them to longitudinal population-based surveys. These linked data have allowed researchers to assess the influence of neighborhood characteristics on the health of older adults in the US. However, these data exclude Puerto Rico. Because of significantly differing historical and political contexts, and widely ranging structural factors between the island and the mainland, it may not be appropriate to apply current knowledge on neighborhood health effects based on studies conducted in the US to Puerto Rico. Thus, we aim to (1) examine the types of neighborhood environments older Puerto Rican adults reside in and (2) explore the association between neighborhood environments and all-cause mortality.

Methods

We linked data from the 2000 US Census to the longitudinal Puerto Rican Elderly Health Conditions Project (PREHCO) with mortality follow-up through 2021 to examine the effects of the baseline neighborhood environment on all-cause mortality among 3,469 participants. Latent profile analysis, a model-based clustering technique, classified Puerto Rican neighborhoods based on 19 census block group indicators related to the neighborhood constructs of socioeconomic status, household composition, minority status, and housing and transportation. The associations between the latent classes and all-cause mortality were assessed using multilevel mixed-effects parametric survival models with a Weibull distribution.

Results

A five-class model was fit on 2,477 census block groups in Puerto Rico with varying patterns of social (dis)advantage. Our results show that older adults residing in neighborhoods classified as Urban High Deprivation and Urban High-Moderate Deprivation in Puerto Rico were at higher risk of death over the 19-year study period relative to the Urban Low Deprivation cluster, controlling for individual-level covariates.

Conclusions

Considering Puerto Rico's socio-structural reality, we recommend that policymakers, healthcare providers, and leaders across industries to (1) understand how individual health and mortality is embedded within larger social, cultural, structural, and historical contexts, and (2) make concerted efforts to reach out to residents living in disadvantaged community contexts to understand better what they need to successfully age in place in Puerto Rico.

Skin-to-Skin Contact: Crucial for Improving Behavior, Immunity, and Redox State after Short Cohabitation of Chronologically Old Mice and Prematurely Aging Mice with Adult Mice

(1) Background: Aging is characterized by a deterioration of the homeostatic systems, namely the nervous and immune systems. The rate of aging can be modified by lifestyle factors such as social interactions. Recently, improvements in behavior, immune function, and oxidative state were observed in adult prematurely aging mice (PAM) and chronologically old mice after cohabitation with exceptional non-PAM (E-NPAM) and adult mice, respectively, for 2 months. However, the cause of this positive effect is not known. The objective of the present work was to study whether skin-to-skin contact promotes these improvements both in chronologically old mice and in adult PAM. (2) Methods: Old and adult CD1 female mice were used as well as adult PAM and E-NPAM. After cohabitation for 15 min/day for 2 months (two old mice or PAM with five adult mice or E-NPAM, respectively, with both non- and skin-to-skin contact), several behavioral tests were performed and functions and oxidative stress parameters in peritoneal leukocytes were analyzed. (3) Results: This social interaction improved behavioral responses, immune functions, redox state, and longevity, but only if the animals had skin-to-skin contact. (4) Conclusions: Physical contact seems to be crucial to experiencing the positive effects of social interaction.

Association between social integration and risk of dementia: A systematic review and meta-analysis of longitudinal studies

BACKGROUND

Dementia is an emerging public health issue. Growing evidence emerged on the association between social integration and the risk of dementia. However, the magnitude of the association between different aspects of social integration and the risk of dementia is unclear.

METHODS

Five databases were systematically searched. Newcastle-Ottawa scale for assessing the quality of the reporting was used for quality appraisal. Longitudinal cohort studies examining the association between social integration and the risk of dementia were analyzed using random effects model. A series of sensitivity analyses was conducted to enhance the robustness of the findings.

RESULTS

Forty publications generated from 32 studies/databases were included. The meta-analysis showed that strong social engagement (overall RR = 0.81, 95% CI = 0.74-0.89, p < 0.001) and frequent social contact (overall RR = 0.86, 95% CI = 0.76-0.97, p = 0.018) were positively associated with decreased risk of dementia. The influence of social support (overall RR = 0.92, 95% CI = 0.80-1.06, p = 0.238) and close social contact (overall RR = 0.74, 95% CI = 0.48-1.13, p = 0.167) was not significant. Loneliness was significantly associated with an increased risk of dementia (overall RR = 1.42, 95% CI = 1.26-1.60, p < 0.001), whereas the influence of social isolation (overall RR = 1.58, 95% CI = 0.80-3.12, p = 0.192) was not significant. A larger social network size (RR = 0.75, 95% CI = 0.59-0.97, p = 0.028) was a promising influencing factor even though the number of studies was insufficient for a meta-analysis. However, the heterogeneity among studies was generally high even though sensitivity analysis was conducted.

CONCLUSIONS

Our findings reveal that high social engagement and frequent social contact are significantly associated with a lower risk of dementia, whereas loneliness is associated with a higher risk. The promising impact of large social network size is also identified. Substantial heterogeneity appeared in most of the analysis, making the inference tentative. Nevertheless, the sensitivity analysis provided valuable implications that enhancing social engagement and reducing loneliness may prevent or delay the onset of dementia among middle-aged and older adults.

Achieving and sustaining behavior change for older adults: A Research Centers Collaborative Network workshop report

Modifying unhealthy behaviors and/or environments may improve or maintain an older adult's health. However, achieving and sustaining behavior change is challenging and depends upon clinical, social, psychological, and political domains. In an effort to highlight the multidisciplinary nature of behavior change, the NIA Research Centers Collaborative Network (RCCN) held a two-day workshop, Achieving and sustaining behavior change for older adults. The workshop was informed by the socioecological model and designed to initiate dialogue around individual, community, and systems-level determinants of behavior change. This paper summarizes key topics presented during the workshop, discusses opportunities for future research, education, and training, and recommends how each of the six NIA research centers may pursue work in behavior change for older adults.

A Predictive Model of Regional Dementia Prevalence Using Geographic Weighted Regression Analysis

Globally, dementia is one of the highest priority public health policy issues. This study was conducted to analyze the spatial distribution pattern of dementia prevalence using geographic weighted regression analysis and to identify preventable risk factors at the regional level of dementia prevalence. For the data to be analyzed, this work used the 2020 regional dementia prevalence index of the Korea Central Dementia Center and the regional health statistics of the Korea Centers for Disease Control and Prevention Agency (KDCA). Spatial autocorrelation analysis, hot spot analysis, and geographic weighted regression analysis were performed to identify regional associations of dementia prevalence, cluster regions with high dementia prevalence, and risk factors for regional dementia prevalence. As a result of the hot spot analysis, the regions corresponding to the hot spots with the high prevalence of dementia were found to be adjacent to each other, such as in Jeonnam, Jeonbuk, and Gyeongbuk, and the regions corresponding to the cold spots with the low prevalence of dementia were adjacent to each other, such as Seoul, Gyeonggi, Incheon, Busan, and Ulsan. The results of geographic weighted regression analysis showed that educational level, walking practice rate, hypertension prevalence, and a low-sodium diet preference were found to be risk factors for the prevalence of dementia. These results suggest that there is a need for a dementia prevalence management strategy to increase the walking practice rate and low-sodium diet preference rate, and decrease the hypertension prevalence, centering on the hot spot area, which is a cluster area with high dementia prevalence. This study is expected to be useful as basic data that can help in prioritizing health policies considering spatial characteristics for community health promotion.

The mediating role of allostatic load in the relationship between early life adversity and cognitive function across the adult lifespan

Early life adversity is consequential for poor cognitive health in mid to late-life. Early life adversity is associated with higher allostatic load, a biological indicator of physiological dysregulation due to cumulative wear-and-tear from chronic stress. Higher allostatic load is also associated with poorer cognitive function across the lifespan. To date, a paucity of research has examined allostatic load as a mechanism through which early life adversity impacts cognition in adulthood. Using cross-sectional data from the Midlife in the United States (MIDUS) Study, the objective of the current study was to investigate the mediating role of allostatic load in the relationship between early life adversity and cognitive performance (global cognition, episodic memory, executive function) among middle-aged and older adults without cognitive impairment (n = 1541, M_age=53 ± 12, 53% female). Early life adversity was measured retrospectively using the Childhood Trauma Questionnaire. Allostatic load was composed of 20 biomarker proxies of neuroendocrine, metabolic, inflammatory, and cardiovascular systems, stratified by sex. Cognitive performance was evaluated using a battery of standardized neuropsychological tests. Controlling for age, education, and race, allostatic load significantly mediated the relationship between early life adversity and global cognition (ß=-0.01, 95%CI [-0.01,-0.001]), and early life adversity and executive function (ß=-0.01, 95%CI [-0.01,-0.001]), but not episodic memory. Findings did not change after controlling for lifestyle behaviours and current depression. Consistent with the biopsychosocial lifespan model of cognitive aging, findings suggest that early life adversity may become biologically embedded over time to negatively impact cognitive function in later adulthood in a domain-specific manner.

SOCIAL ENVIRONMENT IMPROVES THE CYTOKINE PROFILE AND LYMPHOPROLIFERATIVE RESPONSE IN CHRONOLOGICALLY OLD AND PREMATURELY AGING MICE

Among the age-associated changes in the immune system, the most evident is the decrease in proliferative responses of lymphocytes to mitogenic stimuli, which is accompanied by the loss of cytokine network homeostasis. Chronic low-grade inflammatory stress, termed as sterile inflammation, is also observed during aging. In chronologically and prematurely aging mice, cohabitation with adult animals for two months favored improvements in several immune functions. This study aimed to determine whether cohabitation could restore several cytokine networks, improve lymphoproliferative responses to mitogens, and diminish sterile inflammation. Chronologically old mice (76±4 weeks) and prematurely aging mice (33±4 weeks) (PAM and TH-HZ) were cohabited with adults (without premature aging) for two months. Subsequently, lymphoproliferation in both basal (unstimulated) conditions and in the presence of mitogenic stimuli lipopolysaccharide A (LPS) or concanavalin A (ConA) was analyzed in cultures of peritoneal leukocytes for 48h. Cytokine secretions (IL-1β, TNF-α, IL-6, IL-10, and IL-17) in these cultures were also evaluated. The results showed that cohabitation restored the levels of these cytokines in old and prematurely aging mice and improved the subsequent lymphoproliferative responses. In addition, this social strategy diminished sterile inflammation and decreased inflammatory stress in unstimulated conditions. Therefore, this strategy seems to be capable of restoring the relevant immune function of lymphocytes and reducing the inflammatory stress, which are the improvements required for an adequate immune response.

The impact of unconditional cash transfers on morbidity and health-seeking behaviour in Africa: evidence from Ghana, Malawi, Zambia and Zimbabwe

Unconditional cash transfers have demonstrated widespread, positive impacts on consumption, food security, productive activities and schooling. However, the evidence to date on cash transfers and health-seeking behaviours and morbidity is not only mixed, but the evidence base is biased towards conditional programmes from Latin America and is more limited in the context of Africa. Given contextual and programmatic design differences between the regions, more evidence from Africa is warranted. We investigate the impact of unconditional cash transfers on morbidity and health-seeking behaviour using data from experimental and quasi-experimental study designs of five government cash transfer programs in Ghana, Malawi, Zambia and Zimbabwe. Programme impacts were estimated using difference-in-differences models with longitudinal data. The results indicate positive programme impacts on health seeking when ill and on health expenditures. Our findings suggest that while unconditional cash transfers can improve health seeking when ill, morbidity impacts were mixed. More research is needed on longer-term impacts, mechanisms of impact and moderating factors. Additionally, taken together with existing evidence, our findings suggest that when summarizing the impacts of cash transfers on health, findings from conditional and unconditional programmes should be disaggregated.

The accelerated aging phenotype: The role of race and social determinants of health on aging

The pursuit to discover the fundamental biology and mechanisms of aging within the context of the physical and social environment is critical to designing interventions to prevent and treat its complex phenotypes. Aging research is critically linked to understanding health disparities because these inequities shape minority aging, which may proceed on a different trajectory than the overall population. Health disparities are characteristically seen in commonly occurring age-associated diseases such as cardiovascular and cerebrovascular disease as well as diabetes mellitus and cancer. The early appearance and increased severity of age-associated disease among African American and low socioeconomic status (SES) individuals suggests that the factors contributing to the emergence of health disparities may also induce a phenotype of 'premature aging' or 'accelerated aging' or 'weathering'. In marginalized and low SES populations with high rates of early onset age-associated disease the interaction of biologic, psychosocial, socioeconomic and environmental factors may result in a phenotype of accelerated aging biologically similar to premature aging syndromes with increased susceptibility to oxidative stress, premature accumulation of oxidative DNA damage, defects in DNA repair and higher levels of biomarkers of oxidative stress and inflammation. Health disparities, therefore, may be the end product of this complex interaction in populations at high risk. This review will examine the factors that drive both health disparities and the accelerated aging phenotype that ultimately contributes to premature mortality.

User perspectives on emotionally aligned social robots for older adults and persons living with dementia

Introduction

Socially assistive robots are devices designed to aid users through social interaction and companionship. Social robotics promise to support cognitive health and aging in place for older adults with and without dementia, as well as their care partners. However, while new and more advanced social robots are entering the commercial market, there are still major barriers to their adoption, including a lack of emotional alignment between users and their robots. Affect Control Theory (ACT) is a framework that allows for the computational modeling of emotional alignment between two partners.

Methods

We conducted a Canadian online survey capturing attitudes, emotions, and perspectives surrounding pet-like robots among older adults (n = 171), care partners (n = 28), and persons living with dementia (n = 7).

Results

We demonstrate the potential of ACT to model the emotional relationship between older adult users and three exemplar robots. We also capture a rich description of participants’ robot attitudes through the lens of the Technology Acceptance Model, as well as the most important ethical concerns around social robot use.

Conclusions

Findings from this work will support the development of emotionally aligned, user-centered robots for older adults, care partners, and people living with dementia.

Social stress and risk of declining cognition: a longitudinal study of men and women in the United States

Limited research is available on the relationship between social stress and risk of declining cognition. We sought to examine whether social stress has adverse effects on risk of declining episodic memory and executive functioning in aging individuals. We used data from the MIDUS study, a national probability sample of non-institutionalized, English speaking respondents aged 25-74 living in the 48 contiguous states of the United States. The initial wave (1995) included 4963 non-institutionalized adults aged 32-84 (M = 55, SD = 12.4). We used an analytic sample from MIDUS-II (1996/1997) and MIDUS-III (2013) (n = 1821). The dependent variables are episodic memory and executive functioning, which were assessed with the Brief Test for Cognition (BTACT). The independent variables were social stress variables (subjective social status, family and marital stress, work stress and discrimination). To evaluate episodic memory and executive functioning changes over a time period of 10 years, we estimated adjusted linear regression models. Women report significantly lower subjective social status and more discrimination stress than men across all age groups. Controlling for education and income, age, and baseline episodic memory and executive functioning, lower subjective social status had additional adverse effects on declines in episodic memory in men and women. Marital risk had adverse effects on episodic memory in men but not in women. Daily discrimination had adverse effects on executive functioning on all individuals. Public health strategies should focus on reducing social stress in a socio-ecological perspective. Especially, subjective social status and discrimination stress might be a target for prevention efforts.

Religious Service Attendance and Mortality among Adults in the United States with Chronic Kidney Disease

Religion and related institutions have resources to help individuals cope with chronic conditions, such as chronic kidney disease (CKD). The purpose of this investigation is to examine the association between religious service attendance and mortality for adults with CKD. Data were drawn from NHANES III linked to the 2015 public use Mortality File to analyze a sample of adults (n = 3558) who had CKD as defined by a single value of estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m² using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation and/or albumin-to-creatinine ratio ≥17 mg/g for males or ≥25 for females. All-cause mortality was the primary outcome and religious service attendance was the primary independent variable. Cox proportional hazards models were estimated to determine the association between religious service attendance and mortality. The mortality risks for participants who attended a service at least once per week were 21% lower than their peers with CKD who did not attend a religious service at all (HR 0.79; CI 0.64–0.98). The association between religious service attendance and mortality in adults with CKD suggest that prospective studies are needed to examine the influence of faith-related behaviors on clinical outcomes in patients with CKD.

A short social interaction between adult and old mice improves the homeostatic systems and increases healthy longevity

The aging process can be influenced by environmental factors, such as the social environment. The continuous cohabitation of the chronologically old mice with adult animals improves them at the behavioral level, immune function, oxidative stress and longevity, but causes a deterioration of these parameters in adults. Therefore, the objective of the study was to study whether the coexistence for only 15 min a day of old mice with adult mice, can produce that improvement and greater longevity in old animals without causing deterioration in adults. For that, old and adult CD1 female mice, after two months of that social interaction, were submitted to a behavioral battery and then peritoneal leukocytes were collected to assess several immune functions, oxidative and inflammatory stress parameters as well as catecholamine concentrations. When the adult mice reached old age, the same parameters were again analyzed. The life span of each animal was also recorded. Plasmatic concentration of oxytocin was also studied. The results showed that old mice presented better behavioral capacity, immunity and oxi-inflammatory state after this social interaction with adult animals, and consequently an extended life span. Adult mice, in general, did not show any changes after social interaction with old animals, but when they achieved old age, improvements of some parameters and of longevity were observed in comparison with animals that never had a that social interaction. In conclusion, a short social interaction between old and adult individuals can be an excellent strategy for improving in both the health state and longevity.

Protective factors for subjective cognitive decline individuals: trajectories and changes in a longitudinal study with Italian elderly

BACKGROUND AND PURPOSE

Many different factors have been hypothesized to modulate cognition in an aging population according to their functioning at baseline.

METHODS

This retrospective study quantifies the relative contribution of age and sex as demographic factors, comorbidity, education and occupation (classified with the International Standard Classification of Occupation 2008) as cognitive reserve proxies in accounting for cognitive aging. All participants (3081) were evaluated at baseline with a complete neuropsychological test battery (T1) and those with unimpaired profiles were classified as subjective cognitive decline, those mildly impaired as mild neurocognitive decline and those severely impaired as major neurocognitive decline. From the first assessment 543 individuals were assessed a second time (T2), and 125 a third time (T3). Depending on whether they maintained or worsened their profile, based on their initial performance, participants were then classified as resistant or declining.

RESULTS

At baseline, all individuals showed education and occupation as the best predictors of performance, in addition to age. Furthermore, across assessments, the resistant had higher levels of education and occupation than the declining. In particular, the education and occupation predicted cognitive performance in all groups considered, from the subjective cognitive decline to the one with the most severely impaired participants.

CONCLUSIONS

This study highlights the role of working activity in protecting from cognitive decline across all fragile elderly groups and even more so the individuals who are at very high risk of decline.

The Role of Immune Cells in Oxi-Inflamm-Aging

Aging is the result of the deterioration of the homeostatic systems (nervous, endocrine, and immune systems), which preserve the organism's health. We propose that the age-related impairment of these systems is due to the establishment of a chronic oxidative stress situation that leads to low-grade chronic inflammation throughout the immune system's activity. It is known that the immune system weakens with age, which increases morbidity and mortality. In this context, we describe how the function of immune cells can be used as an indicator of the rate of aging of an individual. In addition to this passive role as a marker, we describe how the immune system can work as a driver of aging by amplifying the oxidative-inflammatory stress associated with aging (oxi-inflamm-aging) and inducing senescence in far tissue cells. Further supporting our theory, we discuss how certain lifestyle conditions (such as social environment, nutrition, or exercise) can have an impact on longevity by affecting the oxidative and inflammatory state of immune cells, regulating immunosenescence and its contribution to oxi-inflamm-aging.

A biopsychosocial framework for understanding sexual and gender minority health: A call for action

The number of US adults identifying as lesbian, gay, bisexual, transgender, or a different sexual identity has doubled since 2008, and about 40 % of the sexual and gender minority population identify as people of color. Minority stress theory posits that sexual and gender minorities are at particular risk for stress via stigma and discrimination at the structural, interpersonal, and individual levels. This stress, in turn, elevates the risk of adverse health outcomes across several domains. However, there remains a conspicuously limited amount of research on the psychoneuroimmunology of stress among sexual and gender minorities. We developed the Biopsychosocial Minority Stress Framework which posits that sexual minority status leads to unique experiences of minority stress which results in adverse health behavioral factors, elevated psychological distress and sleep disturbance, and immune dysregulation. Moderators in the model include both individual differences and intersectional identities. There is a crucial need to understand the biological-psychological axis of stress among the increasingly visible sexual and gender minority population to increase their health, longevity, and quality of life.

Predicting nonrecovery in adults with incident traffic injuries including post-traumatic headache

IMPORTANCE

The management of traffic injuries is challenging for clinicians. Knowledge about predictors of nonrecovery from traffic injuries may help to improve patient care.

OBJECTIVE

To develop a prediction model for self-reported overall nonrecovery from traffic injuries six months post-collision in adults with incident traffic injuries including post-traumatic headache (PTH).

DESIGN

Inception cohort studies of adults with incident traffic injuries (including PTH) injured in traffic collisions between November 1997 and December 1999 in Saskatchewan, Canada; and between January 2004 and January 2005 in Sweden.

METHODS

Prediction model development and geographical external validation.

SETTING

The Saskatchewan cohort (development) was population-based (N = 4,162). The Swedish cohort (validation) (N = 379) were claimants from two insurance companies covering 20% of cars driven in Sweden in 2004.

PARTICIPANTS

All adults injured in traffic collisions who completed a baseline questionnaire within 30 days of collision. Excluded were those hospitalized > 2 days, lost consciousness > 30 min, or reported headache < 3/10 on the numerical rating scale. Follow-up rates for both cohorts were approximately 80%.

PREDICTORS

Baseline sociodemographic, pre-injury, and injury factors.

OUTCOME

Self-reported nonrecovery from all injuries (not "all better (cured)" on the self-perceived recovery scale) six months after traffic collision.

RESULTS

Both cohorts were predominantly female (69.8% in Saskatchewan, 65.2% in Sweden), with median ages 35.9 years (Saskatchewan), and 38.0 years (Sweden). Predictors were age, low back pain, symptoms in arms or hands, hearing problems, sleeping problems, pre-existing headache, and lower recovery expectations. With a positive score (i.e., ≥0.85 probability), the model can rule in the presence of self-reported nonrecovery from all injuries at six months (development: specificity = 91.3%, 95% CI 89.2%-93.0%; sensitivity = 27.8%, 95% CI 26.0%-29.7%; positive likelihood ratio (LR + ) = 3.2, 95% CI 2.5-4.0; negative likelihood ratio (LR-) = 0.79, 95% CI 0.76-0.82; validation: specificity = 72.6%, 95% CI 61.4%-81.5%; sensitivity = 60.5%, 95% CI 53.9%-66.7%); LR+ = 2.2, 95% CI 1.5-3.3; LR- = 0.5, 95% CI 0.4-0.7).

CONCLUSIONS AND RELEVANCE

In adults with incident traffic injuries including PTH, predictors other than those related to baseline head and neck pain drive overall nonrecovery. Developing and testing interventions targeted at the modifiable predictors may help to improve outcomes for adults after traffic collision.

Understanding COVID-19 dynamics and the effects of interventions in the Philippines: A mathematical modelling study

BACKGROUND

COVID-19 initially caused less severe outbreaks in many low- and middle-income countries (LMIC) compared with many high-income countries, possibly because of differing demographics, socioeconomics, surveillance, and policy responses. Here, we investigate the role of multiple factors on COVID-19 dynamics in the Philippines, a LMIC that has had a relatively severe COVID-19 outbreak.

METHODS

We applied an age-structured compartmental model that incorporated time-varying mobility, testing, and personal protective behaviors (through a "Minimum Health Standards" policy, MHS) to represent the first wave of the Philippines COVID-19 epidemic nationally and for three highly affected regions (Calabarzon, Central Visayas, and the National Capital Region). We estimated effects of control measures, key epidemiological parameters, and interventions.

FINDINGS

Population age structure, contact rates, mobility, testing, and MHS were sufficient to explain the Philippines epidemic based on the good fit between modelled and reported cases, hospitalisations, and deaths. The model indicated that MHS reduced the probability of transmission per contact by 13-27%. The February 2021 case detection rate was estimated at ~8%, population recovered at ~9%, and scenario projections indicated high sensitivity to MHS adherence.

INTERPRETATION

COVID-19 dynamics in the Philippines are driven by age, contact structure, mobility, and MHS adherence. Continued compliance with low-cost MHS should help the Philippines control the epidemic until vaccines are widely distributed, but disease resurgence may be occurring due to a combination of low population immunity and detection rates and new variants of concern.

End-of-life experience and its toll on quality of life and spirituality: a cross-sectional study

BACKGROUND

Breast and cervical/uterine cancer affect body parts that have symbolic meaning for women. Women with this diagnosis at the end-of-life often experience anxiety and depression that severely impacts their quality of life (QoL).

AIMS

This study aims to determine how the end-of-life experience impacts on the QoL and spirituality of women with advanced cancer.

METHODS

End-of-life patients and their caregivers were evaluated regarding religious and spiritual coping, depression and self-efficacy. Caregivers were interviewed regarding patients' QoL at the end-of-life. A spearman correlation test was used to evaluate correlation between variables.

FINDINGS

Several dimensions of positive religious and spiritual coping stood out for patients at the end of life. However, patients often experienced a negative revaluation of God. Patients reported experiencing low self-efficacy, depression and high levels of stress. The length of hospital stay, time spent in intensive care units and depression also correlated to the amount of worry and stress a patient experienced.

CONCLUSIONS

The end-of-life patients had a poor quality of life, and experienced depression, but also used spiritual beliefs and religion as a means of coping with their end-of-life experience.

Analytic Training for Junior Investigators in Minority Aging Research: The Michigan Model

Since 1997, the Resource Centers for Minority Aging Research Program at the National Institute on Aging has been the model for training social and behavioral scientists in minority aging and health disparities research. The latest cycle of these Centers implemented a new structure for the analytic training of junior investigators and for advancing methodologic work relevant to improving the rigor of minority aging research. In this article, we describe the conceptual framework, logistical approaches, challenges, and lessons learned from our experience training junior investigators in methodology through the Michigan Center for Urban African American Aging Research over the past 20 years, with the goal of informing future analytic training efforts for the next generation of scholars focused on minority aging issues.

Gray Matter Volume Covariance Networks, Social Support, and Cognition in Older Adults

OBJECTIVE

We examined the neural substrates of social support in older adults. Social support is associated with better outcomes in many facets of aging-including cognitive and functional health-but the underlying neural substrates remain largely unexplored.

METHODS

Voxel-based morphometry and multivariate statistics were used to identify gray matter volume covariance networks associated with social support in 112 older adults without dementia (M age = 74.6 years, 50% female), using the Medical Outcomes Study Social Support Survey.

RESULTS

A gray matter network associated with overall social support was identified and included prefrontal, hippocampal, amygdala, cingulate, and thalamic regions. A gray matter network specifically associated with tangible social support (e.g., someone to help you if you were confined to bed) was also identified, included prefrontal, hippocampal, cingulate, insular, and thalamic regions, and correlated with memory and executive function.

DISCUSSION

Gray matter networks associated with overall and tangible social support in this study were composed of regions previously associated with memory, executive function, aging, and dementia. Longitudinal research of the interrelationships between social support, brain structure, and cognition is needed, but strengthening social support may represent a new path toward improving cognition in aging that should be explored.

Racial and Ethnic Differences in Sarcoma Incidence Are Independent of Census-Tract Socioeconomic Status

BACKGROUND

Epidemiologic analyses of sarcoma are limited by the heterogeneity and rarity of the disease. Utilizing population-based surveillance data enabled us to evaluate the contribution of census tract-level socioeconomic status (CT-SES) and race/ethnicity on sarcoma incidence rates.

METHODS

We utilized the Surveillance, Epidemiology, and End Results program to evaluate associations between CT-SES and race/ethnicity on the incidence rates of sarcoma. Incidence rate ratios and 99% confidence intervals were estimated from quasi-Poisson models. All models were stratified by broad age groups (pediatric: <20 years, adult: 20-65 years, older adult: 65+ years) and adjusted for sex, age, and year of diagnosis. Within each age group, we conducted analyses stratified by somatic genome (fusion-positive and fusion-negative sarcomas) and for subtypes with >200 total cases. A P value less than 0.01 was considered statistically significant.

RESULTS

We included 55,415 sarcoma cases in 35 sarcoma subtype-age group combinations. Increasing CT-SES was statistically significantly associated with 11 subtype-age group combinations, primarily in the older age group strata (8 subtypes), whereas malignant peripheral nerve sheath tumors in adults were associated with decreasing CT-SES. Nearly every sarcoma subtype-age group combination displayed racial/ethnic disparities in incidence that were independent of CT-SES.

CONCLUSIONS

We found race/ethnicity to be more frequently associated with sarcoma incidence than CT-SES. Our findings suggest that genetic variation associated with ancestry may play a stronger role than area-level SES-related factors in the etiology of sarcoma.

IMPACT

These findings provide direction for future etiologic studies of sarcomas.

New methodologies in ageing research

Ageing is arguably the most complex phenotype that occurs in humans. To understand and treat ageing as well as associated diseases, highly specialised technologies are emerging that reveal critical insight into the underlying mechanisms and provide new hope for previously untreated diseases. Herein, we describe the latest developments in cutting edge technologies applied across the field of ageing research. We cover emerging model organisms, high-throughput methodologies and machine-driven approaches. In all, this review will give you a glimpse of what will be pushing the field onwards and upwards.

Social Environment Ameliorates Behavioral and Immune Impairments in Tyrosine Hydroxylase Haploinsufficient Female Mice

The social environment can influence the functional capacity of nervous and immune systems, and consequently the state of health, especially in aged individuals. Adult female tyrosine hydroxylase haploinsufficient (TH-HZ) mice exhibit behavioral impairments, premature immunosenescence and oxidative- inflammatory stress. All these deteriorations are associated with a lower lifespan than wild type (WT) counterparts. The aim was to analyze whether the cohabitation with WT animals could revert or at least ameliorate the deterioration in the nervous and immune systems that female TH-HZ mice show at adult age. Female TH-HZ and WT mice at age of 3-4 weeks were divided into following groups: control TH-HZ (5 TH-HZ mice in the cage; TH-HZ100%), control WT (5 WT mice in the cage; WT100%), TH-HZ > 50% and WT < 50% (5 TH-HZ with 2 WT mice in each cage) as well as TH-HZ < 50% and WT > 50% (2 TH-HZ and 5 WT mice in each cage). At the age of 37-38 weeks, all mice were submitted to a battery of behavioral tests, evaluating sensorimotor abilities, exploratory capacities and anxiety-like behaviors. Subsequently, peritoneal leukocytes were extracted and several immune functions as well as oxidative and inflammatory stress parameters were analyzed. The results showed that the TH-HZ < 50% group had improved behavioral responses, especially anxiety-like behaviors, and the immunosenescence and oxidative stress of their peritoneal leukocytes were ameliorated. However, WT mice that cohabited with TH-HZ mice presented higher anxiety-like behaviors and deterioration in immune functions and in their inflammatory stress parameters. Thus, this social environment is capable of ameliorating the impairments associated with a haploinsufficiency of the th gene. Graphical Abstract.

Marriage Aspiration, Perceived Marriage Squeeze, and Anomie Among Unmarried Rural Male Migrant Workers in China

Using data from a survey of rural–urban migrants conducted in Xiamen City, China, during 2009, this study explores determinants of anomie among unmarried rural male migrant workers in the context of China’s gender imbalance. Results indicate that the perceived marriage squeeze has exerted direct effects on anomie, and marriage aspiration has indirect effects on anomie among rural male migrant workers. The perceived marriage squeeze also has a mediating effect between marriage aspiration and anomie among unmarried rural male migrant workers. Social integration in the destination city is also a determinant of anomie among these unmarried migrant workers.

Development and validation of a model predicting post-traumatic headache six months after a motor vehicle collision in adults

IMPORTANCE

The prognosis of post-traumatic headache is poorly understood.

OBJECTIVE

To develop and validate a prognostic model to predict the presence of post-traumatic headache six months after a traffic collision in adults with incident post-traumatic headache.

DESIGN

Secondary analyses of adults with incident post-traumatic headache injured in traffic collisions between November 1997 and December 1999 in Saskatchewan, Canada (development cohort); and between January 2004 and January 2005 in Sweden (validation cohort).

SETTING

The Saskatchewan cohort (development) was population-based (N = 4162). The Swedish cohort (validation) (N = 379) were claimants from two insurance companies covering 20 % of cars driven in Sweden in 2004.

PARTICIPANTS

All adults injured in traffic collisions who completed a baseline questionnaire within 30 days of collision. Excluded were those hospitalized >2 days, lost consciousness >30 min, or reported headache <3/10 on the numerical rating scale. Follow-up rates for both cohorts were approximately 80 %.

PREDICTORS

Baseline sociodemographic, pre-injury, and injury factors.

OUTCOME

Self-reported headache pain intensity ≥3 (numerical rating scale) six months after injury.

RESULTS

Both cohorts were predominantly female (69.7 % in Saskatchewan, 65.2 % in Sweden), with median ages 35.9 years (Saskatchewan), and 38.0 years (Sweden). Predictors were age, work status, headache pain intensity, symptoms in arms or hands, dizziness or unsteadiness, stiffness in neck, pre-existing headache, and lower recovery expectations. With a positive score (i.e., ≥0.75 probability), the model can rule in the presence of post-traumatic headache at six months (development: specificity = 99.8 %, 95 % CI 99.5 %-99.9 %; sensitivity = 1.6 %, 95 % CI 1.0 %-2.6 %; positive likelihood ratio (LR+) = 8.0, 95 % CI 2.7-24.1; negative likelihood ratio (LR-) = 1.0, 95 % CI 1.0-1.0; validation: specificity = 95.5 %, 95 % CI 91.1 %-97.8 %; sensitivity = 27.2 %, 95 % CI 20.4 %-35.2 %); LR+ = 6.0, 95 % CI 2.8-13.2; LR- = 0.8, 95 % CI 0.7-0.8).

CONCLUSIONS AND RELEVANCE

Clinicians can collect patient information on the eight predictors of our model to identify patients that will report ongoing post-traumatic headache six months after a traffic collision. Future research should focus on selecting patients at high risk of poor outcomes (using our model) for inclusion in intervention studies, and determining effective interventions for these patients.

Effect of socioeconomic deprivation on outcomes of diabetes complications in patients with type 2 diabetes mellitus: a nationwide population-based cohort study of South Korea

INTRODUCTION

This study aimed to examine the effect of socioeconomic deprivation on the outcomes of diabetes complications in patients with type 2 diabetes mellitus (T2DM).

RESEARCH DESIGN AND METHODS

We conducted a cohort study using claims data and 2005 national census data. We included of 7510 patients newly diagnosed with T2DM from 2004 to 2012 and aged 40 years or above. We excluded participants who had onset of diabetes complications and hospitalization within 1 year after initial onset T2DM, aged less than 40 years and with missing covariates. We used the regional socioeconomic deprivation index and classified study participants into five categories according to the quintile distribution. We calculated the adjusted HR and 95% CI for hospitalization related to diabetes complications and all-cause mortality by applying Cox proportional hazards model and the adjusted subdistribution hazards model.

RESULTS

The percentages of participants in the first quintile (least deprived) to fifth quintile (most deprived) were 27.0%, 27.9%, 19.5%, 14.8%, and 10.8% for socioeconomic deprivation; 25.4%, 28.8%, 32.4%, 34.6%, and 37.6% for hospitalization due to diabetes complications; 1.3%, 2.1%, 2.5%, 2.9%, and 3.6% for deaths from diabetes complications; and 5.7%, 7.2%, 9.7%, 9.7%, and 13.1% for deaths from all causes, respectively. Participants with higher socioeconomic deprivation had a higher HR for hospitalization and mortality from all-cause and diabetes complications. These associations were the strongest among men and participants in their 40s in hospitalization related to diabetes complications, 50s in diabetes complications-specific mortality and 50s and 60s in all-cause mortality.

CONCLUSIONS

Patients with T2DM with high socioeconomic deprivation had higher hospital admission and mortality rates for diabetes complications than those with low deprivation. We cannot fully explain the effect of socioeconomic deprivation on diabetes outcomes. Therefore, further studies are needed in order to find underlying mechanisms for these associations.

The ratio of prematurely aging to non-prematurely aging mice cohabiting, conditions their behavior, immunity and lifespan

Adult prematurely aging mice (PAM) show behavioral deterioration, premature immunosenescence and increased oxidative stress, impairments that are associated with their shorter lifespan, compared to the corresponding exceptional non-prematurely aging mice (ENPAM). When PAM live in a predominantly ENPAM environment (2/5, respectively) they exhibit an improvement of immunity and redox state in their spleen and thymus leukocytes, and an increased lifespan. Nevertheless, it is unknown if other PAM/ENPAM ratios could affect behavioral and peritoneal leukocyte functions of PAM and change their lifespan. ENPAM and PAM were divided into the following groups: C-ENPAM (8 ENPAM in the cage); C-PAM (8 PAM in the cage); ENPAM>50% and PAM<50% (5 ENPAM/2 PAM in each cage); ENPAM = 50% and PAM = 50% (4 ENPAM/4 PAM in each cage), and PAM>50% and ENPAM<50% (5 PAM/2 ENPAM in each cage). After two months, mice were submitted to a battery of behavioral tests. Several functions and oxidative stress parameters were then assessed in their peritoneal leukocytes. Animals were maintained in these conditions to analyze their lifespan. The results showed that PAM>50%, PAM = 50% and PAM<50% exhibited better behavioral responses, immunity and redox states in their peritoneal leukocytes than C-PAM. This improvement was higher when the number of ENPAM in the cage was increased, with most of the parameters in PAM<50% reaching similar values to those in C-ENPAM, and an increased lifespan. However, ENPAM that cohabited with PAM showed, in general, an impairment of parameters studied. In conclusion, the PAM/ENPAM cohabitation ratio is relevant to behavior and immunity.

Age and poverty status alter the coding and noncoding transcriptome

Emerging evidence indicates that noncoding RNAs play regulatory roles in aging and disease. The functional roles of long noncoding RNAs (lncRNAs) in physiology and disease are not completely understood. Little is known about lncRNAs in the context of human aging and socio-environmental conditions. Microarray profiling of lncRNAs and mRNAs from peripheral blood mononuclear cells from young and old white (n=16) and African American (AA) males (n=16) living above or below poverty from the Healthy Aging in Neighborhoods of Diversity across the Life Span study revealed changes in both lncRNAs and mRNAs with age and poverty status in white males, but not in AA males. We validated lncRNA changes in an expanded cohort (n=40); CTD-3247F14.2, GAS5, H19, TERC and MEG3 changed significantly with age, whereas AK022914,GAS5, KB-1047C11.2, MEG3 and XLOC_003262 changed with poverty. Mitochondrial function and response to DNA damage and stress were pathways enriched in younger individuals. Response to stress, viral infection, and immune signals were pathways enriched in individuals living above poverty. These data show that both human age and a marker of social adversity influence lncRNA expression, which may provide insight about molecular pathways underlying aging and social factors that affect disparities in aging and disease.

Longitudinal Twin Study of Subjective Health: Differences in Genetic and Environmental Components of Variance Across Age and Sex

OBJECTIVE

The current analysis examines sex differences in longitudinal changes in genetic and environmental influences on three measures of subjective health (SH).

METHOD

Sample includes 7,372 twins (mean intake age = 73.22) with up to 8 waves of measurement (mean = 3.1). Three SH items were included: general self-rated health (SRH), health compared to age peers (COMP), and impact of health on activities (ACT) which previous research shows capture different frames of reference.

RESULTS

Latent growth curve modeling indicated significant differences across gender and frame of reference in trajectories of change with age and in genetic and environmental contributions to change. Men have higher mean scores on all three SH measures, indicating better SH, but there were no sex differences in pattern of change with age. Accelerating declines with age were found for SRH and ACT, whereas COMP improved with age. Results indicated more genetic variance for women than men, but declining genetic variance for both after age 70. Increasing shared environmental variance with increasing age was also found for both sexes.

DISCUSSION

As aging triggers a re-evaluation of the meaning of "good health," physical aspects of health may become less important and shared cultural conceptions of health may become more relevant. This change in conceptions of good health may reflect both aging and the change in composition of the elderly population as a result of selective survival.

Financial Education and Coaching: A Lifestyle Medicine Approach to Addressing Financial Stress

Economic stability is a well-documented social determinant of health, and financial stress is an important driver for the health disparities observed in the poor. Persons under financial stress are more likely to engage in smoking, alcohol consumption, overspending, poor diet, and reduced exercise. Financial education and coaching is one strategy that can be used to reduce financial stress and potentially improve engagement in healthy lifestyle behaviors, quality of life, and objective health outcomes. A conceptual model describing the link between financial education/coaching and health is described along with preliminary data from a randomized controlled trial evaluating this intervention.

Association Between Speed of Multimorbidity Accumulation in Old Age and Life Experiences: A Cohort Study

Rapidly accumulating multiple chronic conditions (multimorbidity) during aging are associated with many adverse outcomes. We explored the association between 4 experiences throughout life-childhood socioeconomic circumstances, early-adulthood education, midlife occupational stress, and late-life social network-and the speed of chronic disease accumulation. We followed 2,589 individuals aged ≥60 years from the Swedish National Study on Aging and Care in Kungsholmen for 9 years (2001-2013). Information on life experiences was collected from detailed life-history interviews. Speed of disease accumulation was operationalized as the change in the count of chronic conditions obtained from clinical examinations, medical histories, laboratory data, drug use, and register linkages over 9 years. Linear mixed models were used to analyze the data. Speed of disease accumulation was lower in individuals with more than elementary education (for secondary, β × time = -0.065, 95% CI: -0.126, -0.004; for university, β × time = -0.118, 95% CI: -0.185, -0.050); for active occupations compared with high-strain jobs (β × time = -0.078, 95% CI: -0.138, -0.017); and for richer social networks (for moderate tertile, β × time = -0.102, 95% CI: -0.149, -0.055; for highest tertile, β × time = -0.135, 95% CI: -0.182, -0.088). The association between childhood circumstances and speed of disease accumulation was attenuated by later-life experiences. Diverse experiences throughout life might decelerate chronic disease accumulation during aging.

Gender Differences in Longitudinal Trajectories of Change in Physical, Social, and Cognitive/Sedentary Leisure Activities

Objective

We examined changes in participation in cognitive, social, and physical leisure activities across middle and older adulthood and tested moderation of trajectories of change in participation by gender.

Method

In all, 1,398 participants in the Swedish Adoption/Twin Study of Aging (SATSA) completed a 7-item leisure activity questionnaire up to 4 times over 17 years. Mean baseline age was 64.9 years (range = 36-91); 59% were women. Factor analysis identified physical, social, and cognitive/sedentary leisure activity participation factors. Age-based latent growth curve models adjusted for marital status, gender, education, depressive symptoms, and physical health were used.

Results

Overall, results indicated stability in social activities, increase in cognitive/sedentary activities, and decrease in physical activities, as well as accelerated decline in all three types of activities after about the age of 70 years. Social activity remained mostly stable for women and declined for men. Women reported higher levels of cognitive/sedentary leisure activity across the study. Both men and women declined in physical leisure activity. Variance in leisure activities increased with age; men demonstrated more variance in social activities and women in physical activities.

Conclusions

Understanding change in leisure activities with age and by gender can have important implications for interventions and for use of leisure activity data in epidemiological research.