Midlife as a Pivotal Period in the Life Course: Balancing Growth and Decline at the Crossroads of Youth and Old Age

Causal impact of elevated body mass index on diabetic kidney disease: an integrated Mendelian randomization and Global Burden of Disease Study 2021 analysis

BACKGROUND

Elevated body mass index (BMI) has been implicated in the pathogenesis of diabetic kidney disease among patients with type 2 diabetes mellitus (T2DKD). However, establishing a causal relationship and quantifying the resultant global health impact remain challenging.

METHODS

A two-sample Mendelian randomization (MR) analysis was conducted using summary-level data obtained from the IEU database. Multiple MR approaches, including inverse variance weighted (IVW), MR-Egger regression, weighted median, weighted mode, and simple mode methods, were implemented to ensure robust causal inference. In parallel, Global Burden of Disease Study (GBD) 2021 were analyzed to determine the trends in mortality and disability-adjusted life years (DALYs) in T2DKD attributable to high BMI (HBMI-T2DKD) from 1990 to 2021. Joinpoint regression was used to estimate the average annual percent change (AAPC). Bayesian age-period-cohort (BAPC) models were then applied to project the disease burden through 2049.

RESULTS

MR analyses provided strong evidence for a causal relationship between elevated BMI and T2DKD. The GBD analysis revealed a sustained global increase in HBMI-T2DKD burden over the past three decades. Between 1990 and 2021, the result of AAPC indicated a persistent upward trend. The burden was particularly high among older adults, with the highest impact observed in East Asia and middle Socio-Demographic Index (SDI) region. By 2049, HBMI-T2DKD-related disease burden were projected to continue rising.

CONCLUSIONS

Elevated BMI is a significant causal risk factor for T2DKD. The integration of MR and GBD 2021 data underscores the urgent need for targeted public health interventions to reduce BMI levels, especially in high-risk regions and aging populations.

COVID-19 Pandemic-Related Stress and Subjective Well-Being Across Age: The Mediating Role of Social Resources

Stress associated with the COVID-19 pandemic and the measures implemented to prevent its spread dramatically shifted our social networks, interactions, and contexts, all of which influence the assessment of one's subjective well-being (SWB). Drawing on data collected from 1,318 adults between April and May 2020, we used structural equation modeling to analyze the relationship between pandemic-related stress and SWB (life satisfaction, positive affect, negative affect), and examined how these relationships vary across age. Pandemic-related stress was associated with lower life satisfaction and higher negative affect. However, no evidence of age moderation emerged. Subsequent analysis examined different aspects of social resources as potential mediating variables. Loneliness fully mediated the relationship between stress and life satisfaction, while social support demonstrated evidence of partial mediation. Further, loneliness and social support partially mediated the relationship between stress and negative affect. Findings suggest that pandemic-related stress impacts SWB, and social resources help explain these impacts.

Income inequality and deaths of despair: a population-based study of 19 million Canadian adults

PURPOSE

To estimate the association between regional level income inequality (a relative measure of socioeconomic disparity) and deaths of despair and assess whether this association is moderated by age, gender, racialized minority status, and income.

METHODS

Data from the 2006 Canadian Census Health and Environment Cohort (CanCHEC) study were used. A cohort of Canadian adults (n = 19,436,790) within 288 CDs were followed from May 2006 to December 2019. Multilevel Cox-proportional hazard regression was used to estimate the association between income inequality and time to deaths attributed to suicide, drug overdose, and alcohol.

RESULTS

In models adjusted for confounders, income inequality was associated with time to death due to alcohol (HR = 1.14; 95% CI: 1.05, 1.25), drug overdose (HR = 1.19; 95% CI: 1.06, 1.33), and deaths of despair (HR = 1.05; 95% CI: 1.00, 1.11). Significant interactions were primarily observed in cases of deaths attributed to drug overdose. The association between income inequality and the hazards for drug overdose deaths was stronger for individuals aged 40-49 (HR = 1.71; 95% CI: 1.24, 2.37), males (HR = 1.69; 95% CI: 1.22, 2.35), from low-income households (HR = 1.69; 95% CI: 1.22, 2.35), self identified as White (HR = 1.69; 95% CI: 1.22, 2.35) and those living in low-income areas (HR = 1.69; 95% CI: 1.22, 2.35).

CONCLUSION

Income inequality is associated with high risk of deaths of despair. Additionally, this association is significantly moderated by age, gender, racialized minority status and income at the household and area levels. As such, our findings suggest the need to address income inequality in interventions for reducing deaths of despair among Canadian adults.

Development of a culturally tailored sleep intervention for midlife African American women: A scoping review

STUDY OBJECTIVES

Sleep disturbances are prevalent among midlife African American women (AAW). Given the cultural and psychosocial factors influencing AAW's sleep health, we aim to develop culturally tailored sleep interventions that address their unique needs.

METHODS

This scoping review examines (1) sleep in midlife AAW, (2) factors contributing to their sleep disturbances, (3) previous culturally tailored sleep interventions evaluated in this population, and (4) strategies for developing culturally tailored sleep interventions for midlife AAW. CINAHL, PubMed, and PsycINFO were searched for relevant sources.

RESULTS

Midlife AAW experience worse sleep quantity and quality, both objective and subjective, than White women. Factors contributing to midlife AAW's sleep disturbances include vasomotor symptoms, racism-related stress, various stressors and psychological factors, the superwoman/strong Black woman schema, and environmental factors. A very few studies have applied culturally tailored sleep interventions involving midlife AAW, including sleep health education delivered by peer educators. Recommendations for developing and evaluating a culturally tailored sleep intervention for midlife AAW include the following: (1) use linguistically and culturally tailored methods for recruitment and content, (2) incorporate cultural concepts and values such as religious beliefs and spirituality, (3) address population-specific sleep barriers such as racism-related stress, (4) involve family members, (5) involve community facilitators, and (6) implement interventions in culturally familiar settings, such as churches.

CONCLUSIONS

This study provides practical strategies for developing tailored sleep interventions for midlife AAW. Future research should continue to explore and refine these approaches to improve sleep health outcomes for AAW and promote their overall well-being.

Unveiling the creative self in midlife: A qualitative study of Italian women's psychosocial transformation journeys

This qualitative study explores the psychosocial experiences of midlife Italian women, focusing on the evolution of their creative self. Using Interpretative Phenomenological Analysis, we examined narratives from eight women aged 51-62, capturing their spontaneous perception of the changes characterizing this phase of their life, with a particular focus on the subject of creativity. Three major themes emerged from the interviews: (1) Personal Growth, highlighting increased self-awareness, resilience in the face of adverse events and a deeper connection with their bodies; (2) Relationships with Others, underscoring shifts in friendships, family dynamics, and how relationships foster creativity; and (3) The Creative Self, which explores the redefinition of creativity in midlife as part of a broader transformative process. The study offers new insights into how midlife can serve as a fertile period for personal and creative development, challenging the dominant focus on loss often associated with ageing. This work contributes to the literature by highlighting the underexplored positive transformations occurring during this phase, particularly in the Italian socio-cultural context.

The social-ecological model of depressive symptoms in middle aged in China: a network analysis

BACKGROUND

Depression in middle-aged individuals is influenced by multiple factors; however, research focusing on this demographic remains limited. The social-ecological system framework explores how interactions among individual characteristics, social relationships, and environmental contexts contribute to health outcomes. This study aimed to assess the prevalence, core manifestations, and influencing factors of depression through a comprehensive model grounded in the social-ecological system.

METHODS

Using data from the 2018 Chinese Labor Dynamic Survey, a total of 3,799 middle-aged individuals (mean age: 52.35 years; 53.75% female) were included. Depression was assessed using the Center for Epidemiological Studies Depression Scale, with a cut-off score of 36. We used a graphical gaussian model to identify the measurement network and core symptoms of midlife depression, and logistic regression to identify influencing factors. A social-ecological model of middle-aged depression was constructed through a Mixed Graphical Model.

RESULTS

23.74% of participants exhibited clinically significant depression. Feelings of disgust (Strength = 2.18, Expected Influence = 1.30) and incapacity (Strength = 1.29, Expected Influence = 1.57) emerged as the most central symptoms. Higher global strength (GS = 8.89, p < 0.001) of the network suggested stronger associations and mutual exacerbation of symptoms. Logistic regression showed that education, exercise, and subjective feeling were associated with depression risk (p < 0.05). The social-ecological system emphasized the importance of education (Strength = 2.50, Expected Influence = 2.50) and complex interaction between subjective and objective influencing factors.

CONCLUSION

This study found middle-aged individuals had a high prevalence of depression, characterized by feelings of disgust and incapacity. Influencing factors spanned individual, social and environmental levels. These results emphasize the role of education in depressive individuals, providing guidance for potential future interventions.

Participation in football and health-related quality of life among middle-aged and older men

Background

This study aimed to investigate the relationship between participation in football and health-related quality of life (HRQOL) in middle-aged and older men in Japan.

Methods

This was a survey with cross-sectional design. Middle-aged and older men who were registered members of the Japan Football Association as players were recruited (Football group). We also performed an online survey of middle-aged and older men and categorised them into two groups based on questions for this survey about their current engagement in sports/exercise activities (none group and individual sports group). HRQOL was assessed using the 36-Item Short Form Health Survey (SF-36). The physical component summary (PCS) score and mental component summary (MCS) score were calculated based on eight SF-36 subscales.

Results

The total number of participants in this survey was 5761 (none: 1988; individual sports: 1,776; football: 1997). After adjustment for covariates, PCS scores revealed no differences among groups (none: 51.2±11.1; individual sports: 51.9±8.9; football: 52.1±5.6), although the corresponding subscale scores differed significantly among groups. The football group exhibited significantly higher MCS scores compared with the other groups (none: 48.9±10.1; individual sports: 52.2±9.5; football: 56.2±7.2). The corresponding subscale scores of the MCS were significantly higher in the Football group compared with the other groups.

Conclusions

Findings suggest that middle-aged and older men who are registered football players had better HRQOL in the mental aspect compared with those without any exercise habits and to those who engage in individual sports, although the cross-sectional design could not establish causality.

Assessment of age-related variation in cervical neuroforaminal dimensions

Radiographic parameters for diagnosing cervical neuroforaminal stenosis (CNFS) are not well described. To develop definitive criteria for diagnosis of CNFS, a standardized baseline of average neuroforaminal dimensions must first be established. Thus, the aim of this study was to: (1) use computed tomography (CT) of patients without neck pain or spinal pathology to establish mean cervical neuroforaminal dimensions (CNFD) across multiple age groups and (2) assess differences in CNFD by age. Cervical CT scans of 1,457 asymptomatic patients were reviewed to measure CNFD, defined as follows: axial width, craniocaudal height, and area. Patients were divided into four groups based on age: 18-35, 36-50, 51-64, and 65 + years. Statistical analyses were used to assess differences in CNFD according to age group.Mean overall CNFD for the 18-35 year-old cohort were 6.43 mm for width, 9.28 mm for height, and 58.85 mm2 for area. For the 36-50 year-old cohort, dimensions were 5.89 mm for width, 8.63 mm for height, and 52.78 mm2 for area. For the 51-64 year-old cohort, dimensions were 5.29 mm for width, 8.52 mm for height, and 48.93 mm2 for area. Finally, the 65 + year-old cohort had dimensions of 5.09 mm for width, 8.16 mm for height, and 45.91 mm2 for area. Significant differences in CNFD were observed between age groups, with dimensions decreasing in size from the younger to older age groups. In the studied population, CNFD decreased progressively with age. The results of our study may have utility in the diagnosis of CNFS.

Negative Aging Stereotypes: Fear of Dependency Impact on Anxiety and Depression in Middle and Older Adults, Examined by Gender

Negative stereotypes of aging, such as dependency, tend to paint a picture of older adults as frail or a burden on society. This study aimed to explore the relationship between the Fear of Dependency Scale and anxiety and depression, evaluating gender, age, and physical health as moderators. Findings suggest that age moderated the relationship between fear of dependency and depression and anxiety in women, with middle-aged women reporting the highest levels of depression and anxiety. Similarly, poor physical health in women with high fear of dependency was related to higher levels of depression and anxiety. Fear of dependency was related to higher levels of depression, but not anxiety in men. Age did not moderate the relationship between fear of dependency and mental health measures, but physical health did moderate the relationship. Men with poor perceived health and a high fear of dependency reported higher levels of depression.

A systematic review of epidemiological studies of life course socioeconomic status and adult structural brain changes

INTRODUCTION

Disadvantaged socioeconomic status (SES) are linked with adverse cognitive outcomes in ageing and heightened dementia risk. Few studies have examined relationships between life course SES and adult structural brain changes that may be associated with cognitive decline.

AIMS

This systematic review assesses evidence from neuroimaging based epidemiological studies that have explored relationships between life course SES and adult structural brain changes.

METHODS

Embase, PsycINFO and Medline from inception to November 2020 were systematically searched according to strict search criteria which captured studies examining relationships between life course SES and adult structural neuroimaging changes. Bibliographies and citations of relevant papers were selected. Searches were limited to English language publications.

RESULTS

Amongst 8134 search results, 91 unique titles were screened and 24 studies selected. All 24 studies demonstrated at least partial relationships between disadvantaged life SES and adverse structural brain changes. Selected studies utilised diverse structural imaging techniques, neuroanatomical sites and operational definitions of life course SES. The methodological approaches and statistical analysis varied significantly between studies. We specifically discuss the neurobiological interpretation of Diffusion weighted MRI based studies and MRI volumetric studies investigating associations between life course SES and adult brain structural changes and the wider global health implications of these studies.

CONCLUSION

Disadvantaged life course SES may have associations with structural brain changes which underlie adverse ageing outcomes. Given heterogeneity of study designs and operationalisation of SES, the cross-sectional design of studies and wide-ranging neuroimaging modalities any association should be considered with caution. Mediatory mechanisms including malnutrition, stress, markers of inflammation, hormonal changes and cognitive reserve and health behaviour are presented in selected studies. Targeting life course SES in public health-based interventions may offer approaches to maintain healthy brain structure and function in ageing.

Daily or near-daily cannabis and alcohol use by adults in the United States: A comparison across age groups

BACKGROUND AND AIMS

Patterns of daily or near-daily (DND) use of alcohol and cannabis among adults in the United States have been changing. The current study measured how these shifts have occurred across developmental periods of adulthood.

DESIGN, SETTING, AND PARTICIPANTS

U.S. national data from the Monitoring the Future Panel Study include responses from approximately 20 000 adults aged 19 to 65 in 2023. In total, annual data from 1988 to 2023 include 389 649 responses.

MEASUREMENTS

Self-report measures of use of cannabis and alcohol DND (i.e., 20 + occasions in the last 30 days) were available for the full age ranges of 19-30 years from 1988 to 2023, of 35-50 years from 2008 to 2023, and of 55-65 years in 2023.

FINDINGS

As of 2023, DND cannabis use was nearly three times as prevalent (10.4%) as DND alcohol use (3.6%) among young adults ages 19 to 30. Early midlife adults have had a convergence but not yet a crossover; there were similar prevalence levels of DND use of cannabis (7.5%) and alcohol (7.8%) among those ages 35 to 50 in 2023. Among late midlife adults ages 55 to 65, DND alcohol use remained more than twice as prevalent (11.4%) as DND cannabis use (5.2%) in 2023.

CONCLUSIONS

In the United States, daily or near-daily (DND) alcohol use remains more prevalent than DND cannabis use among late midlife adults, but the opposite is true for young adults.

Association of ambient air pollution exposure with psychological distress in mid and later adulthood: A 26-year prospective cohort study

BACKGROUND

Existing evidence on associations between exposure to air pollution and psychological distress from middle to older age is limited by consideration of short exposure periods, poor historical covariates, exposures and outcomes, and cross-sectional study designs. We aimed to examine this association over a 26-year period between ages 43 and 69.

METHODS

We utilised data from the Medical Research Council National Survey of Health and Development Study (the 1946 British birth cohort). Land-use regression models estimated exposure to specific air pollutants using household addresses for 1991 (NO2), 2001 (PM10, NO2), and 2010 (NO2, NOx, PM10, PM2.5, PMcoarse, PM2.5abs). These were linked to the closest data collection wave at ages 43, 53 and 60-64, respectively. Psychological distress was assessed through the 28-item version of the General Health Questionnaire (GHQ-28), at ages 53, 60-64 and 69. Associations between each of the pollutants with psychological distress were analysed using generalised linear mixed models, adjusted for pollution exposure before age 43, assigned sex, social class, smoking status, neighbourhood deprivation, and previous mental health problems. We also examined effect modification by social class.

RESULTS

At age 69, 2125 participants completed the GHQ-28. In fully adjusted models, higher NO2 exposure was associated with higher GHQ-28 scores across a 26-year period (β=0.023, 95%CI:0.005, 0.040 per interquartile range increase in exposure), whereas higher exposure to PM10 was associated with lower GHQ-28 scores across a 16-year period (β=-0.021, 95%CI:-0.037, -0.006). There was no evidence of associations between exposure to other pollutants at age 60-64 and GHQ-28 at age 69. We found no effect modification by social class.

CONCLUSIONS

In this cohort there was some evidence of an association between higher cumulative exposure to NO2 and higher psychological distress, but mixed associations with other exposures. Policies to reduce pollutant exposure may help improve psychological symptoms in middle to late adulthood.

Longitudinal changes in coping strategies across midlife and older adulthood: findings from the midlife in the United States study

OBJECTIVES

Most studies examining age differences in coping across adulthood come from cross-sectional studies and focus on the broader categories of problem- and emotion-focused coping. We aimed to establish a factor structure for coping items used in a national, longitudinal study of aging (MIDUS) and examine age patterns in coping strategies over 10 years.

METHOD

We performed exploratory and confirmatory factor analysis, and factorial invariance testing. Next we conducted a series of multilevel models for each coping factor with participants from waves II and III of the MIDUS study (N = 2,661, Mage = 55, 58% women, 84% White).

RESULTS

We found a four-factor solution: instrumental action; denial/disengagement; positive reappraisal; focus and venting of emotions. Invariance was established across time and age. At baseline, age was positively associated with the use of three strategies, though younger adults used more focus and venting of emotions. There was an overall decrease over 10 years in use of all strategies, which was moderated by age. Positive reappraisal declined more steeply among midlife participants, whereas the remaining strategies declined more for older participants.

CONCLUSION

Results highlight the multi-dimensionality of MIDUS coping items and underscores the import of age in understanding changes in coping across midlife and older adulthood.

Effects of Diabetes Knowledge and Attitudes Toward Internet Health Information on e-Health Literacy in Middle-Aged Patients with Diabetes

Background/Objectives: Effective diabetes self-management requires useful knowledge and health-related literacy based on a positive attitude toward seeking health information on the Internet. Therefore, this study aimed to determine the relationship of e-health literacy (eHL) with diabetes knowledge and attitudes toward internet health information in middle-aged patients with diabetes and to identify factors influencing patient eHL. Methods: This descriptive correlational study included 185 middle-aged patients with diabetes being followed-up with in the outpatient endocrinology department at a South Korean university hospital between 14 January and 29 February 2024. Data were collected using self-report structured questionnaires and were analyzed using IBM SPSS 27.0. Results: eHL was positively correlated with diabetes knowledge (r = 0.31, p < 0.001) and attitudes toward internet health information (r = 0.62, p < 0.001). Diabetes knowledge was also positively correlated with attitudes toward internet health information (r = 0.25, p < 0.001). Attitudes toward internet health information (β = 0.55, p = <0.001), diabetes knowledge (β = 0.13, p = 0.040), and drinking status (β = 0.12, p = 0.044) were significant variables affecting eHL. Conclusions: The most influencing factor in eHL in middle-aged patients with diabetes is the patient's attitudes toward internet health information; diabetes knowledge was identified as a significant predictor. To improve eHL in middle-aged patients with diabetes, it is important to develop nursing intervention strategies to help promote diabetes knowledge and positive attitudes toward internet health information. Healthcare providers should continuously monitor patients to ensure they acquire and utilize correct information.

Preferences for Features of Current and Future Residential Environments Among Korean Middle-Aged Adults

This study examined differences in middle-aged adults' preferred features of their current versus future residential environments and how these differences varied by health and social characteristics. A sample of 1,651 Korean middle-aged adults (aged 49-64) rated their preferences for each of 12 features (e.g., proximity to family/relatives, house price) regarding current and future residential environments, separately. Respondents considered "accessibility to health services" and "opportunity for leisure activities" more important for future residential environments than for current ones. Respondents with poorer health considered features that help them compensate for health decline more important, while those who contacted friends/neighbors more frequently and participated in more cultural activities considered features that help them maintain their social interactions more important for future residential environments than the past. Our findings identified middle-aged adults' various demands for residential features after retirement, which reflect their strategic reactions to future needs for successful adaptation in later years.

Housing insecurity pathways to physiological and epigenetic manifestations of health among aging adults: a conceptual model

Introduction

Housing insecurity is a social determinant of health, as evidenced by its associations with mental, physical, and biological outcomes. The scientific understanding of the mechanisms by which housing insecurity is associated with health is still limited. This review adapts existing stress process models to propose a conceptual model illustrating potential pathways linking the specific stressor of housing insecurity to physiological and epigenetic manifestations of stress among aging adults.

Methods

This narrative review examines literature across multiple fields, including public health, psychology, and sociology. The literature selected for this review was identified through scientific databases including Web of Science, PubMed, JSTOR, and Google Scholar; primarily peer-reviewed empirical studies, literature reviews, and research reports published in English between 1981 and 2024; and principally based in the United States context. A synthesis of this literature is presented in a proposed conceptual model.

Results

The literature supports the existence of two main predictors of housing insecurity: sociodemographic characteristics and the historical/current context. The main mediating pathways between housing insecurity and manifestations of stress include health behaviors, psychosocial resources, and structural resources. Moderating factors affecting the associations between housing insecurity and manifestations of stress include government assistance, chronic discrimination/unfair treatment, and individual differences. These interdependent mediating and moderating mechanisms affect stressor reactivity, a proximal manifestation of stress, which contributes to the physiological and epigenetic distal manifestations of stress in aging adults.

Discussion and implications

The prevalence of housing insecurity among aging adults is growing in the United States, with significant implications for public health and health disparities, given the growing percentage of aging adults in the population. Further empirical testing of the mediating and moderating mechanisms proposed in the conceptual model will elucidate how housing insecurity is connected to health and provide insight into preventive strategies to ameliorate the adverse effects of housing insecurity on biological health among aging adults.

A Life Course Approach to Cardiovascular Disease Prevention

ABSTRACT

During the past 3 decades, life course socio-ecological frameworks have received considerable attention from clinical and public health professionals; developmental, social, and behavioral scientists; and scholars. Substantial evidence underscores the importance of a life course approach to prevention of cardiovascular (CV) disease and the promotion of optimal CV health. This article provides an overview of evidence on early origins and progression of CV disease (CVD) processes across the life course of individuals from diverse populations. Emphasis is placed on the evidence-based guidelines designed to prevent CVD and promote CV health with recommendations for implementation by CV health professionals and directions for future research in global CVD prevention.

Healthcare utilisation patterns and contributory factors among middle-aged adults: a scoping review

BACKGROUND

Middle-aged adults, defined as individuals between the ages of 45 and 64, represent a significant yet under researched group of healthcare service users. This scoping review aimed to provide a comprehensive overview of the patterns of healthcare utilisation and the factors contributing to them within this demographic.

METHODS

Following PRISMA-ScR guidelines and the framework proposed by Arksey and O'Malley, a systematic literature search was conducted across PubMed, EMBASE, and the Cochrane Library databases from their inception until July 2023. Key search terms such as "healthcare utilisation" and "middle-aged" were used to identify relevant studies. Articles were included if they were original cohort, case-control, or cross-sectional studies published in English. The findings were then synthesised narratively, by identifying recurring concepts and grouping them into broader themes. The themes were categorised according to the Andersen healthcare utilisation model's three factors: predisposing factors, enabling factors, and need-related factors.

RESULTS

After screening 4,810 records, a total of 25 articles were selected for final analysis, comprising 15 from developed countries and 10 from developing countries. Consistent factors influencing healthcare utilisation included multimorbidity, socioeconomic status, and poor health behaviours. Differences emerged across contexts: in developed countries, healthcare utilisation was influenced by lifestyle behaviours and access to private care, while in developing countries, socioeconomic inequalities and limited insurance coverage played more dominant roles. Healthcare system structures likely shaped utilisation patterns.

CONCLUSION

Healthcare utilisation among middle-aged adults is driven by an interplay of medical, social, and economic factors that vary across contexts. Common contributors, such as multimorbidity and poor health behaviours, highlight the need for targeted interventions and policies focusing on primary and preventive care to address the long-term burden of healthcare utilisation. This demographic faces unique challenges in managing healthcare decisions amidst varying systemic and individual-level challenges, which should be further studied.

Mothering While Sick: Poor Maternal Health and the Educational Attainment of Young Adults

At a time when educational attainment in young adulthood forecasts long-term trajectories of economic mobility, better health, and stable partnership, there is more pressure on mothers to provide labor and support to advance their children's interests in the K-12 system. As a result, poor health among mothers when children are growing up may interfere with how far they progress educationally. Applying life course theory to the National Longitudinal Study of Adolescent to Adult Health to investigate this possibility, we found that young adults were less likely to graduate from college when raised by mothers in poor health, especially when those mothers had a college degree themselves. Young people's school-related behaviors mediated this longitudinal association. These findings extend the literature on the connection between education and health into an intergenerational process, speaking to a pressing public health issue-rising morbidity among adults in midlife-and the reproduction of inequality within families.

Livin' La Vida Sola: Network Diversity and Well-Being in Middle-Aged Adults Living Alone

BACKGROUND

For individuals living alone, having a diverse personal network is considered crucial for mitigating the risk of social isolation and enhancing well-being. Although a reciprocal dynamic between network diversity and well-being is likely, longitudinal evidence supporting reciprocal effects is limited. This study investigates dynamic transactions between network diversity and well-being (life satisfaction, loneliness, and depressiveness) in a community-based sample of middle-aged adults from Germany. It also explores moderations by the duration of living alone.

METHOD

Data were drawn from the three-wave RIKSCHA (Risks and Chances of Living Alone) project, which includes N = 389 middle-aged adults living alone.

RESULTS

Cross-lagged panel models revealed high rank-order stabilities and correlated changes in network diversity and well-being. Random-intercept cross-lagged panel models and dynamic panel models indicated that unobserved traits accounted for these high stabilities. Correlated changes disappeared when accounting for the trait-like stability of variables. Across all models, no evidence of reciprocal associations between network diversity and well-being was found. All results remained consistent regardless of the duration of living alone.

CONCLUSIONS

The study discusses trait factors accounting for the high stabilities observed in network diversity and well-being among middle-aged adults living alone. Future research should further explore the traits impacting successful adaptation to living alone within the context of personal networks.

The associations of positive and negative mental well-being with physical activity during the COVID-19 across late adulthood

BACKGROUND

Mental well-being (MWB) may play an important role in physical activity (PA) behavior, but the independent associations of affective MWB indicators and depressive symptoms with PA are sparsely investigated in late adulthood. We investigated the associations of positive affect, negative affect, and depressive symptoms with PA during the COVID-19 restrictions across late adulthood.

METHODS

Cross-sectional data came from two Finnish population-based studies. The younger cohort (N = 162, 56% women, 60-61 years) was drawn from the TRAILS study, and the older (N = 272, 60% women, 72-88 years) from the PASSWORD study. Data on PA frequency (1-7; from "not at all" to "approximately daily") and perceived changes in PA (no change/increased/reduced) during COVID-19 restrictions were self-reported. MWB was assessed by positive and negative affect (International Positive and Negative Affect Schedule Short Form) and depressive symptoms (younger cohort: General Behavioral Inventory; older cohort: Geriatric Depression Scale). Associations between MWB and PA were analyzed using linear and multinominal logistic regression models.

RESULTS

When each MWB indicator was investigated separately, higher positive affect was associated with higher PA frequency in both cohorts and with a higher likelihood of increased PA in the younger cohort; higher negative affect was associated with a higher likelihood of reduced PA in the older cohort; higher depressive symptoms were associated with lower PA frequency in both cohorts and with a higher likelihood of reduced PA in the older cohort (p ≤ 0.009 for all), In the final models including all three MWB indicators, socioeconomic, and health-related covariates, only the association between higher positive affect and higher odds of increased PA remained significant in the younger cohort (OR = 4.28, p = 0.006). In the older cohort, only the associations of higher depressive symptoms with lower PA frequency (β=-0.097, p = 0.024) and higher odds of reduced PA (OR = 1.26, p = 0.010) remained significant.

CONCLUSIONS

Positive affect was independently associated with increased PA during the COVID-19 restrictions in sixty-year-olds. Higher depressive symptoms were independently associated with lower PA frequency and a higher likelihood of reduced PA in 72-88-year-olds. Positive and negative aspects of MWB have different relations to PA among people aged 60 and 70 + when one's daily routines are restricted.

TRIAL REGISTRATION NUMBER

ISRCTN52388040 (the PASSWORD study).

Views of Aging and Subjective Cognition in Middle-Aged and Older Adults: A Systematic Review

INTRODUCTION

Views of aging have been linked with many important outcomes in older adults. Subjective cognition, or one's perception of their cognitive functioning, may be a valuable indicator of cognitive changes as individuals age, but is known to be impacted by a variety of factors. The aim of this systematic review was to synthesize the evidence on relationships between views of aging and subjective cognition, including whether and how these relationships may differ based on age.

METHODS

Guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria, we conducted a comprehensive literature search in four databases: PubMed, CINAHL, PsycINFO, and ProQuest Dissertations and Theses. Critical appraisal utilized the Critical Appraisal Skills Programme (CASP) checklists. Twenty sources (including 21 studies) met inclusion and exclusion criteria, from which data were systematically extracted and results narratively synthesized.

RESULTS

Seventeen out of the 21 identified studies (81%) found a relationship between more positive views of aging and better subjective cognition; however, some studies reported mixed results based on the domain of aging views. Domains that were consistently associated with subjective cognition were subjective age, attitudes toward one's own aging, aging well, and essentialist beliefs about aging. Only three studies reported age group differences or changes in associations over time, precluding conclusions about differences across middle- and older ages.

CONCLUSION

Most studies supported associations between views of aging and subjective cognition. More longitudinal as well as qualitative research is needed to advance understanding of factors that influence these relationships.

Associations of Neighborhood Food and Physical Activity Environments in Young Adulthood With Cardiovascular Health in Midlife: The CARDIA Study

BACKGROUND

Adults who maintain ideal cardiovascular health (CVH) profiles up to midlife have lower risk of several chronic diseases and better quality of life. Some evidence suggests that individual-level exposures earlier in life shape midlife CVH, but the impact of neighborhood-level exposures over the life course remains understudied.

METHODS AND RESULTS

Participants were 3017 Black and White men and women aged 18 to 30 years at baseline (1985-1986), recruited from Birmingham, Alabama; Minneapolis, Minnesota; Chicago, Illinois; and Oakland, California, as part of the CARDIA (Coronary Artery Risk Development in Young Adults) study. Measures of the neighborhood food and physical activity environment were linked to participant addresses collected at baseline. CVH was measured on the basis of the American Heart Association's Life's Simple 7 criteria in young adulthood and 30 years later (2015-2016) when participants were midlife (aged 48-60 years). Associations of young adult neighborhood food environment and physical activity resources with midlife CVH (moderate versus high and low versus high) were examined using multinomial logistic regression. Models were adjusted for young adult sociodemographic factors. Participants who lived farther away from a major park in young adulthood were more likely to have low versus high CVH scores (odds ratio, 1.54 [95% CI, 1.22-1.96]) and more likely to have moderate versus high CVH scores (odds ratio, 1.39 [95% CI, 1.12-1.73]) in midlife. No other neighborhood measures were significantly associated with CVH.

CONCLUSIONS

Young adulthood may be a sensitive period in which having convenient access to physical activity-promoting resources may help them establish healthy habits that can carry into midlife.

Digital, Social Micro-Interventions to Promote Physical Activity Among Midlife Adults With Elevated Cardiovascular Risk: An Ambulatory Feasibility Study With Momentary Randomization

BACKGROUND

Although regular physical activity (PA) mitigates the risk for cardiovascular disease (CVD) during midlife, existing PA interventions are minimally effective. Harnessing social influences in daily life shows promise: digital micro-interventions could effectively engage these influences on PA and require testing.

PURPOSE

This feasibility study employed ecological momentary assessment with embedded micro-randomization to activate two types of social influences (i.e., comparison, support; NCT04711512).

METHODS

Midlife adults (N = 30, MAge = 51, MBMI = 31.5 kg/m2, 43% racial/ethnic minority) with ≥1 CVD risk conditions completed four mobile surveys per day for 7 days while wearing PA monitors. After 3 days of observation, participants were randomized at each survey to receive 1 of 3 comparison micro-interventions (days 4-5) or 1 of 3 support micro-interventions (days 6-7). Outcomes were indicators of feasibility (e.g., completion rate), acceptability (e.g., narrative feedback), and potential micro-intervention effects (on motivation and steps within-person).

RESULTS

Feasibility and acceptability targets were met (e.g., 93% completion); ratings of micro-intervention helpfulness varied by intervention type and predicted PA motivation and behavior within-person (srs=0.16, 0.27). Participants liked the approach and were open to ongoing micro-intervention exposure. Within-person, PA motivation and behavior increased from baseline in response to specific micro-interventions (srs=0.23, 0.13), though responses were variable.

CONCLUSIONS

Experimental manipulation of social influences in daily life is feasible and acceptable to midlife adults and shows potential effects on PA motivation and behavior. Findings support larger-scale testing of this approach to inform a digital, socially focused PA intervention for midlife adults.

Associations between sex and lifestyle activities with cognitive reserve in mid-life adults with genetic risk for Alzheimer's disease

BACKGROUND

Females have a higher age-adjusted incidence of Alzheimer's Disease (AD) than males, even when accounting for longer lifespan and, therefore, stand to benefit the most from dementia prevention efforts. As exposure to many modifiable risk factors for dementia begins in mid-life, interventions must be implemented from middle-age. Building cognitive reserve, particularly through stimulating avocational activities and occupational attainment presents a crucial, underexplored, dementia prevention approach for mid-life. It is currently unknown, however, whether modifiable lifestyle factors can protect against AD processes, from mid-life, differentially for females and males who carry inherited risk for late-life dementia. To address this gap, this study investigated the impact of biological sex and APOE4 carrier status on the relationship between stimulating activities, occupational attainment, and cognition in mid-life.

METHODS

We leveraged the PREVENT-Dementia program, the world's largest study investigating the origins and early diagnosis of dementia in mid-life at-risk individuals (N = 700; 40-59 years). Cognitive performance was measured using the Cognito Battery and the Visual Short Term Memory Binding task. Mid-life specific reserve contributors were assessed via the Lifetime of Experiences Questionnaire.

RESULTS

Females had significantly better episodic and relational memory (p < 0.001), and lower occupational attainment than males (p < 0.001). Engagement in stimulating activities was positively associated with episodic and relational memory, regardless of sex and APOE4 status (β = 0.05, CI 0.03-0.07, p < 0.001). APOE4 carriers showed significant sex differences in the association between occupational attainment and episodic and relational memory (β = 0.38, CI 0.12-0.63, p = 0.003). APOE4 carrier females with higher occupational attainment showed better cognition (β = 0.16, CI -0.002-0.32, p = 0.053), whereas APOE4 carrier males showed the opposite effect (β = -0.20, CI -0.40 - -0.001, p = 0.049).

CONCLUSION

Our findings suggest that occupational attainment in mid-life contributes to cognitive reserve against inherited risk of dementia in females, but not males. They highlight the need for high precision approaches that consider biological sex and APOE4 carrier status to inform Alzheimer's disease prevention strategies and clinical trials.

Association of social gatherings and physical exercise with depressive symptoms among middle-aged and older adults during the COVID-19 pandemic

Strict social isolation and physical distancing measures implemented during the COVID-19 pandemic had significant implications for the psychological well-being of middle-aged and older adults. This study aimed to investigate factors associated with depressive symptoms during the pandemic period among individuals who reported no significant depressive symptoms before the pandemic. Individuals from the Korean Longitudinal Study of Aging without a previous report of significant depressive symptoms across Waves 6 (2016) and 7 (2018) were investigated for the development of depressive symptoms in Wave 8 (2020). The multivariable logistic regression results revealed that both men and women who participated in social gatherings and physical exercise less than once a week were associated with an increase in the likelihood of depressive symptoms (odds ratio [OR] 2.88; 95% confidence interval [CI] 1.80-4.61 and OR 2.61; 95% CI 1.64-4.15, respectively for men and OR 2.58; 95% CI 1.80-3.70 and OR 1.51; 95% CI 1.02-2.23, respectively for women). In addition, unmarried men (OR 2.38; 95% CI 1.37-4.14) and women with one chronic disease (OR 1.98; 95% CI 1.14-3.43) or two or more chronic diseases (OR 2.28; 95% CI 1.31-3.99) reported a significant increase in the likelihood of depressive symptoms. Regular social gatherings and physical exercise were identified as key factors in mitigating depressive symptoms among middle-aged and older adults. The findings can inform the development of public health strategies that promote regular social interactions and physical activity to enhance the psychological resilience and overall well-being of middle-aged and older adults in the endemic era.

Age differences in prosociality across the adult lifespan: A meta-analysis

Lifespan developmental theories and research suggest a positive effect of adult age on prosociality. However, this effect lacks consistency, with many studies excluding the period of midlife. This study summarized cross-sectional studies on adult age and prosociality, combining 120 (independent) samples (n = 103,829) in a lifespan meta-analysis approach. Linear and quadratic age effects on prosociality were analyzed, as well as comparisons between younger, middle-aged, and older adults. Prosociality was assessed via behavioral measures and self-reports. In both these domains, results indicated small linear age effects and higher prosociality in older compared to younger adults, supporting the hypothesis of increased prosociality in older age. Additionally, leveraging open data sets (64/120 independent samples), predominantly unpublished, we found some evidence for potential quadratic age effects on behavioral prosociality: Middle-aged adults exhibited higher behavioral and self-reported prosociality than younger adults, but no differences between middle-aged and older adults were observed. This meta-analysis offers new perspectives on age trajectories of prosociality, suggesting midlife as a potentially important phase of pronounced prosociality.

Trajectories and influencing factors of psychological resilience among Chinese patients with maintenance hemodialysis

Objective

To identify distinct trajectories of psychological resilience among Chinese patients with maintenance hemodialysis, explore influencing factors and inform the formulation of corresponding interventions.

Methods

This was a multi-center longitudinal study with a 6-month follow-up. With convenience sampling, a total of 231 patients with maintenance hemodialysis were recruited between September 2020 and July 2021. Patients' characteristics, including sociodemographic information, social support and family resilience was collected through structured questionnaires as potential baseline influencing factors of psychological resilience trajectories. Psychological resilience was evaluated using the 25-item Chinese version of the Conner and Davidson resilience scale. Latent class growth modeling was conducted to identify homogeneous subgroups with distinct trajectories of psychological resilience. Univariable and multinomial logistic regression analysis were used to examine whether baseline influencing factors were associated with trajectories in patients with maintenance hemodialysis.

Results

Five distinct psychological resilience trajectory groups were identified: declining group (n = 20, 8.7 %), rising group (n = 17, 7.4 %), moderate-stable group (n = 128, 55.4 %), high-stable group (n = 7, 3.0 %) and low-stable group (n = 59, 25.5 %). High-stable group and moderate-stable group were combined into the well-psychological resilience group for multinomial logistic regression analysis. The multinomial logistic regression analysis showed that influencing factors associated with trajectories of psychological resilience were age, religion, monthly household income per capita, and baseline family resilience.

Conclusions

The results highlight the heterogeneity in the development of psychological resilience among Chinese patients with maintenance hemodialysis. There is a need for healthcare professionals to screen for trajectories of psychological resilience in Chinese maintenance hemodialysis patients and prepare individual mental healthcare interventions.

The bottlenose dolphin (Tursiops truncatus): a novel model for studying healthy arterial aging

Endothelial function declines with aging and independently predicts future cardiovascular disease (CVD) events. Diving also impairs endothelial function in humans. Yet, dolphins, being long-lived mammals adapted to diving, undergo repetitive cycles of tissue hypoxia-reoxygenation and disturbed shear stress without manifesting any apparent detrimental effects, as CVD is essentially nonexistent in these animals. Thus, dolphins may be a unique model of healthy arterial aging and may provide insights into strategies for clinical medicine. Emerging evidence shows that the circulating milieu (bioactive factors in the blood) is at least partially responsible for transducing reductions in age-related endothelial function. To assess whether dolphins have preserved endothelial function with aging because of a protected circulating milieu, we tested if the serum (pool of the circulating milieu) of bottlenose dolphins (Tursiops truncatus) induces the same arterial aging phenotype as the serum of age-equivalent humans. We incubated conduit arteries from young and old mice with dolphin and human serum and measured endothelial function ex vivo via endothelium-dependent dilation to acetylcholine. Although young arteries incubated with serum from midlife/older adult human serum had lower endothelial function, those incubated with dolphin serum consistently maintained high endothelial function regardless of the age of the donor. Thus, studying the arterial health of dolphins could lead to potential novel therapeutic strategies to improve age-related endothelial dysfunction in humans.NEW & NOTEWORTHY We demonstrate that, unlike serum of midlife/older adult humans, age-matched dolphin serum elicits higher endothelial function ex vivo in young mouse carotid arteries, suggesting that the circulating milieu of bottlenose dolphins may be geroprotective. We propose that dolphins are a novel model to investigate potential novel therapeutic strategies to mitigate age-related endothelial dysfunction in humans.

Smartphone-Based Sit-to-Stand Analysis for Mobility Assessment in Middle Age

Background and Objectives

Mobility can decline in middle age and growing evidence highlights the importance of assessing mobility at this stage of life. Smartphone-based accelerometry during sit-to-stand has been shown to identify mobility impairments, but its utility in detecting subtle mobility deterioration in middle age has not been tested. This study aimed to examine whether smartphone-based accelerometry data measured during sit-to-stand tests performed on a regular chair and a cushioned sofa could be useful for detecting subtle changes in mobility in middle age.

Research Design and Methods

Twenty-three young (25.0 ± 2.5 years), 25 middle-aged (52.0 ± 5.2 years), and 17 older adults (70.0 ± 4.1 years) performed the 5-times sit-to-stand test on both a standard chair and a sofa. A smartphone attached to the participants' lower back was used to measure lower-limb muscle power, maximal vertical velocity (MVV) during rising, the duration of the total task and the subphase of transition from sitting to standing (SiToSt), and repetition variability using the dynamic time warping method.

Results

Middle-aged adults had reduced lower-limb muscle power compared to young adults (5.25 ± 1.08 vs 6.19 ± 1.38 W/kg, p = .034), being more pronounced on the sofa (6.23 ± 1.61 vs 8.08 ± 2.17 W/kg, p = .004). Differences between middle-aged and young adults in terms of MVV (p = .011) and SiToSt duration (p = .038) were only detected on the sofa, and the middle-aged adults showed less variability compared to the older adults on the chair (p = .018). There was no difference in total task duration between the middle-aged group and the young or older adults in either condition.

Discussion and Implications

Most common tests are limited in their ability to detect early mobility deterioration in midlife due to a ceiling effect. Our results, which show the potential of smartphone-based sit-to-stand assessment in detecting subtle mobility decline in midlife, could serve as a screening tool for this purpose.

Midlife health in Britain and the United States: a comparison of two nationally representative cohorts

BACKGROUND

Older adults in the USA have worse health and wider socioeconomic inequalities in health compared with those in Britain. Less is known about how health in the two countries compares in mid-life, a time of emerging health decline, including inequalities in health.

METHODS

We compare measures of current regular smoking status, obesity, self-rated health, cholesterol, blood pressure and glycated haemoglobin using population-weighted modified Poisson regression in the 1970 British Cohort Study (BCS70) in Britain (N = 9665) and the National Longitudinal Study of Adolescent to Adult Health (Add Health) in the USA (N = 12 300), when cohort members were aged 34-46 and 33-43, respectively. We test whether associations vary by early- and mid-life socioeconomic position.

RESULTS

US adults had higher levels of obesity, high blood pressure and high cholesterol. Prevalence of poor self-rated health and current regular smoking was worse in Britain. We found smaller socioeconomic inequalities in mid-life health in Britain compared with the USA. For some outcomes (e.g. smoking), the most socioeconomically advantaged group in the USA was healthier than the equivalent group in Britain. For other outcomes (hypertension and cholesterol), the most advantaged US group fared equal to or worse than the most disadvantaged groups in Britain.

CONCLUSIONS

US adults have worse cardiometabolic health than British counterparts, even in early mid-life. The smaller socioeconomic inequalities and better overall health in Britain may reflect differences in access to health care, welfare systems or other environmental risk factors.

Unveiling the Hidden Burden: Exploring the Psychological Impact of Gynecological Cancers and Predictive Modeling of Depression in Southwest China

Objective

To explore the psychological impact of gynecological cancers on middle-aged women in Southwest China and identify the risk factors for moderate to severe depressive symptoms.

Methods

This cross-sectional study included 500 patients from Southwest China, divided into two groups: depression (n = 220) and no depression (n = 280). Data on demographics, clinical characteristics, and socioeconomic factors were collected. We developed a logistic regression model to predict depressive symptoms and assessed its accuracy using the area under the receiver operating characteristic curve (AUC).

Results

The study cohort consisted of 500 middle-aged and young female cancer patients with a median age of 44 years. Significant predictors of depressive symptoms included younger age, higher economic stress levels, and out-of-pocket medical expenses. A comparative analysis showed that 220 patients exhibited depression symptoms, with these patients being generally younger (median age 41 years) compared to those without depression (median age 47 years, p < 0.001). Economic stress was consistently higher in the depression group across all cancer types. Patients with ovarian cancer had a reduced risk of depression compared to those with cervical cancer. The predictive model demonstrated high accuracy in identifying depression risk, with an AUC of 0.888. Internal validation yielded an average AUC of 0.885, and external validation produced an AUC of 0.872, underscoring the model's robustness and reliability. These findings emphasize the complex interplay of demographic, socioeconomic, and clinical factors in the psychological well-being of gynecological cancer patients, highlighting the need for tailored psychological and financial support interventions.

Conclusion

Gynecological cancer patients in Southwest China experience significant psychological challenges, particularly younger women and those facing economic stress. Our predictive model can aid in early identification of those at risk for depression, emphasizing the importance of holistic care. Interventions should focus on both psychological and financial support to improve patient outcomes.

Resiliency and Barriers to Successful Aging Among Middle-Aged Mexican Immigrants Residing in a Rural Agricultural Community

OBJECTIVES

The Latino population is one of the largest, most diverse, and fastest-growing demographic groups in the United States. Although Latinos enjoy longer life spans and reduced mortality risk relative to non-Hispanic Whites, they have higher rates of chronic health conditions such as diabetes and dementia and live more of their older years with poor health and disability. Such inequities point to the need for this research focused on examining resiliency strategies and barriers to successful aging among various U.S. Latino subgroups.

METHODS

This qualitative study used thematic content analysis to examine resiliency strategies and barriers to successful aging among Mexican immigrant women (n = 40) residing in an underserved agricultural community and entering mid-life (mean = 49 years old).

RESULTS

With regards to barriers to successful aging, 3 themes emerged: (1) stressful lifestyle in the United States compared to the participants' home countries; (2) stress from expectations at home; and (3) stress due to work and the various components around work. The following 4 resiliency strategies emerged: (1) family as a motivation for moving forward in life and focusing on the success of children; (2) having a positive mindset; (3) praying to God for strength to overcome obstacles; and (4) self-care.

DISCUSSION

Despite experiencing barriers to successful aging, participants practice various resiliency strategies to age successfully. Because many of the barriers identified are related to poverty-related stressors, systemic solutions addressing the social determinants of health are needed.

A Life-Stage Approach to Precision Nutrition: A Narrative Review

The concept of precision nutrition highlights the customization of nutrition to specific needs, emphasizing that a one-size-fits-all approach is not sufficient for either optimal nutrition or optimal health. Precision nutrition encompasses a range of factors, from broad strata of age and sex categories to personal characteristics such as lifestyle to an individual's unique genotype. This breadth of scope requires us to consider how precision nutrition can be implemented in an inclusive and appropriate way for individuals and groups within real-life populations. In this narrative review, we explore the potential of precision nutrition through a life-stage approach that emphasizes age- and gender-specific nutritional needs as these change across the lifespan. Focusing on adult life stages, we delineated trends in age-related conditions and health needs among Korean adults based on national-level survey data (KNHANES 2019-2021). We also reviewed the intake of nutrients associated with these health needs to better understand how life-stage guided approaches to nutrition and supplementation could support optimal health. Looking beyond preventing deficiency or disease, we discuss how tailored supplementation of essential vitamins, minerals, and certain bioactive substances could promote healthy functioning. Finally, we discuss the complexities and challenges of developing multivitamin/multimineral supplements (MVMS) to support life-stage appropriate nutrition while maximizing adherence. Future prospects include leveraging advancements in intelligent technologies and dietary assessments for tracking nutrient intake and health indicators and using these to optimize MVMS formulations in ways that are sensitive to a person's needs and priorities/preferences at different life stages. By adopting a life-stage guided approach to nutrition, we can better support health and well-being across the lifespan.

Midlife diseases of despair and cardiometabolic risk: testing shared origins in adolescent psychopathology

BACKGROUND

Rising midlife mortality in the United States is largely attributable to 'deaths of despair' (deaths from suicide, drug poisonings, and alcohol-related diseases) and deaths from cardiometabolic conditions. Although despair- and cardiometabolic-related mortality are increasing concurrently, it is unclear whether they share common developmental origins. We tested adolescent psychopathology as a potential common origin of midlife diseases of despair and cardiometabolic risk.

METHODS

Participants (N = 4578) were from the National Longitudinal Study of Adolescent to Adult Health, a nationally representative cohort followed from adolescence to early midlife. Adolescent psychopathology included depression, anxiety, eating disorders, PTSD, conduct disorder, and ADHD at ages 11-18. Diseases of despair (suicidality, substance misuse, pain, and sleep problems) and cardiometabolic risk (hypertension, hyperlipidemia, high-risk waist circumference, diabetes, and cardiovascular conditions) were multi-modally measured at ages 33-43.

RESULTS

At midlife, adolescents who experienced psychopathology exhibited more indicators of despair-related diseases and cardiometabolic risk (IRRs = 1.67 [1.46-1.87] and 1.13 [1.04-1.21], respectively), even after accounting for demographics, adolescent SES, and adolescent cognitive ability. Associations were evident for internalizing and externalizing conditions, and in a dose-response fashion. In mediation analyses, low education explained little of these associations, but early-adult substance use explained 21.5% of psychopathology's association with despair-related diseases. Midlife despair-related diseases and cardiometabolic risk co-occurred within individuals (IRR = 1.12 [1.08-1.16]). Adolescent psychopathology accounted for 8.3% of this co-occurrence, and 16.7% together with adolescent SES and cognitive ability.

CONCLUSIONS

Adolescent psychopathology precedes both diseases of despair and cardiometabolic risk. Prevention and treatment of psychopathology may mitigate multiple causes of poor midlife health, reducing premature mortality.

Trend analysis and influencing factors of healthy aging in middle-aged population in China: a longitudinal study based on the China Health and Retirement Longitudinal Study

OBJECTIVES

This study aimed to assess the trends of healthy aging and investigate its determinants in the middle-aged population.

STUDY DESIGN

This was a longitudinal study.

METHODS

The sample comprised 3043 participants aged 45-59 years from the China Longitudinal Study of Health and Retirement 2011-2018. We plotted the prevalence across four waves and used ordered logistic models to investigate the determinants of cumulative times of healthy aging.

RESULTS

We enrolled 3043 middle-aged people in our study. The prevalence of healthy aging is 28.2% at baseline but subsequently decreased to 19.72% at wave 4. Active socializing consistently ranked the lowest among the five dimensions. Participants with older age (odds ratio [OR] = 0.95, 95% confidence interval [CI] = 0.94-0.97), low monthly income (OR = 0.82, 95% CI: 0.69-0.97) or lived in urban (OR = 0.81, 95% CI: 0.70-0.94) were less likely to have per time increase in healthy aging. Participants with more than primary school degree (OR = 1.79, 95% CI: 1.31-2.46), high life satisfaction (OR = 2.38, 95% CI: 1.86-3.06), and good self-report health (OR = 1.97, 95% CI: 1.66-2.34) were more likely to have healthy aging.

CONCLUSION

The number of middle-aged individuals in China who achieved healthy aging is declining and eventually less than one in five, which was far from ideal. Particular attention should be paid to older, women, urban dwellers, individuals with low income, low life satisfaction or poor self-report health. It is urgent to develop public health policies to improve the health and well-being of the middle-aged population.

Biopsychosocial factors of quality of life among middle-aged adults living alone in South Korea: a secondary data analysis using the 2017 Korea Community Health Survey

BACKGROUND

This study aimed to investigate quality of life (QoL) in middle-aged adults living alone and identify comprehensive biological, psychological, interpersonal, and contextual factors related to QoL using the dynamic biopsychosocial model. As a secondary analysis, this study used data from the 2017 Korea Community Health Survey conducted by the Korea Disease Control and Prevention Agency.

METHODS

Among the total 228,381 respondents, 10,639 middle-aged individuals aged 40-64 years from single-person households (5,036 men and 5,603 women) were included in the analysis. QoL was measured using the EuroQoL-5 Dimension (EQ-5D). The EQ-5D descriptive statistics were provided according to biological, psychological, interpersonal, and contextual factors. Considering the data structure of the multistage stratified cluster sampling method, a complex samples general linear model statistic was used to identify the predictors of QoL.

RESULTS

QoL was lower in those who had undesirable psychological status (e.g., more depressive symptoms, poor subjective health, and higher perceived stress), less engagement in social networking (less frequent contact with friends and less frequent participation in social activities such as religious activities, friendship gathering, and leisure), and lower physical, behavioral, and socioeconomic factors.

CONCLUSIONS

This study's findings indicate that psychological and interpersonal factors should be addressed and prioritized to improve the QoL of middle-aged adults living alone. By providing many opportunities for easily accessible social activities that meet the needs and interests of this demographic, their QoL can be improved through strengthening social support.

Loneliness dynamics and physical health symptomology among midlife adults in daily life

OBJECTIVE

The current study examined how average daily loneliness (between-persons [BPs]), intraindividual variability in loneliness across days (within-persons [WPs]), and loneliness stability informed physical health symptomatology.

METHOD

We utilized daily diary data from a national sample of 1,538 middle-aged adults (Mage = 51.02; 57.61% women) who completed eight end-of-day telephone interviews about daily experiences, including loneliness and physical health symptoms (e.g., headaches, nausea). Via multilevel modeling, we examined average daily loneliness (BPs), intraindividual variability in loneliness (WPs), stability in loneliness (individual mean-squared successive difference) in association with the number and average severity of daily physical health symptoms.

RESULTS

When participants were less lonely on average, and on days when loneliness was lower than a person's average, they had fewer and less severe physical health symptoms. Additionally, participants who were more stable in loneliness across 8 days had less severe physical health symptoms. Further, there was a stronger association between instability in loneliness and more physical health symptoms for people who were lonelier on average. Finally, the increase in physical health symptom severity associated with WP loneliness was strongest for participants with low variability in loneliness.

CONCLUSION

Loneliness is associated with physical health symptoms on a day-to-day basis, especially for people who are highly variable in loneliness. Considerations of multiple sources of variation in daily loneliness may be necessary to adequately address loneliness and promote health. Public health interventions addressing loneliness may be most effective if they support social connectedness in people's everyday lives in ways that promote stable, low levels of loneliness. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Childhood and Midlife Cultural Awareness and Activity Engagement Among Korean Married Couples

OBJECTIVES

Cultural reproduction theory posits that cultural resources are transmitted across generations, suggesting early parental influences on cultural experiences in adulthood. Further, cultural resources may be transferred within the same generation-through significant others, such as spouses. This study investigates cultural engagement among middle-aged adults, focusing on individual and spousal influences of childhood cultural engagement.

METHODS

A sample of 1,271 couples (age 49-66) from the 2012 Korean Baby Boomer Panel Study and the Korean Forgotten Generation Study was analyzed. Each respondent reported the number of arts and cultural activities (e.g., paintings, literature, and classical music) and levels of perceived cultural engagement (i.e., cultural awareness) during childhood and at midlife. Actor-partner interdependence models (APIMs) were estimated to examine how spouses' childhood and midlife cultural engagement were linked within couples.

RESULTS

Findings showed that wives reported higher levels of activity participation and cultural awareness in childhood and midlife, compared to husbands. The APIM results indicated that beyond one's own childhood cultural engagement, spouse's childhood cultural awareness was associated with both levels of participation in arts and cultural activities (only for husbands) and cultural awareness (for both husbands and wives) at midlife.

DISCUSSION

Cultural activities and awareness can be valuable assets to enhance overall well-being in later life. Given the cross-spousal associations in cultural engagement among Korean middle-aged couples, both spouses' cultural resources need to be considered for the design of interventions and policies to cultivate cultural competence and promote cultural engagement in adulthood.

"Am I Too Old to Pursue a Degree?" Ageism at Midlife in a Community College Setting

Adults who are beginning or returning to finish a degree program at midlife face different challenges than do their younger counterparts whose college experience begins at 18 years of age. We suspect that internalized ageism, defined as self-directed ageist attitudes and behaviors, may hinder nontraditional age students along with the experience of individual and institutional ageism. To evaluate this notion, we assessed the prevalence of self-reported positive and negative ageist behaviors in 205 students (M = 21.95, SD = 7.28, age range: 16-52 years) and 29 faculty (M = 49.55, SD = 11.07, age range: 33-71 years) in a community college in southeast Louisiana in the spring of 2019. All completed the Relating to Older People Evaluation (ROPE; Cherry & Palmore, 2008) and an open-ended question on how they viewed middle-aged students. Quantitative analyses indicated that students' ROPE scores exceeded those of the faculty and more positive than negative ageist behaviors were reported. Qualitative analyses revealed mostly positive expectations of middle-aged students among narrative responses to the open-ended question. As a follow-up, 10 nontraditional age students were individually interviewed in person to obtain an in-depth assessment of their community college experience. Strong evidence of internalized, individual, and institutional ageism were evident in their responses. Their narratives also revealed atypical life experiences and rich details of faculty-level and institutional-level policies that supported or hindered their academic progress. Implications of these data for addressing ageism on multiple levels in higher education are considered.

Lifestyle and psychosocial associations with cognition at the cusp of midlife using twins and siblings

INTRODUCTION

This study investigates the relationship between cognitive functioning and 59 modifiable and intrinsic factors at the cusp of midlife.

METHODS

We analyzed data from 1221 participants in the Colorado Adoption/Twin Study of Lifespan behavioral development and cognitive aging (CATSLife; Mage = 33.20, %Female = 52.74). We assessed the impact of 59 factors on cognitive functioning using regularized regression and co-twin control models, controlling for earlier-life cognitive functioning and gray matter volume.

RESULTS

Eight robust factors were identified, including education attainment, cognitive complexity, purpose-in-life, and smoking status. Twins reporting higher levels of cognitive complexity and purpose-in-life showed better cognitive performance than their cotwin, while smoking was negatively associated. Using meta-analytically derived effect size threshold, we additionally identified that twins experiencing more financial difficulty tend to perform less well compared with their cotwin.

DISCUSSION

The findings highlight the early midlife link between cognitive functioning and lifestyle/psychological factors, beyond prior cognitive performance, brain status, genetic and familial confounders. Our results further highlight the potential of established adulthood as a crucial window for dementia prevention interventions targeting lifestyle and psychosocial factors.

Highlights

Cog complexity(+), purpose-in-life(+) were associated with cognition in early midlife.Smoking(-) was also associated with cognition in early midlife.Results were consistent controlling for genetic and environmental confounds.Association between EA and cognition might be mostly genetic and familial confounded.

'Looking forward': An actionable framework for proactive health and well-being behaviours in Australian midlife women

ISSUE ADDRESSED

The health and well-being of midlife women are not well-researched. This study uses an actionable framework to demonstrate the influence of biosocial, psychological and cognitive factors on proactive health and well-being behaviours (PHWB) of midlife women, including setting and evaluating their well-being goals.

METHODS

Quantitative cross-sectional data from Australian middle-aged women (N = 904) aged 40-65 residing in Australia was used. Multinomial logistic regression examined associations with three PHWB outcomes (low, medium and high) and biosocial, psychological and cognitive factors.

RESULTS

Proactive health behaviours are influenced by a positive attitude towards ageing, a stronger sense of stoicism and self-control, and a clearer life purpose. Compared to a high PHWB group, low proactiveness was associated with poor biosocial influences, fewer personal relations and less perceived behavioural control, but a higher level of self-acceptance.

CONCLUSION

Findings demonstrate how significant biosocial, psychological and cognitive determinants may empower midlife women to be proactive and to set and achieve a broader set of physical, mental, relationship and financial health and well-being goals for positive health outcomes and healthy ageing. SO WHAT?: The actionable framework provides directions for public health agencies to develop health and well-being communication strategies and health promotion initiatives targeting women at both early and later midlife. The findings point to the importance of understanding and fostering proactiveness in the context of midlife women's health and well-being.

Association between health literacy and self-management among middle-aged women: A systematic review

OBJECTIVE

We aimed to review and synthesize the literature on the association between health literacy (HL) and self-management in middle-aged women aged 35-64 years and examine the definitions and measurements of HL.

METHODS

Eleven electronic databases were used for searching specific terms. Experimental and non-experimental studies in English or Korean were included based on the eligibility criteria. Two authors independently conducted study selection, data extraction, and methodological quality assessment.

RESULTS

One experimental and 13 non-experimental studies were included. Of the 11 studies that defined HL, nine conceptualized it as reflecting multidimensional HL. Four studies measured HL capturing all dimensions of the concept (i.e., accessing, understanding, appraising, and applying) and two studies used context-specific HL measurements. Women with greater HL challenges generally had lower self-management context, process, and outcomes across the health continuum.

CONCLUSIONS

Enhancing HL is a critical strategy for improving self-management in middle-aged women. Future research should investigate the effectiveness of HL interventions on self-management considering multidimensional definitions and measures of HL.

PRACTICE IMPLICATIONS

Health professionals should be alert to middle-aged women's HL and implement HL interventions that provide them with opportunities to access, understand, analyze, and utilize health-related information to effectively improve HL and engage in self-management.

Implementation of a virtual community of practice to promote the empowerment of middle-aged people with multimorbidity: study protocol of a randomised controlled trial

INTRODUCTION

Empowering people living with multimorbidity (multiple chronic conditions) to gain greater confidence in managing their health can enhance their quality of life. Education focused on self-management is a key tool for fostering patient empowerment and is mostly provided on an individual basis. Virtual communities of practice (VCoP) present a unique opportunity for online education in chronic condition self-management within a social context. This research aims to evaluate the effectiveness/cost-effectiveness of individualised, online self-management education compared with VCoP among middle-aged individuals living with multiple chronic conditions.

METHODS AND ANALYSIS

People aged 30-60, living with ≥2 chronic conditions and receiving care in primary care (PC) centres and outpatient hospital-based clinics in Madrid and Canary Islands will enrol in an 18-month parallel-design, blinded (intervention assessment and data analysts), pragmatic (adhering to the intention-to-treat principle), individually randomised trial. The trial will compare two 12-month web-based educational offers of identical content; one delivered individually (control) and the other with online social interaction (VCoP, intervention). Using repeated measures mixed linear models, with the patient as random effect and allocation groups and time per group as fixed effects, we will estimate between-arm differences in the change in Patient Activation Measure from baseline to 12 months (primary endpoint), including measurements at 6-month and 18-month follow-up. Other outcomes will include measures of depression and anxiety, treatment burden, quality of life. In addition to a process evaluation of the VCoP, we will conduct an economic evaluation estimating the relative cost-effectiveness of the VCoP from the perspectives of both the National Health System and the Community.

ETHICS AND DISSEMINATION

The trial was approved by Clinical Research Ethics Committees of Gregorio Marañón University Hospital in Madrid/Nuestra Señora Candelaria University Hospital in Santa Cruz de Tenerife. The results will be disseminated through workshops, policy briefs, peer-reviewed publications and local/international conferences.

TRIAL REGISTRATION NUMBER

NCT06046326.

Cross-sectional associations between patterns and composition of upright and stepping events with physical function: insights from The Maastricht Study

INTRODUCTION

Age-related declines in physical functioning have significant implications for health in later life. Physical activity (PA) volume is associated with physical function, but the importance of the pattern in which PA is accumulated is unclear. This study investigates associations between accelerometer-determined daily PA patterns, including composition and temporal distribution (burstiness) of upright and stepping events, with physical function.

METHODS

Data was from participants who wore an activPAL3 accelerometer as part of The Maastricht Study. Exposures included a suite of metrics describing the composition and the temporal distribution (burstiness) of upright and sedentary behaviour. Physical function outcomes included the six-minute walk test (6MWT), timed chair-stand test (TCST), grip strength (GS), and SF-36 physical functioning sub-scale (SF-36pf). Multivariable linear regression models were used to assess associations, adjusting for covariates including overall PA volume (daily step count).

RESULTS

Participants(n = 6085) had 6 or 7 days of valid data. Upright and stepping event metrics were associated with physical function outcomes, even after adjusting PA volume. Higher sedentary burstiness was associated with better function (6MWT, TCST, and SF-36pf), as was duration and step volume of stepping events (6MWT, TCST, GS, and SF-36pf), step-weighted cadence (6MWT, TCST, and SF-36pf). Number of stepping events was associated with poorer function (6MWT, GS, and SF-36pf), as was upright event burstiness (SF-36pf). Associations varied according to sex.

CONCLUSION

Our study reveals that diverse patterns of physical activity accumulation exhibit distinct associations with various measures of physical function, irrespective of the overall volume. Subsequent investigations should employ longitudinal and experimental studies to examine how changing patterns of physical activity may affect physical function, and other health outcomes.

Cross-sectional associations between temporal patterns and composition of upright and stepping events with physical function in midlife: Insights from the 1970 British Cohort Study

INTRODUCTION

Age-related decline in physical functioning has significant implications for health in later life but declines begin earlier in midlife. Physical activity (PA) volume is associated with physical function, but the importance of the pattern in which PA is accumulated is unclear. This study investigates associations between patterns of PA accumulation, including the composition, variation, and temporal distribution of upright and stepping events, with physical function in midlife.

METHODS

Participants (n = 4378) from the 1970 British Cohort Study wore an activPAL3 accelerometer on the thigh for 7 consecutive days. Exposure measures included a suite of metrics describing the frequency, duration, and composition of upright events, as well as the duration and volume (total steps) of stepping events. In addition, patterns of accumulation of upright and sedentary events were examined including how fragmented/transient they were (upright-to-sedentary transition probability [USTP]) and their burstiness (the tendency for events to be clustered together followed by longer interevent times). Physical function outcomes included grip strength (GS), balance, and SF-36 physical functioning subscale (SF-36pf). Cross-sectional analyses included multivariable linear regression models to assess associations, adjusting for covariates including overall PA volume (mean daily step count).

RESULTS

Higher upright event burstiness was associated with higher GS, and higher USTP was associated with lower GS. Duration and step volume of stepping events were positively associated with SF-36pf in females. Step-weighted cadence was positively associated with SF-36pf and balance. Contradictory findings were also present (e.g., more transient stepping events were associated with better GS) particularly for GS in males. Inconsistencies between sexes were observed across some associations.

CONCLUSION

Our study reveals that diverse patterns of PA accumulation exhibit distinct associations with various measures of physical function in midlife, irrespective of the overall volume. Contradictory findings and inconsistency between sexes warrant further investigation. Patterns of PA accumulation, in addition to volume, should be considered in future PA research. Longitudinal studies are required to determine whether a given volume of activity accumulated in different patterns, impacts associations between PA and health outcomes.

Why do Middle-Aged Adults Report Worse Mental Health and Wellbeing than Younger Adults? An Exploratory Network Analysis of the Swiss Household Panel Data

Despite the growing consensus that midlife appears to be a particularly vulnerable life phase for lower mental health and wellbeing, little is known about the potential reasons for this phenomenon or who the individuals at higher risk are. Our study used six waves (2013-2018) of the Swiss Household Panel (n = 5,315), to compare the distribution of mental health and wellbeing, as well as their key correlates, between midlife (40-55 years) and younger adults (25-39 years) in Switzerland. Moreover, using network analysis to investigate interrelationships across life domains, we describe the complex interrelations between multiple domain-specific correlates and indicators of both mental health and wellbeing across the two age groups. Middle-aged (age 40-55) individuals reported lower life satisfaction and joy, as well as higher anger, sadness, and worry than young adults (age 25-39), with the effect sizes reaching up to 0.20 Cohen's d. They also reported lower social support, relationships satisfaction, health satisfaction, and higher job demands and job insecurity. Relationships satisfaction and social support were the most consistent correlates across all three indicators of wellbeing in both age groups. Health satisfaction was more strongly, and directly, interrelated with energy and optimism in midlife compared with young adulthood (0.21 vs 0.12, p = 0.007). Job demands were more strongly linked with anger and sadness in midlife. The network model helped us to identify correlates or their clusters with direct and strong links to mental health and wellbeing. We hypothesised that health satisfaction, relationships satisfaction, social support, and job demands may help to explain worse mental health and wellbeing in midlife.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11482-024-10274-4.

Adult Development and Associated Health Risks

Much has been learned about adult development in recent decades. Adults go through stages of development (emerging adulthood, young adulthood, middle adulthood, post-retirement, and very old age) with certain challenges at each stage. Viewing patients through a developmental lens is part of providing patient-centered care. Knowing the prominent issues, stressors, and risks at each stage of development is important in understanding patients. This knowledge can help customize medical advice to patients regarding obesity, disability, sleep, substance use, relationships, and age-related declines. This paper summarizes an updated view of adult development and discusses its relevance to health risks and patient-centered care practices at different stages.

Identifying Specific Gaps in Knowledge of Aging and Examining Its Relation to Biases Toward Older Adults

Accurate aging knowledge is key to reducing ageist attitudes that impact older adult well-being. We first investigated how aging knowledge and negative and positive age-bias indirectly expressed via aging knowledge responses were related to an explicitly negative ageism measure. We then identified specific gaps in the aging knowledge of emerging adults and middle-aged adults. More negative ageism correlated with less aging knowledge overall and in psychological and social, but not biological, domains. Negative ageism correlated with negative age-bias, but not positive age-bias, expressed via aging knowledge responses. Knowledge of aging was poorest regarding social and psychological aspects of aging and best regarding biological aging. Middle-aged adults had slightly, but significantly, more accurate aging knowledge and less negative age-bias than emerging adults; positive age-bias did not differ by age-group. These results suggest that effectiveness of anti-ageism educational interventions may be enhanced if focused on improving knowledge of social and psychological aging.

Limited English Proficiency Is Not Associated With Poor Postoperative Outcomes or Follow-Up Rates in Patients Undergoing Breast Reduction Mammoplasty - A Single Institution Retrospective Cohort Study

INTRODUCTION

Limited English Proficiency (LEP) status has been associated with worse patient outcomes on a variety of metrics.

METHODS

A retrospective review of all bilateral breast reduction mammoplasty patients at our institution between 2015 and 2019 was performed. Data collected include patient demographics, language status, interpreter usage, complications, and follow-up clinic/emergency department visits. Patients were grouped into high and low follow-up cohorts by median follow-up. Bivariate testing and regression modeling were used for analysis.

RESULTS

A total of 1023 patients were included. Average age and body mass index (BMI) were 37.7 years and 31.7 kg/m2. All LEP (21%) patients used interpreters. There were 590 individuals in the low follow-up and 433 in the high follow-up group. Those in low follow-up were younger, with lower BMI, and were more likely to use Medicaid. Prevalence of diabetes and postoperative emergency department visits were higher in the high follow-up cohort. There were no significant differences in race/ethnicity, smoking status, and interpreter use between groups. Poisson modeling demonstrated that presence of complications is associated with a 0.435 increase in the number of clinic visits and a 1-y increase in age is associated with a 0.006 increase (P < 0.001). Interpreter use was not significantly associated with postoperative clinic visits. Multivariable regression modeling demonstrated BMI and diabetes to be significantly associated with incidence of any complication (odds ratio: 1.08 & 2.234; P < 0.001 &P = 0.01, respectively).

CONCLUSIONS

LEP status was not associated with worse postoperative outcomes or follow-up length in patients undergoing breast reduction mammoplasty. This may be due to interpreter use and effective patient education.