Network Types and Functional Health in Old Age: It is Not Just the Size of the Network That Matters

OBJECTIVES

Findings on the effect of network size and support on functional health are mixed. We examine whether network types, that simultaneously incorporate multiple network characteristics, are associated with functional health in late life.

METHODS

Data are from the National Social Life, Health, and Aging Project (N = 3005). We estimated the longitudinal effect of membership in five multidimensional network types on disability in six activities of daily living using negative binomial regression, and on mobility (assessed using a timed walk test) using a generalized linear mixed model.

RESULTS

Compared to those in the large without strain network, older adults in the small, restricted, high contact network had fewer disabilities but worse mobility, while those in the large network with strain also had worse mobility.

DISCUSSION

Care plans focusing on function and mobility should consider multiple aspects of older adults' social networks including network size, diversity, and relationship strain.

Neuropsychological Assessment of Older Adults in Nepal for Population-Based Dementia Ascertainment: Needs, Challenges, and Opportunities

The population of Nepal is rapidly aging, as in other low and middle-income countries, and the number of individuals living with Alzheimer's Disease and related dementias (ADRD) is expected to increase. However, information about the neuropsychological assessment of ADRD in Nepal is lacking. We first aimed to examine the needs, challenges, and opportunities associated with the neuropsychological assessment of older adults in Nepal for population-based ADRD ascertainment. Second, we introduce the Chitwan Valley Family Study-Study of Cognition and Aging in Nepal (CVFS-SCAN), which is poised to address these needs, and its collaboration with the Harmonized Cognitive Assessment Protocol (HCAP) international network. We reviewed the existing literature on the prevalence, risk factors, available neuropsychological assessment instruments, and sociocultural factors that may influence the neuropsychological assessment of older adults for ADRD ascertainment in Nepal. Our review revealed no existing population-based data on the prevalence of ADRD in Nepal. Very few studies have utilized formal cognitive assessment instruments for ADRD assessment, and there have been no comprehensive neuropsychological assessment instruments that have been validated for the assessment of ADRD in Nepal. We describe how the CVFS-SCAN study will address this need through careful adaptation of the HCAP instrument. We conclude that the development of culturally appropriate neuropsychological assessment instruments is urgently needed for the population-based assessment of ADRD in Nepal. The CVFS-SCAN is designed to address this need and will contribute to the growth of global and equitable neuropsychology and to the science of ADRD in low- and middle-income countries.

Aging and the Left Behind: Puerto Rico and Its Unconventional Rapid Aging

Puerto Rico is aging more rapidly than almost any country, with 2020 estimates placing its population share of adults older than 65 as being the 10th highest in the world. Unlike most locales, Puerto Rico's aging is driven by both (a) the culmination of long-running fertility and mortality trends and (b) high levels of outmigration of working-age adults, which contributes both directly (removal of young people) and indirectly (reduced births) to its pace of population aging. This article offers an overview of the main issues surrounding population aging in Puerto Rico. Policymakers and government leaders must plan for Puerto Rico's unconventional population aging, which will exacerbate traditional concerns about the sustainability of government services and long-term economic prospects. Additional concerns emerge related to reduced social support networks and their impact on caregiving dynamics and implications for health. Puerto Rico's unique history and political relationship with the United States present challenges and benefits for its aging population. Research on aging in Puerto Rico and public health policies must adapt to the needs of the country's aging society.

Migration is the driving force of rapid aging in Puerto Rico: A Research Brief

The combined effects of declining fertility and increased longevity have accelerated population aging in different parts of the world. Unlike other countries, Puerto Rico is also experiencing unprecedented levels of working-age out-migration. The full impact of high out-migration on Puerto Rican demography is not fully understood. Placing Puerto Rico's aging process in an international context is useful in identifying the role out-migration is having on the accelerated aging of the Puerto Rican society. Using the World Population Prospects 2019 estimates, we compared the pattern of rapid aging found for Puerto Rico with the trajectories of six other countries with the highest population of 65+ in the World, Europe, and the Caribbean from 1960 to 2020. Prior to 2010, the aging process in Puerto Rico was comparable to the other countries. After 2010, the percent of the population over 65 years in Puerto Rico nearly doubled from 11% to 21%. The nearly doubling of the percent of older adults is not observed in any of the comparison countries. We find that the rapid aging of Puerto Rico, changing from a linear trend to an exponential one, is a result of accelerating levels of out-migration, which is concentrated in the working-age population.

The Association of Fire or Police First Responder Initiated Interventions with Out of Hospital Cardiac Arrest Survival

OBJECTIVE

Fire and police first responders are often the first to arrive in medical emergencies and provide basic life support services until specialized personnel arrive. This study aims to evaluate rates of fire or police first responder-initiated cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use, as well as their associated impact on out-of-hospital cardiac arrest (OHCA) outcomes.

METHODS

We completed a secondary data analysis of the MI-CARES registry from 2014 to 2019. We reported rates of CPR initiation and AED use by fire or police first responders. Multilevel modeling was utilized to evaluate the relationship between fire/police first responder-initiated interventions and outcomes of interest: ROSC upon emergency department arrival, survival to hospital discharge, and good neurologic outcome.

RESULTS

Our cohort included 25,067 OHCA incidents. We found fire or police first responders initiated CPR in 31.8% of OHCA events and AED use in 6.1% of OHCA events. Likelihood of sustained ROSC on ED arrival after CPR initiated by a fire/police first responder was not statistically different as compared to EMS initiated CPR (aOR 1.01, CI 0.93-1.11). However, fire/police first responder interventions were associated with significantly higher odds of survival to hospital discharge and survival with good neurologic outcome (aOR 1.25, 95% CI 1.08-1.45 and aOR 1.40, 95% CI 1.18-1.65, respectively). Similar associations were see when examining fire or police initiated AED use.

CONCLUSIONS

Fire or police first responders may be an underutilized, potentially powerful mechanism for improving OHCA survival. Future studies should investigate barriers and opportunities for increasing first responder interventions by these groups in OHCA.

Multidimensional Social Network Types and Their Correlates in Older Americans

Background and Objectives

Social support networks of older adults have been linked to their health and well-being; however, findings regarding the effects of specific network characteristics have been mixed. Additionally, due to demographic shifts increasing numbers of older adults live outside of traditional family structures. Previous studies have not systematically examined the resulting complexity and heterogeneity of older adults’ social networks. Our objectives were to examine this complexity and heterogeneity by developing a multidimensional typology of social networks that simultaneously considers multiple structural and functional network characteristics, and to examine differences in network type membership by sociodemographic characteristics, health characteristics, and birth cohort.

Research Design and Methods

Participants included 5,192 adults aged 57–85 years in the National Social Life, Health, and Aging Project at rounds 1 (2005–2006) and 3 (2015–2016). Data were collected on social relationships including network size, diversity, frequency of contact, and perceived support and strain in relationships. We used latent class analysis to derive the network typology and multinomial logistic regression to examine differences in network type membership by sociodemographic characteristics, health characteristics, and birth cohort.

Results

Older adults were classified into 5 distinct social network types: (i) large, with strain; (ii) large, without strain; (iii) small, diverse, low contact; (iv) small, restricted, high contact; and (v) medium size and support. Membership in these network types varied by age, gender, marital status, race/ethnicity, education, mental health, and birth cohort.

Discussion and Implications

Network typologies can elucidate the varied interpersonal environments of older adults and identify individuals who lack social connectedness on multiple network dimensions and are therefore at a higher risk of social isolation.

Long-term community noise exposure in relation to dementia, cognition, and cognitive decline in older adults

INTRODUCTION

Exposure to noise might influence risk of Alzheimer's disease (AD) dementia.

METHODS

Participants of the Chicago Health and Aging Project (≥65 years) underwent triennial cognitive assessments. For the 5 years preceding each assessment, we estimated 5227 participants' residential level of noise from the community using a spatial prediction model, and estimated associations of noise level with prevalent mild cognitive impairment (MCI) and AD, cognitive performance, and rate of cognitive decline.

RESULTS

Among these participants, an increment of 10 A-weighted decibels (dBA) in noise corresponded to 36% and 29% higher odds of prevalent MCI (odds ratio [OR] = 1.36; 95% confidence interval [CI], 1.15 to 1.62) and AD (OR = 1.29, 95% CI, 1.08 to 1.55). Noise level was associated with worse global cognitive performance, principally in perceptual speed (-0.09 standard deviation per 10 dBA, 95% CI: -0.16 to -0.03), but not consistently associated with cognitive decline.

DISCUSSION

These results join emerging evidence suggesting that noise may influence late-life cognition and risk of dementia.

Multimorbidity and the Transition Out of Full-Time Paid Employment: A Longitudinal Analysis of the Health and Retirement Study

Objectives

This study aims to examine whether older workers aged 50–64 years with multimorbidity are at increased risk to transition from full-time paid employment to part-time employment, partial retirement, unemployment, disability, economic inactivity, full retirement or die than workers without a chronic health condition and workers with one chronic health condition, and whether socioeconomic position (SEP) modifies these transitions.

Method

Using data from the Health and Retirement Study (1992–2014; n = 10,719), sub-distribution hazard ratios with 95% confidence intervals were calculated with a time-varying Fine and Gray competing-risks survival regression model to examine exit from full-time paid employment. We investigated the modifying effect of SEP by examining its interaction with multimorbidity.

Results

Workers with multimorbidity had a higher risk of transitioning to partial retirement (1.45; 1.22, 1.72), disability (1.84; 1.21, 2.78) and full retirement (1.63; 1.47, 1.81), and they had a higher mortality risk (2.58; 1.71, 3.88) than workers without chronic disorders. Compared to workers with one chronic health condition, workers with multimorbidity had an increased risk for partial (1.19; 1.02, 1.40) and full retirement (1.29; 1.17, 1.42), and mortality (1.49; 1.09, 2.04). Only SEP measured as educational level modified the relationship between multimorbidity and mortality.

Discussion

Workers with multimorbidity seem more prone to leave full-time paid employment than workers without or with one a chronic health condition. Personalized work accommodations may be necessary to help workers with multimorbidity prolong their working life.

Grandparenthood and risk of mortality: Findings from the Health and Retirement Study

Grandparenthood constitutes a significant role for older adults and may have important health implications. Our study examines the grandparenthood-mortality nexus, controlling for an array of potentially confounding variables. Longitudinal survey data from the Health and Retirement Study (HRS) were used, comprising twelve biennial waves from 1992 to 2014 with linked data on vital status derived from the National Death Index. The sample included 27,463 participants aged ≥51 years with at least one child. Cox proportional hazard models tested the association between grandparenthood and mortality risk with adjustment for socio-demographic variables, for social variables including characteristics of and contact with children, and for health variables, including measures of general, functional and mental health. Grandparenthood overall was unassociated with mortality risk in both women and men. However, the subpopulation of younger, partnered grandmothers with a larger number of grandchildren tended to exhibit a substantial increase in mortality risk as compared to women without grandchildren.

Racial and Ethnic Differences in Disability Transitions Among Older Adults in the United States

BACKGROUND

Racial and ethnic differences in disability persist and are possibly widening in recent years, but evidence is limited for racial and ethnic differences in disability progression through the entire disablement process and potential influential factors. The objective of this study is to examine racial and ethnic differences in patterns of late-life disability transitions, using a new disability spectrum that incorporates successful accommodation with assistive devices in response to capacity limitations to prolong independence.

METHODS

The study cohort consisted of a nationally representative sample of Medicare beneficiaries aged 65 and older in the United States who were enrolled in the 2011 National Health and Aging Trends Study and followed up annually until 2015 (n = 6,198). First-order Markov transition models were used to determine racial/ethnic differences in transitions among three stages of self-care and mobility limitations (fully able, successful accommodation, difficulty/assistance) and death.

RESULTS

After adjustment for age and sex, non-Hispanic Black and Hispanic respondents had higher probabilities of unfavorable transitions and lower probabilities of remaining in the successful accommodation stage than non-Hispanic White respondents. The racial and ethnic differences in probabilities of maintaining successful accommodation remained statistically significant after adjustment for socioeconomic and health factors (Black: 0.56, 95% CI = 0.52-0.60; Hispanic: 0.53, 95% CI = 0.44-0.61; White: 0.63, 95% CI = 0.61-0.65).

CONCLUSIONS

Successful accommodation with assistive devices may provide possibilities for implementing interventions to enhance older adults' capacities and reducing racial/ethnic differences in late-life disability.

GRANDPARENTHOOD AND RISK OF MORTALITY: FINDINGS FROM THE HEALTH AND RETIREMENT STUDY

Grandparenthood is a significant social role for older adults and may have important health implications. Parenthood itself has been associated with some protective health effects, although findings have been mixed. Whether grandparenthood is associated with important long-term health effects such as mortality is largely unknown. This study examines the grandparenthood-mortality nexus, and whether it is modified by gender and education. Longitudinal data from the Health and Retirement Study (HRS) were used, comprising twelve biennial follow-up waves from 1992 to 2014 with linked data on vital status derived from the National Death Index. Submodules assessed participants’ family structure during follow-up. The sample included 24,325 participants aged > 51 years with at least one child. Cox proportional hazard models were used to test the association between grandparenthood and mortality risk with adjustment for socio-demographic variables, for social variables including characteristics of and contact with children, and for health variables, including measures of overall, functional and mental health. Stratified models assessed these associations separately by gender and education. Grandparenthood was associated with a substantially increased mortality risk in women (fully adjusted HR = 1.65; 95% CI 1.27-21.14), and increased with larger number of grandchildren. No significant association was found for men (fully adjusted HR=1.25; 95% CI 0.97-1.62). Mortality risks associated with grandparenthood were highest among grandparents with low levels of education. The findings are among the first to suggest a potential grandparenthood survival “penalty”, especially for grandmothers. Higher levels of education appear to mitigate this negative survival effect among grandparents.

Subclinical Cardiovascular Disease and Changes in Self-Reported Mobility: Multi-Ethnic Study of Atherosclerosis

Background

We examined associations of three markers of subclinical cardiovascular disease (intimal-medial thickening, coronary artery calcification , and ankle-brachial index) with changes in self-reported walking over time.

Methods

Data were from 6,490 Multi-Ethnic Study of Atherosclerosis participants (aged 45-84 years), free of clinical cardiovascular disease at baseline. Outcomes, assessed four times over 11 years, included self-reported walking pace (none to striding pace; score, 0-4) and total walking time (minutes/week). Linear generalized estimating equation models estimated associations of baseline intimal-medial thickening (z-scored), coronary artery calcification (Agatston units), and ankle-brachial index (ratio of ankle-to-arm systolic blood pressure) with walking pace and walking time modeled continuously in separate analyses.

Results

Median follow-up was 9.2 years (maximum, 11.4). Walking pace (estimate, -0.042 points [95% CI; -0.048, -0.036], p < 0.0001) and walking time (estimate, -4.71 minutes [95% CI: -8.54, -0.88], p = 0.016) decreased yearly. Greater baseline intimal-medial thickening related to faster decline in walking pace in multivariable analyses: walking pace score decreased 0.004 points (95% CI: -0.008, -0.001) more per year for each 1-SD higher intimal-medial thickening z-score, equivalent to an additional 10% slower yearly walking. Greater coronary artery calcification was associated with slower walking but inconsistently related to decline in walking pace. Higher ankle-brachial index was associated with faster baseline walking pace (estimate, 0.043 points [95% CI: 0.027, 0.059] per 1-SD) but unrelated to changes in walking pace. Cardiovascular disease measures were unrelated to total walking time.

Conclusions

Greater subclinical cardiovascular disease is associated with prevalent slower self-reported walking pace in middle-aged and older adults but has limited impact on changes in walking over time.

Genome Analyses of >200,000 Individuals Identify 58 Loci for Chronic Inflammation and Highlight Pathways that Link Inflammation and Complex Disorders

C-reactive protein (CRP) is a sensitive biomarker of chronic low-grade inflammation and is associated with multiple complex diseases. The genetic determinants of chronic inflammation remain largely unknown, and the causal role of CRP in several clinical outcomes is debated. We performed two genome-wide association studies (GWASs), on HapMap and 1000 Genomes imputed data, of circulating amounts of CRP by using data from 88 studies comprising 204,402 European individuals. Additionally, we performed in silico functional analyses and Mendelian randomization analyses with several clinical outcomes. The GWAS meta-analyses of CRP revealed 58 distinct genetic loci (p < 5 × 10-8). After adjustment for body mass index in the regression analysis, the associations at all except three loci remained. The lead variants at the distinct loci explained up to 7.0% of the variance in circulating amounts of CRP. We identified 66 gene sets that were organized in two substantially correlated clusters, one mainly composed of immune pathways and the other characterized by metabolic pathways in the liver. Mendelian randomization analyses revealed a causal protective effect of CRP on schizophrenia and a risk-increasing effect on bipolar disorder. Our findings provide further insights into the biology of inflammation and could lead to interventions for treating inflammation and its clinical consequences.

Effects of social network diversity on mortality, cognition and physical function in the elderly: a longitudinal analysis of the Chicago Health and Aging Project (CHAP)

Background

Having a larger social network has been shown to have beneficial effects on health and survival in adults, but few studies have evaluated the role of network diversity, in addition to network size. We explore whether social network diversity is associated with mortality, cognition and physical function among older black and white adults.

Methods

Data are obtained from the Chicago Health and Aging Project, a longitudinal, population-based study of adults aged 65 years and older at baseline. Using Cox proportional hazards regression, we estimate the hazard of mortality by network diversity (n=6497). The association between network diversity and cognition (n=6560) and physical function (n=6561) is determined using generalised estimating equations. Models were adjusted for age, gender, race, socioeconomic status, marital status and health-related variables.

Results

In fully adjusted models, elderly with more diverse social networks had a lower risk of mortality (HR=0.93, p<0.01) compared with elderly with less diverse networks. Increased diversity in social networks was also associated with higher global cognitive function (coefficient=0.11, p<0.001) and higher physical function (coefficient=0.53, p<0.001).

Conclusions

Social networks are particularly important for older adults as they face the greatest threats to health and depend on network relationships, more than younger individuals, to meet their needs. Increasing diversity, and not just increasing size, of social networks may be essential for improving health and survival among older adults.

Abstract 4219: Breast cancer distribution and survival among Buddhist and Muslim women in southern Thailand

Objective: Thailand is undergoing a period of rapid economic growth, which has led to an epidemiologic transition from infectious to chronic diseases such as cancer. Preliminary research shows a difference in rates of breast cancer incidence and mortality between Buddhist and Muslim women in southern Thailand. This study examines differences in breast cancer and potential explanations for this disparity. Methods: Demographic, diagnostic, and outcome data from breast cancer patients diagnosed from 2001-2015 were collected from a population-based cancer registry in southern Thailand and matched with formalin-fixed paraffin-embedded blocks from Songklanagarind Hospital. This region was selected due to the relatively high proportion of Muslim women. Of 424 cases selected, 369 were Buddhist and 55 were Muslim. Formalin-fixed paraffin-embedded blocks were sent to Michigan Medicine and histological and subtype analyses were performed by two pathologists. Statistical analysis was performed in RStudio using chi-square tests of independence, logistic regression, and Cox proportional hazards models. Results: Muslim women were generally diagnosed at a younger age than Buddhist women (Muslim mean: 46.6 years, Buddhist mean: 52.7 years) and with later stage cancers (Muslim: 36% stage 3 and 14% stage 4, Buddhist: 20% stage 3 and 8% stage 4). Buddhist and Muslim women had similar distributions of Luminal A and B subtypes, but Muslim women were more likely to be diagnosed with Triple Negative breast cancer (Muslim: 30%, Buddhist: 18%), the histological subtype with the worst prognosis. Invasive ductal carcinoma was most common in both groups, but Buddhists had more heterogeneity in subtypes. There were no significant differences in tumor histology or subtype by religion. Conclusions: These analyses show differences in the distribution of breast cancer between Buddhist and Muslim women. Muslim women are diagnosed younger with later stage breast cancers, and with histological differences, which generally lead to lower survival rates. Lack of statistical significance may be due to small sample size, necessitating further studies.

Citation Format: Kali Defever, Katie M. Rentschler, Ana Khazan, Elizabeth Pinkerton, Shama Virani, Hutcha Sriplung, Judy Pang, Celina G. Kleer, Carlos F. Mendes de Leon, Justin A. Colacino, Laura S. Rozek. Breast cancer distribution and survival among Buddhist and Muslim women in southern Thailand [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 4219.

Correction to: The impact of low education and poor health on unemployment varies by work life stage

During the calculation of the physical component score and the mental component score, the score of the RAND 1 was erroneously coded in the opposite direction. After correcting this mistake, the interaction between low education and poor physical health on unemployment in early work life becomes statistically significant.

Ethnic disparity in breast cancer survival in southern Thai women

BACKGROUND

Breast cancer has the highest incidence in women of all cancers and its burden is expected to continue to increase worldwide, especially in middle-income countries such as Thailand. The southern region of Thailand is unique in that it is comprised of 30% Muslims, whereas the rest of Thailand is 95% Buddhist. Breast cancer incidence and survival differ between these religious groups, but the association between clinical subtype of breast cancer and survival has not yet been assessed.

METHODS

Here we characterized differences in breast cancer survival with consideration to clinical subtype by religious group (Muslim Thai and Buddhist Thai women). We compared distributions of age, stage and clinical subtype and assessed overall survival by religion.

RESULTS

Our findings show that Muslim Thai women with breast cancer are diagnosed at a younger age, at later stages and have shorter overall survival times compared to Buddhist Thai women with breast cancer. We also observe a higher proportion of triple negative tumors characterized in Muslim Thai women.

CONCLUSIONS

Our findings confirm previous studies that have shown lower survival rates in Muslim Thai women compared to Buddhist women with breast cancer and offer novel information on subtype distribution. To date, this is the first study assessing clinical subtypes in southern Thailand by religious status.

IMPACT

Our findings are critical in providing information on the role of clinical subtype in cancer disparities and provide evidence from the Southeast Asian region for global studies on breast cancer survival.

Association of a Negative Wealth Shock With All-Cause Mortality in Middle-aged and Older Adults in the United States

Importance

A sudden loss of wealth-a negative wealth shock-may lead to a significant mental health toll and also leave fewer monetary resources for health-related expenses. With limited years remaining to regain lost wealth in older age, the health consequences of these negative wealth shocks may be long-lasting.

Objective

To determine whether a negative wealth shock was associated with all-cause mortality during 20 years of follow-up.

Design, Setting, and Participants

The Health and Retirement Study, a nationally representative prospective cohort study of US adults aged 51 through 61 years at study entry. The study population included 8714 adults, first assessed for a negative wealth shock in 1994 and followed biennially through 2014 (the most recent year of available data).

Exposures

Experiencing a negative wealth shock, defined as a loss of 75% or more of total net worth over a 2-year period, or asset poverty, defined as 0 or negative total net worth at study entry.

Main Outcomes and Measures

Mortality data were collected from the National Death Index and postmortem interviews with family members. Marginal structural survival methods were used to account for the potential bias due to changes in health status that may both trigger negative wealth shocks and act as the mechanism through which negative wealth shocks lead to increased mortality.

Results

There were 8714 participants in the study sample (mean [SD] age at study entry, 55 [3.2] years; 53% women), 2430 experienced a negative wealth shock during follow-up, 749 had asset poverty at baseline, and 5535 had continuously positive wealth without shock. A total of 2823 deaths occurred during 80 683 person-years of follow-up. There were 30.6 vs 64.9 deaths per 1000 person-years for those with continuously positive wealth vs negative wealth shock (adjusted hazard ratio [HR], 1.50; 95% CI, 1.36-1.67). There were 73.4 deaths per 1000 person-years for those with asset poverty at baseline (adjusted HR, 1.67; 95% CI, 1.44-1.94; compared with continuously positive wealth).

Conclusions and Relevance

Among US adults aged 51 years and older, loss of wealth over 2 years was associated with an increased risk of all-cause mortality. Further research is needed to better understand the possible mechanisms for this association and determine whether there is potential value for targeted interventions.

Effects of alcohol and cigarette use on the initiation, reinitiation, and persistence of cannabis use from adolescence to emerging adulthood

OBJECTIVE

Adolescent cannabis use has been associated with several negative outcomes. A previous study on an adult sample found alcohol and cigarette use to be associated with three cannabis use stages: initiation, reinitiation, and persistence, which represent distinct periods of use regarding progression and severity. Yet, the risk factors associated with these important stages have never been examined in a longitudinal study spanning adolescence to emerging adulthood.

METHODS

Using longitudinal data from Add Health Waves 1-3, 1775 nonusers, 200 prior users, and 384 current users of cannabis were identified who were at risk of cannabis use initiation, reinitiation, and persistence, respectively. Three logistic regressions were conducted to examine the effects of prior cigarette and alcohol use on the three cannabis use stages, controlling for sociodemographic factors.

RESULTS

Early onset of cigarette use (OR=2.04, p=0.006) and higher alcohol use frequency (OR=1.40, p<0.001) were associated with cannabis use initiation. Greater cigarette use quantity was associated with a lower likelihood of reinitiation of cannabis use (OR=0.58, p=0.02). Increased cannabis use frequency (OR=1.72, p=0.006) and higher alcohol use frequency (OR=1.32, p=0.048) were associated with persistence of cannabis use. Sociodemographic factors such as household income, sex, and being older adolescents were associated with different cannabis use stages.

CONCLUSIONS

Prior cigarette and alcohol use affect the risk of initiation, reinitiation, and persistence of cannabis use. The specific risk factors vary across different cannabis use stages. Interventions to prevent adolescent cannabis use should recognize these different risk factors and tailor to the stages of cannabis use.

The Influence of Psychosocial and Cognitive Factors on Perceived Threat of Alzheimer's Disease

This study explored psychosocial and cognitive predictors of perceived threat of Alzheimer's disease (AD). Respondents were 1641 adults (mean age: 64.4; 54% female; 82% white) who completed a module in the Health and Retirement Study, a nationally representative survey of adults aged ≥50. Findings show that perceived threat was significantly higher for those aged 50 to 64 ( P < .001) and 65 to 74 ( P < .05) than for those ≥75. Respondents with a family history of AD had significantly greater perceived threat ( P < .001) than those with no experience. Stronger endorsement of the beliefs that stress ( P < .01) or genetics ( P < .01) are important AD risk factors was significantly associated with greater perceived threat, as was having more depressive symptoms ( P < .01), poorer self-rated memory ( P < .01), and lower cognitive function ( P < .01). Personal experience moderated the relationship between perceived threat and 2 variables: age and self-rated memory. Understanding perceived AD threat may inform practice and policies centered on early and accurate diagnosis.

Negative wealth shock and short-term changes in depressive symptoms and medication adherence among late middle-aged adults

BACKGROUND

Experiencing a negative wealth shock in late middle age may cause high levels of stress and induce reductions in health-related consumption.

METHODS

We used data on late middle age individuals (51-64 years) from the longitudinal US-based Health and Retirement Study (N=19 281) to examine the relationship between negative wealth shock and short-term outcomes that serve as markers of the pathways from wealth shock to health: elevated depressive symptoms, as a marker of the stress pathway and cost-related medication non-adherence (CRN), as a marker of the consumption pathway. Negative wealth shock was considered to be a loss of total net worth of 75% or more.

RESULTS

Using a nested cross-over approach-a within-person design among exposed individuals only that adjusts by design for all time-invariant individual characteristics-we found that negative wealth shock was significantly associated with increased odds of elevated depressive symptoms (OR=1.50, CI 1.10 to 2.05), but was not significantly associated with higher odds of CRN (OR=1.18, CI 0.76 to 1.82), even after further adjustment for time-varying sociodemographic and health covariates.

CONCLUSIONS

Negative wealth shock during late middle age confers an increased risk of elevated depressive symptoms, but does not change levels of CRN. Personal and policy factors that may buffer the mental health risks of negative wealth shock, such as social support and social welfare policy, should be considered.

Perceived discrimination and health-related quality-of-life: gender differences among older African Americans

PURPOSE

Emerging data suggest that African-American women may fare worse than African-American men in health-related quality-of-life (HRQOL). Perceived discrimination is an important contributor to poor health overall among African Americans, but few studies examined the intersecting effects of perceived discrimination and gender in explaining HRQOL disparities. We investigated gender differences in HRQOL and tested whether perceived discrimination accounted for these differences.

METHODS

We examined data from the Chicago Health and Aging Project in which 5652 African-American adults aged 65 and older completed structured questionnaires about demographic and socioeconomic characteristics, HRQOL, perceived discrimination, and health-related variables. Logistic regression models were used to identify associations between perceived discrimination and gender differences in poor HRQOL outcomes (defined as 14+ unhealthy days in overall, physical, or mental health over the past 30 days) when controlling for the other variables.

RESULTS

More women reported poor overall HRQOL than men (24 vs. 16% respectively). Higher perceived discrimination was significantly associated with worse overall HRQOL (OR 1.11; 95% CI 1.08, 1.15), with stronger effects for women in overall and mental HRQOL. These gender disparities remained significant until controlling for potentially confounding variables. Perceived discrimination did not account for gender differences in poor physical HRQOL.

CONCLUSIONS

Perceived discrimination is associated with poor HRQOL in older African Americans, with this association appearing stronger in women than men for mental HRQOL. These findings warrant further investigation of effects of perceived discrimination in gender disparities in overall health, and such research can inform and guide efforts for reducing these disparities.

The impact of low education and poor health on unemployment varies by work life stage

Objectives

The aim of this study is to examine associations and interactions of education, and physical and mental health with unemployment in early, mid, and late work life.

Methods

This cross-sectional study uses data from 69,118 respondents from Lifelines. Health status was measured with the RAND-36, education was self-reported, and participants working <12 h per week or indicating to be unemployed were considered unemployed. The relative excess risk due to interaction (RERI) was calculated to measure interaction on the additive scale.

Results

Interactions of low education and poor mental health were found in early [RERI: 2.14; 95% confidence interval (CI): 0.63, 3.65], mid (1.41; 0.61, 2.20) and late (0.63; 0.09, 1.17) work life. Interaction between low education and poor physical health was only found in mid-work life (1.27; 0.61, 1.93).

Conclusions

Low education and poor physical and mental health exacerbate each other’s impact on unemployment varying by work life stage. Policies addressing unemployment may become more effective if they better account for the physical and mental health status of adults in certain stages of their work life.

Electronic supplementary material

The online version of this article (doi:10.1007/s00038-017-0972-7) contains supplementary material, which is available to authorized users.

Early life socioeconomic position and immune response to persistent infections among elderly Latinos

Persistent infections, such as cytomegalovirus (CMV), herpes simplex virus-1 (HSV-1), Helicobacter pylori (H. pylori), and Toxoplasma gondii (T. gondii), are common in the U.S. but their prevalence varies by socioeconomic status. It is unclear if early or later life socioeconomic position (SEP) is a more salient driver of disparities in immune control of these infections. Using data from the Sacramento Area Latino Study on Aging, we examined whether early or later life SEP was the strongest predictor of immune control later in life by contrasting two life course models, the critical period model and the chain of risk model. Early life SEP was measured as a latent variable, derived from parental education and occupation, and food availability. Indicators for SEP in later life included education level and occupation. Individuals were categorized by immune response to each pathogen (seronegative, low, medium and high) with increasing immune response representing poorer immune control. Cumulative immune response was estimated using a latent profile analysis with higher total immune response representing poorer immune control. Structural equation models were used to examine direct, indirect and total effects of early life SEP on each infection and cumulative immune response, controlling for age and gender. The direct effect of early life SEP on immune response was not statistically significant for the infections or cumulative immune response. Higher early life SEP was associated with lower immune response for T. gondii, H. pylori and cumulative immune response through pathways mediated by later life SEP. For CMV, higher early life SEP was both directly associated and partially mediated by later life SEP. No association was found between SEP and HSV-1. Findings from this study support a chain of risk model, whereby early life SEP acts through later life SEP to affect immune response to persistent infections in older age.

Exposure to Traffic-Related Air Pollution in Relation to Progression in Physical Disability among Older Adults

BACKGROUND

Physical disability is common though not inevitable in older age and has direct bearing on a person's ability to perform activities essential for self-care and independent living. Air pollution appears to increase the risk of several chronic diseases that contribute to the progression of disability.

OBJECTIVE

We evaluated long-term exposure to traffic-related air pollution (TRAP) in relation to progression in physical disability.

METHODS

We conducted our investigation within the Chicago Health and Aging Project. We measured participants' exposures to TRAP using two surrogates: residential proximity to major roads (1993 onwards) and ambient concentrations of oxides of nitrogen (NOX; 1999 onwards), predicted via a geographic information systems-based spatiotemporal smoothing model (cross-validation R2 = 0.87) that incorporated community-based monitoring and resolved intraurban exposure gradients at a spatial scale of tens of meters. Participants' lower-extremity physical ability was assessed every 3 years (1993-2012) via tandem stand, chair stand, and timed walking speed.

RESULTS

In multivariable-adjusted analyses (n = 5,708), higher long-term NOX exposure was associated with significantly faster progression in disability. Compared with the 5-year decline in physical ability score among participants in the lowest quartile of NOX exposure, decline among those in the highest exposure quartile was 1.14 units greater (95% confidence interval [CI]: -1.86, -0.42), equivalent to 3 additional years of decline among those in the lowest exposure quartile. The association was linear across the continuum of NOX exposure: per 10-ppb increment in exposure, the 5-year decline in physical ability score was 0.87 unit greater (95% CI: -1.35, -0.39). Proximity to a major road was not associated with disability progression (n = 9,994).

CONCLUSIONS

These data join a growing body of evidence suggesting that TRAP exposures may accelerate aging-related declines in health.

CITATION

Weuve J, Kaufman JD, Szpiro AA, Curl C, Puett RC, Beck T, Evans DA, Mendes de Leon CF. 2016. Exposure to traffic-related air pollution in relation to progression in physical disability among older adults. Environ Health Perspect 124:1000-1008; http://dx.doi.org/10.1289/ehp.1510089.

Sex Differences in Concomitant Trajectories of Self-Reported Disability and Measured Physical Capacity in Older Adults

BACKGROUND

Despite documented age-related declines in self-reported functional status and measured physical capacity, it is unclear whether these functional indicators follow similar trajectories over time or whether the patterns of change differ by sex.

METHODS

We used longitudinal data from 687 initially nondisabled adults, aged 70 or older, from the Precipitating Events Project, who were evaluated every 18 months for nearly 14 years. Self-reported disability was assessed with a 12-item disability scale. Physical capacity was measured using grip strength and a modified version of Short Physical Performance Battery. Hierarchical linear models estimated the intra-individual trajectory of each functional indicator and differences in trajectories' intercept and slope by sex.

RESULTS

Self-reported disability, grip strength, and Short Physical Performance Battery score declined over 13.5 years following nonlinear trajectories. Women experienced faster accumulation of self-reported disability, but slower declines in measured physical capacity, compared with men. Trajectory intercepts revealed that women had significantly weaker grip strength and reported higher levels of disability compared with men, with no differences in starting Short Physical Performance Battery scores. These findings were robust to adjustments for differences in sociodemographic characteristics, length-of-survival, health risk factors, and chronic-disease status.

CONCLUSIONS

Despite the female disadvantage in self-reported disability, older women preserve measured physical capacity better than men over time. Self-reported and measured indicators should be viewed as complementary rather than interchangeable assessments of functional status for both clinical and research purposes, especially for sex-specific comparisons.

Occupational cognitive requirements and late-life cognitive aging

OBJECTIVE

To examine whether occupational cognitive requirements, as a marker of adulthood cognitive activity, are associated with late-life cognition and cognitive decline.

METHODS

Main lifetime occupation information for 7,637 participants aged >65 years of the Chicago Health and Aging Project (CHAP) was linked with standardized data on worker attributes and job characteristics from the Occupational Information Network (O*NET). Ratings of cognitive processes required in 10 work-related tasks were used to create a summary measure of occupational cognitive requirements (possible range 0-7). Multivariable-adjusted linear mixed models were used to estimate the association of occupational cognitive requirements score (OCRS) with cognitive function and rate of cognitive decline.

RESULTS

Higher OCRS corresponded to significantly better late-life cognitive performance at baseline in 1993 (p < 0.001) and to slower decline in global cognitive function over time (p = 0.004). Within a genotyped subsample (n = 4,104), the associations of OCRS with rate of cognitive decline did not differ significantly by APOE ε4 carriership (p = 0.11).

CONCLUSIONS

Findings suggest that occupational cognitive requirements are associated with better cognition and a slower rate of cognitive decline in older age. Adulthood cognitive activity may contribute to cognitive reserve in late life.

Absolute and Relative Socioeconomic Health Inequalities across Age Groups

Background

The magnitude of socioeconomic health inequalities differs across age groups. It is less clear whether socioeconomic health inequalities differ across age groups by other factors that are known to affect the relation between socioeconomic position and health, like the indicator of socioeconomic position, the health outcome, gender, and as to whether socioeconomic health inequalities are measured in absolute or in relative terms. The aim is to investigate whether absolute and relative socioeconomic health inequalities differ across age groups by indicator of socioeconomic position, health outcome and gender.

Methods

The study sample was derived from the baseline measurement of the LifeLines Cohort Study and consisted of 95,432 participants. Socioeconomic position was measured as educational level and household income. Physical and mental health were measured with the RAND-36. Age concerned eleven 5-years age groups. Absolute inequalities were examined by comparing means. Relative inequalities were examined by comparing Gini-coefficients. Analyses were performed for both health outcomes by both educational level and household income. Analyses were performed for all age groups, and stratified by gender.

Results

Absolute and relative socioeconomic health inequalities differed across age groups by indicator of socioeconomic position, health outcome, and gender. Absolute inequalities were most pronounced for mental health by household income. They were larger in younger than older age groups. Relative inequalities were most pronounced for physical health by educational level. Gini-coefficients were largest in young age groups and smallest in older age groups.

Conclusions

Absolute and relative socioeconomic health inequalities differed cross-sectionally across age groups by indicator of socioeconomic position, health outcome and gender. Researchers should critically consider the implications of choosing a specific age group, in addition to the indicator of socioeconomic position and health outcome, as findings on socioeconomic health inequalities may differ between them.

Physical and Cognitive Activities as Deterrents of Cognitive Decline in a Biracial Population Sample

OBJECTIVE

Physical and cognitive activities are associated with slower cognitive decline. Few studies have examined racial differences in these associations, however. The aim of this study was to examine the association of physical and cognitive activities with level and change in cognitive function among black and white participants. A secondary aim was to explore observed differences between black and white participants using post hoc analyses based on education and cognitive function levels.

METHODS

Data came from a longitudinal study of 7,742 (63% black and 61% female) participants assessed three times over an average of 9.5 years. At baseline, each participant reported number of hours of leisure time physical activity (categorized using quartiles) and rated frequency of participation in cognitively stimulating activities (range: 0-4). A standardized measure of cognition was derived from tests of memory, perceptual speed, and orientation.

RESULTS

Of the 7,742 participants, 2,322 (30%) reported no physical activity. Cognitive decline was slower by about 20% (95% CI: 13%-27%) among whites with physical activity above 1.25 hours compared with those with no physical activity, but showed no significant decrease in cognitive decline relative to those with no physical activity among blacks. Further post hoc analysis revealed cognitive decline to be slower by about 29% (95% CI: 20%-38%) among blacks and whites with higher education and above average baseline cognition. A 1-point increase in cognitive activity frequency decreased cognitive decline by 8% (95% CI: 3%-14%) among blacks and by 14% (95% CI: 7%-20%) among whites.

CONCLUSIONS

The benefits of higher physical activity on cognitive decline was observed among whites, and among blacks with higher education and above average baseline cognitive function. Nevertheless, the protective effect of cognitive activity seems to be independent of education and baseline cognitive function among both blacks and whites.

Do Local Social Hierarchies Matter for Mental Health? A Study of Neighborhood Social Status and Depressive Symptoms in Older Adults

OBJECTIVES

Despite a well-established association between relative social position and health, stratification at smaller levels of social organization has received scant attention. Neighborhood is a localized context that has increasing relevance for adults as they age, thus one's relative position within this type of mesolevel group may have an effect on mental health, independent of absolute level of social and economic resources. We examine the relationship between an older adult's relative rank within their neighborhoods on two criteria and depressive symptoms.

METHOD

Using data from the Chicago Health and Aging Project, neighborhood relative social position was ascertained for two social domains: income and social reputation (number of neighbors one knows well enough to visit). Using multilevel models, we estimated the effect of relative position within the neighborhood on depressive symptoms, net of absolute level for each domain and average neighborhood level.

RESULTS

Higher neighborhood relative rankings on both income and visiting neighbors were associated with fewer depressive symptoms. Although both were modest in effect, the gradient in depressive symptoms was three times steeper for the relative rank of visiting neighbors than for income. Men had steeper gradients than women in both domains, but no race differences were observed.

DISCUSSION

These findings suggest that an older adult's relative position in a local social hierarchy is associated with his/her mental health, net of absolute position.

Rate of Cognitive Decline Before and After the Onset of Functional Limitations in Older Persons

BACKGROUND

Loss in physical function is indicative of deterioration in physiological health that may also be associated with deterioration in neurological health. The objective of this study was to examine whether the onset of functional limitations and their severity is associated with increases in cognitive decline among older adults.

METHODS

The study sample consists of 3825 (65% African Americans and 53% females) participants over the age of 65 with no functional limitations. Cognitive function was assessed using a standardized global cognitive score, and functional limitations using a summary measure of 8 Rosow-Breslau and Nagi limitations (ROS-B/Nagi). Cognitive decline before and after the onset of limitations were analyzed using a linear piecewise change point model.

RESULTS

During follow-up, 2682 (70%) participants reported limitations in ROS-B/Nagi measure. The rate of cognitive decline was 0.053-units per year before any limitations, and increased to 0.069-units per year after one or more limitations in ROS-B/Nagi measure. This was about 30% (95% Confidence Interval [CI]: 18 - 42%) increase in the rate of cognitive decline comparing before and after the onset of limitations in ROS-B/Nagi measure. Also, higher number of limitations in ROS-B/Nagi measure at the time of onset was associated with faster cognitive decline.

CONCLUSIONS

The rate of cognitive decline was significantly higher following functional limitations. This study suggests that self-reported measures of functional limitations may serve as an important marker of cognitive decline.

Determinants of trust in health care in an older population

OBJECTIVES

To explore differences in sociodemographic and psychological correlates of institutional trust in health care in an aging population of African Americans and non-Hispanic whites.

DESIGN

Cross-sectional survey data from the longitudinal Chicago Health and Aging Project.

SETTING

Population-based study of three communities in the Chicago area.

PARTICIPANTS

African Americans (n=2,284) and non-Hispanic whites (1,354) with a mean age of 79.3.

MEASUREMENTS

Demographic factors, socioeconomic status (SES), healthcare access, cynical hostility, perceived discrimination, depression, and institutional trust in health care.

RESULTS

African Americans reported substantially lower healthcare trust than non-Hispanic whites (P<.001). After adjustment for demographic variables and SES, only race (P<.001) and age (P=.008) were significantly associated with healthcare trust scores. The association between race and healthcare trust was slightly attenuated after adjusting for cynical hostility, depressive symptoms, and perceived discrimination (P<.001). Each of these variables was negatively associated with healthcare trust, and together these accounted for approximately 15% of racial differences in healthcare trust.

CONCLUSION

Psychological factors, not demographic characteristics, SES, or healthcare factors, appear to contribute the most to disparities in healthcare trust between older African Americans and non-Hispanic whites.

Associations between aspects of pain and cognitive performance and the contribution of depressive symptoms in mid-life women: a cross-sectional analysis

Pain has been associated with cognitive problems in pain patients. This study evaluated the extent to which experiences of pain are associated with cognitive performance in a community sample of mid-life women, and the contribution of depressive symptoms to this association. A cross-sectional analysis was used with data from the Study of Women's Health Across the Nation (SWAN). Associations between aspects of pain and cognitive performance were evaluated using statistical models with and without depressive symptoms. The cognitive performance score was a composite of three cognitive tests, the Digit Span Backward Test, the Symbol Digit Modalities Test and the East Boston Memory Test. Greater pain experiences that interfered with daily work were independently associated with poorer cognitive performance, [β (SE) -0.074 (0.021); p value<0.01] and this association was partially explained by depressive symptoms [β (SE) -0.061 (0.022); p value<0.01 after adjusting for depressive symptoms]. Additionally, an independent association between a greater composite pain score and poorer cognitive performance was identified without adjusting for depressive symptoms, [β (SE) -0.002 (0.0009); p value<0.05] but was no longer significant after adjusting for depressive symptoms. Our results suggest that in mid-life women, greater pain is associated with poorer cognitive performance, and depressive symptoms play an important role in this association. Clinicians should be aware of these relationships when evaluating patients.

Psychosocial influences in onset and progression of late life disability

OBJECTIVES

Disability in older age has been related to several psychosocial characteristics, including social networks, social engagement, and depression. However, the exact role of these characteristics in the disablement process remains uncertain.

METHOD

Data come from a population-based study of black and white adults aged ≥65 years (N = 5,306), with up to 9 yearly data on the primary outcome measure, activities of daily living (ADL) disability. We use a two-part regression model to simultaneously test the association between each psychosocial characteristic and both onset and progression of ADL disability, while controlling for demographic variables, education, and mode of interview in the first model and health status variables in the second model.

RESULTS

Social networks were negatively associated with onset of ADL disability but not associated with progression. The association became non-significant after adjustment for health status. Social engagement was negatively associated with both onset and progression of disability, even after adjustment for health status. Depression was significantly associated with onset of disability after adjustment for health status but not with progression of disability.

DISCUSSION

The results suggest a differential role for psychosocial characteristics in the disablement process, with generally stronger associations for transitions to onset of ADL disability than progression of ADL disability.

Perceived stress is associated with subclinical cerebrovascular disease in older adults

OBJECTIVE

To examine the association of perceived stress with magnetic resonance imaging (MRI) markers of subclinical cerebrovascular disease in an elderly cohort.

METHODS

Using a cross-sectional study of a community-based cohort in Chicago, 571 adults (57% women; 58.1% African American; 41.9% non-Hispanic white; mean [SD] age: 79.8 [5.9] years) from the Chicago Health and Aging Project, an epidemiologic study of aging, completed questionnaires on perceived stress, medical history, and demographics as part of an in-home assessment and 5 years later underwent a clinical neurologic examination and MRI of the brain. Outcome measures were volumetric MRI assessments of white matter hyperintensity volume (WMHV), total brain volume (TBV), and cerebral infarction.

RESULTS

Stress was measured with six items from the Perceived Stress Scale (PSS); item responses, ranging from never (0) to often (3), were summed to create an overall stress score (mean [SD]: 4.9 [3.3]; range: 0-18). Most participants had some evidence of vascular disease on MRI, with 153 participants (26.8%) having infarctions. In separate linear and logistic regression models adjusted for age, sex, education, race, and time between stress assessment and MRI, each one-point increase in PSS score was associated with significantly lower TBV (coefficient = -0.111, SE = 0.049, t[563] = -2.28, p = 0.023) and 7% greater odds of infarction (odds ratio: 1.07; 95% confidence interval: 1.01, 1.13; Wald χ(2)[1] = 4.90; p = 0.027). PSS scores were unrelated to WMHV. Results were unchanged with further adjustment for smoking, body mass index, physical activity, history of heart disease, stroke, diabetes, hypertension, depressive symptoms, and dementia.

CONCLUSIONS

Greater perceived stress was significantly and independently associated with cerebral infarction and lower brain volume assessed 5 years later in this elderly cohort.

Cognitive aging and rate of hospitalization in an urban population of older people

BACKGROUND

The association of age-related cognitive change with hospitalization is not well understood.

METHODS

At 3-year intervals for a mean of 8.7 years, 2,273 older residents of a geographically defined urban community underwent cognitive testing from which a global measure was derived. Hospitalization data were obtained from Part A Medicare beneficiary records. The association of level of cognitive function and rate of cognitive decline in each 3-year interval with subsequent rate of hospitalization was assessed using mixed-effects count regression models.

RESULTS

There were 9,091 hospitalizations involving 1,810 of the 2,273 individuals in the cohort (79.6%). Rate of hospitalization increased by 9.7% (95% confidence interval [CI]: 7.2, 12.3) with each additional study year; by 32.7% (95% CI: 26.8, 38.0) for each 1 point lower on the global cognitive measure at the beginning of an observation interval; and by 24.3% (95% CI: 16.6, 32.6) for each 1-point decrease in the global cognitive measure during the previous observation period. These associations persisted after adjustment for comorbidities and exclusion of those with a Mini-Mental State Examination score less than 26.

CONCLUSION

Individual differences in trajectories of cognitive aging are associated with subsequent risk of hospitalization.

Association of leptin levels with radiographic knee osteoarthritis among a cohort of midlife women

OBJECTIVE

To relate serum leptin levels to prevalent and incident radiographic knee osteoarthritis (OA) and to determine if patterns of change in longitudinal serum leptin measures differ by knee OA status over a 10-year period.

METHODS

Participants in the Michigan Study of Women's Health Across the Nation underwent bilateral knee radiographs at baseline and followup visits 2, 4, and 11 for ascertainment of knee OA status (Kellgren/Lawrence score ≥2). Serum leptin measures were available from baseline and followup visits 1 and 3-7.

RESULTS

The baseline prevalence of knee OA (mean age 46 years) was 18%; the 2-year incidence of knee OA at followup visits 2 and 4 was 18% and 14%, respectively. Serum leptin levels were associated with prevalent and incident knee OA. A 5 ng/ml increase in serum leptin level was associated with 38% higher odds of prevalent knee OA (odds ratio [OR] 1.38, 95% confidence interval [95% CI] 1.26-1.52) and 31% greater odds of incident knee OA (OR 1.31, 95% CI 1.21-1.41) after adjustment for covariates, including body mass index residuals. Leptin levels increased with time; on average, serum leptin levels increased by 0.38 ng/ml per year (P = 0.0004). Women with incident knee OA during the 10-year followup period had consistently higher serum leptin levels as compared to women with no knee OA during followup.

CONCLUSION

Our findings support a metabolic role of obesity in knee OA. A better understanding of the mechanisms by which increased fat mass is associated with joint damage is needed. Management of cardiometabolic dysfunction, including elevated serum leptin levels, may be beneficial in forestalling the onset or progression of knee OA.

Does self-management counseling in patients with heart failure improve quality of life? Findings from the Heart Failure Adherence and Retention Trial (HART)

PURPOSE

Heart failure (HF) is associated with poor health-related quality of life (HRQOL). The purpose of our study is to determine the effect of a self-management intervention on HRQOL domains across time, overall, and in prespecified demographic, clinical, and psychosocial subgroups of HF patients.

METHODS

HART was a single-center, multi-hospital randomized trial. Patients (n = 902) were randomized either to a self-management intervention with provision of HF educational information or an enhanced education control group which received the same HF educational materials. HRQOL was measured by the Quality of Life Index, Cardiac Version, modified, and the Medical Outcomes Study 36-item Short-Form Health Survey physical functioning scale. Analyses included descriptive statistics and mixed-effects regression models.

RESULTS

In general, overall, study participants' HRQOL improved over time. However, no significant differences in HRQOL domain were detected between treatment groups at baseline or across time (p > 0.05). Subgroup analyses demonstrated no differences by treatment arm for change in HRQOL from baseline to 3 years later.

CONCLUSIONS

We conclude that in our cohort of patients, the self-management intervention had no benefit over enhanced education in improving domains of HRQOL and HRQOL for specified HF subgroups.

Racial differences on association of depressive symptoms with combined basic and instrumental activities of daily living

BACKGROUND

Depressive symptoms are predictive of multiple degenerative diseases in older age adults. However, the association of depressive symptoms with onset and progression of disability have not been studied.

METHODS

In a cohort of community-dwelling, older black and white adults, 5,446 initially nondisabled subjects were followed annually for disability between 2000 and 2008. Depressive symptoms were assessed at baseline using a summary measure of 10-item version of the Center for Epidemiologic Survey-Depressive symptoms scale. The disability outcome was based on a summary measure of 13 basic and instrumental activities of daily living, and analyzed using a two-part regression model for onset and progression of disability.

RESULTS

During follow-up, 44% of blacks and 35% of whites reported onset of disability. After adjusting for confounders, depressive symptoms were associated with increased odds of disability onset in blacks (odds ratio = 1.12, 95% confidence interval, 1.07-1.18) and whites (odds ratio = 1.21, 95% confidence interval, 1.08-1.36). The odds of disability onset associated with depressive symptoms also increased significantly over time in whites (odds ratio = 1.06, 95% confidence interval, 1.04-1.09), but not in blacks. In addition, depressive symptoms were associated with an increasing rate of progression of disability in whites (rate ratio = 1.08, 95% confidence interval, 1.06-1.09), but not in blacks.

CONCLUSIONS

Depressive symptoms increased the risk of onset of disability in blacks and whites. This risk tended to increase over time only among whites. A similar race-specific pattern was observed for time-dependent changes due to depressive symptoms in the rate of progression in disability after onset.

Effects of early-life adversity on cognitive decline in older African Americans and whites

OBJECTIVES

Early-life adversity is related to adult health in old age but little is known about its relation with cognitive decline.

METHODS

Participants included more than 6,100 older residents (mean age = 74.9 [7.1] years; 61.8% African American) enrolled in the Chicago Health and Aging Project, a geographically defined, population-based study of risk factors for Alzheimer disease. Participants were interviewed at approximately 3-year intervals for up to 16 years. The interview included a baseline evaluation of early-life adversity, and administration of 4 brief cognitive function tests to assess change in cognitive function. We estimated the relation of early-life adversity to rate of cognitive decline in a series of mixed-effects models.

RESULTS

In models stratified by race, and adjusted for age and sex, early-life adversity was differentially related to decline in African Americans and whites. Whereas no measure of early-life adversity related to cognitive decline in whites, both food deprivation and being thinner than average in early life were associated with a slower rate of cognitive decline in African Americans. The relations were not mediated by years of education and persisted after adjustment for cardiovascular factors.

CONCLUSIONS

Markers of early-life adversity had an unexpected protective effect on cognitive decline in African Americans.

Psychosocial distress and stroke risk in older adults

BACKGROUND AND PURPOSE

To investigate the association of psychosocial distress with risk of stroke mortality and incident stroke in older adults.

METHODS

Data were from the Chicago Health and Aging Project, a longitudinal population-based study conducted in 3 contiguous neighborhoods on the south side of Chicago, IL. Participants were community-dwelling black and non-Hispanic white adults, aged 65 years and older (n=4120 for stroke mortality; n=2649 for incident stroke). Psychosocial distress was an analytically derived composite measure of depressive symptoms, perceived stress, neuroticism, and life dissatisfaction. Cox proportional hazards models examined the association of distress with stroke mortality and incident stroke over 6 years of follow-up.

RESULTS

Stroke deaths (151) and 452 incident strokes were identified. Adjusting for age, race, and sex, the hazard ratio (HR) for each 1-SD increase in distress was 1.47 (95% confidence interval [CI]=1.28-1.70) for stroke mortality and 1.18 (95% CI=1.07-1.30) for incident stroke. Associations were reduced after adjustment for stroke risk factors and remained significant for stroke mortality (HR=1.29; 95% CI=1.10-1.52) but not for incident stroke (HR=1.09; 95% CI=0.98-1.21). Secondary analyses of stroke subtypes showed that distress was strongly related to incident hemorrhagic strokes (HR=1.70; 95% CI=1.28-2.25) but not ischemic strokes (HR=1.02; 95% CI=0.91-1.15) in fully adjusted models.

CONCLUSIONS

Increasing levels of psychosocial distress are related to excess risk of both fatal and nonfatal stroke in older black and white adults. Additional research is needed to examine pathways linking psychosocial distress to cerebrovascular disease risk.

Worship attendance and the disability process in community-dwelling older adults

OBJECTIVES

We examined the contribution of religious involvement to age-related declines in health by examining the association of worship attendance with measures of different stages in the disability continuum.

METHOD

Participants included 5,863 Black and White older adults from the Chicago Health and Aging Project. Worship attendance was coded in 3 levels: very frequent (several times a week or more), frequent (several times a month), and infrequent (several times a year or less). Measures of disability included self-reported instrumental activities of daily living (IADL) and activities of daily living (ADL) disability as well as observed physical function.

RESULTS

In multiple regression models adjusted for demographic factors, compared with those with infrequent worship attendance, those with frequent or very frequent attendance had lower levels of IADL and ADL disability and higher levels of physical performance at baseline. These associations remained significant in models that adjusted for health and cognitive status. There was no association between frequency of worship attendance and change in disability or physical function over time.

DISCUSSION

These results suggest that more frequent worship attendance does not contribute to slowing the progress of disability in late life. Future research is needed to better understand the development of the differences in disability associated with worship attendance observed at baseline.

Race differences in the association of spiritual experiences and life satisfaction in older age

OBJECTIVES

The primary objective of this study was to examine an African American 'faith advantage' in life satisfaction. Specifically, we sought to test the hypothesis that the positive relationship between spiritual experiences and life satisfaction is stronger among older African Americans than among older Whites.

METHOD

The data came from 6864 community-dwelling persons aged 65+ (66% African American) who participated in the Chicago Health and Aging Project. Life satisfaction was measured using a five-item composite and we used a five-item version of the Daily Spiritual Experiences scale.

RESULTS

In a regression model adjusting for age, sex, marital status, education, income and worship attendance, we found that African American race was associated with lower life satisfaction. We also found a positive association between spiritual experiences and life satisfaction. In an additional model, a significant race by spiritual experiences interaction term indicates that spiritual experiences are more positively associated with life satisfaction among African Americans.

CONCLUSION

The data suggest that at higher levels of spiritual experiences, racial differences in life satisfaction are virtually non-existent. However, at lower levels of spiritual experiences, older African Americans show modestly lower levels of life satisfaction than do older Whites. This pattern suggests that spiritual experiences are a positive resource - distinct from worship attendance - that enable older African Americans to overcome decrements in life satisfaction and, in fact, that lower spiritual experiences may be especially harmful for older African American's life satisfaction.

Cognitive and physical functions as determinants of delayed age at onset and progression of disability

BACKGROUND

This study examined the association of cognitive and physical functions with age-related transition and progression of activities of daily living (ADL) disability in a population-based longitudinal cohort of nondisabled older adults.

METHODS

A longitudinal population-based cohort study of 5,317 initially nondisabled older adults with an average age of 73.6 years of an urban Chicago community were interviewed annually for up to 8 years from 2000 through 2008. Cognitive function was assessed using a standardized global cognitive score and physical function using a combination of measured walk, tandem stand, and chair stand. A novel two-part model was used to access the relationship between cognitive and physical functions and age at onset and progression of ADL disability.

RESULTS

The sample consisted of 5,317 participants, 65% blacks, and 61% females. Twenty-five percent reported an onset of ADL disability during follow-up. After adjusting for confounders, lower cognitive and physical functions were associated with an increased risk for lower age at onset. Lower cognitive function was longitudinally associated with increased rate of progression of disability after onset. However, lower physical function did not alter the rate of progression of ADL disability.

CONCLUSIONS

Cognitive and physical functions were associated with age at onset. However, only cognitive function was associated with the rate of progression of ADL disability.

Disability in basic and instrumental activities of daily living is associated with faster rate of decline in cognitive function of older adults

BACKGROUND

The purpose of this study is to examine whether physical disability is associated with faster rate of decline in cognitive function.

METHODS

A longitudinal population-based cohort of 6,678 initially nondisabled older adults from a biracial urban community was interviewed at 3-year intervals from 1993 to 2012. Cognitive function was assessed using a standardized global cognitive score, and physical disabilities using activities of daily living (ADL) and instrumental activities of daily living (IADL).

RESULTS

During the follow-up period, 2,450 of 6,678 participants (37%) developed ADL and 2,069 of 4,287 participants (48%) developed IADL disability. After adjusting for demographic and physiologic confounders, cognitive function declined a mean of 0.048 unit per year before ADL disability and 0.047 unit per year before IADL disability. In comparison, the rate of cognitive decline accelerated further by 0.076 unit per year (156% increase) after ADL disability and 0.054 unit per year (115% increase) after IADL disability. Severity of ADL and IADL disabilities were also associated with faster cognitive decline following disability.

CONCLUSIONS

In old age, cognitive function declines substantially faster following physical disability even after controlling for demographic and physiologic characteristics of participants.