Keeping Us Young? Grandchild Caregiving and Older Adults' Cognitive Functioning

Objective

This study investigates longitudinal associations between providing care to grandchildren and cognitive functioning. It also examines heterogeneity in these relationships.

Background

Grandchild caregiving may support older adults' cognitive functioning by providing social engagement and emotional meaning. However, studies caution that time- intensive or custodial grandchild caregiving can take a toll on grandparents. The cognitive health implications of grandchild caregiving may thus depend on contexts including time spent providing care and living arrangements. They may also vary across sociodemographic groups and have greater effects on older adults who are more vulnerable to cognitive decline.

Method

Data came from the 1998-2016 waves of the Health and Retirement Study (HRS) and represented over 11,000 U.S. adults age 50+. Using linear growth curve and dynamic panel models, the analysis explored relationships between level of grandchild care and cognitive functioning over time and across sociodemographic, family, work and health characteristics.

Results

Those providing 100-199, 200-499 or 500+ hours of care to grandchildren had better cognitive functioning than non-caregivers regardless of whether they lived with grandchildren. Positive links between grandchild caregiving and cognition were stronger for lower income, non-working, and unpartnered adults and grew with age and functional limitations.

Conclusion

These findings suggest that providing care to minor grandchildren may help support cognitive functioning as adults age. They also support the hypothesis that more vulnerable or isolated groups of older adults may benefit the most from grandchild caregiving.

Measuring Cognitive Function and Cognitive Decline with Response Time Data in NSHAP

OBJECTIVES

Scholarly, clinical, and policy interest in cognitive function has grown over the last several decades in part due to large increases in Alzheimer's Disease and related dementias as populations age. However, adequate measures of cognitive function have not been available in many research data sets. We argue that a wealth of previously unexploited survey data exists to model cognition and cognitive decline.

METHODS

We use metadata of the time it takes older respondents in the National Social Life, Health and Aging Survey, which we label response times (RT), to answer questions in a standard cognitive assessment. We compare several measures of RT to a survey-adapted form of the Montreal Cognitive Assessment (MoCA).

RESULTS

We show that RT predict both concurrent and future MoCA scores. Our results show that longer and more varied RT at baseline predict lower MoCA scores five year later, net of baseline scores and controls. We also show that the effect of RT measures on predicting current MoCA differ for individuals of different races and ages, but are not different by gender.

DISCUSSION

Our paper demonstrates that RT constitute a separate powerful measure of cognitive functioning. RT may be remarkably useful both to clinicians and social scientists because they can increase accuracy of cognitive assessment without increasing the time it takes to administer the assessment.

In sickness and in health: Loneliness, depression, and the role of marital quality among spouses of persons with dementia

BACKGROUND

Older adults married to persons living with dementia (PLwD) may be at risk for loneliness and depression. We assessed the prevalence of loneliness and depressive symptoms among spouses of PLwD or cognitive impairment not dementia (CIND), and the role of marital quality in mediating these outcomes.

METHODS

We used a US population-based sample of 4071 couples enrolled in the Health and Retirement Study (2014 and 2016). We included older adults married to PLwD (N = 227), married to persons with CIND (N = 885), or married to persons with no cognitive impairment (NCI) (N = 2959). We determined the prevalence of loneliness (UCLA 3-item scale), depressive symptoms (CESD-8 scale), and both, using multivariable logistic regression adjusting for sociodemographic and health-related characteristics. We then tested for interaction terms between marital quality (4-item scale) and degree of spousal cognitive impairment for each outcome of loneliness and depressive symptoms.

RESULTS

The sample was 55% women and on average 67-years-old (range: 50-97). After adjustment, spouses of persons with cognitive impairment were more likely to be lonely (NCI: 20%, CIND: 23%, PLwD: 29%; p = 0.04), depressed (NCI: 8%, CIND: 15%, PLwD: 14%; p < 0.01), and both (NCI: 4%, CIND: 9%, PLwD: 7%; p < 0.01). The association between cognition and loneliness, but not depression, differed by marital quality (interaction p-value = 0.03). Among couples with high marital quality, spousal cognitive impairment was associated with higher likelihood of loneliness (p < 0.05). In contrast, no association existed between spousal cognition and loneliness among couples with lower marital quality (p = 0.37).

CONCLUSIONS

One in six spouses of persons with CIND or more advanced disease (PLwD) experienced depressive symptoms, and loneliness among spouses of PLwD was experienced at a twofold rate. By identifying and managing both, and facilitating interventions that promote high-quality social connection, clinical teams might improve the lives of older couples facing dementia.

The association of gait speed and self-reported difficulty walking with social isolation: A nationally-representative study

BACKGROUND

Mobility assessments are commonly used among older adults as risk stratification for falls, preoperative function, frailty, and mortality. We determined if gait speed and self-reported difficulty walking are similarly associated with social isolation and loneliness, which are key markers of social well-being and linked to health outcomes.

METHODS

We used 2015-2016 data from the National Social life Health and Aging Project (NSHAP), an in-person nationally-representative survey of 2640 community-dwelling adults ≥65 years old. We measured gait speed (timed 3-m walk: unable to walk, ≥5.7 s, and <5.7 s), and self-reported difficulty walking one block or across the room (unable, "much," "some," or "no" difficulty). Social measures included loneliness (3-item UCLA scale), social isolation (12-item scale), and individual social activities (frequency socializing, religious participation, community participation, and volunteering). We used logistic regression to determine the adjusted probability of each social measure by gait speed and difficulty walking, adjusting for sociodemographic and health characteristics, and tested for interaction terms with age.

RESULTS

Participants were on average 75 years old (SD = 7.1), 54% female, 9% Black/African American, and 6% Hispanic. Difficulty walking one block was associated with (p < 0.05): social isolation (much difficulty: 26% vs no difficulty: 18%), low socializing (33% vs 19%), low volunteering (67% vs 53%), low community participation (54% vs 43%), low religious participation (51% vs 46%), and loneliness (25% vs 14%). Difficulty walking across the room was similarly strongly associated with social isolation and individual activities. The association between self-reported difficulty walking and social isolation was stronger at older ages (p-value of interaction <0.001).

CONCLUSIONS

Self-reported mobility difficulty is a widely used clinical assessment that is strongly associated with loneliness and social isolation, particularly at older ages. Among persons with limited mobility, clinicians should consider a careful social history to identify social needs and interventions addressing mobility to enhance social connections.

From safety to frustration: The neural substrates of inhibitory learning in aversive and appetitive conditioning procedures

Inhibitory associative learning counters the effects of excitatory learning, whether appetitively or aversively motivated. Moreover, the affective responses accompanying the inhibitory associations are of opponent valence to the excitatory conditioned responses. Inhibitors for negative aversive outcomes (e.g. shock) signal safety, while inhibitors for appetitive outcomes (e.g. food reward) elicit frustration and/or disappointment. This raises the question as to whether studies using appetitive and aversive conditioning procedures should demonstrate the same neural substrates for inhibitory learning. We review the neural substrates of appetitive and aversive inhibitory learning as measured in different procedural variants and in the context of the underpinning excitatory conditioning on which it depends. The mesocorticolimbic dopamine pathways, retrosplenial cortex and hippocampus are consistently implicated in inhibitory learning. Further neural substrates identified in some procedural variants may be related to the specific motivation of the learning task and modalities of the learning cues. Finally, we consider the translational implications of our understanding of the neural substrates of inhibitory learning, for obesity and addictions as well as for anxiety disorders.

SOCIAL RESOURCES, COGNITION, AND MENTAL HEALTH DURING THE COVID-19 PANDEMIC

This study assesses the extent to which changes in mental health among older adults from pre- to during the pandemic varied by cognitive functioning and the role that decreases in social resources played in this association. We use data from the National Social Life, Health, and Aging Project (NSHAP)—a population-based panel study of older U.S. adults that has surveyed respondents every 5 years since 2005—and the NSHAP COVID-19 supplement, conducted between September 2020 and January 2021 (N=2,672). Results from linear regression models suggest that (1) higher cognitive functioning in 2015 was associated with greater loneliness (β=-0.03; p<.05) during the pandemic; (2) this association is explained in part by a decrease in emotional support during COVID-19 (β=0.94; p<.001); and (3) cognitive status did not moderate links between social resources with happiness nor loneliness. Results emphasize the importance of social resources for older adults’ mental health, regardless of cognitive ability.

IMPLICATIONS FOR MORTALITY RISK: CONSEQUENCES OF SURVEY NONRESPONSE IN HOME-DWELLING OLDER ADULTS

Nonrespondents generally suffer from worse health outcomes than respondents. Are they unwilling or unable to respond? Our aim was to address this issue. Data (N=3,130) from 2010-2015 waves of National Social Life Health and Aging Project (NSHAP, W2, W3) was used. Four groups of participants were considered based on their response status at W3: alive, incapacitated, deceased, and nonrespondents. Nonrespondents represented cases with no information at W3, beyond their disability and death information. General linear models were used to compare group means at baseline (W2) in terms of mortality risk (Lee index) or cognitive impairment (MOCA), adjusted for demographic variables. Like the deceased or incapacitated groups, the nonrespondent group displayed significantly worse outcomes (Least Squares Means) than the alive group: Lee index alive=5.82, deceased=9.66, incapacitated=8.29 and nonrespondents=7.80; MOCA alive=21.57, deceased=19.79, incapacitated=19.19 and nonrespondents=19.84. Being a nonrespondent likely indicates incapacity, not reluctance to responding. Earlier follow-up surveys could optimize response rates.

COHORT DIFFERENCES IN SOCIAL TIES TO FAMILY AND FRIENDS

Dramatic changes in family life may have altered the structure and quality of social ties to family and friends. However, little is known about whether and how social relationships vary between older adults from different cohorts. Using data from the National Social Life, Health, and Aging Project, we compared social network composition and social support between older adults at ages 57 to 67 from the Silent Generation cohort (N=2,316) and the Baby Boom cohort (N=1,500). Compared with the Silent Generation cohort, the Baby Boom cohort had significantly higher odds of not listing any kin in their core discussion network. There were no cohort differences in proportion of friends in the network. The Baby Boom cohort also reported lower levels of family and friend support than their counterparts. Results suggest that the Baby Boom cohort is more socially disconnected from friends and particularly family compared with the Silent Generation cohort.

Strain comparisons in inhibitory discrimination learning and novel object recognition procedures

Strain differences in visual abilities and exploratory tendencies can confound rats' performance in cognitive tests of learning and memory. In the present study we compared the performance of albino Wistar and pigmented Lister Hooded rats in appetitive conditioning and recognition memory procedures, specifically within-subjects inhibitory learning (A+ /AX-) and novel object recognition (NOR) variants. The inhibition task included an excitatory training stage and summation and retardation tests. Difference scores were used to help control for individual variation in baseline nosepoke responding. NOR was tested after a 10 min delay, following 24hr delay and using a recency variant. Discrimination ratios were used to control for individual variation in exploratory activity. In the inhibitory learning procedure, Lister Hooded showed more magazine activity prior to stimulus presentations than Wistar rats but this was a transient effect restricted to day 1 of excitatory training. There was no strain difference in associative learning at the excitatory training stage. The Wistars went on to show some performance advantage at the inhibitory discrimination stage and marginally stronger retardation test performance. In the NOR tasks, there was no significant effect of strain on cognitive performance, but the Wistars showed some advantage in the 10 min delay variant, whereas in the 24hr delay and relative recency NOR variants, the Lister Hooded rats showed some advantage. Overall the results of the present study confirm the suitability of Wistar rats for use in associative learning and basic NOR procedures.

Variability in Hourly Activity Levels: Statistical Noise or Insight Into Older Adult Frailty?

BACKGROUND

Frailty is associated with lower mean activity; however, hourly activity is highly variable among older individuals. We aimed to relate frailty to hourly activity variance beyond frailty's association with mean activity.

METHOD

Using the 2010-2011 National Social Life, Health and Aging Project wrist accelerometry data (n = 647), we employed a mixed-effects location scale model to simultaneously determine whether an adapted phenotypic frailty scale (0-4) was associated with the log10-mean hourly counts per minute (cpm) and between-and within-subject hourly activity variability, adjusting for demographics, health characteristics, season, day-of-week, and time-of-day. We tested the significance of a Frailty × Time-of-day interaction and whether adjusting for sleep time altered relationships.

RESULTS

Each additional frailty point was associated with a 7.6% (10-0.0343, β = -0.0343; 95% CI: -0.05, -0.02) lower mean hourly cpm in the morning, mid-day, and late afternoon but not evening. Each frailty point was also associated with a 24.5% (e0.219, β = 0.219; 95% CI: 0.09, 0.34) greater between-subject hourly activity variance across the day; a 7% (e0.07, β = 0.07; 95% CI: 0.01¸ 0.13), 6% (e0.06, β = 0.06; 95% CI: 0, 0.12), and 10% (e0.091, β = 0.091; 95% CI: 0.03, 0.15) greater within-subject hourly activity variance in the morning, mid-day, and late afternoon, respectively; and a 6% (e-0.06, β = -0.06; 95% CI: -0.12, -0.003) lower within-subject hourly activity variance in the evening. Adjusting for sleep time did not alter results.

CONCLUSIONS

Frail adults have more variable hourly activity levels than robust adults, a potential novel marker of vulnerability. These findings suggest a need for more precise activity assessment in older adults.

Older Adult Sexuality, Partnership, and Health: Cohort Comparisons of Baby Boomers and Traditionalists

This paper updates prior work on older adult sexuality, partnership, and health by examining the most current wave of the National Social Life, Health, and Aging Project (2015-16), a population-based study of health and social factors on a national scale. Comparing data from Wave I, Cohort 1 (2005-06) and Wave I, Cohort 2 (2015-16), we ask whether there are differences in partnership, sexual behaviors and health outcomes between two cohorts (‘Traditionalists’ vs. ‘Baby Boomers’). Additionally, we examine whether sexual frequency is related to physical health, particularly the health conditions of arthritis, diabetes, cognitive impairment, and prior stroke, in both cohorts. We find significant differences between cohorts through a logistic model. For Traditionalists, age, gender, education level, partnership status and diabetes were all significantly related to sexual activity (p < 0.001). Older adults were less sexually active; men were more sexually active; the higher educated were more sexually active; diabetes patients were less sexually active; and partnered were more sexually active. For Baby Boomers, only age and partnership status were significantly related to sexual activity (p < 0.001); gender and diabetes diagnosis were also related (p <0.005). Significantly, partnership status for Boomers is negatively related to sexual activity; the other three relationships – age is related to less sexual activity, men have slightly higher sexual activity, and diabetes was related to less sexual activity – were as expected. Importantly, our findings may imply that partnership or marriage is not as significant to sexual activity, or to health outcomes, as previously believed.

Early Life Conditions, Adulthood Experiences, and Edentulism at Older Ages

The role of childhood in shaping overall adult health has been well documented, especially for physical and mental health, but much less is known about the impact of early disadvantage on oral health in later life. Using data from the 2006 and 2012 Health and Retirement Study, we investigate the link between childhood financial and psychosocial adversity and edentulism over a six-year period among U.S. adults aged 51 and older. We find that those growing up with parents with fewer resources face higher risks of having lost all their tooth at baseline and during the follow-up. Adulthood socioeconomic status and health behaviors are strongly associated with the risk of edentulism, net of childhood conditions. However, the effect of low parental resources on the onset of edentulism persists when accounting for these life course factors. Part of a symposium sponsored by the Oral Health Interest Group.

Social Isolation and Loneliness: Moderators of the Relationship Between Sensory Impairment and Cognition

Hearing and vision impairment have been independently linked to accelerated cognitive decline in older adults, however there is limited evidence on the effect of dual sensory impairment (DSI) (both hearing and vision impairment) on cognition. Additionally, the impact of social isolation and loneliness, both correlates of DSI and independent risk factors for cognitive decline, on the DSI-cognition relationship has yet to be studied. Using data from the National Social Life, Health, and Aging Project (N=3,091), multivariable linear regression models were used to describe the cross-sectional relationship between self-reported functional sensory impairment (none, hearing only, vision only, DSI) and cognitive function, measured by the survey adapted Montreal Cognitive Assessment. We also included an interaction term in the model to investigate whether cognition is worse among older adults with sensory impairment who also are socially isolated or lonely. Participants in this sample are between 62-91 years with 15% reporting hearing impairment, 11% reporting vision impairment, and 7% reporting DSI. DSI was associated with significantly lower global cognitive function compared to no sensory impairment (-0.31 standard deviations (SD), 95% CI:-0.44 to-0.18), hearing impairment alone (-0.29 SD, 95% CI: -0.44 to -0.15), and vision impairment alone (-0.22 SD, 95% CI: -0.39 to -0.06). Furthermore, cognitive function was significantly worse among older adults with both DSI and smaller social networks (p-interaction <0.05). No differences in the DSI-cognition relationship were observed by level of loneliness. These findings add to the limited research on the relationship between DSI, social isolation and loneliness, and cognition.

Cohort Differences in Social Participation in the National Social Life, Health, and Aging Project

Has American society become more socially disconnected as Robert Putnam argues in Bowling Alone? Claude Fischer disputes this contention with evidence that Americans remain about as connected to friends and family as in the past. We address this debate with data for older adults from the National Social Life, Health and Aging Study, collected in 2005, 2010, and 2015. We compare social participation as reported at ages 57 to 68 for members of the Silent Generation cohort vs the Baby Boom cohort. We find that the gender gap in social participation evident for the Silent Generation does not exist at all for younger Baby Boomers, only appearing after age 62. These same cohort differences appear for participation in religious services and organized groups. This suggest that the gendered separation of social roles that characterized older generations is becoming less pronounced, with implications for social support and social isolation.

Global Sensory Impairment Independently Predicts Decreased Social Function Over Time

The classical senses (vision, hearing, touch, taste, and smell) play a key role in social function by allowing interaction and communication. We assessed whether sensory impairment across all 5 modalities (global sensory impairment [GSI]) was associated with social function in older adults. Sensory function was measured in 3,005 home-dwelling older U.S. adults at baseline in the National Social Life, Health, and Aging Project and GSI, a validated measure, was calculated. Social network size and kin composition, number of close friends, and social engagement were assessed at baseline and 5- and 10-year follow-up. Ordinal logistic regression and mixed effects ordinal logistic regression analyzed cross-sectional and longitudinal relationships respectively, controlling for demographics, physical/mental health, disability, and cognitive function (at baseline). Adults with worse GSI had smaller networks (β=-0.159, p=0.021), fewer close friends (β=-0.262, p=0.003) and lower engagement (β=-0.252, p=0.006) at baseline, relationships that persisted at 5 and 10 year follow-up. Men, older people, African-Americans, and those with less education, fewer assets, poor mental health, worse cognitive function, and more disability had worse GSI. Men and those with fewer assets, worse cognitive function, and less education had smaller networks and lower engagement. African-American and Hispanic individuals had smaller networks and fewer close friends, but more engagement. Older respondents also had more engagement. In summary, GSI independently predicts smaller social networks, fewer close friends, and lower social engagement over time, suggesting that sensory decline results in decreased social function. Thus, rehabilitating multisensory impairment may be a strategy to enhance social function as people age.

Hearing Impairment and Loneliness in Older Adults in the United States

Hearing impairment impacts fluidity of communication and social interactions and thus may contribute to loneliness. We investigated the cross-sectional association between hearing impairment and loneliness in community-dwelling older U.S. adults using data from the National Social Life, Health, and Aging Project ( N = 3,196). Individuals reporting fair/poor hearing had 50% (95% confidence interval [CI] = [1.09–2.05]) higher odds of any loneliness compared with those reporting excellent hearing after adjusting for comorbidity index, functional and cognitive ability, self-reported health, and demographic characteristics. Test for trend suggests a dose–response relationship over levels of hearing impairment. Hearing impairment is highly prevalent and may be an important target for consideration in interventions to reduce loneliness. Further investigation of whether treatment of hearing impairment alleviates loneliness and its disabling effects is also needed.

Cognitive limitations in older adults receiving care reduces well-being among spouse caregivers

A large number of older adults have physical and/or cognitive challenges and require help to manage everyday activities. Many older adults receive care from a spouse. Over the long term, this has adverse consequences for caregiver health and well-being. Less is known about the outcomes associated with the early transition to becoming a spousal caregiver. Nor is it clear how mild-cognitive decline worsens caregiver outcomes. The present study uses dyadic data from 588 couples in the National Social Life, Health, and Aging Project to compare mental and social well-being in marital partners who became a spousal caregiver versus those who remained noncaregivers or became caregivers for someone other than a spouse between 2010 and 2015. Cognitive ability was assessed using a validated version of the Montreal Cognitive Assessment. Moderated Actor-Partner Independence Models revealed that becoming a caregiver was associated with an increase in perceived stress in both men and women, and an increase in anxiety among men. Partners' cognitive limitations moderated, in a dose-dependent fashion, the association between becoming a caregiver and changes in well-being. Specifically, becoming a caregiver was associated with increased support from friends for wives at lower levels of husband's cognitive ability, and with increased anxiety for husbands at lower levels of wife's cognitive ability. Associations were independent of demographic characteristics and physical limitations. We discuss the value of using population-based samples to study the transition to caregiving and implications for interventions during the early transition to a caregiving role for even modestly cognitively impaired partners. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

NEW ACCELEROMETRY PATTERNS IN FRAILTY: HOURLY ACTIVITY AND VARIANCE

Wearable sensors may improve our ability to identify frailty in the community. Frailty has been historically defined, in part, by reduced average activity; however, new analytic methods of aggregate, free-living accelerometry data suggest that frailty may be more fully characterized above and beyond reduced average activity. Using mixed-effect regression models of awake hourly activity from the National Social Life, Health and Aging Project dataset, we have shown that frail adult activity is most reduced in the morning relative to pre- and non-frail adults rather than the afternoon or evening. High residual between- and within-subject activity variance in this model prompted further study of activity variance. A follow-up analysis using a mixed-effect location-scale model of hourly activity data revealed that increasing frailty in older adults is associated with greater between-subject as well as within-subject hourly activity variability, particularly in the morning and afternoon. Study implications and future directions will be discussed.

DISTRIBUTION, PREDICTORS, AND CLINICAL RELEVANCE OF 5-YEAR CHANGE IN FRAILTY MEASURES

Implementing frailty assessment into routine clinical practice is a priority. Gait speed and performance on 5 repeated chair stands are two measures of frailty. We face a number of clinical implementation challenges: (1) We lack normative data for U.S. older adults and (2) The clinical relevance of change in frailty measures is unclear. The National Social Life, Health and Aging Project dataset allows an examination of the distribution of 3-meter gait and 5-repeated chair stands times as well as 5-year change in these measures in a nationally-representative, community-dwelling older adult sample. Dr. Huisingh-Scheetz will describe demographic predictors of change in these measures as well as determine whether baseline plus 5-year change in these measures predicts loss of independence in activities of daily living (ADLs).

The Relationship Between Physical Activity and Frailty Among U.S. Older Adults Based on Hourly Accelerometry Data

Background/Objectives

Accelerometry measures older adult (in)activity with high resolution. Most studies summarize activity over the entire wear time. We extend prior work by analyzing hourly activity data to determine how frailty and other characteristics relate to activity among older adults.

Methods

Using wrist accelerometry data collected from the National Social Life, Health and Aging Project (n = 651), a nationally-representative probability sample of older adults, we used mixed effects linear regression to model the logarithm of hourly counts per minute as a function of an adapted phenotypic frailty score, adjusting for demographic and health characteristics, season, day of week and time of day.

Results

Higher frailty scores were associated with modestly lower activity; each frailty point (0-4) corresponded to a 7% lower mean hourly counts per minute. Older age, more comorbidities, male gender, and higher BMI were also associated with lower activity, though the latter was not evident among frail respondents. After adjusting for differences associated with frailty and other covariates, a substantial amount of between-individual variability in activity remained, as well as within-individual variability across days.

Conclusion

Our findings indicate that frail elders, men, those who are older, overweight or have multiple comorbidities are most likely to have low activity. However, residual differences between individuals remain larger than the differences associated with frailty and other covariates. We suggest defining individual-specific activity goals and further research to identify the sources of between-individual variability to better understand how activity reflects health status and to permit the development of more effective interventions.

Disability, Psychological Well-Being, and Social Interaction in Later Life in China

Many studies show that disability predicts lower social participation and poorer psychological well-being. However, few have examined how disability, social interaction, and psychological well-being interrelate with one another. We use diary data from World Health Organization's Study on Global AGEing and Adult Health, 2007-2010 ( N = 8,771) and mediation analysis to examine the links between disability, daily social interaction, and the momentary and global well-being of older adults in China. We find suggestive support for the hypothesis that psychological well-being predicts social interaction in the context of disablement, but little evidence for the converse. Specifically, in a cross-sectional analysis, disability predicts lower levels of momentary affect, happiness, and life satisfaction, which are linked to spending more time alone and participating in fewer activities with grandchildren, friends, and coworkers. These findings are consistent with the hypothesis that a less active social life is explained by poor functional performance and compromised psychological vibrancy.

Social capital predicts accelerometry-measured physical activity among older adults in the U.S.: a cross-sectional study in the National Social Life, Health, and Aging Project

Background

Older adults receive important health benefits from more robust social capital. Yet, the mechanisms behind these associations are not fully understood. Some evidence suggests that higher levels of social capital ultimately affect health through alterations in physical activity (PA), but most of this research has relied on self-reported levels of PA. The aim of this study was to determine whether components of social capital, including social network size and composition as well as the frequency of participation in various social and community activities, were associated with accelerometry-measured PA levels in a nationally representative sample of community-dwelling older adults (≥ 62 years).

Methods

We conducted a cross-sectional analysis using data from the wrist accelerometry sub-study (n = 738) within Wave 2 of the National Social, Health, and Aging Project (NSHAP), a population-based longitudinal study that collects extensive survey data on the physical, cognitive, and social health of older adults. Participants’ physical activity was measured with a wrist accelerometer worn for 72 consecutive hours. We related seven, self-reported social relationship variables (network size, network proportion friends, and frequencies of socializing with friends and family, visiting with neighbors, attending organized group meetings, attending religious services, and volunteering) to accelerometer-measured PA (mean counts-per-minute) using multivariate linear regression analysis, while adjusting for potential confounders.

Results

Larger social networks (p = 0.042), higher network proportion friends (p = 0.013), more frequent visiting with neighbors (p = 0.009), and more frequent attendance at organized group meetings (p = 0.035) were associated with higher PA levels after controlling for demographic and health covariates. Volunteering was significant prior to adjusting for covariates. No significant associations were found between frequencies of socializing with friends and relatives or attendance at religious services and PA.

Conclusions

This study suggests social capital is significantly related to objectively measured PA levels among older adults, and that friendships as well as social participation in groups and with neighbors may be particularly pertinent to PA. These findings expand our understanding of and offer a potential mechanism linking social relationships and overall health among older adults. They also have implications for how we might motivate older adults to be more physically active.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5664-6) contains supplementary material, which is available to authorized users.

Is the Relationship between Depression and C Reactive Protein Level Moderated by Social Support in Elderly?-Korean Social Life, Health, and Aging Project (KSHAP)

OBJECTIVE

To investigate the buffering effects of social support as an effects modifier in the association between depression and inflammation in the elderly.

METHODS

We analyzed the Korean Social Life, Health, and Aging Project (KSHAP) for questionnaire, clinical, and laboratory data of 530 older adults living in a rural community. Multivariate regression models were used to investigate the association between depressive symptoms and C-reactive protein level (CRP), a marker of inflammation, at varying levels of social support.

RESULTS

Social support affected the association between depressive symptoms and CRP level in both sexes. However, the direction of effects modification was different for men and women. In men, a higher CRP level was significantly associated with depressive symptoms only among those with lower support from a spouse or family members. By contrast, in women, the association was significant only among subgroups with higher spousal or family support. Social support from neighbors or friends did not affect the depression-inflammation relationship in men but modestly affected the relationship in women.

CONCLUSION

Our findings suggest that social support may have a buffering effect in the relationship between depression and inflammation in elderly Koreans. But the influence of social support may run in different directions for men and women.

Sleep Characteristics and Daytime Cortisol Levels in Older Adults

Objective

Older adults frequently report sleep problems and are at increased risk of cardiometabolic disruption. Experimental sleep restriction of younger adults has suggested that cortisol may be on the pathway between sleep restriction and cardiometabolic disease. We investigated whether the natural variation in sleep among older adults is associated with daytime cortisol level.

Methods

Salivary cortisol samples and actigraphy sleep data were collected from a random subsample of participants in the National Social Life, Health and Aging Project, a nationally representative probability sample of adults aged 62-90 (N = 672). Salivary cortisol was measured with 3 timed samples at the beginning, middle, and end of a 2-hr in-home interview. Sleep characteristics were derived from wrist actigraphy (fragmentation, wake after sleep onset [WASO], and duration) and from survey responses about usual sleep duration and sleep problems. For each individual, a single summary daytime cortisol level was estimated by fitting a marginal longitudinal model for the 3 time-stamped cortisol samples. The resulting estimates were then regressed on each sleep measure, adjusting for sociodemographics, health behaviors, and comorbidities.

Results

From actigraphy, both higher fragmentation score (β = 0.02; 95% confidence interval [CI] = 0.00 to 0.03) and longer WASO (β = 0.27; 95% CI = 0.04 to 0.51) were significantly associated with higher daytime cortisol; sleep duration was not. Self-reported sleep duration and sleep problems were also not associated with cortisol.

Conclusion

Actigraph measures of sleep disturbance are associated with higher daytime cortisol among older adults. However, cross-sectional data cannot distinguish causal direction or whether cortisol and sleep disruption have a common cause.

Measuring Physical Activity with Hip Accelerometry among U.S. Older Adults: How Many Days Are Enough?

Introduction

Accelerometers are increasingly used in research. Four to 7 days of monitoring is preferred to estimate average activity but may be burdensome for older adults. We aimed to investigate: 1) 7-day accelerometry protocol adherence, 2) demographic predictors of adherence, 3) day of the week effect, and 4) average activity calculated from 7 versus fewer days among older adults.

Methods

We used the 2003–2006 older adult hip accelerometry data from the National Health and Nutrition Examination Survey (NHANES) sample. We determined proportions with 1–7 valid (10–20 hours) wear days and identified wear day correlates using ordinal logistic regression. We determined the day of week effect on 5 accelerometry measures (counts per minute, CPM; % sedentary behavior; % light-lifestyle activity; % moderate-vigorous activity, MVPA; total activity counts) using multivariate linear regression and compared averages estimated over 2 or 3 versus 7 days using correlations, linear regression, and Bland-Altman plots.

Results

Among 2,208 participants aged 65+, 85% of participants had ≥2 and 44% had 7 valid wear days. Increasing age (p = 0.01) and non-white race (p < 0.001) were associated with fewer days. Daily CPM, % MVPA, and total daily activity counts were similar Monday through Saturday, but significantly lower on Sundays (p < 0.001). Daily % sedentary behavior and % light-lifestyle activity were significantly different on Saturdays (p = 0.04–0.045) and Sundays (p < 0.001) compared to weekdays. Among participants with 7 valid days, 2 or 3 day averages were highly correlated with 7 day averages for all 5 accelerometry measures (2 versus 7 days: r = 0.90–0.93, 3 versus 7 days: r = 0.94–0.96).

Conclusions

Protocols of 2–3 days, adjusting for Sundays (average CPM, % moderate-vigorous activity, and average total daily activity counts) or weekends (% sedentary behavior and % light-lifestyle activity), give reliable estimates of older adult activity.

Diabetes Risk and Disease Management in Later Life: A National Longitudinal Study of the Role of Marital Quality

OBJECTIVES

We assess the association between marital quality and both the risk of developing diabetes and the management of diabetes after its onset in later life.

METHOD

We use data from the first two waves of the National Social Life, Health, and Aging Project to estimate regression models with lagged dependent variables. The sample includes 1,228 married respondents, among whom 389 were diabetic. Those with either a reported diagnosis or with HbA1c ≥ 6.5% are identified diabetic. We categorize diabetic respondents into three groups: controlled, undiagnosed, and uncontrolled diabetes. We conduct factor analysis to construct positive and negative marital quality scales.

RESULTS

For women, an increase in positive marital quality between Waves 1 and 2 is related to a lower risk of being diabetic at Wave 2, net of diabetes status at Wave 1; surprisingly, for men, an increase in negative marital quality between Waves 1 and 2 is related to both a lower risk of being diabetic at Wave 2 and a higher chance of controlling diabetes at Wave 2 after its onset.

DISCUSSION

Our results challenge the traditional assumption that negative marital quality is always detrimental to health and encourage family scholars to distinguish different sources and types of negative marital quality.

Relating wrist accelerometry measures to disability in older adults

OBJECTIVE

This analysis assessed the extent to which: (1) wrist accelerometer measures were associated with difficulty performing specific activities of daily living and instrumental activities of daily living and (2) these measures contributed important information about disability beyond a typical self-reported vigorous activity frequency question.

METHODS

We used data from the National Social Life, Health and Aging Project (NSHAP) accelerometry sub-study (n=738). Activity was assessed using two wrist-accelerometer measures assessed over 3 days (routine activity expressed as mean count/15s epoch during wake time, and immobile time expressed as the proportion of wake time spent immobile), and self-reported average vigorous activity frequency. The association between routine activity, immobile time and difficulty performing fourteen activities of daily living (ADLs) and instrumental activities of daily living (IADLs) plus two summary measures (any ADL or IADL difficulty), was assessed using logistic regression models, with and without controlling for self-reported vigorous activity.

RESULTS

Self-reported activity was mildly correlated with routine activity (r=0.27) and immobile time (r=-0.21). Routine activity, immobile time, and self-reported vigorous activity were significantly associated with twelve, ten, and fourteen disability measures, respectively. After controlling for self-reported activity, significant associations remained between routine activity and eight disabilities, and immobile time and six disabilities.

CONCLUSION

Wrist accelerometry measures were associated with many ADL and IADL disabilities among older adults. Wrist acclerometry in older adults may be useful to help assess disability risks and set individualized physical activity targets.

Assessment of sleep in the National Social Life, Health, and Aging Project

OBJECTIVES

The relationship of sleep to health has been an active area of research in recent years, and the National Social Life, Health, and Aging Project (NSHAP) expanded sleep data collection in Wave 2 with enhanced core questions and a novel sleep module that included an objective measure of sleep duration and quality.

METHOD

A randomly selected one-third of Wave 2 participants and their spouses or coresident partners were invited to participate in the sleep module. Objective sleep data were collected using wrist actigraphy, an accelerometer that records an integrated measure of motion over short epochs (15 s each). This information is stored and subsequently analyzed to determine sleep and wake periods by epoch. Individuals were instructed to wear the actiwatches for 72 hr. Several sleep parameters were derived from the accelerometer. Individuals concurrently kept a sleep diary.

RESULTS

Sleep actigraphy data were successfully collected from 780 individuals. Many of the survey-based and the actigraph-estimated sleep parameters varied by age and gender. However, age and gender patterns often differed for sleep characteristics that were both asked and measured, such as sleep duration.

DISCUSSION

The survey and actigraphy data provide different information about sleep characteristics. The opportunity to examine actigraph-estimated sleep characteristics in a nationally representative sample of older adults allows novel analyses of the associations of sleep parameters with social and health data.

Geriatric syndromes and functional status in NSHAP: rationale, measurement, and preliminary findings

INTRODUCTION

The geriatric functional measures and syndromes collected 5 years apart in Waves 1 and 2 of the National Social Life, Health, and Aging Project (NSHAP) data set included: difficulty with activities of daily living and instrumental activities of daily living, the timed up and go, a 3-m timed walk, repeated chair stands, self-reported physical activity, accelerometry-assessed (in)activity, falls, fractures, and frailty. The purpose of this paper was to describe the data collection methods and report preliminary population estimates for each measures.

METHOD

Frequencies, means, or medians were estimated for each measure stratified by age and gender, using the age-eligible samples in Wave 1 (n = 3,005) and Wave 2 (n = 3,196). An adapted phenotypic frailty scale was constructed in the sample common to both waves (n = 2,261). Changes over 5 years were reported for four measures common to both waves.

RESULTS

The functional measures worsened with age (p < .001). The syndromes were more prevalent with age except "all fractures" (p value range < .001-.03). Functional measures were worse among females than males except chair stand performance and the accelerometry-assessed (in)activity measures (p value range < .001-.01). The syndromes were more common among females than males except Wave 2 falls and Wave 2 hip fractures (p value range < .001-.03). Changes from Wave 1 to 2 revealed 11.5%-25.2% of individuals reported better health and 21.3%-44.7% reported worse health.

DISCUSSION

The NSHAP provides a comprehensive assessment of geriatric health. Our findings are consistent with the literature and support the construct of the study measures.

Bad marriage, broken heart? Age and gender differences in the link between marital quality and cardiovascular risks among older adults

Working from a life course perspective, we develop hypotheses about age and gender differences in the link between marital quality and cardiovascular risk and test them using data from the first two waves of the National Social Life, Health, and Aging Project. The analytic sample includes 459 married women and 739 married men (aged 57-85 in the first wave) who were interviewed in both waves. We apply Heckman-type corrections for selection bias due to mortality and marriage. Cardiovascular risk is measured as hypertension, rapid heart rate, C-reactive protein, and general cardiovascular events. Results suggest that changes in marital quality and cardiovascular risk are more closely related for older married people than for their younger counterparts and that the link between marital quality and cardiovascular risk is more pronounced among women than among men at older ages. These findings fit with the gendered life course perspective and cumulative disadvantage framework.

Insomnia symptoms and actigraph-estimated sleep characteristics in a nationally representative sample of older adults

BACKGROUND

Reports of insomnia symptoms are common among the elderly. However, little is known about the relationship between insomnia symptoms and objective assessments of sleep in the general population of older adults. We assessed concordance between insomnia symptoms and actigraphic sleep characteristics in a nationally representative sample of older Americans.

METHODS

In a national probability sample of 727 adults aged 62-91 years in 2010-2011 from the National Social Life, Health, and Aging Project, respondents were asked how often they (a) feel rested when they wake up, (b) have trouble falling asleep, (c) have trouble with waking up during the night, and (d) have trouble waking up too early and not being able to fall asleep again. Responses to these questions were compared to sleep characteristics estimated from three nights of actigraphy for the same individuals. Statistical analyses were adjusted for age, gender, race and ethnicity, income, assets, and education.

RESULTS

Feeling rested (Question (a), above) was not correlated with any actigraphy-estimated sleep characteristics. Questions (b)-(d) each had several significant correlations with the actigraphy metrics, but generally not with the specific objective sleep characteristics that each question intended to reference. In some cases, the associations were not in the expected direction.

CONCLUSIONS

Although three of four questions about insomnia symptoms were significantly associated with objectively estimated sleep characteristics, responses seem to be general indicators of sleep quality rather than reports of specific sleep characteristics.

Health and functional status of adults with intellectual disability referred to the specialist health care setting: a five-year experience

Aims and Method. The Developmental Disability Database in the Department of Rehabilitation Medicine at a metropolitan hospital was audited for observations on adults with Intellectual Disability living in the local region (total population 180,000) who were seen in an identified multidisciplinary specialist clinic, during 2006-2010. Results. There were 162 people (representing half the known number of adults with Intellectual Disability living in the region): 77 females, 85 males, age range 16-86 years. The most common complex disabilities referred to the specialists in this clinic were epilepsy (52%), challenging or changing behavior (42%) and movement disorders (34%). Early onset dementia was a feature of the group (7%). The prevalence of prescription of medications for gastro-oesophageal reflux was high (36%) and similar to the numbers of people taking psychotropic medications. The rates of chronic cardiovascular disease (2%), chronic respiratory disease (10%) and generalised arthritis (11%) were low overall, but did rise with increasing age. Conclusions. Complex neurological disabilities are common, and chronic medical illnesses are uncommon in adults with Intellectual Disability referred to specialist clinicians in this region. A combined, coordinated, multidisciplinary clinic model addresses some of the barriers experienced by adults with Intellectual Disability in the secondary health system.

Socioeconomic status and bone health in community-dwelling older men: the CHAMP Study

SUMMARY

The association between socioeconomic status (SES) and bone health, specifically in men, is unclear. Based upon data from the large prospective Concord Health in Ageing Men Project (CHAMP) Study of community-dwelling men aged 70 years or over, we found that specific sub-characteristics of SES, namely, marital status, living circumstances, and acculturation, reflected bone health in older Australian men.

INTRODUCTION

Previous studies reported conflicting results regarding the relationship between SES and bone health, specifically in men. The main objective of this study was to investigate associations of SES with bone health in community-dwelling men aged 70 years or over who participated in the baseline phase of the CHAMP Study in Sydney, Australia.

METHODS

The Australian Socioeconomic Index 2006 (AUSEI06) based on the Australian and New Zealand Standard Classification of Occupations was used to determine SES in 1,705 men. Bone mineral density and bone mineral content (BMC) were determined by dual-energy X-ray absorptiometry. Bone-related biochemical and hormonal parameters, including markers of bone turnover, parathyroid hormone, and vitamin D, were measured in all men.

RESULTS

General linear models adjusted for age, weight, height, and bone area revealed no significant differences across crude AUSEI06 score quintiles for BMC at any skeletal site or for any of the bone-related biochemical measures. However, multivariate regression models revealed that in Australian-born men, marital status was a predictor of higher lumbar BMC (β = 0.07, p = 0.002), higher total body BMC (β = 0.05, p = 0.03), and lower urinary NTX-I levels (β=-0.08, p = 0.03), while living alone was associated with lower BMC at the lumbar spine (β=-0.05, p = 0.04) and higher urinary NTX-I levels (β=0.07, p = 0.04). Marital status was also a predictor of higher total body BMC (β = 0.14, p = 0.003) in immigrants from Eastern and South Eastern Europe. However, in immigrants from Southern Europe, living alone and acculturation were predictors of higher femoral neck BMC (β = 0.11, p = 0.03) and lumbar spine BMC (β = 0.10, p = 0.008), respectively.

CONCLUSIONS

Although crude occupation-based SES scores were not significantly associated with bone health in older Australian men, specific sub-characteristics of SES, namely, marital status, living circumstances, and acculturation, were predictors of bone health in both Australia-born men and European immigrants.

Families, social life, and well-being at older ages

As people age, many aspects of their lives tend to change, including the constellation of people with whom they are connected, their social context, their families, and their health--changes that are often interrelated. Wave I of the National Social Life, Health, and Aging Project (NSHAP) has yielded rich information on intimate ties, especially dyads and families, and on social connections generally. Combined with extensive biological and other health measures, NSHAP enables researchers to address key questions on health and aging. We begin with recent findings on intimate dyads, then move to social participation, and finally to elder mistreatment. Among dyads, we find that whereas sexual activity drops sharply with age for both women and men, gender differences in partner loss as well as psychosocial and normative pressures constrain women's sex more than men's. However, surviving partnerships tend to be emotionally and physically satisfying and are marked by relatively frequent sex. In contrast to sex, nonsexual intimacy is highly prevalent at older ages, especially among women. Older adults are also socially resilient--adapting to the loss of social ties by increasing involvement with community and kin networks. Despite these social assets, older adults remain vulnerable to mistreatment. Overall, these findings yield a mixed picture of gender-differentiated vulnerabilities balanced by proactive adaptation and maintenance of social and dyadic assets.

A lumped parameter model of left ventricular filling-pressure waveforms

Assessment of left-ventricular function and quantification of valve stenosis are important in clinical practice as well as in physiological research. This paper describes a mathematical model of diastolic ventricular filling and flow across the mitral valve. The model primarily consists of a system of three first-order, non-linear ordinary differential equations. The equations are solved in MATLAB using the ode45 command. The model generates pressure versus time waveforms for the atrium and ventricle, and flow versus time waveforms for mitral valve flow. Comparisons between model outputs and in-vivo data collected in two porcine experiments show excellent agreement.

How is household vulnerability gendered? Female-headed households in the collectives of Suleimaniyah, Iraqi Kurdistan

This research tries to reach an understanding of the well-being of female-headed household members through a comparison to male-headed household members in the collectives of the Suleimaniyah governorate in Iraqi Kurdistan. Research was undertaken in five collectives in Suleimaniyah during the summer of 1998. The research contributes to the current gender and development debates which are concerned with improving the understanding of the specific gendered forms of disadvantage faced by female-headed households rather than assuming the universal poverty of this group. An understanding of well-being is approached through a broad conceptualisation of vulnerability in preference to a narrow poverty definition. That the findings of this research are complex attests to the multi-dimensional and mutually constitutive gendered experiences of vulnerability. The definitive conclusion to emerge from this research is a refuting of the rhetoric-fuelled stereotype that households headed by women are at a disadvantage in all the dimensions of vulnerability in comparison to households headed by men. The research also establishes the methodological necessity of examining intra-household distributive mechanisms that determine individuals' well-being.

Long-term benzodiazepine use by elderly people living in the community

OBJECTIVE

To investigate the prevalence of long-term benzodiazepine use in an elderly community sample, and factors associated with such use.

METHOD

Data came from the Sydney Older Persons Study, a longitudinal study of people aged 75 or over. There were 337 subjects who were interviewed in 1991-93, and subsequently followed up after three and 4.5 years. At the first interview, subjects were assessed for socio-demographic characteristics, physical and mental health, and use of health services. At the first and subsequent interviews, subjects were asked about use of medications, including benzodiazepines.

RESULTS

There were 16.6% who were using benzodiazepines at the time of all three interviews, while a further 19.6% were using them at one or two interviews. In a multivariate ordered logit regression model, long-term benzodiazepine use was associated with treatment for nervous conditions, restless sleep, being female, being divorced and greater contact with medical services.

CONCLUSIONS

The prevalence of benzodiazepine use in the elderly is high and much of this use is long term. The high prevalence of benzodiazepine use stands in contrast to the findings from national surveys that the elderly living in the community tend to have better mental health than younger age groups.

IMPLICATIONS

Efforts are needed to reduce the number of elderly people becoming long-term users. The use of benzodiazepines in this age group is of particular concern, because they may be a risk factor for falls and for cognitive impairment in the elderly.