Subjective Functional Difficulties Were Associated With Subjective Cognitive Decline Among U.S. Older Adults: Mentally Unhealthy Days Mediation and Income Level Moderation Effects

Introduction

Subjective cognitive decline (SCD) is a self-perceived decline in cognition that may progress to mild cognitive impairment or Alzheimer's disease. SCD may be associated with difficulties in daily functioning and psychological distress. Previous research has shown the association between functional difficulties and SCD via mentally unhealthy days (MUDs). However, whether income levels influence the mediation effect of MUDs is less understood.

Objectives

This study examined the association between subjective functional difficulties and the odds of SCD through MUDs, and whether the mediation effect was moderated by income levels.

Methods

Cross-sectional data were obtained from the 2019 Behavioral Risk Factor Surveillance System (N = 13,160 older adults aged 65+; 7,370 women). SCD was assessed by more frequent or worse memory loss and confusion in the past 12 months. Subjective functional difficulties represented difficulties with daily activities. MUDs denoted the days that a person felt mentally unwell within the past 30 days. We used path analysis with 5,000 bootstrapped confidence intervals and logistic regression to classify the risks of SCD based on subjective functional difficulties and MUDs.

Results

Subjective functional difficulties were positively associated with SCD through mediation by MUDs (b = 0.119, 95% CI 0.102, 0.137). After accounting for covariates, we found that greater subjective functional difficulties were associated with 2.50 times the odds of SCD (AOR = 2.50; 95% CI: 2.14, 2.91); MUDs were related to 1.06 times the odds of SCD reporting (AOR = 1.06; 95% CI: 1.05, 1.07). Income levels moderated the indirect effect of MUDs in the subjective functional difficulties-SCD relationship, with an income of <$15,000 showing the most prominent effect. Those earning ≥$50,000 self-reported a lower SCD than those earning <$15,000.

Conclusions

Our study extends previous findings by demonstrating that greater subjective functional difficulties are associated with higher odds of SCD through more frequent MUDs, with higher income levels being associated with more SCD reporting.

Subjective Aging Difficulties among Older Adults with Subjective Cognitive Decline

In older adults, subjective cognitive decline (SCD) may progress to an early stage of dementia. Yet, its association with subjective daily functional difficulties in aging is less well studied by experiences of mentally unhealthy days (MUDs). Employing a cross-sectional design approach, we analyzed the Behavioral Risk Factor Surveillance System dataset on 7429 older adults with SCD (aged 65 to >80, 45% males, 55% females) to explore SCD in instrumental daily activities of living (SCD-IADLs) and healthcare access mediation by MUDs and moderated mediation by age cohort, controlling gender and education. The bias-corrected percentile bootstrap with 5000 samplings revealed that MUDs partially mediate the relationship between SCD-IADLs and healthcare access, with a 28.2% mediating effect. Age cohort moderated the relationship between healthcare access and MUDs, MUDs and SCD-IADLs. Specifically, the predictive effects from healthcare access to MUDs and MUDs to SCD-IADLs were more profound in the 70-74 age cohort.

Subjective Functional Difficulties and Subjective Cognitive Decline in Older-Age Adults: Moderation by Age Cohorts and Mediation by Mentally Unhealthy Days

Background and Objectives: Despite the expected positive association between subjective functional difficulties (SFD) and subjective cognitive decline (SCD), their mediation by mentally unhealthy days (MUDs) is under-studied. Moreover, few SCD studies have examined affective reactivity to functional difficulties by age cohort. This study examined the mediation effect of MUDs on the association between SFD and SCD by age cohorts' moderation among older adults. Methods: Using a cross-sectional design approach, we used the 2019 BRFSS dataset on 13,377 older adults aged 65 to ≥80 (44% males and 56% females). Results: The bias-corrected percentile bootstrap with 5000 samplings revealed that MUDs partially mediate the relationship between SFD and SCD (14.12% mediation effect), controlling depressive symptoms, education, income levels, and race. Age cohorts moderated the relationship between SFD and SCD and between SFD and SCD but not between MUDs and SCD. The predictive effects of the path from SFD to MUDs and from MUDs to SCD were stronger in the younger-old (65-69) than the middle-old (70-79) and oldest-old (≥80) age cohorts. Worse SCD was associated with being Asian, in female older adults, and in those with lower education and income levels. Conclusions: These findings extend the chronic stress theory predictions that accentuated emotional vulnerability to subjective functional difficulties may magnify SCD, particularly in the younger-old age group. By implication, preventive SCD interventions should seek to support younger-old adults in their activities of daily life for successful aging transitioning into older-age cohorts.

Health Disparities in Cognitive Impairment and Dementia: Role of Social Strain, Depression, and C-Reactive Protein

We investigated the association of social strain from friends, depression, and systemic inflammation (C-Reactive Protein [CRP]) with cognitive impairment without dementia (CIND) and dementia among 9,262 participants (age ≥ 65). We analyzed data from the Health Retirement Study (HRS), performing Chi-squared and logistic regression analyses. Measures included the 27-point HRS cognition scale, social strain scale, Center for Epidemiological Studies Depression scale, and dried-blood CRP levels. Black and Hispanic participants had a significantly increased dementia risk (OR = 2.69 and OR = 2.54). Black participants also had a high risk of CIND (OR = 2.80), but no association of Hispanic participants with CIND. Increased social strain from friends and depression were significantly associated with CIND (OR = 1.50 and OR = 1.44) and dementia (OR = 1.57 and OR = 1.78). Elevated CRP levels were only linked to CIND risk (OR = 1.03), not dementia. Early detection and interventions targeting social strain, depression, and CRP levels may help promote cognitive functioning in older adults.

VALIDITY AND RELIABILITY OF THE ROWLAND UNIVERSAL DEMENTIA ASSESSMENT SCALE: IMPLICATIONS OF AN INDONESIAN STUDY

Standardized dementia screening self-report assessments from developing countries are increasingly adopted in developing countries. Yet the cross-cultural transportability of dementia screening tools cannot be assumed. The Southeast Asia region has one of the fast-growing geriatric populations but no locally developed or validated measures of cognitive decline among older adults. This study aimed to determine the validity and reliability of scores from the Rowland Universal Dementia Assessment Scale (RUDAS) for use in the multiethnic older adult population in Indonesia. Participants were 135 Indonesian older adults (females = 61.5%, males = 38.5%; age range = 60-82) who were patients of a geriatric nursing centre. They completed the Indonesian translation of the Rowland Universal Dementia Assessment Scale (RUDAS-Ina). Exploratory factor analysis and confirmatory factor analysis of the scores yielded two factors explaining a total of 55.13% (the first factor explained 38.18%; the second factor explained 16.96%) of the variance for the entire set of variables. The reliability of scores from the RUDAS-Ina was marginally satisfactory (Cronbach α = .61), suggesting a need for locally developed measures for use with the Indonesian geriatric population. Future studies should consider the feasibility of developing and calibrating an adapted RUDAS to the Indonesian setting, which also may be studied in other Southeast Asian countries.

Quality of Life of People with Cardiovascular Disease: A Descriptive Study

In Indonesia, cardiovascular disease (CVD) ranks ninth among 22 types of diseases that result in death. Patients with history of CVD may experience various physical and emotional symptoms such as fatigue, edema, and sleeping difficulties that limit their physical and social activities which will in turn result in poor quality of life. Hospitalization and mortality has been associated with poor quality of life therefore people with history of CVD should be assessed appropriately to determine its impact on patients’ daily lives. This study aimed to examine the quality of life in older people with history of heart diseases. This study was conducted in an outpatient department of a private hospital in Tangerang, Banten Province, Indonesia. This quantitative, descriptive study involved 397 older patients. Data were collected via purposive sampling. Older patients with a history of CVD (cardiovascular diseases), aged 60–74 years, who could communicate and understand the Indonesian language and were not in a state that hindered completing a questionnaire were included in the study. Quality of life was measured using the WHOQOL-BREF questionnaire, which comprises four domains: physical health, psychological aspects, social relationships, and environment. Data were analyzed using a descriptive analysis. The results showed that 94% of respondents with a history of CVD had a good quality of life, with 85% having an adequate environmental aspect, 60.7% having active social relationships, 54.7% having good physical health, and 44.8% having a stable psychological condition. Despite having a history of CVD, most respondents in this study reported a good quality of life. However, the measurement tool used in this study measured quality of life in general. Future research should consider using a tool that is specific for measuring the quality of life of people with cardiac diseases.