Cognitive health among older adults in the United States and in England.

TitleCognitive health among older adults in the United States and in England.
Publication TypeJournal Article
Year of Publication2009
AuthorsLanga, KM, Llewellyn, DJ, Lang, IA, Weir, DR, Wallace, RB, Kabeto, MU, Huppert, FA
JournalBMC Geriatr
Date Published2009 Jun 25
ISSN Number1471-2318
Call Numbernewpubs20090908_LangaBMC.pdf
KeywordsAged, Aged, 80 and over, Aging, Cognition, Cognition Disorders, Cohort Studies, Cross-Sectional Studies, England, Female, Health Status, Humans, Longitudinal Studies, Male, Neuropsychological tests, United States

BACKGROUND: Cognitive function is a key determinant of independence and quality of life among older adults. Compared to adults in England, US adults have a greater prevalence of cardiovascular risk factors and disease that may lead to poorer cognitive function. We compared cognitive performance of older adults in the US and England, and sought to identify sociodemographic and medical factors associated with differences in cognitive function between the two countries.

METHODS: Data were from the 2002 waves of the US Health and Retirement Study (HRS) (n = 8,299) and the English Longitudinal Study of Ageing (ELSA) (n = 5,276), nationally representative population-based studies designed to facilitate direct comparisons of health, wealth, and well-being. There were differences in the administration of the HRS and ELSA surveys, including use of both telephone and in-person administration of the HRS compared to only in-person administration of the ELSA, and a significantly higher response rate for the HRS (87% for the HRS vs. 67% for the ELSA). In each country, we assessed cognitive performance in non-hispanic whites aged 65 and over using the same tests of memory and orientation (0 to 24 point scale).

RESULTS: US adults scored significantly better than English adults on the 24-point cognitive scale (unadjusted mean: 12.8 vs. 11.4, P < .001; age- and sex-adjusted: 13.2 vs. 11.7, P < .001). The US cognitive advantage was apparent even though US adults had a significantly higher prevalence of cardiovascular risk factors and disease. In a series of OLS regression analyses that controlled for a range of sociodemographic and medical factors, higher levels of education and wealth, and lower levels of depressive symptoms, accounted for some of the US cognitive advantage. US adults were also more likely to be taking medications for hypertension, and hypertension treatment was associated with significantly better cognitive function in the US, but not in England (P = .014 for treatment x country interaction).

CONCLUSION: Despite methodological differences in the administration of the surveys in the two countries, US adults aged >/= 65 appeared to be cognitively healthier than English adults, even though they had a higher burden of cardiovascular risk factors and disease. Given the growing number of older adults worldwide, future cross-national studies aimed at identifying the medical and social factors that might prevent or delay cognitive decline in older adults would make important and valuable contributions to public health.


PMID: 19555494

User Guide Notes

Endnote Keywords

Cross Cultural Comparison/Cognitive Function/Hypertension/Medicine/ELSA_/cross-national comparison

Endnote ID


Alternate JournalBMC Geriatr
Citation Key7346
PubMed ID19555494
PubMed Central IDPMC2709651
Grant ListK08 AG019180 / AG / NIA NIH HHS / United States
R01 AG027010 / AG / NIA NIH HHS / United States
U01 AG009740 / AG / NIA NIH HHS / United States
U01 AG09740 / AG / NIA NIH HHS / United States