@article {11680, title = {Cognitive Performance Trajectories Before and After Sleep Treatment Initiation in Middle-Aged and Older Adults: Results from the Health and Retirement Study.}, journal = {The Journals of Gerontology: Series A }, volume = {77}, year = {2022}, pages = {570-578}, abstract = {

BACKGROUND: Sleep disturbances are associated with risk of cognitive decline but it is not clear if treating disturbed sleep mitigates decline. We examined differences in cognitive trajectories before and after sleep treatment initiation.

METHODS: Data came from the 2006-2014 Health and Retirement Study. At each of five waves, participants were administered cognitive assessments and scores were summed. Participants also reported if, in prior two weeks, they had taken medications or used other treatments to improve sleep. Our sample (N=3,957) included individuals who at HRS 2006 were >50 years, had no cognitive impairment, reported no sleep treatment, and indicated experiencing sleep disturbance. We identified differences between those receiving vs. not receiving treatment in subsequent waves, and among those treated (N=1,247), compared cognitive trajectories before and after treatment.

RESULTS: At baseline, those reporting sleep treatment at subsequent waves were more likely to be younger, female, Caucasian, to have more health conditions, to have higher BMI, and more depressive symptoms (all p{\textquoteright}s<=0.015). Decline in cognitive performance was mitigated in periods after sleep treatment vs. periods before (B=-0.20, 95\% CI=-0.25, -0.15, p<0.001; vs., B=-0.26, 95\% CI=-0.32, -0.20, p<0.001), and this same trend was seen for self-initiated and doctor-recommended treatments. Trends were driven by those with higher baseline cognitive performance-those with lower performance saw cognitive declines following sleep treatment.

CONCLUSIONS: In middle-aged and older adults with sleep disturbance, starting sleep treatment may slow cognitive decline. Future research should assess types, combinations, and timing of treatments most effective in improving cognitive health in later life.

}, keywords = {Cognitive decline, Sleep, sleep treatment}, issn = {1758-535X}, doi = {10.1093/gerona/glab164}, author = {Christopher N Kaufmann and Bondi, Mark W and Thompson, Wesley K and Adam P Spira and Ancoli-Israel, Sonia and Anil K. Malhotra} } @article {11606, title = {Insomnia Symptoms and Subsequent Cognitive Performance in Older Adults: Are Depressive Symptoms and Vascular Disease Mediators?}, journal = {Sleep}, volume = {44}, year = {2021}, pages = {A212 - A212}, abstract = {Alzheimer{\textquoteright}s disease and related dementias (ADRD) are growing public health concerns, and poor sleep may represent a modifiable risk factor. However, there is limited research on insomnia as a predictor of subsequent performance in different cognitive domains and mechanisms that might underlie domain-specific associations. The current study examined: (1) which insomnia symptoms predicted performance across five cognitive domains 14 years later, and (2) whether depressive symptoms and/or vascular diseases mediated these associations.Participants included 2,496 adults aged 51+ in the Health and Retirement Study. Insomnia symptoms in 2002 (i.e., {\textquotedblleft}baseline{\textquotedblright}) were quantified by four self-reported items on frequency of trouble falling asleep, nighttime awakenings, early awakenings, and feeling rested upon awakening. Cognition was assessed in 2016 as part of the Harmonized Cognitive Assessment Protocol and operationalized with five factor scores corresponding to episodic memory, executive function, language, visuoconstruction, and processing speed. Multiple regressions examined associations between baseline insomnia symptoms and subsequent cognitive performance, controlling for sociodemographics and baseline global cognitive performance. Mediation models tested whether associations were explained by self-reported depressive symptoms and/or vascular diseases (i.e., hypertension, heart disease, diabetes, and/or stroke) in 2014, controlling for baseline values.Only trouble falling asleep in 2002 was associated with cognition in 2016. Specifically, more frequent trouble falling asleep predicted poorer episodic memory, executive function, language and processing speed performance, but not visuoconstruction. These associations were mediated by depressive symptoms and vascular diseases in 2014 for all domains except episodic memory; only depressive symptoms mediated the association involving memory. After accounting for these mediators, direct effects of trouble falling asleep remained for episodic memory, executive function and language, but not processing speed.Difficulty with sleep initiation may be more consequential for later-life cognition than other insomnia symptoms. Depressive symptoms and vascular diseases may partially drive these associations. We speculate that sleep-onset insomnia could mean less total sleep, immune dysfunction, or endocrine effects that worsen mood, vascular health, and cognition. Remaining associations indicate that additional research is needed to characterize other mechanisms through which sleep initiation problems could contribute to later impairments in frontal and temporal cognitive systems, which are implicated early in ADRD.Support (if any):}, keywords = {Cognition, Depressive symptoms, insomnia, vascular disease}, isbn = {0161-8105}, doi = {10.1093/sleep/zsab072.535}, author = {Afsara B. Zaheed and Adam P Spira and Ronald D Chervin and Laura B Zahodne} } @article {8957, title = {Insomnia as a predictor of job exit among middle-aged and older adults: results from the Health and Retirement Study.}, journal = {Journal of Epidemiology and Community Health}, volume = {71}, year = {2017}, pages = {750-757}, abstract = {

OBJECTIVES: Poor health is a recognised predictor of workforce exit, but little is known about the role of insomnia in workforce exit. We examined the association between insomnia symptoms and subsequent job exit among middle-aged and older adults from the Health and Retirement Study (HRS).

METHODS: The study sample consisted of 5746 respondents aged between 50 and 70 who were working for pay when interviewed in the HRS 2004 and were followed up in the HRS 2006. Multinomial logistic regression was used to determine the association between number of insomnia symptoms (0, 1-2, 3-4) and job exit (no exit, health-related exit or exit due to other reasons).

RESULTS: In models adjusting for demographic characteristics, baseline health status and baseline job characteristics, compared with respondents with no insomnia symptoms, those with 3-4 insomnia symptoms had approximately twice the odds of leaving the workforce due to poor health (adjusted relative risk ratio=1.93, 95\% CI 1.04 to 3.58, p=0.036). There was no association between insomnia and job exit due to non-health reasons.

CONCLUSIONS: An elevated number of insomnia symptoms is independently associated with leaving paid employment. Workplace screening for and treatment of insomnia symptoms may prolong labour force participation of middle-aged and older adults.

}, keywords = {Employment and Labor Force, Older Adults, Sleep}, issn = {1470-2738}, doi = {10.1136/jech-2016-208630}, author = {Dong, Liming and Agnew, Jacqueline and Ramin Mojtabai and Pamela J Surkan and Adam P Spira} } @article {6521, title = {Racial/Ethnic Differences in Insomnia Trajectories Among U.S. Older Adults}, journal = {The American Journal of Geriatric Psychiatry}, volume = {24}, year = {2016}, pages = {575-584}, chapter = {575}, abstract = {Objectives Insomnia is reported to be more prevalent in minority racial/ethnic groups. Little is known, however, about racial/ethnic differences in changes in insomnia severity over time, particularly among older adults. We examined racial/ethnic differences in trajectories of insomnia severity among middle-aged and older adults. Design Data were drawn from five waves of the Health and Retirement Study (2002 2010), a nationally representative longitudinal biennial survey of adults aged andgt; 50 years. Setting Population-based. Participants 22,252 participants from non-Hispanic white, non-Hispanic black, Hispanic, and other racial/ethnic groups. Measurements Participants reported the severity of four insomnia symptoms; summed scores ranged from 4 (no insomnia) to 12 (severe insomnia). We assessed change in insomnia across the five waves as a function of race/ethnicity. Results Across all participants, insomnia severity scores increased 0.19 points (95 CI: 0.14 0.24; t = 7.52; design df = 56; p andlt; 0.001) over time after adjustment for sex, race/ethnicity, education, and baseline age. After adjusting for the number of accumulated health conditions and body mass index, this trend decreased substantially and even changed direction (B = 0.24; 95 CI: 0.29 to 0.19; t = 9.22; design df = 56; p andlt; 0.001). The increasing trajectory was significantly more pronounced in Hispanics compared with non-Hispanic whites, even after adjustment for number of accumulated health conditions, body mass index, and number of depressive symptoms. Conclusions Although insomnia severity increases with age largely due to the accumulation of health conditions this trend appears more pronounced among Hispanic older adults than in non-Hispanic whites. Further research is needed to determine the reasons for a different insomnia trajectory among Hispanics.}, keywords = {Health Conditions and Status, Other}, doi = {10.1016/j.jagp.2016.02.049}, url = {http://www.sciencedirect.com/science/article/pii/S1064748116002153}, author = {Christopher N Kaufmann and Ramin Mojtabai and Hock, Rebecca S. and Roland J. Thorpe Jr. and Sarah L. Canham and Chen, Lian-Yu and Alexandra M. V. Wennberg and Lenis P. Chen-Edinboro and Adam P Spira} } @article {8292, title = {Binge drinking and insomnia in middle-aged and older adults: the Health and Retirement Study}, journal = {International Journal of Geriatric Psychiatry}, volume = {30}, year = {2015}, note = {Canham, Sarah L Kaufmann, Christopher N Mauro, Pia M Mojtabai, Ramin Spira, Adam P eng F31 AG044052/AG/NIA NIH HHS/ K01 AG033195/AG/NIA NIH HHS/ T32 DA007292/DA/NIDA NIH HHS/ England 2014/05/07 06:00 Int J Geriatr Psychiatry. 2015 Mar;30(3):284-91. doi: 10.1002/gps.4139. Epub 2014 May 5.}, pages = {284-91}, publisher = {30}, abstract = {Objective Alcohol use in later life has been linked to poor sleep. However, the association between binge drinking, which is common among middle-aged and older adults, and insomnia has not been previously assessed. Methods: We studied participants aged 50 years and older (n = 6027) from the 2004 Health and Retirement Study who reported the number of days they had 4 drinks on one occasion in the prior 3 months. Participants also reported the frequency of four insomnia symptoms. Logistic regression analyses assessed the association between binge drinking frequency and insomnia. Results Overall, 32.5 of participants had 0 to 2 binge drinking days/week; and 3.6 had 2 binge drinking days/week. After adjusting for demographic variables, medical conditions, body mass index, and elevated depressive symptoms, participants who binged 2 days/week had a 64 greater odds of insomnia than non-binge drinkers (adjusted odds ratio aOR = 1.64, 95 confidence interval CI = 1.09 2.47, p = 0.017). Participants reporting 0 to 2 binge days/week also had a 35 greater odds of insomnia than non-binge drinkers (aOR = 1.35, 95 CI = 1.15 1.59, p = 0.001). When smoking was added to the regression model, these associations fell just below the level of significance. Conclusions: Results suggest that binge drinking is associated with a greater risk of insomnia among adults aged 50 years and older, although this relationship may be driven in part by current smoking behavior. The relatively high prevalence of both binge drinking and sleep complaints among middle-aged and older populations warrants further investigation into binge drinking as a potential cause of late-life insomnia.}, keywords = {Health Conditions and Status}, doi = {10.1002/gps.4139}, url = {http://dx.doi.org/10.1002/gps.4139}, author = {Sarah L. Canham and Christopher N Kaufmann and Pia M Mauro and Ramin Mojtabai and Adam P Spira} } @article {6478, title = {Depression and anxiety symptoms in male veterans and non-veterans: The Health and Retirement Study}, journal = {International Journal of Geriatric Psychiatry}, volume = {30}, year = {2015}, note = {Export Date: 20 January 2015 Article in Press}, pages = {623-630}, chapter = {623}, abstract = {Objectives: We examined whether veteran status was associated with elevated depression and anxiety symptoms in men aged 50 and older after adjusting for sociodemographic factors. Methods: Participants were 6577 men aged 50years and older who completed the 2006 wave of the Health and Retirement Study (HRS). Forty-nine percent of participants were veterans. A randomly selected subset of participants completed the HRS Psychosocial Questionnaire (N=2957), which contained the anxiety items. Elevated depression and anxiety symptoms were determined based on brief versions of Center for Epidemiologic Studies-Depression Scale (CES-D total score 4) and Beck Anxiety Inventory (BAI total score 12). Results: Elevated depression and anxiety symptoms were found in 11.0 and 9.9 of veterans, respectively, compared with 12.8 and 12.3 of non-veterans. Veteran status was not associated with increased odds of anxiety or depression symptoms in the multivariable-adjusted logistic regression analyses. Additional analyses indicated that Vietnam War veterans were more than twice as likely as World War II or Korean War veterans to have elevated depression symptoms (OR=2.15, 95 CI: 1.54-3.00) or anxiety symptoms (OR=2.12, 95 CI: 1.28-3.51). Conclusions: In a community-based sample of men aged 50 and older, veteran status was not associated with the presence of elevated depression and anxiety symptoms. Rather, these symptoms were associated with age, ethnicity, education, and medical conditions. Among veterans, cohort effects accounted for differences in psychiatric symptoms. Including younger cohorts from the Global War on Terror may yield different results in future studies.}, keywords = {Demographics, Health Conditions and Status}, url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-84906295551andpartnerID=40andmd5=4ec6b4f1c99e0f3fd36effe28a7f26c2}, author = {Christine E Gould and Rideaux, T. and Adam P Spira and Sherry A. Beaudreau} } @article {6467, title = {Neighborhood physical disorder, social cohesion, and insomnia: results from participants over age 50 in the Health and Retirement Study}, journal = {International Psychogeriatrics}, volume = {27}, year = {2015}, note = {Export Date: 20 January 2015 Article in Press}, pages = {289-296}, chapter = {289}, abstract = {Background:: We determined the association between neighborhood socio-environmental factors and insomnia symptoms in a nationally representative sample of US adults aged 50 years. Methods:: Data were analyzed from two waves (2006 and 2010) of the Health and Retirement Study using 7,231 community-dwelling participants (3,054 men and 4,177 women) in the United States. Primary predictors were neighborhood physical disorder (e.g. vandalism/graffiti, feeling safe alone after dark, and cleanliness) and social cohesion (e.g. friendliness of people, availability of help when needed, etc.); outcomes were insomnia symptoms (trouble falling asleep, night awakenings, waking too early, and feeling unrested). Results:: After adjustment for age, income, race, education, sex, chronic diseases, body mass index, depressive symptoms, smoking, and alcohol consumption, each one-unit increase in neighborhood physical disorder was associated with a greater odds of trouble falling asleep (odds ratio (OR) = 1.09, 95 confidence interval (CI): 1.04 1.14), waking too early (OR = 1.05, 95 CI: 1.00 1.10), and, in adults aged 69 years (adjusting for all variables above except age), feeling unrested in the morning (OR = 1.11, 95 CI: 1.02 1.22 in 2006). Each one-unit increase in lower social cohesion was associated with a greater odds of trouble falling asleep (OR = 1.06, 95 CI: 1.01 1.11) and feeling unrested (OR = 1.09, 95 CI: 1.04 1.15). Conclusions:: Neighborhood-level factors of physical disorder and social cohesion are associated with insomnia symptoms in middle-aged and older adults. Neighborhood-level factors may affect sleep, and consequently health, in our aging population.}, keywords = {Consumption and Savings, Demographics, Health Conditions and Status}, url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-84911902104andpartnerID=40andmd5=b1c8afcbfd51895bd32bf5836deba987}, author = {Lenis P. Chen-Edinboro and Christopher N Kaufmann and Augustinavicius, J. L. and Ramin Mojtabai and Parisi, J. M. and Alexandra M. V. Wennberg and Smith, M. T. and Adam P Spira} } @article {8239, title = {Substance-use coping and self-rated health among US middle-aged and older adults.}, journal = {Addict Behav}, volume = {42}, year = {2015}, note = {Export Date: 20 January 2015}, month = {2015 Mar}, pages = {96-100}, publisher = {42}, abstract = {

The prevalence of alcohol, drug, and tobacco use among US middle-aged and older adults is increasing. A subset of this population uses substances to cope with stress, but the characteristics of these individuals, and the association between substance-use coping and health outcomes remain unclear. We identified correlates of substance-use coping and measured its association with self-rated health in a community-based sample of adults aged 54-99 in the Health and Retirement Study (HRS). In the 2008 HRS, 1351 participants reported their frequency of prescription/other drug-, alcohol-, and cigarette-use coping with stress and reported self-rated health (excellent/very good, good, or fair/poor); 1201 of these participants also reported self-rated health in 2010. One in six participants frequently used substances to cope. The oldest participants were least likely to engage in frequent alcohol-use coping. Those with elevated depressive symptoms were more likely to frequently engage in cigarette- and prescription/other drug-use coping. In multivariable-adjusted analyses, participants who frequently used cigarettes (compared to participants who infrequently used cigarettes) to cope had 2.7 times (95\% CI=1.1-6.7) the odds of poor (vs. excellent) self-rated health. Relative to participants who infrequently used prescription/other drugs to cope, participants who frequently used prescription/other drugs to cope had 2.4 times (95\% CI=1.1-5.1) the odds of reporting poor self-rated health. The association between prescription/other drug-use coping in 2008 and self-rated health in 2010 was statistically significant (relative OR=3.5, 95\% CI=1.7-7.2). Participants engaging in substance-use coping likely have particular demographic and clinical characteristics. Interventions to reduce substance-use coping may prevent adverse health outcomes.

}, keywords = {Adaptation, Psychological, Aged, Aged, 80 and over, Alcohol Drinking, depression, Female, Health Status, Humans, Male, Middle Aged, Smoking, Substance-Related Disorders, United States}, issn = {1873-6327}, doi = {10.1016/j.addbeh.2014.10.031}, author = {Pia M Mauro and Sarah L. Canham and Silvia S Martins and Adam P Spira} } @article {7882, title = {Insomnia and Health Services Utilization in Middle-Aged and Older Adults: Results From the Health and Retirement Study}, journal = {The Journals of Gerontology Series A: Biological Sciences and Medical Sciences}, year = {2013}, abstract = {Background. Complaints of poor sleep are common among older adults. We investigated the prospective association between insomnia symptoms and hospitalization, use of home health care services, use of nursing homes, and use of any of these services in a population-based study of middle-aged and older adults.Methods. We studied 14,355 adults aged 55 and older enrolled in the 2006 and 2008 waves of the Health and Retirement Study. Logistic regression was used to study the association between insomnia symptoms (0, 1, or 2) in 2006 and reports of health service utilization in 2008, after adjustment for demographic and clinical characteristics.Results. Compared with respondents reporting no insomnia symptoms, those reporting one symptom had a greater odds of hospitalization (adjusted odds ratio AOR = 1.28, 95 confidence interval CI = 1.15 1.43, p .001), use of home health care services (AOR = 1.29, 95 CI = 1.09 1.52, p = .004), and any health service use (AOR = 1.28, 95 CI = 1.15 1.41, p .001). Those reporting greater than or equal to two insomnia symptoms had a greater odds of hospitalization (AOR = 1.71, 95 CI = 1.50 1.96, p .001), use of home health care services (AOR = 1.64, 95 CI = 1.32 2.04, p .001), nursing home use (AOR = 1.45, 95 CI = 1.10 1.90, p = .009), and any health service use (AOR = 1.72, 95 CI = 1.51 1.95, p .001) after controlling for demographics. These associations weakened, and in some cases were no longer statistically significant, after adjustment for clinical covariates.Conclusions. In this study, insomnia symptoms experienced by middle-aged and older adults were associated with greater future use of costly health services. Our findings raise the question of whether treating or preventing insomnia in older adults may reduce use of and spending on health services among this population.}, keywords = {Health Conditions and Status, Healthcare, Public Policy}, doi = {10.1093/gerona/glt050}, url = {http://biomedgerontology.oxfordjournals.org/content/early/2013/05/09/gerona.glt050.abstract}, author = {Christopher N Kaufmann and Sarah L. Canham and Ramin Mojtabai and Amber M Gum and Dautovich, Natalie D. and Kohn, Robert and Adam P Spira} }