@article {13531, title = {Health care utilization and costs in the years preceding dementia identification.}, journal = {Alzheimer{\textquoteright}s \& Dementia: the journal of the Alzheimer{\textquoteright}s association}, year = {Forthcoming}, abstract = {

INTRODUCTION: There is evidence that health care utilization increases after incident dementia, particularly after dementia diagnosis and toward the end of life; however, less is known about utilization in the years before dementia identification.

METHODS: In this retrospective cohort study we obtained data on n~=~5547 beneficiaries from the Health and Retirement Study (HRS)-Medicare linked sample (n~=~1241 with and n~=~4306 without dementia) to compare longitudinal trends in health care costs and utilization in the 6 years preceding dementia identification relative to a confounder-balanced reference group without dementia.

RESULTS: We found that persons with dementia had a greater prevalence of outpatient emergency department (ED), inpatient hospital, skilled nursing, and home health use, and total health care costs in the years preceding dementia identification compared to their similar counterparts without dementia across a comparable timespan in later life.

CONCLUSIONS: This study provides evidence to suggest greater healthcare burden may exist well before clinical manifestation and identification of dementia.

HIGHLIGHTS: Several studies have documented the tremendous healthcare-related costs of living with dementia, particularly toward the end of life. Dementia is a progressive neurodegenerative disease, which, for some, includes a prolonged pre-clinical phase. However, health services research to date has seldom considered the time before incident dementia. This study documents that health care utilization and costs are significantly elevated in the years before incident dementia relative to a demographically-similar comparison group without dementia.

}, keywords = {Alzheimer{\textquoteright}s disease and related dementias, comorbidities, Epidemiology, Health Care Costs, Health care utilization, mild cognitive impairment}, issn = {1552-5279}, doi = {10.1002/alz.13476}, author = {Kumar, Raj G and Lund, Evan Bollens and Ornstein, Katherine A and Li, Jing and Covinsky, Kenneth E and Kelley, Amy S} } @article {12777, title = {Investigating biological pathways underpinning the longitudinal association between loneliness and cognitive impairment.}, journal = {The Journals of Gerontology, Series A }, year = {Forthcoming}, abstract = {

BACKGROUND: Loneliness precedes the onset of cognitive impairment (CI) in older adults. Although the mechanisms through which loneliness "gets under the skin" to influence the risk of developing CI has been conceptually proposed, they are rarely empirically examined. The Evolutionary Theory of Loneliness posits that loneliness as a stressor could cause dysregulations in multiple physiological systems. The current study investigated whether inflammatory, cardiovascular, and kidney biomarkers mediate the longitudinal association between loneliness and CI.

METHODS: Cross-lagged panel models (CLPM) were used to examine the hypothesized relationships, using 2006, 2010, and 2014 waves of data from the Health and Retirement Study (N=7,037). Loneliness was measured with the 3-item UCLA loneliness scale. CI was assessed with the modified telephone interview for cognitive status. Biomarkers included HbA1C, LDL cholesterol, HDL cholesterol, CRP, and Cystatin C. Using a stepwise model-building approach, first, the model included only loneliness, CI, and biomarker variables; then, sociodemographic covariates were added; lastly, health and behavioral covariates were controlled for.

RESULTS: In unadjusted and partially adjusted models, loneliness was associated with higher odds of worse cognitive status in an 8-year follow-up. Only HbA1C mediated the longitudinal association between loneliness and CI. However, after further controlling for health status, all associations became non-significant.

CONCLUSIONS: Examining a large number of participants and linking a limited number of biological markers with cognition and loneliness longitudinally, our empirical data did not support theoretical propositions, highlighting the critical importance of controlling for confounders in future studies examining longitudinal mediational relationships underlying loneliness and CI.

}, keywords = {Biomarkers, cognitive aging, Epidemiology, Loneliness, Psychosocial}, issn = {1758-535X}, doi = {10.1093/gerona/glac213}, author = {Yu, Kexin and Ng, Ted Kheng Siang} } @article {13557, title = {Loneliness and Depressive Symptoms Are High Among Older Adults With Digestive Disease and Associated With Lower Perceived Health.}, journal = {Clin Gastroenterol Hepatol}, year = {Forthcoming}, abstract = {

BACKGROUND \& AIMS: Current approaches to managing digestive disease in older adults fail to consider the psychosocial factors contributing to a person{\textquoteright}s health. We aimed to compare the frequency of loneliness, depression, and social isolation in older adults with and without a digestive disease and to quantify their association with poor health.

METHODS: We conducted an analysis of Health and Retirement Study data from 2008 to 2016, a nationally representative panel study of participants 50 years and older and their spouses. Bivariate analyses examined differences in loneliness, depression, and social isolation among patients with and without a digestive disease. We also examined the relationship between these factors and health.

RESULTS: We identified 3979 (56.0\%) respondents with and 3131 (44.0\%) without a digestive disease. Overall, 60.4\% and 55.6\% of respondents with and without a digestive disease reported loneliness (P < .001), 12.7\% and 7.5\% reported severe depression (P < .001), and 8.9\% and 8.7\% reported social isolation (P~= NS), respectively. After adjusting for covariates, those with a digestive disease were more likely to report poor or fair health than those without a digestive disease (odds ratio [OR], 1.25; 95\% CI, 1.11-1.41). Among patients with a digestive disease, loneliness (OR, 1.43; 95\% CI, 1.22-1.69) and moderate and severe depression (OR, 2.93; 95\% CI, 2.48-3.47; and OR, 8.96; 95\% CI, 6.91-11.63, respectively) were associated with greater odds of poor or fair health.

CONCLUSIONS: Older adults with a digestive disease were more likely than those without a digestive disease to endorse loneliness and moderate to severe depression and these conditions are associated with poor or fair health. Gastroenterologists should feel empowered to screen patients for depression and loneliness symptoms and establish care pathways for mental health treatment.

}, keywords = {Epidemiology, General Practice, Outcomes Research, Psychiatric Disorders}, issn = {1542-7714}, doi = {10.1016/j.cgh.2023.08.027}, author = {Cohen-Mekelburg, Shirley and Jordan, Ariel and Kenney, Brooke and Burgess, Helen J and Chang, Joy W and Hu, Hsou Mei and Tapper, Elliot and Kenneth M. Langa and Levine, Deborah A and Waljee, Akbar K} } @article {12605, title = {Prediction Model Development and Validation of 12-Year Incident Edentulism of Older Adults in the United States.}, journal = {JDR Clinical \& Translational Research}, year = {Forthcoming}, abstract = {

INTRODUCTION: Edentulism affects health and quality of life.

OBJECTIVES: Identify factors that predict older adults becoming edentulous over 12 y in the US Health and Retirement Study (HRS) by developing and validating a prediction model.

METHODS: The HRS includes data on a representative sample of US adults aged >50 y. Selection criteria included participants in 2006 and 2018 who answered, "Have you lost all of your upper and lower natural permanent teeth?" Persons who answered "no" in 2006 and "yes" in 2018 experienced incident edentulism. Excluding 2006 edentulous, the data set ( = 4,288) was split into selection (70\%, = 3,002) and test data (30\%, = 1,286), and Monte Carlo cross-validation was applied to 500 random partitions of the selection data into training ( = 1,716) and validation ( = 1,286) data sets. Fitted logistic models from the training data sets were applied to the validation data sets to obtain area under the curve (AUC) for 32 candidate models. Six variables were included in all models (age, race/ethnicity, gender, education, smoking, last dental visit) while all combinations of 5 variables (income, alcohol use, self-rated health, loneliness, cognitive status) were considered for inclusion. The best parsimonious model based on highest mean AUC was fitted to the selection data set to obtain a final prediction equation. It was applied to the test data to estimate AUC and 95\% confidence interval using 1,000 bootstrap samples.

RESULTS: From 2006 to 2018, 9.7\% of older adults became edentulous. The 2006 mean (SD) age was 66.7 (8.7) for newly edentulous and 66.3 (8.4) for dentate ( = 0.31). The baseline 6-variable model mean AUC was 0.740. The 7-variable model with cognition had AUC = 0.749 and test data AUC = 0.748 (95\% confidence interval, 0.715-0.781), modestly improving prediction. Negligible improvement was gained from adding more variables.

CONCLUSION: Cognition information improved the 12-y prediction of becoming edentulous beyond the modifiable risk factors of smoking and dental care use, as well as nonmodifiable demographic factors.

KNOWLEDGE TRANSFER STATEMENT: This prediction modeling and validation study identifies cognition as well as modifiable (dental care use, smoking) and nonmodifiable factors (race, ethnicity, gender, age, education) associated with incident complete tooth loss in the United States. This information is useful for the public, dental care providers, and health policy makers in improving approaches to preventive care, oral and general health, and quality of life for older adults.

}, keywords = {Epidemiology, Geriatrics, Incidence, Oral Health, Tooth Loss}, issn = {2380-0852}, doi = {10.1177/23800844221112062}, author = {Preisser, J S and Moss, K and Finlayson, T L and Jones, J A and Weintraub, J A} } @article {13605, title = {Prevalence and incidence of mild cognitive impairment in adults with diabetes in the United States.}, journal = {Diabetes research and clinical practice}, volume = {205}, year = {Forthcoming}, pages = {110976}, abstract = {

BACKGROUND: Limited evidence exists about the prevalence and incidence of mild cognitive impairment (MCI) in individuals with diabetes in the U.S. We aimed to address such knowledge gaps using a nationally representative study dataset.

METHOD: We conducted a secondary analysis from the Health and Retirement Study (HRS) (1996-2018). The sample for examining the prevalence of MCI was14,988, with 4192 (28.0\%) having diabetes, while the sample for the incidence was 21,824, with 1534 (28.0\%) having diabetes.

RESULTS: Participants with diabetes had a higher prevalence of MCI than those without diabetes (19.9~\% vs. 14.8~\%; odds ratio [95~\% confidence interval] (OR[95~\%CI]): 1.468 [1.337, 1.611], p~<.001). The incidence of MCI in participants with/without newly diagnosed diabetes was 42.9~\% vs. 31.6~\% after a mean 10-year follow-up, with the incidence rate ratio (IRR) [95~\%CI] (1.314 [1.213, 1.424], p~<.001). Newly diagnosed diabetes was associated with elevated risks of MCI compared with non-diabetes, with the uncontrolled hazard ratio (HR) [95~\%CI] (1.498 [1.405, 1.597], p~<.001).

CONCLUSIONS: Using a nationally representative study data in the U.S., participants with diabetes had a higher prevalence and incidence of MCI than those without diabetes. Findings show the importance of developing interventions tailored to the needs of individuals with diabetes and cognitive impairment.

}, keywords = {Clinical, cognition impairment, Complications of diabetes, Epidemiology, prevalence estimation, type 2 diabetes mellitus}, issn = {1872-8227}, doi = {10.1016/j.diabres.2023.110976}, author = {Zheng, Yaguang and Ma, Qianheng and Qi, Xiang and Zhu, Zheng and Wu, Bei} } @article {13643, title = {Spouses of individuals living with mild cognitive impairment or dementia in the United States: A descriptive, population-based study.}, journal = {Alzheimers \& dementia: the journal of the Alzheimer{\textquoteright}s Association}, year = {Forthcoming}, abstract = {

BACKGROUND: Little is known about the population of individuals who live with a spouse with cognitive impairment (CI) or dementia.

METHODS: Using the US Health and Retirement Study, 2000 to 2018, we estimated the population of adults >= 50 years old co-residing with a spouse with probable CI/dementia. We described their socio-demographic and health characteristics and quantified socio-demographic inequities.

RESULTS: Among community-dwelling adults >= 50 years old, 6\% of women and 4\% of men co-resided with a spouse with probable CI/dementia. Among those who were married/partnered, the prevalence of spousal dementia was greater for Black and Hispanic adults compared to their White counterparts, and for those with lower versus higher educational attainment. Among spouses, activities of daily living disability, depression, and past 2-year hospitalization was common.

DISCUSSION: Millions of older adults, disproportionately Black and Hispanic people and people with lower levels of educational attainment, live with a spouse with CI while also facing their own major health challenges.

}, keywords = {Dementia, Epidemiology, Family, health equity, mild cognitive impairment, Spouses}, issn = {1552-5279}, doi = {10.1002/alz.13555}, author = {Torres, Jacqueline M and Flores Romero, Karla Renata and Kotwal, Ashwin A and Chen, Ruijia and Hill-Jarrett, Tanisha and Mitchell, Uchechi A and Glymour, Medellena Maria} } @article {13736, title = {Trajectory of multimorbidity before dementia: A 24-year follow-up study.}, journal = {Alzheimers \& dementia (Amsterdam, Netherlands)}, volume = {16}, year = {2024}, pages = {e12523}, abstract = {

INTRODUCTION: Although the multimorbidity-dementia association has been widely addressed, little is known on the long-term trajectory of multimorbidity (TOM) in preclinical dementia.

METHODS: Based on the Health and Retirement Study, burden of multimorbidity was quantified with the total number of eight long-term conditions (LTC). Patterns of TOM before dementia diagnosis were investigated with mixed-effects models.

RESULTS: In 1752 dementia cases and 5256 matched controls, cases showed higher and faster increasing predicted number of LTC than controls, with a significant case-control difference from 20 years prior to dementia diagnosis. Larger increases in number of LTC during preclinical phase of dementia were found in White participants, females, those whose age at dementia onset was younger, and those who were less educated.

DISCUSSION: Our findings emphasize the faster accumulation of multimorbidity in prodromal dementia than in natural aging, as well as effect modifications by age and sex.

HIGHLIGHTS: TOM increased faster in prodromal dementia than in natural ageing.Patterns of TOM by dementia status diverged at 20 years before dementia diagnosis.Patterns of TOM were modified by age and sex.

}, keywords = {Dementia, Epidemiology, multimorbidity, trajectory}, issn = {2352-8729}, doi = {10.1002/dad2.12523}, author = {Guo, Jing and Gao, Bin and Huang, Yun and Song, Suhang} } @article {12379, title = {Assessing patterns and stability of ADL hierarchical scales for functional disability assessment.}, journal = {Gerontologist}, volume = {63}, year = {2023}, pages = {773-782}, abstract = {

BACKGROUND AND OBJECTIVES: This study examined the stability over time of activities of daily living (ADL) items in three comparable longitudinal datasets and evaluated ADL loss sequences for older adults in the U.S., South Korea, and Japan.

RESEARCH DESIGN AND METHODS: Data from the U.S. Health and Retirement Study, and its two international sister surveys, were analyzed. Subjects were community-dwelling adults aged 60 and above. For each dataset, Rasch analysis was implemented to determine if the ordering of items remained stable across multiple waves (2006-2014), such that a single ADL hierarchy may be derived from multi-wave data.

RESULTS: Data fitted the Rasch model well. Item calibrations were sufficiently stable across measurement periods in each dataset, reflecting a stable frame of reference. Results were also robust to sample variations. The derived ADL hierarchies based on scaled logit scores revealed that "dressing" and "bathing" were relatively more difficult items for older adults in all study populations.

DISCUSSION AND IMPLICATIONS: Scale stability is essential when exploiting longitudinal data to analyze patterns in ADL disabilities. The consistency in ADL scales across measurement periods supports their use as screening tools and identifying those at risk for transitions in care. Interventions to reduce dependency in bathing and dressing can help improve independent functioning for community-dwelling elderly.

}, keywords = {ADL index, Epidemiology, functional disability, Psychometrics, Rasch analysis}, issn = {1758-5341}, doi = {10.1093/geront/gnac057}, author = {Fong, Joelle H and Youn, Yongjoon} } @article {12387, title = {Associations between participation in community arts groups and aspects of~wellbeing in older adults in the United States: a propensity score matching analysis.}, journal = {Aging \& Mental Health}, volume = {27}, year = {2023}, pages = {1163-1172}, abstract = {

There is a social gradient in both arts engagement and wellbeing that may have led to an overestimation of the impact of arts engagement on wellbeing. We tested whether participation in community arts groups was associated with wellbeing after removing confounding by demographic, socioeconomic, and health-related factors. Using propensity score matching, we analyzed data from 12,055 older adults in the Health and Retirement Study. We measured community arts groups participation and concurrent life satisfaction (evaluative wellbeing), positive and negative affect (experienced wellbeing), and purpose in life, constraints on personal control, and mastery (eudaimonic wellbeing). After matching, arts group participation was associated with higher positive affect (average treatment effect on the treated [ATT] = 0.18, 95\% CI = 0.12-0.24), life satisfaction (ATT = 0.09, 95\% CI = 0.04-0.15), purpose in life (ATT = 0.07, 95\% CI = 0.02-0.13), and mastery (ATT = 0.07, 95\% CI = 0.01-0.14) than not participating. Participation was not associated with negative affect or constraints on personal control. In sensitivity analyses, these associations were maintained four years later. Arts group participation was associated with the positive elements of evaluative, experienced, and eudaimonic wellbeing. Facilitating participation in community arts groups could help to promote healthy aging, enabling a growing segment of the population to lead more fulfilling and satisfying lives.

}, keywords = {community groups, Cultural engagement, Epidemiology, Mental Health, music and arts, Quality of Life, Wellbeing}, issn = {1364-6915}, doi = {10.1080/13607863.2022.2068129}, author = {Bone, Jessica K and Fancourt, Daisy and Fluharty, Meg E and Paul, Elise and Sonke, Jill K and Bu, Feifei} } @article {12956, title = {Diabetes, Edentulism, and Cognitive Decline: A 12-Year Prospective Analysis.}, journal = {Journal of Dental Research}, volume = {102}, year = {2023}, pages = {879-886}, abstract = {

Diabetes mellitus (DM) is a recognized risk factor for dementia, and increasing evidence shows that tooth loss is associated with cognitive impairment and dementia. However, the effect of the co-occurrence of DM and edentulism on cognitive decline is understudied. This 12-y cohort study aimed to assess the effect of the co-occurrence of DM and edentulism on cognitive decline and examine whether the effect differs by age group. Data were drawn from the 2006 to 2018 Health and Retirement Study. The study sample included 5,440 older adults aged 65 to 74 y, 3,300 aged 75 to 84 y, and 1,208 aged 85 y or older. Linear mixed-effect regression was employed to model the rates of cognitive decline stratified by age cohorts. Compared with their counterparts with neither DM nor edentulism at baseline, older adults aged 65 to 74 y (β = -1.12; 95\% confidence interval [CI], -1.56 to -0.65; < 0.001) and those aged 75 to 84 y with both conditions (β = -1.35; 95\% CI, -2.09 to -0.61; < 0.001) had a worse cognitive function. For the rate of cognitive decline, compared to those with neither condition from the same age cohort, older adults aged 65 to 74 y with both conditions declined at a higher rate (β = -0.15; 95\% CI, -0.20 to -0.10; < 0.001). Having DM alone led to an accelerated cognitive decline in older adults aged 65 to 74 y (β = -0.09; 95\% CI, -0.13 to -0.05; < 0.001); having edentulism alone led to an accelerated decline in older adults aged 65 to 74 y (β = -0.13; 95\% CI, -0.17 to -0.08; < 0.001) and older adults aged 75 to 84 (β = -0.10; 95\% CI, -0.17 to -0.03; < 0.01). Our study finds the co-occurrence of DM and edentulism led to a worse cognitive function and a faster cognitive decline in older adults aged 65 to 74 y.

}, keywords = {dental health, Epidemiology, Gerontology, oral-systemic disease(s), Public Health}, issn = {1544-0591}, doi = {10.1177/00220345231155825}, author = {Wu, B and Luo, H and Tan, C and Qi, X and Sloan, F A and Kamer, A R and Schwartz, M D and Martinez, M and Plassman, B L} } @article {13038, title = {The Epidemiology of Smoking in Older Adults: A National Cohort Study.}, journal = {Journal of General Internal Medicine}, volume = {38}, year = {2023}, pages = {1697-1704}, abstract = {

BACKGROUND: Older smokers account for the greatest tobacco-related morbidity and mortality in the USA, while quitting smoking remains the single most effective preventive health intervention for reducing the risk of smoking-related illness. Yet, knowledge about patterns of smoking and smoking cessation in older adults is lacking.

OBJECTIVE: Assess trends in prevalence of cigarette smoking between 1998 and 2018 and identify patterns and predictors of smoking cessation in US older adults.

DESIGN: Retrospective cohort study PARTICIPANTS: Individuals aged 55+ enrolled in the nationally representative Health and Retirement Study, 1998-2018 MAIN MEASURES: Current smoking was assessed with the question: "Do you smoke cigarettes now?" Quitting smoking was defined as having at least two consecutive waves (between 2 and 4 years) in which participants who were current smokers in 1998 reported they were not currently smoking in subsequent waves.

KEY RESULTS: Age-adjusted smoking prevalence decreased from 15.9\% in 1998 (95\% confidence interval (CI) 15.2, 16.7) to 11.2\% in 2018 (95\% CI 10.4, 12.1). Among 2187 current smokers in 1998 (mean age 64, 56\% female), 56\% of those living to age 90 had a sustained period of smoking cessation. Smoking less than 10 cigarettes/day was strongly associated with an increased likelihood of quitting smoking (subdistribution hazard ratio 2.3; 95\% CI 1.9, 2.8), compared to those who smoked more than 20 cigarettes/day.

CONCLUSIONS: Smoking prevalence among older persons has declined and substantial numbers of older smokers succeed in quitting smoking for a sustained period. These findings highlight the need for continued aggressive efforts at tobacco cessation among older persons.

}, keywords = {Epidemiology, Geriatrics, Public Health, Smoking}, issn = {1525-1497}, doi = {10.1007/s11606-022-07980-w}, author = {Hunt, Lauren J and Covinsky, Kenneth E and Cenzer, Irena and Espejo, Edie and Boscardin, W John and Leutwyler, Heather and Lee, Alexandra K and Cataldo, Janine} } @article {13734, title = {Prevalence and Trends of Basic Activities of Daily Living Limitations in Middle-Aged and Older Adults in the United States.}, journal = {Epidemiologia (Basel, Switzerland)}, volume = {4}, year = {2023}, pages = {483-491}, abstract = {

BACKGROUND: Population-level surveillance of the prevalence and trends of basic self-care limitations will help to identify the magnitude of physical disablement in the rapidly growing older American demographic. We sought to evaluate the prevalence and trends of activities of daily living (ADL) limitations in the United States.

METHODS: The analytic sample included 30,418 Americans aged >=50 years from the 2006-2018 waves of the Health and Retirement Study. ADLs were self-reported. Weighted prevalence estimates were presented, and trends analyses were performed.

RESULTS: Although overall ADL disability prevalence was 16.5\% (95\% confidence interval: 15.8-17.2) in 2018, there were no changes in limitations during the study period ( = 0.52). Older adults had a greater ADL disability prevalence than middle-aged adults ( < 0.001). While older persons experienced a declining trend of ADL limitations ( < 0.001), middle-aged persons had an increasing trend ( < 0.001). Males had a lower ADL limitation prevalence than females ( < 0.001). Hispanic and non-Hispanic Black had a higher ADL disability prevalence than non-Hispanic White ( < 0.001).

CONCLUSIONS: This investigation revealed that while the estimated prevalence of ADL limitations in the United States was substantial, changes in such limitations were not observed. Our findings can help guide ADL screening, target sub-populations with an elevated ADL limitation prevalence, and inform interventions.

}, keywords = {Epidemiology, Geriatrics, Population Surveillance, self-care}, issn = {2673-3986}, doi = {10.3390/epidemiologia4040040}, author = {Heimbuch, Halli and Rhee, Yeong and Douglas, Marty and Juhl, Kirsten and Knoll, Kelly and Stastny, Sherri and McGrath, Ryan} } @article {PAVELA2022101200, title = {The associations between relative and absolute body mass index with mortality rate based on predictions from stigma theory}, journal = {SSM - Population Health}, volume = {19}, year = {2022}, pages = {101200}, abstract = {Background The social consequences of obesity may influence health and mortality rate (MR), given obesity{\textquoteright}s status as a highly stigmatized condition. Hence, a high absolute body mass index (BMI) in conjunction with the stigmatization of a high BMI may each independently increase the rate of MR. Objectives We tested whether relative BMI, defined as ordinal rank within a social reference group jointly defined by age, sex, and race/ethnicity, is associated with MR independent of absolute BMI. Methods Data were from three nationally representative datasets: the Health and Retirement Study (n = 31,115), the National Health Interview Survey (NHIS, n = 529,362), and the National Health and Nutrition Examination Survey (n = 31,115). Relative BMI kg/m2 deciles were calculated within twenty-four subgroups jointly defined by age (6 levels), sex (2 levels), and race/ethnicity (4 levels). The association between ordinal rank BMI and MR was assessed using Cox survival generalized additive models in each dataset with adjustments for age, race, sex, smoking, educational attainment, and absolute BMI. Results Absolute BMI had a significant non-monotonic association with MR, such that BMI was positively associated with mortality at BMI levels above approximately 25 kg/m2. Contrary to expectations, results from NHIS indicated that individuals in the first decile of relative BMI had the highest MR whereas relative BMI was not associated with MR in the NHANES and HRS. Conclusion We hypothesized that the stigmatization of obesity might lead to an increased MR after controlling for absolute BMI. Contrary to expectations, a higher relative BMI was not associated with an increased MR independent of absolute BMI.}, keywords = {BMI, Deviance, Epidemiology, Lifespan, Longevity, Mortality rate, Obesity, Relative weight, Stigma}, issn = {2352-8273}, doi = {https://doi.org/10.1016/j.ssmph.2022.101200}, author = {Gregory Pavela and Nengjun Yi and Luis Mestre and Stella Lartey and Pengcheng Xun and David B. Allison} } @article {12410, title = {A Matched Cohort Analysis for Examining the Association Between Slow Gait Speed and Shortened Longevity in Older Americans}, journal = {Journal of Applied Gerontology}, volume = {41}, year = {2022}, pages = {1905-1913}, abstract = {

This investigation examined the association between slow gait speed, as defined with newly established cut-points, and all-cause mortality in older Americans with a matched cohort analysis. The analytic sample included 10,259 Americans aged >=65 years from the 2006-2014 waves of the Health and Retirement Study. Walking speed was measured in participant residences. Slow gait speed cut-points of <0.60 and <0.75 m/s were used separately for classifying participants as having slow walking speed. Nearest-neighbor propensity score matching was used to match the slow to the not-slow cohorts separately using both cut-points using relevant covariates. Persons with gait speed <0.60 m/s had a 1.42 higher hazard for mortality (95\% CI: 1.28-1.57). Older Americans with gait speed <0.75 m/s had a 1.36 higher hazard for mortality (95\% CI: 1.23-1.50). Slow gait speed may represent failing health and addressing how slow gait speed could be improved may help with referrals to appropriate interventions.

}, keywords = {Aging, Epidemiology, Geriatric Assessment, Physical Functional Performance, walk test}, issn = {1552-4523}, doi = {10.1177/07334648221092399}, author = {McGrath, Brenda M and Johnson, Pamela Jo and McGrath, Ryan and Cawthon, Peggy M and Klawitter, Lukus and Choi, Bong-Jin} } @article {11729, title = {Multimorbidity and Social Participation Is Moderated by Purpose in Life and Life Satisfaction.}, journal = {Journal of Applied Gerontology}, volume = {41}, year = {2022}, pages = {560-570}, abstract = {

OBJECTIVES: We examined the association between multimorbidity and social participation and whether purpose in life and life satisfaction moderate this relationship.

METHODS: Participants were 12,825 Health and Retirement Study adults. We used multiple linear regression to examine the association between a cumulative-updated multimorbidity-weighted index (MWI) and social participation.

RESULTS: Among adults with average purpose in life or life satisfaction, MWI was associated with lower social participation. For those with above average purpose in life, each 1-point increase in MWI was associated with a 0.11-point (95\% confidence interval [CI]: [0.07, 0.14]) better social participation score. Participants with above average life satisfaction experienced a 0.04-point (95\% CI: [0.02, 0.07]) better social participation score with each 1-point increase in MWI.

DISCUSSION: Multimorbidity was associated with worse social participation, but this was reversed by above average purpose in life and life satisfaction. Interventions that improve well-being should be assessed to enhance social participation among older adults with any degree of multimorbidity.

}, keywords = {Epidemiology, health-related quality of life, Leisure, Successful aging}, issn = {1552-4523}, doi = {10.1177/07334648211027691}, author = {Jamie E Luster and Ratz, David and Melissa Y Wei} } @article {11755, title = {The role of frailty in the association between depression and fall risk among older adults}, journal = {Aging \& Mental Health}, volume = {26}, year = {2022}, pages = {1805-1812}, abstract = {Objectives Although there is a recognized association between depression and greater fall risk among older adults, the mechanisms explaining this association are unclear. This study evaluated the role of frailty, a common geriatric syndrome, in determining greater risk of falls among older adults with depression.Method We used longitudinal data from three biennial waves of the Health and Retirement Study (HRS; 2010?2014). The sample included community-dwelling survey respondents age >= 65 who participated in objective physiological measures. Major Depression (MD) was measured using Composite International Diagnostic Interview for depression short form. Frailty was measured using criteria outlined in the frailty phenotype model. Causal mediation analysis was used to differentiate the direct effect of depression and indirect effect mediated by frailty on falls, fall injuries, and multiple falls.Results Major depression was associated with significantly greater odds of experiencing a fall (OR: 1.91; 95\% CI: 1.31, 2.77), fall injury (OR: 1.86; 95\% CI: 1.17, 2.95), and multiple falls (OR: 2.26; 95\% CI: 1.52, 3.37) over a two-year period. Frailty was a significant mediator of the effects of depression on falls and multiple falls, accounting for approximately 18.9\% and 21.3\% of the total effects, respectively. We found no evidence of depression-frailty interaction. Sensitivity analyses showed that results were robust to unmeasured confounding and alternative operationalizations of depression.Conclusion Frailty explains a significant proportion of increased likelihood of falls among older adults with depression. Treatment and management of frailty symptoms may be an important components of fall prevention among older adults with depression.}, keywords = {Causal mediation analysis, Epidemiology, falls and mobility problems}, isbn = {1360-7863}, doi = {10.1080/13607863.2021.1950616}, author = {Matthew C. Lohman and Briana Mezuk and Amanda J Fairchild and Nicholas V Resciniti and Anwar T Merchant} } @article {12332, title = {Sense of purpose in life and inflammation in healthy older adults: A longitudinal study.}, journal = {Psychoneuroendocrinology}, volume = {141}, year = {2022}, pages = {105746}, abstract = {

BACKGROUND: A higher sense of purpose in life has been linked with reduced risk of age-related chronic health conditions that share elevated inflammation as a key risk factor (e.g., neurodegenerative diseases, heart disease, and diabetes). While prior research has documented cross-sectional associations between higher sense of purpose and lower inflammation, few studies have examined the association between purpose and changes in inflammation over time.

OBJECTIVE: We tested if a higher sense of purpose was prospectively associated with lower likelihood of developing unhealthy C-reactive protein levels in older adults who initially had healthy CRP levels (i.e., <3~ug/mL).

METHODS: Participants were 6925 adults aged >~50 in the Health and Retirement Study who were followed for 8 years. Participants completed the purpose in life subscale of the Ryff Psychological Well-being Scales at study baseline in 2006/2008. CRP was obtained from blood spots collected at baseline and after 4 and 8 years of follow-up. Pooled logistic regression estimated discrete-time hazard ratios (HR) and 95\% confidence intervals (CI) for the association between baseline purpose and onset of unhealthy CRP levels (>3~ug/mL).

RESULTS: There was no strong evidence of an association between baseline continuous purpose scores and onset of unhealthy CRP levels over time in the overall analytic sample. In sex-stratified models, higher purpose was associated with lower hazards of developing unhealthy CRP levels among men, while associations were null in women (e.g., in sociodemographics-adjusted model, men: HR=0.89, 95\% CI: 0.79-0.99; women: HR=0.96, 95\% CI: 0.85-1.08; interaction between continuous purpose scores and sex p~=~0.15).

CONCLUSIONS: Findings suggest that a higher versus lower sense of purpose is associated with lower inflammation levels in older men. In specific populations, purpose may serve as a novel target for future interventions aimed at reducing inflammation.

}, keywords = {C-reactive protein, Epidemiology, Health psychology, Inflammation, Purpose in life}, issn = {1873-3360}, doi = {10.1016/j.psyneuen.2022.105746}, author = {Guimond, Anne-Josee and Shiba, Koichiro and Kim, Eric S and Kubzansky, Laura D} } @article {11918, title = {Sex Differences in the Association between Metabolic Dysregulation and Cognitive Aging: The Health and Retirement Study.}, journal = {The Journals of Gerontology, Series A }, volume = {77}, year = {2022}, pages = {1827-1835}, abstract = {

BACKGROUND: Dysregulation of some metabolic factors increases the risk of dementia. It remains unclear if overall metabolic dysregulation, or only certain components, contribute to cognitive aging and if these associations are sex-specific.

METHODS: Data from the 2006-2016 waves of the Health and Retirement Study (HRS) was used to analyze 7,103 participants aged 65+ at baseline (58\% women). We created a metabolic-dysregulation risk score (MDRS) composed of blood pressure/hypertension status, HbA1c/diabetes status, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and waist circumference, and assessed cognitive trajectories from repeated measures of the HRS-Telephone Interview for Cognitive Status (HRS-TICS) over 10 years of follow-up. Linear mixed-effects models estimated associations between MDRS or individual metabolic factors (biomarkers) with mean and change in HRS-TICS scores and assessed sex-modification of these associations.

RESULTS: Participants with higher MDRSs had lower mean HRS-TICS scores, but there were no statistically significant differences in rate of decline. Sex-stratification showed this association was present for women only. MDRS biomarkers revealed heterogeneity in the strength and direction of associations with HRS-TICS. Lower HRS-TICS levels were associated with hypertension, higher HbA1c/diabetes, and lower HDL-C and TC; while faster rate of cognitive decline was associated with hypertension, higher HbA1c/diabetes and higher TC. Participants with higher HbA1c/diabetes presented worse cognitive trajectories. Sex-differences indicated women with higher HbA1c/diabetes to have lower HRS-TICS levels while hypertensive males presented better cognitive trajectory.

CONCLUSIONS: Our results demonstrate that metabolic dysregulation is more strongly associated with cognition in women compared to men, though sex-differences vary by individual biomarker.

}, keywords = {Biomarkers, Brain Aging, Diabetes, Epidemiology}, issn = {1758-535X}, doi = {10.1093/gerona/glab285}, author = {Chanti-Ketterl, Marianne and Rebecca C Stebbins and Obhi, Hardeep K and Daniel W. Belsky and Brenda L Plassman and Yang, Yang Claire} } @article {11828, title = {Trans-ethnic Meta-analysis of Interactions between Genetics and Early Life Socioeconomic Context on Memory Performance and Decline in Older Americans.}, journal = {The Journals of Gerontology, Series A}, volume = {77}, year = {2022}, pages = {2248-2256}, abstract = {

Later life cognitive function is influenced by genetics as well as early- and later-life socioeconomic context. However, few studies have examined the interaction between genetics and early childhood factors. Using gene-based tests (iSKAT/iSKAT-O), we examined whether common and/or rare exonic variants in 39 gene regions previously associated with cognitive performance, dementia, and related traits had an interaction with childhood socioeconomic context (parental education and financial strain) on memory performance or decline in European ancestry (EA, N=10,468) and African ancestry (AA, N=2,252) participants from the Health and Retirement Study. Of the 39 genes, 22 in EA and 19 in AA had nominally significant interactions with at least one childhood socioeconomic measure on memory performance and/or decline; however, all but one (father{\textquoteright}s education by SLC24A4 in AA) were not significant after multiple testing correction (FDR <0.05). In trans-ethnic meta-analysis, two genes interacted with childhood socioeconomic context (FDR <0.05): mother{\textquoteright}s education by MS4A4A on memory performance, and father{\textquoteright}s education by SLC24A4 on memory decline. Both interactions remained significant (p<0.05) after adjusting for respondent{\textquoteright}s own educational attainment, APOE ε4 status, lifestyle factors, BMI, and comorbidities. For both interactions in EA and AA, the genetic effect was stronger in participants with low parental education. Examination of common and rare variants in genes discovered through GWAS shows that childhood context may interact with key gene regions to jointly impact later life memory function and decline. Genetic effects may be more salient for those with lower childhood socioeconomic status.

}, keywords = {Childhood SES, Cognition, Education, Epidemiology, Gene-Environment Interaction, Genetics, Memory, Rare Variant}, issn = {1758-535X}, doi = {10.1093/gerona/glab255}, author = {Jessica Faul and Kho, Minjung and Zhao, Wei and Rumfelt, Kalee E and Yu, Miao and Colter Mitchell and Smith, Jennifer A} } @article {11120, title = {Antidepressant Use Partially Mediates the Association Between Depression and Risk of Falls and Fall Injuries Among Older Adults.}, journal = {The Journals of Gerontology: Series A }, volume = {76}, year = {2021}, pages = {e171}, abstract = {

BACKGROUND: The association between depression and fall risk in older adults is recognized, yet the mechanisms underlying this association are unclear. This study estimated the mediating role of antidepressant use in the association between depression and falls and fall injuries.

METHODS: Longitudinal data from the Health and Retirement Study (HRS; 2004-2006) were linked with medication data from the Prescription Drug Study (PDS; 2005). The sample included community-dwelling adults age >= 65 with data on depression and medication use (n=3,565). Depression was measured using two independent survey tools: Composite International Diagnostic Interview for depression short form and an 8-item version of the Centers for Epidemiologic Studies Depression scale. We used causal mediation analysis to estimate and compare the direct and indirect (mediated by antidepressant use) effects of depression on falls and fall injuries.

RESULTS: Individuals with major depressive disorder (MDD) were significantly more likely to experience a fall (OR: 1.92; 95\% CI: 1.41, 2.62) and a fall injury (OR: 1.67; 95\% CI: 1.09, 2.55) over two years. Indirect effect estimates showed that antidepressant medication use accounted for approximately 19\% and 18\% of the association between MDD and falls and fall injuries, respectively. Results were similar when using an alternative depression measure and when considering only selective serotonin reuptake inhibitor antidepressants.

CONCLUSION: Antidepressant use explains a significant proportion, but not a majority, of the association between depression and greater fall risk. Treatment benefits of antidepressants should be considered with, and may outweigh, concerns about increased risk of falls associated with antidepressant use.

}, keywords = {Causal mediation analysis, Epidemiology, falls and mobility problems}, issn = {1758-535X}, doi = {10.1093/gerona/glaa253}, author = {Matthew C. Lohman and Amanda J Fairchild and Anwar T Merchant} } @article {11430, title = {Association Between Lifetime History of Traumatic Brain Injury, Prescription Opioid Use and Persistent Pain: A Nationally Representative Study.}, journal = {Journal of Neurotrauma}, volume = {38}, year = {2021}, pages = {2284-2290}, abstract = {

Pain is common among adults with traumatic brain injury (TBI), yet little data exists regarding prevalence of opioid use in this population. The objective of this retrospective cohort study was to evaluate the association between lifetime TBI exposure, opioid use, and pain in a nationally-representative sample of 1,022 adults aged 50+ who participated in the Health and Retirement Study (HRS). Our primary exposure was lifetime TBI history measured via the Ohio State University TBI Identification Method. We evaluated three alternate TBI exposures (years since most recent TBI, age at first TBI, and number of lifetime TBIs) in sensitivity analyses. We evaluated two outcomes: recent opioid medication use, and moderate-to-severe pain measured over two HRS waves. We classified three pain groups (persistent, intermittent, and no pain). Prevalence of opioid use among individuals with and without TBI were 19.7\% and 13.6\%, respectively. After adjustment for age, sex, and race, individuals with TBI had a 52\% increased risk for opioid use compared to individuals without TBI (RR=1.52, 95\% CI: 1.11, 2.04). Individuals with recent TBI (1-10 years ago), first TBI after age 40+, and 2+ lifetime TBIs had greatest risk for opioid use. Compared to individuals without TBI, individuals with TBI had 4.9-times increased odds for persistent versus no pain, and 1.9-times increased odds of intermittent versus no pain. Persistent pain among adults with lifetime TBI is elevated compared to the general population, which may contribute to increased opioid use among persons with TBI, particularly those with recent injuries or multiple lifetime TBIs.

}, keywords = {Brain Injuries, Epidemiology}, issn = {1557-9042}, doi = {10.1089/neu.2020.7496}, author = {Raj G. Kumar and Katherine A Ornstein and Corrigan, John and Adams, Rachel Sayko and Dams-O{\textquoteright}Connor, Kristen} } @article {11416, title = {The dynamic association between body mass index and cognition from midlife through late-life, and the effect of sex and genetic influences}, journal = {Scientific Reports}, volume = {11}, year = {2021}, pages = {7206}, abstract = {Body mass index (BMI) is associated with cognitive abilities, but the nature of the relationship remains largely unexplored. We aimed to investigate the bidirectional relationship from midlife through late-life, while considering sex differences and genetic predisposition to higher BMI. We used data from 23,892 individuals of European ancestry from the Health and Retirement Study, with longitudinal data on BMI and three established cognitive indices: mental status, episodic memory, and their sum, called total cognition. To investigate the dynamic relationship between BMI and cognitive abilities, we applied dual change score models of change from age 50 through 89, with a breakpoint at age 65 or 70. Models were further stratified by sex and genetic predisposition to higher BMI using tertiles of a polygenic score for BMI (PGSBMI). We demonstrated bidirectional effects between BMI and all three cognitive indices, with higher BMI contributing to steeper decline in cognitive abilities in both midlife and late-life, and higher cognitive abilities contributing to less decline in BMI in late-life.\&nbsp;The effects of BMI on change in cognitive abilities were more evident in men compared to women, and among those in the lowest tertile of the PGSBMI compared to those in the highest tertile, while the effects of cognition on BMI were similar across groups. In conclusion, these findings highlight a reciprocal relationship between BMI and cognitive abilities, indicating that the negative effects of a higher BMI persist from midlife through late-life, and that weight-loss in late-life may be driven by cognitive decline.}, keywords = {Cognition, Epidemiology, Genetics, longitudinal, Obesity}, isbn = {2693-5015}, doi = {10.21203/rs.3.rs-186197/v1}, author = {Ida Karlsson and Margaret Gatz and Thalida E. Arpawong and Anna K. Dahl Aslan and Chandra A Reynolds} } @article {11948, title = {Epidemiology of undiagnosed depression in people with diabetes mellitus: a comparative analysis of Ireland, England and the USA.}, journal = {BMJ Open}, volume = {11}, year = {2021}, pages = {e049155}, abstract = {

OBJECTIVES: Improving detection of depression in people with diabetes is recommended. However, little is known about how different health systems compare in depression detection. We estimated and compared the (1) prevalence of depression detection in people with and without diabetes, and (2) association between diabetes and undiagnosed depression across three health systems.

DESIGN: Cross-sectional analysis of three nationally representative studies: The Irish Longitudinal Study on Ageing, the English Longitudinal Study on Ageing and the Health and Retirement Study.

SETTING: Community-dwelling adults in Ireland, England and the USA.

PARTICIPANTS: Adults aged >=50 years.

PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was depression diagnosis. The secondary outcome was any depression. Any depression was defined by the presence of self-reported doctor-diagnosed depression or current depression symptoms on the Centre for Epidemiological Studies-Depression scale. Depression diagnosis was categorised as: undiagnosed, symptomatic and diagnosed, and asymptomatic and diagnosed. We estimated age-standardised prevalence of depression diagnosis by country and diabetes status. Anyone who self-reported having ever received a doctor diagnosis of diabetes was classified as having diabetes. Among respondents with depression, we estimated the association between diabetes and undiagnosed depression by country using multivariable logistic regression.

RESULTS: The prevalence of depression (diagnosed and undiagnosed) was higher in people with diabetes in each country with absolute rates varying by country; undiagnosed prevalence (Ireland: diabetes 10.1\% (95\% CI 7.5\% to 12.8\%) vs no diabetes 7.5\% (95\% CI 6.8\% to 8.2\%), England: diabetes 19.3\% (95\% CI 16.5\% to 22.2\%) vs no diabetes 11.8\% (95\% CI 11.0\% to 12.6\%), USA: diabetes 7.4\% (95\% CI 6.4\% to 8.4\%) vs no diabetes 6.1\% (95\% CI 5.7\% to 6.6\%)). In the fully adjusted model, there was no clear pattern of association between diabetes status and undiagnosed depression; Ireland: OR=0.82 (95\% CI 0.5 to 1.3), England: OR=1.47 (95\% CI 1.0 to 2.1), USA: OR=0.80 (95\% CI 0.7 to 1.0).

CONCLUSIONS: Although undiagnosed depression was more prevalent among people with diabetes, the relationship between diabetes and undiagnosed depression differed by country. Targeted efforts are needed to improve depression detection among community-dwelling older adults, particularly those with diabetes.

}, keywords = {depression, Diabetes, Epidemiology}, issn = {2044-6055}, doi = {10.1136/bmjopen-2021-049155}, author = {McGrath, Niamh and O Neill, Kate and McHugh, Sheena M and Toomey, Elaine and Kearney, Patricia M} } @article {11631, title = {Evidence for a causal association between milk intake and cardiometabolic disease outcomes using a two-sample Mendelian Randomization analysis in up to 1,904,220 individuals.}, journal = {International Journal of Obesity}, volume = {45}, year = {2021}, pages = {1751-1762}, abstract = {

BACKGROUND: High milk intake has been associated with cardio-metabolic risk. We conducted a Mendelian Randomization (MR) study to obtain evidence for the causal relationship between milk consumption and cardio-metabolic traits using the lactase persistence (LCT-13910 C > T, rs4988235) variant as an instrumental variable.

METHODS: We tested the association of LCT genotype with milk consumption (for validation) and with cardio-metabolic traits (for a possible causal association) in a meta-analysis of the data from three large-scale population-based studies (1958 British Birth Cohort, Health and Retirement study, and UK Biobank) with up to 417,236 participants and using summary statistics from consortia meta-analyses on intermediate traits (N = 123,665-697,307) and extended to cover disease endpoints (N = 86,995-149,821).

RESULTS: In the UK Biobank, carriers of {\textquoteright}T{\textquoteright} allele of LCT variant were more likely to consume milk (P = 7.02 {\texttimes} 10). In meta-analysis including UK Biobank, the 1958BC, the HRS, and consortia-based studies, under an additive model, {\textquoteright}T{\textquoteright} allele was associated with higher body mass index (BMI) (P = 4.68 {\texttimes} 10) and lower total cholesterol (TC) (P = 2.40 {\texttimes} 10), low-density lipoprotein cholesterol (LDL-C) (P = 2.08 {\texttimes} 10) and high-density lipoprotein cholesterol (HDL-C) (P = 9.40 {\texttimes} 10). In consortia meta-analyses, {\textquoteright}T{\textquoteright} allele was associated with a lower risk of coronary artery disease (OR:0.86, 95\% CI:0.75-0.99) but not with type 2 diabetes (OR:1.06, 95\% CI:0.97-1.16). Furthermore, the two-sample MR analysis showed a causal association between genetically instrumented milk intake and higher BMI (P = 3.60 {\texttimes} 10) and body fat (total body fat, leg fat, arm fat and trunk fat; P < 1.37 {\texttimes} 10) and lower LDL-C (P = 3.60 {\texttimes} 10), TC (P = 1.90 {\texttimes} 10) and HDL-C (P = 3.00 {\texttimes} 10).

CONCLUSIONS: Our large-scale MR study provides genetic evidence for the association of milk consumption with higher BMI but lower serum cholesterol levels. These data suggest no need to limit milk intakes with respect to cardiovascular disease risk, with the suggested benefits requiring confirmation in further studies.

}, keywords = {Epidemiology, Nutrition, nutrition disorders}, issn = {1476-5497}, doi = {10.1038/s41366-021-00841-2}, author = {Vimaleswaran, Karani Santhanakrishnan and Zhou, Ang and Cavadino, Alana and Hypp{\"o}nen, Elina} } @article {11202, title = {Frailty Changes Predict Mortality in 4 Longitudinal Studies of Aging}, journal = {The Journals of Gerontology: Series A }, volume = {76}, year = {2021}, pages = {1619-1626}, abstract = {Baseline frailty index (FI) values have been shown to predict mortality among older adults, but little is known about the effects of changes in FI on mortality.In a coordinated approach, we analyzed data from 4 population-based cohorts: the Health and Retirement Study (HRS), the Survey of Health, Ageing and Retirement in Europe (SHARE), the English Longitudinal Survey of Ageing (ELSA), and the Longitudinal Aging Study Amsterdam (LASA), comprising a total of 24 961 respondents (65+), 95 897 observations, up to 9 repeated FI assessments, and up to 23 years of mortality follow-up. The effect of time-varying FI on mortality was modeled with joint regression models for longitudinal and time-to-event data.Differences (of 0.01) in current FI levels (hazard ratio [HR] = 1.04, 95\% credible interval [CI] = 1.03{\textendash}1.05) and baseline FI levels (HR = 1.03, 95\% CI = 1.03{\textendash}1.05) were consistently associated with mortality across studies. Importantly, individuals with steeper FI growth also had a higher mortality risk: An increase in annual FI growth by 0.01 was associated with an increased mortality risk of HR = 1.56 (95\% CI = 1.49{\textendash}1.63) in HRS, HR = 1.24 (95\% CI = 1.13{\textendash}1.35) in SHARE, HR = 1.40 (95\% CI = 1.25{\textendash}1.52) in ELSA, and HR = 1.71 (95\% CI = 1.46{\textendash}2.01) in LASA.FI changes predicted mortality independently of baseline FI differences. Repeated assessment of frailty and individual{\textquoteright}s frailty trajectory could provide a means to anticipate further health deterioration and mortality and could thus support clinical decision making.}, keywords = {ELSA, Epidemiology, Frailty, Mortality, Public Health, SHARE}, isbn = {1079-5006}, doi = {10.1093/gerona/glaa266}, author = {Stolz, Erwin and Emiel O Hoogendijk and Mayerl, Hannes and Wolfgang Freidl} } @article {11117, title = {Geriatric Syndromes and Atrial Fibrillation: Prevalence and Association with Anticoagulant Use in a National Cohort of Older Americans.}, journal = {Journal of the American Geriatrics Society}, volume = {69}, year = {2021}, pages = {349-356}, abstract = {

BACKGROUND: Although guidelines recommend focusing primarily on stroke risk to recommend anticoagulants in atrial fibrillation (AF), physicians report that geriatric syndromes (e.g., falls and disability) are important when considering anticoagulants. Little is known about the prevalence of geriatric syndromes in older adults with AF or the association with anticoagulant use.

METHODS: We performed a cross-sectional analysis of the 2014 Health and Retirement Study, a nationally representative study of older Americans. Participants were asked questions to assess domains of aging, including function, cognition, and medical conditions. We included participants 65 years and older with 2 years of continuous Medicare enrollment who met AF diagnosis criteria by claims codes. We examined five geriatric syndromes: one or more falls within the last 2 years, receiving help with activities of daily living (ADLs) or instrumental ADLs (IADL), experienced incontinence, and cognitive impairment. We determined the prevalence of geriatric syndromes and their association with anticoagulant use, adjusting for ischemic stroke risk (i.e., CHA DS -VASc score [congestive heart failure, hypertension, age, diabetes mellitus, stroke, vascular disease, and sex]).

RESULTS: In this study of 779 participants with AF (median age = 80 years; median CHA DS -VASc score = 4), 82\% had one or more geriatric syndromes. Geriatric syndromes were common: 49\% reported falls, 38\% had ADL impairments, 42\% had IADL impairments, 37\% had cognitive impairments, and 43\% reported incontinence. Overall, 65\% reported anticoagulant use; guidelines recommend anticoagulant use for 97\% of participants. Anticoagulant use rate decreased for each additional geriatric syndrome (average marginal effect = -3.7\%; 95\% confidence interval = -1.4\% to -5.9\%). Lower rates of anticoagulant use were reported in participants with ADL dependency, IADL dependency, and dementia.

CONCLUSION: Most older adults with AF had at least one geriatric syndrome, and geriatric syndromes were associated with reduced anticoagulant use. The high prevalence of geriatric syndromes may explain the lower than expected anticoagulant use in older adults.

}, keywords = {anticoagulants, Atrial Fibrillation, Epidemiology, geriatric syndromes}, issn = {1532-5415}, doi = {10.1111/jgs.16822}, author = {Sachin J Shah and Margaret C Fang and Sun Y Jeon and Gregorich, Steven E and Kenneth E Covinsky} } @article {10700, title = {Handgrip Strength Asymmetry and Weakness Together are Associated with Functional Disability in Aging Americans}, journal = {The Journals of Gerontology: Series A}, volume = {76}, year = {2021}, pages = {291}, abstract = {Evaluating handgrip strength (HGS) asymmetry may help to improve the prognostic value of HGS. This study sought to determine the associations of HGS asymmetry and weakness on future activities of daily living (ADL) disability in a national sample of aging Americans.The analytic sample included 18,468 Americans aged >=50-years from the 2006-2016 waves of the Health and Retirement Study. A handgrip dynamometer measured HGS. Those with HGS \>10\% stronger on either hand were considered as having any HGS asymmetry. Individuals with HGS \>10\% stronger on their dominant hand were considered as having dominant HGS asymmetry, while those with HGS \>10\% stronger on their non-dominant hand were classified as having non-dominant HGS asymmetry. Men with HGS \<26-kilograms and women with HGS \<16-kilograms were considered weak. ADLs were self-reported. Generalized estimating equations were used for analyses.Relative to those with symmetric HGS and no weakness, each HGS asymmetry and weakness group had increased odds for future ADL disability: 1.11 (95\% confidence interval (CI): 1.02-1.20) for any HGS asymmetry alone, 1.42 (CI: 1.16-1.74) for weakness alone, and 1.81 (CI: 1.52-2.16) for both any HGS asymmetry and weakness. Most weakness and HGS asymmetry dominance groups had increased odds for future ADL disability: 1.30 (CI: 1.13-1.50) for non-dominant HGS asymmetry alone, 1.42 (CI: 1.16-1.74) for weakness alone, 1.72 (CI: 1.29-2.29) for both weakness and non-dominant HGS asymmetry, and 1.86 (CI: 1.52-2.28) for both weakness and dominant HGS asymmetry.HGS asymmetry and weakness together may increase the predictive utility of handgrip dynamometers.}, keywords = {Biomarkers, Disablement Process, Epidemiology, Functional Performance}, issn = {1079-5006}, doi = {10.1093/gerona/glaa100}, author = {Ryan P McGrath and Brenda Vincent and Donald A Jurivich and Kyle J Hackney and Grant R Tomkinson and Lindsey J Dahl and Brian C Clark} } @article {11818, title = {The Longitudinal Association of Vision Impairment with Transitions to Cognitive Impairment and Dementia: Findings from The Aging, Demographics and Memory Study.}, journal = {The Journals of Gerontology - Series A }, volume = {76}, year = {2021}, pages = {2187-2193}, abstract = {

BACKGROUND: Vision impairment (VI) is associated with incident cognitive decline and dementia. However, it is not known whether VI is associated only with the transition to cognitive impairment, or whether it is also associated with later transitions to dementia.

METHODS: We used data from the population-based Aging, Demographics and Memory Study (ADAMS) to investigate the association of visual acuity impairment (VI; defined as binocular presenting visual acuity <20/40) with transitions from cognitively normal (CN) to cognitive impairment no dementia (CIND) and from CIND to dementia. Multivariable Cox proportional hazards models and logistic regression were used to model the association of VI with cognitive transitions, adjusted for covariates.

RESULTS: There were 351 participants included in this study (weighted percentages: 45\% male, 64\% age 70-79 years) with a mean follow-up time of 4.1 years. In a multivariable model, the hazard of dementia was elevated among those with VI (HR=1.63, 95\%CI=1.04-2.58). Participants with VI had a greater hazard of transitioning from CN to CIND (HR=1.86, 95\%CI=1.09-3.18). However, among those with CIND and VI a similar percentage transitioned to dementia (48\%) and remained CIND (52\%); there was no significant association between VI and transitioning from CIND to dementia (HR=0.94, 95\%CI=0.56-1.55). Using logistic regression models, the same associations between VI and cognitive transitions were identified.

CONCLUSIONS: Poor vision is associated with the development of CIND. The association of VI and dementia appears to be due to the higher risk of dementia among individuals with CIND. Findings may inform the design of future interventional studies.

}, keywords = {blindness, cognitive transitions, Epidemiology}, issn = {1758-535X}, doi = {10.1093/gerona/glab157}, author = {Joshua R Ehrlich and Bonnielin K Swenor and Zhou, Yunshu and Kenneth M. Langa} } @article {11815, title = {No association between rheumatoid arthritis and cognitive impairment in a cross-sectional national sample of older U.S. adults.}, journal = {BMC Rheumatology}, volume = {5}, year = {2021}, pages = {24}, abstract = {

BACKGROUND: Studies suggest an increased prevalence of cognitive impairment (CI) among people with rheumatoid arthritis (RA). However, most prior studies have used convenience samples which are subject to selection biases or have failed to adjust for key confounding variables. We thus examined the association between CI and RA in a large national probability sample of older US adults.

METHODS: Data were from interviews with 4462 participants in the 2016 wave of the nationally representative U.S. Health and Retirement Study with linked Medicare claims. RA diagnoses were identified via a minimum of two ICD-9CM or ICD-10 codes in Medicare billing records during the prior 2 years. The Langa-Weir Classification was used to classify cognitive status as normal, cognitively impaired non-dementia (CIND), or dementia based on a brief neuropsychological battery for self-respondents and informant reports for proxy respondents. We compared the odds of CI between older adults with and without RA using logistic regression, adjusted for age, education, gender, and race.

RESULTS: Medicare records identified a 3.36\% prevalence of RA (150/4462). While age, gender, education, and race independently predicted CI status, controlling for these covariates we found no difference in CI prevalence according to RA status (prevalent CI in 36.7\% of older adults with RA vs. 34.0\% without RA; adjusted OR = 1.08, 95\% CI 0.74-1.59, p~= .69).

CONCLUSION: There was no association between RA and CI in this national sample of older U.S. adults.

}, keywords = {cognitive impairment, Epidemiology, National health survey, rheumatoid arthritis}, issn = {2520-1026}, doi = {10.1186/s41927-021-00198-z}, author = {Booth, Michael J and Mary R Janevic and Lindsay C Kobayashi and Daniel Clauw and John D Piette} } @article {11797, title = {The role of education and income for cognitive functioning in old age: A cross-country comparison.}, journal = {International Journal of Geriatric Psychiatry}, volume = {36}, year = {2021}, pages = {1908-1921}, abstract = {

OBJECTIVES: Previous studies have shown that higher education promotes cognitive health. This effect, however, is embedded in the living conditions of a particular country. Since it is not clear to what extent the country and its specific living standards are necessary preconditions for the observed effect, we investigated whether the impact of education and income on cognitive functioning differs between countries.

METHODS: Analyses were based on harmonized data from the World Health Organization{\textquoteright}s multi-country Study on global AGEing and adult health (WHO SAGE), the Health and Retirement Study (HRS), and the Survey of Health, Ageing and Retirement in Europe (SHARE)) of over 85,000 individuals aged 50 years and older. Analyses were conducted via multivariate regression analyses and structural equation modelling adjusted for age, gender, marital status, health status, and depression.

RESULTS: The effect of education was twice as large as the effect of income on cognitive functioning and indirectly moderated the effect of income on cognitive functioning. The effect sizes varied strongly between countries. The country{\textquoteright}s gross domestic product per capita seems to influence cognitive functioning.

CONCLUSIONS: Our findings indicate that education has a dominant effect on cognitive functioning in people aged 50 years and older, which might even offset the adverse implications of living with low income on cognitive health. Therefore, expanding efforts to achieve universal education are essential to mitigate health disparities due to low income and early life disadvantages, including chances for good cognitive functioning over the life-span. This article is protected by copyright. All rights reserved.

}, keywords = {cognitive functioning, Cognitive Reserve, Cross-country comparison, deprivation, Education, Epidemiology, Income, Life-course, Poverty, SHARE}, issn = {1099-1166}, doi = {10.1002/gps.5613}, author = {Rodriguez, Francisca S and Hofbauer, Lena M and R{\"o}hr, Susanne} } @article {11829, title = {Sense of Purpose in Life and Subsequent Physical, Behavioral, and Psychosocial Health: An Outcome-Wide Approach.}, journal = {American Journal of Health Promotion}, volume = {36}, year = {2021}, pages = {137-147}, abstract = {

PURPOSE: Growing evidence indicates that a higher sense of in life () is associated with reduced risk of chronic diseases and mortality. However, epidemiological studies have not evaluated if change in is associated with subsequent health and well-being outcomes.

DESIGN: We evaluated if positive change in (between t; 2006/2008 and t;2010/2012) was associated with better outcomes on 35 indicators of physical health, health behaviors, and psychosocial well-being (at t;2014/2016).

SAMPLE: We used data from 12,998 participants in the Health and Retirement study-a prospective and nationally representative cohort of U.S. adults aged >50.

ANALYSIS: We conducted multiple linear-, logistic-, and generalized linear regressions.

RESULTS: Over the 4-year follow-up period, people with the highest (versus lowest) purpose had better subsequent physical health outcomes (e.g., 46\% reduced risk of mortality (95\% CI [0.44, 0.66])), health behaviors (e.g., 13\% reduced risk of sleep problems (95\% CI [0.77, 0.99])), and psychosocial outcomes (e.g., higher optimism (β = 0.41, 95\% CI [0.35, 0.47]), 43\% reduced risk of depression (95\% CI [0.46, 0.69]), lower loneliness (β = -0.35, 95\% CI [-0.41, -0.29])). Importantly, however, purpose was not associated with other physical health outcomes, health behaviors, and social factors.

CONCLUSION: With further research, these results suggest that sense of purpose might be a valuable target for innovative policy and intervention work aimed at improving health and well-being.

}, keywords = {Epidemiology, psychological well-being, Purpose in life, Sense of purpose, Well-being}, issn = {2168-6602}, doi = {10.1177/08901171211038545}, author = {Eric S Kim and Chen, Ying and Julia S Nakamura and Carol D Ryff and Tyler J VanderWeele} } @article {https://doi.org/10.1002/dad2.12252, title = {Subtle mistakes in self-report surveys predict future transition to dementia}, journal = {Alzheimer{\textquoteright}s \& Dementia: Diagnosis, Assessment \& Disease Monitoring}, volume = {13}, year = {2021}, pages = {e12252}, abstract = {Introduction We investigate whether indices of subtle reporting mistakes derived from responses in self-report surveys are associated with dementia risk. Methods We examined 13,831 participants without dementia from the prospective, population-based Health and Retirement Study (mean age 69 {\textpm} 10 years, 59\% women). Participants{\textquoteright} response patterns in 21 questionnaires were analyzed to identify implausible responses (multivariate outliers), incompatible responses (Guttman errors), acquiescent responses, random errors, and the proportion of skipped questions. Subsequent incident dementia was determined over up to 10 years of follow-up. Results During follow-up, 2074 participants developed dementia and 3717 died. Each of the survey response indices was associated with future dementia risk controlling for confounders and accounting for death as a competing risk. Stronger associations were evident for participants who were younger and cognitively normal at baseline. Discussion Mistakes in the completion of self-report surveys in longitudinal studies may be early indicators of dementia among middle-aged and older adults.}, keywords = {cognitive impairment, Dementia, early detection, Epidemiology, functional abilities, self-report surveys}, doi = {https://doi.org/10.1002/dad2.12252}, author = {Stefan Schneider and Junghaenel, Doerte U. and Elizabeth Zelinski and Erik Meijer and Arthur A. Stone and Kenneth M. Langa and Arie Kapteyn} } @article {11022, title = {Childhood Misfortune and Late-Life Stroke Incidence, 2004{\textendash}2014}, journal = {The Gerontologist}, volume = {60}, year = {2020}, pages = {1060 - 1070}, abstract = {Although most strokes occur in later life, recent studies reveal that negative exposures decades earlier are associated with stroke risk. The purpose of this study was to examine whether accumulated and/or specific domains of early misfortune are related to stroke incidence in later life.A decade of longitudinal data from stroke-free participants 50 years or older in the Health and Retirement Study were analyzed (N = 12,473). Incident stroke was defined as either self-reported first incident stroke or death due to stroke between 2004 and 2014.Analyses revealed that accumulated misfortune was associated with increased stroke risk, but the relationship was moderated by wealth. Examining specific domains of childhood misfortune revealed that stroke incidence was greater for persons with behavioral/psychological risks, but that this relationship also was moderated by higher wealth for those with only one behavioral/psychological risk.Accumulated childhood misfortune and adolescent depression heighten the risk of stroke in later life, but the influence is remediable through adult wealth. Reducing poverty in later life may decrease stroke incidence for persons exposed to negative childhood exposures.}, keywords = {Cerebrovascular disease, Epidemiology, Life course analysis}, isbn = {0016-9013}, doi = {https://doi.org/10.1093/geront/gnaa007}, author = {Zaborenko, Callie J and Kenneth F Ferraro and Monica Williams-Farrelly} } @article {10919, title = {Education-Related Inequalities in Dental Services Use among Older Adults in 23 Countries}, journal = {Journal of Dental Research}, year = {2020}, abstract = {This study aimed to measure the magnitude of education-related inequalities in the use of dental services among older adults (aged 50?y or older) from a sizable multicountry sample of 23 upper-middle- and high-income countries. This study used cross-sectional data from nationally representative surveys of people aged 50 y and over. Countries included in the Health and Retirement Study surveys were the following: Brazil, China, South Korea, Mexico, United States, Austria, Belgium, Croatia, Czech Republic, Denmark, Estonia, France, Germany, Greece, Italy, Israel, Luxembourg, Poland, Portugal, Slovenia, Spain, Sweden, and Switzerland. The dependent variable was the use of dental services, based on the self-report of having had a dental visit within the previous year, except for the United States and South Korea, which used 2-y recall periods. Educational level was used as the measure of socioeconomic position and was standardized across countries. Multivariate logistic regression modeling was used to evaluate the factors associated with the use of dental services, and the magnitude of education inequalities in the use of dental services was assessed using the slope index of inequality (SII) to measure absolute inequalities and the relative index of inequality for relative inequalities. The pooled prevalence of the use of dental services was 31.7\% and ranged from 18.7\% in China to 81.2\% in Sweden. In the overall sample, the absolute difference in the prevalence of use between the lowest and highest educational groups was 20?percentage points. SII was significant for all countries except Portugal. Relative educational inequalities were significant for all countries and ranged from 3.2 in Poland to 1.2 in Sweden. There were significant education-related inequalities in the use of dental care by older adults in all countries. Monitoring these inequalities is critical to the planning and delivery of dental services.}, keywords = {Dental Care, Epidemiology, health care disparities, Health Services for the Aged, Oral Health, Socioeconomic factors}, isbn = {0022-0345}, doi = {10.1177/0022034520935854}, author = {Andrade, F. Bof de and Antunes, J.L.F. and Andrade, F.C.D. and Lima-Costa, M.F.F. and Macinko, J.} } @article {10670, title = {Methods and Early Recruitment of a Community-Based Study of Cognitive Impairment Among Mexican Americans and Non-Hispanic Whites: The BASIC-Cognitive Study}, journal = {Journal of Alzheimer{\textquoteright}s Disease}, volume = {73}, year = {2020}, month = {2020}, pages = {185-196}, type = {Journal}, abstract = {Background: As the Mexican American (MA) population grows and ages, there is an urgent need to estimate the prevalence of cognitive impairment or dementia (CID), cognitive trajectories, and identify community resource needs. The Brain Attack Surveillance in Corpus Christi (BASIC)-Cognitive project is a population-based study to address these issues among older MAs and non-Hispanic whites (NHW) and their informal care providers. Objective: Present the methodology and initial recruitment findings for the BASIC-Cognitive project. Method: Random, door-to-door case ascertainment is used in Nueces County, Texas, to recruit community-dwelling and nursing home residents >=65 and informal care providers. Households are identified from a two-stage area probability sample, using Census data to aim for equal balance of MAs and NHWs. Individuals with cognitive screens indicative of possible CID complete neuropsychological assessment (Harmonized Cognitive Assessment Protocol from the Health and Retirement Study). Informal care providers complete comprehensive interview and needs assessment. Study pairs repeat procedures at 2-year follow-up. Asset and concept mapping are performed to identify community resources and study care providers{\textquoteright} perceptions of needs for individuals with CID. Results: 1,030 age-eligible households were identified, or 27\% of households for whom age could be determined. 1,320 individuals were age-eligible, corresponding to 1.3 adults per eligible household. Initial recruitment yielded robust participation in the MA eligible population (60\% of 689 individuals that completed cognitive screening). Conclusion: The BASIC-Cognitive study will provide critical information regarding the prevalence of CID in MAs, the impact of caregiving, and allocation of community resources to meet the needs of this population.}, keywords = {Caregivers, Dementia, Epidemiology, Health Resources, mexican american, mild cognitive impairment}, isbn = {1875-8908}, doi = {10.3233/JAD-190761}, url = {https://content.iospress.com/articles/journal-of-alzheimers-disease/jad190761}, author = {Emily Brice{\~n}o and Mehdipanah, Roshanak and Gonzales, Xavier and Steven G Heeringa and Deborah A Levine and Kenneth M. Langa and Garcia, Nelda and Longoria, Ruth and Lewis B Morgenstern} } @article {10704, title = {Racial Disparities in Stroke Recovery Persistence in the Post-Acute Stroke Recovery Phase: Evidence from the Health and Retirement Study}, journal = {Ethnicity \& Disease}, volume = {30}, year = {2020}, pages = {339-348}, type = {Journal}, abstract = {Background and Purpose: Blacks have a higher burden of post-stroke disability. Factors associated with racial differences in long-term post-stroke disability are not well-understood. Our aim was to assess the long-term racial differences in risk factors associated with stroke recovery.Methods: We examined Health and Retire-ment Study (HRS) longitudinal interview data collected from adults living with stroke who were aged >50 years during 2000- 2014. Analysis of 1,002 first-time, non- Hispanic, Black (210) or White (792) stroke survivors with data on activities of daily liv-ing (ADL), fine motor skills (FMS) and gross motor skills (GMS) was conducted. Ordinal regression analysis was used to assess the impact of sex, race, household residents, household income, comorbidities, and the time since having a stroke on functional outcomes.Results: Black stroke survivors were young-er compared with Whites (69 {\textpm} 10.4 vs 75 {\textpm} 11.9). The majority (~65\%) of Black stroke survivors were female compared with about 54\% White female stroke survivors (P=.007). Black stroke survivors had more household residents (P<.001) and comor-bidities (P<.001). Aging, being female, being Black and a longer time since stroke were associated with a higher odds of hav-ing increased difficulty in ADL, FMS and/or GMS. Comorbidities were associated with increased difficulty with GMS. Black race increased the impact of comorbidities on ADL and FMS in comparison with Whites.Conclusion: Our data suggest that the effects of aging, sex and unique factors associated with race should be taken into consideration for future studies of post-stroke recovery and therapy.}, keywords = {Activities of Daily Living, Blacks, Epidemiology, Motor Skills, Risk Factors}, doi = {10.18865/ed.30.2.339}, url = {https://www.ncbi.nlm.nih.gov/pubmed/32346280}, author = {Buie, Joy and Zhao, Yujing and Burns, Suzanne and Magwood, Gayenell and Adams, Robert and Sims, Catrina and Lackland, Daniel} } @article {10917, title = {Sense of purpose in life and five health behaviors in older adults}, journal = {Preventive Medicine}, volume = {139}, year = {2020}, abstract = {Accumulating evidence shows that a higher sense of purpose in life is associated with lower risk of chronic conditions and premature mortality. Health behaviors might partially explain these findings, however, the prospective association between sense of purpose and health behaviors is understudied. We tested whether a higher sense of purpose at baseline was associated with lower likelihood of developing unhealthy behaviors over time. Prospective data were from the Health and Retirement Study, a national sample of U.S. older adults. Our sample included 13,770 adults assessed up to five times across eight years. Among people who met recommended guidelines for a given health behavior outcome at baseline, those in the top versus lowest quartile of purpose in life had 24\% lower likelihood of becoming physically inactive (95\% CI: 0.68{\textendash}0.85), 33\% lower likelihood of developing sleep problems (95\% CI: 0.58{\textendash}0.79), and 22\% lower likelihood of developing unhealthy body mass index (BMI) (95\% CI: 0.69{\textendash}0.87) in sociodemographic-adjusted models. Further there was a marginal reduction in smoking relapse (HR = 0.65, 95\% CI: 0.41{\textendash}1.03) and no association with heavy alcohol use (HR = 1.02, 95\% CI: 0.81{\textendash}1.29). Findings for physical inactivity, sleep problems, and unhealthy BMI remained evident after further adjusting for baseline health status and depression. Our results, suggest that a sense of purpose in life might emerge (with further research) as a valuable target to consider for interventions aimed at helping older adults maintain some health behaviors.}, keywords = {Alcohol Consumption, Body Weight, Epidemiology, Health behaviors, Health psychology, Physical activity, psychological well-being, Purpose in life, Sleep, Smoking}, isbn = {0091-7435}, doi = {10.1016/j.ypmed.2020.106172}, author = {Eric S Kim and Shiba, Koichiro and Boehm, Julia K. and Laura D Kubzansky} } @article {10958, title = {University College London: Health Inequalities Worse in U.S. Than England}, journal = {Targeted News Service}, year = {2020}, address = {Washington, D.C.}, abstract = {Across every income group surveyed, people living in the US had worse health than their counterparts of similar incomes in England, finds the study published in JAMA Internal Medicine, led by the University of Michigan.}, keywords = {Blood pressure, Diabetes, Epidemiology, Health Disparities, Internal medicine, Longitudinal Studies, Low income groups, Public Administration, Researchers}, url = {https://www.ucl.ac.uk/news/2020/jul/health-inequalities-worse-us-england} } @article {10701, title = {Using syndrome mining with the Health and Retirement Study to identify the deadliest and least deadly frailty syndromes}, journal = {Scientific Reports}, volume = {10}, year = {2020}, type = {Journal}, abstract = {Syndromes are defined with signs or symptoms that occur together and represent conditions. We use a data-driven approach to identify the deadliest and most death-averse frailty syndromes based on frailty symptoms. A list of 72 frailty symptoms was retrieved based on three frailty indices. We used data from the Health and Retirement Study (HRS), a longitudinal study following Americans aged 50 years and over. Principal component (PC)-based syndromes were derived based on a principal component analysis of the symptoms. Equal-weight 4-item syndromes were the sum of any four symptoms. Discrete-time survival analysis was conducted to compare the predictive power of derived syndromes on mortality. Deadly syndromes were those that significantly predicted mortality with positive regression coefficients and death-averse ones with negative coefficients. There were 2,797 of 5,041 PC-based and 964,774 of 971,635 equal-weight 4-item syndromes significantly associated with mortality. The input symptoms with the largest regression coefficients could be summed with three other input variables with small regression coefficients to constitute the leading deadliest and the most death-averse 4-item equal-weight syndromes. In addition to chance alone, input symptoms{\textquoteright} variances and the regression coefficients or p values regarding mortality prediction are associated with the identification of significant syndromes.}, keywords = {Epidemiology, Geriatrics}, isbn = {2045-2322}, doi = {10.1038/s41598-020-60869-8}, author = {Yi-Sheng Chao and Chao-Jung Wu and Hsing-Chien Wu and Hui-Ting Hsu and Tsao, Lien-Cheng and Cheng, Yen-Po and Lai, Yi-Chun and Wei-Chih Chen} } @mastersthesis {10561, title = {Analysis of Dementia Risks among African Immigrants Compared with Caucasian Americans in Retirement}, volume = {D.P.H.}, year = {2019}, note = {Copyright - Database copyright ProQuest LLC; ProQuest does not claim copyright in the individual underlying works; Last updated - 2020-01-13}, pages = {119}, school = {Capella University}, type = {phd}, abstract = {This dissertation investigated the differential risk factors for Alzheimer{\textquoteright}s disease and dementias among foreign-born African immigrants and native-born Americans in retirement. As immigrants integrate and assimilate, other behavioral processes such as adoption of host nation lifestyle practices endanger immigrant health status that adversely impact cognitive functioning at old age. Bivariate and multivariate logistic regression models were used to assess risk factors for Alzheimer{\textquoteright}s disease and dementia diagnoses among the study subjects. The results showed that acculturation between 10{\textendash}15 years in the United States puts foreign-born African immigrants at 1.71 OR unadjusted:1.71; 98\% CI (1.16, 2.51); p = 0.0012] times higher risk of being diagnosed with dementia or Alzheimer{\textquoteright}s disease compared with Caucasian Whites. Similarly, African race OR adjusted=1.39; 98\% CI (0.97, 2); p = 0.0361] indicated the lack of sufficient and statistically significant evidence that being Black race plays a statistically significant role in the risk of being diagnosed with Alzheimer{\textquoteright}s disease or dementias in retirement compared with Caucasian Whites. Higher educational attainment OR adjusted=0.45; 98\% CI (0.29, 0.68); p < 0.0001] was statistically significant protective factor against the risk of being diagnosed as demented or Alzheimer{\textquoteright}s disease among African immigrants compared with Caucasian Whites. Also, when educational attainments were equivalent among African immigrants and native Caucasians, the risk was substantially higher OR adjusted=1.11; 98\% CI (0.71, 2.91); p = 0.073] but not statistically significant among African immigrants compared with Caucasian Whites. In conclusion, as foreign-born African immigrants adopt host nation health behaviors and dietary practices, live in the United States for at least 10 years, and had fewer than 13 years of educational attainment were at increased risks of being diagnosed with Alzheimer{\textquoteright}s disease and related dementias.}, keywords = {0308:Biostatistics, 0347:Mental health, 0631:Ethnic studies, 0766:Epidemiology, Alzheimer{\textquoteright}s disease, Biostatistics, Demography, Epidemiologic transition, Epidemiology, Ethnic studies, Foreign-born African immigrant, Health and Retirement Study, Mental Health}, isbn = {9781392544235}, url = {https://search.proquest.com/docview/2336369737?pq-origsite=gscholar}, author = {Bibio, Desmond K.} } @article {VANDERLEEUW2019103991, title = {The association between pain and prevalent and incident Motoric Cognitive Risk syndrome in older adults}, journal = {Archives of Gerontology and Geriatrics}, year = {2019}, pages = {103991}, abstract = {Background The Motoric Cognitive Risk Syndrome (MCR) is a pre-dementia syndrome characterized by subjective cognitive complaints and slow gait in the absence of dementia and mobility disability. Worse cognitive and motoric function is associated with chronic pain in older adults. Our aim was to study the association between pain and prevalent and incident MCR in adults aged 65 years and older. Methods We analyzed the cross-sectional association between severity of pain and prevalent MCR in 3,244 older adults participating in the Health and Retirement Study (2008 wave) using logistic regression analysis adjusting for demographic, peripheral, central or biological risk factors. Additionally, we analyzed the longitudinal association between severity of pain and incident MCR in 362 participants in the Central Control of Mobility in Aging Study, using Cox regression analysis. Results The 155 Health and Retirement Study participants with severe pain had an increased risk of prevalent MCR (n = 249), compared to 2245 individuals without pain (adjusted for demographics OR: 2.78, 95\% CI:1.74-4.45). Over a mean follow-up of 3.01 years (SD 1.38), 29 individuals in the Central Control of Mobility in Aging Study developed incident MCR. Older adults with severe pain had over a five times increased risk of developing incident MCR, compared to those without pain even after adjusting for demographic variables (HR: 5.44, 95\% CI: 1.81-16.40). Conclusion Older adults with severe pain have a higher prevalence and incidence of MCR. These findings should be further explored to establish if pain is a potentially modifiable risk factor to prevent cognitive decline.}, keywords = {Aging, Cognition, Dementia, Epidemiology, Motoric Cognitive Risk Syndrome, pain}, issn = {0167-4943}, doi = {https://doi.org/10.1016/j.archger.2019.103991}, url = {http://www.sciencedirect.com/science/article/pii/S0167494319302341}, author = {Guusje van der Leeuw and Emmeline Ayers and Annette H. Blankenstein and Henri{\"e}tte E. van der Horst and Joe Verghese} } @mastersthesis {10337, title = {Functional Status and Muscle Evaluation in Older Women with Urinary Incontinence}, volume = {M.S.}, year = {2019}, note = {Copyright - Database copyright ProQuest LLC; ProQuest does not claim copyright in the individual underlying works; Last updated - 2019-07-13}, pages = {103}, school = {University of Maryland, Baltimore}, type = {phd}, abstract = {Background: Urinary incontinence (UI) and mobility limitations are prevalent in older women suggesting common pathophysiology. Objectives: 1) to evaluate Short Physical and Performance Battery (SPPB) and Modified Physical Performance Test (MPPT); 2) to describe lower extremities/pelvic floor muscles among older women with UI. Methods: Women age >= 70 years with UI underwent functional testing, clinical, and magnetic resonance imaging evaluation. Spearman correlation coefficients were calculated between UI and mobility limitations. Results: MPPT was inversely moderately associated with UI severity impact on daily activities. SPPB was negatively associated with UI but findings were not statistically significant. Levator ani muscles were atrophic in all participants. Obturator and gluteal muscles had mild and moderate fatty infiltration, respectively. Conclusions: Lower MPPT is associated with increased UI severity impact on daily activities. Further research into shared pathophysiology between UI and mobility}, keywords = {0766:Epidemiology, Epidemiology, Functional status, Health and environmental sciences, Levator ani muscle, mobility, Pelvic floor muscle, Physical performance, Urinary incontinence}, isbn = {9781392301593}, url = {https://archive.hshsl.umaryland.edu/handle/10713/9585}, author = {Tatiana V D Sanses} } @article {13079, title = {Informing Educational Interventions using Genome-Wide Data, 2016-2019}, year = {2019}, institution = {Barcelona Computing Center}, address = {Catalonia, Spain}, keywords = {Economics, ECONOMICS OF EDUCATION, Epidemiology}, url = {https://t2-4.by-covid.bsc.es/jspui/handle/123456789/59600}, author = {N Davies} } @mastersthesis {10320, title = {The Role of Cumulative Advantage/Disadvantage in Disparities in Alzheimer{\textquoteright}s Disease Risk}, volume = {PhD}, year = {2019}, note = {Copyright - Database copyright ProQuest LLC; ProQuest does not claim copyright in the individual underlying works; Last updated - 2019-07-02}, pages = {207}, school = {University of Arizona}, type = {phd}, abstract = {BACKGROUND: Substantial disparities have been observed in Alzheimer{\textquoteright}s disease (AD) by race and social class. The persistence of health disparities over time and for diseases with distinct etiological processes suggests that the fundamental cause may reside within processes of advantage and disadvantage that accumulate across the life course. Although education is a well established risk factor for AD, it is unclear if the mechanistic role of education in AD disparities is through direct cognitive stimulation{\textemdash}the most commonly accepted hypothesis in AD research{\textemdash}or if it operates indirectly as a marker of social status and discrimination. OBJECTIVES: This dissertation aims to answer the question of how social processes at different points in the life course produce socioeconomic and racial inequalities in Alzheimer{\textquoteright}s disease risk. This question is broken into a series of three studies that examine the existing evidence for the role of modifiable risk factors in AD, and test for the role of cumulative advantage/disadvantage in the context of socioeconomic, and racial disparities. METHODS: Study one is a structured narrative review of studies that tested for differences by race of the effect of any of six modifiable risk factors (education, obesity, smoking, physical activity, social isolation, and psychosocial stress) for AD risk. Study two used a Generalized Estimating Equation to examine the effect of individual SES and state-level income inequality on Subjective Cognitive Decline, as reported in the Cognitive Decline module of the Behavioral Risk Factor Surveillance System. Study three used structural equation modeling to conduct mediation and conditional process analysis (moderated mediation) to examine the role of markers of socioeconomic status and stress in racial disparities in AD risk among participants of the National Social Life Health and Aging Project. RESULTS: Of 3,464 identified studies in study one, 45 tested for differences in the modifiable risk factors by race. Education was the most widely examined risk factor, and the only factor in the review with strong evidence for a role in racial disparities. In study two, a dose-response effect was observed for income while those with high school education reported better cognition than those with some college. State-level income inequality was not associated with cognitive decline. In study three, education consistently mediated the race-cognition pathway, and perceived stress and assets mediated the education-cognition pathway. In all models, the direct effect of race on cognition remained large. CONCLUSIONS: Combined, these studies confirmed the importance of education for socioeconomic and racial disparities in AD risk, but suggested that education operates as an indicator of social status and discrimination, as well as through its role via cognitive stimulation. These findings point to the importance of considering social factors from across the life course in public health research and interventions aiming to understand and reduce disparities in AD risk.}, keywords = {0573:Public health, 0626:Sociology, 0766:Epidemiology, African American, cognitive aging, Epidemiology, Health and environmental sciences, Health Disparities, Inequality, Public Health, race, Social Sciences, Social status, Sociology}, isbn = {9781392188200}, url = {https://repository.arizona.edu/handle/10150/633085}, author = {Peterson,Rachel L.} } @article {MCGRATH2019, title = {Weakness May Have a Causal Association With Early Mortality in Older Americans: A Matched Cohort Analysis}, journal = {Journal of the American Medical Directors Association}, year = {2019}, abstract = {Objectives Quantifying the association between muscle weakness and mortality with carefully matched cohorts will help to better establish the impact of weakness on premature death. We used a matched cohort analysis in a national sample of older Americans to determine if those who were weak had a higher risk for mortality compared with control groups with incrementally higher strength capacities. Design Longitudinal panel. Setting Detailed interviews that included physical measures were conducted in person, whereas core interviews were often performed over the telephone. Participants Data from 19,729 Americans aged at least 50 years from the 2006-2014 waves of the Health and Retirement Study were analyzed. Measures A handgrip dynamometer was used to assess handgrip strength (HGS) in each participant. Men with HGS <26 kg were considered weak, >=26 kg were considered not weak, and >=32 kg were considered strong. Women with HGS <16 kg were classified as weak, >=16 kg were classified as not-weak, and >=20 kg were classified as strong. The National Death Index and postmortem interviews determined the date of death. The greedy matching algorithm was used to match cohorts. Results Of the 1077 weak and not-weak matched pairs, 401 weak (37.2\%) and 296 not-weak (27.4\%) older Americans died over an average 4.4 {\textpm} 2.5-year follow-up. There were 392 weak (37.0\%) and 243 strong (22.9\%) persons who died over a mean 4.5 {\textpm} 2.5-year follow-up from the 1057 weak and strong matched pairs. Those in the weak cohort had a 1.40 [95\% confidence interval (CI) 1.19, 1.64] and 1.54 (CI 1.30, 1.83) higher hazard for mortality relative to persons in the not-weak and strong control cohorts, respectively. Conclusions and Implications Our findings may indicate a causal association between muscle weakness and mortality in older Americans. Health care providers should include measures of HGS as part of routine health assessments and discuss the health risks of muscle weakness with their patients.}, keywords = {Aging, Epidemiology, Geriatrics, Hand Strength, Muscle Strength, sarcopenia}, issn = {1525-8610}, doi = {https://doi.org/10.1016/j.jamda.2019.10.016}, url = {http://www.sciencedirect.com/science/article/pii/S152586101930756X}, author = {Ryan P McGrath and Brenda Vincent and Mark D Peterson and Donald A Jurivich and Lindsey J Dahl and Kyle J Hackney and Brian C Clark} } @mastersthesis {10284, title = {Chronic Conditions Profiles and Cardiometabolic Risk Factor Control among a Diverse Sample of Older Adults with Type 2 Diabetes Mellitus}, volume = {Master of Science in Public Health }, year = {2018}, note = {Copyright - Database copyright ProQuest LLC; ProQuest does not claim copyright in the individual underlying works; Last updated - 2018-08-08}, pages = {61}, school = {Gondar Medical University}, type = {phd}, abstract = {Background: Multiple chronic condition is common in older adults with diabetes. Several prior studies have shown that having multiple chronic condition impact cardiometabolic risk factor controls (i.e., blood pressure, High-density lipoprotein (HDL) cholesterol level, and high glycated hemoglobin (HbA1c). However, it is not clear whether these results extend to a multiethnic sample of older adults. Objectives: (1). Examine the association between Comorbidity profile and ABCs goals achievement. (2). Examine whether the association between comorbidity profile and ABCs goals achievement is moderated by race/ethnicity. Methods: A sample of 3532 participants from Health and Retirement Study (HRS) years 2010 and 2012 and corresponding HRS Biomarker data were included in this analysis. Individual without complete diabetes status and those with missing value of all outcome variables were excluded. The main outcome measures were three cardiometabolic risk factor controls (blood pressure control, glycated hemoglobin (HbA1c) control and HDL cholesterol control), which measured based on guideline-defined threshold. Explanatory variables were a participant{\textquoteright}s comorbidity profile, characterized by the presence of specific chronic condition types (none, concordant only, discordant only, and both concordant and discordant). Analyses included logistic regression adjusted for survey years, socio-demographic, clinical and lifestyle characteristic factors. Results: In the final study sample, (66\%) were had both concordant and discordant condition, 19\% were had only concordant condition, 9\% were had only discordant condition, and only 6\% were had no other chronic condition beside diabetes. We did not find significant associations between comorbidity profile and Blood pressure control (for concordant: OR = 0.9, 95\% CI = (.05- 1.7), discordant: OR= 1.2, 95\% CI (0.6 {\textendash} 2.1), and both condition: OR= 1.0 95\% CI (0.6 {\textendash} 1.8)). Diabetes patient with only discordant chronic condition or both concordant and discordant chronic condition were more likely to have HbA1c controlled than those with no chronic condition beside diabetes (for discordant: OR = 2.37 95\% CI = (1.30 {\textendash} 4.33) and both condition: OR= 2.15 95\% CI (1.18 {\textendash} 3.93). The association between HDL cholesterol and comorbidity profile were modified by race/ethnicity. Having concordant conditions was negatively associated with HDL cholesterol control among Hispanic (OR = 0.36 95\% CI = 0.14 {\textendash} 0.92). The association was not significant among whites or blacks. Conclusions: This study shows that Comorbidity profile is associated with ABCs goals achievements among older adults with diabetes. Having discordant chronic conditions makes HbA1c goal achievement more likely. However, having concordant conditions makes HDL cholesterol goal achievement less likely: an effect that varies by race/ethnicity. Future study should further examine the association by using comprehensive set of chronic conditions.}, keywords = {0766:Epidemiology, Epidemiology, Health and environmental sciences}, isbn = {9780438112858}, url = {https://scholarcommons.sc.edu/etd/4505/}, author = {Kidanie,Tsion} }