TY - JOUR T1 - Early Cognitive Decline and Its Impact On Spouse’s Loneliness JF - Research in Human DevelopmentResearch in Human Development Y1 - 2020 A1 - Amanda N Leggett A1 - Choi, Hwajung A1 - William J. Chopik A1 - Hui Liu A1 - Gonzalez, Richard KW - cognition impairment KW - depression KW - Loneliness KW - Spouses AB - Loneliness is common in dementia caregivers as cognitive impairment (CI) alters marital and social relationships. Unexplored is how an individual's loneliness is affected at earlier, more ambiguous, periods of their spouse's CI. Using the Health and Retirement Study, our study participants included 2,206 coupled individuals with normal cognitive function at the 2006/8 baseline. Loneliness outcomes at baseline, 4-year, and 8-year follow-up are assessed by the status of transition to cognitive impairment no dementia (TCIND) (2010/12 & 2014/16) using linear mixed models. Individual's loneliness was stable when their spouse's cognition remained normal, but increased with the spouse's TCIND. The increase in loneliness did not vary by gender. Loneliness, a key risk factor for reduced life quality and increased depression, increases even at early stages of a partner's CIND. This work suggests the potential impact of early intervention and social support for partners of individuals with CIND. VL - 17 SN - 1542-7609 IS - 1 ER - TY - JOUR T1 - Frailty Phenotype and Cause-Specific Mortality in the United States JF - The Journals of Gerontology: Series A Y1 - 2020 A1 - Matthew C. Lohman A1 - Amanda Sonnega A1 - Nicholas V Resciniti A1 - Amanda N Leggett KW - Cause of Death KW - Frailty KW - Incidence KW - Mortality KW - Prefrailty AB - Frailty is a common condition among older adults increasing risk of adverse outcomes including mortality; however, little is known about the incidence or risk of specific causes of death among frail individuals.Data came from the Health and Retirement Study (HRS; 2004–2012), linked to underlying cause-of-death information from the National Death Index (NDI). Community-dwelling HRS participants aged 65 and older who completed a general health interview and physical measurements (n = 10,490) were included in analysis. Frailty was measured using phenotypic model criteria—exhaustion, low weight, low energy expenditure, slow gait, and weakness. Underlying causes of death were determined using International Classification of Diseases, Version 10 codes. We used Cox proportional hazards and competing risks regression models to calculate and compare incidence of cause-specific mortality by frailty status.During follow-up, prefrail and frail older adults had significantly greater hazard of all-cause mortality compared to individuals without symptoms (adjusted hazard ratio [HR] prefrail: 1.85, 95\% CI: 1.51, 2.25; HR frail: 2.75, 95\% CI: 2.14, 3.53). Frailty was associated with 2.96 (95\% CI: 2.17, 4.03), 2.82 (95\% CI: 2.02, 3.94), 3.48 (95\% CI: 2.17, 5.59), and 2.87 (95\% CI: 1.47, 5.59) times greater hazard of death from heart disease, cancer, respiratory illness, and dementia, respectively.Significantly greater risk of mortality from several different causes should be considered alongside the potential costs of screening and intervention for frailty in subspecialty and general geriatric clinical practice. Findings may help investigators estimate the potential impact of frailty reduction approaches on mortality. VL - 75 IS - 10 N1 - glaa025 ER - TY - JOUR T1 - Physical Activity and Insomnia Symptoms Over 10 Years in a U.S. National Sample of Late-Middle-Age and Older Adults: Age Matters JF - Journal of Aging and Physical Activity Y1 - 2020 A1 - Amanda Sonnega A1 - Amanda N Leggett A1 - Renee Pepin A1 - Shervin Assari KW - insomnia AB - Research suggests that physical activity may influence sleep, yet more research is needed before it can be considered a frontline treatment for insomnia. Less is known about how this relationship is moderated by age. Using multilevel modeling, we examined self-reported physical activity and insomnia symptoms in 18,078 respondents from the U.S. nationally representative Health and Retirement Study (2004–2014). The mean baseline age was 64.7 years, with 53.9% female. Individuals who reported more physical activity (B = −0.005, p < .001) had fewer insomnia symptoms. Over 10 years, the respondents reported fewer insomnia symptoms at times when they reported more physical activity than was average for them (B = −0.003, p < .001). Age moderated this relationship (B = 0.0002, p < .01). Although modest, these findings concur with the literature, suggesting moderate benefits of physical activity for sleep in older adults. Future research should aim to further elucidate this relationship among adults at advanced ages. ER - TY - JOUR T1 - Till death do us part: Intersecting health and spousal dementia caregiving on caregiver mortality. JF - Journal of Aging and Health Y1 - 2020 A1 - Amanda N Leggett A1 - Amanda Sonnega A1 - Matthew C. Lohman KW - Caregiving KW - Cognitive Ability KW - End of life decisions KW - Marriage AB -

OBJECTIVE: We consider whether it is the healthiest dementia caregivers who experience a mortality benefit and whether a protective association is consistent for leading causes of mortality.

METHOD: Using the Health and Retirement study (2000-2012), Cox survival models predict time to death for dementia caregivers, including an interaction between dementia caregiver status and self-rated health. The nationally representative sample consisted of 10,650 married adults aged 51 or older (917 dementia caregivers).

RESULTS: A significant interaction between dementia caregiver status and self-rated health suggested that relative to noncaregivers, dementia caregivers had reduced mortality, with this effect particularly strong at lower levels of self-rated health. The protective effect of dementia caregiver status was consistent across death by heart disease, cancer, and cerebrovascular disease.

DISCUSSION: These findings add to a growing body of literature suggesting that caregiving may provide a mortality benefit and a reason to maintain health.

VL - 32 IS - 7-8 ER - TY - JOUR T1 - Comparing Estimates of Fall-Related Mortality Incidence Among Older Adults in the United States JF - The Journals of Gerontology: Series A Y1 - 2019 A1 - Matthew C. Lohman A1 - Amanda Sonnega A1 - Emily J Nicklett A1 - Estenson, Lillian A1 - Amanda N Leggett KW - Falls KW - Mortality KW - Risk Factors AB - Background Falls are the leading cause of injury-related mortality among older adults in the United States, but incidence and risk factors for fall-related mortality remain poorly understood. This study compared fall-related mortality incidence rate estimates from a nationally representative cohort with those from a national vital record database and identified correlates of fall-related mortality. Methods Cause-of-death data from the National Death Index (NDI; 1999–2011) were linked with eight waves from the Health and Retirement Study (HRS), a representative cohort of U.S. older adults (N = 20,639). Weighted fall-related mortality incidence rates were calculated and compared with estimates from the Centers for Disease Control and Prevention (CDC) vital record data. Fall-related deaths were identified using International Classification of Diseases (Version 10) codes. Person-time at risk was calculated from HRS entry until death or censoring. Cox proportional hazards models were used to identify individual-level factors associated with fall-related deaths. Results The overall incidence rate of fall-related mortality was greater in HRS–NDI data (51.6 deaths per 100,000; 95% confidence interval: 42.04, 63.37) compared with CDC data (42.00 deaths per 100,000; 95% confidence interval: 41.80, 42.19). Estimated differences between the two data sources were greater for men and adults aged 85 years and older. Greater age, male gender, and self-reported fall history were identified as independent risk factors for fall-related mortality. Conclusion Incidence rates based on aggregate vital records may substantially underestimate the occurrence of and risk for fall-related mortality differentially in men, minorities, and relatively younger adults. Cohort-based estimates of individual fall-related mortality risk are important supplements to vital record estimates. UR - https://academic.oup.com/biomedgerontology/advance-article/doi/10.1093/gerona/gly250/5144627http://academic.oup.com/biomedgerontology/advance-article-pdf/doi/10.1093/gerona/gly250/26613013/gly250.pdf ER - TY - JOUR T1 - The association of insomnia and depressive symptoms with all-cause mortality among middle-aged and old adults. JF - International Journal of Geriatric Psychiatry Y1 - 2018 A1 - Amanda N Leggett A1 - Amanda Sonnega A1 - Matthew C. Lohman KW - Depressive symptoms KW - Longevity KW - Mortality KW - Sleep AB -

OBJECTIVES: Insomnia and depressive symptoms are commonly reported by adults and have independently been found to be associated with mortality, though contrasting findings are reported. Given the high comorbidity and interrelatedness between these symptoms, we tested whether insomnia symptoms explain risk of death independent of depressive symptoms. We examined insomnia symptoms and depressive symptoms, in addition to other health and demographic covariates, as predictors of all-cause mortality.

METHODS: The sample included 15 418 adults aged 51 and older drawn from a nationally representative, population-based study of adults in the United States, the Health and Retirement Study. Cox survival models were used to analyze time to death between the 2002 and 2014 study waves (5 waves). Controlling for health and demographic covariates, in 3 separate models, depressive symptoms and insomnia symptoms were independently and then together considered as risk factors for all-cause mortality (drawn from the National Death Index).

RESULTS: After adjustment for covariates, insomnia symptoms (HR = 1.10, CI:1.07-1.13) and depressive symptoms (HR = 1.14, CI:1.12-1.16) each were associated with a greater hazard of death. When considered together, however, depressive symptoms fully accounted for the association between insomnia symptoms and mortality.

CONCLUSION: Though their effects are small relative to health and demographic characteristics, both insomnia symptoms and depressive symptoms were associated with a greater hazard of death. Yet depressive symptoms accounted for the insomnia association when both were considered in the model. Screening for depression and providing validated treatments may reduce mortality risk in old adults with depressive symptoms.

VL - 33 IS - 9 U1 - http://www.ncbi.nlm.nih.gov/pubmed/29939437?dopt=Abstract ER - TY - JOUR T1 - Major Depression and Subthreshold Depression among Older Adults Receiving Home Care. JF - American Journal of Geriatric Psychiatry Y1 - 2018 A1 - Xiang, Xiaoling A1 - Amanda N Leggett A1 - Himle, Joseph A A1 - Helen C Kales KW - Caregiving KW - Community-dwelling KW - Depressive symptoms AB -

OBJECTIVE: This study aims to estimate the prevalence and correlates of major and subthreshold depression and the extent of treatment utilization in older adults receiving home care.

METHODS: The study sample included 811 community-dwelling adults aged 60 and over who received paid home care during the 2008-2014 waves of the Health and Retirement Study. Depression was assessed using short forms of the Composite International Diagnostic Interview and the Center for Epidemiologic Studies Depression Scale. Logistic regression was used to examine correlates of depression type and treatment utilization.

RESULTS: One in two older home care recipients suffered from probable depression; 13.4% of the sample suffered from major depression and an additional 38.7% met study criteria for subthreshold depression. The majority (72.7%) of participants with major depression and almost half (44.5%) of participants with subthreshold depression reported taking medication for anxiety or depression. One-third (33.2%) of older home care recipients with major depression and 14.2% of those with subthreshold depression reported receiving formal psychiatric or psychological treatment. Males as compared with females and persons with pain problems as compared with no pain complaints had a higher risk of subthreshold and major depression. The receipt of medication or psychiatric treatment declined with age. African Americans were less likely to receive medication for anxiety or depression compared with non-Hispanic whites.

CONCLUSION: Depression affects a substantial proportion of older adults receiving home care and may be inappropriately treated. Future research is needed to develop optimal strategies for integrating depression assessment and treatment into home care.

VL - 26 IS - 9 U1 - http://www.ncbi.nlm.nih.gov/pubmed/29884541?dopt=Abstract ER - TY - JOUR T1 - Depressive symptoms in recipients of home- and community-based services in the United States: Are older adults receiving the care they need? JF - American Journal of Geriatric Psychiatry Y1 - 2017 A1 - Renee Pepin A1 - Amanda N Leggett A1 - Amanda Sonnega A1 - Shervin Assari KW - Caregiving KW - Community-based services KW - Depressive symptoms AB -

OBJECTIVE: To understand unmet depression needs of older adults, the current study investigates depressive symptoms, psychiatric treatment, and home- and community-based service (HCBS) use in a nationally representative sample of older adults in the United States.

METHODS: Participants included 5,582 adults aged 60 and over from the 2010-2012 waves of the nationally representative Health and Retirement Study. Weighted bivariate analyses were used to examine the frequency of depressive symptoms (Center for Epidemiologic Studies Depression Scale) and psychiatric treatment among HCBS recipients compared with non-HCBS recipients. Weighted logistic regression models were used to evaluate the effect of depressive symptoms on HCBS use.

RESULTS: HCBS recipients had a higher frequency of depressive symptoms compared with nonrecipients (27.5% versus 10.4%, respectively). In particular, transportation service recipients had the highest frequency of depressive symptoms (37.5%). HCBS recipients with depressive symptoms were no more likely than nonrecipients to receive psychiatric services. Depressive symptoms were associated with HCBS use, above and beyond sociodemographic and health risk factors.

CONCLUSION: Depressive symptoms are more frequent among HCBS recipients compared with nonrecipients; however, depressed HCBS recipients are no more likely to receive psychiatric services, suggesting unmet depression needs. HCBS may be a key setting for depression detection and delivery of mental health interventions.

VL - 25 IS - 12 U1 - http://www.ncbi.nlm.nih.gov/pubmed/28760513?dopt=Abstract ER - TY - JOUR T1 - Distress Associated with Dementia-Related Psychosis and Agitation in Relation to Healthcare Utilization and Costs. JF - American Journal of Geriatric Psychiatry Y1 - 2017 A1 - Donovan T Maust A1 - Helen C Kales A1 - Ryan J McCammon A1 - Frederic C. Blow A1 - Amanda N Leggett A1 - Kenneth M. Langa KW - Dementia KW - Depressive symptoms KW - Healthcare KW - Stress AB -

OBJECTIVES: Explore the relationship between behavioral and psychological symptoms of dementia (BPSD; specifically, delusions, hallucinations, and agitation/aggression) and associated caregiver distress with emergency department (ED) utilization, inpatient hospitalization, and expenditures for direct medical care.

DESIGN/SETTING/PARTICIPANTS: Retrospective cross-sectional cohort of participants with dementia (N = 332) and informants from the Aging, Demographics, and Memory Study, a nationally representative survey of U.S. adults >70 years old.

MEASUREMENTS: BPSD of interest and associated informant distress (trichotomized as none/low/high) were assessed using the Neuropsychiatric Inventory (NPI). Outcomes were determined from one year of Medicare claims and examined according to presence of BPSD and associated informant distress, adjusting for participant demographics, dementia severity, and comorbidity.

RESULTS: Fifty-eight (15%) participants with dementia had clinically significant delusions, hallucinations, or agitation/aggression. ED visits, inpatient admissions, and costs were not significantly higher among the group with significant BPSD. In fully adjusted models, a high level of informant distress was associated with all outcomes: ED visit incident rate ratio (IRR) 3.03 (95% CI: 1.98-4.63; p < 0.001), hospitalization IRR 2.78 (95% CI: 1.73-4.46; p < 0.001), and relative cost ratio 2.00 (95% CI: 1.12-3.59; p = 0.02).

CONCLUSIONS: A high level of informant distress related to participant BPSD, rather than the symptoms themselves, was associated with increased healthcare utilization and costs. Effectively identifying, educating, and supporting distressed caregivers may help reduce excess healthcare utilization for the growing number of older adults with dementia.

VL - 25 IS - 10 U1 - http://www.ncbi.nlm.nih.gov/pubmed/28754586?dopt=Abstract ER - TY - JOUR T1 - Predictors of New Onset Sleep Medication and Treatment Utilization Among Older Adults in the United States JF - The Journals of Gerontology Series A: Biological Sciences and Medical Sciences Y1 - 2016 A1 - Amanda N Leggett A1 - Renee Pepin A1 - Amanda Sonnega A1 - Shervin Assari KW - Health Conditions and Status AB - Background. Sleep disturbances are common among older adults resulting in frequent sleep medication utilization, though these drugs are associated with a number of risks. We examine rates and predictors of new prescription sleep medications and sleep treatments, as well as sleep treatments without a doctor s recommendation.Methods. Participants were 8,417 adults aged 50 and older from two waves of the nationally representative Health and Retirement Study (HRS) who were not using a sleep medication or treatment at baseline (2006). Logistic regression analyses are run with sociodemographic, health, and mental health factors as predictors of three outcomes: new prescription medication use, sleep treatment use, and sleep treatment out of a doctor s recommendation in 2010.Results. New sleep medication prescriptions were started by 7.68 , 12.62 started using a new sleep treatment, and 31.93 were using the treatment outside of their doctor s recommendation. Common predictors included greater severity of insomnia, worsening insomnia, older age, and use of psychiatric medications. New prescription medication use was also associated with poorer mental and physical health, whereas new sleep treatment was associated with being White, higher educated, and drinking less alcohol.Conclusions. Starting a new prescription sleep medication may reflect poorer health and higher health care utilization, whereas beginning a sleep treatment may reflect an individual s awareness of treatments and determination to treat their problem. Clinicians should be aware of predictors of new sleep medication and treatment users and discuss various forms of treatment or behavioral changes to help patients best manage sleep disturbance. VL - 71 UR - http://biomedgerontology.oxfordjournals.org/content/early/2016/01/10/gerona.glv227.abstract IS - 7 U4 - depression/medication/sleep ER -