%0 Journal Article %J PNAS %D 2023 %T Association of cumulative loneliness with all-cause mortality among middle-aged and older adults in the United States, 1996 to 2019. %A Yu, Xuexin %A Cho, Tsai-Chin %A Westrick, Ashly C %A Chen, Chen %A Kenneth M. Langa %A Lindsay C Kobayashi %K cumulative loneliness %K excess death %K Mortality %X

Loneliness is a growing public health concern worldwide. We characterized the association between cumulative loneliness and subsequent all-cause mortality, using data from 9,032 participants aged 50+ in the population-based US Health and Retirement Study (HRS) from 1996 to 2019. Loneliness status (yes; no) was measured biennially from 1996 to 2004, and we categorized the experience of cumulative loneliness over the 8-y period as never, one time point, two time points, and ≥three time points. A multivariable-adjusted age-stratified Cox proportional hazards regression model was fitted to examine the association between cumulative loneliness from 1996 to 2004 and all-cause mortality from 2004 to 2019. Excess deaths due to each category of cumulative loneliness were calculated. Compared to those who never reported loneliness from 1996 to 2004, participants experiencing loneliness at one time point, two time points, and ≥three time points respectively had 1.05 (95% CI: 0.96 to 1.15), 1.06 (95% CI: 0.95 to 1.19), and 1.16 (95% CI: 1.02 to 1.33) times higher hazards of mortality from 2004 to 2019 ( trend = 0.01). These results correspond to 106 (95% CI: 68 to 144), 202 (95% CI: 146 to 259), and 288 (95% CI: 233 to 343) excess deaths per 10,000 person-years, for those experiencing loneliness at each of one, two, or ≥three time points from 1996 to 2004. Cumulative loneliness in mid-to-later life may thus be a mortality risk factor with a notable impact on excess mortality. Loneliness may be an important target for interventions to improve life expectancy in the United States.

%B PNAS %V 120 %P e2306819120 %G eng %N 51 %R 10.1073/pnas.2306819120 %0 Journal Article %J J of the American Geriatric Society %D 2023 %T The devil's in the details: Variation in estimates of late-life activity limitations across national cohort studies. %A Ankuda, Claire K %A Covinsky, Kenneth %A Freedman, Vicki A %A Kenneth M. Langa %A Aldridge, Melissa D %A Yee, Cynthia %A Kelley, Amy S %K Activities of Daily Living %K Cohort Studies %K Disabled Persons %K Medicare %K Self Care %X

BACKGROUND: Assessing activity limitations is central to aging research. However, assessments of activity limitations vary, and this may have implications for the populations identified. We aim to compare measures of activities of daily living (ADLs) and their resulting prevalence and mortality across three nationally-representative cohort studies: the National Health and Aging Trends Study (NHATS), the Health and Retirement Survey (HRS), and the Medicare Current Beneficiary Survey (MCBS).

METHODS: We compared the phrasing and context of questions around help and difficulty with six self-care activities: eating, bathing, toileting, dressing, walking inside, and transferring. We then compared the prevalence and 1-year mortality for difficulty and help with eating and dressing.

RESULTS: NHATS, HRS, and MCBS varied widely in phrasing and framing of questions around activity limitations, impacting the proportion of the population found to experience difficulty or receive help. For example, in NHATS 12.4% [95% confidence interval (CI) 11.5%-13.4%] of the cohort received help with dressing, while in HRS this figure was 6.4% [95% CI 5.7%-7.2%] and MCBS 5.3% [95% CI 4.7%-5.8%]. When combined with variation in sampling frame and survey approach of each survey, such differences resulted in large variation in estimates of the older population of older adults with ADL disability.

CONCLUSIONS: In order to take late-life activity limitations seriously, we must clearly define the measures we use. Further, researchers and clinicians seeking to understand the experience of older adults with activity limitations should be careful to interpret findings in light of the framing of the question asked.

%B J of the American Geriatric Society %V 71 %P 858-868 %G eng %N 3 %R 10.1111/jgs.18158 %0 Journal Article %J Lancet Healthy Longev %D 2023 %T Negative wealth shocks in later life and subsequent cognitive function in older adults in China, England, Mexico, and the USA, 2012-18: a population-based, cross-nationally harmonised, longitudinal study. %A Cho, Tsai-Chin %A Yu, Xuexin %A Gross, Alden L %A Zhang, Yuan S %A Lee, Jinkook %A Kenneth M. Langa %A Lindsay C Kobayashi %X

BACKGROUND: Household wealth is positively related to cognitive health outcomes in later life. However, the association between negative wealth shocks and cognitive function in later life, and whether this association might differ across countries at different levels of economic development, is unclear. We aimed to investigate whether negative wealth shocks in later life are associated with cognitive function in older adults in China, England, Mexico, and the USA, and whether this association is modified by country income level.

METHODS: For this population-based, cross-nationally harmonised, longitudinal study, data were analysed from core interviews of the population-based US Health and Retirement Study (2012 and 2016) and its partner studies in China (the China Health and Retirement Longitudinal Study; 2015 and 2018), England (the English Longitudinal Study of Ageing; 2012 and 2016), and Mexico (Mexican Health and Aging Study; 2012 and 2015-16), and their respective Harmonized Cognitive Assessment Protocols (HCAPs). Negative wealth shocks over the follow-up periods of the respective cohorts were defined in two ways: an extreme loss of 75% or greater from the baseline amount of wealth, and a decline in within-population wealth quintile rank. The primary outcome was the harmonised general cognitive function (GCF) factor score, which was constructed with factor analysis on the HCAP neuropsychological assessments of memory, orientation, attention, executive function, and verbal fluency performance (mean 0; SD 1). We used sampling-weighted, multivariable-adjusted linear models to examine associations.

FINDINGS: Data from 9465 participants were included in this analysis: 3796 from China, 1184 from England, 1193 from Mexico, and 3292 from the USA. The mean baseline age of participants was 68·5 (SD 5·4) years in China (49·8% women), 72·0 (7·0) years in England (54·6% women), 70·6 (6·8) years in Mexico (55·1% women), and 72·7 (7·5) years in the USA (60·4% women). A wealth loss of 75% or greater was negatively associated with subsequent cognitive function in the USA (β -0·16 SD units; 95% CI -0·29 to -0·04) and China (-0·14; -0·21 to -0·07), but not in England (-0·01; -0·24 to 0·22) or Mexico (-0·11; -0·24 to 0·03). Similarly, within-population wealth quintile rank declines were negatively associated with subsequent cognitive function in the USA (β -0·07 per quintile rank decline; 95% CI -0·11 to -0·03) and China (β -0·07; -0·09 to -0·04), but not in England (-0·05; -0·11 to 0·01) or Mexico (-0·03; -0·07 to 0·01).

INTERPRETATION: The impact of wealth shocks in later life on subsequent lower level of cognitive function of older adults in China, England, Mexico, and the USA differed across macro-level socioeconomic structures. These findings suggest that government policies and social safety nets in countries with different levels of economic development might have a role in protecting older adults from adverse health effects of wealth losses in later life.

FUNDING: US National Institute on Aging, US National Institutes of Health.

%B Lancet Healthy Longev %G eng %R 10.1016/S2666-7568(23)00113-7 %0 Journal Article %J JAMA Network Open %D 2022 %T Association of Perceived Job Insecurity With Subsequent Memory Function and Decline Among Adults 55 Years or Older in England and the US, 2006 to 2016. %A Yu, Xuexin %A Kenneth M. Langa %A Cho, Tsai-Chin %A Lindsay C Kobayashi %K COVID-19 %K ELSA %K Employment %K England %K Female %K Male %K Memory Disorders %K Pandemics %K Prospective Studies %X

Importance: Intensified global economic competition and recent financial crises, including those associated with the COVID-19 pandemic, have contributed to uncertainty about job security. However, little is known about the association of perceived job insecurity with memory function and decline among older adults.

Objectives: To investigate the association between perceived job insecurity and subsequent memory function and rate of memory decline among older adults in the US and England.

Design, Setting, and Participants: This 10-year prospective population-based cohort study used data from the US Health and Retirement Study (HRS) and the English Longitudinal Study of Ageing (ELSA) collected from 2006 to 2016. Participants included 9538 adults 55 years or older. Data were analyzed from August 1 to 31, 2021.

Exposures: Perceived job insecurity (yes vs no) at baseline.

Main Outcomes and Measures: Episodic memory z scores at baseline and rate of decline during the follow-up.

Results: Among the 9538 study participants, the mean (SD) age at baseline was 60.97 (6.06) years, and 4981 (52.22%) were women. A total of 2320 participants (24.32%) reported job insecurity at baseline (1088 of 3949 [27.55%] in England and 1232 of 5589 [22.04%] in the US). Perceived job insecurity after 55 years of age was associated with lower baseline memory z scores in the fully adjusted model (β = -0.04 [95% CI, -0.08 to -0.01]) but not with rate of memory decline (β = 0.01 [95% CI, -0.01 to 0.01]). The association appeared to be stronger in the US than in England (job insecurity × US, β = -0.05 [95% CI, -0.11 to 0.02]), but the estimate was imprecise, potentially owing to low statistical power.

Conclusions and Relevance: The findings of this cohort study suggest that exposure to job insecurity in middle to late life was associated with worse memory function among older adults in the US and England. This association may vary across socioeconomic and social welfare contexts, although future studies with large samples from diverse socioeconomic settings are warranted.

%B JAMA Network Open %V 5 %P e227060 %G eng %N 4 %R 10.1001/jamanetworkopen.2022.7060 %0 Journal Article %J Innovation in Aging %D 2022 %T EDUCATION GRADIENTS IN LATER-LIFE COGNITIVE FUNCTION ACROSS LOW-, MIDDLE-, AND HIGH-INCOME COUNTRIES %A Yuan Zhang %A Brendan O'Shea %A Xuexin Yu %A Tsai-Chin Cho %A Kenneth M. Langa %A Alden Gross %A Lindsay C Kobayashi %K Education gradient %X Education is positively related to cognitive function. However, educational gradients in cognitive function may vary across older populations with different educational compositions and physical and social environments. We conducted one of the first cross-national comparative studies on educational differences in later-life cognitive function using harmonized data. Multivariable linear regressions were employed to estimate the association between education according to International Standard Classification of Education (ISCED) categories and cognitive function for adults ages 60+ from the United States, England, Mexico, South Africa, India, and China. Cross-country differences were tested using fully interacted models. Controlling for demographics and parental education, we found significant educational gradients in cognitive function in low- and middle-income countries; however, in high-income countries, only those with upper secondary education and above had a consistent cognitive advantage over those with primary education. This study suggests substantial country-level differences in cognitive benefits of educational attainment. %B Innovation in Aging %V 6 %8 12/2022 %G eng %N Supplement_1 %9 Journal Article %& 103 %R 10.1093/geroni/igac059.409 %0 Conference Paper %B ISEE Conference Abstracts %D 2021 %T Associations of Long-term Air Pollution Exposure and Incident Late-Life Disability in Older U.S. Adults: The Health Retirement Study %A Gao, Jiaqi %A Carlos F. Mendes de Leon %A D'Souza, Jennifer %A Zhang, Boya %A Szpiro, Adam %A Young, Michael %A Weuve, Jennifer %A Kenneth M. Langa %A Jessica Faul %A Kaufman, Joel %A Richard A Hirth %A Sara Dubowsky Adar %K Activities of Daily Living %K Air Pollution %K Long-Term Exposure %X Late-life disability is of critical concern to older adults and can reflect the cumulative burden of chronic disease over the lifespan. Although air pollution has been associated with many common chronic conditions, associations with disability are understudied. We aimed to quantify associations between long-term exposures to air pollution and late-life disability. METHODS: We used biennial data between 2000 and 2016 on self-reported Activities of Daily Living (ADL) from participants 65 years from the nationally representative Health and Retirement Study. Using a spatiotemporal prediction model, we estimated 10-year PM2.5, PM10-2.5, NO2, and O3 concentrations at participant residences. We then estimated the risk of incident ADL disability as a function of time-varying air pollution, adjusting for individual and area-level confounders and sampling weights in a Cox model. We fitted single- and two-pollutant models. RESULTS:Our study population of 16,927 adults (70+6.4 years) was predominantly non-Hispanic White (76%), Non-Hispanic Black (14%), and Hispanic White (8%) and 32% reported a new disability during follow-up. Overall, we found some evidence that air pollution was associated with an increased risk of ADL disability. After adjustment for place and PM2.5, we found that interquartile increases in PM10-2.5 and NO2 were associated with 8% (HR: 1.08 per 5 µg/m3, 95% CI: 1.01, 1.17) and 9% (HR: 1.09 per 6 ppb, 95% CI: 1.00, 1.19) greater hazards of ADL, respectively, with similar findings in the single pollutant models. PM2.5 and O3 were not associated with higher hazards of ADL in single or multipollutant models after detailed adjustment for place. CONCLUSIONS:This prospective study in a nationally representative sample of older adults found some evidence that higher levels of some but not all long-term air pollutants assessed are associated with increased risk of late-life disability. %B ISEE Conference Abstracts %V 2021 %G eng %U https://ehp.niehs.nih.gov/action/doSearch?AllField=Associations+of+Long-term+Air+Pollution+Exposure+and+Incident+Late-Life+Disability+in+Older+U.S.+Adults%3A+The+Health+Retirement+Study %N 1 %0 Journal Article %J Journal of Head Trauma Rehabilitation %D 2020 %T Physical and Functional Impairment Among Older Adults With a History of Traumatic Brain Injury. %A Erica S Kornblith %A Kenneth M. Langa %A Kristine Yaffe %A Raquel C Gardner %K Brain injury %K functional impairment %K physical impairment %X

OBJECTIVES: To examine the association of lifetime history of traumatic brain injury (TBI) with later-life physical impairment (PI) and functional impairment (FI) and to evaluate the impact of neurobehavioral symptoms that frequently co-occur with TBI on these relations.

PARTICIPANTS: A total of 1148 respondents to the 2014 Wave of the Health and Retirement Study, a nationally representative survey of older community-dwelling adults, randomly selected to participate in a TBI exposure survey. They reported no prior TBI (n = 737) or prior TBI (n = 411).

DESIGN: Cross-sectional survey study.

MAIN MEASURES: Physical impairment (self-reported difficulty with ≥1 of 8 physical activities); FI (self-reported difficulty with ≥1 of 11 activities of daily living); self-reported current neurobehavioral symptoms (pain, sleep problems, depression, subjective memory impairment); The Ohio State University TBI Identification Method (OSU-TBI-ID)-short form.

ANALYSES: Stepwise logistic regression models ([1] unadjusted; [2] adjusted for demographics and medical comorbidities; [3] additionally adjusted for neurobehavioral symptoms) compared PI and FI between TBI groups.

RESULTS: Traumatic brain injury-exposed (mean: 33.6 years postinjury) respondents were younger, less likely to be female, and reported more comorbidities and neurobehavioral symptoms. Although TBI was significantly associated with increased odds of PI and FI in unadjusted models and models adjusted for demographics/comorbidities (adjusted odds ratio, 95% confidence interval: PI 1.62, 1.21-2.17; FI 1.60, 1.20-2.14), this association was no longer statistically significant after further adjustment for neurobehavioral symptoms.

CONCLUSION: History of TBI is associated with substantial PI and FI among community-dwelling older adults. Further research is warranted to determine whether aggressive management of neurobehavioral symptoms in this population may mitigate long-term PI and FI in this population.

%B Journal of Head Trauma Rehabilitation %V 35 %G eng %N 4 %R 10.1097/HTR.0000000000000552 %0 Journal Article %J Journal of NeurotraumaJournal of Neurotrauma %D 2020 %T Prevalence of Lifetime History of Traumatic Brain Injury among Older Male Veterans Compared to Civilians: A Nationally Representative Study %A Erica S Kornblith %A Kristine Yaffe %A Kenneth M. Langa %A Raquel C Gardner %K Brain Injuries %K Dementia %K Traumatic %X Traumatic brain injury (TBI) is common among older adults as well as among Veterans in the United States and can increase risk for dementia. We compared prevalence of TBI in older male Veterans and civilians using a nationally representative sample. We examined data from 599 male respondents to the 2014 Wave of the Health and Retirement Study (HRS), a nationally representative survey of older adults, randomly selected to participate in a comprehensive TBI survey. Respondents self-reported no injury, non-TBI head/neck injury (NTI), or TBI. We used weighted analyses to examine prevalence of injury and relative risk of injury sub-types. Among male Veterans, we found a national prevalence of over 70% for lifetime history of any head/neck injury (TBI plus NTI), 14.3% for multiple NTI, and 36% for lifetime history of at least one TBI. In contrast, prevalence estimates for male civilians were 58% for lifetime history of head/neck injury, 4.8% for multiple NTI, and 45% for lifetime history of at least one TBI (all comparisons p<0.001). Male civilians have higher self-reported TBI prevalence, while male Veterans have higher self-reported NTI and multiple-NTI prevalence. Further research on drivers of the unexpectedly higher prevalence of lifetime history of TBI in male civilians, as well as on mechanisms and sequelae of the highly prevalent non-TBI head/neck injuries among older male Veterans, is warranted.Traumatic brain injury (TBI) is common among older adults as well as among Veterans in the United States and can increase risk for dementia. We compared prevalence of TBI in older male Veterans and civilians using a nationally representative sample. We examined data from 599 male respondents to the 2014 Wave of the Health and Retirement Study (HRS), a nationally representative survey of older adults, randomly selected to participate in a comprehensive TBI survey. Respondents self-reported no injury, non-TBI head/neck injury (NTI), or TBI. We used weighted analyses to examine prevalence of injury and relative risk of injury sub-types. Among male Veterans, we found a national prevalence of over 70% for lifetime history of any head/neck injury (TBI plus NTI), 14.3% for multiple NTI, and 36% for lifetime history of at least one TBI. In contrast, prevalence estimates for male civilians were 58% for lifetime history of head/neck injury, 4.8% for multiple NTI, and 45% for lifetime history of at least one TBI (all comparisons p<0.001). Male civilians have higher self-reported TBI prevalence, while male Veterans have higher self-reported NTI and multiple-NTI prevalence. Further research on drivers of the unexpectedly higher prevalence of lifetime history of TBI in male civilians, as well as on mechanisms and sequelae of the highly prevalent non-TBI head/neck injuries among older male Veterans, is warranted. %B Journal of NeurotraumaJournal of Neurotrauma %@ 0897-7151 %G eng %R https://doi.org/10.1089/neu.2020.7062 %0 Journal Article %J Journal of the American Geriatrics Society %D 2017 %T Neuroprotective diets are associated with better cognitive function: The Health and Retirement Study. %A Claire T McEvoy %A Heidi M Guyer %A Kenneth M. Langa %A Kristine Yaffe %K Cognitive Ability %K Eating habits %X

OBJECTIVES: To evaluate the association between the Mediterranean diet (MedDiet) and the Mediterranean-DASH diet Intervention for Neurodegeneration Delay (MIND diet) and cognition in a nationally representative population of older U.S. adults.

DESIGN: Population-based cross-sectional study.

SETTING: Health and Retirement Study.

PARTICIPANTS: Community-dwelling older adults (N = 5,907; mean age 67.8 ± 10.8).

MEASUREMENTS: Adherence to dietary patterns was determined from food frequency questionnaires using criteria determined a priori to generate diet scores for the MedDiet (range 0-55) and MIND diet (range 0-15). Cognitive performance was measured using a composite test score of global cognitive function (range 0-27). Linear regression was used to compare cognitive performance according to tertiles of dietary pattern. Logistic regression was used to examine the association between dietary patterns and clinically significant cognitive impairment. Models were adjusted for age, sex, race, educational attainment, and other health and lifestyle covariates.

RESULTS: Participants with mid (odds ratio (OR) = 0.85, 95% confidence interval (CI) = 0.71-1.02, P = .08) and high (OR 0.65, 95% CI = 0.52-0.81, P < .001) MedDiet scores were less likely to have poor cognitive performance than those with low scores in fully adjusted models. Results for the MIND diet were similar. Higher scores in each dietary pattern were independently associated with significantly better cognitive function (P < .001) in a dose-response manner (P trend  < .001).

CONCLUSION: In a large nationally representative population of older adults, greater adherence to the MedDiet and MIND diet was independently associated with better cognitive function and lower risk of cognitive impairment. Clinical trials are required to elucidate the role of dietary patterns in cognitive aging.

%B Journal of the American Geriatrics Society %V 65 %P 1857-1862 %G eng %N 8 %1 http://www.ncbi.nlm.nih.gov/pubmed/28440854?dopt=Abstract %R 10.1111/jgs.14922 %0 Journal Article %J PLoS Medicine %D 2017 %T Subjective and objective cognitive function among older adults with a history of traumatic brain injury: A population-based cohort study. %A Raquel C Gardner %A Kenneth M. Langa %A Kristine Yaffe %K Brain injury %K Cognitive Ability %K Older Adults %X

BACKGROUND: Traumatic brain injury (TBI) is extremely common across the lifespan and is an established risk factor for dementia. The cognitive profile of the large and growing population of older adults with prior TBI who do not have a diagnosis of dementia, however, has not been well described. Our aim was to describe the cognitive profile associated with prior TBI exposure among community-dwelling older adults without dementia-an understudied but potentially vulnerable population.

METHODS AND FINDINGS: In this population-based cohort study, we studied 984 community-dwelling older adults (age 51 y and older and their spouses) without dementia who had been randomly selected from respondents to the 2014 wave of the Health and Retirement Study to participate in a comprehensive TBI survey and who either reported no prior TBI (n = 737) or prior symptomatic TBI resulting in treatment in a hospital (n = 247). Mean time since first TBI was 38 ± 19 y. Outcomes assessed included measures of global cognitive function, verbal episodic memory, semantic fluency, and calculation as well as a measure of subjective memory ("How would you rate your memory at the present time?"). We compared outcomes between the two TBI groups using regression models adjusting for demographics, medical comorbidities, and depression. Sensitivity analyses were performed stratified by TBI severity (no TBI, TBI without loss of consciousness [LOC], and TBI with LOC). Respondents with TBI were younger (mean age 64 ± 10 y versus 68 ± 11 y), were less likely to be female, and had higher prevalence of medical comorbidities and depression than respondents without TBI. Respondents with TBI did not perform significantly differently from respondents without TBI on any measure of objective cognitive function in either raw or adjusted models (fully adjusted: global cognitive function score 15.4 versus 15.2, p = 0.68; verbal episodic memory score 4.4 versus 4.3, p = 0.79; semantic fluency score 15.7 versus 14.0, p = 0.21; calculation impairment 22% versus 26%, risk ratio [RR] [95% CI] = 0.86 [0.67-1.11], p = 0.24). Sensitivity analyses stratified by TBI severity produced similar results. TBI was associated with significantly increased risk for subjective memory impairment in models adjusted for demographics and medical comorbidities (29% versus 24%; RR [95% CI]: 1.26 [1.02-1.57], p = 0.036). After further adjustment for active depression, however, risk for subjective memory impairment was no longer significant (RR [95% CI]: 1.18 [0.95-1.47], p = 0.13). Sensitivity analyses revealed that risk of subjective memory impairment was increased only among respondents with TBI with LOC and not among those with TBI without LOC. Furthermore, the risk of subjective memory impairment was significantly greater among those with TBI with LOC versus those without TBI even after adjustment for depression (RR [95% CI]: partially adjusted, 1.38 [1.09-1.74], p = 0.008; fully adjusted, 1.28 [1.01-1.61], p = 0.039).

CONCLUSIONS: In this population-based study of community-dwelling older adults without dementia, those with prior TBI with LOC were more likely to report subjective memory impairment compared to those without TBI even after adjustment for demographics, medical comorbidities, and active depression. Lack of greater objective cognitive impairment among those with versus without TBI may be due to poor sensitivity of the cognitive battery or survival bias, or may suggest that post-TBI cognitive impairment primarily affects executive function and processing speed, which were not rigorously assessed in this study. Our findings show that among community-dwelling non-demented older adults, history of TBI is common but may not preferentially impact cognitive domains of episodic memory, attention, working memory, verbal semantic fluency, or calculation.

%B PLoS Medicine %V 14 %P e1002246 %8 03/2017 %G eng %N 3 %R 10.1371/journal.pmed.1002246 %0 Journal Article %J Information, Communication and Society %D 2016 %T Mapping the Two Levels of Digital Divide: Internet Access and Social Network Site Adoption among Older Adults in the USA %A Rebecca P. Yu %A Nicole B. Ellison %A Ryan J McCammon %A Kenneth M. Langa %K Demographics %K Health Conditions and Status %X Older adults have increasingly adopted Internet and social network sites (SNSs), but little communication scholarship has explored systematic differences in access within this population. Using a nationally representative sample of Americans over the age of 50 years from the 2012 Health and Retirement Study, we examine Internet access (N?=?18,851) and SNS adoption patterns (N?=?869) among this sample and explore how these patterns vary by age. Regarding Internet access, results suggest that while the gender divide has reversed in favor of women, older adults who are economically, socioculturally, or physically disadvantaged are less likely to have reliable Internet access. In addition, the view that the various divides in Internet access are less of a concern for those who are younger is only partially supported, as some access-related divides do not vary by age or even decrease with age. For SNS adoption, we found that access to technological resources (diversity of online activities) positively predicts SNS use. Moreover, SNS users are more likely to be younger, female, widowed, and homemakers, perhaps because these individuals are more motivated to use SNSs to complement or compensate for their existing social status. These findings reveal unique challenges and motivations in relation to Internet access and SNS adoption patterns across the later life span. %B Information, Communication and Society %V 19 %P 1445-1464 %G eng %U http://dx.doi.org/10.1080/1369118X.2015.1109695 %N 10 %4 Social network site/Internet access/digital divide/older adults %$ 999999 %& 1445 %R 10.1080/1369118X.2015.1109695 %0 Journal Article %J Ageing and Society %D 2015 %T The relationships that matter: social network site use and social wellbeing among older adults in the United States of America %A R. P. Yu %A Ryan J McCammon %A Nicole B. Ellison %A Kenneth M. Langa %K Adult children %K Health Conditions and Status %X An increasing number of middle-aged and older Americans are using social network sites (SNSs), but little research has addressed how SNS use is associated with social wellbeing outcomes in this population. Using a nationally representative sample of 1,620 Americans older than 50 from the 2012 Health and Retirement Study (HRS), we examine the relationship between older adults SNS use and social wellbeing associated with non-kin and kin relations and explore how these associations vary by age. Results of ordinary least-squares regression analyses suggest that SNS use is positively associated with non-kin-related social wellbeing outcomes, including perceived support from friends ( = 0.13; p 0.001; N = 460) and feelings of connectedness ( = 0.10; p 0.001; N = 463). Regression models employing interaction terms of age and SNS use further reveal that SNS use contributes to feelings of connectedness to a greater extent as people age ( = 0.10; p 0.001; N = 463). Of all kin-related social wellbeing outcomes, SNS use only predicts increased perceived support from children ( = 0.08; p 0.05; N = 410), and age negatively shapes this relationship ( = 0.14; p 0.001; N = 410). As older people engage with an increasingly smaller and narrower network with a greater proportion of kin contacts, our results suggest that SNS use may help older adults access differential social benefits throughout later life. Copyright Cambridge University Press 2015 This is a work of the U.S. Government and is not subject to copyright protection in the United States. %B Ageing and Society %G eng %U http://www.scopus.com/inward/record.url?eid=2-s2.0-84934325062andpartnerID=40andmd5=4576f4f7c6bbe43a40f9370e613cde7a %4 feelings of connectedness/feelings of isolation/social network site/social support/social wellbeing %$ 999999 %R 10.1017/S0144686X15000677 %0 Journal Article %J Alzheimers Dement %D 2014 %T Development and validation of a brief dementia screening indicator for primary care. %A Deborah E Barnes %A Alexa S. Beiser %A Anne Lee %A Kenneth M. Langa %A Alain Koyama %A Sarah R Preis %A John Neuhaus %A Ryan J McCammon %A Kristine Yaffe %A Seshadri, Sudha %A Mary Haan %A David R Weir %K Aged %K Cohort Studies %K Dementia %K Female %K Humans %K Male %K Mass Screening %K Predictive Value of Tests %K Primary Health Care %K Proportional Hazards Models %K Risk Assessment %X

BACKGROUND: Detection of "any cognitive impairment" is mandated as part of the Medicare annual wellness visit, but screening all patients may result in excessive false positives.

METHODS: We developed and validated a brief Dementia Screening Indicator using data from four large, ongoing cohort studies (the Cardiovascular Health Study [CHS]; the Framingham Heart Study [FHS]; the Health and Retirement Study [HRS]; the Sacramento Area Latino Study on Aging [SALSA]) to help clinicians identify a subgroup of high-risk patients to target for cognitive screening.

RESULTS: The final Dementia Screening Indicator included age (1 point/year; ages, 65-79 years), less than 12 years of education (9 points), stroke (6 points), diabetes mellitus (3 points), body mass index less than 18.5 kg/m(2) (8 points), requiring assistance with money or medications (10 points), and depressive symptoms (6 points). Accuracy was good across the cohorts (Harrell's C statistic: CHS, 0.68; FHS, 0.77; HRS, 0.76; SALSA, 0.78).

CONCLUSIONS: The Dementia Screening Indicator is a simple tool that may be useful in primary care settings to identify high-risk patients to target for cognitive screening.

%B Alzheimers Dement %I 10 %V 10 %P 656-665.e1 %8 2014 Nov %G eng %U http://www.scopus.com/inward/record.url?eid=2-s2.0-84893186546andpartnerID=40andmd5=3b617dce24578e022db389d90ad9ddd1 %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/24491321?dopt=Abstract %2 PMC4119094 %4 Dementia/Primary care/Risk prediction modeling/Screening/Cognitive Impairment %$ 999999 %R 10.1016/j.jalz.2013.11.006 %0 Journal Article %J BMC Medicine %D 2013 %T Depression, antidepressant medications, and risk of Clostridium difficile infection. %A Mary A M Rogers %A M. Todd Greene %A Vincent B Young %A Sanjay Saint %A Kenneth M. Langa %A John Y Kao %A David M. Aronoff %K Antidepressants %K Clostridium %K Depressive symptoms %K Infection %K Older Adults %X

BACKGROUND: An ancillary finding in previous research has suggested that the use of antidepressant medications increases the risk of developing Clostridium difficile infection (CDI). Our objective was to evaluate whether depression or the use of anti-depressants altered the risk of developing CDI, using two distinct datasets and study designs.

METHODS: In Study 1, we conducted a longitudinal investigation of a nationally representative sample of older Americans (n = 16,781), linking data from biennial interviews to physician and emergency department visits, stays in hospital and skilled nursing facilities, home health visits, and other outpatient visits. In Study 2, we completed a clinical investigation of hospitalized adults who were tested for C. difficile (n = 4047), with cases testing positive and controls testing negative. Antidepressant medication use prior to testing was ascertained.

RESULTS: The population-based rate of CDI in older Americans was 282.9/100,000 person-years (95% confidence interval (CI)) 226.3 to 339.5) for individuals with depression and 197.1/100,000 person-years for those without depression (95% CI 168.0 to 226.1). The odds of CDI were 36% greater in persons with major depression (95% CI 1.06 to 1.74), 35% greater in individuals with depressive disorders (95% CI 1.05 to 1.73), 54% greater in those who were widowed (95% CI 1.21 to 1.95), and 25% lower in adults who did not live alone (95% CI 0.62 to 0.92). Self-reports of feeling sad or having emotional, nervous or psychiatric problems at baseline were also associated with the later development of CDI. Use of certain antidepressant medications during hospitalization was associated with altered risk of CDI.

CONCLUSIONS: Adults with depression and who take specific anti-depressants seem to be more likely to develop CDI. Older adults who are widowed or who live alone are also at greater risk of CDI.

%B BMC Medicine %V 11 %P 121 %8 2013 May 07 %G eng %R 10.1186/1741-7015-11-121 %0 Journal Article %J New England Journal of Medicine %D 2013 %T New insights into the dementia epidemic. %A Eric B Larson %A Kristine Yaffe %A Kenneth M. Langa %K Aging %K Cognitive Ability %K Dementia %K Health Conditions and Status %K Older Adults %B New England Journal of Medicine %V 369 %P 2275-7 %8 2013 Dec 12 %G eng %N 24 %R 10.1056/NEJMp1311405 %0 Journal Article %J Arch Intern Med %D 2011 %T Development and validation of a brief cognitive assessment tool: the sweet 16. %A Tamara G Fong %A Richard N Jones %A James L Rudolph %A Frances Margaret Yang %A Tommet, Douglas %A Habtemariam, Daniel %A Edward R Marcantonio %A Kenneth M. Langa %A Sharon K Inouye %K Aged %K Aged, 80 and over %K Cognition Disorders %K Cohort Studies %K Dementia %K Female %K Humans %K Male %K Neuropsychological tests %K Surveys and Questionnaires %X

BACKGROUND: Cognitive impairment is often unrecognized among older adults. Meanwhile, current assessment instruments are underused, lack sensitivity, or may be restricted by copyright laws. To address these limitations, we created a new brief cognitive assessment tool: the Sweet 16.

METHODS: The Sweet 16 was developed in a cohort from a large post-acute hospitalization study (n=774) and compared with the Mini-Mental State Examination (MMSE). Equipercentile equating identified Sweet 16 cut points that correlated with widely used MMSE cut points. Sweet 16 performance characteristics were independently validated in a cohort from the Aging, Demographics, and Memory Study (n=709) using clinical consensus diagnosis, the modified Blessed Dementia Rating Scale, and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE).

RESULTS: The Sweet 16 correlated highly with the MMSE (Spearman r, 0.94; P<.001). Validated against the IQCODE, the area under the curve was 0.84 for the Sweet 16 and 0.81 for the MMSE (P=.06). A Sweet 16 score of less than 14 (approximating an MMSE score <24) demonstrated a sensitivity of 80% and a specificity of 70%, whereas an MMSE score of less than 24 showed a sensitivity of 64% and a specificity of 86% against the IQCODE. When compared with clinical diagnosis, a Sweet 16 score of less than 14 showed a sensitivity of 99% and a specificity of 72% in contrast to an MMSE score with a sensitivity of 87% and a specificity of 89%. For education of 12 years or more, the area under the curve was 0.90 for the Sweet 16 and 0.84 for the MMSE (P=.03).

CONCLUSIONS: The Sweet 16 is simple, quick to administer, and will be available open access. The performance of the Sweet 16 is equivalent or superior to that of the MMSE.

%B Arch Intern Med %I 171 %V 171 %P 432-7 %8 2011 Mar 14 %G eng %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/21059967?dopt=Abstract %3 21059967 %4 Older people/Cognition/reasoning/Correlation analysis/Medical diagnosis/Dementia/Hospitalization %$ 25220 %R 10.1001/archinternmed.2010.423 %0 Journal Article %J Alzheimers Dement %D 2009 %T "Below average" self-assessed school performance and Alzheimer's disease in the Aging, Demographics, and Memory Study. %A Kala M. Mehta %A Anita L Stewart %A Kenneth M. Langa %A Kristine Yaffe %A Sandra Y. Moody-Ayers %A Brie A Williams %A Kenneth E Covinsky %K Aged %K Aged, 80 and over %K Aging %K Alzheimer disease %K Apolipoprotein E4 %K Cognition Disorders %K Educational Status %K Female %K Geriatric Assessment %K Humans %K Male %K Memory %K Neuropsychological tests %K Risk Factors %X

BACKGROUND: A low level of formal education is becoming accepted as a risk factor for Alzheimer's disease (AD). Although increasing attention has been paid to differences in educational quality, no previous studies addressed participants' own characterizations of their overall performance in school. We examined whether self-assessed school performance is associated with AD beyond the effects of educational level alone.

METHODS: Participants were drawn from the population-representative Aging, Demographics, and Memory Study (ADAMS, 2000-2002). The ADAMS participants were asked about their performance in school. Possible response options included "above average," "average," or "below average." The ADAMS participants also underwent a full neuropsychological battery, and received a research diagnosis of possible or probable AD.

RESULTS: The 725 participants (mean age, 81.8 years; 59% female; 16% African-American) varied in self-assessed educational performance: 29% reported "above average," 64% reported "average," and 7% reported "below average" school performance. Participants with a lower self-assessed school performance had higher proportions of AD: 11% of participants with "above average" self-assessed performance had AD, as opposed to 12% of participants with "average" performance and 26% of participants with "below average" performance (P < 0.001). After controlling for subjects' years in school, a literacy test score (Wide-Range Achievement Test), age, sex, race/ethnicity, apolipoprotein E-epsilon4 status, socioeconomic status, and self-reported comorbidities, respondents with "below average" self-assessed school performance were four times more likely to have AD compared with those of "average" performance (odds ratio, 4.0; 95% confidence interval, 1.2-14). "Above average" and "average" self-assessed school performance did not increase or decrease the odds of having AD (odds ratio, 0.9; 95% confidence interval, 0.5-1.7).

CONCLUSIONS: We suggest an association between "below average" self-assessed school performance and AD beyond the known association with formal education. Efforts to increase cognitive reserve through better school performance, in addition to increasing the number of years of formal education in early life, may be important in reducing vulnerability throughout the life course.

%B Alzheimers Dement %I 5 %V 5 %P 380-7 %8 2009 Sep %G eng %U http://www.sciencedirect.com/science?_ob=ArticleURLand_udi=B7W6D-4X6VH7W-7and_user=99318and_coverDate=09 2F30 2F2009and_rdoc=1and_fmt=highand_orig=searchand_origin=searchand_sort=dand_docanchor=andview=cand_acct=C000007678and_version=1and_urlVersion=0and_ %N 5 %L newpubs20101112_Mehta.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/19751917?dopt=Abstract %2 PMC2787515 %4 alzheimer disease/cognition Disorders/educational Status/Geriatric Assessment/neuropsychological Tests/risk Factors %$ 23670 %R 10.1016/j.jalz.2009.07.039 %0 Journal Article %J Psychol Sci %D 2009 %T Caregiving behavior is associated with decreased mortality risk. %A Stephanie Brown %A Dylan M Smith %A Schulz, Richard %A Mohammed U Kabeto %A Peter A. Ubel %A Poulin, Michael %A Yi, Jaehee %A Kim, Catherine %A Kenneth M. Langa %K Altruism %K Caregivers %K Humans %K Mortality %X

Traditional investigations of caregiving link it to increased caregiver morbidity and mortality, but do not disentangle the effects of providing care from those of being continuously exposed to an ailing loved one with serious health problems. We explored this possible confound in a national, longitudinal survey of elderly married individuals (N= 3,376). Results showed that spending at least 14 hr per week providing care to a spouse predicted decreased mortality for the caregiver, independently of behavioral and cognitive limitations of the care recipient (spouse), and of other demographic and health variables. These findings suggest that it may be premature to conclude that health risks for caregivers are due to providing active help. Indeed, under some circumstances, caregivers may actually benefit from providing care.

%B Psychol Sci %I 20 %V 20 %P 488-94 %8 2009 Apr %G eng %U http://pss.sagepub.com/content/20/4/4 %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/19320860?dopt=Abstract %2 PMC2865652 %4 Caregivers/Mortality/Risk assessment/Psychology/Older people %$ 25420 %R 10.1111/j.1467-9280.2009.02323.x %0 Journal Article %J J Gerontol A Biol Sci Med Sci %D 2003 %T Additive effects of cognitive function and depressive symptoms on mortality in elderly community-living adults. %A Kala M. Mehta %A Kristine Yaffe %A Kenneth M. Langa %A Laura Sands %A Whooley, Mary %A Kenneth E Covinsky %K Aged %K Cognition %K depression %K Female %K Humans %K Male %K Mortality %K Proportional Hazards Models %K Risk Factors %X

BACKGROUND: Poor cognitive function and depressive symptoms are common in the elderly, frequently coexist, and are interrelated. Both risk factors are independently associated with mortality. Few studies have comprehensively described how the combination of poor cognitive function and depressive symptoms affect the risk for mortality. Our aim was to examine whether the combination of varying levels of cognitive function and depressive symptoms affect the risk of mortality in community-living elderly adults.

METHODS: We studied 6301 elderly adults (mean age, 77 years; 62% women; 81% white) enrolled in the Asset and Health Dynamics Among the Oldest Old (AHEAD) study, a prospective study of community-living participants conducted from 1993 to 1995. Cognitive function and depressive symptoms were measured using two validated measures developed for the AHEAD study. On each measure, participants were divided into tertiles representing the best, middle, and worst scores, and then placed into one of nine mutually exclusive groups ranging from best functioning on both measures to worst functioning on both measures. Mortality rates were assessed in each of the nine groups. Cox proportional hazards models were used to control for potentially confounding characteristics such as demographics, education, income, smoking, alcohol consumption, comorbidity, and baseline functional impairment.

RESULTS: During 2 years of follow-up, 9% (548) of the participants died. Together, cognitive function and depressive symptoms differentiated between elderly adults at markedly different risk for mortality, ranging from 3% in those with the best function on both measures to 16% in those with the worst function on both measures (p <.001). Furthermore, for each level of cognitive function, more depressive symptoms were associated with higher mortality rates, and for each level of depressive symptoms, worse cognitive function was associated with higher mortality rates. In participants with the best cognitive function, mortality rates were 3%, 5%, and 9% in participants with low, middle, and high depressive symptoms, respectively (p <.001 for trend). The corresponding rates were 6%, 7%, and 12% in participants with the middle level of cognitive function (p <.001 for trend), and 10%, 13%, and 16% in participants with the worst level of cognitive function (p <.001 for trend). After adjustment for confounders, participants with the worst function on both measures remained at considerably higher risk for death than participants with the best function on both measures (adjusted hazard ratio, 3.1; 95% confidence interval, 2.0-4.7).

CONCLUSIONS: Cognitive function and depressive symptoms can be used together to stratify elderly adults into groups that have significantly different rates of death. These two risk factors are associated with an increased risk in mortality in a progressive, additive manner.

%B J Gerontol A Biol Sci Med Sci %I 58A %V 58 %P M461-7 %8 2003 May %G eng %N 5 %L pubs_2003_Mehta_KJoG.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/12730257?dopt=Abstract %4 Cognitive Function/Depressive Symptoms/Mortality %$ 8680 %R 10.1093/gerona/58.5.m461