Social and gender inequalities in depressive symptoms among urban older adults of latin america and the Caribbean

OBJECTIVE: This study examined gender differences in depression by examining differential exposure and vulnerability to socioeconomic factors during the life course. METHODS: The data used for the analyses originated from a cross-national survey of older adults living in seven large Latin American cities. We examined associations between depressive symptomatology and socioeconomic conditions and health indicators in childhood, adulthood, and old age. We used the Geriatric Depression Scale to classify respondents with high levels of depressive symptoms. RESULT: The prevalence of depression in the urban population of Latin America was relatively low, ranging across cities from 0.4 to 5.2% in men and from 0.3 to 9.5% in women. Women were more exposed to social and material disadvantages during their life course than men but were not more vulnerable to them than men. Current socioeconomic conditions and health status as well as functional disabilities mainly accounted for gender differences in the prevalence of depression. Additionally, poor health and hunger during childhood, as well as illiteracy or lack of education, were associated with depression in both men and women. DISCUSSION: Cumulative life course exposure to social and material disadvantage and current material, social, and health conditions explain the higher frequency of depression in women.     

Physical Activity Over the Life Course and Its Association with Cognitive Performance and Impairment in Old Age

OBJECTIVE: To determine how physical activity at various ages over the life course is associated with cognitive impairment in late life. DESIGN: Cross‐sectional study. SETTING: Four U.S. sites. PARTICIPANTS: Nine thousand three hundred forty‐four women aged 65 and older (mean 71.6) who self‐reported teenage, age 30, age 50, and late‐life physical activity. MEASUREMENTS: Logistic regression was used to determine the association between physical activity status at each age and likelihood of cognitive impairment (modified Mini‐Mental State Examination (mMMSE) score >1.5 standard deviations below the mean, mMMSE score≤22). Models were adjusted for age, education, marital status, diabetes mellitus, hypertension, depressive symptoms, smoking, and body mass index. RESULTS: Women who reported being physically active had a lower prevalence of cognitive impairment in late life than women who were inactive at each time (teenage: 8.5% vs 16.7%, adjusted odds ratio (AOR)=0.65, 95% confidence interval (CI)=0.53–0.80; age 30: 8.9% vs 12.0%, AOR=0.80, 95% CI=0.67–0.96); age 50: 8.5% vs 13.1%, AOR=0.71, 95% CI=0.59–0.85; old age: 8.2% vs 15.9%, AOR=0.74, 95% CI=0.61–0.91). When the four times were analyzed together, teenage physical activity was most strongly associated with lower odds of late‐life cognitive impairment (OR=0.73, 95% CI=0.58–0.92). However, women who were physically inactive as teenagers and became active in later life had lower risk than those who remained inactive. CONCLUSIONS: Women who reported being physically active at any point over the life course, especially as teenagers, had a lower likelihood of cognitive impairment in late life. Interventions should promote physical activity early in life and throughout the life course.     

Living alone and cognitive function in later life

BackgroundLiving alone may be associated with greater risk for social isolation and loneliness. Living alone, social isolation, loneliness, and limited engagement in social activity have all been associated with poorer cognitive function in later life. Hence, if individuals who live alone are also at greater risk of isolation and loneliness, this may exacerbate poor cognitive function.ObjectiveTo determine whether people living alone are more at risk of social isolation, feelings of loneliness, and limited social activity, and to examine the associations between living alone and cognitive function in later life.MethodBaseline (N = 2197) and two-year follow-up (N = 1498) data from community-dwelling participants, age ≥65 years, without cognitive impairment or depression at baseline from CFAS-Wales were used. Linear regression analyses were conducted to assess the association between living arrangement and cognitive function at baseline and two-year follow-up.ResultsPeople living alone were more isolated from family and experienced more emotional loneliness than those living with others, but were not more isolated from friends, did not experience more social loneliness, and were more likely to engage in regular social activity. Living alone was not associated with poorer cognitive function at baseline or two-year follow-up.DiscussionThese findings have positive implications and suggest that people who live alone in later life are not at greater risk of poor cognitive function at baseline or two-year follow-up. Social isolation may be more associated with poor cognitive function.     

Women who maintain optimal cognitive function into old age

OBJECTIVES: To determine whether older women who maintain optimal cognitive function into old age differ from those who experience minor cognitive decline typically associated with normal aging. DESIGN: Prospective cohort study. SETTING: The Study of Osteoporotic Fractures. PARTICIPANTS: Nine thousand seven hundred four older women. MEASUREMENTS: A modified Mini-Mental State Examination (mMMSE) was performed at baseline and Years 6, 8, 10, and 15. Random-effects regression was used to classify subjects as cognitive maintainers (slope>/=0), minor decliners (slope < 0 but > lowest tertile), or major decliners (slope 相似文献   

Life course, gender and ethnic inequalities in functional disability in a Brazilian urban elderly population

BACKGROUND AND AIMS: To examine life course social, gender and ethnic inequalities in ADL disability in a Brazilian urban elderly population. METHODS: We used the S?o Paulo-SABE study (health, well-being and aging in Latin America and the Caribbean) to assess the associations between ADL disability and gender, ethnicity and life course social conditions (childhood socio-economic and health status, education, lifetime occupation, current perception of income), controlling for current physical and mental health (cognitive impairment and comorbidity). ADL disability was defined as the presence of one or more difficulties with six tasks: bathing, toileting, dressing, walking across the room, eating, and getting out of bed. RESULTS: Results suggest that social inequalities during the life course (hunger and poverty in early life; illiteracy, a low skilled occupation, having been a housewife; insufficient income) tend to result in disability in later life. The prevalence of ADL disability was higher among women (22.4%) than among men (14.8%). Mestizo/ Native elders reported higher prevalence of disability compared with Whites and Blacks/Mulattos. Ethnic inequalities concerning ADL disability were explained by social and health conditions, but the gender gap persisted (OR women vs men= 2.16; 95% CI 1.32-3.55). Despite their higher rate of ADL disability in old age, women appear to be more resilient than men toward poor socio-economic conditions throughout the life course. Chronic conditions were more likely to result in ADL disability among men than women (OR= 1.83; 95% CI 1.41-2.38 in women; OR= 3.42; 95% CI 2.41-4.86 in men). CONCLUSIONS: Decreasing social inequalities during childhood and adulthood will reduce socio-economic inequalities in disability in old age, especially among men.     

Changes in everyday function in individuals with psychometrically defined mild cognitive impairment in the Advanced Cognitive Training for Independent and Vital Elderly Study

OBJECTIVES: To examine trajectories of change in everyday function for individuals with cognitive deficits suggestive of mild cognitive impairment (MCI). DESIGN: Using data from the longitudinal, multisite Advanced Cognitive Training for Independent and Vital Elderly Study allowed for post hoc classification of MCI status at baseline using psychometric definitions for amnestic MCI, nonamnestic MCI, multidomain MCI, and no MCI. SETTING: Six U.S. cities. PARTICIPANTS: Two thousand eight hundred thirty-two volunteers (mean age 74; 26% African American) living independently, recruited from senior housing, community centers, hospitals, and clinics. MEASUREMENTS: Mixed-effect models examined changes in self-reported activities of daily living and instrumental activities of daily living (IADLs) from the Minimum Data Set Home Care Interview in 2,358 participants over a 3-year period. RESULTS: In models for IADL performance, IADL difficulty, and a daily functioning composite, there was a significant time by MCI classification interaction for each MCI subtype, indicating that all MCI groups showed faster rates of decline in everyday function than cognitively normal participants with no MCI. CONCLUSION: Results demonstrate the importance of MCI as a clinical entity that not only predicts progression to dementia, but also predicts functional declines in activities that are key to autonomy and quality of life. MCI classification guidelines should allow for functional changes in MCI, and clinicians should monitor for such changes. Preservation of function may serve as a meaningful outcome for intervention efforts.     

Depressive Symptoms in Middle Age and the Development of Later‐Life Functional Limitations: The Long‐Term Effect of Depressive Symptoms

OBJECTIVES: To determine whether middle‐aged persons with depressive symptoms are at higher risk for developing activity of daily living (ADL) and mobility limitations as they advance into older age than those without. DESIGN: Prospective cohort study. SETTING: The Health and Retirement Study (HRS), a nationally representative sample of people aged 50 to 61. PARTICIPANTS: Seven thousand two hundred seven community living participants in the 1992 wave of the HRS. MEASUREMENTS: Depressive symptoms were measured using the 11‐item Center for Epidemiologic Studies Depression Scale (CES‐D 11), with scores of 9 or more (out of 33) classified as significant depressive symptoms. Difficulty with five ADLs and basic mobility tasks (walking several blocks or up one flight of stairs) was measured every 2 years through 2006. The primary outcome was persistent difficulty with ADLs or mobility, defined as difficulty in two consecutive waves. RESULTS: Eight hundred eighty‐seven (12%) subjects scored 9 or higher on the CES‐D 11 and were classified as having significant depressive symptoms. Over 12 years of follow‐up, subjects with depressive symptoms were more likely to reach the primary outcome measure of persistent difficulty with mobility or difficulty with ADL function (45% vs 23%, Cox hazard ratio (HR)=2.33, 95% confidence interval (CI)=2.06–2.63). After adjusting for age, sex, measures of socioeconomic status, comorbid conditions, high body mass index, smoking, exercise, difficulty jogging 1 mile, and difficulty climbing several flights of stairs, the risk was attenuated but still statistically significant (Cox HR=1.44, 95% CI=1.25–1.66). CONCLUSION: Depressive symptoms independently predict the development of persistent limitations in ADLs and mobility as middle‐aged persons advance into later life. Middle‐aged persons with depressive symptoms may be at greater risk for losing their functional independence as they age.     

Pulmonary Function and Cognitive Decline in an Older Chinese Population in Singapore

Abstract

Introduction: Various cognitive deficits associated with reduced pulmonary function are reported in different studies, but the pattern of cognitive deficits across multiple domains and its associated everyday functional disability remain unclear. Methods: We analyzed neuropsychological functioning, cognitive impairment and accompanying disability in instrumental activities of daily living (IADL) associated with reduced pulmonary function in community-living middle-aged and older adults in Singapore. Performance on a comprehensive battery of neuropsychological tests, spirometry and cognitively demanding IADLs were assessed in the population-based Singapore Longitudinal Ageing Studies. Results: Consecutive 10% increase in forced expiratory volume in 1 s (FEV1) as percent of predicted was positively associated with 0.18 points increase in Mini-mental state examination (MMSE) and 0.04 points increase in executive function, independent of age, education and other variables. Subjects with moderate-to-severe airway obstruction showed significantly poorer MMSE score (p for linear trend = 0.001), and information processing speed (p for linear trend < 0.001). FEV1 (per 10% of predicted) was significantly associated with lower risk of cognitive impairment (OR = 0.92, 95% CI: 0.87-0.98, P = 0.005) and cognitive IADL disability (OR = 0.86,95% CI:0.79–0.93, P < 0.001). Pulmonary restriction was associated with greater risk of cognitive impairment (OR = 1.98, 95% CI: 1.26-3.11, P = 0.003) and cognitive IADL disability (OR = 2.43, 95% CI: 1.31-4.53, P = 0.005). Moderate-to-severe airway obstruction (OR = 2.04, 95% CI: 1.11–3.74, P = 0.022) was positively associated with cognitive IADL disability. Conclusion: The findings suggest a measurable but modest cognitive effect of low pulmonary function that was accompanied by corresponding disability in living activities. The effect on executive functioning should be further investigated in longitudinal studies.     

Prevalence of frailty and factors associated with frailty in the elderly population of Lleida, Spain: The FRALLE survey

The aim of this study was to assess the prevalence of frailty and to identify factors associated with frailty in older people living in the community through a cross-sectional study of community-dwelling persons age 75 and older. A total of 640 individuals were interviewed using the FRALLE survey between 2009 and 2010. This survey measures frailty through the five Fried criteria, and through questions on sociodemographics, health habits, health status, social relations and data on health-related quality of life. The mean age of the participants was 81.3±5.0; 39.7% were men. The prevalence of frailty was 9.6% (95% confidence interval (CI): 7.6-11.5) and that of pre-frailty was 47% (95% CI: 42.7-51.2). After the logistic regression, age (over 85 years) (odds ratio (OR): 3.61; 95% CI: 1.65-7.91; p<0.001), depressive symptoms (OR: 3.13; 95% CI: 1.37-7.13; p=0.0006), comorbidity (OR: 5.20; 95% CI: 1.78-15.16; p=0.0002), cognitive impairment (OR: 3.22; 95% CI: 1.48-7.02; p=0.0003), poor social ties (OR: 0.57; 95% CI: 0.43-0.77; p<0.001) and poor physical health (OR: 0.98; 95% CI: 0.97-0.98; p<0.001) were significantly associated with frailty. There is great variability in the prevalence of frailty depending on the study considered. The lack of homogeneity in the measurement of the five criteria, the age of participants and the degree of dependence could explain the differences observed. Here, the factors associated with frailty were age, comorbidity, cognitive impairment and depressive symptoms, while the diversity of social interaction and health-related physical function were protective factors.     

Neighborhood deprivation, individual socioeconomic status, and cognitive function in older people: analyses from the English Longitudinal Study of Ageing

OBJECTIVES: To assess the relationship between cognitive function, socioeconomic status, and neighborhood deprivation (lack of local resources of all types, financial and otherwise).
DESIGN: Nationally representative cross-section.
SETTING: The English Longitudinal Study of Ageing (ELSA).
PARTICIPANTS: Seven thousand one hundred twenty-six community-dwelling individuals aged 52 and older and resident in urban areas.
MEASUREMENTS: Individual cognitive function score and index of multiple deprivation (IMD) at the Super Output Area level, adjusting for health, lifestyle, and sociodemographic confounders. Analyses were conducted separately according to sex and age group (52–69 and ≥70).
RESULTS: IMD affected cognitive function independent of the effects of education and socioeconomic status. For example, in fully adjusted models, women aged 70 and older had a standardized cognitive function score ( z -score) that was 0.20 points (95% confidence interval (CI)=0.01–0.39) lower in the bottom 20% of wealth than the top 20%, 0.44 points (95% CI=0.20–0.69) lower in the least-educated group than in the most educated, and 0.31 points (95% CI 0.15–0.48) lower if resident lived in an area in the bottom 20% of IMD than in the top 20%.
CONCLUSION: In community-based older people in urban neighborhoods, neighborhood deprivation—living in a neighborhood with high levels of deprivation, compared with national levels—is associated with cognitive function independent of individual socioeconomic circumstances. The mechanisms underlying this relationship are unclear and warrant further investigation.     

Cognitive impairment,depressive symptoms,and functional decline in older people

OBJECTIVES: Although cognitive impairment and depressive symptoms are associated with functional decline, it is not understood how these risk factors act together to affect the risk of functional decline. The purpose of this study is to determine the relative contributions of cognitive impairment and depressive symptoms on decline in activity of daily living (ADL) function over 2 years in an older cohort. DESIGN: Prospective cohort study. SETTING: A U.S. national prospective cohort study of older people, Asset and Health Dynamics in the Oldest Old. PARTICIPANTS: Five thousand six hundred ninety-seven participants (mean age 77, 64% women, 86% white) followed from 1993 to 1995. MEASUREMENTS: Cognitive impairment and depressive symptoms were defined as the poorest scores: 1.5 standard deviations below the mean on a cognitive scale or 1.5 standard deviations above the mean on validated depression scales. Risk of functional decline in participants with depressive symptoms, cognitive impairment, and both, compared with neither risk factor, were calculated and stratified by baseline dependence. Analyses were adjusted for demographics and comorbidity. RESULTS: Eight percent (n = 450) of subjects declined in ADL function. In participants who were independent in all ADLs at baseline, the relative risk (RR) of 2-year functional decline was 2.3 (95% confidence interval (CI) = 1.7-3.1) for participants with cognitive impairment, 1.9 (95% CI = 1.3-2.6) for participants with depressive symptoms, and 2.4 (95% CI = 1.4-3.7) for participants with cognitive impairment and depressive symptoms. In participants who were dependent in one or more ADLs at baseline, RR of 2-year functional decline was 1.9 (95% CI = 1.2-2.8) for participants with cognitive impairment, 0.6 (95% CI = 0.3-1.3) for participants with depressive symptoms, and 1.5 (95% CI = 0.8-2.6) for participants with cognitive impairment and depressive symptoms. CONCLUSIONS: In participants with no ADL dependence at baseline, cognitive impairment and depressive symptoms are risk factors for decline, but that, in participants with dependence in ADL at baseline, cognitive impairment, but not depressive symptoms, is a risk factor for additional decline.     

Depressive symptoms, chronic diseases, and physical disabilities as predictors of cognitive functioning trajectories in older Americans

OBJECTIVES: To determine the concurrent influence of depressive symptoms, medical conditions, and disabilities in activities of daily living (ADLs) on rates of decline in cognitive function of older Americans. DESIGN: Prospective cohort. SETTING: National population based. PARTICIPANTS: A national sample of 6,476 adults born before 1924. MEASUREMENTS: Differences in cognitive function trajectories were determined according to prevalence and incidence of depressive symptoms, chronic diseases, and ADL disabilities. Cognitive performance was tested five times between 1993 and 2002 using a multifaceted inventory examined as a global measure (range 0–35, standard deviation (SD) 6.0) and word recall (range 0–20, SD 3.8) analyzed separately. RESULTS: Baseline prevalence of depressive symptoms, stroke, and ADL limitations were independently and strongly associated with lower baseline cognition scores but did not predict future cognitive decline. Each incident depressive symptom was independently associated with a 0.06‐point lower (95% confidence interval (CI)=0.02–0.10) recall score, incident stroke with a 0.59‐point lower total score (95% CI=0.20–0.98), each new basic ADL limitation with a 0.07‐point lower recall score (95% CI=0.01–0.14) and a 0.16‐point lower total score (95% CI=0.07–0.25), and each incident instrumental ADL limitation with a 0.20‐point lower recall score (95% CI=0.10–0.30) and a 0.52‐point lower total score (95% CI=0.37–0.67). CONCLUSION: Prevalent and incident depressive symptoms, stroke, and ADL disabilities contribute independently to poorer cognitive functioning in older Americans but do not appear to influence rates of future cognitive decline. Prevention, early identification, and aggressive treatment of these conditions may ameliorate the burdens of cognitive impairment.     

Subjective memory impairment,objective cognitive functioning and social activity in French older people: Findings from the Three Cities study

Aim: To investigate the association between subjective memory impairment (SMI) and objective cognitive impairment in later life, and to ascertain whether this is modified by level of social activity, education or living alone. Methods: Data were analyzed from three French community surveys carried out in Bordeaux, Dijon and Montpellier. Representative samples of 9294 residents aged 65 years and over were included in the study. SMI was ascertained and investigated in relation to performance on the Benton Visual Retention Test (BVRT), the Isaac Set Test (IST) and Trail Making Test B (TMT). Adjustments were made for age, sex, education, depressive symptoms (Centre for Epidemiological Depression scale), site where study was carried out and living alone. Stratified analyses investigated modification by high or low social activity, education or living arrangement. Results: SMI was reported by 21.9% of the sample, and was significantly associated with lower scores on BVRT and TMT after adjustment for age, sex, education, depressive symptoms, site and living alone. These associations were not significantly modified by social activity, education or living alone. Conclusion: Worse subjective memory was associated independently with worse performance on two tests of cognitive function; however, in these cohorts, no evidence was found for modification of associations by social activity/support or education. Geriatr Gerontol Int 2013; 13: 139–145 .     

Childhood socioeconomic status predicts physical functioning a half century later

BACKGROUND: Socioeconomic status (SES) affects health outcomes at all stages of life. Relating childhood socioeconomic environment to midlife functional status provides a life course perspective on childhood factors associated with poor and good health status later in life. METHODS: The British 1946 birth cohort was prospectively evaluated with periodic examinations from birth through age 53 years, when physical performance tests assessing strength, balance, and rising from a chair were administered. Early childhood socioeconomic factors were examined as predictors of low, middle, or high function at midlife. We tested the hypothesis that adulthood behavioral risk factors would explain the childhood SES-midlife physical function associations. RESULTS: Multiple measures of childhood deprivation were associated with midlife function but in multivariate analyses only father's occupation was associated with low function (relative risk [RR] for manual occupation = 1.6; 95% confidence interval [CI], 1.1-2.3), and only mother's education was associated with high function (RR for lower mother's education = 0.49; 95% CI, 0.34-0.72). Early adulthood behavioral risk factors and middle-age SES and disease status only modestly attenuated the relationship between father's occupation and low function and had no impact on the relationship of mother's education with high function. CONCLUSIONS: The social environment in which a child grows up has a strong association with midlife, objectively measured functional status, which is a reflection of the aging process and chronic diseases accumulated over the life course. Of particular interest is the role of higher maternal education in promoting high midlife functioning.     

Cognitive function, habitual gait speed, and late-life disability in the National Health and Nutrition Examination Survey (NHANES) 1999-2002

BACKGROUND: Both cognitive function and gait speed are important correlates of disability. However, little is known about the combined effect of cognitive function and gait speed on multiple domains of disability as well as about the role of gait speed in the association between cognitive function and late-life disability. OBJECTIVE: To investigate (1) how cognition and habitual gait speed are related to late-life disability; (2) the role of habitual gait speed in the cognitiondisability association; and (3) the combined effect of cognitive function and habitual gait speed on late-life disability. METHOD: Participants (>60 years, n = 2,481) were from the National Health and Nutrition Examination Survey 1999-2002. Disability in activities of daily living (ADL), instrumental ADL (IADL), leisure and social activities (LSA), and lower extremity mobility (LEM) was obtained by self-report. Cognitive function was measured by a 2-min timed Digit Symbol Substitution Test (DSST), an executive function measure from the Wechsler Adult Intelligence Test. Habitual gait speed was obtained from a 20-foot timed walk. Multiple logistic regression was used to assess the association between cognitive function and disability. RESULTS: Cognitive function was associated with decreased likelihood for disability in each domain. The odds ratios (ORs) for disability in ADL, IADL, LSA, and LEM for each standard deviation (SD) increase in the DSST score were 0.47 (95% confidence interval [CI] = 0.34-0.64), 0.53 (95% CI = 0.42-0.67), 0.61 (95% CI = 0.47-0.79), and 0.73 (95% CI = 0.61-0.86), respectively, in the multi-variable models. After additional adjustment for habitual gait speed in the cognition-disability relationship, DSST score was no longer a significant correlate for LSA and LEM disability. The strength of the association between DSST score and disability in ADL/IADL was also diminished. The attenuated association between cognition and disability implies that limitation in gait speed likely mediates the association between cognitive function and disability. We found additive effects of cognition and habitual gait speed on late-life disability. The OR of disability in respective domains were lowest among participants with high-DSST score (high executive function) and with high gait speed. In contrast, the OR tended to be highest among participants with low-DSST score (low executive function) and low gait speed. CONCLUSION: Cognitive function was associated with multiple domains of disability. There was a joint effect of cognitive function and gait speed on late-life disability. This study also suggested that habitual gait speed partially mediated the inverse association between cognitive function and late-life disability, providing a mechanistic explanation in the context of disablement process.     

Circadian Activity Rhythms and Mortality: The Study of Osteoporotic Fractures

OBJECTIVES: To determine whether circadian activity rhythms are associated with mortality in community‐dwelling older women. DESIGN: Prospective study of mortality. SETTING: A cohort study of health and aging. PARTICIPANTS: Three thousand twenty‐seven community‐dwelling women from the Study of Osteoporotic Fractures cohort (mean age 84). MEASUREMENTS: Activity data were collected using wrist actigraphy for a minimum of three 24‐hour periods, and circadian activity rhythms were computed. Parameters of interest included height of activity peak (amplitude), midline estimating statistic of rhythm (mesor), strength of activity rhythm (robustness), and time of peak activity (acrophase). Vital status, with cause of death adjudicated through death certificates, was prospectively ascertained. RESULTS: Over an average of 4.1 years of follow‐up, there were 444 (14.7%) deaths. There was an inverse association between peak activity height and all‐cause mortality rates, with higher mortality rates observed in the lowest activity quartile (hazard ratio (HR)=2.18, 95% confidence interval (CI)=1.63–2.92) than in the highest quartile after adjusting for age, clinic site, race, body mass index, cognitive function, exercise, instrumental activity of daily living impairments, depression, medications, alcohol, smoking, self‐reported health status, married status, and comorbidities. A greater risk of mortality from all causes was observed for those in the lowest quartiles of mesor (HR=1.71, 95% CI=1.29–2.27) and rhythm robustness (HR=1.97, 95% CI=1.50–2.60) than for those in the highest quartiles. Greater mortality from cancer (HR=2.09, 95% CI=1.04–4.22) and stroke (HR=2.64, 95% CI=1.11–6.30) was observed for later peak activity (after 4:33 p.m.; >1.5 SD from mean) than for the mean peak range (2:50–4:33 p.m.). CONCLUSION: Older women with weak circadian activity rhythms have higher mortality risk. If confirmed in other cohorts, studies will be needed to test whether interventions (e.g., physical activity, bright light exposure) that regulate circadian activity rhythms will improve health outcomes in older adults.     

A life course approach to the development of mental skills

A wide variety of factors across the life course jointly influence cognitive and emotional development. Indeed, research from a variety of disciplines strongly suggests that cognition and mental health are intertwined across the life course, by their common antecedents and underlying physiology in development and in their interplay across adult and later life. We suggest that cognitive and socioemotional function fuse to form skills for life supporting self-regulation, competence, and quality of life that persist into later life through linked reciprocal processes of genetic influence, nurturing, schooling, work, and lifestyle.     

Effect of exercise on ease in performing activities of daily living and instrumental activities of daily living from age 70 to 77: the Jerusalem longitudinal study

OBJECTIVES: To determine the prevalence of independence and ease of performance in activities of daily living (ADLs) and instrumental activities of daily living (IADLs) at ages 70 and 77 in a well-characterized cohort and to measure the effect of regular exercise at age 70 on independence and ease of performance 7 years later. DESIGN: Two stages of a longitudinal study of an age-homogeneous cohort employing extensive interview data, physical examination, and clinical laboratory investigation. SETTING: Home-based interviews and examinations in Jerusalem. PARTICIPANTS: Two hundred eighty-seven west Jerusalem residents, born between June 1920 and May 1921, who participated fully in two phases of an ongoing longitudinal cohort study. Subjects were culled from a larger study population of 605 in the first phase and 1,021 in the second phase. MEASUREMENTS: Two-stage comprehensive demographic, social, and economic profile; medical history and examination; cognitive and affective assessment; and clinical laboratory studies performed in 1990-91 and 1997-98. The investigation questionnaire included details of ADL and IADLs and voluntary exercise. RESULTS: Most aspects of personal and social life did not change from age 70 to 77. Independence in ADLs remained high, as did self-reliance in IADLs for women. A more-sensitive marker of diminished function was reported ease in performance, which declined for use of the toilet, dressing, and all spheres of IADLs. For nearly every task, subjects who reported exercising 4 days a week at age 70 were more likely to report ease in performance at age 77. In a logistic regression accounting for the presence of diabetes mellitus, hypertension, obesity, chronic back pain, loneliness, and performance with ease at age 70 and deterioration in self-assessed health from age 70 to 77, ease of performance in at least three of four ADL tasks was independently related to exercise at age 70 for women (odds ratio (OR) = 8.5, 95% confidence interval (CI) = 2.0-36.2) and for men (OR = 4.3, 95% CI = 1.1-17.1). Ease of independent function in at least four of five IADL tasks also correlated to exercise for men in this regression (OR = 3.7, 95% CI = 1.1-12.2) but not for women (OR = 2.0, 95% CI = 0.6-6.3). Ease in shopping, alternatively, correlated with physical activity for men (OR = 4.3, 95% CI = 1.5-12.0) and women (OR = 2.6, 95% CI = 1.1-6.1). CONCLUSIONS: Subjects remained active and independent at age 77. Reported ease of performance declined and revealed changes in function. Exercise at least four times a week at age 70 preserved ease of performance at age 77 independent of the influence of specific disease or general self-assessed health.     

Factors leading to the trajectory of cognitive decline in middle-aged and older adults using group-based trajectory modeling: A cohort study

Currently, studies exploring factors associated with the cognition at some time point and no study identifying the trajectories of cognitive changes and factors might associate with the trajectories of cognitive changes in people. This study was to identify factors associated with the trend of cognitive decline in middle-aged and older people. In this cohort study, the data of 6954 subjects were collected from China Health and Retirement Longitudinal Survey database. Group-based trajectory modeling was applied for identifying three different trajectories of cognitive function change [high initial level and slow decline group (n = 1024), moderate initial level and moderate decline group (n = 2673) and low initial level and rapid decline (LRD) group (n = 3277)]. Univariate and multivariate logistic regression analysis was conducted to identify variables influencing factors of the trajectories of cognitive function in middle-aged and older people. The follow-up interval was 2 years from 2011 to 2015, and 3 years from 2015 to 2018 via face-to-face interview. High initial level and slow decline group versus LRD group, age (OR = 2.591, 95% CI: 1.962–3.421), gender (OR = 1.398, 95% CI: 1.133–1.725), education (OR = 0.051, 95% CI: 0.039–0.068), place of residence (OR = 2.768, 95% CI: 1.663–4.606), disabled (OR = 1.557, 95% CI: 1.189–2.039), family annual income (OR = 0.757, 95% CI: 0.618–0.929), sleep duration (OR = 1.266, 95% CI: 1.023–1.567), instrumental activity of daily living impairment (OR = 2.513, 95% CI: 1.947–3.245), community activities participation (OR = 0.611, 95% CI: 0.500–0.748), depression (OR = 1.471, 95% CI: 1.185–1.828), and systolic blood pressure (OR = 1.005, 95% CI: 1.001–1.009) were factors influencing the trajectories of cognitive function. Comparing moderate initial level and moderate decline group and LRD group, age (OR = 1.245, 95% CI: 1.052–1.474), gender (OR = 1.244, 95% CI: 1.062–1.458), education (OR = 0.244, 95% CI: 0.190–0.314), marital status (OR = 1.291, 95% CI: 1.079–1.546), place of residence (OR = 1.677, 95% CI: 1.358–2.071), disability (OR = 1.396, 95% CI: 1.180–1.652), smoking (OR = 1.249, 95% CI: 1.071–1.457), family annual income (OR = 0.863, 95% CI: 0.768–0.970), sleep duration (OR = 1.215, 95% CI: 0.973–1.541), instrumental activity of daily living impairment (OR = 1.309, 95% CI: 1.098–1.560), community activities participation (OR = 0.804, 95% CI: 0.718–0.900) and depression (OR = 1.383, 95% CI: 1.217–1.571) were factors associated with the trajectories of cognitive function changes. Middle-aged and older adults who had characteristics associated with increased risk of cognitive decline might be provided with timely interventions.     

Effect of Central Nervous System Medication Use on Decline in Cognition in Community-Dwelling Older Adults: Findings from the Health, Aging and Body Composition Study

OBJECTIVES: To evaluate whether combined use of multiple central nervous system (CNS) medications over time is associated with cognitive change.
DESIGN: Longitudinal cohort study.
SETTING: Pittsburgh, Pennsylvania, and Memphis, Tennessee.
PARTICIPANTS: Two thousand seven hundred thirty-seven healthy adults (aged ≥65) enrolled in the Health, Aging and Body Composition study without baseline cognitive impairment (modified Mini-Mental State Examination (3MS) score ≥80).
MEASUREMENTS: CNS medication (benzodiazepine- and opioid-receptor agonists, antipsychotics, antidepressants) use, duration, and dose were determined at baseline (Year 1) and Years 3 and 5. Cognitive function was measured using the 3MS at baseline and Years 3 and 5. The outcome variables were incident cognitive impairment (3MS score <80) and cognitive decline (≥5-point decline on 3MS). Multivariable interval-censored survival analyses were conducted.
RESULTS: By Year 5, 7.7% of subjects had incident cognitive impairment; 25.2% demonstrated cognitive decline. CNS medication use increased from 13.9% at baseline to 15.3% and 17.1% at Years 3 and 5, respectively. It was not associated with incident cognitive impairment (adjusted hazard ratio (adj HR)=1.11, 95% confidence interval (CI)=0.73–1.69) but was associated with cognitive decline (adj HR 1.37, 95% CI=1.11–1.70). Longer duration (adj HR=1.39, CI=1.08–1.79) and higher doses (>3 standardized daily doses) (adj HR=1.87, 95% CI=1.25–2.79) of CNS medications suggested greater risk of cognitive decline than with nonuse.
CONCLUSION: Combined use of CNS medications, especially at higher doses, appears to be associated with cognitive decline in older adults. Future studies must explore the effect of combined CNS medication use on vulnerable older adults.