Negative life events and cognitive performance in a population of older adults

OBJECTIVE: This study examined the association between negative life events in the past year and cognitive performance in a population of older adults. METHODS: Secondary data analysis was conducted on 428 participants from the Charlotte County Healthy Aging Study. Participants completed tests of episodic memory, attention, and psychomotor speed and endorsed the presence and severity of 24 life events. Life events were examined in the aggregate as well as individually. RESULTS: Hierarchical multiple regression results suggest no significant relationship between the aggregate frequency and severity measures of negative life events and cognitive performance. At the individual-event level, individuals who experienced the injury or illness of a friend during the past year and rated it as having more of an effect on their lives performed better on all three cognitive tasks. However, individuals who reported having less money to live on over the past year and rated the event as having more of an effect on their lives performed more poorly on the psychomotor speed tasks. DISCUSSION: The findings support previous research indicating that using estimates of individual stressors rather than aggregate stress measures increases the predictive validity of stress measurement. Furthermore, the individual negative life events can have both a positive and a negative effect, which nullify one another when using the sum score of events.     

Perceived health and functional status among spouse caregivers of frail older persons

This national interview study examined the health impact of caring for frail elders in a sample of 437 spouse caregivers. The principal findings were that (a) caregiver emotional strain was the strongest common predictor of both poor perceived health and functional limitations, (b) wife caregivers' poor health was associated with care recipients' perceived unmet needs and increased depression, (c) husband caregivers' poor health status was predicted by longer caregiving duration, and (d) non-White wife caregivers reported poorer perceived health than did their White counterparts.     

Predictors of decreased self-care among spouse caregivers of older adults with dementing illnesses

This study describes the health behaviors (alcohol consumption, exercise, sleep patterns, smoking, and weight maintenance) of a sample of older adult spouse caregivers (N = 233) and investigates the predictors of decreased self-care since caregiving began. Multiple regression results indicate that caregivers who experience greater developmental burden, report a greater number of depressive symptoms, perform a greater number of activities of daily living (ADL) tasks in caregiving and spend more hours in a day providing care, and who have lower self-efficacy for both self-care and spouse care are at greater risk for negative health behavior change. Results have implications for the identification of caregivers who may be particularly vulnerable to the negative health impact of caregiving.     

Care-related stress. A comparison of spouse and adult-child caregivers in shared and separate households.

This research examines the role that relationship and household arrangement have in explaining the levels of care-related stress effects experienced by spouse and adult-child caregivers in shared and separate residences. Data from 180 spouse and adult-child caregivers were analyzed to identify differences in caregiver health decline, relationship strain, and activity restriction across these settings when the effects of elder impairment, caregiver age, and use of social supports are controlled. Results show that spouse and adult children in shared households experience similar levels of care-related strain. However, comparison of adult children in shared and separate households show considerable cross-setting differences in strain, with those in shared households having significantly greater activity restriction but less relationship strain. These findings have implications for the delivery of social services, specifically for targeting health monitoring, respite, and family counseling services.     

Longitudinal associations between cancer history and cognitive functioning among older adults

ObjectivesThis study aimed to examine (1) whether cancer history accelerates older adults’ rates of cognitive decline over time and (2) whether chemotherapy increases older cancer patients’/ survivors’ rates of cognitive decline over time.MethodsThis longitudinal study drew a subsample of 8811 adults aged 65 or older from Wave 6 of the Health and Retirement Study in 2002 and followed biennually until Wave 13 in 2016. Linear mixed-effects models were performed to test whether cancer history and chemotherapy were associated with accelerated rates of cognitive decline over time among older adults in different age groups.ResultsMiddle-old adults (aged 75–84) with a cancer history had significantly reduced rates of cognitive decline over time, including the global measure of cognitive functioning (B = 0.16, p< .01), mental status (B = 0.08, p< .01), and episodic memory (B = 0.09, p< .05) compared to their counterparts without a cancer history. This effect was not significant for the youngest-old (aged 65–74) or oldest-old adults (aged 85 or older). Also, chemotherapy was not significantly associated with older cancer patients’/survivors’ cognitive functioning at baseline or over time in different age groups.ConclusionsThis study finds that cancer history and chemotherapy do not further exacerbate older adults’ cognitive functioning over time. On the contrary, cancer history shows a “protective” effect on middle-old adults’ cognitive functioning. This encouraging finding indicates that older adults can be more actively engaged in the decision-making of treatments and following care plans. Future mediation studies are needed to further investigate underlying mechanisms.     

Kidney function and cognitive performance and decline in older men

OBJECTIVES: To examine the association between kidney function and cognitive impairment and decline in elderly men. DESIGN: Observational prospective cohort. SETTING: Community based. PARTICIPANTS: Five thousand five hundred twenty‐nine community dwelling men aged 65 and older (mean age 73.6 ± 5.9). MEASUREMENTS: Estimated glomerular filtration rate (eGFR) calculated using the standardized Modification of Diet in Renal Disease (MDRD) equation; cognitive function assessed using the Modified Mini‐Mental State Examination (3MS) and Trail Making Test B (Trails B). RESULTS: At baseline, 148 (2.7%) and 494 (9.1%) men were classified as cognitively impaired and, in the 5‐year prospective analysis, 931 (23%) and 432 (11.6%) met the criteria for cognitive decline at follow‐up defined according to 3MS and Trails B performance, respectively. In unadjusted analysis, the odds of prevalent cognitive impairment and risk of cognitive decline were significantly higher in men with an eGFR less than 45 and 45 to 59 mL/min per 1.73 m² than in men with an eGFR 60 mL/min per 1.73 m² or greater. Differences in age, race, and education between eGFR categories largely explained these associations, with the exception of the association between poorer renal function and higher odds of impairment based on Trails B test score, which persisted despite adjustment for multiple potential confounders. CONCLUSION: This study found evidence of an independent association between mild to moderate reductions in kidney function and poor executive function at baseline but not with global cognitive impairment or risk of cognitive decline in older men.     

Diminished cardiac hypertrophy and muscle performance in older compared with younger adult rats with chronic atrioventricular block

The combined effect of advancing age and hemodynamic overload on cardiac muscle function has received little attention. In male, Sprague-Dawley rats, we studied the interaction of chronic atrioventricular heart block induced by transvenous electrocautery for 4-12 months (mean, 7 months) and age at study (12, 19 +/- 0.7, and 24 +/- 0.2 months) on cardiac hypertrophy and muscle function compared with age-matched, sham-operated controls. Hypertrophy was determined by the ratio of heart weight to tibial length. Muscle function was first determined from the mechanical variables of the isometric contraction of an excised, thin, left ventricular trabecular muscle bathed at 29 degrees C under a variety of calcium concentrations and stimulation patterns. Then, in the same muscles after disruption of membranes with Triton X-100, the force-pCa curve of the myofibrils was obtained. No hypertrophy occurred with aging in the control group, but alteration in hypertrophy with age occurred in the block group such that the youngest animals with block had the most hypertrophy (170%) and the oldest animals with block the least hypertrophy (120%). The tension developed by cardiac muscle and the duration of the isometric contraction were not affected by age in the control group but were significantly affected by age in the block group. The young animals with block had a markedly prolonged contraction duration and almost twice the developed tension compared with the older animals with block or with controls. The age-related difference in muscle contraction duration in the block group was associated with, and may have only been secondary to, the age-related difference in the extent of cardiac hypertrophy. For developed tension, the age-related difference in the block group could not be explained by differences in the extent of cardiac hypertrophy. Rather, this difference was attributable to both an increased myofibrillar force-generating capacity in the young block and to an impairment in excitation-contraction coupling in the old block. The results show that during long-term block, age exerted not only a significant effect on the extent of cardiac hypertrophy but also an independent effect on the developed tension of cardiac muscle.     

An examination of perceived stress in family caregivers of older adults with heart failure

This investigation evaluates the moderating influence of social support on the negative effects of stress for family caregivers and validates the Perceived Stress Scale as a standard of measurement. Seventy-five family caregivers to older adults with heart failure were interviewed in their homes about perceived stress, depressive symptoms, and social support after hospital discharge. The Perceived Stress Scale demonstrated internal consistency. Social support did not moderate the effects of stress on depressive symptoms. Lack of a significant association between salivary cortisol and the Perceived Stress Scale did not support testing of construct validity. Stress levels, however, frequently vary due to caregiving demands and additional influencing factors.     

Pain reports by older hospice cancer patients and family caregivers: the role of cognitive functioning

PURPOSE: Prior research in nursing homes has shown that cognitive impairment may reduce self-reported pain, but this relation has not been systematically explored among hospice patients. The assessment and treatment of pain is a primary goal of hospice care, and both disease processes and the use of opioid analgesics may lead to cognitive impairment among hospice patients. However, little is known about how cognitive functioning may impact the self-report of pain or the report of care recipient pain by family caregivers. DESIGN AND METHODS: We explored the associations between pain, cognitive functioning, and gender among cancer patients and their family caregivers (N = 176 dyads) during in-home hospice care. This was a cross-sectional, correlational study. RESULTS: Contrary to expectation, care recipients with cognitive impairment reported more intense pain than care recipients with intact cognitive functioning. However, cognitive impairment among care recipients had no impact on the pain report of family caregivers. Care recipient cognitive impairment was related to greater discrepancy in the pain reports of caregivers and care recipients. No gender differences in pain intensity report were found. IMPLICATIONS: Measurement issues and implications for assessing self-reported pain among hospice cancer patients with impaired cognitive functioning and the report of care recipient pain by family caregivers are discussed. Specifically, hospice staff must educate family caregivers regarding the potential impact of care recipient cognitive impairment on pain reports in order to facilitate accurate pain assessment and management.     

Mental and physical health of male caregivers of a spouse with Alzheimer's disease

Fifty-two male spouse caregivers of patients with Alzheimer's disease and 53 demographically equated controls completed multidimensional assessments of mental and physical health. Results indicate that compared with noncaregiving men, male spouse caregivers have poorer mental and physical health, but only within limited domains of health outcomes. In particular, caregiving men showed higher levels of depression, respiratory system symptoms, and poorer levels of health habits, but did not differ from noncaregiving men on other indexes of physical and mental health. The importance of focusing on understudied specific subgroups of caregivers, such as male spouses, as well as using multidimensional instead of summary measures of mental and physical health are emphasized.     

Aberrant behaviors and Alzheimer's disease: mental health effects on spouse caregivers

The relationships between well-being of 262 caregivers of Alzheimer's disease patients and forgetful, asocial, and disoriented behaviors on the part of the impaired spouse were examined using three one-way MANOVAs. Results indicate that asocial and disoriented behaviors have linear relationships with levels of burden, specific mental health problems attributed to caregiving, and the extent to which caregivers sacrificed aspects of their social life. Asocial behaviors were also linearly related to overall level of caregiver depression. Forgetful behaviors, on the other hand, have relationships with burden, specific mental health problems attributed to caregiving, and social change that are nonlinear. Data are interpreted in terms of the predictable course of Alzheimer's disease and associated role expectations.