Innovation in Aging最新文献

Background and objectives: Identifying predictors of dementia may help improve risk assessments, increase awareness for risk reduction, and identify potential targets for interventions. We use a life-course psychosocial multidisciplinary modeling framework to examine leading predictors of dementia incidence.

Research design and methods: We use data from the Health and Retirement Study to measure 57 psychosocial factors across 7 different domains: (i) demographics, (ii) childhood experiences, (iii) socioeconomic conditions, (iv) health behaviors, (v) social connections, (vi) psychological characteristics, and (vii) adverse adulthood experiences. Our outcome is dementia incidence (over 8 years) operationalized using Langa-Weir classification for adults aged 65+ years who meet criteria for normal cognition at the baseline when all psychosocial factors are measured (N = 1 784 in training set and N = 1 611 in testing set). We compare the standard statistical method (Logistic regression) with machine learning (ML) method (Random Forest) in identifying predictors across the disciplines of interest.

Results: Standard and ML methods identified predictors that spanned multiple disciplines. The standard statistical methods identified lower education and childhood financial duress as among the leading predictors of dementia incidence. The ML method differed in their identification of predictors.

Discussion and implications: The findings emphasize the importance of upstream risk and protective factors and the long-reaching impact of childhood experiences on cognitive health. The ML approach highlights the importance of life-course multidisciplinary frameworks for improving evidence-based interventions for dementia. Further investigations are needed to identify how complex interactions of life-course factors can be addressed through interventions.

Background and objectives: Neighborhood walkability can influence walking behaviors in older adults. However, its associations of walkability with walking may differ by demographic, socioeconomic, health, social, and residential characteristics due to factors such as increased vulnerability to environmental factors or increased resilience.

Research design and methods: In a sample of older adults (n = 493, median age = 82 [range 78-89], 56% female, 31% Black), a walkability index was derived from audits of Google Street View images of participants' immediate neighborhoods. Walking was self-reported in the past week. Effect modifiers by demographic (age, race, gender, marital status), socioeconomic (education, income), health (gait speed, falls, knee pain, depressive symptoms, cognitive status, perceived energy), social (driving status, social engagement), and residential/neighborhood (residence type, neighborhood socioeconomic status [SES], population density) characteristics were assessed by interaction terms in logistic regression models, adjusted for gender, race, gait speed, prior falls, high depressive symptoms, currently driving, and cognitive status. When effect modification was suggested (p for interaction <.1), adjusted analyses of walkability with walking stratified on the effect modifier were conducted.

Results: In this sample, 59% walked in the past week and greater walkability was associated with greater odds of walking (odds ratio [OR] = 1.16, 95% confidence interval [CI]: 1.01-1.34). This association (p for interaction range 0.002-0.07) was present for those who were not currently married (OR = 1.35, 95% CI: 1.17-1.56), who reported knee pain (OR = 1.40, 95% CI: 1.14-1.72) or high depressive symptoms (OR = 1.30, 95% CI: 1.06-1.60), or who had declining cognitive function (OR = 1.30, 95% CI: 1.09-1.55).

Discussion and implications: High walkability may influence physical activity, particularly for those with vulnerabilities related to social, pain, and brain health characteristics. These results should inform neighborhood planning and targeted interventions for vulnerable older adults.

Background and objectives: Sex and gender are important topics of increasing interest in aging and dementia research. Few studies have jointly examined sex (as a biological attribute) and gender (as a sociocultural and behavioral characteristic) within a single study. We explored a novel data mining approach to include both sex and gender as potentially related influences in memory aging research.

Research design and methods: Participants were 746 cognitively normal older adults from the Victoria Longitudinal Study. First, we adapted the Gender Outcomes INternational Group: To Further Well-being Development (GOING-FWD) framework-which is informed by gender dimensions of the Women's Health Research Network-to identify, extract, and operationalize gender-related variables in the database. Second, we applied principal component analysis (PCA) to a pool of potential gender variables for creating empirically derived gender-related components. Third, we verified the expected pattern of sex differences in memory performance and evaluated each gender-related component as a potential mediator of the observed sex-memory association.

Results: Systematic data mining produced a roster of potential gender-related variables, 56 of which corresponded to gender dimensions represented in the GOING-FWD framework. The PCA revealed 6 gender-related components (n indicators = 37): Manual Non-Routine Household Tasks, Subjective Memory Beliefs, Leisure Free Time, Social and Routine Household Management, Health Perceptions and Practices, and Brain Games. We observed sex differences in latent memory performance whereby females outperformed males. Sex differences in memory performance were mediated by Manual Non-Routine Household Tasks, Social and Routine Household Management, and Brain Games. Follow-up analyses showed that education also mediated the sex-memory association.

Discussion and implications: We show that (i) data mining can identify and operationalize gender-related variables in archival aging and dementia databases, (ii) these variables can be examined for associations with sex, and (iii) sex differences in memory performance are mediated by selected facets of gender.

Background and objectives: Older adults are vulnerable to social isolation, making it crucial to understand its impact on dementia risk. Yet, existing evidence lacks consistency, with studies using varied measures of social isolation and overlooking potential confounders. We aim to investigate the associations between social isolation and dementia risk among older adults, hypothesizing that this association may diminish after adjusting for confounding factors.

Research design and methods: We used 2 977 community-dwelling older adults who had no dementia in 2015 from National Health and Aging Trends. Group-based trajectory modeling was used to analyze the trajectories of social isolation, depression, and anxiety from 2011 to 2015. Cox proportional hazards regression models were then employed to estimate the association between social isolation trajectories and incident dementia from 2015 to 2022, adjusting for demographic variables, depression, anxiety, self-rated health, smoking status, and cardiovascular disease-related variables.

Results: Three social isolation trajectories were identified: minimal, moderate, and high levels of social isolation. During a mean follow-up of 3.6 years, 19.0% of participants were diagnosed with dementia. When only demographics were adjusted, individuals in the moderate social isolation group were 22% less likely to develop dementia compared to those with high social isolation. This association between social isolation and incident dementia became nonsignificant after further adjustment for depression, anxiety, and health indicators.

Discussion and implications: The association between social isolation and dementia risk may be mediated by factors such as depression and other health indicators.

Background and objectives: Previous systemic reviews, predominantly including observational studies, have shown that participation in social activities is a protective factor against cognitive decline. However, this association is subject to potential reverse causality, creating a knowledge gap in our understanding of the effect of social interaction interventions on cognitive function. Therefore, this study aims to conduct a systematic review and meta-analysis of randomized controlled trials to examine the effects of social interaction interventions on cognitive decline among older adults without dementia.

Research design and methods: This systematic review, registered in PROSPERO (CRD42022367828), systematically searched 6 databases from inception to May 6, 2022, to identify relevant articles on the effects of activities with social interaction components on cognitive function in community-dwelling older adults without dementia aged above 60. Two independent reviewers conducted study selection, data extraction, and bias assessment, with RevMan5.3 used for meta-analysis. Subgroup analysis was conducted to assess variation in intervention effects among subgroups.

Results: We included 11 studies for qualitative analysis and 8 studies for the meta-analysis. The results showed that social interaction intervention had a significant effect on executive function (standardized mean difference [SMD] = 1.60; 95% CI, 0.50 to 2.70; p = .004), but not attention and memory. The subgroup analysis showed a greater cognitive benefit for healthy older adults, but not those with mild cognitive impairment. Moreover, in-person social interaction positively affected global cognition, whereas online interaction did not.

Discussion and implications: Social interaction interventions have a limited impact on cognitive function in older adults without dementia but showed potential effects on executive function. This finding offers insights for implementing social intervention in the community.

Background and objectives: There is a paucity of data on the prevalence, risk factors, and impact of olfactory impairment (OI) on key health indicators and economic outcomes in Asian populations. We aimed to address these gaps in a population of community-dwelling older adults.

Research design and methods: We included 2 101 participants (mean age ± standard deviation [SD]: 72.9 ± 8.1 years; 55.1% women) from the baseline assessment of the Population Health and Eye Disease Profile in Elderly Singaporeans (PIONEER) study (2017-2022). Any OI was based on a score of <11 on the 16-item identification segment of the Sniffin' Sticks test battery; subcategorized into hyposmia (score 9-10) and anosmia (score ≤8). Sociodemographic, clinical, and lifestyle risk determinants, health indicators (health-related quality of life, depressive symptoms, daily caloric intake, frailty, and cognitive impairment), and economic outcomes (healthcare expenditure, productivity loss) were assessed via standardized clinical testing and validated questionnaires. Multivariable logistic and linear regression models were utilized to explore the risk factor profile of OI across its severity spectrum and its impact on health indicators and economic outcomes.

Results: The census-adjusted prevalence of any OI, hyposmia, and anosmia were 34.0%, 20.5%, and 13.5%, respectively. Older age and male gender were associated with increased likelihood of hyposmia and anosmia, while the presence of diabetes and >4 days/week alcohol consumption were associated with increased odds of having anosmia only (all p < .05). Both hyposmia and anosmia were also associated with more than twofold increased odds of having CI.

Discussion and implications: Over a third of our community-dwelling older Singaporean population had OI, with 1-in-10 experiencing total olfaction loss. Those with OI had more than double the odds of having CI, regardless of its severity. Our results suggest the importance of community-based programs aimed at detecting and delaying the progression of OI in high-risk individuals.

Background and objectives: When older adults face increasing care needs or limited support, remaining safely and comfortably at home becomes challenging. Extant research has primarily concentrated on characteristics of the older adult or their primary caregiver on nursing home admission. This study examines the risk of older adults transitioning to residential care (e.g., assisted living, nursing home), focusing on the influence of their care network or involvement of multiple helpers.

Research design and methods: Using the National Health and Aging Trends Study, we conducted competing risk regression models that account for mortality, following 7,085 initially community-dwelling older adults across Rounds 1-9 (2011-2019). We assessed network composition, size, shared tasks, and the number of in-network specialists or generalists while controlling for individual sociodemographic and health factors.

Results: Individuals with care networks that shared medical tasks had the highest risk of moving to a residential care setting, followed by those sharing household tasks. Conversely, shared mobility or self-care and transportation responsibilities were associated with lower risks. Having more generalists, but not specialists, increased the risk. Larger networks were associated with heightened risk, although having close family members like a spouse was protective.

Discussion and implications: The findings underscore that care network characteristics are critical to older adults' ability to age in place. Specifically, older adults with larger networks, lacking a spouse or child, and providing complex care are at greater risk for relocating. Understanding care networks can guide interventions related to care network coordination and resource allocation to help avoid or postpone a residential care move.

Background and objectives: Oral health of older adults in nursing homes is poor, which can negatively affect general health and well-being. Most oral health problems are preventable with good oral hygiene and regular dental check-ups. Caregivers can help improve residents' oral health through regular oral health assessments. The interRAI instrument used in Long-Term Care Facilities to evaluate older adults' health and well-being, has the potential to integrate oral care into general care planning. The recently optimized Oral Health Section for inclusion in the interRAI instruments (OHS-interRAI) enables nondental caregivers to identify residents requiring help with oral hygiene and/or a dental referral. This study reports the first data obtained using the OHS-interRAI, describing the oral health situation of older adults in Flemish and Dutch nursing homes.

Research design and methods: In this cross-sectional study, interRAI Long-Term Care Facilities data, including OHS-interRAI data, were collected from October 2020 to January 2023 and analyzed from 417 and 795 persons aged 65 years or older in Flemish and Dutch nursing homes, respectively.

Results: Most common oral health problems were poor oral hygiene and compromised teeth. Differences in oral health were found between Flemish and Dutch residents. Flemish residents had significantly more problems with chewing, dry mouth, oral and denture hygiene, and tongue condition than their Dutch counterparts. They also had a higher need for help with oral hygiene (19.4% vs 14.0%), and a dental referral (36.8% vs 20.9%). Older adults in Flemish nursing homes (20.3%) had significantly fewer dental check-ups than those in Dutch nursing homes (73.5%).

Discussion and implications: The use of the OHS-interRAI by nondental caregivers identified at least one-third of the residents requiring help with oral hygiene and/or a dental referral. By means of trigger algorithms (Collaborative Action Points), the OHS-interRAI enables the integration of oral care into general care planning.

Background and objectives: The main purpose of the study was to examine the factors influencing older adults' seeking dental care, in the context of coronavirus disease 2019 (COVID-19) pandemic, based on the Health Belief Model (HBM).

Research design and methods: Phone interviews were conducted using a structured questionnaire, among 200 older adults aged 65 and above, who are members of the Israeli largest sick fund Clalit Health Services, that were sampled through a systematic random sample. The data were collected between January 2022 and March 2022 and during September 2022.

Results: Our findings indicate that since the outbreak of COVID-19 in Israel, 61.5% and 55% of the participants reported visiting a dentist and a dental hygienist, respectively, and about a fifth of the participants have foregone care at both. Seeking dental care was associated with an increase in perceived threat, benefits, willingness to seek care, and with a decrease in perceived barriers. The HBM was found to be a suitable framework for illuminating older adults' dental behavior, which explains 43% of the variance.

Discussion and implications: The results of the study provided first-hand findings regarding seeking dental care during the COVID-19 pandemic. These findings emphasize the importance of providing dental services with clear recommendations about dental care and appropriate protective equipment, even under conditions of health concern, to enhance oral health services utilization.