Innovation in Aging最新文献

[This corrects the article DOI: 10.1093/geroni/igae031.].

[This corrects the article DOI: 10.1093/geroni/igad104.1771.][This corrects the article DOI: 10.1093/geroni/igad104.2432.][This corrects the article DOI: 10.1093/geroni/igad104.2578.].

Background and objectives: Delirium and depression are prevalent in aging. There is considerable clinical overlap, including shared symptoms and comorbid conditions, including Alzheimer's disease, functional decline, and mortality. Despite this, the long-term relationship between depression and delirium remains unclear. This study assessed the associations of depression symptom burden and its trajectory with delirium risk in a 12-year prospective study of older hospitalized individuals.

Research design and methods: A total of 319 141 UK Biobank participants between 2006 and 2010 (mean age 58 years [range 37-74, SD = 8], 54% women) reported frequency (0-3) of 4 depressive symptoms (mood, disinterest, tenseness, or lethargy) in the preceding 2 weeks prior to initial assessment visit and aggregated into a depressive symptom burden score (0-12). New-onset delirium was obtained from hospitalization records during 12 years of median follow-up. 40 451 (mean age 57 ± 8; range 40-74 years) had repeat assessment on average 8 years after their first visit. Cox proportional hazard models examined whether depression symptom burden and trajectory predicted incident delirium.

Results: A total of 5 753 (15 per 1 000) newly developed delirium during follow-up. Increased risk for delirium was seen for mild (aggregated scores 1-2, hazards ratio, HR = 1.16, [95% confidence interval (CI): 1.08-1.25], p < .001), modest (scores 3-5, 1.30 [CI: 1.19-1.43], p < .001), and severe (scores ≥ 5, 1.38 [CI: 1.24-1.55], p < .001) depressive symptoms, versus none in the fully adjusted model. These findings were independent of the number of hospitalizations and consistent across settings (eg, surgical, medical, or critical care) and specialty (eg, neuropsychiatric, cardiorespiratory, or other). Worsening depression symptoms (≥1 point increase), compared to no change/improved score, were associated with an additional 39% increased risk (1.39 [1.03-1.88], p = .03) independent of baseline depression burden. The association was strongest in those over 65 years at baseline (p for interaction <.001).

Discussion and implications: Depression symptom burden and worsening trajectory predicted delirium risk during hospitalization. Increased awareness of subclinical depression symptoms may aid delirium prevention.

[This corrects the article DOI: 10.1093/geroni/igad104.2232.].

Background and objectives: Modifiable risk factors across the life course play a role in the development of Alzheimer's disease and related dementias (ADRD). Studies have identified racial and ethnic disparities in ADRD risk factors. Few studies have explored the epidemiology of ADRD risk among Middle Eastern and North African (MENA) Americans, largely due to their classification as White in US national health surveys. Our aim was to estimate ADRD risk factors among MENA immigrants compared to US- and foreign-born non-Hispanic White adults.

Research design and methods: We linked cross-sectional 2000-2017 National Health Interview Survey and 2001-2018 Medical Expenditure Panel Survey data (N = 108 695; age ≥ 18 years). Modifiable risk factors for ADRD that were evaluated (yes or no) included less than ninth grade education, hearing loss, traumatic brain injury, hypertension, alcohol use, obesity, smoking, depressive symptoms, marital status, physical inactivity, and diabetes. Bivariate analysis and multivariable logistic regression were conducted. Regression models were adjusted by age and sex.

Results: Compared to US-born White adults, MENA immigrants had higher odds of reporting less than 9th grade education (OR = 1.93; 95% CI = 1.17-3.21) and psychological health concerns (OR = 1.28; 95% CI = 1.06-1.56). Compared to foreign-born White adults, MENA immigrants had higher odds of diabetes (OR = 1.48; 95% CI = 1.06-2.08) and psychological health concerns (OR = 1.24; 95% CI = 1.01-1.54).

Discussion and implications: The findings provide the first comprehensive look at potentially modifiable risk factors for ADRD among MENA immigrants based on a life course model. Without a racial/ethnic identifier for MENA individuals on a national level, ADRD risk factors among US-born MENA adults and MENA immigrants cannot be examined. More research is needed to explore these risk factors by life stage (early, midlife, and late) to further determine ADRD risk and prevention strategies for MENA Americans.

Background and objectives: Social isolation (SI) and loneliness are key factors that contribute to frailty among older adults. Current estimates regarding how frailty affects SI and loneliness and how SI and loneliness affect frailty may be flawed due to reverse causality. This study aimed to investigate the bidirectional relationships and mediating effects among SI, loneliness, and frailty among older adults in China.

Research design and methods: The study analyzed data from 6 waves of the Chinese Longitudinal Healthy Longevity Survey conducted between 2002 and 2018. The sample included individuals aged 65 and older. The General Cross-Lagged Panel Model was used to account for confounding factors and reveal mediating effects.

Results: Our findings specifically indicate a direct effect of SI on frailty, although suggesting that loneliness may indirectly affect frailty through its influence on SI. Additionally, frailty can lead to increased SI and loneliness.

Discussion and implications: SI and loneliness are strongly intertwined with frailty among older adults in China. To prevent the development of frailty, public health initiatives should prioritize reducing SI among older adults. Furthermore, efforts to decrease frailty levels can yield positive outcomes by mitigating both SI and loneliness among this population.

Background and objectives: The growing interest in the impact of lifetime occupational exposures on later-life health underscores the need to expand and evaluate the quality of data resources. The present study took advantage of a retrospective life history survey fielded within the context of the Health and Retirement Study to assess the accuracy of retrospectively obtained information on job history. We evaluated hypotheses related to job history and respondent characteristics to understand more about factors associated with recall accuracy.

Research design and methods: We used data from the Life History Mail Survey (LHMS), a self-administered survey conducted in 2015 and 2017. We compared the match rate of work status collected in the LHMS questionnaire with data collected concurrently during HRS core face-to-face or phone interviews from 1992 through 2016 with respect to jobs held at the time of the interview. We also conducted a limited set of comparisons of occupation and industry match.

Results: The sample was 61.79% women, 82.12% White, and 8.57% Hispanic with a mean age of 74.70 years. The overall work status match rate was 83%. Jobs held longer ago were recalled with less accuracy. Jobs held for longer durations and that were full-time rather than part-time were recalled with greater accuracy. More complex job histories that involved a larger number of jobs were also associated with a lower match rate. Higher levels of conscientiousness and cognitive functioning were both associated with a higher match between the two sources of work status information. The occupation match rate was 69%, and the industry match rate was 77%.

Discussion and implications: A self-administered, paper-and-pencil questionnaire attempting to measure decades-long histories of autobiographically important dimensions of life can provide reasonably accurate historical employment information. Several factors are likely to influence the relative accuracy of recalled information.

Background and objectives: Proper symptom management, informal caregiver support, and service innovation are required to reduce dementia care burden. The objective of this study is to investigate the effect of the multicomponent LIVE (Learning, Innovation, Volunteering, Empowerment) intervention on caregiver experience of the self-perceived care situation, coordinator performance, and informal care time.

Research design and methods: We conducted a 24-month multicomponent, stepped-wedge randomized control trial including dyads of people ≥65 years with mild-to-moderate dementia with minimum weekly contact with their informal caregivers in Norway. The intervention was implemented by municipal coordinators over a 6-month period. This study investigates the first 6-month period (September 2019-March 2020) of the trial, due to the coronavirus disease 2019 (COVID-19) pandemic. Primary outcomes are changes in provision of informal care time assessed by Resource Utilization in Dementia Care (RUD) and informal caregiver experience assessed by the Clinical Global Impression of Change (CGIC). We use logistic regression and feedback system analysis to assess the reach of the multicomponent intervention.

Results: A total of 280 dyads were included at baseline, mean age of the person with dementia was 81.8 years, and 62.5% were female. After 6 months, the feedback system analysis reveals that the caregivers randomized to the intervention period reported improved caregiver situation (CGIG-T: intervention 0.63 (SD 2.4) vs control -0.43 (SD 1.7), p < .01), even though informal care time for activities of daily living was not reduced (p = .31). Informal caregivers registered a positive change for the Learning, Innovation, and Empowerment components, while no change was found for Volunteer support.

Discussion and implications: Findings illustrate the usefulness of dementia care coordinators that provide regular follow-up. We also show that complex intervention studies benefit from applying feedback system analysis. Meeting the needs of persons with dementia and their caregivers is a complex process that requires coordinated input from health services and user communities.

Clinical trial registration number: NCT04043364.

Background and objectives: Consumer credit has shown increasing relevance to the health of older adults; however, studies have not been able to assess the extent to which creditworthiness influences future health or health influences future creditworthiness. We assessed the relationships between 4-year pre and postmorbid consumer credit history and self-rated physical and mental health outcomes among older adults.

Research design and methods: Generalized estimating equations models assessed pre and postmorbid credit history (credit scores, derogatory accounts, and unpaid accounts in collections) and the onset of poor self-rated health (SF-36 score <50) among 1,740 participants aged 65+ in the Advanced Cognitive Training for Independent and Vital Elderly study from 2001 to 2017, linked to TransUnion consumer credit data.

Results: In any given year, up to 1/4 of participants had a major derogatory, unpaid, or collections account, and up to 13% of the sample had poor health. Each 50-point increase in credit score trended toward a 5% lower odds of poor health in the next 1 year, a 6% lower odds in the next 2 years, and a statistically significant finding of 13% lower odds by 3 years. A drop in credit score was associated with a 10% greater odds of poor health in the next year, and having a major derogatory account was associated with an 86% greater odds of poor health in the next 3 years. After poor health onset, credit scores continued to see significant losses up to the 3 years, with larger decrements over time.

Discussion and implications: Having a major derogatory account or a sudden loss in credit may be a time to monitor older adults for changes in health. After a downturn in health, supporting older adults to manage their debt may help stabilize their credit.