Innovation in Aging最新文献

Background and objectives: Cognitive function is crucial for older adults' independence and quality of life. This study investigated the longitudinal relationship between fear of falling and cognitive function using data from the Korean Longitudinal Study of Ageing. Specifically, it examined whether social engagement (regular informal contact and social activities) and physical activity mediate the impact of fear of falling on cognitive function, informing targeted strategies to mitigate cognitive decline.

Research design and methods: This study analyzed seven waves (2006 to 2018) of a nationally representative longitudinal survey involving 3,453 older adults in Korea. To minimize omitted variable bias, the research applied ordinary least squares models with lagged dependent variables and conducted Sobel-Goodman mediation tests for additional insights.

Results: Developing a fear of falling over 2 years is negatively associated with cognitive function. Additionally, although fear of falling negatively impacts social activities and informal contacts, it does not significantly alter physical activity. Mediation analyses show that reduced social activities account for 31% of the cognitive decline associated with fear of falling, compared to 15% for informal social contacts. These findings highlight active social participation as a key factor in protecting cognitive health. Physical activity did not mediate this relationship.

Discussion and implications: Interventions should prioritize enhancing social engagement to mitigate cognitive decline related to fear of falling. Facilitating active community participation can effectively support cognitive health and overall well-being in aging populations.

While opioid overdoses impact Americans of all ages, the full extent of the impact of the evolving opioid crisis on older adults remains poorly understood due to significant gaps in data reporting. Inaccurate documentation of drug poisoning deaths-where opioids are often not listed as primary or secondary causes-obscures the real toll. Additionally, less is known about non-fatal overdoses due to inconsistent reporting and a lack of standardized data collection. To address these challenges, there is a need to reimagine data systems that link local, state, and federal sources to capture geographical risk factors. This article will reflect on current opioid overdose prevalence rates, discuss challenges in existing data solutions, and highlight novel attempts toward building better data systems to enhance our understanding of the risks for and effectiveness of different opioid prevention efforts. Texas A&M University's efforts in leveraging its data integration capabilities to link overdose events with specific interventions, utilizing diverse datasets to offer a more holistic view of the crisis and tailoring responses based on regional needs will serve as a case example. However, achieving optimal data systems will require further improvements, such as standardizing data across districts and enhancing interoperability between public health agencies. This coordinated effort, integrating geographical and demographic risk factors, will be essential to creating timely, accurate data systems that inform targeted interventions for persons of all ages and reduce direct and indirect impacts on older adults and their families.

Background and objectives: Solitude is a common yet nuanced experience in later life, but how older couples jointly experience and perceive solitude remains underexplored. This study examines the influence of congruent and incongruent emotional states between spouses on their subjective experience of solitude, with particular attention to potential gender differences. Understanding this relational dynamic may provide insights to support emotional well-being among aging couples.

Research design and methods: A total of 73 older couples aged 60 to 100 years in Hong Kong SAR, China, participated in this study. Participants completed online questionnaires and Ecological Momentary Assessments (EMA) twice daily for 14 days. Polynomial longitudinal regression models and Response Surface Analysis (RSA) were employed to explore the relationship between congruence and discrepancy in positive affect (PA) and negative affect (NA) between spouses and their perceived solitude.

Results: Significant associations were found between spousal congruence in NA and perceived solitude for both genders, with women showing a more pronounced impact when perceiving greater NA than their partners (women: a ₁ = 0.389, p < .001; a ₂ = 0.360, p <.001; a ₃ = 0.559, p <.001; men: a ₁ = 0.494, p < .001; a ₂ = 0.333, p <.001; a ₃ = 0.452, p < .001). For PA, women experienced increased solitude when perceiving greater PA than their partners (a ₁ = -0.285, p < .001; a ₄ = 0.429, p < .001), whereas men's solitude was affected by both congruence and incongruence in PA (a ₁ = -0.224, p < .001; a ₃ = -0.228, p < .001).

Discussions and implications: Spousal emotional congruence significantly influences perceptions of solitude, differing by gender. Interventions should target emotional communication skills, couple-based therapy, and support groups to enhance relational dynamics, reduce loneliness, and promote emotional well-being in older adults navigating solitude together.

Background and objectives: In 2004, Mexico introduced a public health insurance program, Seguro Popular, to address the large uninsured population. The program was replaced with the Instituto de Salud para el Bienestar (INSABI) in 2020. This change led to an increase in the uninsured population. Using data from the 2018 and 2021 waves of the Mexican Health and Aging Study, we examined the association between insurance loss, medication use for chronic conditions, and health care utilization.

Research design and methods: The final sample included 6,051 participants with hypertension, diabetes, heart disease, stroke, asthma, or arthritis. We examined the following outcomes: (a) stopping medications for one or more chronic conditions; (b) stopping medication due to cost; (c) not seeing a physician for a serious health problem; and (d) the reasons for not seeking care. The main independent variable was the change in self-reported health insurance status between 2018 and 2021. Logistic regression models were used to estimate the association between losing health insurance, medication use, and not seeking medical care.

Results: Approximately 20% of participants who had health insurance in 2018 were uninsured in 2021. Among those taking medications for at least one chronic condition in 2018 (n = 5,518), losing insurance was associated with higher odds of discontinuing medications in 2021 (OR = 2.11). Among all participants, becoming uninsured was associated with significantly higher odds of stopping medications due to cost (OR = 1.95) and not seeing a physician for a serious health condition (OR = 1.50), with cost being the most common reason for not seeking care (OR = 4.97).

Discussion and implications: Our findings suggest that the increase in the uninsured population has negatively affected health care utilization among middle-aged and older adults in Mexico.

Background and objectives: This study aimed to investigate the relationship between mental work, work intensity, and accelerated biological aging, focusing on the mediating role of the Visceral Adiposity Index (VAI).

Research design and methods: In this cross-sectional study, data were collected from the Kailuan physical activity cohorts in the Asia-Pacific region. Biological aging was assessed using PhenoAge and Klemera-Doubal method age (KDMAge) acceleration. Multivariable linear regression models examined the link between mental work and biological aging, while mediation analysis assessed the role of VAI.

Results: Among 3,933 participants (mean age 56.4 years; 55.6% male), mental workers showed greater biological age (BA) acceleration: KDMAge acceleration increased by 1.52 years (p for trend = .04) and PhenoAge by 1.46 years (p for trend < .001) compared to manual workers, after adjusting for age and sex. In mental workers, high labor intensity was associated with greater BA acceleration: KDMAge β  =  0.40, 95% CI [0.10-0.65]; PhenoAge β  =  0.51, 95% CI [0.10-1.38]. In manual workers, high labor intensity also correlated with increased BA acceleration: KDMAge β  =  1.53, 95% CI [0.91-2.12]; PhenoAge β  =  1.32, 95% CI [0.37-2.26]. Mediation analysis showed that VAI mediated 9.8% of the mental work-PhenoAge relationship and 20.9% of the KDMAge relationship.

Discussion and implications: Mental work is associated with accelerated biological aging. These results highlight the importance of interventions targeting work intensity and metabolic health to reduce age-related disease burdens.

Background and objectives: The population of older adults with lived experience of homelessness in the United States is growing. Homelessness is associated with accelerated aging and opioid misuse. Older adults who have experienced homelessness suffer from greater functional impairment than nonhomeless older adults. Opioid misuse may catalyze functional impairment in this population, yet little is known about the prevalence of opioid use disorder (OUD) among currently and formerly homeless older adults. We report findings about the prevalence of OUD and functionality that we hope will spur future research about longevity and OUD in this population.

Research design and methods: Using a secondary analysis of data collected in New York City through electronic medical records, we examined 253 patients who met three inclusion criteria: (a) aged 50 years and older, (b) history of homelessness, and (c) received community-based medical services. We summarize the prevalence of OUD in our cohort and present descriptive statistics about pain and cognitive function for a small subset measured by the Pain Enjoyment of Life and General Activity (PEG) and Mini-Cog scales.

Results: Twelve percent (n = 31) had OUD diagnoses (age range = 50-81; mean age = 65; median age = 65; female = 11; and receiving agonist therapy = 5). Of those, 18 completed Mini-Cog; two showed clinically important cognitive impairment; 14 completed PEG; and eight reported moderate to severe pain.

Discussion and implications: Our report is among the first to describe OUD among older adults who have experienced homelessness. Currently and formerly homeless older adults with OUD are younger, on average, and more likely to be female, than those without OUD. They are more likely to report pain but less likely to exhibit cognitive impairment. Possible explanations for these observations include care engagement, untreated pain, and a survivor effect wherein older adults with OUD who survive homelessness may have traits that protect them from cognitive decline and fatal overdose.

Background and objectives: This study examines education-labor overmatch as a novel work-related exposure and its impact on health disparities among aging immigrants. Drawing on cumulative disadvantage theory, we argue that mismatches between educational attainment and occupational roles contribute to long-term health risks, exacerbating disparities later in life.

Research design and methods: Using nationally representative data from the Health and Retirement Study (n = 19,587), we investigate the relationship between overmatch and stress-sensitive health outcomes across nativity.

Results: Years of education overmatch was unassociated with health outcomes for U.S.-born workers, except for worse self-reported health (OR = 0.90, 95% CI [0.85, 0.96]). However, for immigrants, overmatch was positively associated with worse self-reported health (OR = 0.88, 95% CI [0.78, 0.98]), diabetes (OR = 1.14, 95% CI [1.01, 1.28]), smoking (OR = 1.13, 95% CI [1.01, 1.26]), adiposity (OR = 1.15, 95% CI [1.01, 1.32]), and high blood pressure (OR = 1.21, 95% CI [1.05, 1.38]); income and insurance access attenuated the relationship of overmatch with self-reported health and smoking.

Discussion and implications: Our findings contribute to a growing body of literature that highlights work experiences across the lifecourse as a critical determinant of immigrant health disparities. These insights underscore the need for labor policies that address skill utilization and mitigate long-term health consequences for immigrant populations.

Background and objectives: Depressive symptoms are common in people with dementia, significantly reducing well-being and potentially exacerbating dementia symptoms. The objective of the present study was to investigate the role of support from the social environment for depressive symptoms in people with dementia over a 4-year period.

Research design and methods: We used data from a cohort of 334 community-dwelling people with dementia (M _age = 80.2, 59.3% female) who were interviewed annually in their homes by specially qualified nurses. We used multilevel growth curve models with random intercepts and slopes to model depressive symptoms over time. We modeled both the role of between-person differences and the role of within-person changes in social support for depressive symptoms.

Results: At the beginning of the study, 13.8% of people with dementia reported mild to severe depressive symptoms. People with more social support showed fewer depressive symptoms overall over the 4-year period (% change per point on a scale from 22 to 110: -1.2, 95% CI: -1.8, -0.4). In addition, a decline in a person's social support was associated with more depressive symptoms (% change: -0.9, 95% CI: -1.7, -0.2). These effects were stable even after controlling for sociodemographic (age, sex, education) and clinical factors (cognitive and functional status, comorbidities).

Discussion and implications: The social environment plays an important role in depressive symptoms in people with dementia-beyond clinical factors like cognitive and functional abilities. Improving support from the social environment could be a lever for alleviating depressive symptoms. In the care of people with dementia, not only medical needs but also psychosocial needs should come to the forefront.

Background and objectives: In a cluster randomized trial, we found that augmenting adult day services (ADS) with a multicomponent caregiver support program, ADS Plus, reduced caregiver depressive symptoms and increased ADS use. Unclear is whether the program was implemented with fidelity across sites and the relationship of fidelity to site characteristics and caregiver outcomes.

Research design and methods: Sixteen ADS sites were randomly assigned to ADS Plus (n = 102 caregivers), which offered dementia education, referrals/linkages, validation/support, and strategies for self-care and caregiver-identified challenges. Sites were categorized with high, moderate, or low fidelity based on the number of caregivers enrolled (delivery), care challenges addressed, and prescriptions (strategies) provided (receipt). We examined staff documentation of delivery, receipt, and enactment characteristics, the relationship of fidelity to site characteristics, and caregiver outcomes (depressive symptoms, stress) collected by interviewers 3, 6, and 12 months postbaseline.

Results: Of 102 caregivers, 79.5% were in high (n = 58, 56.9%) or moderate (n = 23, 22.6%), versus 20.6% (n = 21) in low-fidelity sites. High/moderate versus low-fidelity sites delivered more sessions and spent less preparatory time. Caregiver receptivity to sessions was high across all sites. Caregivers with enactment data (n = 43) reported reduced difficulties and upset in high/moderate fidelity sites, and enhanced confidence managing care challenges in high-fidelity sites (p < .0001). Sites with higher percentages of White, non-Hispanic families (p = .006) and dementia clients (p = .004) had better fidelity. At three and 12 months but not at 6 months, caregivers in high/moderate fidelity sites had greater reductions in depressive symptoms and stress (p<.05) compared to those in low-fidelity sites.

Discussion and implications: Most caregivers received ADS Plus with moderate to high fidelity. High/moderate fidelity sites delivered more sessions to more caregivers with substantially stronger caregiver benefits. As fidelity varied by site characteristics, adaptations to staff training and the program appear needed for low-fidelity sites.

Clinical trial registration number: NCT02927821.