scholarly journals CHRONIC PAIN AND ASSOCIATED RISK OF COGNITIVE IMPAIRMENT AMONG MIDDLE-AGED AND OLDER ADULTS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S719-S719
Author(s):  
Yi-Han Hu ◽  
Hsien-Chang Lin
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Cognitive Processing ◽  
Cox Proportional Hazards ◽  
Time Dependent ◽  
Insurance Companies ◽  
Administrative Claims ◽  
Middle Aged ◽  
The Impact

Abstract Chronic non-cancer pain (CNCP) is an emerging health issue among the older population. Not only did the CNCP prevalence increase gradually in past decades, but also it may cause difficulties in cognitive processing and social and emotional functioning. However, evidence for the associations between CNCP and incident mild cognitive impairment (MCI) and Alzheimer’s disease and related dementias (ADRDs) is inconsistent and insufficient. Using the administrative claims data from health insurance companies from January 2007 to December 2017, this prospective cohort study investigated the impact of CNCP on the risks of developing MCI and ADRDs among adults aged 50 and older. To reduce potential selection bias, the propensity-score matched cohort design was applied for selecting comparable CNCP and non-CNCP patients at the beginning of the follow-up. Time-dependent Cox proportional-hazards regression models were conducted to estimate the hazard ratios (HRs) of incident MCI/ADRDs, adjusting for baseline sociodemographics and time-dependent medical conditions. Of 236,782 patients with/without CNCP, 342 individuals (0.14%) developed MCI and 1,183 patients (5.0%) had been diagnosed with one type of ADRDs during the follow-up. After adjusting confounders, CNCP patients had a 42% increased MCI risk (HR=1.42; 95% CI=1.14-1.76) and a 20% increased ADRDs risk (HR=1.20; 95% CI=1.07-1.34) relative to non-CNCP patients. Our findings indicate that CNCP is associated with incidences of MCI and ADRDs. Early diagnosis of CNCP and CNCP management may prevent cognitive impairment among middle-aged and older adults. Future studies are warranted to explore the potential effects of pain treatments on restoring cognitive function of CNCP patients.

scholarly journals Physical Isolation and Mental Health Among Older U.S. Adults in the COVID-19 Coping Study

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 39-39
Author(s):  
Carly Joseph ◽  
Brendan O'Shea ◽  
Jessica Finlay ◽  
Lindsay Kobayashi
Keyword(s):  
Mental Health ◽  
Older Adults ◽  
Mixed Effects Models ◽  
Middle Aged ◽  
Linear Mixed Effects ◽  
Us States ◽  
Physical Isolation ◽  
The Impact ◽  
Do So

Abstract The ongoing COVID-19 pandemic has set an urgent need to understand the impact of physical isolation on mental health. We aimed to investigate the relationships between physical isolation during the period when many US states had shelter-in-place orders (April-May 2020) and subsequent longitudinal trajectories of mental health in middle-aged and older adults (aged 55+, N=3,978) over a six-month follow-up (April to October 2020). We used population and attrition-weighted multivariable linear mixed-effects models. At baseline, 7 days/week of physical isolation (vs. 0 days/week) was associated with elevated depressive symptoms (β=0.82; 95% CI: 0.04-1.60), and all of 1-3, 4-6, and 7 days/week of physical isolation (vs. 0 days/week) were associated with elevated anxiety symptoms and loneliness. Physical isolation was not associated with changes in mental health symptoms over time. These findings highlight the need to prioritize opportunities for in-person connection for middle-aged and older adults when safe to do so.

scholarly journals Impact of Individual and Neighborhood dimensions of Socioeconomic Status on the Prevalence of Mild Cognitive Impairment over Seven-Year Follow-Up

2019 ◽  
Author(s):  
Miguel Ángel Fernández-Blázquez ◽  
Bárbara Noriega-Ruiz ◽  
Marina Ávila-Villanueva ◽  
Meritxell Valentí-Soler ◽  
Belén Frades-Payo ◽  
...  
Keyword(s):  
Older Adults ◽  
Socioeconomic Status ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Low Socioeconomic Status ◽  
Social Inequalities ◽  
Housing Price ◽  
Individual Characteristics ◽  
The Impact

IMPORTANCE: There is strong evidence about the association between low socioeconomic status (SES) and higher risk of dementia. However, it has not been conveniently addressed so far the role of SES on the incidence of Mild Cognitive Impairment (MCI) which is considered a prodromal stage of latter dementia.OBJECTIVE: To examine the impact of individual and neighborhood dimensions of SES, as well as their interaction, on the risk of developing MCI in a sample of older adults that were followed-up for seven years.DESIGN, SETTING, AND PARTICIPANTS: Data from the Vallecas Project cohort, an ongoing community-based longitudinal study for early detection of cognitive impairment and dementia, were used to build two indices of SES namely individual and neighborhood, as well as a global SES as a combination of both, and to investigate their effects on MCI conversion by means of a multivariate-adjusted Cox proportional hazard model.MAIN OUTCOMES AND MEASURES: Based on data referred to as individual-level (one´s educational attainment, occupation, parent´s level of education) and neighborhood-level (district´s income, unemployment rate, housing price, percentage of people with no formal qualifications, with higher education, and with white-collar employs) different composite measures of SES were built and quartiles were considered for further analyses. MCI diagnoses were agreed between neurologists and neuropsychologists at consensus meetings.RESULTS: 1180 participants aged 70 years and older were enrolled in this study (mean age at baseline, 74.9 years; 63.5% females). Of these, 199 cases of MCI (16.9%) were diagnosed at any point of the follow-up. The individual and neighborhood dimensions of SES played different roles in the dynamics of the MCI occurrence through ageing. Most importantly, the risk of developing MCI was almost double for lower SES quartiles when compared to the highest one.CONCLUSIONS AND RELEVANCE: The incidence of MCI in older adults was related to both individual characteristics and socioeconomic context. Public health strategies should be holistic and focus not only on promoting the classical individual preventive measures, but also on reducing social inequalities as a means of fostering healthy ageing and reducing dementia burden.

scholarly journals Prospective association between social engagement and cognitive impairment among middle-aged and older adults: evidence from the China Health and Retirement Longitudinal Study

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e040936
Author(s):  
Shuduo Zhou ◽  
Suhang Song ◽  
Yinzi Jin ◽  
Zhi-Jie Zheng
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Longitudinal Study ◽  
Protective Effect ◽  
Low Income ◽  
Social Engagement ◽  
Lower Risk ◽  
Middle Aged ◽  
Prospective Association

ObjectivesCognitive impairment is a precursor of dementia. This study aimed to examine the association of social engagement with cognitive decline during the process of normal ageing.MethodsWe used data from the China Health and Retirement Longitudinal Study. The cognitive functions were tested at baseline, and 2-year and 4-year follow-up visits. Social engagement was constructed as a comprehensive measure including the quantity and frequency of social activities. Activities of social engagement were classified into three types. Multilevel logistic model was fitted to evaluate the prospective association between social engagement and cognitive impairment.ResultsAfter 2-year follow-up, compared with participants with the lowest level of social engagement, those with level-2, level-3 and level-4 social engagement had a 12% (OR=0.88, 95% CI 0.71 to 1.09, p=0.242), 17% (OR=0.83, 95% CI 0.71 to 0.97, p=0.020) and 25% (OR=0.75, 95% CI 0.61 to 0.93, p=0.008) lower risk for developing cognitive impairment, respectively. A similar pattern of significantly protective association was found at 4-year follow-up. Combined effect analysis showed that participants who attended one type of social engagement had a lower risk of developing cognitive impairment and the protective effect was even larger with those who attended two or three types of social engagement.ConclusionsSocial engagement had a protective effect on cognitive impairment among middle-aged and older adults in China. Given the growing epidemic of dementia and rapid pace of ageing in low-income and middle-income countries, our study shed lights on comprehensive and tailored public health programmes for improving social engagement, to delay cognitive impairment at mid-age and later life.

Co-existence of social isolation and homebound status increase the risk of all-cause mortality

2018 ◽  
Vol 31 (5) ◽  
pp. 703-711 ◽  
Author(s):  
Ryota Sakurai ◽  
Masashi Yasunaga ◽  
Mariko Nishi ◽  
Taro Fukaya ◽  
Masami Hasebe ◽  
...  
Keyword(s):  
Older Adults ◽  
Social Isolation ◽  
Proportional Hazards ◽  
Later Life ◽  
Cox Proportional Hazards ◽  
Face To Face ◽  
All Cause Mortality ◽  
Socially Isolated ◽  
The Impact

ABSTRACTBackground:Social isolation and homebound statuses are possible risk factors for increased mortality among older adults. However, no study has addressed the impact of accumulation of these two factors on mortality. The aim of this study was to examine whether such accumulation increased the risk of all-cause mortality.Methods:The analyzed sample was drawn from a mail survey of 1,023 older adults without instrumental activities of daily living disability. Participants were classified into four groups according to the frequency of both face-to-face and non-face-to-face interactions with others (social isolation and non-social isolation) and the frequency of going outdoors (homebound and non-homebound). Social isolation and homebound statuses were defined as having a social interaction less than once a week and going outdoors either every few days or less, respectively. All-cause mortality information during a six-year follow-up was obtained.Results:In total, 78 (7.6%) participants were both socially isolated and homebound. During the follow-up period, 65 participants died, with an overall mortality rate of 10.6 per 1000 person-years. Cox proportional hazards regression analyses demonstrated that older adults who were socially isolated and homebound showed a significantly higher risk of subsequent all-cause mortality compared with healthy adults who were neither socially isolated nor homebound, independent of potential covariates (aHR, 2.19; 95% CI: 1.04–4.63).Conclusion:Our results suggest that the co-existence of social isolation and homebound statuses may synergistically increase risk of mortality. Both active and socially integrated lifestyle in later life might play a major role in maintaining a healthy status.

scholarly journals Predictors of incident epilepsy in older adults

Neurology ◽  
2017 ◽  
Vol 88 (9) ◽  
pp. 870-877 ◽  
Author(s):  
Hyunmi Choi ◽  
Alison Pack ◽  
Mitchell S.V. Elkind ◽  
W.T. Longstreth ◽  
Thanh G.N. Ton ◽  
...  
Keyword(s):  
Older Adults ◽  
The United States ◽  
Incidence Rates ◽  
Cox Proportional Hazards ◽  
Self Report ◽  
Health Study ◽  
Cardiovascular Health Study ◽  
Administrative Claims ◽  
History Of

Objective:To determine the prevalence, incidence, and predictors of epilepsy among older adults in the Cardiovascular Health Study (CHS).Methods:We analyzed data prospectively collected in CHS and merged with data from outpatient Medicare administrative claims. We identified cases with epilepsy using self-report, antiepileptic medication, hospitalization discharge ICD-9 codes, and outpatient Medicare ICD-9 codes. We used Cox proportional hazards regression to identify factors independently associated with incident epilepsy.Results:At baseline, 42% of the 5,888 participants were men and 84% were white. At enrollment, 3.7% (215 of 5,888) met the criteria for prevalent epilepsy. During 14 years of follow-up totaling 48,651 person-years, 120 participants met the criteria for incident epilepsy, yielding an incidence rate of 2.47 per 1,000 person-years. The period prevalence of epilepsy by the end of follow-up was 5.7% (335 of 5,888). Epilepsy incidence rates were significantly higher among blacks than nonblacks: 4.44 vs 2.17 per 1,000 person-years (p < 0.001). In multivariable analyses, risk of incident epilepsy was significantly higher among blacks compared to nonblacks (hazard ratio [HR] 4.04, 95% confidence interval [CI] 1.99–8.17), those 75 to 79 compared to those 65 to 69 years of age (HR 2.07, 95% CI 1.21–3.55), and those with history of stroke (HR 3.49, 95% CI 1.37–8.88).Conclusions:Epilepsy in older adults in the United States was common. Blacks, the very old, and those with history of stroke have a higher risk of incident epilepsy. The association with race remains unexplained.

The Influence of Cognitive Impairment on Health Behaviors among Older Adults

2020 ◽  
Vol 44 (2) ◽  
pp. 159-168
Author(s):  
Sung-wan Kang ◽  
Xiaoling Xiang
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Cognitive Impairment ◽  
Health Behaviors ◽  
Vigorous Physical Activity ◽  
Cognitive Status ◽  
Health Promotion Programs ◽  
The Impact ◽  
Retirement Study

Objectives: Previous research on cognitive impairment and health behaviors has focused largely on how health behaviors affect cognition; rarely has it examined whether cognitive impairment affects health behaviors. The purpose of this study was to examine the impact of cognitive impairment on engagement in health behaviors among older adults. Methods: The study sample included 19,644 adults aged 50 or older from the Health and Retirement Study 1995-2012 surveys. We used mixed-effects logistic regression to analyze the influence of cognitive impairment, measured using the Telephone Interview for Cognitive Status, on the engagement of health behaviors including physical activity, smoking, and drinking. Results: Cognitive impairment without dementia [CIND] (OR = .84, 95% CI = .80-.89) and dementia (OR = .68, 95% CI = .61-.75) were associated with a lower likelihood of engaging in regular vigorous physical activity during longitudinal follow-up, after adjusting for covariates. CIND or dementia was not significantly associated with the likelihood of smoking or alcohol consumption. Conclusions: CIND and dementia are risk factors for physical inactivity among older adults. Promotion of regular physical activity should be an essential component of health promotion programs for persons with cognitive impairment.

scholarly journals The impact of phlebotomy and hydroxyurea on survival and risk of thrombosis among older patients with polycythemia vera

2018 ◽  
Vol 2 (20) ◽  
pp. 2681-2690 ◽  
Author(s):  
Nikolai A. Podoltsev ◽  
Mengxin Zhu ◽  
Amer M. Zeidan ◽  
Rong Wang ◽  
Xiaoyi Wang ◽  
...  
Keyword(s):  
Older Adults ◽  
Polycythemia Vera ◽  
Proportional Hazards ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Treatment Modalities ◽  
Cox Proportional Hazards Models ◽  
Medicare Database ◽  
The Impact

Abstract Current guidelines recommend therapeutic phlebotomy for all polycythemia vera (PV) patients and additional cytoreductive therapy (eg, hydroxyurea [HU]) for high-risk PV patients. Little is known about the impact of these therapies in the real-world setting. We conducted a retrospective cohort study of older adults diagnosed with PV from 2007 to 2013 using the linked Surveillance, Epidemiology, and End Results–Medicare database. Multivariable Cox proportional hazards models were used to assess the effect of phlebotomy and HU on overall survival (OS) and the occurrence of thrombotic events. Of 820 PV patients (median age = 77 years), 16.3% received neither phlebotomy nor HU, 23.0% were managed with phlebotomy only, 19.6% with HU only, and 41.1% with both treatments. After a median follow-up of 2.83 years, 37.2% (n = 305) of the patients died. Phlebotomy (yes/no; hazard ratio [HR] = 0.65; 95% confidence interval [CI], 0.51-0.81; P &lt; .01), increasing phlebotomy intensity (HR = 0.71; 95% CI, 0.65-0.79; P &lt; .01), and a higher proportion of days covered (PDC) by HU were all significantly associated with lower mortality. When thrombosis was the outcome of interest, phlebotomy (yes/no; HR = 0.52; 95% CI, 0.42-0.66; P &lt; .01) and increasing phlebotomy intensity (HR = 0.46; 95% CI, 0.29-0.74; P &lt; .01) were significantly associated with a lower risk of thrombotic events, so was a higher HU PDC. In this population-based study of older adults with PV reflecting contemporary clinical practice, phlebotomy and HU were associated with improved OS and decreased risk of thrombosis. However, both treatment modalities were underused in this cohort of older PV patients.

The impact of statin therapy after surgical or endovascular treatment of cerebral aneurysms

2020 ◽  
Vol 133 (1) ◽  
pp. 182-189
Author(s):  
Tae-Jin Song ◽  
Seung-Hun Oh ◽  
Jinkwon Kim
Keyword(s):  
Statin Therapy ◽  
Coil Embolization ◽  
Primary Outcome ◽  
Cox Regression ◽  
Cerebral Aneurysms ◽  
Time Dependent ◽  
Lipid Lowering ◽  
Surgical Clipping ◽  
The Impact

OBJECTIVECerebral aneurysms represent the most common cause of spontaneous subarachnoid hemorrhage. Statins are lipid-lowering agents that may expert multiple pleiotropic vascular protective effects. The authors hypothesized that statin therapy after coil embolization or surgical clipping of cerebral aneurysms might improve clinical outcomes.METHODSThis was a retrospective cohort study using the National Health Insurance Service–National Sample Cohort Database in Korea. Patients who underwent coil embolization or surgical clipping for cerebral aneurysm between 2002 and 2013 were included. Based on prescription claims, the authors calculated the proportion of days covered (PDC) by statins during follow-up as a marker of statin therapy. The primary outcome was a composite of the development of stroke, myocardial infarction, and all-cause death. Multivariate time-dependent Cox regression analyses were performed.RESULTSA total of 1381 patients who underwent coil embolization (n = 542) or surgical clipping (n = 839) of cerebral aneurysms were included in this study. During the mean (± SD) follow-up period of 3.83 ± 3.35 years, 335 (24.3%) patients experienced the primary outcome. Adjustments were performed for sex, age (as a continuous variable), treatment modality, aneurysm rupture status (ruptured or unruptured aneurysm), hypertension, diabetes mellitus, household income level, and prior history of ischemic stroke or intracerebral hemorrhage as time-independent variables and statin therapy during follow-up as a time-dependent variable. Consistent statin therapy (PDC > 80%) was significantly associated with a lower risk of the primary outcome (adjusted hazard ratio 0.34, 95% CI 0.14–0.85).CONCLUSIONSConsistent statin therapy was significantly associated with better prognosis after coil embolization or surgical clipping of cerebral aneurysms.

Cognitive Impairment and Physical Activity in Old Age: The Impact on All-Cause Mortality in a 15-Year Follow-Up of the Bambuí Cohort Study of Aging

2020 ◽  
Author(s):  
Erico Castro-Costa ◽  
Jerson Laks ◽  
Cecilia Godoi Campos ◽  
Josélia OA Firmo ◽  
Maria Fernanda Lima-Costa ◽  
...  
Keyword(s):  
Physical Activity ◽  
Cohort Study ◽  
Cognitive Impairment ◽  
Old Age ◽  
All Cause Mortality ◽  
The Impact

scholarly journals The Impact of Work Hours on Depressive Symptoms among Koreans Aged 45 and Over

2021 ◽  
Vol 18 (3) ◽  
pp. 853
Author(s):  
Juyeong Kim ◽  
Eun-Cheol Park
Keyword(s):  
Older Adults ◽  
Depressive Symptoms ◽  
Social Services ◽  
Depression Scale ◽  
Epidemiological Studies ◽  
Work Hours ◽  
Middle Aged ◽  
Health Studies ◽  
Males And Females ◽  
The Impact

Background: Given the documented importance of employment for middle-aged and older adults’ mental health, studies of the association between their number of work hours and depressive symptoms are needed. Objectives: To examine the association between the number of work hours and depressive symptoms in Korean aged 45 and over. Methods: We used data from the first wave to fourth wave of the Korea Longitudinal Study of Aging. Using the first wave at baseline, data included 9845 individuals. Depressive symptoms were measured using the 10-item Center for Epidemiological Studies Depression scale. We performed a longitudinal analysis to estimate the prevalence of depressive symptoms by work hours. Results: Both unemployed males and females aged 45–65 years were associated with higher depressive symptoms (β = 0.59, p < 0.001; β = 0.32, p < 0.001). Females working ≥ 69 h were associated with higher depressive symptoms compared to those working 41–68 h (β = 0.25, p = 0.013). Among those both middle-aged and older adults, both males and females unemployed were associated with higher depressive symptoms. Those middle-aged female working ≥69 h were associated with higher depressive symptoms. Conclusions: An increase in depressive symptoms was associated with unemployed males and females working ≥69 h compared to those working 41–68 h. Although this association was found among middle-aged individuals, a decrease in depressive symptoms in both sexes was associated with working 1–40 h. Depressive symptoms should decrease by implementing employment policies and social services to encourage employers to support middle-aged and older adults in the workforce considering their sex and age differences.

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