Longitudinal associations between insomnia symptoms and all-cause mortality among middle-aged and older adults: A population-based cohort study

SLEEP ◽  
2022 ◽  
Author(s):  
Asos Mahmood ◽  
Meredith Ray ◽  
Kenneth D Ward ◽  
Aram Dobalian ◽  
Sang Nam Ahn
Keyword(s):  
Older Adults ◽  
The United States ◽  
Early Morning ◽  
Time Varying ◽  
Middle Aged ◽  
Insomnia Symptom ◽  
All Cause Mortality ◽  
Longitudinal Associations ◽  
Insomnia Symptoms

Abstract To date, there is no scientific consensus on whether insomnia symptoms increase mortality risk. We investigated longitudinal associations between time-varying insomnia symptoms (difficulty initiating sleep, difficulty maintaining sleep, early-morning awakening, and non-restorative sleep) and all-cause mortality among middle-aged and older adults during 14 years of follow-up. Data were obtained from 2004 through 2018 survey waves of the Health and Retirement Study in the United States for a population-representative sample of 15,511 respondents who were ≥50 years old in 2004. Respondents were interviewed biennially and followed through the end of the 2018 survey wave for the outcome. Marginal structural discrete-time survival analyses were employed to account for time-varying confounding and selection bias. Of the 15,511 cohort respondents (mean [±SD] age at baseline, 63.7 [±10.2] years; 56.0% females), 5,878 (31.9%) died during follow-up. At baseline (2004), 41.6% reported experiencing at least one insomnia symptom. Respondents who experienced one (HR=1.11; 95% CI: 1.03–1.20), two (HR=1.12; 95% CI: 1.01–1.23), three (HR=1.15; 95% CI: 1.05–1.27), or four (HR=1.32; 95% CI: 1.12–1.56) insomnia symptoms had on average a higher hazard of all-cause mortality, compared to those who were symptom-free. For each insomnia symptom, respondents who experienced difficulty initiating sleep (HR=1.12; 95% CI: 1.02–1.22), early-morning awakening (HR=1.09; 95% CI: 1.01–1.18), and nonrestorative sleep (HR=1.17; 95% CI: 1.09–1.26), had a higher hazard of all-cause mortality compared to those not experiencing the symptom. The findings demonstrate significant associations between insomnia symptoms and all-cause mortality, both on a cumulative scale and independently, except for difficulty maintaining sleep. Further research should investigate the underlying mechanisms linking insomnia symptoms and mortality.

Longitudinal associations between time-varying insomnia symptoms and all-cause healthcare services utilization among middle-aged and older adults in the US

2021 ◽  
Author(s):  
Asos Mahmood ◽  
Satish Kedia ◽  
Aram Dobalian ◽  
Cyril F. Chang ◽  
SangNam Ahn
Keyword(s):  
Older Adults ◽  
Nursing Home ◽  
Healthcare Services ◽  
Early Morning ◽  
Home Healthcare ◽  
Time Varying ◽  
Middle Aged ◽  
Services Utilization ◽  
Hospital Stays ◽  
Insomnia Symptoms

Abstract This study examines longitudinal associations between time-varying insomnia symptoms (including difficulty initiating sleep, difficulty maintaining sleep, early-morning awakenings, and nonrestorative sleep) and all-cause healthcare services utilization (HSU; overnight hospital stays, nursing home stays, and home healthcare services) among middle-aged and older adults. Data were obtained from 2002 through 2018 waves of the Health and Retirement Study in the US for a population-representative sample of 13,168 adults (aged ≥50 years; mean [SD] age= 66.8±9.4; females= 57.7%; ≥2 comorbid medical conditions= 52.5%). A marginal structural modeling approach and generalized estimating equations were implemented to capture time-varying biological, psycho-cognitive, lifestyle, or behavioral health factors and to adjust for selection bias due to differential loss to follow-up. At baseline, 38.9% of respondents reported experiencing at least one insomnia symptom. During the 16-year follow-up, 72.9%, 17.9%, and 35.1% reported overnight hospital stays, nursing home stays, and home healthcare services utilization, respectively. Higher numbers of insomnia symptoms on a cumulative scale were associated with more overnight hospital stays, nursing home stays, and home healthcare services utilization. Further, experiencing each of difficulty initiating and maintaining sleep, and nonrestorative sleep, as standalone symptoms, was associated with a higher likelihood of HSU compared to those not experiencing any of these symptoms. Independent associations of early-morning awakening with nursing home stays and home healthcare utilization were not significant. The results emphasize the roles of screening and addressing symptoms of insomnia among middle-aged and older adults or those prone to sleep disorders to reduce avoidable HSU. Future investigations should focus on the underlying causes and health systems pathways linking insomnia symptoms to HSU.

scholarly journals Association of a Negative Wealth Shock With All-Cause Mortality in Middle-aged and Older Adults in the United States

JAMA ◽  
2018 ◽  
Vol 319 (13) ◽  
pp. 1341 ◽  
Author(s):  
Lindsay R. Pool ◽  
Sarah A. Burgard ◽  
Belinda L. Needham ◽  
Michael R. Elliott ◽  
Kenneth M. Langa ◽  
...  
Keyword(s):  
United States ◽  
Older Adults ◽  
The United States ◽  
Middle Aged ◽  
All Cause Mortality ◽  
Wealth Shock

scholarly journals The Association Between Obesity and Long-Term Cognitive Performance in Middle-Aged and Older Adults

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 379-380
Author(s):  
Andrew Fiscella ◽  
Ross Andel
Keyword(s):  
United States ◽  
Older Adults ◽  
Executive Function ◽  
Cognitive Performance ◽  
Oldest Old ◽  
The United States ◽  
Normal Weight ◽  
Middle Aged ◽  
Global Cognition

Abstract Obesity is a growing epidemic in the United States and has been associated with negative health outcomes such as cardiovascular disease and diabetes. However, an obesity paradox has emerged which suggests that the effects of obesity may vary by age, with older adults potentially seeing a protective effect of obesity. This study examined the effects of overweight and obese status on cognitive performance at baseline and follow-up. It was hypothesized that obese middle-aged adults would perform worse than normal weight peers, but that reverse would be observed in older adults. Data from 701 participants in the Midlife in the United States study were included. Body mass index (BMI) and waist circumference were employed as measures of obesity. Z-scores for executive function, memory, and global cognition were used to quantify cognitive performance. While obese participants tended to perform worse on average than normal weight individuals there were no significant differences in performance between obese and normal weight participants in global cognition (p=.134), executive function (p=.164), or episodic memory (p=.708). Additionally, age did not moderate this relationship. However, there was a significant effect of education on all three domains. When stratified by education, participants with some college or higher, had a significant time*obesity*age interaction (F[3,328]=3.016, p<.05). For the oldest-old participants, executive function scores were higher for obese participants at follow-up compared to normal weight participants, but not at baseline. These findings suggest that level of education may serve as a form of cognitive reserve which compensates for deficits due to obesity.

scholarly journals Elevations in time-varying resting heart rate predict subsequent all-cause mortality in older adults

2014 ◽  
Vol 22 (4) ◽  
pp. 527-534 ◽  
Author(s):  
Bríain ó Hartaigh ◽  
Heather G Allore ◽  
Mark Trentalange ◽  
Gail McAvay ◽  
Stefan Pilz ◽  
...  
Keyword(s):  
Older Adults ◽  
Heart Rate ◽  
Time Varying ◽  
Resting Heart Rate ◽  
All Cause Mortality

scholarly journals Domestic and International Perspectives on Financing Adult Education and Training

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 389-390
Author(s):  
Abigail Helsinger ◽  
Oksana Dikhtyar ◽  
Phyllis Cummins ◽  
Nytasia Hicks
Keyword(s):  
Older Adults ◽  
Adult Education ◽  
Adult Learners ◽  
Low Income ◽  
The United States ◽  
Education And Training ◽  
Technological Advancement ◽  
Middle Aged ◽  
Structured Interviews ◽  
And Training

Abstract Adult education and training (AET) over the life-course is necessary to participate in economic, social, and political activities in the time of globalization and technological advancement. However, little research has been done to identify mechanisms to fund AET opportunities among middle-aged and older adults from a comparative international perspective. Our study aimed to identify strategies to finance AET opportunities for middle-aged and older adults through an international lens, to help identify barriers and facilitators in effort to best support adult learners regardless of education background or socioeconomic characteristics. We carried out a descriptive qualitative study to facilitate an in-depth understanding of funding mechanisms available to adult learners in the selected countries, from the perspective of adult education and policy experts. Data were collected using semi-structured interviews with 61 international adult education experts from government agencies, non-governmental organizations, and education institutions. Our informants represented 10 countries including Australia, Canada, Germany, Italy, the Netherlands, Norway, Singapore, Sweden, the United Kingdom, and the United States. Data included at least one in-depth phone or web-based qualitative interview per informant in addition to information gathered from written materials (e.g., peer-reviewed publications and organizational reports). We identified three financing options that arose as themes: government-sponsored funding; employer-sponsored funding; and self-funding. We found that government-sponsored funding is especially important for low-skilled, low-income older adults for whom employer-sponsored or self-funding is not available. Our results have implications for lifelong AET policy changes, such as adaptations of successful AET funding programs across global communities.

scholarly journals Longitudinal Associations of Stroke With Cognitive Impairment Among Older Adults in the United States: A Population-Based Study

2021 ◽  
Vol 9 ◽  
Author(s):  
Xia Wu ◽  
Li Fan ◽  
Songqing Ke ◽  
Yangting He ◽  
Ke Zhang ◽  
...  
Keyword(s):  
United States ◽  
Older Adults ◽  
Cognitive Impairment ◽  
Univariate Analysis ◽  
The United States ◽  
Hazard Ratio ◽  
Multivariable Model ◽  
The Future ◽  
Longitudinal Associations ◽  
Weighted Proportion

Objective: The aim of this study was to explore the longitudinal associations of stroke with cognitive impairment in older US adults.Method: The data used in this longitudinal analysis were extracted from the National Health and Aging Trends Study (NHATS) from 2011 to 2019. Univariate and multivariable Cox proportional hazards regression models were used to estimate the longitudinal association of stroke with cognitive impairment. The multivariable model was adjusted by demographic, physical, and mental characteristics, and the complex survey design of NHATS was taken into consideration.Results: A total of 7,052 participants with complete data were included. At the baseline, the weighted proportion of cognitive impairment was 19.37% (95% CI, 17.92–20.81%), and the weighted proportion of the history of stroke was 9.81% (95% CI, 8.90–10.72%). In univariate analysis, baseline stroke history was significantly associated with cognitive impairment in the future (hazard ratio, 1.746; 95% CI, 1.461–2.088), and the baseline cognitive impairment was significantly associated with future report of stroke (hazard ratio, 1.436; 95% CI, 1.088–1.896). In multivariable model, stroke was also significantly associated with cognitive impairment (hazard ratio, 1.241; 95% CI, 1.011–1.522); however, the reverse association was not significant (hazard ratio, 1.068; 95% CI, 0.788–1.447). After the data from proxy respondents were excluded, in the sensitive analyses, the results remained unchanged.Conclusion: Older adults in the United States who suffered strokes are more likely to develop cognitive impairment as a result in the future than those who have not had strokes. However, the reverse association did not hold. Furthermore, the study suggests that it is necessary to screen and take early intervention for cognitive impairment in stroke survivors and prevent the incidence of stroke by modifying risk factors in the general population with rapidly growing older US adults.

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