Cognitive Impairment and the Trajectory of Loneliness in Older Adulthood: Evidence from the Health and Retirement Study

Objective: To examine whether the trajectory of facets of loneliness—emotional and social—varied by cognitive impairment status in older adulthood. Methods: Data came from the Health and Retirement Study 2008–2018 waves ( N = 15,352). Cognitive impairment was assessed using standard cutoffs for cognitive impairment no dementia (CIND) and dementia. The 11-item UCLA loneliness scale was used to measure emotional and social loneliness. Results: Using multilevel modeling, we found that CIND and dementia status were associated with higher overall, emotional, and social loneliness, controlling for physical health, social contact, and depressive symptoms. The trajectory of loneliness did not vary by cognitive status. There were modest variations by sociodemographic factors. Discussion: Persons with CIND and dementia experience heightened emotional and social loneliness, but cognitive impairment does not contribute to the worsening of loneliness. Older adults' social integration may be maintained early in cognitive impairment.

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The Effect of Cognitive Impairment on Loneliness in Older Adulthood: Evidence From HRS 2008-2018

Innovation in Aging ◽

10.1093/geroni/igaa057.1031 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 322-322

Author(s):

Ji Hyun Lee ◽

Martina Luchetti ◽

Angelina Sutin ◽

Antonio Terracciano

Keyword(s):

Cognitive Impairment ◽

Social Isolation ◽

Functional Limitation ◽

Social Contact ◽

Cognitive Status ◽

Older Adulthood ◽

Emotional Loneliness ◽

Unique Association ◽

Retirement Study ◽

Social Loneliness

Abstract Background: People experience loneliness when there is a mismatch between desired and actual social interaction. Demographic and health factors have been implicated in loneliness; less is known about the unique association of cognitive impairment on loneliness in older adulthood. Purpose: This study examined the link between cognitive impairment status and level and change in loneliness over a 9-year period and whether it is independent of physical health, depression, and social isolation. We examine the associations for overall and the emotional and social loneliness sub-domains of loneliness. Methods: Data were from the Health and Retirement Study 2008-2018 waves (N = 8,269, age 50+). Cognitive impairment status was categorized using mTICS. Loneliness was measured with 11-item UCLA Loneliness scale. Multilevel modeling was used to analyze the effects of cognitive status on loneliness, controlling for time-varying functional limitation, disease burden, social contact, and depression. Results: Cognitive impairment not dementia (CIND) was associated with higher loneliness (b = .04, p < .001). CIND (b = .03, p = .036) and dementia (b = .09, p = .017) were linked to higher emotional loneliness but were not independent of social isolation and depression. Those with CIND had higher social loneliness (b = .04, p = .016), even after adjusting for covariates. The trajectory of loneliness did not vary by cognitive status. Conclusions: Cognitive impairment is a risk factor for loneliness among older adults. Those with mild cognitive impairment experienced heightened loneliness, especially for social belongingness. Cognitive function should be considered in designing interventions for loneliness.

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Same-Sex Couples and Cognitive Impairment: Evidence From the Health and Retirement Study

The Journals of Gerontology Series B ◽

10.1093/geronb/gbaa202 ◽

2020 ◽

Author(s):

Hui Liu ◽

Ning Hsieh ◽

Zhenmei Zhang ◽

Yan Zhang ◽

Kenneth M Langa

Keyword(s):

Cognitive Impairment ◽

The United States ◽

Population Based ◽

Cognitive Status ◽

Health And Retirement Study ◽

Sex Partners ◽

Physical And Mental Health ◽

Same Sex ◽

Same Sex Couples ◽

Retirement Study

Abstract Objectives We provide the first nationally representative population-based study of cognitive disparities among same-sex and different-sex couples in the United States. Methods We analyzed data from the Health and Retirement Study (2000–2016). The sample included 23,669 respondents (196 same-sex partners and 23,473 different-sex partners) aged 50 and older who contributed to 85,117 person-period records (496 from same-sex partners and 84,621 from different-sex partners). Cognitive impairment was assessed using the modified version of the Telephone Interview for Cognitive Status. Mixed-effects discrete-time hazard regression models were estimated to predict the odds of cognitive impairment. Results The estimated odds of cognitive impairment were 78% (p < .01) higher for same-sex partners than for different-sex partners. This disparity was mainly explained by differences in marital status and, to a much lesser extent, by differences in physical and mental health. Specifically, a significantly higher proportion of same-sex partners than different-sex partners were cohabiting rather than legally married (72.98% vs. 5.42% in the study sample), and cohabitors had a significantly higher risk of cognitive impairment than their married counterparts (odds ratio = 1.53, p < .001). Discussion The findings indicate that designing and implementing public policies and programs that work to eliminate societal homophobia, especially among older adults, is a critical step in reducing the elevated risk of cognitive impairment among older same-sex couples.

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Optimism, pessimism and health biomarkers in older couples

10.31234/osf.io/yu2rk ◽

2019 ◽

Author(s):

Reout Arbel ◽

Dikla Segel-Karaps

Keyword(s):

Health Outcomes ◽

Multilevel Modeling ◽

Biological Markers ◽

Chronic Conditions ◽

Marital Relationship ◽

Summary Score ◽

Health And Retirement Study ◽

Older Couples ◽

Older Adulthood ◽

Retirement Study

Objective: Studies have demonstrated the importance of optimism to various health outcomes. However, fewer studies have focused on biological markers, and none have examined whether marital partners levels of optimism and pessimism affect each other's biological markers. Thus, our objectives were to examine whether one's partners optimism and pessimism affect own biological markers. Methods: Three waves of the Health and Retirement Study collected in 2006, 2010 and 2014 were used to test own and partner’s effect on CRP, HDL and Hba1c. Actor-Partner models were used to examine the contribution of partner’s optimism and pessimism on health. Multilevel modeling (MLM) was used to adjust for the interdependence of individuals within dyads. In a series of nine models we tested the separate contribution of pessimism and optimism to each biomarker, within each wave. All models were adjusted for respondent's age, sex and a summary score of respondent's doctor-diagnosed chronic conditions. Results: Partners’ pessimism ad optimism levels were moderately associated. Own and partner’s pessimism, but not optimism, showed significant associations with s partners’ health biomarkers levels. However, effects were not robust and occured primarily at the first assessment waves, when partners were in their early 60s. Conclusion: While optimism seems to have no effect, own and partner's pessimism affects biological markers. Interventions aimed at facilitating healthier life in older adulthood could aim at decreasing pessimism and taking a dyadic approach addressing both partners in a marital relationship.

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Cardiovascular Disease and Cumulative Incidence of Cognitive Impairment in The Health and Retirement Study

10.21203/rs.3.rs-123071/v1 ◽

2020 ◽

Author(s):

Allyson Covello ◽

Leora Horwitz ◽

Shreya Singhal ◽

Caroline Blaum ◽

Yi Li ◽

...

Keyword(s):

Cardiovascular Disease ◽

Cognitive Impairment ◽

Cumulative Incidence ◽

Cognitive Status ◽

Competing Risk ◽

Health And Retirement Study ◽

Risk Of Death ◽

Increased Risk ◽

Significant Difference ◽

Retirement Study

Abstract Background: We sought to examine whether people with a diagnosis of cardiovascular disease (CVD) experienced a greater incidence of subsequent cognitive impairment (CI) compared to people without CVD, as suggested by prior studies, using a large longitudinal cohort. Methods: We employed Health and Retirement Study (HRS) data collected biennially from 1998-2014 in 1,305 U.S. adults age ≥65 newly diagnosed with CVD vs. 2,610 age- and gender-matched controls. Diagnosis of CVD was adjudicated with an established HRS methodology and included self-reported coronary heart disease, angina, heart failure, myocardial infarction, or other heart conditions. CI was defined as a score <11 on the 27-point modified Telephone Interview for Cognitive Status. We examined incidence of CI over an 8-year period using a cumulative incidence function accounting for the competing risk of death.Results: Mean age at study entry was 73 years, 55% were female, and 13% were non-white. Cognitive impairment developed in 1,029 participants over 8 years. The probability of death over the study period was greater in the CVD group (19.8% vs. 13.8%, p <.001). The cumulative incidence analysis, which adjusted for the competing risk of death, showed no significant difference in likelihood of cognitive impairment between the CVD and control groups (29.7% vs. 30.6%, p = 0.64). This finding did not change after adjusting for relevant demographic and clinical characteristics using a proportional subdistribution hazard regression model.Conclusions: Overall, we found no increased risk of subsequent CI among participants with CVD (compared with no CVD), despite previous studies indicating that incident CVD accelerates cognitive decline.

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Gender Modifies the Association of Cognition With Age-Related Hearing Impairment in the Health and Retirement Study

Frontiers in Public Health ◽

10.3389/fpubh.2021.751828 ◽

2021 ◽

Vol 9 ◽

Author(s):

Jing Yuan ◽

Shuping Sang ◽

Jessica Pham ◽

Wei-Jia Kong

Keyword(s):

Cognitive Impairment ◽

Hearing Impairment ◽

Cognitive Status ◽

Health And Retirement Study ◽

Sex And Gender ◽

Female Sex ◽

Hearing Acuity ◽

Multivariable Models ◽

And Gender ◽

Retirement Study

Introduction: Despite growing recognition of hearing loss as a risk factor for late life cognitive disorders, sex and gender analysis of this association has been limited. Elucidating this is one means to advocate for holistic medicine by considering the psychosocial attributes of people. With a composite Gender Score (GS), we aimed to assess this among aging participants (50+) from the 2016 Health and Retirement Study (HRS) cohort.Methods: The GS was derived from gender-related variables in HRS by factor analyses and logistic regression, ranging from 0 (toward masculinity) to 100 (toward femininity). GS tertiles were also used to indicate three gender types (GS tertile 1: lower GS indicates masculinity; GS tertile 2: middle GS indicates androgyny; GS tertile 3: higher GS indicates femininity). Univariate followed by multiple logistic regressions were used to estimate the Odds Ratio (OR) and 95% confidence intervals (CI) of cognitive impairment (assessed by adapted Telephone Interview for Cognitive Status) from hearing acuity, as well as to explore the interactions of sex and gender with hearing acuity. The risk of cognitive impairment among hearing-impaired participants was assessed using multivariable models including sex and gender as exposure variables.Results: Five variables (taking risks, loneliness, housework, drinking, and depression) were retained to compute the GS for each participant. The distribution of GS between sexes partly overlapped. After adjusting for confounding factors, the OR for cognitive impairment associated with hearing impairment was significantly higher (OR = 1.65, 95% CI: 1.26, 2.15), and this association was not modified by female sex (OR = 0.77, 95% CI: 0.46, 1.27), but by androgynous gender (OR = 0.44, 95% CI: 0.24, 0.81). In the multivariable models for participants with hearing impairment, androgynous and feminine gender, as opposed to female sex, was associated with lower odds of cognitive impairment (OR of GS tertile 2 = 0.59, 95% CI: 0.41, 0.84; OR of GS tertile 3 = 0.60, 95% CI: 0.41, 0.87; OR of female sex = 0.78, 95% CI: 0.57, 1.08).Conclusions: Hearing impairment was associated with cognitive impairment among older people, and this association may be attenuated by a more feminine GS.

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Associations Between Midlife Functional Limitations and Self-Reported Health and Cognitive Status: Results from the 1998–2016 Health and Retirement Study

Journal of Alzheimer s Disease ◽

10.3233/jad-215192 ◽

2021 ◽

pp. 1-17

Author(s):

Benson Wu ◽

Mohammad Usama Toseef ◽

Ariana M. Stickel ◽

Hector M. González ◽

Wassim Tarraf

Keyword(s):

Cognitive Impairment ◽

Physical Function ◽

Cognitive Aging ◽

Multinomial Logistic Regression ◽

Functional Limitations ◽

Later Life ◽

Cognitive Status ◽

Health And Retirement Study ◽

Reported Health ◽

Retirement Study

Background: Life-course approaches to identify and help improve modifiable risk factors, particularly in midlife, may mitigate cognitive aging. Objective: We examined how midlife self-rated physical functioning and health may predict cognitive health in older age. Methods: We used data from the Health and Retirement Study (1998–2016; unweighted-N = 4,685). We used survey multinomial logistic regression and latent growth curve models to examine how midlife (age 50–64 years) activities of daily living (ADL), physical function, and self-reported health affect cognitive trajectories and cognitive impairment not dementia (CIND) and dementia status 18 years later. Then, we tested for sex and racial/ethnic modifications. Results: After covariates-adjustment, worse instrumental ADL (IADL) functioning, mobility, and self-reported health were associated with both CIND and dementia. Hispanics were more likely to meet criteria for dementia than non-Hispanic Whites given increasing IADL impairment. Conclusion: Midlife health, activities limitations, and difficulties with mobility are predictive of dementia in later life. Hispanics may be more susceptible to dementia in the presence of midlife IADLs. Assessing midlife physical function and general health with brief questionnaires may be useful for predicting cognitive impairment and dementia in later life.

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INTERNET USE AND LONELINESS OF OLDER ADULTS OVER TIME: THE MEDIATION EFFECT OF SOCIAL CONTACT

Innovation in Aging ◽

10.1093/geroni/igz038.697 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S194-S194

Author(s):

Kexin Yu ◽

Shinyi Wu ◽

Iris Chi

Keyword(s):

Older Adults ◽

Older People ◽

Internet Use ◽

Social Contact ◽

Total Effect ◽

Mediation Effect ◽

Health And Retirement Study ◽

Longitudinal Association ◽

Retirement Study ◽

Over Time

Abstract Internet is increasingly popular among older adults and have changed interpersonal interactions. However, it remains controversial whether older people are more or less lonely with internet use. This paper tests the longitudinal association of internet use and loneliness among older people. One pathway that explains the association, the mediation effect of social contact, was examined. Data from the 2006, 2010 and 2014 waves of Health and Retirement Study was used. Hierarchical liner modeling results showed internet use was related to decreased loneliness over 12-year period of time (b=-0.044, p<.001). Internet use was associated with more social contact with family and friends overtime (b=0.261, p<.001), social contact was related to less perceived loneliness longitudinally (b=0.097, p<.001). The total effect of internet use on loneliness is -0.054 and the mediated effect is -0.025. The findings imply that online activities can be effective for reducing loneliness for older people through increased social contact.

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The Importance of Engaging in Physical Activity in Older Adulthood for Transitions Between Cognitive Status Categories and Death: A Coordinated Analysis of 14 Longitudinal Studies

The Journals of Gerontology Series A ◽

10.1093/gerona/glaa268 ◽

2020 ◽

Author(s):

Tomiko Yoneda ◽

Nathan A Lewis ◽

Jamie E Knight ◽

Jonathan Rush ◽

Rebecca Vendittelli ◽

...

Keyword(s):

Physical Activity ◽

Cognitive Impairment ◽

Longitudinal Studies ◽

Sex Education ◽

Cognitive Status ◽

Extensive Literature ◽

Multinomial Regression ◽

Older Adulthood ◽

Modifiable Factors ◽

The Impact

Abstract Background Given increasing incidence of cognitive impairment and dementia, further understanding of modifiable factors contributing to increased healthspan is crucial. Extensive literature provides evidence that physical activity (PA) delays the onset of cognitive impairment; however, it is unclear whether engaging in PA in older adulthood is sufficient to influence progression through cognitive status categories. Method Applying a coordinated analysis approach, this project independently analyzed 14 longitudinal studies (NTotal = 52 039; mean baseline age across studies = 69.9–81.73) from North America and Europe using multistate survival models to estimate the impact of engaging in PA on cognitive status transitions (nonimpaired, mildly impaired, severely impaired) and death. Multinomial regression models were fit to estimate life expectancy (LE) based on American PA recommendations. Meta-analyses provided the pooled effect sizes for the role of PA on each transition and estimated LEs. Results Controlling for baseline age, sex, education, and chronic conditions, analyses revealed that more PA is significantly associated with decreased risk of transitioning from nonimpaired to mildly impaired cognitive functioning and death, as well as substantially longer LE. Results also provided evidence for a protective effect of PA after onset of cognitive impairment (eg, decreased risk of transitioning from mild-to-severe cognitive impairment; increased likelihood of transitioning backward from severe-to-mild cognitive impairment), though between-study heterogeneity suggests a less robust association. Conclusions These results yield evidence for the importance of engaging in PA in older adulthood for cognitive health, and a rationale for motivating older adults to engage consistently in PA.

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Effect of Demographic and Health Dynamics on Cognitive Status in Mexico between 2001 and 2015: Evidence from the Mexican Health and Aging Study

Geriatrics ◽

10.3390/geriatrics6030063 ◽

2021 ◽

Vol 6 (3) ◽

pp. 63

Author(s):

Silvia Mejia-Arango ◽

Jaqueline Avila ◽

Brian Downer ◽

Marc A. Garcia ◽

Alejandra Michaels-Obregon ◽

...

Keyword(s):

Older Adults ◽

Health Care ◽

Cognitive Impairment ◽

Cardiovascular Diseases ◽

Educational Attainment ◽

Access To Health Care ◽

Sociodemographic Factors ◽

Cognitive Status ◽

Access To Health ◽

Mexican Adults

Sources of health disparities such as educational attainment, cardiovascular risk factors, and access to health care affect cognitive impairment among older adults. To examine the extent to which these counteracting changes affect cognitive aging over time among Mexican older adults, we examine how sociodemographic factors, cardiovascular diseases, and their treatment relate to changes in cognitive function of Mexican adults aged 60 and older between 2001 and 2015. Self and proxy respondents were classified as dementia, cognitive impairment no dementia (CIND), and normal cognition. We use logistic regression models to examine the trends in dementia and CIND for men and women aged 60 years or older using pooled national samples of 6822 individuals in 2001 and 10,219 in 2015, and sociodemographic and health variables as covariates. We found higher likelihood of dementia and a lower risk of CIND in 2015 compared to 2001. These results remain after adjusting for sociodemographic factors, cardiovascular diseases, and their treatment. The improvements in educational attainment, treatment of diabetes and hypertension, and better access to health care in 2015 compared to 2001 may not have been enough to counteract the combined effects of aging, rural residence disadvantage, and higher risks of cardiovascular disease among older Mexican adults.

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