Trajectories of frailty with aging: Coordinated analysis of five longitudinal studies

Background and Objectives There is an urgent need to better understand frailty and it’s predisposing factors. Although numerous cross-sectional studies have identified various risk and protective factors of frailty, there is a limited understanding of longitudinal frailty progression. Furthermore, discrepancies in the methodologies of these studies hamper comparability of results. Here, we use a coordinated analytical approach in five independent cohorts to evaluate longitudinal trajectories of frailty and the effect of three previously identified critical risk factors: sex, age, and education. Research Design and Methods We derived a frailty index (FI) for five cohorts based on the accumulation of deficits approach. Four linear and quadratic growth curve models were fit in each cohort independently. Models were adjusted for sex/gender, age, years of education, and a sex/gender-by-age interaction term. Results Models describing linear progression of frailty best fit the data. Annual increases in FI ranged from 0.002 in the InCHIANTI cohort to 0.009 in the LASA. Women had consistently higher levels of frailty than men in all cohorts, ranging from an increase in the mean FI in women from 0.014 in the HRS cohort to 0.046 in the LASA cohort. However, the associations between sex/gender and rate of frailty progression were mixed. There was significant heterogeneity in within-person trajectories of frailty about the mean curves. Discussion and Implications Our findings of linear longitudinal increases in frailty highlight important avenues for future research. Specifically, we encourage further research to identify potential effect modifiers or groups that would benefit from targeted or personalized interventions.

The Long-Term Impact of Childhood Disability on Mental Health Trajectories in Mid- to Late-Life

Objectives We draw from the life course and stress process frameworks to examine how experiencing disability in early life influences mental health in adulthood. Methods Data come from the Health and Retirement Study Cross-Wave Childhood Health and Family Aggregated Data file (2008-2018, n = 15,289). Childhood disability status is a retrospective self-report of whether respondents were disabled for six months or more because of a health problem before the age of 16 ( n = 581). We used age-based growth curve models to construct trajectories of depressive symptoms by childhood disability status. Results Respondents who experienced childhood disability exhibit more depressive symptoms at age 50 compared to those who did not experience this stressor. However, there is no difference in the growth of depressive symptoms with age between these groups, suggesting maintained inequality over the late adulthood life course. Discussion Findings suggest that childhood disability has long-term implications for life course mental health.

The increasing educational divide in the life course development of subjective wellbeing across cohorts

Labour market, health, and wellbeing research provide evidence of increasing educational inequality as individuals age, representing a pattern consistent with the mechanism of cumulative (dis)advantage. However, individual life courses are embedded in cohort contexts that might alter life course differentiation processes. Thus, this study analyses cohort variations in education-specific life course patterns of subjective wellbeing (i.e. life, health and income satisfaction). Drawing upon prior work and theoretical considerations from life course theories, this study expects to find increasing educational life course inequality in younger cohorts. The empirical analysis relies on German Socio-Economic Panel data (1984–2016, v33). The results obtained from cohort-averaged random effects growth curve models confirm the cumulative (dis)advantage mechanism for educational life course inequality in subjective wellbeing. Furthermore, the results reveal substantial cohort variation in life course inequality patterns: regarding life and income satisfaction, the results indicate that the cumulative (dis)advantage mechanism does not apply to the youngest cohorts (individuals born between 1970 and 1985) under study. In contrast, the health satisfaction results suggest that educational life course inequality follows the predictions of the cumulative (dis)advantage mechanism only for individuals born after 1959. While the life course trajectories of highly educated individuals change only slightly across cohorts, the subjective wellbeing trajectories of low-educated individuals start to decline at earlier life course stages in younger cohorts, leading to increasing life course inequality over time. Thus, the overall findings of this study contribute to our understanding of whether predictions derived from sociological middle range theories are universal across societal contexts.

Socioeconomic Status and Later-Life Health: Longitudinal Evidence From Europe and China

Scholars are divided as to how the protective effect of SES on health (the SES-health gradient) varies over the later-life course: The age-as-leveler perspective suggests that the SES-health gradient weakens with age, whereas the cumulative (dis)advantages perspective suggests that it strengthens with age. To clarify this, we used SHARE 2004-2017 (73,407 respondents from 19 European countries) and CHARLS 2011-2018 (8,370 Chinese respondents). Congruent with the age-as-leveler perspective, growth curve models revealed that the overall protective effect of SES on multimorbidity was weaker for older than younger adults (the country-specific effects were significant in two thirds of the case). We interpret this as a selection effect. However, the within-participant protective effect of SES on multimorbidity did not vary over the later-life course (the country-specific effects were nonsignificant in the majority of the case). Findings suggest that extant cross-sectional studies should be interpreted with caution and that longitudinal, cross-national studies are needed.

Dementia Caregivers' Trajectories of Well-Being Before and During the COVID-19 Pandemic

Residents of long-term care settings and their family caregivers have been severely impacted by the COVID-19 pandemic. The present mixed-methods study examines trajectories of well-being pre- and post-pandemic onset for caregivers of persons with dementia living in residential long-term care. Participants were taking part in, or had recently completed, an ongoing intervention trial to support families transitioning a relative into long-term care. Beginning in summer 2020, we started assessing caregivers’ COVID-19-related experiences and added three surveys spanning 4-months beyond the 12-month parent study period to capture caregivers' adjustment throughout the pandemic. Using latent growth curve models, we estimated caregivers' (N = 104) trajectories of depressive symptoms, burden, and self-efficacy before and during the pandemic. We also tested whether the counseling intervention had protective effects for participants in the treatment group, and examined moderators including long-term care facility size, care recipient's dementia and health status, and quality of staff interactions.

Marital Quality as a Moderator of the Association Between Sensory Impairments and Cognitive Functioning

Research suggests that marital quality may buffer the impact of sensory impairments in later life, and that marital quality relates to cognitive functioning. This study explored how marital quality moderated links between sensory impairments and cognitive functioning. We used data from 723 paired marital dyads from two cohorts in the NHATS and NSOC studies across three-year periods (n=340 dyads from waves 1, 2, 3; n=383 dyads from waves 5, 6, 7). Growth curve models of executive functioning indicated that marital quality moderated effects of both hearing and vision impairment on changes in cognitive functioning longitudinally. Specifically, higher marital quality was associated with higher executive functioning across time. Results suggested no improvement in executive functioning among those with average or lower marital quality. Although cognition declines with advanced age and with sensory impairments, results suggest that older adults with higher marital quality may improve in some aspects of cognition longitudinally.

Moves to age-restricted housing and functional health trajectories among independent living older adults

Where independent living older adults live has been found to have strong links with disability. For example, older adults living in age-restricted housing contexts (e.g., retirement communities) have been found to have worse functional health compared to those living in non-age-restricted settings. Theories and empirical research demonstrate positive and negative aspects of living in age-restricted housing. Recent availability of population-level longitudinal data with sufficiently large samples has made examination of this heterogeneity possible. In this study we examine whether a move to age-restricted housing is associated with functional health trajectories and whether age at time of move moderates this link. We examine these questions using nine waves of longitudinal data from a representative sample of 8,687 U.S. adults age 65 and older from the National Health and Aging Trends Study. Spline-like growth curve models were estimated to determine the intercept, slope prior to move to age-restricted housing, and slope after the move. We also tested whether these processes are conditional on age at time of move. Results indicate that regardless of age all respondents experienced a decline in functional health following a move to age-restricted housing. However, there is variation in the steepness of this decline by age at time of the move. People who move to age-restricted housing earlier experience a less steep decline in functional health post-move compared to those who move later. Findings suggest moving to age-restricted housing earlier may enable older adults to utilize resources often available in these settings to prevent steep health declines.

Social Support and Social Strain as Predictors of Depressive Symptom Trajectories Following a Marital Transition

We investigated trajectories of depressive symptoms over 10 years following a marital transition (widowed or divorced) using data from the Health and Retirement Study (N = 377, mean age = 67.55 years; years 2006-2016). Piecewise growth curve models were estimated to investigate whether social support and strain from one’s spouse, measured prior to transition, predicted depressive symptom trajectories following the transition. Covariates included sex, age, education, race/ethnicity, wealth, and chronic conditions. Overall, trajectories of depressive symptoms after a marital transition were significantly negative, indicating a decrease in depressive symptoms over time. Findings did not differ significantly between participants who were widowed and those who were divorced. Spousal social support was associated with an increase in depressive symptoms and spousal social strain was associated with a decrease in depressive symptoms following a marital transition in separate models: support: b = .250, SE = .062, p <.001; strain: b = -.209, SE = .095, p <.05. However, social strain was not significant when examined jointly with social support. Depressive symptoms declined significantly for low (b = -.370, SE = .100, p <.001) and average levels of social support (b = -.113, SE = .037, p <.01), but not for high levels of spouse social support (b = .143, SE = .109, p = .188). These results suggest those with the highest levels of spousal support prior to the transition, whether divorced or widowed, experienced a more difficult recovery and may be targets for additional mental health support following a marital transition.

Remote activity monitoring for family caregivers of persons living with dementia: a mixed methods, randomized controlled evaluation

Background The goal of the present study was to determine whether a remote activity monitoring (RAM) system benefited caregivers who aided relatives with Alzheimer’s disease or related dementias (ADRD) living at home. We hypothesized that over 18 months, families randomly assigned to receive RAM technology in the home of the person with ADRD would experience statistically significant (p < .05): 1) improvements in caregiver self-efficacy and sense of competence when managing their relative’s dementia; and 2) reductions in caregiver distress (e.g., burden, role captivity, and depression). Methods An embedded mixed methods design was utilized, where 179 dementia caregivers were randomly assigned to receive RAM or not. Caregivers were surveyed bi-annually over an 18-month period to collect quantitative and qualitative data on RAM’s effects. Semi-structured interviews with 30 caregivers were completed following the 18-month data collection period to explore more in-depth how and why RAM was perceived as helpful or not. Results Growth curve models showed no direct or moderation effect of RAM on dementia caregiver outcomes. The qualitative data revealed a complex utilization process of RAM influenced by the care environment/context as well as the temporal progression of ADRD and the caregiving trajectory. Conclusions The findings suggest the need for developing more effective mechanisms to match appropriate technologies with the heterogeneous needs and care contexts of people living with ADRD and their caregivers. A triadic approach that incorporates professional care management alongside passive monitoring systems such as RAM may also enhance potential benefits. Trial registration ClinicalTrials.govNCT03665909, retrospectively registered on 11 Sept 2018.

Couples’ Communication Behaviour and the Gender Division of Family Work Across the Transition to Parenthood

This study investigates the conceptual argument that constructive and explicit couple communication may reduce gender inequalities in couples’ division of family work. We focus on the transition to parenthood which for most couples in Germany results in a shift towards a more traditional division of labour. Using 314 first-time parents from the German Family Panel, we apply growth curve models to assess whether partners’ prenatal characteristics explain the division of housework and childcare around the time of childbirth and in the following years. After controlling for gender ideologies and economic resources, male partners’ frequency of positive communication is associated with greater father involvement in housework and childcare from the start. However, neither men’s nor women’s communication behaviours dampen the shift towards a more traditional division of housework and childcare in the first years after childbirth. The frequency of negative communication does not correlate with the division of family work.