Abstract P224: Does Cognitive Function And C-reactive Protein Produce A Combined Effect On All-cause Mortality Risk? An Analysis Of Older Adults In The 1999-2002 NHANES

Introduction: There is limited evidence examining the combined effects of cognitive function and C-reactive protein (CRP) on mortality risk using a large nationally representative sample of U.S. adults. Hypothesis: We assessed the hypothesis that cognitive function and CRP produce a combined effect in predicting all-cause mortality risk. Objective: Examine the combined effects of cognitive function and CRP in predicting all-cause mortality in a large nationally representative sample of U.S. adults. Methods: The study sample (n=2,111) included older adults (≥ 60 years of age) who participated in the 1999-2002 National Health and Nutrition Examination Survey. A four-level variable was created based on CRP concentration and cognitive function (high cognitive function and low to average CRP; high cognitive function and high CRP; low cognitive function and low to average CRP; low cognitive function and high CRP). Results: Compared to a referent group with low to average CRP and high cognitive function, analysis revealed a statistically significant increase in risk of all-cause mortality in adults with high CRP and low cognitive function (Hazards Ratio [HR] 1.97; 95% Confidence Interval [CI], 1.52-2.55, p<0.0001) and in adults with low to average CRP and low cognitive function (HR 1.76; 95% CI, 1.44-2.15, p<0.0001). Similar relationships were not revealed in adults with high cognitive function, regardless of CRP concentration. Conclusions: In a large nationally representative sample of older U.S. adults, low cognitive function was associated with increased all-cause mortality risk independent of CRP concentration.

Effect of the Information Support Robot on the Daily Activity of Older People Living Alone in Actual Living Environment

Information support robots (ISRs) have the potential to assist older people living alone to have an independent life. However, the effects of ISRs on the daily activity, especially the sleep patterns, of older people have not been clarified; moreover, it is unclear whether the effects of ISRs depend on the levels of cognitive function. To investigate these effects, we introduced an ISR into the actual living environment and then quantified induced changes according to the levels of cognitive function. Older people who maintained their cognitive function demonstrated the following behavioral changes after using the ISR: faster wake-up times, reduced sleep duration, and increased amount of activity in the daytime (p < 0.05, r = 0.77; p < 0.05, r = 0.89, and p < 0.1, r = 0.70, respectively). The results suggest that the ISR is beneficial in supporting the independence of older people living alone since living alone is associated with disturbed sleep patterns and low physical activity. The impact of the ISR on daily activity was more remarkable in the subjects with high cognitive function than in those with low cognitive function. These findings suggest that cognitive function is useful information in the ISR adaptation process. The present study has more solid external validity than that of a controlled environment study since it was done in a personal residential space.

Low Cognitive Function Is Associated With Reduced Functional Fitness Among Community-Dwelling Older Adults

Among older adults over 70, 22-30% report difficulty performing at least one activity of daily living (ADL). While the precipitants of ADL decline are multifactorial, over 50% of cognitively impaired adults require assistance with ADLs. The exact relationship between cognitive and functional decline remains unknown, but it is important to understand their relationship. Eighty-three older adults (80.9 + 5.4 years) enrolled in this study and completed functional fitness and cognitive assessments. Functional fitness assessments included: Short Physical Performance Battery (SPPB), 10-meter walk, dual-task, and power chair stand (average and peak). Cognition was assessed using the Montreal Cognitive Assessment (MoCA) and Visual Paired Comparison task (VPC). Categories of low cognitive function (LCF) and high cognitive function (HCF) were determined by VPC scores. SPPB was 10.2% greater among the HCF group. The HCF group walked 12.6% (0.16 m/s) faster than the LCF group. Dual-task (fast) performance was 13.2% faster among the HCF group. Additionally, when rising from a seated position during the average and peak power chair stand task, the HCF group moved 16.7% and 16.1% faster than the LCF group, respectively. MoCA scores were 2.8 points greater among the HCF group. Based on the current results, significant differences exist between cognitive groups suggesting a relationship between functional fitness and cognition. What remains unknown is the ability to influence functional fitness by changing cognition or vice versa. Future research is warranted to determine the relationship of change in either domain over time.

Education as A Moderator in the Effect of Successful Aging on Mortality Risk in Different Genders of Elderly Chinese: a National Longitudinal Study (2011-2016)

Background Plenty of evidence has found that successful aging and its components were significantly associated with older adults’ health, their achievement has a positive effect on reducing mortality rates. However, it is unclear whether education could modify the effect of successful aging on morality risk. Numerous literatures from worldwide were cross-sectional and previous studies on the association between successful aging and mortality in China were quite few. Methods Using four waves (2011-2012, 2013-2014, 2014-2015, 2015-2016) of a large nationally representative survey in China derived from CHARLS (China Health and Retirement Longitudinal Study) with 4,824 older adults aged 60 and older, this study aimed to evaluate the effect of successful aging and each of its components on mortality risk of different gender of older adults in China, we further discussed whether education was a moderator in this effect and investigated differences in results among males and females. Successful aging was measured by absence of major diseases, freedom from disability, high cognitive function, no depressive symptoms, and active social engagement in life. Cox proportional hazards models were applied to estimate the education's moderate effect on the relationship between successful aging and mortality after controlling a rich set of covariates that included demographics, socioeconomic status, and health behaviors.Results We found that 15.18% (n=367) for males and 15.74% (n=379) for females were defined as successful aging and the mortality were 2.61% (n=63) for males and 3.45% (n=83) for females during the survey. The overall prevalence of successful aging in both genders were12.5% (n=603) and the overall mortality rate was 3.03% (n=146).It is the first longitudinal study using national cohort data to research the educational effects on the association between mortality and successful aging, our study showed that the effect only existed in females aged 65-74 years old group with lower education.Conclusions Education has the significant effect on the relationship between successful aging and mortality. Physical health is significantly associated with the achieving of successful aging among young older. More measures should be paid on improving mental health among the young female older with lower education to achieve successful aging and to against mortality and live longevity.

Distinct Cognitive Trajectories in Late Life and Associated Predictors and Outcomes: A Systematic Review

Background: Cognitive aging is a dynamic process in late life with significant heterogeneity across individuals. Objective: To review the evidence for latent classes of cognitive trajectories and to identify the associated predictors and outcomes. Methods: A systematic search was performed in MEDLINE and EMBASE for articles that identified two or more cognitive trajectories in adults. The study was conducted following the PRISMA statement. Results: Thirty-seven studies were included, ranging from 219 to 9,704 participants, with a mean age of 60 to 93.4 years. Most studies (n = 30) identified distinct cognitive trajectories using latent class growth analysis. The trajectory profile commonly consisted of three to four classes with progressively decreasing baseline and increasing rate of decline—a ‘stable-high’ class characterized as maintenance of cognitive function at high level, a ‘minor-decline’ class or ‘stable-medium’ class that declines gradually over time, and a ‘rapid-decline’ class with the steepest downward slope. Generally, membership of better classes was predicted by younger age, being female, more years of education, better health, healthier lifestyle, higher social engagement and lack of genetic risk variants. Some factors (e.g., education) were found to be associated with cognitive function over time only within individual classes. Conclusion: Cognitive aging in late life is a dynamic process with significant inter-individual variability. However, it remains unclear whether similar patterns of cognitive aging are observed across all cognitive domains. Further research into unique factors which promote the maintenance of high-cognitive function is needed to help inform public policy.

Suboptimal Sleep Among E-athletes: Do E-athletes Need More Game Play to Win?

Introduction: Empirical evidences are escalating to suggest that E-athletes are at threat of suboptimal sleep due to its relation to video gaming. Furthermore, digital gaming is also included in the 11th Revision of the International Classification of Diseases (ICD-11) as gaming disorder. Disruption stages of sleep and difficulty in sleeping are shown to have associated with video gaming due to reduce quality and quantity of sleep. Currently, the paucity of grounded literature limits the knowledge of suboptimal sleep threat and their risk factors for performance among Eathletes.Objective: Our aim is to provide opinion and to illustrate fundamental causes of suboptima l sleep among E-athletes and its consequences.Methods: Review of literature in relevance to sleep and E-sports were carried out in broader discipline of sleep and sport medicine. Bowtie diagram tool was used to illustrate the causeeffect- consequences relationship.Results: The potential causes for suboptimal sleep among E-athletes include evening use of light emitting device, pre-existing health status, incessant travel, overtraining and stimula nt abuse. The potential consequences include increase in cardiovascular strain, impaired cognit ive function, unhealthy behaviours, mental health like gaming disorder and increased risk of noncommunicable disease.Conclusion: The relationship of suboptimal sleep and its consequences such as impaired cognitive function and deleterious effect which eventually affected performance are well described in sleep medicine discipline. In view that E-sports performance demands high cognitive function abilities, we hypothesize that performance of E-athletes could also be affected due to suboptimal sleep obtained. We argue Eathletes require more time on training for better performance. In contrast, proper mentoring, guided and goal-directed for specific skills and tactics are essential for determining Eathletes performance to win. Our review could assist stakeholders in E-sports arena strategically managing sleep among E-athletes for better performance to win. Nonetheless, future research should be carried out to establish the causation.International Journal of Human and Health Sciences Supplementary Issue: 2019 Page: 28

ASSOCIATION BETWEEN BLOOD PRESSURE AND COGNITIVE FUNCTION OF COMMUNITY-DWELLING OLDEST OLD IN OKINAWA, JAPAN

Background: Adults 80 years and older are the fastest-growing segment of the Japanese population and face a high risk of cognitive decline. There are some evidences connecting hypertension to cognitive decline. In mid-life hypertension is known to have influence the cognitive decline in older age. However, a few study have examined the association between hypertension or vascular stiffness and cognitive function among elderly over 80 years old. We analyzed the associations between vascular stiffness and cognitive function among relatively healthy community-dwelling non-demented oldest old. Method: Data came from the Keys to Optimal Cognitive Aging (KOCOA) study; an ongoing cohort of relatively healthy volunteers aged over 80 years old, living in Okinawa, Japan. In 2017, 105 non-demented (Clinical Dementia Rating &lt; 1) subjects completed three kinds of examination for vascular function (75 % female, mean age (SD) 84.0 (3.0)). We categorized subjects into low and high cognitive function groups using Montreal Cognitive Assessment (MoCA) (25/26 as a cutpoint). Logistic regression models were used to examine the association between cognitive and vascular functions. Results: Narrower pulse pressure, an indicator of lower arterial stiffness, was associated with better cognitive function among subjects, after adjusting for gender, age, and education (p≦0.05), although systolic and diastolic blood pressure were not. Conclusion: Our findings suggest that narrower pulse pressure is related with cognitive preservation. The present study supports the hypothesis that lower arterial stiffness is related with better cognitive function even among the oldest old.

CARDIOVASCULAR HEALTH AND SUCCESSFUL AGING: THE MULTI-ETHNIC STUDY OF ATHEROSCLEROSIS

Individual risk factors have been shown to be associated with successful aging. However, the combined effect of behaviors and biomarkers on successful aging remains unclear. By using the Multi-Ethnic Study of Atherosclerosis (MESA) dataset, this study was to examine the association of AHA’s Cardiovascular Health (CVH) with successful aging. A total of 1,597 who were followed from baseline (2000-2002) at age 49-64 through exam 6 (2016-2018) at age 65-80 were included. CVH, including smoking, body mass index (BMI), physical activity, diet, blood pressure, cholesterol, and blood glucose, was measured at baseline. The CVH score, ranging from 0-14, was divided into ideal (11–14), intermediate (9–10), and poor (0–8) groups. Normal or successful aging, defined as avoiding major disease (including cancer, cardiovascular, or severe lung or kidney diseases), no disability, high cognitive function, high physical functioning, and engagement with life, was assessed at exam 6. We compared the cumulative incidence of successful aging among three groups. Modified Poisson regression model was employed to estimate relative risk (RR) adjusting for age, gender, race, education, income, marital status, and alcohol consumption. Among study participants at baseline, 36% were in ideal, 39% in Intermediate, and 25% in poor CVH. By exam 6, only 18% met the criteria for successful aging. Compared with the poor group, the adjusted RRs (95 % CI) of successful aging for the intermediate and ideal groups were 1.78 (1.23-2.56) and 2.56 (1.79-3.67). Our data suggest that CVH in midlife is associated with successful aging in later life.

SUCCESSFUL AGING AND HEALTHCARE SERVICE UTILIZATION IN EAST ASIA: NATIONAL COMPARISONS OF CHINA, KOREA, AND JAPAN

As the older population increases and lives longer, the demand for healthcare has been increased dramatically. To date, it is unknown whether older people’s healthcare utilization varies between countries and how it relates to successful aging. Using Rowe and Kahn’s model, we examine cross-national differences in the relationship between successful aging and healthcare service utilization in East Asia. Harmonized datasets at baseline from China Health and Retirement Longitudinal Study (CHARLS), Korean Longitudinal Study (KLoSA), and Japanese Study on Aging and Retirement (JSTAR) were used. Including 7,651 participants (aged 65-75 years), successful agers were identified using Rowe and Kahn’s criteria (i.e., no disease, no disability, high cognitive function, and active engagement). Healthcare service utilization includes hospital visit, number of hospital stay, number of nights per hospital stay, regular medical center visit, number of medical center visits, and possession of private insurance in previous year. Generalized linear models showed that successful agers’ healthcare service utilization is significantly different from non-successful agers (e.g., OR=2.19, p&lt;.001 for regular medical center visits), and Korean and Chinese healthcare service utilization is different from Japanese (e.g., OR=0.44 and OR=10.18 for Chinese and Korean number of medical center regular visits, respectively, p&lt;.001). Furthermore, the number of nights in hospital among Chinese and Korean successful agers tend to be greater than that of Japanese successful agers (OR=2.93 and OR=1.99 for Chinese and Korean successful agers, respectively, p&lt;.001). This study indicates cross-national variations in pattern of healthcare service utilization between successful and non-successful agers in East Asia.

Social support and cognitive function in middle- and older-aged adults: descriptive analysis of CLSA tracking data

Background Cognitive function is important for healthy aging. Social support availability (SSA) may modify cognitive function. We descriptively examined the association between SSA and cognitive function in a population-level sample of middle- and older-aged adults. Methods We analyzed the tracking dataset of the Canadian Longitudinal Study on Aging. Participants aged between 45 and 85 years answered questions about SSA and performed three cognitive tests (Rey Auditory Verbal Learning Test, Animal Fluency Test and Mental Alternation Test) via telephone. We divided global SSA and global cognitive function scores into tertiles and generated contingency tables for comparisons across strata defined by sex, age group, region of residence, urban vs. rural residence and education. Results The proportion of participants with low global cognitive function was often greater among persons who reported low global SSA. The proportion of persons with high cognitive function was greater in participants with high SSA. The findings were most pronounced for females, 45- to 54-year olds, all regions (especially Québec) except Atlantic Canada, urban dwellers and persons with less than high school education. Conclusions Our results can help public health officials focus on providing social supports to subgroups of the population who would benefit the most from policy interventions.