Suchergebnisse

AbstractBackgroundHearing and vision difficulties are some of the most common deficits experienced by older adults. Having either visual or hearing difficulties increases the risk of comorbidity, disability, and poor quality of life. So far, however, few studies have examined the association between vision and hearing difficulties on life expectancy without activities of daily living (ADL) or instrumental ADL (IADL) limitations (LEWL).MethodsData came from the English Longitudinal Study of Ageing and the Health and Retirement Study in the United States from 2002 to 2013. The outcome was defined as reporting 2+ limitations with ADL/IADL. Life expectancy was estimated by discrete-time multistate life table models for hearing and vision difficulties separately as well as for combined vision and hearing difficulties by sex and age.ResultsThirteen percent of men in England and the United States had ADL/IADL limitations, whereas, for women, it was 16% and 19% in England and the United States. At all ages, either vision or hearing difficulty was associated with shorter LEWL compared to no difficulties. Dual sensory difficulty (vision and hearing) reduced LEWL by up to 12 years in both countries. At the ages of 50 and 60 in England, hearing difficulty was associated with fewer years lived without ADL/IADL limitations than vision difficulty. In contrast, in the United States, vision difficulty led to fewer years lived without ADL/IADL limitations than hearing difficulty.ConclusionsThe implementation of strategies to reduce the prevalence and incidence of vision and hearing difficulties has the potential to increase the number of years spent without ADL/IADL limitations.

Abstract

Background
Chronic pain has been associated with accelerated biological aging, which may be related to epigenetic alterations. We evaluated the association of high-impact pain (ie, pain that limits activities and function) with epigenetic aging, a measure of biological aging, in a nationally representative sample of middle-aged and older adults in the United States.


Methods
Cross-sectional analysis of adults 50 years of age and older from the 2016 Health and Retirement Study. Epigenetic aging was derived from 13 epigenetic clocks based on DNA methylation patterns that predict aging correlates of morbidity and mortality. Ordinary least squares regressions were performed to test for differences in the epigenetic clocks, adjusting for the complex survey design, as well as biological, social, and behavioral factors.


Results
The analysis consisted of 3 855 adults with mean age of 68.5 years, including 59.8% with no pain and 25.8% with high-impact pain. Consistent with its operational definition, high-impact pain was associated with greater functional and activity limitations. High-impact pain was associated with accelerated epigenetic aging compared to no pain, as measured via second (Zhang, PhenoAge, GrimAge) and third (DunedinPoAm) generation epigenetic clocks. Additionally, GrimAge was accelerated in high-impact pain as compared to low-impact pain.


Conclusions
High-impact pain is associated with accelerated epigenetic aging among middle-aged and older adults in the United States. These findings highlight aging-associated epigenetic alterations in high-impact chronic pain and suggest a potential for epigenetic therapeutic approaches for pain management and the preservation of physical function in older adults.

Abstract

Background
In a secondary analysis of data taken from a publicly available database, we examined cognitive performance, postural sway, and relations between them for 4 groups: younger and older individuals with versus without a recent history of falls. Our objective was to compare linear versus nonlinear measures of postural activity as post hoc predictors of cognitive performance and falling.


Methods
We evaluated standing body sway in 147 participants (18–85-years old) over 60 seconds, separately with eyes-open and with eyes-closed. We evaluated cognitive performance using portions of the Trail Making Test. We evaluated postural activity in terms of standard deviation, velocity, and amplitude of the Center of Pressure (CoP). Separately, we used detrended fluctuation analysis (DFA) to examine the complexity of CoP displacements. Using analysis of variance, we conducted separate analyses of cognitive performance and postural activity comparing Younger and Older Adults and Non-fallers and Fallers, taking into account Vision (eyes-closed vs open) and the direction of postural movements (Anteroposterior vs Mediolateral) while also controlling for participants' characteristics. We used moderation analyses to evaluate whether relationships between Trail Making Test scores and the linear and nonlinear outcomes were moderated by Age group or Fall status.


Results
For postural activity, only DFA differed between Non-fallers and Fallers. Older adults exhibited increased complexity associated with better processing speed function, while fallers show an opposite association, relying on processing speed to increase postural rigidity instead of facilitating adaptive control of balance.


Conclusions
We conclude that DFA can provide information regarding postural activity and cognitive performance that cannot be obtained from more traditional, linear measures of postural activity and that DFA may be a valuable tool for assessing fall risk.

Abstract

Background
The network approach may provide a framework for understanding intrinsic capacity (IC) as a system's underlying functioning. The system's resilience to resist functional decline may arise from the interrelationships among system components, that is, body functions or capacities. We applied network analysis to investigate whether the interplay between different intrinsic capacities differs according to age and self-rated health (SRH) in older adults.


Methods
The study sample consisted of a population-based cohort of community-dwelling older adults aged 75, 80, and 85 years (men n = 356 and women n = 469). We quantified 5 IC domains: vitality, locomotion, cognition, psychology, and sensory, using performance-based measurements and questionnaires, and estimated IC networks for 2 age (75 vs 80 and 85 years) and SRH (higher vs lower) groups separately for sexes. Differences in global network properties (eg, density, overall connectivity) and centrality indices were compared between the groups.


Results
Intrinsic capacity network density (ie, the number of edges) was higher in the 80- and 85-year-olds compared to the 75-year-olds, and in the worse compared to the better SRH group in both sexes. However, the differences in edge weights and global strength of the networks were statistically nonsignificant. Walking speed was the most central node in the estimated networks.


Conclusions
With increasing age and health decline, the IC network seems to become denser, which may indicate a loss of system resilience. Walking is a more complex activity than the others requiring the functioning of many subsystems, which may explain why it connects multiple domains in the IC network.

Abstract

Background
Respite care provides short-term relief for caregivers. Despite efforts to promote respite use among Black caregivers, little is known if disparities in respite use between Black and White dementia caregivers have decreased over time. We examined a trend nationally to see if more recent efforts may have helped reduce disparities in respite use.


Methods
We used a repeated cross-sectional design, with the data from 2015, 2017, and 2021 of the National Health and Aging Trends Study and National Study of Caregiving. Our study sample included 764 (in 2015), 839 (in 2017), and 521 (in 2021) non-Hispanic White and Black caregivers who provided care to older adults living with dementia, representing weighted 5 157 569 (2015), 5 877 997 (2017), and 4 712 144 (2021) dementia caregivers nationally. We conducted logistic regression models to assess the differences in respite use between White and Black caregivers over time.


Results
In 2015, Black dementia caregivers had a respite care use rate 11.6 percentage points (95% CI: −16.9 to −6.4) lower than that of White dementia caregivers. However, both in 2017 and 2021, the difference in the use of respite was not statistically significant, leading to a reduced or no gap in respite use between White and Black dementia caregivers. However, respite use remained low in both groups.


Conclusions
Although the gap in respite use between Black and White dementia caregivers had been gradually narrowed over time, more efforts are needed to encourage more respite use among both groups through targeted efforts to address factors that hinder respite use.

Abstract
Large Language Models (LLMs) stand on the brink of reshaping the field of aging and dementia care, challenging the one-size-fits-all paradigm with their capacity for precision medicine and individualized treatment strategies. The "Large Pre-Trained Models with a Focus on AD/ADRD and Healthy Aging" symposium, organized by the National Institute on Aging and the Johns Hopkins Artificial Intelligence & Technology Collaboratory for Aging Research, served as a platform for exploring this potential. The symposium brought together diverse experts to discuss the integration of LLMs in aging and dementia care. They highlighted the roles LLMs can play in clinical decision support and predictive analytics, while also addressing critical ethical concerns including bias, privacy, and the responsible use of artificial intelligence (AI). The discussions focused on the need to balance technological advancement with ethical considerations in AI deployment. In conclusion, the symposium projected a future where LLMs not only revolutionize healthcare practices but also pose significant challenges that require careful navigation.

Abstract

Background
Cardiometabolic risk (CMR) is associated with cognitive health, but the association can be affected by broader social, economic, and medical contexts. The United States and China have very different developmental and epidemiological histories, and thus CMR among older people could be linked to cognitive function differently in the 2 countries.


Methods
Cross-sectional and longitudinal ordinary least squares regression models were estimated for each country using nationally representative samples of populations over age 50: 7 430/4 474 Americans and 6 108/3 655 Chinese in the cross-sectional/longitudinal samples.


Results
In the United States, higher CMR is associated with worse cognitive function (b = −0.08, p < .016). Longitudinally, CMR increase is associated with worse cognitive function at a marginally significant level (b = −0.10, p = .055). No relationship between CMR level or change and cognitive function is observed in China. Higher education levels are linked to better cognitive function and slower cognitive decline in both countries. Unlike older Americans, relative to those with very low education levels, among older Chinese with the highest education level, a higher CMR links to better cognitive function (b = 0.63, p = .013) and slower cognitive decline (b = 0.35, p = .062); Nevertheless, a rapid increase in CMR is additionally harmful (b = −0.54, p = .050) for cognitive function and may lead to faster cognitive decline (b = −0.35, p = .079).


Conclusions
The significant relationship between CMR and cognitive function in the United States suggests the importance of monitoring and controlling CMR factors at older ages. The insignificant relationship in China may be explained by the high CMR among those with high education levels, highlighting the need for improving cardiometabolic health through education and promoting healthy lifestyles.

Abstract

Background
Researchers are increasingly interested in better methods for assessing the pace of aging in older adults, including vocal analysis. The present study sought to determine whether paralinguistic vocal attributes improve estimates of the age and risk of mortality in older adults.


Methods
To measure vocal age, we curated interviews provided by male U.S. World War II Veterans in the Library of Congress collection. We used diarization to identify speakers and measure vocal features and matched recording data to mortality information. Veterans (N = 2 447) were randomly split into testing (n = 1 467) and validation (n = 980) subsets to generate estimations of vocal age and years of life remaining. Results were replicated to examine out-of-sample utility using Korean War Veterans (N = 352).


Results
World War II Veterans' average age was 86.08 at the time of recording and 91.28 at the time of death. Overall, 7.4% were prisoners of war, 43.3% were Army Veterans, and 29.3% were drafted. Vocal age estimates (mean absolute error = 3.255) were within 5 years of chronological age, 78.5% of the time. With chronological age held constant, older vocal age estimation was correlated with shorter life expectancy (aHR = 1.10; 95% confidence interval: 1.06–1.15; p < .001), even when adjusting for age at vocal assessment.


Conclusions
Computational analyses reduced estimation error by 71.94% (approximately 8 years) and produced vocal age estimates that were correlated with both age and predicted time until death when age was held constant. Paralinguistic analyses augment other assessments for individuals when oral patient histories are recorded.

Abstract

Background
Single-country studies document varying time trends in memory function and impairment. Comparative analyses are limited.


Methods
We used self-respondent data on adults aged 50+ years in 13 countries from 3 surveys (United States: Health and Retirement Study, 1998–2018; England: English Longitudinal Study of Ageing, 2002–2018; 11 European countries: Survey of Health, Ageing and Retirement in Europe, 2004–2019). Memory is measured with tests of immediate and delayed word recall. Unweighted age- and gender-adjusted mixed effects regression models as well as models with adjustments for additional sociodemographic characteristics and health behaviors were examined. Heterogeneity in trends by gender, age group, and educational attainment was measured.


Results
The age-adjusted 10-year improvement in average test score is 0.04 standard deviations (SDs) (95% confidence interval [CI]: 0.03, 0.05) in the United States, 0.17 SDs (95% CI: 0.15, 0.19) in England, and 0.24 SDs (95% CI: 0.23, 0.25) in SHARE countries. Trends are largely similar across gender, age groups, and educational attainment. Regional differences in trends remain after adjustment for potential mechanisms. The difference between the United States and other countries is particularly large under 75 years of age compared to 75 years and older.


Conclusions
Pace of improvement in memory function varies strongly across countries. On average, the 11 European countries studied had the fastest improvement, followed by England. The trend in the United States indicates improvement, but at a much slower pace compared to that in England and other European countries. Uncovering the causes for the cross-country heterogeneity in time trends, and in particular the reasons for the comparatively poor performance of the United States, should be both a research and public health priority.

Abstract

Background
Chronic hepatitis C virus (HCV) infection is associated with early onset of chronic diseases and increased risk of chronic disorders. Chronic viral infections have been linked to accelerated biological aging based on epigenetic clocks. In this study, we aimed to investigate the association between HCV infection and clinical measures of biological aging among 8 306 adults participating in the 2015–2018 waves of the National Health and Nutrition Examination Survey (NHANES).


Methods
NHANES 2015–2018 participants aged 20 years and older who had complete data on clinical blood markers and HCV-related tests were included in the current study. We estimated biological age using 2 approaches including phenotypic age (PhenoAge) and allostatic load (AL) score based on 9 clinical biomarkers.


Results
After adjusting for demographic and other confounding factors, HCV antibody-positivity was associated with advanced PhenoAge (β = 2.43, 95% confidence interval: 1.51–3.35), compared with HCV antibody-negativity. Additionally, both active HCV infection (HCV RNA (+)) and resolved infection were associated with greater PhenoAge acceleration. The positive association with the AL score was not statistically significant. We did not observe any significant interactions of potential effect modifiers, including smoking and use of drug/needle injection, with HCV infection on measures of biological aging.


Conclusions
Our findings suggest that HCV infection is independently associated with biological aging measured by phenotypic age in the U.S. general population. Further studies are warranted to confirm the findings.

Abstract

Background
The adverse health effects of incarceration are well-documented, affecting individuals throughout their life course. However, the influence of a history of incarceration on end-of-life (EOL) experiences remains unexplored. This study aims to examine how prior incarceration affects individuals' experiences and care needs as they approach the EOL.


Methods
Leveraging the Health and Retirement Study, we conducted secondary analyses on 1 710 individuals who participated between 2012 and 2018. Through retrospective cohort analysis, we explored the association between incarceration history and EOL care, focusing on pain and symptom burden.


Results
Analyses showed that individuals with a history of incarceration experienced significantly higher levels of pain (65% reported "moderate" or "severe" pain) compared to nonincarcerated individuals (50%; adjusted odds ratio = 1.45, 95% confidence interval [CI]: 1.22–1.71, p < .001). Additionally, the symptom burden index revealed that formerly incarcerated individuals had a higher average symptom score (2.8 vs 2.1; β = 0.7, 95% CI: 0.5–0.9, p < .001), indicating a greater range of symptoms in their final year of life. These disparities persisted after adjusting for demographic, health, and socioeconomic variables.


Conclusions
This study reveals that a history of incarceration significantly affects EOL experiences, with formerly incarcerated individuals facing higher levels of pain and a greater symptom burden compared to nonincarcerated individuals. This underscores the need for tailored palliative care to address the unique needs of this vulnerable population. This research highlights a critical area for intervention and calls for healthcare systems to adapt their practices to better serve those with incarceration histories.

Abstract

Background
While childhood adversity (CA) is known to be associated with multiple adverse outcomes, its link with dementia is an area with limited exploration and inconsistent agreement. The study aimed to examine the longitudinal associations of CA with incident all-cause dementia and to quantify the potential mediating pathways.


Methods
Data from the UK Biobank. CA, encompassing neglect and abuse, was evaluated retrospectively by an online mental health questionnaire. Physical performance, psychological factors, lifestyles, and biological indicators assessed at baseline were considered potential mediators. Incident all-cause dementia was defined by International Classification of Diseases, Tenth Revision codes obtained through self-reported medical conditions, primary care, hospital admission, and death registrations. Cox proportional hazard models were applied to estimate the longitudinal associations. Mediation analyses were conducted on potential mediators to examine their contribution.


Results
This cohort study comprised 150 152 nondemented individuals (mean [SD] age, 55.9 [7.7] years) at baseline (2006–2010). Compared to individuals who did not experience CA, those exposed to any CA exhibited a 30.0% higher risk of dementia (hazard ratio = 1.300, 95% confidence interval [CI]: 1.129–1.496). Each additional CA was associated with a 15.5% (95% CI: 8.8%–22.5%, pfor trend < .001) increased dementia risks. Depression, smoking, and low grip strength explained 8.7%, 2.4%, and 0.9% of the associations, respectively. Biomarkers involving inflammation, erythrocytes, liver, and kidney function mediated the associations by 0.6%–1.4%.


Conclusions
The study revealed the detrimental effects of CA on dementia and identified some potential mediators, namely depression, smoking, low grip strength, and several targeted biomarkers. In addition to calling more attention to CA, the findings underscore the importance of interventions targeting modifiable mediators in preventing dementia.

Abstract

Background
The relationship between subjective and objective health is complex and not always matched. Although frailty and self-rated health (SRH) have been separately associated with adverse outcomes, their joint effects remained unclear.


Methods
Participants were 5 300 adults ≥60 years from the China Health and Retirement Longitudinal Study in 2011. Frailty, measured by the validated physical frailty phenotype approach, was classified as nonfrail, prefrail, and frail. SRH was categorized into 3 groups: excellent/very good/good, fair, and poor/very poor. We used the Cox models to examine the independent and joint association of frailty and SRH with mortality. We used the interaction approach to determine whether the association of SRH with mortality differed by frailty. Subgroup analyses were conducted by depression and cognitive impairment.


Results
About 8.1% of frail participants reported excellent/very good/good health; 21.2% of the nonfrail reported poor/very poor health. Prefrailty and frailty were associated with a 1.63- and 2.38-fold increase in the hazard of mortality than the nonfrail, respectively, after adjusting for SRH. Reporting fair and poor/very poor health was associated with a 29% and 100% increase in the hazard of mortality, respectively, after adjusting for frailty. No significant interaction was found. Prefrail and frail older adults with excellent/very good/good health had a similar mortality as the nonfrail with poor/very poor SRH. The association of SRH with mortality was less pronounced among individuals with depression or cognitive impairment.


Conclusions
SRH is a potential marker of resilience among people living with frailty that may be a target for ameliorating health risks induced by frailty.

Abstract

Background
Physical activity (PA) may be an important fall prevention strategy. Current PA guidelines emphasize total PA dose, but daily patterning of PA is underappreciated. With aging, PA bouts become less frequent and shorter in duration (ie, more fragmented). PA fragmentation may be an indicator of fall risk, but the relationship is not well understood. This study examined daily PA accumulation and patterns with fall risk in older adults.


Methods
Participants (n = 685, 54.3% women, 61.5% aged 70–79 years) from the National Health and Aging Trends Study with wrist-worn accelerometry PA data from Round 11 (baseline) and sample person interviews with fall data from Round 12 (follow-up) were included. PA variables were categorized into tertiles and incident falls were defined as ≥1 self-reported fall in the year following the PA assessment between baseline and follow-up. A modified Poisson approach was used to estimate the relative risk of both PA accumulation and fragmentation with falls.


Results
Overall, 40.0% reported an incident fall. After adjustment for sociodemographic and health characteristics, those in the highest tertile of total PA accumulation had lower fall risk (aRR = 0.74, 95% CI: 0.57, 0.95) and those in the highest tertile of PA fragmentation had increased fall risk (aRR = 1.33, 95% CI: 1.03, 1.73). Models were attenuated after adjustment for physical functioning.


Conclusions
PA fragmentation may identify fall risk in older adults. Longitudinal studies are needed to disentangle the temporal sequencing of the complex relationship between PA and physical functioning across the life course.