Abstract
BackgroundCognitive function is a key determinant of independence and quality of life among older adults. Compared to adults in England, US adults have a greater prevalence of cardiovascular risk factors and disease that may lead to poorer cognitive function. We compared cognitive performance of older adults in the US and England, and sought to identify sociodemographic and medical factors associated with differences in cognitive function between the two countries.MethodsData were from the 2002 waves of the US Health and Retirement Study (HRS) (n = 8,299) and the English Longitudinal Study of Ageing (ELSA) (n = 5,276), nationally representative population-based studies designed to facilitate direct comparisons of health, wealth, and well-being. There were differences in the administration of the HRS and ELSA surveys, including use of both telephone and in-person administration of the HRS compared to only in-person administration of the ELSA, and a significantly higher response rate for the HRS (87% for the HRS vs. 67% for the ELSA). In each country, we assessed cognitive performance in non-hispanic whites aged 65 and over using the same tests of memory and orientation (0 to 24 point scale).ResultsUS adults scored significantly better than English adults on the 24-point cognitive scale (unadjusted mean: 12.8 vs. 11.4, P < .001; age- and sex-adjusted: 13.2 vs. 11.7, P < .001). The US cognitive advantage was apparent even though US adults had a significantly higher prevalence of cardiovascular risk factors and disease. In a series of OLS regression analyses that controlled for a range of sociodemographic and medical factors, higher levels of education and wealth, and lower levels of depressive symptoms, accounted for some of the US cognitive advantage. US adults were also more likely to be taking medications for hypertension, and hypertension treatment was associated with significantly better cognitive function in the US, but not in England (P = .014 for treatment × country interaction).ConclusionDespite methodological differences in the administration of the surveys in the two countries, US adults aged ≥ 65 appeared to be cognitively healthier than English adults, even though they had a higher burden of cardiovascular risk factors and disease. Given the growing number of older adults worldwide, future cross-national studies aimed at identifying the medical and social factors that might prevent or delay cognitive decline in older adults would make important and valuable contributions to public health.
Highlights
Cognitive function is a key determinant of independence and quality of life among older adults
A recent study reported that adults in the United States were much more likely to have hypertension, obesity, diabetes, and heart disease than adults in England, [2] and there is growing evidence that these cardiovascular risks are risks for cognitive impairment and dementia among older adults. [3,4,5] Other important developments over the past two decades on both sides of the Atlantic, such as more effective treatments for hypertension and high cholesterol, new medications for the treatment of Alzheimer's disease, lifestyle changes such as use of cigarettes and alcohol, and rising levels of education and wealth may have had an impact on cognitive health and function among older adults in the United States and England.[6]
We report here the first comparison of cognitive function in the United States and England, using the same cognitive measures administered to nationally representative samples of older adults in both countries
Summary
We compared cognitive performance of older adults in the US and England, and sought to identify sociodemographic and medical factors associated with differences in cognitive function between the two countries. Cognitive function is a key determinant of independence and quality of life among older adults.[1] Recent demographic, medical and social trends in both the United States and England are likely to have had an important impact on the cognitive health of older adults in both countries. We report here the first comparison of cognitive function in the United States and England, using the same cognitive measures administered to nationally representative samples of older adults in both countries. Our research questions were: 1) Are there differences in cognitive function among adults aged 65 and older in the two countries; and 2) If so, are there differences in demographic, socioeconomic or health measures across the two countries that account for the difference in cognitive function?
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