Late-life Changes Research Articles

Aging and Subjective Well-Being in Later Life

This paper examines age-related changes in subjective well-being (SWB) in later life using multiple measures that cover eudemonic, evaluative, and affective dimensions of well-being. Using data from 5 waves of respondents aged 50 and older from the English Longitudinal Study of Ageing (2002-11), we fit multilevel linear growth curve models to examine the cohort differences and individual aging effects on quality of life, depressive symptomatology, and life satisfaction. Older cohorts are shown to have equivalent or better SWB than younger cohorts for each well-being measure. Nonetheless, individual aging effects for each well-being measure were observed with deterioration in well-being being greatest in older cohorts, even when adjusting for age-related changes in later life, including widowhood, retirement, and declining health. The results suggest that although older cohorts enjoy higher levels of SWB than their younger counterparts when under similar circumstances, they experience sharper declines, especially in the very oldest cohorts. The findings demonstrate the importance of separating out cohort differences and aging effects and also of taking into account the multidimensionality of SWB to determine the point at which age deterioration begins to occur across different measures.

Long-term effects of gestational nicotine exposure and food-restriction on gene expression in the striatum of adolescent rats.

Gestational exposure to environmental toxins such as nicotine may result in detectable gene expression changes in later life. To investigate the direct toxic effects of prenatal nicotine exposure on later brain development, we have used transcriptomic analysis of striatal samples to identify gene expression differences between adolescent Lister Hooded rats exposed to nicotine in utero and controls. Using an additional group of animals matched for the reduced food intake experienced in the nicotine group, we were also able to assess the impact of imposed food-restriction on gene expression profiles. We found little evidence for a role of gestational nicotine exposure on altered gene expression in the striatum of adolescent offspring at a significance level of p<0.01 and |log2 fold change >0.5|, although we cannot exclude the possibility of nicotine-induced changes in other brain regions, or at other time points. We did, however, find marked gene expression differences in response to imposed food-restriction. Food-restriction resulted in significant group differences for a number of immediate early genes (IEGs) including Fos, Fosb, Fosl2, Arc, Junb, Nr4a1 and Nr4a3. These genes are associated with stress response pathways and therefore may reflect long-term effects of nutritional deprivation on the development of the stress system.

Comparing changes in late-life depressive symptoms across aging, disablement, and mortality processes.

Developmental processes are inherently time-related, with various time metrics and transition points being used to proxy how change is organized with respect to the theoretically underlying mechanisms. Using data from 4 Swedish studies of individuals aged 70-100+ (N = 453) who were measured every 2 years for up to 5 waves, we tested whether depressive symptoms (according to the Center for Epidemiologic Studies Depression Scale; Radloff, 1977) are primarily driven by aging-, disablement-, or mortality-related processes, as operationally defined by time-from-birth, time-to/from-disability-onset (1st reported impairment in Personal Activities of Daily Living; Katz, Ford, Moskowitz, Jackson, & Jaffe, 1963), and time-to-death metrics. Using an approach based on Akaike weights, we tested whether developmental trajectories (for each time metric) of depressive symptoms in late life are more efficiently described as a single continuous process or as a 2-phase process. Comparing fits of linear and multiphase growth models, we found that 2-phase models demonstrated better fit than did single-phase models across all time metrics. Time-to-death and time-to/from-disability-onset models provided more efficient descriptions of changes in depressive symptoms than did time-from-birth models, with time-to-death models representing the best overall fit. Our findings support prior research that late-life changes in depressive symptoms are driven by disablement and, particularly, mortality processes, rather than advancing chronological age. From a practical standpoint, time-to/from-disability-onset and, particularly, time-to-death metrics may provide better "base" models from which to examine changes in late-life depressive symptoms and determine modifiable risk and protective factors. Developmental researchers across content areas can compare age with other relevant time metrics to determine if chronological age or other processes drive the underlying developmental change in their construct of interest.

Multidomain trajectories of psychological functioning in old age: A longitudinal perspective on (uneven) successful aging.

Life-span developmentalists have long been interested in the nature of and the contributing factors to successful aging. Using variable-oriented approaches, research has revealed critical insights into the intricacies of human development and successful aging. In the present study, we opted instead for a more subgroup-oriented approach and examined multiple-indicator information of late-life change at the person level. We applied latent profile analysis to 8-year longitudinal data pooled together across 4 Swedish studies of the oldest old (N = 1,008; Mage = 81 years at Time 1; 61% women). Results revealed 4 psychosocial aging profiles with uneven patterns of successful (and less successful) aging characterized by distinct trajectories of change across indicators of depressive symptoms, social, and memory functions: a preserved system integrity group of participants who maintained functioning across very old age; an aging in isolation group with a persistent lack of social support, and 2 groups of people with average well-being and social functions but distinctive memory profiles. A compromised memory group was characterized by poor memory throughout late life, whereas participants in a memory failing group exhibited dramatic memory declines late in life. The subgroups were also differentiated by sociodemographic characteristics, functional limitations, and mortality hazards, which may have served as antecedents, correlates, or consequents of profile trajectories. We discuss the promises and challenges of using subgroup-oriented approaches in the study of successful aging.

Age and time-to-death trajectories of change in indicators of cognitive, sensory, physical, health, social, and self-related functions.

Mortality-related processes are known to modulate late-life change in cognitive abilities, but it is an open question whether and how precipitous declines with impending death generalize to other domains of functioning. We investigated this notion by using 13-year longitudinal data from now-deceased participants in the Berlin Aging Study (N = 439; 70-103 years at first occasion; M = 87 years). Using time metrics of chronological age and time-to-death, we compared changes in key indicators of cognitive, sensory, physical, health, social, and self-related domains. Across variables and domains, mortality models revealed steeper average rates of change than age models. However, some domain indicators were more prone to mortality-related change than others. Examining between-person differences, we found that sociodemographic characteristics (surviving to an older age at death, being a woman, lower socioeconomic status) and proxies of pathologies (comorbidities, disability, and suspected dementia) related to lower levels of late-life functioning. In contrast, little evidence was found for correlates of differential change. Our results illustrate both the pervasive nature of progressive processes leading toward death and their domain specificity. Inquiries with more closely spaced multidomain measurements are needed to identify invariant and variable aspects of the end-of-life "cascade."

Improvements and Decline in the Physical Functioning of Israeli Older Adults

The current study depicts improvement and decline in functioning among 3 population groups of Israeli older adults: Jews and veteran immigrants, former Soviet Union immigrants, and Arabs. Using longitudinal data from 2005 and 2010 Survey of Health and Retirement (SHARE) in Israel (n = 982), we examined 4 functional changes in late life in mobility, movement, activities of daily living (ADL), and instrumental ADL, as a function of sociodemographic, health, and social variables The findings reveal that physical functioning among older adults can decline as well as improve over time. Older age, higher number of diseases and comorbidity, living with others (not the spouse) compared with living alone, receiving informal help and formal help with homemaking, and declined mental health and cognitive status predict deterioration in physical functioning. Also, Arab older adults are at higher risk of deterioration over time compared with Jewish older adults. Findings imply that noncompatible assistance to older adults may "save them the hassle" of doing things by themselves and thus, weakens a potential functional rehabilitation process. There is a need to guide not only professional personnel but also nonprofessional home care workers and family members on how to encourage and retain older adults' functions as much as possible in order to improve their quality of life. Another implication of investing in rehabilitation is that it might reduce the disability rate among older adults and thus save health expenditures on long-term care at the macrosocial level.

Building a New Paradigm for the Early Recognition of Behavioral Variant Frontotemporal Dementia: Late Onset Frontal Lobe Syndrome Study

To describe the aims and design of the ongoing Late Onset Frontal Lobe Syndrome study (LOF study), a study on the spectrum of neurodegenerative and psychiatric etiologies causing behavioral changes in later life, and on the role of magnetic resonance imaging (MRI), [(18)F]-fluorodeoxyglucose-positron emission tomography (FDG-PET), and cerebrospinal fluid (CSF) biomarkers in predicting and identifying the different underlying pathologies with a special focus on the behavioral variant of frontotemporal dementia. The LOF study is an observational cross-sectional and prospective follow-up study. Patients aged 45-75 years with a frontal behavioral change consisting of apathy, disinhibition, or compulsive/stereotypical behavior were included (April 2011-2013). Patients underwent a multidisciplinary assessment by a neurologist and psychiatrist and MRI, CSF, and PET measurements at inclusion and after 2 years of follow-up. The diagnostic added value of MRI, PET, and CSF results and their predictive value will be measured after 2 years of follow-up. This is the first large-scale prospective follow-up study of patients with late-onset behavioral disorders.

Inquiry Into Terminal Decline: Five Objectives for Future Study

Notions of terminal decline propose that late-life change is primarily driven by processes closely tied to pathology and mortality rather than chronological age. We use the rationales of longitudinal research as outlined by Baltes and Nesselroade (Baltes, P., & Nesselroade, J. [1979]. History and rationale of longitudinal research. In J. R. Nesselroade & P. Baltes (Eds.), Longitudinal research in the study of behavior and development [pp. 1-39]. San Diego, CA: Academic Press) as a framework for organizing research on terminal decline. In doing so, we note that there are relatively robust descriptions of terminal decline across a variety of different domains, as well as the extent of interindividual differences in the levels of function, rates of change, and timing of terminal decline (research rationales 1 and 2). However, there is much more to learn about the interrelations among change in different domains, the underlying mechanisms of change, and the factors that contribute to interindividual differences in change (research rationales 3-5). Needed are new study designs and analytical models that better address the structural, temporal, and causal interrelations that contribute to and protect against terminal decline.

‘Aging well’ in de 21e eeuw: een psychosociaal perspectief

Aging well refers to retaining or restoring well-being in the face of various age-related changes in later life. This process is influenced by the quality of social relationships and active adaptation to loss and change. According to recent studies from the Longitudinal Aging Study Amsterdam, more older adults are maintaining relationships with friends, colleagues and other non-kin longer. Greater diversity in their social networks contributes to happiness and morale, and provides protection against anxiety, depression and loneliness. There is also a slight increase in mastery and in cognitive functioning among new cohorts of older adults. These developments promote adaptation to declines in health and loss of the partner. These improvements are found less frequently among those with lower education, lower incomes, and/or small networks. Several interventions have proven to be effective for these disadvantaged groups: a visiting service for widows and widowers and two self-management interventions for chronically ill or physically vulnerable older adults.

Personality Change in the Oldest‐Old: Is It a Matter of Compromised Health and Functioning?

The present longitudinal study investigates continuity and change in the personality dimensions of extraversion and neuroticism among the oldest-old. Overall disease load, self-rated health, functional capacity, impaired vision and hearing, self-reported cognitive impairment, and measured cognitive status were tested for their role as potentially relevant late-life predictors of personality change. The sample consists of 408 individuals aged 80-98 in the Swedish OCTO-Twin Study who completed the Eysenck Personality Inventory at four measurement occasions during a 6-year period. Growth curve analyses revealed an age-related linear decrease in extraversion and stability in neuroticism. More extraverted individuals were more educated and perceived their health and cognition as better. Notably, only hearing impairment was found to be related to a steeper age-related decline in extraversion. A life span developmental model focusing on health-related changes can improve our understanding of personality change in late life.

Life Satisfaction Among Elders in Senior Residences: A Pilot Study

ABSTRACTObjective: This pilot study investigated predictors of life satisfaction among elders residing in senior residences with a focus on feeling valued and important (FVI), a seldom-studied predictor that has the potential for late-life changes through occupational therapy intervention. Method: Using existing data from an intervention study (N = 47), simultaneous multiple regression analysis was employed. Results: The regression model, which included predictors of self-rated health, education level, and FVI, was significant F(3,43) = 21.16, p < 0.001. Further, FVI was a stronger predictor of life satisfaction than the well-established predictor of self-rated health. Conclusion: FVI is a significant predictor of life satisfaction in older adults residing in senior residences. Practice implications include promoting participation in occupations that provide the opportunity for meaningful contributions to family and society.

Ageing

Ageing

Editorial: Epidemiologic Reviews 2013--Special Issue on the Epidemiology of Aging

The papers in this volume (1–13 )r eflect substantial and diverse epidemiologic research activity on some of the major health problems of older people. When the call for papers was announced, no particular themes within this vast field of the epidemiology of aging were suggested or encouraged. This led to a series of reviews covering a breadth of modern and important topics. These topics touch many disciplines that dovetail with the science of aging, including evaluating putative social and biological risk factors for age-related change and survivorship, identifying biological processes and modern biomarkers of aging, and exploring aging outcomes in older populations, such as the issue of multimorbidity among older Americans and military veterans in Canada and other countries. Several papers review risk factors for altered cognitive function and dementia-related illnesses. Although firm conclusions are not always possible given the state of the science, important directions for moving forward are offered. The preventive potential of these works is always close to the surface. The papers also encompass some of the general themes and challenges of population aging research. The importance of life-course concepts in the epidemiology of aging is present in several reports. For example, the report by Dahl and Hassing (2) finds an association of midlife obesity and late-life cognitive function. Other reports also address the problem of accurately identifying early life exposures that predict late-life age-related changes. The incorporation of modern biological indicators of aging and survivorship, such as genetic and genomic factors (13) and telomere length (9), reflects the importance of molecular approaches to the long-standing quest for biomarkers of the progression of age-related change, biomarkers that are precise and robust across populations. As these biomarkers are validated, they will take their places as useful prognostic factors for personalized medicine. However, to be useful, such biomarkers need to be generally independent of untoward environmental exposures and the variety of diseases that are prevalent in older populations, a common problem noted in the report by Salive (6). Other reports in this volume denote the great variation in health and function among older populations, highlighting the challenges for defining preventive approaches for older persons that can reach large segments of this very heterogeneous group. Although new methodological approaches are always welcome, collectively this collection of review papers bespeaks the active international activity in population aging and points to directions in understanding aging mechanisms; defining potential biological, clinical, and social intervention studies to enhance successful aging; and providing more targeted, efficient, and effective approaches to delivering health services to older persons. The epidemiology of aging is alive and well!

APOE ε4, Alzheimer's disease pathology, cerebrovascular disease, and cognitive change over the years prior to death.

The goal of this study was to examine the association of the APOE ε4 allele with the late-life cognitive trajectory and test the hypothesis that the association of ε4 with cognitive decline is explained by Alzheimer's disease (AD) neuropathology. Participants (N = 581) came from 2 longitudinal clinical-pathologic studies of aging and dementia, the Religious Orders Study (ROS) and the Memory and Aging Project (MAP). Longitudinal measures of cognition were derived from detailed annual neuropsychological testing. Uniform neuropathologic evaluations provided quantitative measures of AD pathology, chronic cerebral infarctions, and Lewy bodies. Participants with 1 or more copies of the ε4 allele (ε2/4 excluded) were considered ε4 carriers. Random change point models were applied to examine the association of the ε4 allele with onset of terminal decline as well as preterminal and terminal slopes. On average, the onset of terminal decline occurred around 3 years before death, and the rate of terminal decline was eightfold faster than the preterminal decline. The presence of the ε4 allele was associated with an earlier onset of terminal decline and faster rates of decline before and after its onset. After adjusting for AD pathology, the ε4 allele was no longer associated with onset of terminal decline or preterminal slope, and the association with terminal slope became marginal. The APOE ε4 allele is an important determinant of late-life change in cognition, including terminal decline, and works primarily through AD pathology.

New perspectives on central and peripheral immune responses to acute traumatic brain injury

Traumatic injury to the brain (TBI) results in a complex set of responses involving various symptoms and long-term consequences. TBI of any form can cause cognitive, behavioral and immunologic changes in later life, which underscores the problem of underdiagnosis of mild TBI that can cause long-term neurological deficits. TBI disrupts the blood–brain barrier (BBB) leading to infiltration of immune cells into the brain and subsequent inflammation and neurodegeneration. TBI-induced peripheral immune responses can also result in multiorgan damage. Despite worldwide research efforts, the methods of diagnosis, monitoring and treatment for TBI are still relatively ineffective. In this review, we delve into the mechanism of how TBI-induced central and peripheral immune responses affect the disease outcome and discuss recent developments in the continuing effort to combat the consequences of TBI and new ways to enhance repair of the damaged brain.

Trajectories of Late-Life Change in God-Mediated Control

To track within-individual change during late life in the sense of personal control and God-mediated control (the belief that one can work collaboratively with God to achieve one's goals and exercise control over life events) and to evaluate the hypothesis that this element of religion is related to declining personal control. A longitudinal survey representative of older White and Black adults in the United States tracked changes in personal and God-mediated control in four waves over the course of 7 years. Growth curve analysis found that the pattern of change differed by race. White adults had less sense of God-mediated control at younger ages, which increased among those who were highly religious but decreased among those who were less religious. Black adults had higher God-mediated control, which increased over time among those with low personal control. These results indicate that God-mediated control generally increases during older adulthood, but that its relationships with personal control and religious commitment are complex and differ between Black and White adults.

Body mass index across midlife and cognitive change in late life

BackgroundHigh midlife body mass index (BMI) has been linked to a greater risk of dementia in late life, but few have studied the effect of BMI across midlife on cognitive abilities and cognitive change in a dementia free sample.MethodsWe investigated the association between body mass index (BMI), measured twice across midlife (mean age 40 and 61 years, respectively), and cognitive change in four domains across two decades in the Swedish Adoption/Twin Study of Aging (SATSA).ResultsLatent growth curve models fitted to data from 657 non-demented participants showed that persons who were overweight/obese in early midlife had significantly lower cognitive performance across domains in late life and significantly steeper decline in perceptual speed, adjusting for cardio-metabolic factors. Both underweight and overweight/obesity in late midlife were associated with lower cognitive abilities in late life. However, the association between underweight and low cognitive abilities did not remain significant when weight decline between early and late midlife was controlled for.ConclusionsThere is a negative effect on cognitive abilities later in life related to being overweight/obese across midlife. Moreover, weight decline across midlife rather than low weight in late midlife per se was associated with low cognitive abilities. Weight patterns across midlife may be prodromal markers of late life cognitive health.

A brief report on an action learning group exploration of how older people adapt to change in later life

In collaboration with Age Concern UK, older people were invited to participate in action learning groups to explore how they adapt to change. Themes for discussion were initially identified using a nominal focus method. Discussions identified actual and desired methods of coping with changes in later life. A series of weekly meetings with three cohorts of urban, rural and sheltered accommodation participants with an average age of 81 years revealed that they were concerned with having to cope with and adapt to a wide range of experiences. These included the loss of sharing and reduced sociability, reduced mobility, bereavement, physical changes, having to move house and/or location, having to retire, and having to deal with outside agencies. In order to cope with these experiences, participants engaged in a range of activities that centered on aspects of communication and social networking. Participants talked to each other socially and informally, exchanging information and advice. When able, they also participated in more structured but non-specific social events during which time they also had the opportunity to support each other. Participants suggested that there was a role for statutory and nonstatutory bodies and professions such as mental health and community adult nursing, occupational therapy and social work to provide more formal social networking and information exchange opportunities.

Personal and Neighborhood Resources, Future Time Perspective, and Social Relations in Middle and Older Adulthood

Aging-related changes in motivation and the availability of resources have been hypothesized to result in social network changes in later life. However, few studies have examined associations of both motivation and resources with different aspects of social network composition in the same analytical context. The present study examined associations of key motivational (future time perspective [FTP]) and resource variables (partner status, physical health, and perceived neighborhood cohesion) with social network size and positive and negative social exchanges. A population-based sample of midlife (aged 55-59 years, n = 169) young-old (aged 60-74 years, n = 306) and old-old (aged 75+ years, n = 77) adults completed a questionnaire. Those who were partnered reported larger networks with family, whereas never-married individuals reported larger networks with neighbors. Perceived neighborhood cohesion was related to larger networks with family, neighbors, and friends. Open-ended FTP was associated with larger networks of friends and more frequent positive social exchanges. Our results point to FTP and resources having different implications for social engagement across network domains.

Education Does Not Slow Cognitive Decline with Aging: 12-Year Evidence from the Victoria Longitudinal Study

Although the relationship between education and cognitive status is well-known, evidence regarding whether education moderates the trajectory of cognitive change in late life is conflicting. Early studies suggested that higher levels of education attenuate cognitive decline. More recent studies using improved longitudinal methods have not found that education moderates decline. Fewer studies have explored whether education exerts different effects on longitudinal changes within different cognitive domains. In the present study, we analyzed data from 1014 participants in the Victoria Longitudinal Study to examine the effects of education on composite scores reflecting verbal processing speed, working memory, verbal fluency, and verbal episodic memory. Using linear growth models adjusted for age at enrollment (range, 54-95 years) and gender, we found that years of education (range, 6-20 years) was strongly related to cognitive level in all domains, particularly verbal fluency. However, education was not related to rates of change over time for any cognitive domain. Results were similar in individuals older or younger than 70 at baseline, and when education was dichotomized to reflect high or low attainment. In this large longitudinal cohort, education was related to cognitive performance but unrelated to cognitive decline, supporting the hypothesis of passive cognitive reserve with aging.