Group-based Trajectory Modeling Research Articles

Associations of Blood Pressure Trajectories with Subsequent Cognitive Decline, Dementia and Mortality.

Hypertension may harm cognitive performance, but the potential correlates of longitudinal patterns of blood pressure (BP), especially diastolic BP (DBP), to cognition have been unclear. To examine long-term BP trajectories in relation to subsequent cognitive decline, incident dementia and all-cause mortality in the general population. Population-based cohort study. Communities in England. The study included 7566 participants from the English Longitudinal Study of Ageing (ELSA). BP were measured in 1998, 2004, 2008. Group-based trajectory modeling was used to identify long-term patterns of systolic BP (SBP) and DBP. Outcomes including cognitive function, incident dementia, and all-cause mortality were followed up to 10 years. Five distinct trajectories were identified for SBP and DBP, respectively. The normal-stable trajectory was used as the reference. For cognitive decline, both SBP and DBP trajectories were independently associated with subsequent cognitive decline, with the fastest decline appeared in the high-stable SBP group of 180 mmHg and the low-stable DBP group of 60 mmHg (both P<0.005). For incident dementia, the multivariable adjusted hazard ratio (HR) was also greatest in high-stable group (4.79, 95% confidence interval: 2.84 to 8.07) across all SBP trajectories. Conversely, low (HR: 1.58) and moderate-low stable (HR: 1.56) DBP trajectories increased dementia risk (both P<0.005). Similar patterns were found in BP trajectories in relation to all-cause mortality. Our study evaluates the potential health impact from different BP trajectories and suggests that controlling long-term SBP and maintaining adequate DBP may be relevant for the current practice to promote cognitive health and extend lifespan.

Dispensing patterns of antidepressant and antianxiety medications for psychiatric disorders after benign hysterectomy in reproductive-age women: Results from group-based trajectory modeling.

Women with gynecologic disorders requiring a hysterectomy often have co-existing psychiatric diagnoses. A change in the dispensing pattern of antidepressant (AD) and antianxiety (AA) medications around the time of hysterectomy may be due to improvement in gynecologic symptoms, such as pelvic pain and abnormal bleeding, or the emotional impact of the hysterectomy. Unfortunately, these dispensing patterns before and after hysterectomy are currently undescribed. To model the dispensing patterns of AD and AA medications over time among women with psychiatric disorders before and after benign hysterectomy for endometriosis and uterine fibroids; and to characterize clusters of patients with various dispensing behaviors based on these patterns. Retrospective cohort study. This is a study of women who underwent a benign hysterectomy using data from the Merative MarkertScan® Research Databases (Ann Arbor, MI, USA). Inclusion criteria were reproductive-aged women (18-50 years), diagnosis of at least one mood or anxiety disorder, and at least one dispensing of AD or AA medications. We measured monthly adherence and persistence of AD/AA medication use over 12 months after hysterectomy. Group-based-trajectory modeling (GBTM) was used to identify trajectory groups of monthly AD/AA medication dispensing over the study period. Multinomial logistic regression was used to identify factors independently associated with individual dispensing trajectory patterns. For a total of 11,607 patients, 6 dispensing trajectory groups were identified during the study period: continuously high (27.0%), continuously moderate (21.9%), continuously low (17.9%), low-to-high (10.0%), moderate-to-low (9.8%), and low-to-moderate (13.4%). Compared with the continuously high group, younger age, no history of a mood disorder, and uterine fibroids were clinical predictors of low dispensing. The discontinuation rate at 3 months after hysterectomy was higher at 88.6% in the continuously low group and at 66.5% in the continuously low-to-moderate group. This study demonstrates that GBTM identified six distinct trajectories of AD/AA medication dispensing in the perioperative period. Trajectory models could be used to identify specific dispensing patterns for targeting interventions.

Later-Life Cognitive Trajectories and Risk of Death: Results from a 6-Year Longitudinal Study of 7082 Chinese.

To identify cognitive decline trajectories in a Chinese elderly population, explore the associations between these trajectories and mortality, and further identify risk factors related to certain trajectories of cognitive decline. Prospective cohort study. The group-based trajectory modeling and Cox proportional hazards models were conducted to explore the association between cognitive trajectory groups and mortality, while multinomial logistic regression models were constructed to estimate potential risk factors. We included 7082 participants aged 65 years or above in three consecutive but non-overlapping cohorts of the Chinese Longitudinal Healthy Longevity Survey with the Chinese version of the Mini-Mental State Examination up to 6 years. Participants were subsequently followed for a median (IQR) of 2.89 (1.38-3.12) years to obtain their survival status and date of death. Chinese version of the Mini-Mental State Examination was used to measure participants' cognitive function. Through use of group-based trajectory modeling, we determined three cognitive trajectory groups. Then, after adjusting for confounding factors, we found a monotonic and positive association between cognitive decline and mortality risk. Meanwhile, the association varied among elderly populations in different age groups and BMI categories, but did not differ by sex, smoking, drinking and exercising. Older seniors, females and those with poorer baseline cognitive function and less social participation tended to be more likely to be in the unfavorable trajectory groups. We found that the faster the cognitive decline, the higher the mortality, especially among those aged 65-79 years and those overweight. Our findings suggested the importance of implement better monitoring of the cognitive function of the elderly population.

Associations between serum albumin level trajectories and clinical outcomes in sepsis patients in ICU: insights from longitudinal group trajectory modeling.

Sepsis triggers a strong inflammatory response, often leading to organ failure and high mortality. The role of serum albumin levels in sepsis is critical but not fully understood, particularly regarding the significance of albumin level changes over time. This study utilized Group-based Trajectory Modeling (GBTM) to investigate the patterns of serum albumin changes and their impact on sepsis outcomes. We conducted a retrospective analysis on ICU patients from West China Hospital (2015-2022), employing GBTM to study serum albumin fluctuations within the first week of ICU admission. The study factored in demographics, clinical parameters, and comorbidities, handling missing data through multiple imputation. Outcomes assessed included 28-day mortality, overall hospital mortality, and secondary complications such as AKI and the need for mechanical ventilation. Data from 1,950 patients revealed four serum albumin trajectories, showing distinct patterns of consistently low, increasing, moderate, and consistently high levels. These groups differed significantly in mortality, with the consistently low level group experiencing the highest mortality. No significant difference in 28-day mortality was observed among the other groups. Subgroup analysis did not alter these findings. The study identified four albumin trajectory groups in sepsis patients, highlighting that those with persistently low levels had the worst outcomes, while those with increasing levels had the best. Stable high levels above 30 g/L did not change outcomes significantly. These findings can inform clinical decisions, helping to identify high-risk patients early and tailor treatment approaches.

PM2.5 constituents associated with childhood obesity and larger BMI growth trajectory: A 14-year longitudinal study

BackgroundThe association of specific PM2.5 chemical constituents with childhood overweight or obesity (OWOB) remain unclear. Furthermore, the long-term impacts of PM2.5 exposure on the trajectory of children's body mass index (BMI) have not been explored. MethodsWe conducted a longitudinal study among 1,450,830 Chinese children aged 6–19 years from Beijing and Zhongshan in China during 2005–2018 to examine the associations of PM2.5 and its chemical constituents with incident OWOB risk. We extracted PM2.5 mass and five main component exposure from Tracking Air Pollution in China (TAP) dataset. Cox proportional hazards models were applied to quantify exposure–response associations. We further performed principal component analysis (PCA) to handle the multi-collinearity and used quantile g-computation (QGC) approach to analyze the impacts of exposure mixtures. Additionally, we selected 125,863 children with at least 8 physical examination measurements and combined group-based trajectory models (GBTM) with multinomial logistic regression models to explore the impacts of exposure to PM2.5 mass and five constituents on BMI and BMI Z-score trajectories during 6–19 years. ResultsWe observed each interquartile range increment in PM2.5 exposure was significantly associated with a 5.1 % increase in the risk of incident OWOB (95 % confidence Interval [CI]: 1.036–1.066). We also found black carbon, sulfate, organic matter, often linked to fossil combustion, had comparable or larger estimates of the effect (HR = 1.139–1.153) than PM2.5. Furthermore, Exposure to PM2.5 mass, sulfate, nitrate, ammonium, organic matter and black carbon was significantly associated with an increased odds of being in a larger BMI trajectory and being assigned to persistent OWOB trajectory. ConclusionsOur findings provide evidence that the constituents mainly from fossil fuel combustion may have a perceptible influence on increased OWOB risk associated with PM2.5 exposure in China. Moreover, long-term exposure to PM2.5 contributes to an increased odds of being in a lager BMI and a persistent OWOB trajectories.

Socioeconomic Disparity in the Effect of SARS-CoV-2 on Outpatient Visits among People with Type 2 Diabetes in Taiwan.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak posed impact on healthcare. This study evaluated the effect of SARS-CoV-2 outbreak on the outpatient visits of patients with type 2 diabetes and determined the most affected groups. We analyzed Taiwan's National Health Insurance data, including 1,922,702 patients diagnosed with type 2 diabetes from 2018 to 2021. Group-based trajectory modelling identified four distinct outpatient visit patterns, namely, consistently high (Group 1, 74.2%), low-to-high (Group 2, 8.1%), high-to-low (Group 3, 6.0%) and consistently low (Group 4, 11.7%) utilization. Logistic regression was used to analyze correlations between trajectory types and patients' demographics and health statuses. Group 3 members had higher odds of being male [adjusted odds ratio (aOR) = 1.04, 95% confidence interval (CI) 1.03-1.05] and earning below 20,000 New Taiwan Dollar monthly (aOR = 1.29, 95% CI 1.26-1.31) than those in Group 1. However, they were less likely to be under 80 years old (aOR = 0.70-0.97), from lower median family income regions (aOR = 0.81-0.89) or possess a Charlson Comorbidity Index score > 2 (aOR = 0.67, 95% CI 0.66-0.68). Patients with lower income in affluent areas displayed the highest likelihood of falling into Group 3. Patients with type 2 diabetes and low income from wealthy areas were vulnerable during the pandemic. This result emphasizes the need to target resources and support for this subgroup during such crises.

Trajectories of U.S. Parents’ Remote Work during the COVID-19 Pandemic

The COVID-19 pandemic had numerous consequences for work and family, but one of the most important was the substantial increase in remote work. Despite interest in changes to remote work and questions about whether the new environment of remote work will persist long-term, we know little about variation in workers’ experiences with remote work since the beginning of the pandemic. In this data visualization, we use longitudinal data on U.S. working parents from 2020–2023 and group-based trajectory models to illustrate varying patterns of remote work for partnered parents. The heterogeneity of parents’ experiences with remote work throughout the pandemic reveals important nuances not previously identified in tracking polls and highlights important gender differences that likely had implications for mothers’ and fathers’ well-being and gender equality.

The husband's mental health is affected by the wife's happiness, but not vice versa: a longitudinal observation.

The psychological states of wives and husbands are thought to influence each other to varying degrees. However, relatively little is known from a longitudinal observation about the effects of spouses' psychological distress and well-being on their mental health. To address this question, we analyzed the TWIN Study II dataset using a three-wave annual survey of the psychological distress and happiness of 379 dual-income families. A group-based trajectory modeling analysis was conducted to identify psychological distress patterns and happiness over time, while estimating the effects of spouses' psychological distress and happiness and their own job demands, control, and support as time-varying covariates. The two- or three-group trajectory model best fit husbands' and wives' psychological distress and happiness trajectories. Husbands' trajectories of psychological distress and happiness were significantly influenced by wives' happiness as well as their own job demands and/or support, whereas wives' happiness and psychological distress were not.

Trajectories and Predictors of Weight-Bearing and Non-Weight-Bearing Pain in Knee Osteoarthritis: A 9-Year Follow-Up Study.

To identify distinct developmental trajectories of weight-bearing pain (WBP) and non-weight-bearing pain (NWBP) and examine the trajectory predictors in individuals with or at risk of knee osteoarthritis. We included 971 participants from the Osteoarthritis Initiative whose baseline magnetic resonance imaging data and 9-year follow-up data on pain were available. We applied group-based trajectory modeling to identify WBP and NWBP trajectories over 9 years. Univariate and multivariate multinomial logistic regression analyses were performed to examine the predictors of identified trajectories. Three distinct WBP trajectories were identified: "no pain" (32.4%), "mild pain" (44.6%), and "moderate pain" (23%). Three distinct NWBP trajectories were identified: "no pain" (50.9%), "mild pain" (33.4%), and "moderate pain" (15.7%). In multivariate analyses, high body mass index, depression, multisite pain, radiographic knee OA, and comorbidities were associated with worse development trajectories for WBP and NWBP. Weak quadriceps strength and bone marrow lesion were only associated with worse WBP trajectories, whereas low education level was only associated with worse NWBP trajectories. The developmental course of pain is heterogeneous in WBP or NWBP. Quadriceps strength and bone marrow leisure may be WBP-specific predictors, whereas education level may be a NWBP-specific predictor. The assessment of knee pain should be more accurate, which may help select appropriate therapeutic targets.

The effect of childhood depression trajectories on sugar-sweetened beverage habit trajectories in adolescence: Exploring sleep problems as a mediator

Although depression has been linked to the habit of consuming sugar-sweetened beverages (SSBs), little is known about their long-term relationships and the mediating role of sleep problems. This study examines the associations between childhood depressive symptoms trajectories and adolescent SSB-habit trajectories and whether these associations were mediated by sleep problems. Data came from 1560 adolescents participating in a longitudinal study across grades 1 through 12 in northern Taiwan. Group-based trajectory modeling was used to identify development of childhood depressive symptoms and an SSB habit in adolescence. Multinomial logistic regression was conducted to examine the influence of childhood depressive symptoms and adolescent SSB habit. Mediation analysis was conducted to test whether sleep problems mediated the associations examined. Four distinct trajectories of childhood depressive symptoms were identified: low-stable (30.79%), moderate-stable (42.32%), increasing (12.29%), and high-stable (11.60%). Three distinct trajectories of SSB habit in adolescence were identified: low-stable (44.32%), increasing (15.02%), and high-stable (40.65%). Children who had moderate-stable (aOR = 1.35; CI: 1.04–1.77), high-stable (aOR = 2.01; CI: 1.28–3.15), or increasing (aOR = 1.97; CI: 1.26–3.06) trajectories of depressive symptoms relative to those in the low-stable group were significantly more likely to belong to the high-stable trajectory of SSBs than to the low-stable SSBs group. The Z-mediation test showed that sleep problems significantly mediated the associations between trajectories of childhood depressive symptoms and trajectories of SSBs during adolescence (all p < 0.05). Childhood depressive symptoms conferred risks for adolescent SSB habits; and the effects were seen, in part, through increasing sleep problems.

Longitudinal medication adherence group-based trajectories of aging adults in the US: A retrospective analysis using monthly proportion of days covered calculations

BackgroundIt is thought that half of the patients with chronic conditions are not adherent to their medications, which contributes to significant health and economic burden. Many studies estimate medication non-adherence by implementing a threshold of ≥80% of Proportion of Days Covered (PDC), categorizing patients as either adherent or non-adherent. Healthcare quality metrics pertaining to medication use are based on this dichotomous approach of medication adherence, including the Medicare Part D Star Ratings. Among others, the Medicare Part D Star Ratings rewards part D plan sponsors with quality bonus payments based on this dichotomous categorization of beneficiaries’ medication adherence. ObjectivesDescribe the longitudinal adherence trajectories of adults ≥65 years of age covered by Medicare for 3 classes of drugs in the Part D Star Ratings: diabetes medications, statins, and select antihypertensives. MethodsThis study used Medicare healthcare administrative claims data linked to participants from the Health Retirement Study between 2008 and 2016. Group-based trajectory models (GBTM) elicited the number and shape of adherence trajectories from a sample of N = 11,068 participants for the three pharmacotherapeutic classes considered in this study. Medication adherence was estimated using monthly PDC. ResultsGBTM were estimated for the sample population taking antihypertensives (n = 7,272), statins (n = 8,221), and diabetes medications (n = 3,214). The hypertension model found three trajectories: high to very high adherence (47.55%), slow decline (32.99%), and rapid decline (19.47%) trajectories. The statins model found 5 trajectories: high to very high adherence (35.49%), slow decline (17.12%), low then increasing adherence (23.58%), moderate decline (12.62%), and rapid decline (11.20%). The diabetes medications model displayed 6 trajectories: high to very high adherence (24.15%), slow decline (16.84%), high then increasing adherence (25.56%), low then increasing (13.58%), moderate decline (10.60%), and rapid decline (9.27%). ConclusionsThis study showed the fluid nature of long-term medication adherence to the medications considered in the Medicare Part D Star Ratings and how it varies by pharmacotherapeutic class. These challenge previous assumptions about which patients were considered adherent to chronic medications. Policy and methodological implications about medication adherence are discussed.

Early childhood trajectories of domain-specific developmental delay and gestational age at birth: An analysis of the All Our Families cohort.

To describe developmental domain-specific trajectories from ages 1 through 5 years and to estimate the association of trajectory group membership with gestational age for children born between ≥34 and <41 weeks gestation. Using data from the All Our Families cohort, trajectories of the domain-specific Ages & Stages Questionnaire scores were identified and described using group-based trajectory modeling for children born ≥34 and <41 weeks of gestation (n = 2664). The trajectory groups association with gestational age was estimated using multinomial logistic regression. Across the five domains, 4-5 trajectory groups were identified, and most children experienced changing levels of risk for delay over time. Decreasing gestational age increases the Relative risk of delays in fine motor (emerging high risk: 1.46, 95% CI: 1.19-1.80; resolving moderate risk: 1.11, 95% CI: 1.03-1.21) and gross motor (resolving high risk: 1.21, 95% CI: 1.04-1.42; and consistent high risk: 1.64, 95% CI: 1.20-2.24) and problem solving (consistent high risk: 1.58 (1.09-2.28) trajectory groups compared to the consistent low risk trajectory groups. This study highlights the importance of longitudinal analysis in understanding developmental processes; most children experienced changing levels of risk of domain-specific delay over time instead of having a consistent low risk pattern. Gestational age had differential effects on the individual developmental domains after adjustment for social, demographic and health factors, indicating a potential role of these factors on trajectory group membership.

Individual and dual trajectories of insomnia symptoms and body mass index before and after retirement and their associations with changes in subjective cognitive functioning

BackgroundWe examined individual and dual trajectories of insomnia symptoms and body mass index (BMI) before and after retirement, and their associations with changes in subjective cognitive functioning after retirement. MethodsWe used the Helsinki Health Study's (n = 2360, 79% women, aged 40–60 at baseline, Finland) repeated surveys to identify the developmental patterns of insomnia symptoms and BMI (2000–2017) and changes in subjective cognitive functioning (2017–2022). We analysed the data using latent group-based dual trajectory modelling and logistic regression analysis. ResultsThree latent groups were identified for insomnia symptoms (stable low, decreasing and increasing symptoms) and BMI (stable healthy weight, stable overweight and stable obesity). Insomnia symptoms were associated with declining subjective cognitive functioning and largely explained the effects in the dual models. Conclusion:The association between dual trajectories of insomnia symptoms and BMI with subjective cognitive decline is dominated by insomnia symptoms.

Impact of the baseline insulin resistance surrogates and their longitudinal trajectories on cardiovascular disease (coronary heart disease and stroke): a prospective cohort study in rural China.

This study aimed to assess the association of baseline insulin resistance (IR) surrogates and their longitudinal trajectories with cardiovascular diseases (CVD) to provide a useful reference for preventing CVD. This study was a prospective cohort study conducted in the 51st Regiment of the Third Division of Xinjiang Corps. A total of 6362 participants were recruited in 2016 to conduct the baseline survey, and the follow-up surveys in 2019, 2020, 2021, and 2022. The Kaplan-Meier method was used to estimate the cumulative incidence of CVD according to the baseline IR surrogates of metabolic insulin resistance score (METS-IR) and triglyceride-glucose (TyG) index. Cox regression models were used to assess the association between the baseline IR surrogates and CVD. The impact of the longitudinal trajectories of the IR surrogates on CVD was analyzed after excluding those with IR surrogate data measured ≤2 times. Based on the group-based trajectory model (GBTM), the trajectory patterns of IR surrogates were determined. The Kaplan-Meier method was used to estimate the cumulative incidence of CVD in each trajectory group of METS-IR and TyG index. Cox regression models were used to analyze the association between different trajectory groups of each index and CVD. In addition, the Framingham model was utilized to evaluate whether the addition of the baseline IR surrogates increased the predictive potential of the model. Baseline data analysis included 4712 participants. During a median follow-up of 5.66 years, 572 CVD events were recorded (mean age, 39.42 ± 13.67 years; males, 42.9%). The cumulative CVD incidence increased with the ascending baseline METS-IR and TyG index quartiles (Q1-Q4). The hazard ratio and 95% confidence interval for CVD risk in Q4 of the METS-IR and TyG index were 1.79 (1.25, 2.58) and 1.66 (1.28, 2.17), respectively, when compared with Q1. 4343 participants were included in the trajectory analysis, based on the longitudinal change patterns of the METS-IR and TyG index, the following three trajectory groups were identified: low-increasing, moderate-stable, and elevated-increasing groups. Multivariate Cox regression revealed that the hazard ratio (95% confidence interval) for CVD risk in the elevated-increasing trajectory group of the METS-IR and TyG index was 2.13 (1.48, 3.06) and 2.63 (1.68, 4.13), respectively, when compared with the low-rising group. The C-index, integrated discrimination improvement value, and net reclassification improvement value were enhanced after adding the baseline METS-IR and TyG index values to the Framingham model (P<0.05). Elevated baseline IR surrogates and their higher long-term trajectories were strongly associated with a high risk of CVD incidence in Xinjiang's rural areas. Regular METS-IR and TyG index monitoring can aid in the early detection of CVD-risk groups.

TRAJECTORIES OF INTRINSIC CAPACITY AND IMPACT ON ADVERSE OUTCOMES IN COMMUNITY OLDER ADULTS: A LONGITUDINAL STUDY

Abstract Background Maintaining and delaying Intrinsic capacity(IC) in older adults is key to healthy ageing. Determining the point at which IC occurs and declines to delay its progression and intervene in a timely manner is critical. This study aims to explore the trajectories and the critical point of the trajectory changes among the elderly in the Chinese community. Methods The data used in this study are from the ongoing national longitudinal study CHARLS, which surveys the elderly population in China. A total of 3901 older adults from the cohort study were included. Logistic regression, group-based trajectory models (GBTM) were used to identify potential heterogeneity in longitudinal changes over time and investigate associations between baseline predictors and trajectories for different cohort members. Results Four different trajectories of IC in older people, namely, Increase (15.7%), Stable (52.7%), and Decline (31.6%) were found. We found several predictors that predict the trends in IC. Age, gender, living area, BMI, self-reported health states, the number of chronic diseases and initial IC scores significantly impact the IC change rate over time. Decreased cognitive function, psychology status and locomotion at baseline predicted new ADL and IADL dependence after 5 years. Conclusion The nature of genetics and environmental factors were associated with different trajectory groups of intrinsic capacity, which could help to guide the timing and focus of prevention strategies. Early prevention or intervention of the determinants of these trajectories can maintain or delay the rate of decline in intrinsic capacity and improve healthy ageing.

CARE-RESISTANT BEHAVIOR TRAJECTORIES OF PERSONS WITH DEMENTIA IN NURSING HOMES AND DISTAL OUTCOMES IN ORAL HEALTH

Abstract Persons with dementia (PWD) who exhibit care-resistant behaviors (CRB) are likely to resist mouthcare and have poor oral health. This study aimed to examine predictors and describe the characteristics of CRB trajectories and their distal outcome in oral health among PWD in nursing homes (NH). Group-based trajectory modeling was used to analyze dynamic changes in CRB intensity over 21 days with two time-points (morning and afternoon) among 75 PWD. Sub-group analysis demonstrated the characteristics of each trajectory group membership. Distal-outcome models explored the association between oral health variation and mouthcare completion to CRB trajectories. The most influential predictors included CRB intensity at baseline, duration of mouthcare, and the number of antipsychotics prescribed. Three distinctive CRB trajectories were identified for both morning and afternoon in the context of mouthcare. Oral health status and the mouthcare completion rates differed by CRB trajectory groups, and worse oral health status was associated with higher level of CRB intensity trajectories. The High-start CRB groups had the worst oral health status and lowest mouthcare completion in both model estimation and pre-post test. Oral health showed improvement across all three trajectory groups. A tailored individual-level strategy based on a daily pattern of CRB intensity may provide the key to developing interventions that find the “sweet spot” between providing optimal mouthcare while minimizing CRB. Results imply that balancing CRB and mouthcare by providing morning-only mouthcare to those with high CRBs may allocate resources to PLWD most in need of mouthcare. Antipsychotics have not shown usefulness in managing CRB.

JOINT TRAJECTORIES OF MULTIMORBIDITY AND FRAILTY AMONG OLDER AMERICANS

Abstract Little is known about how health status considering both multimorbidity and frailty develops over time. This study aims to investigate joint trajectories of multimorbidity and frailty and examine their associated factors among older American adults.We used data from the National Health and Aging Trends Study (2011–2019). Fourteen chronic conditions were ascertained each year. Frailty was measured annually using the Fried frailty phenotype. Group-based trajectory models were fitted to identify joint trajectories of multimorbidity and frailty. Multinomial logistic regression model was adapted to examine the association of baseline characteristics with the trajectories. We identified six distinct joint trajectories of multimorbidity and frailty, including four concordant and two discordant trajectories. Compared with the Newly-developing condition and Constant non-frailty group, increasing age, low education, dual Medicare-Medicaid status, former or current smoker, mild or severe insomnia symptoms, and bothersome or activity-limiting pain were significantly associated with an increased likelihood of belonging to the other five groups with higher levels of multimorbidity or frailty (all P&amp;lt; 0.05). Multiple distinct joint trajectories of multimorbidity and frailty offer complementary evidence to the heterogeneous patterns in aging, as well as inform clinicians, policymakers, and researchers to develop targeted interventions and provide comprehensive care management in community settings.

OLFACTORY DYSFUNCTION AND DEPRESSION TRAJECTORIES IN COMMUNITY-DWELLING OLDER ADULTS

Abstract Olfactory dysfunction has been linked with all-cause mortality and neurodegenerative disease risk, though less is known about the association between olfaction and late-life depression (LLD). We examined the relationship between baseline olfactory performance and incident significant depressive symptoms and longitudinal depression trajectories in well-functioning older adults from the Health, Aging, and Body Composition study. Older adults (n=2,125, age 71-82, 51% women, 37% Black) completed an odor identification task at Year 3 (our study baseline). Cognitive assessments and depressive symptoms were ascertained across multiple visits over 8 years. We employed discrete time complementary log-log models, group-based trajectory models and multivariable-adjusted multinomial logistic regression to assess the relationship between baseline olfaction and incident depression and longitudinal depression trajectories. Mediation analysis assessed the influence of cognition on these relationships. Individuals with lower olfaction had increased risk of developing significant depressive symptoms at follow-up (hazard ratio [HR]=1.04, 95% CI:1.00, 1.08). Of the three longitudinal depression score patterns identified (stable low, stable moderate, stable high), poorer olfaction was associated with a 6% higher risk of membership in the stable moderate (relative risk ratio [RRR]=1.06, 95% CI:1.02, 1.10) and stable high (RRR=1.06, 95% CI:1.00, 1.12) groups, compared to the stable low group. Poor cognitive status only partially mediated the relationship between olfaction and incident depression severity. Suboptimal olfaction may serve as a prognostic indicator of vulnerability for development of LLD. These findings underscore the need for a greater understanding of olfaction in LLD and the demographic, cognitive and biological factors that influence these relationships over time.

TRAJECTORIES OF C-REACTIVE PROTEIN OVER THE MENOPAUSE TRANSITION: THE STUDY OF WOMEN’S HEALTH ACROSS THE NATION

Abstract Inflammation is a mechanistic pillar of aging contributing to the pathogenesis of several common medical conditions. Numerous in-vitro and animal experiments support a link between estrogen decline over the menopause transition (MT) and inflammation. Whether the MT per-se is associated with increased inflammatory load is not obvious. Using longitudinal data from 1,459 (11,373 observations) women (at baseline: 42-52 years old; underweight/normal 39.6%, overweight 28%, obese 32.4%; White 44.5%, Black 27.8%, Chinese 10.7%, Japanese 12.1%, Hispanic 4.9%) with a known final-menstrual-period (FMP) date and at least 3-measures of high sensitivity C-reactive protein (hs-CRP) spanning between 10 years before to 14 years after FMP, we characterized trajectories of hs-CRP and their associations with premenopausal obesity and race/ethnicity. Observations indicating acute inflammation were deleted and data were censored at first use of hormone therapy. Group-based trajectory modeling adjusted for time-varying smoking-status and steroids/statin use was utilized to identify trajectories. LOESS plots and piecewise linear mixed-effects models were used to determine if trajectories were linear or had inflection points around FMP. Three distinct hs-CRP trajectories were identified: low-rise (low-level significantly increased 2.5Yrs after FMP; 26.6%), medium-stable (remained stable across MT; 41.7%), and high-decline (high-level significantly declined at FMP; 31.7%). White women were more likely to show the medium-stable trajectory, Black and Hispanic the high-decline, and Chinese and Japanese the low-rise trajectory. Premenopausal obesity predicted the high-decline trajectory, underweight/normal predicted the low-rise, while overweight predicted the medium-stable trajectory. Heterogeneous patterns of hs-CRP over the MT exist and are related to women’s race/ethnicity and premenopausal obesity.

BETTER DIET QUALITY IS ASSOCIATED WITH REMAINING NON-FRAIL OVER TIME IN A DIVERSE COHORT

Abstract Frailty is a major public health concern affecting the health and well-being of adults. Poor diet is among several modifiable risk factors for developing frailty. We examined associations of dietary quality assessed by the Healthy Eating Index with frailty status over mean 8.7y follow-up. The sample was comprised of African American (AA) and White participants enrolled in the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study (44% male, 44% AA, mean baseline age of 48.5y). Only participants from the baseline study and first 2 follow-up visits with dietary data, 2 recall days per visit, and frailty data were included (n=2901). Frailty was prospectively determined by the modified FRAIL scale. Group-based trajectory modeling identified 3 diet quality groups (high: g3 [5.2% of sample, HEI(X±SD): 57.4±4.1], medium (g2: 48.2%, 46.1±3.7), low (g1: 46.5%, 38.2±2.9) and 2 frailty groups (remaining non-frail [20.2% sample] or being pre-frail or frail over time). Multiple logistic and Cox proportional hazards regressions found high and medium HEI trajectory groups, compared to the low HEI group, were associated with reduced risk of being pre-frail or frail, with a clear dose-response relationship (g2 vs. g1: HR=0.77, 95% CI: 0.64-0.92, p=0.004; g3 vs. g1: HR=0.29, 95% CI: 0.18-0.49, P&amp;lt; 0.001), even after adjusting for sociodemographic factors, smoking, drug use, and allostatic load. These findings were corroborated with Kaplan-Meier curves and log-rank tests, providing longitudinal evidence of the link between better diet quality with lower frailty risk, and the importance of diet in successful aging during middle age.