Health In Later Life Research Articles

Longitudinal Associations Between Childhood Adversity and Adolescent Intimate Partner Violence in Malawi.

Adverse childhood experiences (ACEs)-including child maltreatment, witnessing violence, and household dysfunction-have been robustly associated with poor health in later life. There is also increasing evidence that those who experience childhood adversity are more likely subsequently to be victims or perpetrators of intimate partner violence (IPV). Most evidence, however, is cross-sectional and concentrated in high-income settings, and cannot be generalized to more diverse contexts. In contrast, this study assessed longitudinal relations between ACEs and IPV in a low-income country. We interviewed 1,878 adolescents in rural Malawi between 2017 and 2018 (aged 10-16) and again in 2021 (aged 13-20). Adolescents completed the Adverse Childhood Experience-International Questionnaire. Past-year physical, sexual, and emotional IPV victimization and perpetration were measured using the WHO's Violence Against Women Instrument. We estimated multivariate regression models between cumulative adversity (0-13 adversities) at baseline and IPV at follow-up among respondents who reported any romantic or sexual partnerships. The cumulative ACEs score was associated with emotional IPV victimization for boys (OR = 1.12 per ACE) and sexual IPV victimization for girls (OR = 1.18). The ACEs score demonstrated a significant association with perpetration for girls only (OR = 1.33 for emotional IPV). By using longitudinal data, we more rigorously demonstrated the critical role of childhood adversity in shaping later IPV behavior. There are ongoing efforts toward primary prevention of childhood adversity. Given the burden that adolescents already carry (six ACEs on average in our sample), we also need secondary interventions that can help interrupt the pathway from adversity to IPV. This calls for increased collaboration between those working to address violence against children and violence against women.

Women’s fertility and allostatic load in the post-reproductive years: An analysis of the Indonesian Family Life Survey

We know little about the effects of the reproductive health burden in contexts where unsafe abortions, miscarriages, stillbirths, and low-quality maternal care are common. The aim of this study is to investigate the use of allostatic load to understand the impact of reproductive histories on later-life health. We applied path models to the Indonesian Family Life Survey with a sample of 2,001 women aged 40+. Although number of children was not associated with allostatic load, pregnancies not ending in live birth and parenthood before age 18 were both negatively associated with health. We also identified clear cohort and educational effects and a possible rural advantage. Our contribution is twofold: we highlight the importance of reproductive histories beyond live births on women’s later-life health in a context of increasing population ageing, and we demonstrate the applicability of using allostatic load to measure health outside the Global North.

Socially stratified associations between self-employment and health among Chilean older people.

Non-standard forms of employment, such as self-employment, are among the most prevalent routes for older people to access the workforce. While the financial benefits of any form of self-employment in later life have been widely acknowledged, less is known about their impact on health. This study explores the association between self-employment and 16 health outcomes among older people with different social stratification characteristics in Chile, a developing country experiencing rapid population ageing. We rely on a rich representative life history survey of Chilean men and women between the ages 65 and 75years (N=802) living in the capital Santiago, weighted sequence analysis to reconstruct employment histories and weighted regression analysis to measure the association between self-employment and health in later life. All our analyses are adjusted by both individual lifetime health indicators and employment trajectories. Our results show that being self-employed relative to not working is positively associated with health in seven out of 16 outcomes. More surprisingly, those in a self-employment position seem to enjoy better health outcomes, particularly among the less educated and lower-income levels. These stratified associations raise questions about how these individuals enjoy better health despite facing adverse social conditions.

The Foundations for Chronic Low Back Pain Management may Start in Early Life. Exploring the Role of Caregiver Parental Leave on Future Low Back Pain in the Offspring

Chronic low back pain is difficult to treat and despite increased spending on health services, clinical outcomes for people with low back pain have not improved. Innovative, large scale initiatives seem necessary to stem the cost of low back pain. Psychological health contributes to the development and persistence of chronic low back pain and psychological interventions are important in the management of low back pain. Given the contribution of psychological health to low back pain development and management, it raises the question; can we support psychological health in later life by bolstering emotional development in early life, and reduce the burden of this common condition? Positive early life experiences, including those induced by extended paid parental leave, could bolster emotional development and support the psychological health necessary to manage low back pain in later life. We present the current state of evidence demonstrating the potential value of increasing support for parent-child relationships in early life to reduce the burden of low back pain in future generations. The current evidence is limited to cross-sectional associations, but strong preclinical data clearly shows the potential negative impacts of maternal separation on rodent pup health that compels consideration in human populations. PerspectiveThe benefits stemming from enhanced child development include stable emotional foundations, possibly improving psychological health and low back pain management in the future. This perspective raises questions for future studies – within the context of low back pain, what ingredients bolster stable psychological health? And are these ingredients influenced by parental leave?

A study of diet in older community-dwelling adults in the UK during the COVID-19 pandemic: Findings from the Southampton Longitudinal Study of Ageing (SaLSA).

Adequate nutrition is important for health in later life. Older adults are especially vulnerable to adverse outcomes following infection by COVID-19 and have commonly spent a disproportionate time within their own homes to reduce risk of infection. There are concerns that advice to shield may have led to malnutrition as older adults may modify daily routines including usual shopping habits. The aims of this study were to report self-reported pandemic-related changes in diet and examine lifestyle and medical correlates of these changes in older UK community-dwelling adults. We recruited 491 participants from the city of Southampton, UK. Participants completed a postal questionnaire in summer/autumn 2021, over a year after the first UK national lockdown was announced. The questionnaire ascertained demographic and lifestyle factors, in addition to number of comorbidities, nutrition risk scores, and presence of frailty. Associations between these participant characteristics in relation to self-reported changes in diet quality (lower, similar or higher when compared to before the first lockdown) were examined using ordinal logistic regression. Median (lower quartile, upper quartile) age was 79.8 (77.0, 83.7) years. Overall, 11 (4.9%) men and 25 (9.4%) women had poorer diet quality compared to before the first UK lockdown. The following participant characteristics were associated with increased risk of being in a worse category for change in diet quality after adjustment for sex: lower educational attainment (p = 0.009); higher BMI (p < 0.001); higher DETERMINE (a malnutrition assessment) score (p = 0.004); higher SARC-F score (p = 0.013); and self-reported exhaustion in the previous week on at least 3 days (p = 0.002). Individuals at higher nutritional risk were identified as reporting increased risk of deterioration in diet quality during the pandemic. Further investigation of the factors leading to these changes, and an understanding of whether they are reversible will be important, especially for future pandemic management.

Peers’ parental education and cardiovascular disease risk in adulthood: The mediating role of health-related behaviors

RationaleAlthough there is a growing body of empirical evidence on the relationship between peers' parental education and adolescents' educational outcomes, little is known about whether exposure to highly educated peers’ parents is associated with improved physical health in adulthood. ObjectiveThis study investigated the relationship between the education level of peers' parents (Wave I) and the risk of developing cardiovascular disease (CVD) in adulthood (Wave IV). Moreover, we considered a set of health-related behaviors (Wave II) as the underlying mechanisms linking peers’ parental education to later-life physical health such as substance use (smoking, binge drinking, and marijuana use) and other lifestyle behaviors (physical activity, sedentary behavior, and unhealthy dietary habits). MethodsData from the National Longitudinal Study of Adolescent to Adult Health (Add Health), spanning respondents’ adolescence to adulthood, were used. To address the endogenous school selection problem and account for the unobserved school-level confounders, this study exploited quasi-experimental within-school/across-cohort variation in peer composition. To formally test for mediation, Sobel tests were conducted. ResultsThe results of this study revealed that independent of own parents' education levels, exposure to higher levels of peers' parental education is associated with a lower CVD risk score in adulthood. For a one-standard-deviation increase in peers' parental education—that is, about a 0.98-year increase in grademates’ parental educational attainment, a CVD risk in adulthood increased by about 6.2%. Our mediation analyses showed that part of this association is explained by a decrease in substance use (27% for smoking, 10% for binge drinking, and 11% for marijuana use). In contrast, none of the other lifestyle behaviors evaluated significantly mediated the association. ConclusionThe study's findings suggest that the role of peers' parents should not be overlooked when developing health-promoting interventions for adolescents. Policymakers and practitioners may wish to increase opportunities for students to benefit from health-related social learning from their peers’ highly educated parents.

Changes in Self-Perceptions of Aging Among Black and White Older Adults: The Role of Volunteering.

Given the health consequences of self-perceptions of aging (SPA), understanding how SPA change among Black and White older adults may shed light on racial disparities in late-life health. The current study is the first to assess whether Black older adults exhibit less favorable patterns of change in SPA than White older adults. We also tested whether the salubrious effect of volunteering on SPA would be particularly salient among Black older adults. A pooled sample of adults aged 50+ (N=10,183; Black: n=1,672, White: n=8,511) from the Health and Retirement Study rated positive and negative SPA once every 4years across 3 waves (2008/2010, 2012/2014, and 2016/2018). We assessed participants' reports on volunteering status in each wave. Growth curve models revealed that positive SPA decreased over time whereas negative SPA increased. Black older adults reported more positive and less negative SPA at baseline and flatter time-related changes than their White counterparts. We found that volunteering was significantly associated with more positive and less negative SPA across waves, but this effect was only evident in White older adults. Findings revealed vulnerabilities in White older adults as they experience and perceive age-related changes but also identified volunteering as a way to uniquely protect them. More research is needed to refine our understanding of racial disparities in the United States and help tailor interventions intended to maximize benefits to older adults from diverse backgrounds.

Arterial Aging and Cerebrovascular Function: Impact of Aerobic Exercise Training in Older Adults.

Advanced age is the major risk factor for dementia including Alzheimer's disease. The clinical effects of recently developed anti-amyloid therapy for Alzheimer's disease were modest and the long-term outcome is unknown. Thus, an in-depth understanding of the mechanisms of brain aging is essential to develop preventive interventions to maintain cognitive health in late life. Mounting evidence suggests that arterial aging manifested as increases in central arterial stiffness is associated closely with cerebrovascular dysfunction and brain aging while improvement of cerebrovascular function with aerobic exercise training contributes to brain health in older adults. We summarized evidence in this brief review that 1) increases in central arterial stiffness and arterial pulsation with age are associated with increases in cerebrovascular resistance, reduction in cerebral blood flow, and cerebrovascular dysfunction, 2) aerobic exercise training improves cerebral blood flow by modifying arterial aging as indicated by reductions in cerebrovascular resistance, central arterial stiffness, arterial pulsation, and improvement in cerebrovascular function, and 3) improvement in cerebral blood flow and cerebrovascular function with aerobic exercise training may lead to improvement in cognitive function. These findings highlight the associations between arterial aging and cerebrovascular function and the importance of aerobic exercise in maintaining brain health in older adults.

Supplemental Material for Can Emotional Acceptance Buffer the Link Between Executive Functioning and Mental Health in Late Life?

Supplemental Material for Can Emotional Acceptance Buffer the Link Between Executive Functioning and Mental Health in Late Life?

Biobanks, offspring fitness and the influence of developmental plasticity in conservation biology.

Mitigation of the widely known threats to the world's biodiversity is difficult, despite the strategies and actions proposed by international agreements such as the United Nations Framework Convention on Climate Change (UNFCCC) and the Convention on Biological Diversity (CBD). Nevertheless, many scientists devote their time and effort to finding and implementing various solutions to the problem. One potential way forward that is gaining popularity involves the establishment of biobank programs aimed at preserving and storing germplasm from threatened species, and then using it to support the future viability and health of threatened populations. This involves developing and using assisted reproductive technologies to achieve their goals. Despite considerable advances in the effectiveness of reproductive technologies, differences between the reproductive behavior and physiology of widely differing taxonomic groups mean that this approach cannot be applied with equal success to many species. Moreover, evidence that epigenetic influences and developmental plasticity, whereby it is now understood that embryonic development, and subsequent health in later life, can be affected by peri-conceptional environmental conditions, is raising the possibility that cryopreservation methods themselves may have to be reviewed and revised when planning the biobanks. Here, I describe the benefits and problems associated with germplasm biobanking across various species, but also offer some realistic assessments of current progress and applications.

Immune Remodeling during Aging and the Clinical Significance of Immunonutrition in Healthy Aging.

Aging is associated with changes in the immune system and the gut microbiota. Immunosenescence may lead to a low-grade, sterile chronic inflammation in a multifactorial and dynamic way, which plays a critical role in most age-related diseases. Age-related changes in the gut microbiota also shape the immune and inflammatory responses. Nutrition is a determinant of immune function and of the gut microbiota. Immunonutrion has been regarded as a new strategy for disease prevention and management, including many age-related diseases. However, the understanding of the cause-effect relationship is required to be more certain about the role of immunonutrition in supporting the immune homeostasis and its clinical relevance in elderly individuals. Herein, we review the remarkable quantitative and qualitative changes during aging that contribute to immunosenescence, inflammaging and microbial dysbiosis, and the effects on late-life health conditions. Furthermore, we discuss the clinical significance of immunonutrition in the treatment of age-related diseases by systematically reviewing its modulation of the immune system and the gut microbiota to clarify the effect of immunonutrition-based interventions on the healthy aging.

EARLY-LIFE EXPOSURE TO THE CHINESE FAMINE OF 1959–1961 AND LATER-LIFE HEALTH: EARLY LIFE AS A CRITICAL PERIOD

Abstract Barker’s fetal origins hypothesis and the critical period theory suggest that early life events have long-term health effects. However, evidence of the famine exposure in early life and its effects on health in later life is scarce and inconsistent. To explore the effects of early-life exposure to the Chinese famine of 1959-1961 on later-life multimorbidity, we performed Poisson growth curve models using CHARLS Life History 2014 and CHARLS 2011-2018 (42,775 observations from 12,060 respondents). Our analyses revealed two findings. First, there was an overall detrimental effect of the early-life famine exposure on multimorbidity, although there was no effect of severity of famine exposure. Second, there was no overall interaction between famine exposure and life stages, although a more parsimonious model suggested that the detrimental effect of famine exposure was more pronounced in earlier life stages than in later life stages. Findings suggest that early life is a critical period in the life course and provides developmental origins of health and disease in later life.

GENDER DIFFERENCES IN RURAL-URBAN MIGRATION AND ITS IMPACT ON MENTAL HEALTH IN LATER LIFE

Abstract Although rural-to-urban migration has been well researched, how gender shapes processes and outcomes, including later life health outcomes, has not been thoroughly investigated. Guided by a life course perspective, this study explores gender differences in rural-urban migration patterns and its association with mental health in later life among Chinese older adults. Exploiting rich life history data from the China Health and Retirement Longitudinal Study, we employ sequence analysis to identify the typical migration trajectories of Chinese older adults. Moderated mediation analysis is then used to examine gender-specific health pathways linking migration trajectories and later-life mental health. The results indicate that: men and women follow different migration trajectories across the life course. Men are more likely to migrate between rural and urban areas, and to migrate multiple times. Rural migrants who settled in urban regions have better mental health in later life than return migrants or rural non-migrants; the gender gap in mental health is marginally smaller among early urban settlers than rural non-migrants. Household income and Hukou conversion mediate the relationship between migration trajectories and later-life mental health among older people of rural origin. Household income in later life has stronger mediation effects for migrant men than for migrant women. The study suggests that a life course perspective and awareness of gender dynamics should be incorporated in policymaking to reduce the rural-urban divide and gender-based inequality in mental health.

NEIGHBORHOOD PREDICTORS OF MENTAL HEALTH OF OLDER AMERICANS: EVIDENCE FROM A 5-YEAR LONGITUDINAL STUDY

Abstract With increasing dependence on other people in old age, environmental resources become an important asset for older adults to experience healthy aging. Data on the longitudinal relationship between neighborhood and mental health in late life is scanty. This study utilized hierarchical multiple regression model analysis to investigate whether and which neighborhood factors predicted depression and anxiety among older Americans followed up for over five years within the same neighborhood. Two waves of data containing a cohort of 1,731 older adults from the NSHAP project were used. Outcome measures were depression and anxiety. Predictors were four neighborhood factors: Social cohesion (NSC), social ties (NSC), neighborhood problems (NP), and perceived neighborhood danger (PND). We adjusted for demographic and physical health characteristics. The mean age of the respondents was 71.4 ± 6.5 years and were mostly females (55.5%). Lower NSC and a higher PND significantly predicted depression. However, the model only explained 2.8% of the variance in depression. In the covariate-adjusted model, none of the neighborhood factors predicted depression, but the model significantly improved to 32.5%. NP was the only significant predictor of anxiety in the final model and explained 27.8% of the variance in anxiety. Covariates, which are primary determinants of mental health disparity, have a much larger role to play. This study sheds some light on the complexity of the relationship between neighborhood and mental health in older adults. Future policy development and interventions should target improving both physical and social environments to enhancing the mental wellbeing of older adults.

AGE MODERATES THE LINK BETWEEN DAILY POSITIVE EVENTS AND WELL-BEING: A META-ANALYSIS

Abstract Daily positive events are linked to better health and well-being, and this association might be stronger for older adults due to age-related changes in motivations and emotion regulation. We therefore investigated whether age moderated the links between positive events and health-related outcomes, using data from a meta-analysis of 142 studies spanning 50 years of research. Multilevel meta-analytical moderation analyses revealed stronger correlations of positive events with better well-being (i.e. higher positive affect and life satisfaction), mental health, and lower disability in older compared to younger samples (p’s &amp;lt; .05). No age moderation was found for links of positive events with social connection, health behaviors, physical symptoms, perceived stress, self-reported health, and inflammation. Findings suggest that although daily positive events were protective for health and well-being for all adult age groups, these experiences may be especially beneficial for positive well-being and mental health in late life.

PSYCHOSOCIAL RESILIENCE, FAMILY SUPPORT, AND COGNITIVE STATUS: FROM EVIDENCE TO ACTION

Abstract Increasing evidence suggests the important role of social connections and family support in maintaining optimal cognitive status among older adults. This symposium includes four studies from China and the U.S with a focus on generating actionable evidence to inform the development of strategies that target psychosocial resilience and family support to promote cognitive health. Using data from the 2006, 2010, and 2014 waves of the Health and Retirement Study, the first study assessed the impact of social isolation on cognitive function, and how sleep disturbance mediated the association on cognitive decline. The study findings suggest addressing sleep disturbance might be a viable way to mitigate the negative effect of social isolation on cognitive function. Companion piece includes another HRS-based study that assessed the impact of loneliness on psychological resilience and cognitive health in later life. Findings from this study show loneliness is indirectly associated with baseline cognitive status and accelerated cognitive decline through deteriorating phycological resources. The third study used a prospective longitudinal design and applied group-based trajectory modeling to identify distinct family functions among 170 Chinese stroke survivors. Four family function trajectories were identified; healthy and stable family function was associated with better cognition and quality of life. Lastly, the fourth study aimed to use an experienced-based co-design approach to develop a cognitive training intervention to promote cognitive health in older Chinese immigrants in the U.S. This approach allows researchers to engage end-users early and to optimize the development of a culturally and linguistically relevant cognitive training intervention.

FINANCIAL HARDSHIP AND INCOME SECURITY AND MENTAL HEALTH AMONG OLDER WORKERS: MULTI-CHANNEL SEQUENCE APPROACH

Abstract Drawing on the life course perspective and multi-channel sequence approach, this research identifies long-term financial hardship and income security patterns among older adults and examines their relationship with depressive symptoms. Data were from the 2010 to 2018 HRS with 3,077 older workers aged 62–71 in 2010. Four clusters of key sequences were identified: 1) High food and low medical insecurities with private pension plans (43%); 2) Moderate food and low medical insecurities with gradually acquired private pension plans (13%); 3) High food and low medical insecurities with both private and employment-based pension plans (40%); 4) High food insecurity with employment-based pension plans(3%). Regarding the association with depressive symptoms, a group of people who experienced high food and low medical insecurities with private pension plans (b= 0.14, p &amp;lt; 0.1) and those who experienced moderate food and low medical insecurities with gradually acquired private pension plans (b= 0.32, p &amp;lt; 0.01) were more likely to have depressive symptoms compared to those high food and low medical insecurities with both private and employment-based pension plans. These findings highlight the heterogeneity of long-term patterns of financial hardships and patterns of income security, including the limited accessibility for a pension plan through their occupation and that an individual pension plan may not be sufficient to ensure mental health in later life. The results imply the importance of dual security of private and employment-based pensions on their mental health and provide important insights for future tailored income support programs for older adults.

THE IMPACTS OF CHANGES IN DIABETES AND ORAL HEALTH CONDITIONS ON COGNITIVE TRAJECTORIES

Abstract Despite the emerging research studying the relationship between diabetes mellitus (DM), oral health problems, and cognitive function, little is known about how changes in DM and oral health status affected the trajectories of cognitive decline. Using data of 12,802 participants aged 51+ from the 2006-2018 English Longitudinal Study of Ageing, this study examined the longitudinal relationships of cognitive functions with time-varying DM and oral health status – measured by edentulism, self-rated dental condition, and oral impact on daily performance (OIDP) scale at five time-points from 2006 to 2018. Results showed that participants had DM and edentulism throughout the study period had an accelerated decline in verbal fluency (mean=20.9; b=-0.17, 95% CI=-0.28, -0.07); and those had both DM and OIDP-problem had an accelerated decline in memory function (mean=10.4; b=-0.09, 95% CI=-0.15, -0.03). Prevention and treatment of multiple chronic conditions are essential for cognitive health in later life.

MULTIDIMENSIONAL CONSTRUCTS OF SLEEP IN OLDER ADULTS

Abstract Sleep disturbances are common in older adults and are associated with a variety of adverse mental and physical health outcomes. While most studies have characterized sleep based on a single dimension of sleep (typically sleep duration or self-reported sleep quality), there is a growing paradigm shift to characterize “Sleep Health” as multidimensional. More research is needed to identify the clinical utility of a multidimensional approach to characterizing sleep specifically in older adults. In this symposium, we will present five studies that explore how multidimensional Sleep Health relates to age-related health outcomes (e.g., fall risk). Our first presentation will identify associations between subjective/objective sleep quality and physical activity, and examine the moderating role of chronotype. Second, we will examine the extent to which a multidimensional index of Sleep Health and its individual dimensions relate to fall risk. Third, we will ascertain the impact of mindfulness on various Sleep Health dimensions. Fourth, we will identify the extent to which discordance in subjective and objective sleep metrics are related to cognitive functioning. Finally, we will explore how the accumulation of disturbances in Sleep Health may increase risk for early mortality. Findings from this symposium will highlight the clinical relevance of a multidimensional approach to Sleep Health in older adults, and identify the ways in which sleep interventions can be tailored to specific sleep dimensions to promote health in later life.

IT'S ABOUT WHO YOU KNOW: RELATIONSHIPS BETWEEN SOCIAL NETWORKS, COGNITIVE FUNCTION, AND BRAIN HEALTH IN LATER LIFE

Abstract Evidence has been steadily increasing about the benefit of social connectedness for healthy aging. Yet, thanks to the complexity of human social interactions, it remains difficult to pinpoint specific benefits and mechanisms by which such benefits emerge. We offer this symposium to address this issue by presenting new findings from ongoing work at Indiana University in collaboration with the Indiana Alzheimer’s Disease Research Center. First, an overview of recent literature will be presented alongside a brief introduction to egocentric network analysis and its utility in probing social determinants of health. Next, we turn our attention to characteristics of social networks and their importance for cognitive health in later life. Different types of social enrichment will be evaluated in terms of their respective influence on cognitive reserve (i.e., neuropsychological evaluations, brain health). Additional attention will be paid to the comparison of emotionally supportive (i.e., social bonding) and more informationally supportive (i.e., social bridging) ties as promoters of brain health. Then, the final talks will describe potential avenues for increasing social connectedness in older adulthood. Individual differences in social cognitive function, namely Theory of Mind (i.e., reading another person’s thoughts, feelings, and intentions), has been implicated as mechanism by which older adults can maintain larger networks with more weak ties, in turn, promoting cognitive function. Separately, the presence of ambivalent ties (i.e., connections that beget positivity and negativity) may serve as a window of opportunity whereby older adults can leverage strengths in emotion regulation to maintain these ties without negative health consequences.