MacArthur Studies Of Successful Aging Research Articles

A prospective study of the effect of fracture on measured physical performance: results from the MacArthur Study--MAC.

To examine the impact of fractures on measured physical performance and to assess whether specific fractures have unique sequelae. 762 men and women, aged 70 to 79 at baseline, who were part of the MacArthur Study of Successful Aging. A longitudinal case-cohort: those with prevalent fractures at baseline were excluded; cases were persons with a medically diagnosed hip, arm, spine, or wrist fracture during the follow-up period (1988-1995). Eight physical performance tests: turning a circle, walking fast, chair stands, timed tap, tandem stand, grip strength, single leg stand, and balance (average of single leg and tandem stands) measured at baseline and follow-up. Two fracture groups were defined: (1) those with incident wrist fractures (n = 7) and (2) those with a fracture of the hip, arm, or spine (combined fractures group, n = 16). Change in physical performance was analyzed using crude, age-adjusted, and multiply-adjusted ANCOVA models. The combined fracture group demonstrated statistically significant (P < .05) declines seven of eight of the performance tests compared with individuals without fractures. In contrast, individuals with wrist fractures did not experience a statistically significant decline in any performance measure compared with the no fracture group. Relative to those without fractures, individuals with a hip, arm, or clinical spinal fracture show similar global declines in physical performance, whereas those with wrist fracture demonstrate no physical performance decrements.

The effect of race and health-related factors on naming and memory. The MacArthur Studies of Successful Aging.

The purpose of the analyses was to examine the impact of health-related variables on race differences in neuropsychological functioning (Boston Naming Task). Using cross-sectional data from the MacArthur Successful Aging Study, the authors examined the relationship of demographic characteristics, health status, health habits, physical functioning, and speed of performance to naming and incidental recall of items from the Boston Naming Task. Participants were 1,175 healthy African American and European American older persons 70 to 79 years old. Regression analyses indicated that although race differences persisted for confrontational naming after controlling for demographic and health factors, there was no effect due to race for incidental recall scores or for savings scores for recall. The racial differences found in test performance may reflect differences in cultural appropriateness of the material rather than differences in ability.

Variation in the impact of social network characteristics on physical functioning in elderly persons: MacArthur Studies of Successful Aging.

Social support and social networks have been shown to exert significant effects on health and functioning among elderly persons. Although theorists have speculated that the strength of these effects may differ as a function of sociodemographic characteristics and prior health status, few studies have directly tested the moderating effects of these variables. Longitudinal data from the MacArthur Study of Successful Aging were used to examine the effects of structural and functional social support on changes in physical functioning over a 7-year period, measured by the Nagi scale, in a sample of initially high-functioning men and women aged 70 to 79 years. Multiple regression analyses were used to test the main effects of social support and social network variables, as well as their interactions with gender, income, and baseline physical performance. After controlling for potential confounding effects, respondents with more social ties showed less functional decline. The beneficial effects of social ties were stronger for respondents who were male or had lower levels of baseline physical performance. The effects of social support and social networks may vary according to the individual's gender and baseline physical capabilities. Studies of functional decline among elderly persons should not ignore this population variation in the effects of social networks.

The relation between cortisol excretion and fractures in healthy older people: results from the MacArthur studies-Mac.

In persons with depression, higher urinary cortisol is associated with lower bone mineral density. To examine the relation between urinary free cortisol (UFC) and fractures. Community-based samples from Durham, NC, East Boston, MA, and New Haven, CT. 684 men and women, aged 70 to 79 at baseline, who were part of the MacArthur Study of Successful Aging. Cohort study. Participants with previous history of fractures at baseline were excluded. The primary exposure variable was overnight (8:00 p.m. to 8:00 a.m.) UFC (microg/g creatinine) at baseline (1988). Outcomes were self-reported hip, arm, spine, wrist, or other fracture during the follow-up period (1988-1995). Covariates were baseline age, gender, race, body mass index, current physical activity, lower extremity strength, depression subscale of the Hopkins Symptom Checklist, and current use of cigarettes and alcohol. Logistic regression was used to predict the occurrence of incident fractures (1988-1995) as a function of quartiles of baseline UFC. Models were adjusted for age, gender, and race and were also multiply adjusted for the remaining covariates listed above. Gender-stratified models and models that excluded corticosteroid users were also run. In multiply adjusted models, higher baseline levels of UFC were significantly associated with incident fractures. Odds of fracture (95% Confidence Intervals) for increasing quartiles of baseline UFC, multiply adjusted, were: 2.28 (.91, 5.77); 3.40 (1.33, 8.69); 5.38 (1.68, 17.21). Results were not materially influenced by exclusion of persons using corticosteroids. Higher baseline UFC is an independent predictor of future fracture.

Self-efficacy beliefs and perceived declines in functional ability: MacArthur studies of successful aging.

Longitudinal data from a cohort of older men and women, aged 70-79, were used to test the hypothesis that stronger self-efficacy beliefs would protect against onset of perceived functional disabilities over a 2.5-year follow-up, independent of underlying physical ability. Standard self-report scales were used to assess perceived functional disabilities, ranging from mild performance difficulties (measured by a 5-item scale based on items by Nagi) to more severe disabilities (measured by the 7-item Katz Activities of Daily Living Scale [ADL]). Performance-based measurements of strength, balance, and gait provide more objective assessments of physical abilities. Self-efficacy beliefs were measured in terms of beliefs relating to managing interpersonal relationships and beliefs relating to managing more instrumental daily activities. Gender-specific multiple regression models revealed that weaker instrumental self-efficacy beliefs predicted declines in reported functional status as measured by the Nagi performance scale among both men and women, independent of standard sociodemographic, health status, and health behaviors. Among men, instrumental efficacy beliefs were also negatively related to reports of onset of Katz ADL. Self-efficacy beliefs were unrelated to measured changes in actual physical performance abilities for both men and women. These findings suggest that self-efficacy beliefs have significant impacts on perceptions of functional disability, independent of actual underlying physical abilities. Through such influences on perceptions of disability, self-efficacy beliefs may importantly affect lifestyles and quality of life at older ages.

The predictive value of combined hypoalbuminemia and hypocholesterolemia in high functioning community-dwelling older persons: MacArthur Studies of Successful Aging.

To examine the effect of simultaneous hypoalbuminemia and hypocholesterolemia levels on 3- and 7-year rates of mortality and decline in functional status. In this cohort study, 937 community-based persons aged 70 to 79 years in 1988, who had high baseline physical and cognitive functioning, were classified into four groups: Group 1 (low albumin, low cholesterol), Group 2 (low albumin, normal cholesterol), Group 3 (normal albumin, low cholesterol) and Group 4 (normal albumin, normal cholesterol) using baseline blood values. Crude and multiply adjusted rates of (1) mortality (2) decline in Rosow-Breslau (RB) functional status, and (3) mortality or decline in RB functional status in 1991 and 1995 were calculated. Group 1 subjects had multiply adjusted relative risks (ARR) of 3.62 and 3.53 for 3-and 7-year mortality compared with Group 4. Group 1 subjects had ARRs of 3.82, 3.02, and 2.67 of 3-year mortality or decline in RB activity scale when compared with Groups 4, 2, and 3, respectively. Concomitant low serum cholesterol and albumin levels may identify high functioning older persons who are at increased risk of subsequent mortality and functional decline.

Conjugating the "tenses" of function: discordance among hypothetical, experimental, and enacted function in older adults.

Within the field of aging, the conceptualization and measurement of functioning has been dominated by the disability model. In this paper, one limitation of that model is described by calling attention to a distinction between three "tenses" of functioning. Inadequate attention has been paid to the distinction between the capacity to function in the abstract (hypothetical tense) and actual performance in daily life (enacted tense). Failure to attend to this distinction has obscured considerable discordance between what people say they are able to do in standard functional disability assessments, and what they actually do at home. To illustrate this point, data from the MacArthur Studies of Successful Aging comparing the hypothetical to the enacted tenses are presented. These data show a consistent pattern of discordance between these two tenses.

Is educational attainment associated with shared determinants of health in the elderly? Findings from the MacArthur Studies of Successful Aging.

To investigate the association of educational attainment with an array of risk factors for poor health among high-functioning older men and women. Cross-sectional analyses of psychosocial, behavioral, and biological factors and educational attainment were conducted using data from a population-based cohort study of older men and women. Participants consisted of 70- to 79-year-old residents of communities of East Boston, MA; New Haven, CT; and Durham County, NC (N = 1192) participating in the Established Populations for Epidemiologic Studies of the Elderly programs, a three-site longitudinal study of community-dwelling men and women. Participants were selected on the basis of high physical and cognitive function, representing approximately the top third of their peers in terms of functional ability in 1988. In-home interviews were conducted. Associations among education and behavioral (e.g., cigarette smoking and physical activity), biological (e.g., pulmonary function, serum cholesterol), psychological (e.g., self-efficacy, anxiety), and social (e.g., networks and support) factors were examined. Low levels of education were associated with poorer psychological function (less mastery, efficacy, happiness), less optimal health behaviors (increased tobacco consumption and decreased levels of physical activity), poorer biological conditions (decreased pulmonary function, increased body mass index and waist-to-hip ratio), and larger social networks (increased number of contacts, decreased negative support). Several factors (alcohol consumption, high-density lipoprotein cholesterol) were nonlinearly related to educational attainment. Educational attainment is associated with a broad array of psychosocial and biological conditions among the elderly. That an education gradient functions over an array of factors that structure daily life, even in later life in a healthy population, may suggest how socioeconomic status influences health.

Price of adaptation--allostatic load and its health consequences. MacArthur studies of successful aging

Price of adaptation--allostatic load and its health consequences. MacArthur studies of successful aging

Increase in urinary cortisol excretion and memory declines: MacArthur studies of successful aging.

Cortisol production is increased during stress, and the actions of cortisol on receptors in the brain and other body organs are involved in allostasis, the process of adaptation to stress, as well as in allostatic load, the wear and tear associated with excessive exposure to cortisol. Using data from a community-based longitudinal study of older men and women, aged 70-79 yr, we tested the hypothesis that exposure to increasing levels of cortisol is associated with declines in memory performance. Associations between 12-h urinary free cortisol excretion and performance on tests of memory (delayed verbal recall and spatial recognition), abstraction, and spatial ability were examined. Among the women, greater cortisol excretion was associated with poorer baseline memory performance, independent of socio-demographic, health status, health behavior, and psychosocial characteristics. Moreover, women who exhibited increases in cortisol excretion over a 2.5-yr follow-up period were more likely to show declines in memory performance. By contrast, women who experienced declines in cortisol exhibited improvements in memory performance. No significant associations were found among the men. The results for the women suggest that decrements in memory performance associated with increases in cortisol may not represent irreversible effects, as declines in cortisol were associated with improvements in memory.

Increase in Urinary Cortisol Excretion and Memory Declines: MacArthur Studies of Successful Aging

Increase in Urinary Cortisol Excretion and Memory Declines: MacArthur Studies of Successful Aging

Physical Activity and Measures of Cognitive Function in Healthy Older Adults: The MacArthur Study of Successful Aging

To investigate the association between physical activity and cognitive ability, cross-sectional data from a representative cohort of 1,189 adults (70–79 years old) participating in the MacArthur Study of Successful Aging were examined. The frequency of current house/yardwork and recreational activities was assessed using five categories of responses. A total physical activity score was derived, and cognitive ability was assessed. The total physical activity score showed a modest yet significant bivariate correlation with the total cognitive ability score. In the multivariate analysis, physical activity showed a significant association with the total cognitive ability score, independent of gender, self-rated health, average peak expiratory flow rate, body mass index, number of current social relationships, and visual contacts in the past month. When education was added to the model, however, the effect of physical activity was substantially diminished. Higher levels of physical activity appear to be associated with some cognitive benefits among a population of healthy older adults, although this association is influenced strongly by their joint association with education.

Social network characteristics and onset of ADL disability: MacArthur studies of successful aging.

The relationship between social network structural and support characteristics and onset of new or recurrent activities of daily living (ADL) disability was examined in a cohort of older men and women. No significant protective effects were found for network structural or support characteristics. However, greater frequency of instrumental support was associated with significantly increased risk of ADL disability among men; a similar though nonsignificant pattern was seen among women. These findings indicate that receipt of more instrumental support may not have uniformly beneficial effects on functional status. They serve to underscore the need for more comprehensive research, examining both the positive and negative effects of social interactions on health and functioning.

Self-efficacy beliefs and change in cognitive performance: MacArthur Studies of Successful Aging.

Data from a cohort of relatively high functioning, older men and women were used to test the hypothesis that stronger self-efficacy beliefs predict better maintenance of cognitive performance. Structural equation modeling revealed that stronger baseline instrumental efficacy beliefs predicted better verbal memory performance at follow-up among men but not among women, controlling for baseline verbal memory score and sociodemographic and health status characteristics. For both men and women there were no significant associations between either type of self-efficacy beliefs and measures of nonverbal memory, abstraction, or spatial ability. Consistent with previous research showing relationship between baseline cognitive performance and change in self-efficacy beliefs, better abstraction ability was also predictive of increase in instrumental efficacy beliefs among the men.

Behavioral and psychosocial predictors of physical performance: MacArthur studies of successful aging.

Performance-based measures of physical performance are examined for an older cohort of relatively high-functioning men and women. The influences of baseline behavioral, social, and psychological characteristics on patterns of change in performance over 2.5 years are examined. A cohort of relatively high-functioning men and women, aged 70-79, identified in 1988 by subsampling from three community-based studies on the basis of physical and cognitive function. Baseline assessments included physical performance, sociodemographic characteristics, health status, and behavioral, social, and psychological characteristics. A summary measure of physical performance was developed from tests of balance, gait, lower body strength and coordination, and manual dexterity. In-home assessments were repeated at follow-up in 1991. Linear regression models were used to identify significant behavioral, social, and psychological predictors of better performance at follow-up, controlling for known sociodemographic and health status predictors. Significant, independent associations with better performance were found for participation in moderate and/or strenuous exercise activity and greater frequency of emotional support from social networks, particularly among those reporting low frequency of instrumental support. These effects remained significant independent of incident health conditions during follow-up. None of the psychological characteristics was a significant predictor. Maintenance of better physical performance within a high-functioning cohort is influenced by prior exercise behavior and social network emotional support. Observed patterns of both decline and improvement in performance suggest that older age is not uniformly associated with declines. Predictors of better performance identified here may offer potential for effective interventions to promote more successful aging.

Change in Productive Activity in Late Adulthood: MacArthur Studies of Successful Aging

Both cross-sectional comparisons and patterns of change in productive activities among members of the MacArthur Successful Aging cohort were examined. The data came from a three-site longitudinal study of community-dwelling adults aged 70-79. The highest functioning cohort (n = 1,192) was found to be significantly more productive than a comparison group of medium- and low-functioning respondents at baseline in four of five domains examined. In longitudinal models, we tested several hypotheses regarding the determinants of change in levels of productive activity over a three-year period. Overall, 15.1 percent (n = 162) of the cohort became less productive, while another 12.7 percent (n = 136) became more productive. Risk factors for decline in productivity included hospital admission and stroke. Age, functional disability, marriage, and increased mastery were protective against declines. Conversely, Blacks, those who were more satisfied with life at baseline, and those reporting increased mastery were more likely to increase their productivity.

Predictors of cognitive change in older persons: MacArthur studies of successful aging.

Predictors of cognitive change in older persons: MacArthur studies of successful aging.

Predictors of cognitive change in older persons: MacArthur studies of successful aging.

This study used a linear structural relations modeling technique (LISREL) to examine longitudinal data for 1,192 persons from a community-based population. The goal was to test the ability of an a priori model to predict cognitive change over a 2.0- to 2.5-year period in older adults aged 70-79 at the initial evaluation. The model included 22 demographic, physical, and psychosocial variables as predictors of cognitive function and cognitive change. The study used an exploratory-confirmatory design, enabling cross-validation of the model developed in the exploratory set in the confirmatory sample. Structural equation modeling analyses identified 4 endogenous model variable (education, strenuous activity, peak pulmonary expiratory flow rate, and self-efficacy) as direct predictors of cognitive change over the study period.

Self-esteem and neuroendocrine response to challenge: MacArthur studies of successful aging

The role of self-esteem in modulating patterns of neuroendocrine response to challenge at older ages was examined in 16 healthy 70-yr-olds. Responses to two challenges were examined: (1) a driving simulation designed to reflect a ‘real life’ challenge situation; and (2) a pharmacologic, corticotropin-releasing-hormone (CRH) challenge (1 μg/kg). Both challenges evoked significant elevations in cortisol and adrenocorticotropic hormone (ACTH). Levels of self-esteem were significantly and negatively associated with peak elevations in cortisol in response to the driving simulation challenge ( r = -0·51, p = 0·04). ACTH responses showed similar trends ( r = -0·41, p = 0·12). Self-esteem levels were not correlated with responses to the CRH challenge. These data indicate that psychological characteristics such as self-esteem may play a role in modulating patterns of neuroendocrine response to cognitive/behavioral challenges in everyday life in older individuals.

Validation and use of performance measures of functioning in a non-disabled older population: MacArthur studies of successful aging.

Assessment of physical functioning in older persons has generally focused on identifying and characterizing subjects at the disabled end of the functional spectrum. This paper examines the validity of objective, standardized performance measures of physical functioning in characterizing the hierarchy of functioning in non-disabled, higher functioning older persons. Data are from 1192 participants aged 70-79 years in The MacArthur Research Network on Successful Aging Field Study. Participants were drawn from three community-based populations and represented the upper tertile of functioning, based on cognitive and physical screening assessments. The cohort showed a great deal of heterogeneity on most of the performance measures of functioning that were used. Several analyses provided evidence that this variability was not random and that the performance measures were valid measures of functioning in this cohort: 1) individual performance measures showed a moderate degree of correlation with each other; 2) a summary measure of performance showed an association with chronic diseases and other factors known to be associated with health status; and 3) a larger group than expected by chance alone was found to be functioning at the very highest level.