Middle-aged Adults Research Articles

2.X.1. Sleep Health Disparities across the life-course: from research to public health policy

Abstract Poor sleep health is a recognized common problem across the life cycle, globally. Factors that contribute to this problem include the demands of a “Western” lifestyle (urgency, productivity), economic stressors, social and environmental determinants of health, and global crises including international conflicts, political tensions, and climate change. There is a growing consensus that optimizing sleep health should be a public health priority because poor sleep patterns are a modifiable risk factor for myriad health outcomes, such as cardiovascular disease, diabetes, cancer, cognitive decline, mental illness, and early mortality. In Canada, a nationwide sleep consortium funded by the Canadian Institutes of Health Research (CIHR) was recently formed with a mandate to generate new knowledge that will inform clinical practice and support public health initiatives to deliver resources where they are most needed. The proposed workshop organized by the Chronic Disease EPH section will start with a general overview of the impact of sleep health disparities across the life-course, from childhood to older age, as well as discuss evidence-based public health approaches to promote sleep hygiene and mitigate the risk of adverse health outcomes, including chronic disease (Saverio Stranges). It will be followed by three presentations to address the root causes of sleep health disparities and their impact on chronic disease (Dayna Johnson); participatory research with families and care providers on infant sleep intervention development (Elizabeth Keys), and strategies to address common sleep disorders among middle-aged and older adults (Tetyana Kendzerska). Key messages • Sleep health disparities are a neglected public health issue. • Optimizing sleep health is both a clinical and public health priority, as sleep patterns represent a modifiable risk factor for a range of adverse health outcomes.

Prevalence of stage B heart failure in healthy adults and people with type 2 diabetes

Abstract Introduction People with Type 2 Diabetes (T2D) are at increased risk of heart failure, and as such are classified as having Stage A Heart Failure (SAHF). Those with additional evidence of raised filling pressures, biochemical or structural cardiac changes, without heart failure symptoms, are deemed to have Stage B heart failure (SBHF). Identifying patients with SBHF may help determine those at highest risk of disease progression. Purpose The aim of this work was to assess the prevalence of SBHF in a cohort of asymptomatic healthy volunteers and people with T2D characterised according to current American Heart Association/American College Cardiology/Heart Failure Society of America. Methods A single-centre, prospectively recruited cohort of middle-aged asymptomatic adults with T2D and healthy volunteers, with no history or signs of cardiovascular disease, underwent comprehensive cardiac phenotyping with transthoracic echocardiography and circulating brain natriuretic peptide. Healthy volunteers with risk factors for heart failure, including hypertension and obesity, were excluded from analysis. Prevalence of SBHF was determined by comparing cardiovascular data to proposed standards, left ventricular ejection fraction and global longitudinal strain parameters were omitted from analysis due to data availability. Results We included 383 T2Ds (diabetes duration 9(5,15) years) and 65 healthy volunteers (Table 1); 91% of those with T2D and 65% of healthy volunteers met ≥1 criteria for SBHF (Table 2). Median number of SBHF criteria met in the T2D cohort was 3 (2,4); in particular, a large proportion of the cohort met defined cut offs for relative wall thickness (70.6%), lateral e’ (62.2%), septal e’ (54.1%) and LV wall thickness (47.4%). Of the 65 healthy volunteers, median number of SBHF criteria met was 1 (0,2.5). In healthy volunteers, SBHF was most commonly defined by lateral e’ (40.0%), septal e’ (38.3%), relative wall thickness (32.2%), left atrial volume indexed (22.4%) and serum brain natriuretic peptide (23.3%). Of note, brain natriuretic peptide levels met current SBHF parameters in 18.8% of healthy volunteers and 9.9% people with T2D, which may be attributable to the exclusion of obesity in the healthy volunteer group. Conclusion Using currently proposed standards, a high proportion of middle-aged asymptomatic people with T2D, and healthy volunteers without any risk factors for heart failure, would be categorised as having SBHF. These data strongly suggest that the majority of the proposed parameters for the definition of SBHF are not specific for a UK population and if applied will incorrectly classify many asymptomatic people at high risk of developing heart failure.

Long COVID prevalence differences across 27 European countries that participated in the 2021 Survey of Health, Ageing and Retirement in Europe

Abstract The COVID-19 pandemic caused a significant burden in Europe, with over 60% of infected individuals developing Long COVID symptoms. Variations in Long COVID prevalence across countries are linked to individual-level factors, but the influence of population-based country-level characteristics remains unclear. Thus, our objective was to assess how country-level characteristics related to: (i) the way European countries responded to the COVID-19 pandemic, (ii) their population-level health status, (iii) provision and access to healthcare services, (iv) human development, governance, and environmental risk factors, are associated with Long COVID. We used a sample of 4,004 middle-aged and older adults from 27 European countries who, in summer 2021, participated in Corona Survey 2 (from Survey of Health, Ageing and Retirement in Europe) and who reported COVID-19 infection one year prior to the survey. To assess the potential role of country-level characteristics, while controlling for key individual-level factors, we estimated three sequential multilevel random intercept logistic regression models. Approximately 70% of respondents who had COVID-19 also experienced Long COVID symptoms and there were significant cross-country differences in Long COVID rates, ranging from 32% to 89%. About 13% of the total variance in the risk of having Long COVID can be attributed to cross-country differences and the remaining 87% to individual-level factors. The individual-level characteristics also accounted for 6% of the observed cross-country differences in Long COVID rates (compositional effects) while the country-level characteristics further reduced this variance by over 50%. Both individual and country-level factors influence Long COVID occurrence, emphasizing the need for tailored recovery plans, healthcare planning and resource allocation at the national level to address this condition.

Association between household solid fuel usage and trajectories of multimorbidity among middle-aged and older adults: a nationwide population-based cohort study

BackgroundThis study aimed to explore the effect of household solid fuel usage on the multimorbidity trajectories among middle-aged and older adults.MethodsBased on the 2011–2018 China Health and Retirement Longitudinal Study, the group-based trajectory modeling and the multinomial logistic regression model were used to explore the relationship between multimorbidity trajectories of older adults with different fuel types, duration of solid fuel usage, and potential interaction with PM2.5. Three multimorbidity trajectory patterns were identified by group-based trajectory modeling and labeled as “non-chronic morbidity” (no disease increase), “newly developing multimorbidity” (diseases grew from 0 to 2), and “multi-chronic multimorbidity” (diseases grew from 2 to 4).ResultsCompared to “Non-chronic morbidity,” solid fuel was significantly associated with adverse multimorbidity trajectories, with an odds ratio (OR) and 95% confidence interval (CI) of 1.33 (1.11, 1.60) and 1.35 (1.18, 1.55) for newly developing and multi-chronic group, respectively. An adverse multimorbidity trajectory tended to be established with longer durations of solid fuel usage than “Non-chronic morbidity.” For “Newly-developing multimorbidity,” the ORs (95% CI) for 1–7 years and ≥ 8 years of solid fuel usage were 1.16 (0.94, 1.42) and 1.41 (1.12, 1.76), respectively, with P trend=0.001, while in “Multi-chronic multimorbidity,” those were 1.25 (1.07, 1.47) and 1.68 (1.41, 2.00), respectively, with P trend <0.001. In the interaction analysis, the association between solid fuel usage and trajectories was significant only in areas where PM2.5 was lower than 50 μg/m3.ConclusionFor the middle-aged and older Chinese population, a higher risk of multimorbidity trajectory is associated with household solid fuel usage, especially in the areas with lower PM2.5.

Effects of a Six-Month Physical Activity Program on Health Risk Factors and Body Composition Among Overweight and Obese Middle-Aged Adults

Introduction. Physical activity is vital for preventing and managing lifestyle-related diseases, which pose significant health and socio-economic challenges. This study aimed to evaluate the effects of a six-month supervised physical activity program on health risk factors and body composition in middle-aged individuals with overweight or obesity. Methods. The study involved 166 men and women aged 30 to 65 years, with a body mass index (BMI) ranging from 26 to 35 and moderate to severe health risks. Participants of the study were engaged in a six-month physical activity training program designed in accordance with World Health Organization guidelines. Comprehensive assessments were performed at baseline and after the intervention, including measurements of various anthropometric and body composition parameters, as well as evaluations of functional performance. Fitness tests were also conducted to assess participants’ physical capacity and to monitor improvements throughout the training period. Results. Baseline measures of body mass composition and age demonstrated a strong positive correlation with visceral fat rating (VFR) in both men (r = 0.364, p < 0.001) and women (r = 0.420, p = 0.002). Following the six-month training program, participants exhibited an average improvement of 30% (p < 0.001) in their Cooper endurance test results. The physical activity intervention positively impacted body mass index (BMI) and various body composition metrics, including fat mass, VFR, and muscle mass, across all participants and most subgroups (gender, BMI, and age). In males, training at higher maximum heart rate (HRmax) zones significantly contributed to a reduction in the percentage of fat mass (80–89% HRmax) and an increase in the percentage of muscle mass (70–79% and 80–89% HRmax). Conclusions. The study indicates that a six-month supervised physical activity program significantly improves health risk factors and body composition (visceral fat reduction and improvement in percent of fat and muscle mass) among middle-aged individuals with overweight or obesity. Therefore, we advocate for the integration of structured physical activity interventions into healthcare practices to effectively enhance health outcomes in this population.

Defining high risk in the cardiovascular-kidney-metabolic syndrome and associated cardiovascular disease outcomes

Abstract Background The American Heart Association (AHA) recently developed the cardiovascular-kidney-metabolic (CKM) syndrome construct with stages 0-4 to comprehensively characterize the spectrum of cardiovascular disease (CVD) risk [1]. CKM Stage 3 is defined by subclinical CVD or high (≥20%) estimated 10-year CVD risk according to the newly-derived PREVENT models [2]. However, within CKM Stage 3, the burden of subclinical atherosclerosis equivalent to a ≥20% estimated CVD risk, and long-term CVD outcomes associated with CKM Stage 3, are not known. Purpose To (1) characterize the distribution of subclinical atherosclerosis by coronary artery calcium (CAC) according to PREVENT estimated CVD risk categories, and (2) quantify long-term CVD risk associated with CKM Stage 3, in two international cohorts of adults without prior CVD. Methods In participants of the Multi-Ethnic Study of Atherosclerosis (MESA, age 45-84 years) and the Rotterdam Study (age ≥55 years), the burden of CAC was calculated across estimated 10-year CVD risk (low, 0 to <5%; borderline 5 to <7.5%; intermediate, 7.5 to <20%; high, ≥20%). Participants were categorized into CKM stages according to CVD risk factors (body mass index, waist circumference, glycemic status, blood pressure, lipids, kidney function), estimated 10-year CVD risk (by AHA PREVENT model), and presence of CAC. The association of CKM syndrome stage with fatal or nonfatal CVD outcomes was evaluated with covariate-adjusted proportional hazards regression. Results Among 6,123 MESA participants (52% female, mean age 61.4 years) and 1,691 Rotterdam Study participants (46% female, mean age 67.1 years), the distribution of CAC across absolute 10-year CVD risk categories is shown in Figure 1. In high (≥20%) CVD risk adults, CAC score ≥100 was present in 50% of MESA participants and 48% of Rotterdam Study participants. Most participants were classified as CKM Stage 3 (53% in MESA, 83% in Rotterdam). Over a median follow-up of 17.5 years in MESA, CVD events occurred in 5% of CKM Stage 0, 6% of Stage 1, 9% of Stage 2, and 26% of Stage 3 participants. Over a median follow-up of 10.2 years in the Rotterdam Study, CVD events occurred in 0% of CKM Stage 0 and 1, 8% of Stage 2, and 17% of Stage 3 participants (Figure 2). The risk of total CVD was significantly higher in CKM Stage 3 participants relative to CKM Stage 0-2 (MESA: adjusted HR 2.74, 95% CI 2.32, 3.23; Rotterdam: adjusted HR 2.18, 95% CI 1.34, 3.54). Conclusions In an international, multi-ethnic sample of middle-aged adults, adults with high (≥20%) absolute 10-year CVD risk by PREVENT had substantial burden of CAC. Adults in CKM Stage 3 had approximately 2.2- to 2.7-times higher risk for CVD, compared with adults in lower CKM stages. Accounting for estimated CVD risk and burden of cardiovascular, kidney, and metabolic risk factors informs prevention of subclinical and clinical CVD.

Exploring the Relationship Between Health and Out-of-Pocket Health Expenditures: Evidence for Middle-Aged and Older Adults in China

Background/Objectives: With population aging, disability and chronic conditions are increasingly prevalent among middle-aged and older adults in China. Using panel data from the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2018, this paper explores the effects of Activities of Daily Living limitations, Instrumental Activities of Daily Living limitations, and chronic conditions on Out-of-Pocket Expenditures (OOPEs) among middle-aged and older adults in China. Methods: A first-difference model and a system-generalized method of moment model (GMM) are used. Results: The system-GMM model for the first time addresses unobserved heterogeneity and produces unbiased estimates of the effects of health and OOPEs. Additionally, this paper assesses the heterogeneity of the results across the demographic and socioeconomic groups. Conclusions: These findings can be used to inform policymakers on improving medical resource allocation and ensure better financial protection for those living with a disability and chronic diseases.

Dynamic changes in hs-CRP and risk of all-cause mortality among middle-aged and elderly adults: findings from a nationwide prospective cohort and mendelian randomization

IntroductionThe general population experiences mortality rates that are related to high levels of high-sensitivity C-reactive protein (hs-CRP). We aim to assess the linkage of longitudinal trajectories in hs-CRP levels with all-cause mortality in Chinese participants.MethodsWe utilized data from the China Health and Retirement Longitudinal Study (CHARLS). The exposures were dynamic changes in the hs-CRP and cumulative hs-CRP from 2012 to 2015, and the outcome was all-cause mortality. All participants were categorized into four trajectories according to hs-CRP levels. Multivariable logistic regression analysis, adjusted for potential confounders, was employed to evaluate the relationship of different trajectories of hs-CRP with mortality risk. A two-sample Mendelian randomization (TSMR) method and SHapley Additive exPlanations (SHAP) for identifying determinants of mortality risk were also employed.ResultsThe study included 5,445 participants with 233 deaths observed, yielding a mortality proportion of 4.28%. Compared to individuals maintaining low, stable levels of hs-CRP (Class 1), individuals with sustained elevated levels of hs-CRP (Class 4), those experiencing a progressive rise in hs-CRP levels (Class 2), or those transitioning from elevated to reduced hs-CRP levels (Class 3) all faced a significantly heighted death risk, with adjusted Odds Ratios (ORs) ranging from 2.34 to 2.47 across models. Moreover, a non-linear relationship was found between them. Further TSMR analysis also supported these findings. SHAP showed that hs-CRP was the fifth most important determinant of mortality risk.ConclusionsOur study shows all-cause mortality increases with dynamic changes in hs-CRP levels among middle-aged and elderly adults in China, and cumulative hs-CRP shows an L-shaped relationship with all-cause mortality.

C-reactive protein improves the ability to detect hypertension and insulin resistance in mild-to-moderate obstructive sleep apnea: Age effect.

C-reactive protein (CRP) appears to improve the ability to detect cardiometabolic risk in young and middle-aged adults with mild-to-moderate obstructive sleep apnea (mmOSA). The aim of this study is to assess utility of CRP in identifying the risk of hypertension and insulin resistance across a wide age range including older patients with mmOSA. Adults (n = 216) of a wide age range (28-90 years old, mean age 52.64 ± 12.74) with mmOSA (5 ≤ AHI < 30) completed in-lab polysomnography or home sleep apnea testing, physical examination including blood pressure (BP) measures, structured medical history questionnaire, and blood draw for CRP and fasting glucose and insulin levels. In adults < 60 years, lnCRP but not the apnea-hypopnea index (AHI) was associated with greater odds for hypertension (odds ratio [OR] = 2.40, 95% CI = 1.20-4.84, p = 0.01; OR = 1.00, 95% CI = 0.92-1.08, p = 0.92, respectively) and with higher average systolic and diastolic BP. Also, in adults < 60 years lnCRP but not AHI, was associated with higher lnHOMA values. In contrast, in adults > 60 years neither lnCRP nor AHI were associated with greater odds for hypertension, average systolic and diastolic BP, and lnHOMA. Receiver-operating characteristics curves revealed that adding CRP to standard clinical factors (age, sex, and BMI) yielded moderately good risk models for hypertension in patients < 60 years (AUC = 0.721). In conclusion, CRP improves the ability to detect cardiometabolic risk in young and middle-aged, but not older adults with mmOSA, suggesting that inflammation may be a primary pathogenetic mechanism in younger patients with OSA.

Age-Related Changes in Postural Stability in Response to Varying Surface Instability in Young and Middle-Aged Adults

As individuals transition into middle age, subtle declines in postural control may occur due to gradual reductions in neuromuscular control. The current study aimed to examine the effect of age on bipedal postural control across three support surfaces with varying degrees of instability: a firm surface, a foam pad, and a multiaxial balance board. The effect of surface stability was also assessed. Postural accelerations were recorded using a tri-axial accelerometer placed over the lumbar spine (L5) in 24 young female adults (23.9 ± 5.3 years) and 24 middle-aged female adults (51.4 ± 5.9 years). Sample entropy (SampEn) was used to analyze the complexity of postural control by measuring the regularity of postural acceleration. The main results show significant age-related differences in the mediolateral and anteroposterior acceleration directions (p ≤ 0.012). Young adults exhibit more irregular fluctuations in postural acceleration (high SampEn), reflecting greater efficiency or automaticity in postural control compared to middle-aged adults. Increased surface instability also progressively decreases SampEn in the mediolateral direction (p &lt; 0.001), reflecting less automaticity with increased instability. However, no interaction effects are observed. These findings imply that incorporating balance training on unstable surfaces might help middle-aged adults maintain postural control and prevent future falls.

Lifespan trajectories of negative and positive affect: A coordinated analysis of 14 longitudinal studies

Lifespan developmental theories suggest age-related shifts in motivation, cognition, emotion regulation, and stressor experience lead to changes in mean levels of negative and positive affect across the lifespan. The present research used coordinated data analysis to examine mean-level affective trajectories in 186,752 participants ranging from 11–104 years old across 14 longitudinal studies. Random-effects models were used to estimate meta-analytic effect sizes. On average, negative affect decreased until early older adulthood, and then remained stable throughout older adulthood. Meanwhile, positive affect remained stable across most of the younger and middle-aged adult lifespan, before starting its descent in later middle-aged adulthood and continuing to decline throughout older adulthood. Studies with older samples showed a clearer flattening effect of negative affect and steeper decline of positive affect in late-life relative to younger samples. These findings suggest that lifespan developmental affect trajectories are nuanced and not a direct inverse of each other.

Physical activity levels and musculoskeletal disease risk in adults aged 45 and above: a cross-sectional study

BackgroundMusculoskeletal disease (MSD) is a major cause of disability among older adults, and understanding the role of physical activity (PA) in preventing these conditions is crucial. This study aimed to explore the association between PA levels and MSD risk among adults aged 45 and above, clarify the dose‒response relationship, and provide tailored guidelines.MethodsUsing data from the China Health and Retirement Longitudinal Study (CHARLS), a cross-sectional analysis was conducted on 15,909 adults aged 45 and over. The study population was divided into MSD (n = 7014) and nMSD (n = 8895) groups based on musculoskeletal health status. PA levels were assessed using the International Physical Activity Questionnaire and categorized into low intensity physical activity (LIPA), moderate vigorous physical activity (MVPA), and vigorous physical activity (VPA). Multivariable logistic regression models and restricted cubic spline regression were used to examine the relationship between PA levels and MSD risk in middle-aged and older adults. Sensitivity analyses and stratified analyses were also performed.ResultsThe main outcome measures were musculoskeletal diseases prevalence and PA levels. MVPA and VPA reduced MSD risk by 19% [OR = 0.81, 95% CI (0.72, 0.90), P < 0.001] and 12% [OR = 0.88, 95% CI (0.79, 0.98), P < 0.05], respectively. What’s more, after adjusting for confounding factors, VPA increased risk by 32% [OR = 1.32, 95% CI (1.04, 1.66), P < 0.05]. The relationship was nonlinear, showing a U-shaped pattern with age and hypertension status as significant moderators. The optimal PA energy expenditure was identified as approximately 1500 metabolic equivalents of tasks (METs) per week for adults aged 45–74, 1400 METs per week for those aged 75 and above, and 1600 METs per week for hypertensive adults aged 45 and older.ConclusionsFor adults aged 45 years and older, VPA significantly increases the risk of MSD. Adults aged 45 years and older should adjust their weekly METs based on their age. Additionally, those with hypertension should moderately increase their weekly METs to promote optimal musculoskeletal health.

The effect of internet use on the health of middle-aged and older adults: evidences from China general social survey

BackgroundAccording to the United Nations classification of aging societies, China is rapidly transitioning into a moderately aging society, facing significant challenges related to population aging. Concurrently, China is actively implementing the Internet Power Strategy and the Internet Plus action plan, which are profoundly transforming the daily lives of individuals, including their health status. However, research on the impact of internet use on the health of middle-aged and older adults has not reached a consensus. This study aims to investigate the effects of internet use on the health of middle-aged and older adults, as well as the mechanisms and heterogeneity of these effects.MethodsThis study utilized data from the China General Social Survey conducted in 2018, which includes a sample of 6470 individuals. Self-rated health, mental health, and objective health were used as key health indicators, with internet use identified as the primary independent variable. The study aims to analyze the impact of internet use on the health status of middle-aged and older adults through the application of an ordered probit model and instrumental variable methods.ResultsThe results indicate that internet use has a significant positive impact on the health of middle-aged and older adults, with significance at the 1% level. This finding has passed a series of robustness tests. Mechanism analysis reveals that information acquisition is a crucial mediating mechanism between internet use and the health of middle-aged and older adults. This suggests that increased internet use enhances information access, thereby improving health outcomes. Furthermore, heterogeneity analysis shows that the impact of internet use on health is more pronounced among individuals living in rural areas, western regions, low-income groups, and those aged under 60, compared to their counterparts in urban areas, eastern regions, higher-income brackets, and those aged 60 and above.ConclusionInternet use can improve the health of middle-aged and older adults. Therefore, government departments, senior universities, communities, and families should collaborate to actively conduct digital skills training for older adults. Additionally, efforts should be accelerated to adapt electronic products to be more elder-friendly, helping older adults overcome the digital divide and thereby reducing health inequalities among middle-aged and older groups.

Longitudinal associations between personality traits and cognitive complaints in midlife and older age across 20 years

Cross-sectional work suggests that higher neuroticism and lower conscientiousness are consistently related to more subjective cognitive complaints. Little is known about the longitudinal associations. We used data from the Interdisciplinary Longitudinal Study of Adult Development to examine how personality and cognitive complaints jointly unfolded over 20 years. Participants came from a midlife ( n = 502, Mage = 43.7) and an older age group ( n = 500, Mage = 62.5). Random-intercept cross-lagged panel models were used to test the personality-complaint associations at the between-person and within-person levels. Analyses controlled for gender, education, subjective health, objective health, and memory. At the between-person level, higher neuroticism and lower conscientiousness were associated with more cognitive complaints over 20 years, and these associations were stronger in older than middle-aged adults. Among older adults, lower extraversion, openness, and agreeableness were longitudinally associated with more cognitive complaints. At the within-person level, all five traits were concurrently related to cognitive complaints, with small to medium-sized effects, but not across all measurement occasions. Few cross-lagged effects were found, with no consistent pattern across time or age cohorts. This work provides longitudinal evidence of personality-complaint associations and suggests that these associations varied more across individuals than within individuals over time.

Association of Spouses’ Sensory Loss with Depressive Symptoms, Self-Reported Health, and Functional Disability Among Middle-Aged and Older Adults in China: A Cross-Sectional Study

ABSTRACT Objective To investigate cross-sectional associations between spouses’ sensory loss and depressive symptoms, self-rated health, and functional disability. Methods We included 10,410 individuals from the China Health and Retirement Longitudinal Study. We used the cross-sectional design and determined hearing loss, vision loss, and dual sensory loss by self-reports. We assessed depressive symptoms using the Center for Epidemiological Studies Depression Scale. We assessed self-reported health status using one item. Functional disability was defined as having difficulties in activities of daily living (ADL) and instrumental activities of daily living (IADL). Results Individuals with spouses’ dual sensory loss had a higher prevalence of depressive symptoms (45.19%), ADL (17.31%), and IADL impairments (21.97%) and a lower rate of self-rated good health (20.78%) than those with no or single loss. Spouse’s sensory loss was associated with depressive symptoms, self-rated health, ADL, and IADL impairments (p < .05). Husbands’ ADL impairments were associated with wives’ vision loss (p < .05). Wives’ IADL impairments were associated with husbands’ hearing loss (p < .05). Conclusions Spouses’ sensory loss was related to depressive symptoms, self-rated health, ADL, and IADL impairments. There was a gender specificity in the effect of spousal vision loss or hearing loss on ADL and IADL impairments.

Internet use and cognitin among American middle-aged and older adults: The gendered moderating effect of age

The popularity of Internet use brings more potential for healthy cognitive aging among older adults. Emerging studies have examined the age and gender differences in the link between older adults&amp;rsquo; Internet use and cognition. However, few studies have investigated the gendered age difference regarding this association. The purpose of this study was to examine whether age would moderate the effect of Internet use on cognition among middle-aged and older adults and whether this relationship would be different between men and women. A total of 6,338 adults aged 50 or older were drawn on from the 2016 Wave of the Health and Retirement Study. Sequential linear regressions were conducted to examine the interactions between Internet use, age, and gender on cognition. The three-way interaction of Internet use, age, and gender was a significant predictor of cognition (&amp;beta; = 0.01, p &lt; 0.05). Specifically, the positive effect of Internet use on cognition was higher among older women of older age than those of younger age, while the positive effect remained the same for older men of different ages. The Internet offers a valuable resource for engaging middle-aged and older adults in activities that not only provide social interaction but also stimulate cognitive processes. The study suggests that the aging process does not necessarily inhibit the cognitive benefits that middle-aged and older adults can gain from using the Internet. Findings from this study indicated that future Internet/technology training to increase cognition among middle-aged and older adults should be age- and gender-tailored.

Machine learning-based prediction of sarcopenia in community-dwelling middle-aged and older adults: findings from the CHARLS.

Sarcopenia is a prominent issue among aging populations and associated with poor health outcomes. This study aimed to examine the predictive value of questionnaire and biomarker data for sarcopenia, and to further develop a user-friendly calculator for community-dwelling middle-aged and older adults. We used two waves (2011 and 2013) of the China Health and Retirement Longitudinal Study (CHARLS) to predict sarcopenia, defined by the Asian Working Group for Sarcopenia 2019 criteria. We restricted the analytical sample to adults aged 45 or above (N = 2934). Five machine learning models were used to construct Q-based (only questionnaire variables), Bio-based (only biomarker variables), and combined (questionnaire plus biomarker variables) models. Area under the receiver operating characteristic curve (AUROC) was used for performance assessment. Temporal external validation was performed based on two datasets from CHARLS. Important predictors were identified by Shapley values and coefficients. Extreme gradient boosting (XGBoost), considering both questionnaire and biomarker characteristics, emerged as the optimal model, and its AUROC was 0.759 (95% CI: 0.747-0.771) at a decision threshold of 0.20 on the test set. Models also performed well on the external datasets. We found that cognitive function was the most important predictor in both Q-based and combined models, and blood urea nitrogen was the most important predictor in the Bio-based model. Other key predictors included education, haematocrit, total cholesterol, drinking, number of chronic diseases, and instrumental activities of daily living score. Our findings offer a potential for early screening and targeted prevention of sarcopenia among middle-aged and older adults in the community setting.

Changes in attitudes toward suicide after brief gatekeeper education: Findings from population-based repeated cross-sectional surveys conducted among middle-aged and older adults

Objective This study aimed to investigate changes in attitudes toward suicide following a universal home visitation program that included a brief face-to-face educational session focusing on gatekeeper roles in Japan.Methods Between 2015 and 2017, members of 169 households in an intervention district from a northern Japanese township were invited to attend an educational session during home visits. The participation rate was 72.8%, with 94.5% of the participants aged over 40. Repeated cross-sectional population-based surveys were conducted among adults in the towns in 2015 and 2021. Data from the surveys, focusing on individuals aged 40-79 years and residing in the intervention and matched control districts (where no visits occurred and only information was distributed through leaflets), were used to assess the prevalence of self-reported views toward suicide. The self-reported views encompassed "no substantial thoughts," "inevitable," "shameful," "annoying," "tragic," "must be managed," and "romantic" in addition to personal and perceived stigma, depressive symptoms (assessed using the Kessler Psychological Distress Scale-6), and suicidal ideation. Data were analyzed using generalized linear mixed models. The Cochran-Armitage test was used to analyze linear trends in the proportion of views that exhibited changes.Results Participation rates were 61.8% (n ＝ 357) in 2015 and 52.8% (n ＝ 257) in 2021. The intervention group showed a significant difference in the prevalence of the "inevitable" view between baseline and 4-year follow-up (P ＝ 0.026). Marginal pre-post differences were observed among the two types of stigma; however, the symptoms remained unchanged. A marginally significant difference in the change of the "inevitable" view was observed between the two groups. In the follow-up, more knowledgeable respondents in the intervention group were less likely to view suicide as "inevitable," a trend not seen in the control group.Conclusions The universal home visitation program, including a face-to-face session focusing on the gatekeeper role, was associated with a decreased prevalence of the "inevitable" attitude between the baseline and 4-year follow-up among community-dwelling adults aged 40-79. This suggests that face-to-face interactions with healthcare professionals can reduce the tendency to condone suicide among middle-aged and older adults in community settings.

Associations of exposure to PM2.5 and its compounds with carotid intima-media thickness among middle-aged adults

BackgroundExposure to fine particulate matter (PM2.5) has been linked to an increased risk of atherosclerosis. However, it remains unclear whether specific compounds within PM2.5, rather than the overall mass, serve as a better indicator of adverse cardiovascular health outcomes associated with air pollution. MethodsIn this cross-sectional study, we included 3257 participants (aged 37–51 years) from the Coronary Artery Risk Development in Young Adults (CARDIA) study. Exposure to PM2.5 and its constituent compounds, black carbon (BC), ammonium, nitrate, organic matter, sulfate, mineral dust, and sea salt were included in the analyses. Carotid intima media thickness (cIMT; the average of common, bulb, and internal carotid) was measured by carotid ultrasonography. We assessed the cross-sectional associations of one-year exposure to PM2.5 and its compounds with mean cIMT using linear regression models adjusting for participants' demographics, individual- and neighborhood-level socioeconomic status, behavioral components, and health conditions. We also adopted Bayesian kernel machine regression (BKMR) models to investigate the association between the PM2.5 compound mixture and cIMT as well as the contribution of each compound to the association. ResultsGreater exposure to BC was associated with higher cIMT (mm) (β =0.034, 95 % CI = 0.019–0.049, per IQR increase [0.56 μg/m3] of BC) among participants with a mean age of 45.0, consisting of 45.9 % Black and 54.1 % White males and females. The association was generally consistent across participants' demographic characteristics. In our BKMR analysis, BC exhibited a dose-response association with cIMT with a high contribution to the association of cIMT with PM2.5 compound as a mixture (posterior inclusion probability [PIP]: 1.00). ConclusionsOur findings suggest that certain compounds of PM2.5, such as BC, may offer more reliable indications of the impact of air pollution on cardiovascular health.

Association Between Dietary Diversity and Subjective Cognitive Decline in the Middle-Aged and Elderly Chinese Population: A Cross-Sectional Study

Background: This cross-sectional study aimed to examine the association between dietary diversity and risk of subjective cognitive decline (SCD), a precursor of dementia, in middle-aged and elderly Chinese populations residing in eastern China. Methods: Participants aged ≥ 45 years were recruited from a community in an eastern Chinese city after excluding potential objective cognitive impairment using the Mini-Cognitive Assessment Instrument (Mini-Cog). SCD was assessed using the Subjective Cognitive Decline Questionnaire-9 (SCD-Q9). Dietary data were collected using the Dietary Quality Questionnaire (DQQ), and the Food Group Diversity Score (FGDS) and the Consumed All Five Recommended Food Score (All-5) were calculated as indicators of dietary diversity. Odds ratios (ORs) and 95% confidence intervals (CIs) were computed to evaluate the associations of FGDS and All-5 scores with SCD after adjusting for age, sex, socioeconomic status, lifestyle factors, and health status. Results: Among the 871 participants, 358 (41.1%) were classified as having SCD. Compared with participants with the highest FGDS (≥8) and those with the highest All-5 score (5), those with the lowest FGDS (≤4) and the lowest All-5 score (≤3) exhibited 85% (OR = 1.85; 95% CI: 1.10–3.13; p = 0.02) and 90% (OR = 1.90; 95% CI: 1.21–2.97; p &lt; 0.01) higher risk of SCD, respectively, after adjusting for all covariates. Fruits were the only food group among the All-5 components that demonstrated a significant association with SCD risk. Conclusions: Poor dietary diversity was associated with an elevated risk of SCD in middle-aged and older adults, and fruits were the food group with the most substantial effect.