Midlife Men Research Articles

An Adapted Sociocultural Model of Body Image Concerns and Disordered Eating Among Midlife Men

An Adapted Sociocultural Model of Body Image Concerns and Disordered Eating Among Midlife Men

Comedies of Beset Manhood: Midlife Masculinity in the Films of Alexander Payne

The career of director-writer Alexander Payne has coincided with, and developed alongside, the cultural discourse about men in crisis. His last seven films have engaged several of the concerns that have informed considerations of contemporary manhood since the 1990s. Avoiding the overwrought tone of many of such works, Payne’s films collectively examine the disorientation and disappointments of midlife men, but they defy simplistic narrative resolutions. Both employing and subverting the conventions of comic form, Payne’s films artfully reveal how ideologies of iconic White manhood weigh on individuals who fall outside of—or age out of—those masculine ideals. In narrativizing and individualizing the concerns of the men-in-crisis conversation, Payne adds complexity and depth to ongoing discourses about gender and aging.

Psychometric Assessment of a Homophobia Management Scale Among Cisgender Sexual Minority Men in Midlife and Older Adulthood.

Interpersonal management of homophobic stigma (e.g., selectively constructing one's social network; confronting stigma) is an understudied area of resilience among sexual minority people. Among a sample of cisgender sexual minority men (SMM; N = 798) in midlife and older adulthood, we assessed the psychometric properties and characterized the sociodemographic differences of our newly developed, theory-informed homophobia management scale. Data come from the Healthy Aging substudy of the Multicenter AIDS Cohort Study, which is a prospective longitudinal study implemented to evaluate the natural trajectories of HIV risk and treatment among sexual minority men. Guided by the proactive coping processes model, the Healthy Aging team proposed eight items to measure homophobia management, which were included at four waves of survey data collection completed at semiannual study visits. Using factor analyses and linear regressions, we assessed our scale's construct validity, convergent validity, and internal consistency, and characterized scores by age, race/ethnicity, sexual orientation, and HIV status. Factor analyses yielded a six-item scale with adequate construct validity and acceptable internal consistency (Cronbach's alpha = .69). Our final scale exhibited convergent validity given its statistically significant inverse association with internalized homophobia and positive association with psychological connections to the gay community. Bivariate differences in homophobia management emerged by age, race/ethnicity, and sexual orientation but were not statistically significant in multivariable analyses. Our study provides a validated, unidimensional scale to assess homophobia management among SMM in midlife and older adulthood. We provide recommendations to improve the implementation of our scale in future surveillance.

Effects of Heavy Alcohol Use on Fasting Glucose and Insulin Resistance in Mid-Life Adults

Introduction: As our population ages, type 2 diabetes has become more prevalent in the United States and one in five mid-life adults (50-64 years) have type 2 diabetes. Unhealthy and heavy alcohol use (that exceeds recommended drinking limits) causes dysfunction of the liver and pancreas that can impact glucose control and thereby increase risks of type 2 diabetes. In young adults, we previously found that fasting glucose and insulin resistance were not associated with heavy alcohol use. However, it remains unclear if heavy alcohol use contributes to the development of type 2 diabetes in an aged population. Therefore, the purpose of this study is to determine the effect of heavy alcohol use on fasting glucose and insulin resistance in apparently healthy mid-life adults. Methods: Mid-life men (n=21) and postmenopausal women (n=28), non-smokers, free of obesity and major clinical diseases, were recruited from the community around the Dallas—Fort Worth metroplex. All participants underwent physical exam and fasting blood sampling. Alcohol use was assessed by the US Alcohol Use Disorders Identification Test (USAUDIT) and a dried blood spot phosphatidylethanol (PEth) test. A PEth cutoff of 20 ng/mL was used to define heavy drinkers. Insulin resistance was assessed by calculating HOMA-IR (Homeostatic model assessment for insulin resistance) as insulin (μU/L) x glucose (nmol/L)/22.5. Results: A total of 24 participants had PEth levels of <20 ng/mL (non-heavy drinkers; PEth ranged from <limit of quantification to 13 ng/mL; mean ± SEM for age: 58±1 years and body mass index: 25.2±0.6 kg/m2) and the other 25 participants had PEth levels ≥20 ng/mL (heavy drinkers; PEth ranged from 20 to 665 ng/mL; age: 57±1 years and body mass index: 25.7±0.5 kg/m2). Heavy drinkers had higher USAUDIT scores than non-heavy drinkers (11.3±1.4 vs. 3.3±0.5, p<0.001). No significant difference between these two groups were found in lipid values (P≥0.1) as well as renal (P≥0.3) and liver function values (P≥0.08). Compared to non-heavy drinkers, heavy drinkers had a higher level of fasting blood glucose (96±2 vs. 91±1 mg/dL, P=0.02), but similar blood insulin (9.2±2.5 vs. 5.5±0.5 μIU/L, P=0.2) and HOMA-IR (2.23±0.64 vs. 1.23±0.11, P=0.1). The results for stepwise linear regression model indicate that only USAUDIT score was an independent factor of fasting glucose (B=0.59, p<0.001). Conclusion: Our results indicate that compared to mid-life adult non-heavy drinkers, heavy drinkers had higher fasting blood glucose levels, despite similar renal and liver function. Our results also indicate that higher risks of alcohol use disorder were associated with higher levels of fasting glucose. These data suggest that heavy alcohol use may have negative effects on glucose regulation in aged populations and increase risks of type 2 diabetes. This work was supported by NIAAA AA028537 to CLH. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Mental health during the COVID-19 pandemic: the importance of social support in midlife women

Objective This study aimed to examine sex differences in factors associated with mood and anxiety in midlife men and women during the COVID-19 pandemic. Methods During a remote visit, 312 adults aged 40–60 years (167 female; 23.6% perimenopausal) from the Human Connectome Project in Aging completed PROMIS measures of depression, anxiety and anger/irritability; perceived stress; and questions about social support, financial stress and menopause stage. Multivariate linear regression models assessed sex differences in mental health and the association of social support, financial stress and menopause stage with mental health. Results Anxiety was higher in women than in men (b = 2.39, p = 0.02). For women only, decreased social support was associated with increased anxiety (b = −2.26, p = 0.002), anger/irritability (b = −1.89, p = 0.02) and stress (b = −1.67, p = 0.002). For women only, not having close family was associated with increased depressive symptoms (b = −6.60, p = 0.01) and stress (b = −7.03, p < 0.001). For both sexes, having children was associated with lower depressive symptoms (b = −3.08, p = 0.002), anxiety (b = −1.93, p = 0.07), anger/irritability (b = −2.73, p = 0.02) and stress (b = −1.44, p = 0.07). Menopause stage was unrelated to mental health. Conclusion Social support, but not financial stress, influenced mental health during the COVID-19 pandemic at midlife, particularly for women.

From couplepause to doublepause: the impact of midlife physical, psychological, and social changes on the sexual life of aging couples.

Midlife men and women are facing frequent sexual problems that affect not only individuals' sexual health but also the sexual health of aging couples. To review the main sexual life challenges faced by midlife couples, to present the concepts of couplepause and doublepause as 2 new paradigms to address the sexual health needs of aging couples, and to discuss key aspects in couple-focused care. An online meeting attended by 5 European experts in sexual health was carried out in June 2023 to discuss the topic. The conversation centered on their clinical experience and expert opinion. Additionally, the indexed literature was reviewed to endorse and complement the expert opinions obtained in the aforementioned meeting. Midlife men and women face physical, psychological, and sociocultural changes that affect their sexual activity. These changes may be experienced differently between genders. Both members of a couple may experience age-related changes concurrently or in an unsynchronized manner affecting their sexual health. Communication, sharing expectations, defining sexual dynamics, and couple goals are determinant for the sexual health of a midlife couple. Couplepause and doublepause are 2 new complementary paradigms that effectively address the sexual health needs of aging couples as a unit, considering physical, psychological, cultural, social, and dyadic-related factors. Couple-centered strategies should promote open communication about couple intimacy issues, understanding the diverse expectations according to gender and orientation, communication styles, and goals. The following are identified as crucial aspects to promote couple-focused care: education and training of health care professionals, the provision of information to aging couples, physician involvement in addressing sexual problems, the need for collaboration across medical specialties, and the development of effective tools and strategies. The sexual problems of aging couples should be managed following couple-centered strategies that effectively address their sexual health needs as a couple.

Reflexive Planning for Later Life: Minority Stress and Aging Challenges among Midlife Chinese Lesbians and Gay Men

ABSTRACT This study examines how Chinese lesbians and gay men make sense of the prospect of growing old and plan for later life in Hong Kong, where same-sex relationships are yet to be legally recognized. Drawing on in-depth narrative interviews, the results show that lesbians and gay men in midlife reported a range of previous, current, and anticipated challenges associated with the stigma attached to homosexuality. These, in turn, shaped their ways of perceiving and planning for later life. Three forms of reflexivity in response to minority stress and the prospect of aging were identified: coping with fears of aging alone, striving for self-mastery, and planning ahead with feelings of wariness. Participants’ concerns and plans around aging demonstrated differing degrees of reflexivity, through which they attempted to navigate family norms and structural constraints and find ways to accumulate resources for later life. Meanwhile, their heightened sense of uncertainty and insecurity showed that their perceptions and experiences of aging were influenced by minority stress and material, familial, and socio-political circumstances. This article builds a constructive dialogue between sexuality and aging studies by unraveling both the aging insecurity and capacities for reflexive planning among an oft-neglected group of sexual minority people in midlife.

A Narrative Review Discussing Vasectomy-Related Impact upon the Status of Oxidative Stress and Inflammation Biomarkers and Semen Microbiota

Male contraceptive approaches besides tubal sterilization involve vasectomy and represent the method of choice among midlife men in developing countries thanks to many advantages. However, the subsidiary consequences of this intervention are insufficiently explored since the involved mechanisms may offer insight into a much more complex picture. Thus, in this manuscript, we aimed to reunite all available data by searching three separate academic database(s) (PubMed, Web of Knowledge, and Scopus) published in the past two decades by covering the interval 2000-2023 and using a predefined set of keywords and strings involving "oxidative stress" (OS), "inflammation", and "semen microbiota" in combination with "humans", "rats", and "mice". By following all evidence that fits in the pre-, post-, and vasectomy reversal (VR) stages, we identified a total of n = 210 studies from which only n = 21 were finally included following two procedures of eligibility evaluation. The topic surrounding this intricate landscape has created debate since the current evidence is contradictory, limited, or does not exist. Starting from this consideration, we argue that further research is mandatory to decipher how a vasectomy might disturb homeostasis.

Mid-life cyclists preserve muscle mass and composition: a 3D MRI study

Physical activity and a healthy lifestyle are crucial factors for delaying and reducing the effects of sarcopenia. Cycling has gained popularity in the last decades among midlife men. While the cardiovascular benefits of cycling and other endurance exercises have been extensively proved, the potential benefits of lifelong aerobic exercise on muscle health have not been adequately studied. Our aim was to quantify the benefits of cycling in terms of muscle health in middle-aged men, using magnetic resonance imaging. We ran a cross-sectional study involving two groups of middle-aged male adults (mean age 49 years, range 30–65) that underwent Dixon MRI of the pelvis. The groups consisted of 28 physically inactive (PI) and 28 trained recreational cyclists. The latter had cycled more than 7000 km in the last year and have been training for 15 years on average, while the PI volunteers have not practiced sports for an average of 27 years. We processed the Dixon MRI scans by labelling and computing the fat fraction (FF), volume and lean volume of gluteus maximus (GMAX) and gluteus medius (GMED); and measuring the volume of subcutaneous adipose tissue (SAT). We found that the cyclists group had lower FF levels, a measure of intramuscular fat infiltration, compared to the PI group for GMAX (PI median FF 21.6%, cyclists median FF 14.8%, p < 0.01) and GMED (PI median FF 16.0%, cyclists median FF 11.4%, p < 0.01). Cyclists had also larger GMAX and GMED muscles than the PI group (p < 0.01), after normalizing it by body mass. Muscle mass and fat infiltration were strongly correlated with SAT volume. These results suggest that cycling could help preserve muscle mass and composition in middle-aged men. Although more research is needed to support these results, this study adds new evidence to support public health efforts to promote cycling.

Positive impacts of leisure-time physical activity on cardiorespiratory fitness, co-morbidity level, cardiovascular health and quality of life among midlife adults: a cross-sectional study of a Nigerian population

BackgroundRegular physical activity (PA) improves general health and quality of life (QoL) of the general population. It is however not known if leisure-time PA (LTPA) behaviour will reduce co-morbidity and adiposity, and improve cardiorespiratory fitness and QoL in midlife men. This study explored the impacts of regular LTPA behaviour on co-morbidity, adiposity, cardiorespiratory fitness and QoL among male midlife sports club members in a Nigerian population.MethodsThis cross-sectional study involved 174 age-matched male midlife adults: 87 engaging in LTPA (LTPA group) and 87 not engaging in LTPA (non-LTPA group). Information on age, body mass index (BMI), waist circumference (WC), maximal oxygen uptake (VO2max), resting heart rate (RHR), QoL and co-morbidity level was collected using standardized procedures. Data were summarized using mean and standard deviation, and explored using frequency and proportion. Independent t-test, Chi Square and Mann–Whitney U test were employed to determine the impacts of LTPA at 0.05 significance level.ResultsThe LTPA group had lower co-morbidity score (p = 0.05) and RHR (p = 0.004), and higher QoL (p = 0.01) and VO2max (p = 0.003) than non-LTPA group. While heart disease (χ2 = 10.99; p = 0.01) and hypertension (χ2 = 15.24; p = 0.004) severity levels were associated with LTPA behaviour, hypertension (p = 0.01) was the only co-morbid condition that had a significantly lower score in the LTPA group than in the non-LTPA group.ConclusionsRegular LTPA improves cardiovascular health, physical work capacity and QoL in the sample of Nigerian mid-life men. Regular LTPA behaviour is recommended for cardiovascular health promotion, and improved physical work capacity and life satisfaction in midlife men.

Perceptions of alcohol health harm among midlife men in England: a qualitative interview study

In recent years attention has been directed at harmful levels of alcohol consumption among middle-aged and older people. In England, midlife men are over-represented in the social patterning of risk of alcohol harm. Insights into midlife men’s understandings of alcohol harm are limited, and research suggests poor effectiveness of existing alcohol education messaging and guidance. A better understanding of the ‘lay epidemiology’ of alcohol health harm can inform and thus enhance the effectiveness of public health and alcohol education measures. In-depth individual interviews were undertaken with 42 men aged 45–60 drinking over 240 grams (30 UK units) of alcohol per week. The men’s perceptions reflected three dimensions of how alcohol health harm: 1) is experienced and perceived, 2) is understood to work and 3) is best managed and communicated. The harmful bodily effects from alcohol were recognised in ‘problem drinkers’ and as acute effects. The men understood the effect of alcohol as a poison linked to excessive consumption or when consumption was continuous. Alcohol health harms were understood in relation to wider lifestyle behaviours and the men requested that public health advice should give them choices, and not simply tell them what to do. The men had a limited understanding of how alcohol affected their bodies and, drawing on the medical anthropological concept of ‘explanatory models’, it is suggested that providing clear and accessible explanations of how specific alcohol-related health harms occur may help people to make informed choices of moderation and improve the effectiveness of public health messages.

Abstract 12217: Effect of Repeated Binge Drinking in Mid-Life Adults on Vascular Function

Introduction: Age-related changes in vascular function, including endothelial dysfunction and arterial stiffening, contribute to the development of cardiovascular disease. “Mid-life adults”, defined as age 50-64, begin to show signs of vascular aging. One in five mid-life adults engage in binge drinking and our previous studies in young adults showed that repeated binge drinking was associated with endothelial dysfunction and arterial stiffening. However, it is unclear how binge drinking influences vascular function in aged individuals. Therefore, the purpose of this study is to investigate endothelial function and arterial stiffness in mid-life adults who binge drink regularly (binge drinkers) compared to those who did not drink alcohol (alcohol abstainers). Methods: Twelve apparently healthy mid-life men and postmenopausal women, with no smoking history were included in this study (mean±SEM, age: 57±1 years, body mass index: 26.0±0.8 kg/cm 2 , systolic blood pressure: 119±5 mmHg). Alcohol use was assessed by the Alcohol Use Disorders Identification Test (AUDIT) and dried blood spot phosphatidylethanol. Endothelial function was assessed by brachial artery response to reactive hyperemia (flow-mediated dilation, FMD) via ultrasonography. Arterial stiffness was assessed by carotid to femoral pulse wave velocity (cfPWV) via use of the cuff-based SphygmoCor Xcel. Results: Binge drinkers (n=6) had an AUDIT score≥5 (11.8±2.1) and positive phosphatidylethanol level (162±103 ng/mL), while alcohol abstainers (n=6) had an AUDIT score≤1 (0.8±0.2) and negative phosphatidylethanol level. Compared to alcohol abstainers, binge drinkers had a lower brachial artery FMD (alcohol abstainers vs. binge drinkers: 9.8±1.2% vs. 5.1±0.9%, P=0.01), but similar cfPWV (7.2±0.7 vs. 7.0±0.5 m/sec, P=0.8). Conclusions: Our results indicate that compared to mid-life adult alcohol abstainers, binge drinkers had lower endothelial function, but similar arterial stiffness. These findings suggest that repeated binge drinking may further impair endothelial function throughout the aging process.

Sexual Motives, Stress, and Depressive Symptoms Among Midlife Different-Sex and Same-Sex Couples.

Within relationships, sexual motives and stress are independent determinants of psychological health, with notable gendered patterns. However, previous research largely focuses on young adults and different-sex couples. Both sexual motives and levels of stress may be uniquely important to psychological health in midlife, and in potentially different ways for same-sex and different-sex couples. This study examined how the associations between sexual motives, stress, and depressive symptoms differ for midlife men and women in same-sex and different-sex marriages. Using dyadic data from same-sex and different-sex midlife married couples (N = 830 individuals; 415 couples), we examined the associations of intrinsic (e.g., sex for enjoyment and pleasure) and extrinsic (e.g., sex to please one's spouse) motives for having sex with depressive symptoms and tested whether these associations differed by levels of stress for same-sex and different-sex spouses. Intrinsic sexual motives were associated with fewer depressive symptoms only for same-sex married couples under high stress. Extrinsic sexual motives were related to greater depressive symptoms for women in low-stress conditions and men in high-stress conditions, and this did not differ for same-sex compared to different-sex marriages. Results show that the interplay between sexual motives and stress varies for men and women in same-sex and different-sex marriages. These findings underscore the importance of considering both gender and sexuality in studying sexual motives in midlife and suggest sexual motives as a useful treatment focus for protecting the psychological health of midlife married couples.

Identification of Factors to Predict Adults’ Self-esteem in Japan: Focusing on Generativity

Purpose: The current study identifies factors that contribute to or predict older adults’ high self-esteem with the effect of generativity being focused. The aims of this study are; 1) to investigate whether the sense of generativity goes up as adults get older, 2) to identify the variables associated with generativity and analyze the differences between younger and midlife adults, as well as men and women, and 3) to determine the factors that predict self-esteem.&#x0D; Method: Participants were recruited by snow-ball sampling. The questionnaires comprised; 1) profiles, 2) Rosenberg’s Self-esteem Scale, 3) present anxiety (PA) and future anxiety (FA), and 4) one question on generative concern, “For the next generation, I try not to do harmful things but do good things for the environment.” Responses were analyzed with HAD. Student’s t-test, correlation analysis, multiple comparison procedure, ANOVA, MANOVA, hierarchical multiple regression, and multiple regression analysis were conducted.&#x0D; Results: Older adults had the higher generativity in accordance with self-esteem, with the peak age of 55-59. Men showed a sharp rise, and women showed a mild rise with high generativity in early age. Self-esteem showed a correlation with generativity except for younger adults. Education showed the strongest correlation with generativity only in women, followed by self-esteem and age. Childrearing and future worries showed no correlation. Self-esteem was predicted by present anxiety most in all groups, and it was the only factor that predicted women’s self-esteem. For midlife adults, childrearing and generativity predicted their self-esteem. The effect of generativity on younger men’s self-esteem was the greatest.&#x0D; Conclusion: Generativity goes up with self-esteem and can be a positive factor to predict self-esteem with its peak in the late 50s. Present anxiety has the biggest negative effect on self-esteem in all groups. Childrearing has nothing to do with generativity, but it is a factor in predicting midlife adults’ self-esteem, especially for midlife men. Developing a sense of generativity might help raise self-esteem for young male adults. Female adults tend to be much more negatively affected by anxiety than men, and education may have some effect on their self-esteem as education may relate to other factors to reduce present anxiety such as higher income.

Increasing obstructive sleep apnea risk is associated with hearing impairment in middle-aged Chinese men-A cross-sectional study.

ObjectiveMidlife males with obstructive sleep apnea (OSA) bear a high risk for cardiovascular diseases. However, the association of OSA and hearing impairment is controversial. Our objective was to observe the incidence of hearing loss in middle-aged males with different risks for OSA.Methods794 men aged 40–65 who participated in health examination and pure tone hearing screening between January and June 2021 were recruited in the study. Medical history was collected. Height, weight and blood pressure were tested, and biochemical test including blood lipids and blood glucose was performed. According to the STOP-BANG score, the observed subjects were divided into low, intermediate and high groups for OSA risk. Hearing impairment was defined as failure in responding to any pure tone of 25 dB HL in any ear at the frequencies: 4 kHz for high frequency range and 0.5k, 1k, 2 kHz for low/medium frequency range. The incidence of hearing loss in those groups was compared after adjusting the cardiovascular risk factors.ResultsThe incidence of hearing impairment in the groups of intermediate, high, and intermediate/high risk for OSA (46.9%, 45.2%, 46.3%, respectively) were higher than that in the group of low risk for OSA (33.3%, P<0.001). After adjusting cardiovascular risk factors, the risk of hearing impairment in the group of high risk for OSA is 1.64 times of the group of low risk for OSA (95%CI: 1.02–2.69, P<0.05). The risk of hearing impairment at high frequency(4kHz) in the group of intermediate/high risk for OSA is 1.43 times of the group of low-risk for OSA (95%CI: 1.00–2.06, P<0.05).ConclusionThe risk of hearing impairment in midlife men with high, intermediate/high risk for OSA is significantly increased, especially at high frequency of 4 kHz.

Counselling for Testosterone Therapy in Mid Life Men.

Testosterone is frequently used for the optimization of mid-life health. This therapy is effective and safe if accompanied by adequate counseling, before prescription, and during administration. In this opinion piece, we discuss the style and substance of medication counseling for testosterone therapy. The role and scope of counseling are highlighted, with a focus on screening, diagnosis, medication counseling, sexual counseling, and monitoring. This article should prove useful for all health care professionals.

Initial Longitudinal Outcomes of Risk-Stratified Men in Their Forties Screened for Prostate Cancer Following Implementation of a Baseline Prostate-Specific Antigen.

Prostate cancer (PCa) screening can lead to potential over-diagnosis/over-treatment of indolent cancers. There is a need to optimize practices to better risk-stratify patients. We examined initial longitudinal outcomes of mid-life men with an elevated baseline prostate-specific antigen (PSA) following initiation of a novel screening program within a system-wide network. We assessed our primary care network patients ages 40 to 49 years with a PSA measured following implementation of an electronic health record screening algorithm from 2/2/2017-2/21/2018. The multidisciplinary algorithm was developed taking factors including age, race, family history, and PSA into consideration to provide a personalized approach to urology referral to be used with shared decision-making. Outcomes of men with PSA ≥1.5 ng/mL were evaluated through 7/2021. Statistical analyses identified factors associated with PCa detection. Clinically significant PCa (csPCa) was defined as Gleason Grade Group (GGG) ≥2 or GGG1 with PSA ≥10 ng/mL. The study cohort contained 564 patients, with 330 (58.5%) referred to urology for elevated PSA. Forty-nine (8.7%) underwent biopsy; of these, 20 (40.8%) returned with PCa. Eleven (2.0% of total cohort and 55% of PCa diagnoses) had csPCa. Early referral timing (odds ratio [OR], 4.58) and higher PSA (OR, 1.07) were significantly associated with PCa at biopsy on multivariable analysis (both p<0.05), while other risk factors were not. Referred patients had higher mean PSAs (2.97 vs. 1.98, p=0.001). Preliminary outcomes following implementation of a multidisciplinary screening algorithm identified PCa in a small, important percentage of men in their forties. These results provide insight into baseline PSA measurement to provide early risk stratification and detection of csPCa in patients with otherwise extended life expectancy. Further follow-up is needed to possibly determine the prognostic significance of such mid-life screening and optimize primary care physician-urologist coordination.

Mobile health assisted self-monitoring is acceptable for supporting weight loss in rural men: a pragmatic randomized controlled feasibility trial

BackgroundAddressing overweight and obesity among men at-risk for obesity-related diseases and disability in rural communities is a public health issue. Commercial smartphone applications (apps) that promote self-monitoring for weight loss are widely available. Evidence is lacking regarding what support is required to enhance user engagement with and effectiveness of those technologies. Pragmatically comparing these apps effectiveness, including rural men’s desired forms of support when using them, can lead to greater weight loss intervention impact and reach. This study assessed the feasibility and acceptability of a mobile technology application applied differently across two groups for weight loss.MethodsIn a two-armed, pragmatic pilot feasibility study, 80 overweight and obese men aged 40–69 were randomized using a 1:1 ratio to either an enhanced Mobile Technology Plus (MT+) intervention or a basic Mobile Technology (MT) intervention. The MT+ group had an enhanced smartphone app for self-monitoring (text messaging, discussion group, Wi-Fi scale) whereas the MT group received a basic app that allowed self-monitoring logging only. Assessments were collected at baseline, 3 and 6 months. App logs were analyzed to track engagement and adherence to self-monitoring. Acceptability was assessed via focus groups. Analysis included descriptive statistics and qualitative content analysis.ResultsOf 80 men recruited, forty were allocated to each arm. All were included in the primary analysis. Recruitment ended after 10 months with a 97.5 and 92.5% (3 month, 6 month) retention rate. Over 90% of men reported via survey and focus groups that Lose-It app and smart scale (MT+) was an acceptable way to self-monitor weight, dietary intake and physical activity. Adherence to daily app self-monitoring of at least 800 dietary calories or more (reported respectively as MT+, MT) was positive with 73.4, 51.6% tracking at least 5 days a week. Adherence to tracking activity via recorded steps four or more days weekly was positive, 87.8, 64.6%. Men also adhered to self-weighing at least once weekly, 64, 46.3%. At 6 months, an observed mean weight loss was 7.03 kg (95% CI: 3.67, 10.39) for MT+ group and 4.14 kg (95% CI: 2.22, 6.06) for MT group, with 42.9 and 34.2% meeting ≥5% weight loss, respectively. No adverse events were reported.ConclusionsThis National Institutes of Health-funded pilot study using mobile technologies to support behavior change for weight loss was found to be feasible and acceptable among midlife and older rural men. The interventions demonstrated successful reductions in weight, noting differing adherence to lifestyle behaviors of eating, monitoring and activity between groups, with men in the MT+ having more favorable results. These findings will be used to inform the design of a larger scale, clinical trial.Trial registrationThe trial was prospectively registered with ClinicalTrials NCT03329079. 11/1/2017.

Association of sex differences in dementia risk factors with sex differences in memory decline in a population-based cohort spanning 20\u201376\xa0years

Sex differences in late-life memory decline may be explained by sex differences in dementia risk factors. Episodic memory and dementia risk factors were assessed in young, middle-aged and older adults over 12 years in a population-based sample (N = 7485). For men in midlife and old age, physical, cognitive and social activities were associated with less memory decline, and financial hardship was associated with more. APOE e4 and vascular risk factors were associated with memory decline for women in midlife. Depression, cognitive and physical activity were associated with memory change in older women. Incident midlife hypertension (β = − 0.48, 95% CI − 0.87, − 0.09, p = 0.02) was associated with greater memory decline in women and incident late-life stroke accounted for greater memory decline in men (β = − 0.56, 95% CI − 1.12, − 0.01), p = 0.05). Women have fewer modifiable risk factors than men. Stroke and hypertension explained sex differences in memory decline for men and women respectively.

Age of Migration and Cognitive Life Expectancies Among Older Latinos: Evidence From the Health and Retirement Study

This study used data from the Health and Retirement Study (1998-2014) to estimate Sullivan-based life tables of cognitively intact, cognitively impaired/no dementia (CIND), and dementia life expectancies by nativity, age of migration, and sex for older Latinos residing in the United States. Results show foreign-born Latinos, regardless of age of migration or sex, spend a greater number of years after age 50 with CIND compared to U.S.-born Latinos. Furthermore, we document an advantage in total life expectancy and cognitively intact life expectancy among mid-life immigrant men relative to their U.S.-born counterparts. The robust relationship between nativity, age of migration, and cognitive health suggests that the foreign-born may place particularly serious burdens on families and the government. This issue merits special attention in the development of community-based long-term care programs to appropriately target the specific needs of different subgroups of older Latinos who are entering into their last decades of life.