National Sample Of Older Adults Research Articles

Residential Street Block Disorder and Biological Markers of Aging in Older Adults: The National Health and Aging Trends Study.

Residential environments are associated with older adults' health, but underlying physiologic causal mechanisms are not well understood. As adults age, street blocks are likely more relevant to their health than the larger neighborhood environment. This study examined the effects of adverse street block conditions on aging biomarkers among older adults. We included community-dwelling Medicare beneficiaries aged 67 and older with 2017 biomarker data from the nationally representative National Health and Aging Trends Study (n = 4357). Street block disorder in 2016 was measured using interviewer report of any trash/glass/litter, graffiti, or vacant buildings on participants' blocks. Propensity score models were used to create balanced groups with regard to multiple 2015 participant characteristics, including demographic, socioeconomic, residence, and early-life characteristics. Linear regressions modeled street block disorder as a predictor of 4 aging biomarkers, hemoglobin A1C, high-sensitivity C-reactive protein, interleukin-6, and cytomegalovirus antibodies, before and after applying propensity score weighting. Adjusting for participant sociodemographic characteristics and applying propensity score weights, living on a block with any disorder was associated with 2% higher mean hemoglobin A1C levels (95% confidence interval [CI]: 0.002-0.03), 13% higher C-reactive protein (95% CI: 0.03-0.23), 10% higher interleukin-6 (95% CI: 0.02-0.19), and 19% more cytomegalovirus antibodies (95% CI: 0.09-0.29) compared to living on a block with no disorder. Street block disorder predicted subsequent aging biomarkers after applying a propensity score approach to account for confounding among a national sample of older adults. Targeting street-level residential contexts for intervention may reduce the risk for poor health in older adults.

Formal and informal social participation and elder mistreatment in a national sample of older adults.

Older adults' susceptibility to mistreatment may be affected by their participation in social activities, but little is known about relationships between social participation and elder mistreatment. Cross-sectional analysis. National probability sample of older community-dwelling U.S. adults interviewed in 2015-2016, including 1268 women and 973 men (mean age 75 years and 76 years, respectively; 82% non-Hispanic white). Frequency of participation in formal activities (organized meetings, religious services, and volunteering) and informal social activities (visiting friends and family) was assessed by questionnaire. Elder mistreatment included emotional (four items), physical (two items), and financial mistreatment (two items) since age 60. Multivariable logistic regression examined associations between each type of social participation and elder mistreatment among men and women, adjusting for age, race/ethnicity, education, and comorbidity. Forty percent of women and 22% of men reported at least one form of mistreatment (emotional, physical, or financial). Women reporting at least monthly engagement in formal social activities were more likely to report emotional mistreatment (adjusted odds ratio (AOR) 1.59, 95% confidence interval (CI) 1.09-2.33). Among men, monthly organized meeting attendance was associated with increased odds of emotional mistreatment (AOR 1.34, 95% CI 1.01-1.93). Weekly informal socializing was inversely associated with emotional mistreatment (AOR 0.59, 95% CI 0.44-0.78) and financial mistreatment (AOR 0.59, 95% CI 0.42-0.85) among women. In this national cohort, older adults who were frequently engaged in formal social activities reported similar or higher levels of mistreatment than those with less frequent organized social participation. Older women with regular informal contact with family or friends were less likely to report some kinds of mistreatment. Strategies for detecting and mitigating elder mistreatment should consider differences in patterns of formal and informal social participation and their potential contribution to mistreatment risk.

Bidirectional and Dynamic Relationships Between Social Isolation and Physical Functioning Among Older Adults: A Cross-Lagged Panel Model of US National Survey Data.

Previous studies examining unidirectional relationships between social isolation and physical functioning among older adults may be biased due to reverse causality. This study leveraged data from a US national sample of older adults and a novel estimation method to identify bidirectional associations between these 2 phenomena and their associated temporal dynamics. The analyses were based on 9 waves of panel data from a sample of adults aged 65 and older from the US National Health and Aging Trends Study (n = 12 427 individuals) and a cross-lagged panel model. Social isolation was measured using the Social Isolation Index (SII) and physical functioning through the Short Physical Performance Battery (SPPB). One SD increase in the SPPB was associated with a -0.013 SD decrease (95% confidence interval [CI]: -0.023 to -0.004) in the SII a year later, whereas 1 SD increase in the SII was associated with a larger -0.058 SD decrease (95% CI: -0.069 to -0.046) in the SPPB a year later. The SII→SPPB effect lasted for approximately 5 years, whereas the SPPB→SII lasted for approximately 3 years. This study confirmed the existence of statistically significant bidirectional associations between social isolation and physical functioning among older adults in the United States, net of reverse causation. Because the effect of social isolation dominates, the findings indicate that public health strategies to promote successful aging should prioritize interventions that enrich older adults' social networks. Furthermore, the effect time horizons yielded by the model point to the optimal timing for the re-delivery of interventions.

Prevalence of Malnutrition in a National Sample of Older Adults Residing in Community or Residential Care: NHATS 2017

The national prevalence of malnutrition in older adults living in the community and residential care (non-nursing home) is not known. We determined the prevalence of malnutrition (Mini-Nutritional Assessment) in a representative sample (N=4472) living in the community (95%) or residential care (5%), and examined known nutrition risk factors (inflammation [hsCRP, IL-6], socio-demographic variables). The majority (68%) were nourished, 26% were at risk, and 6% were malnourished. Those living in residential care vs community were more likely to be malnourished (12% vs 5%, respectively p<.01). Compared to nourished group, those with malnutrition were more likely to have hsCRP greater than median (1.36) (OR = 1.45 [95% CI 1.01-1.92]) and those at nutritional risk were more likely to have IL-6 greater than median (4.22) (OR=1.34 [95% CI 1.09-1.63]). Malnourished older adults were more likely to be older, female, live alone, report worse self-reported health, and use Meals on Wheels (p <.05).

Having a Usual Source of Care Is Associated with Longer Telomere Length in a National Sample of Older Adults.

To provide a potential biological, mechanistic link for the well-established association between primary care access and reduced mortality, this study sought to measure the impact of having a usual source of health care on leukocyte telomere length (LTL). Our study population included 3202 participants aged 50 to 84 years from National Health and Nutrition Examination Survey 1999 to 2001. Cross-sectional Study. LTLs between people with and without a usual source of care were compared using unadjusted and adjusted linear regression models. Fully adjusted models accounted for demographic characteristics, health conditions, and health behaviors. After controlling for individual factors, health conditions, and health behaviors, people who had a usual source of health care had significantly longer LTL (β = 89.8 base pairs, P-value = .005) compared with those without a usual source of care; corresponding to approximately 7 years of life. Having a usual source of health care is associated with longer LTL among older adults. This study provides a potential biologic link for the noted association between primary care access and reduced mortality that has been observed at the individual and population level.

Associations of loneliness and social isolation with actigraph and self-reported sleep quality in a national sample of older adults.

To examine associations of social isolation and loneliness with sleep in older adults and whether associations differ for survey and actigraph sleep measures. This study used data from the National Social Life, Health, and Aging Project (NSHAP), a nationally representative study of community-dwelling older adults born 1920-1947. A random one-third of participants in 2010-2011 were invited to participate in a sleep study (N = 759) that included survey questions, 72 hours of wrist actigraphy, and a sleep log. Perceived loneliness was measured using three questions from the UCLA Loneliness Scale. An index of social isolation was constructed from nine items that queried social network characteristics and social interactions. We used ordinary least squares and ordinal logistic regression to examine whether sleep measures were associated with loneliness and social isolation adjusted for potential sociodemographic confounders. Social isolation and loneliness had a low correlation (Spearman's correlation = 0.20). Both loneliness and social isolation were associated with actigraphy measures of more disrupted sleep: wake after sleep onset and percent sleep. Neither was associated with actigraph total sleep time. Increased loneliness was strongly associated with more insomnia symptoms and with shorter sleep duration assessed by a single question, but social isolation was not. More isolated individuals spent a longer time in bed. We found that both loneliness and social isolation were associated with worse actigraph sleep quality, but their associations with self-reported sleep differed. Only loneliness was associated with worse and shorter self-reported sleep.

Fine Particulate Matter and Poor Cognitive Function among Chinese Older Adults: Evidence from a Community-Based, 12-Year Prospective Cohort Study.

Background:Research on the relationship between long-term exposure to particulate matter with aerodynamic diameter () and poor cognitive function is lacking in developing countries, especially in highly polluted areas.Objectives:We evaluated associations of long-term exposure to with poor cognitive function in a diverse, national sample of older adults in China.Methods:This analysis included data on 13,324 older adults (5,879 who were 65–79 years of age, 3,052 who were 80–89 years of age, 2,634 who were 90–99 years of age, and 1,759 who were of age) with normal cognitive function at baseline from March 2002 to September 2014, with 64,648 person-years of follow-up. We used a geographic information system analysis to estimate the annual average satellite-derived concentration for the geocoded location of the participants’ baseline residences. Poor cognitive function was defined as a score of less than 18 on the Chinese version of the Mini-Mental State Examination (MMSE). Competing risk models were performed to explore the association of with poor cognitive function.Results:Each increase in was associated with a 5.1% increased risk of poor cognitive function [adjusted hazard ratio (HR): 1.051; 95% confidence interval (CI): 1.023, 1.079]. Compared to the lowest quartile of (), adjusted values were 1.20 (95% CI: 1.09, 1.33), 1.27 (95% CI: 1.15, 1.41), and 1.21 (95% CI: 1.09, 1.34) for the second (), third (), and fourth () quartiles of , respectively (p for trend ). Subgroup analyses suggested stronger associations between and poor cognitive impairment in men than women. The association was positive in the 65- to 79- and age group but not significant and positive in the other two age groups with similar results.Conclusion: was identified as a risk factor for poor cognitive function in Chinese older adults. Improving air quality may reduce the future population burden of poor cognitive function, especially in areas with high air pollution. https://doi.org/10.1289/EHP5304

The moderating role of social factors in the relationship between an incident of fall and depressive symptoms: a study with a national sample of older adults in South Korea

Objectives The purpose of the study was to examine the effect of an incident of fall on depressive symptoms and the moderating role of social factors (marital status, living arrangement, family network, and friend network) in older adults in South Korea. We hypothesized that the adverse mental health effect of a fall would be pronounced among those who lack social resources (e.g., no spouse, living alone, and social disconnectedness). Method Using the 2017 National Survey of Older Koreans, data were drawn from 8,522 survey participants (aged 65 or older). Multivariate linear regression models of depressive symptoms were examined with an array of predictors: (1) demographic and health variables, (2) social factors, (3) an incident of fall, and (4) interactions between falls and social factors. Results More than 15% of the sample had at least one fall in the past 12 months. Higher levels of depressive symptoms were associated with an incident of fall, not married and living alone, and lack of family and friend networks. Not married and living alone and family network significantly moderated the relationship between falls and depressive symptoms. The adverse mental health effect of a fall was more pronounced among those who were not married and living alone and who reported not having any close family members than their counterparts. Conclusion The findings highlight the critical role of family and social resources in protecting older Koreans from the negative mental health consequences of a fall. Findings also provide implications for developing fall prevention and management programs, suggesting prioritizing older adults with limited social resources.

Race and Asthma Outcomes in Older Adults: Results from the National Asthma Survey

The number of older adults with asthma continues to rise, yet the effects of race and ethnicity on asthma outcomes in this population are unknown. To characterize the effect of race and ethnicity on asthma outcomes in a large national sample of older adults and to identify factors that are associated with disparities found. Data from the 2015 Behavioral Risk Factor Surveillance Survey and Asthma Call-Back Survey were analyzed. Respondents were included if they had a current asthma diagnosis, were aged ≥55, and self-identified as non-Hispanic white, African American, or Hispanic. Demographic variables, health care access, comorbidities, and asthma history were correlated with asthma outcomes (health care utilization and asthma control). Asthma outcome variables were further analyzed using multivariable logistic regression. A total of 4700 individuals were included. Compared with non-Hispanic white respondents, African American and Hispanic respondents had lower incomes, greater impaired access to health care due to cost, and increased reliance on rescue medications. After controlling for factors including income, education, comorbidities, and health insurance, African American and Hispanic respondents were twice as likely to visit the emergency room (ER) for asthma (P < .001 for both) and 40% less likely to report uncontrolled daytime symptoms (P= .002 and .008). Racial differences in asthma outcomes persist despite controlling for multiple social determinants of health and access to health insurance through Medicare. Minority patients were more likely to visit the ER but less likely to report frequent daytime symptoms. These findings indicate that comprehensive strategies to address assessment, monitoring, and treatment are needed to decrease health disparities.

Social gradients in dental attendance among older adults: Findings from the National Survey on Demographics and Health in Peru.

To assess the presence of inequalities in attendance to dental services in relation to socio-economic position (SEP) in a national sample of older adults in Peru. A cross-sectional study using multivariate regression analysis of secondary data obtained from the National survey on demographics and family health in Peru (Encuesta Nacional en Demografía y Salud familiar, ENDES). 4749 ≥60-year-olds. Attendance at dental health services in the last 2 years. Independent variable: Wealth Index as a measure of SEP. Covariates: Sex, age, natural region of residence, place of residence and health insurance coverage. There was a social gradient for the association between attendance to dental health services and SEP, with older adults from the richest (fifth) quintile showing a 3.01 times higher probability of visiting dental services (95%CI 2.15-4.19), those in the fourth quintile PR=2.19 (95%CI 1.61-3.00), third quintile PR=2.00 (95%CI 1.49-2.69), and those in the second quintile PR=1.42 (95%CI 1.10-1.84), when compared to the poorest quintile after adjusting for sex, age, residence, natural region and health insurance coverage. There is a clear social gradient in dental attendance among older adults in Peru. This is important to provide further insights into current national programmes and relevant long-term policies.

No seasonal influence on cognitive performance in a national sample of older adults in New Zealand.

A recent North American study reported seasonal differences in cognitive functioning in older adults. We assessed seasonality of cognitive functioning in a large data set of older adults in New Zealand. The International Residential Assessment Instrument-Home Care (interRAI-HC) data set was analysed using a non-parametric method for testing seasonal distribution of cognitive and depression scale scores. Participants were 73285 New Zealanders 65years and older who completed their first interRAI-HC assessment (mean age, 81.4years; 57% female). We analysed this sample cross-tabulating season (summer, autumn, winter and spring) and the Cognitive Performance Scale (CPS) score (Kruskal-Wallis test, P=0.45). Month-by-month CPS scores also demonstrated no variation (Spearman's test, P=0.96). There was no association between season of assessment and the Depression Rating Scale score, ruling out variability in affect impacting on cognitive performance (Kruskal-Wallis test, P=0.99). Our findings, limited to the Southern Hemisphere, demonstrate a lack of seasonality in cognitive performance and impairment in older adults.

Does salivary telomere length explain race/ethnic differences in aging?

ABSTRACT Telomere length (TL) is a biomarker that can be used to characterize variability in aging and may explain race/ethnic differences in aging. Yet, it remains unclear if TL is related to aging-associated health risks in multi-ethnic populations or if it explains race/ethnic differences in health. We examine whether salivary TL (STL) explains any of the race/ethnic variability in 15 indicators of high-risk biological, physical, and cognitive health among 4,074 White, Black, and Latinx older adults ages 54+ in the 2008 Health and Retirement Study. TL was assayed from saliva using quantitative PCR (T/S ratio). Decomposition analyses from logistic regression models show variation in STL does not account for any of the observed race/ethnic differences health. In age-adjusted, race-stratified models, STL was associated with HDL, total cholesterol, and lung function among Whites, but was not associated with any markers of health among Black or Latinx groups. In this diverse national sample of older adults, STL does not account for race/ethnic differences in late life health, is associated with relatively few indicators of health among Whites, and is not associated with indicators of health among Black or Latinx groups. STL may not be a useful biomarker for understanding racial/ethnic differences in population aging among older adults.

Food Insecurity Is Associated with Lower Cognitive Functioning in a National Sample of Older Adults

BackgroundFood insecurity, a social and economic condition of inadequate food resources, is known to affect cognitive development in children. However, research is sparse among adult populations, particularly older adults who may be more susceptible to accelerated cognitive decline. ObjectivesThe aim of this study was to examine the associations between food insecurity and cognitive functioning among older adults. MethodsData came from 1823 older adults (≥60 y) with incomes ≤300% of the federal poverty level (FPL) from the 2011–2014 NHANES. Food security was measured using the 10-item Adult Food Security Survey Module. Cognitive function was measured using the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) word learning subtest and delayed word recall, the Animal Fluency Test (AFT), and the Digit Symbol Substitution Test (DSST). The cognitive assessments were then standardized and an overall cognitive function z score was created by averaging across all cognitive assessments. Associations with food insecurity were examined using multivariate linear regression models, adjusting for sociodemographic and health characteristics. ResultsIn the analytic population, the prevalence of food insecurity was 23.7%. Across all cognitive assessments, the mean scores among food-insecure adults was significantly lower than the mean scores among food-secure adults. After adjusting for sociodemographic and health characteristics, food insecurity was associated with lower scores on the CERAD word learning subtest (β = −0.14, 95% CI: −0.26, −0.01), the AFT (β = −0.13, 95% CI: −0.25, −0.002), and the DSST (β = −0.24, 95% CI: −0.33, −0.15). Food insecurity was also associated with a lower score on the overall cognitive function z score (β = −0.15, 95% CI: −0.26, −0.05). ConclusionsIn this national sample of 1823 adults aged ≥60 y, food insecurity was inversely associated with cognitive function, which may translate into higher risk of cognitive impairment over time.

So Help Me, God: Religiosity and End-of-Life Choices in a Nationally Representative Sample.

Background: Studies show significant associations between the various dimensions of religiousness and end-of-life (EOL) decisions, such as individuals with high religiosity are more likely to choose aggressive care at EOL. However, these studies focused largely on smaller cancer populations. To our knowledge, there is no existing literature about the association between religiosity and EOL decisions within a national sample of older adults. Objective: The objective of this study was to investigate the association between religiosity and advance directive (AD) completion, and among those with an AD, documented EOL care preferences, using a nationally representative sample. Methods: This was an observational study. Descriptive statistics and logistic regression were conducted with 6051 decedents from the Health and Retirement Study using self-reported frequency of religious service attendance, importance of religion, and religious affiliation. Measurements: The dependent variables were AD completion and care preference. The independent variables were self-reported frequency of religious service attendance, importance of religion, and religious affiliation. Results: Protestants and Catholics had significantly lower odds of AD completion, compared with those with no religious preferences. Decedents who reported religion as very important had significantly lower odds of AD completion than decedents who said religion is not too important. Furthermore, decedents who attended religious services at least once a week, compared with those who do not attend, had significantly higher odds of completing an AD. Among those who completed an AD, neither religiosity nor religious affiliation was significantly associated with preference for prolonged care. Conclusions: Our study demonstrates the influence religiosity has on the development of ADs, prompting seriously ill patients' religious needs to be recognized and supported. It further suggests that religious services may provide a good opportunity for promoting knowledge and completion of ADs.

Cancer in the context of aging: Health characteristics, function and caregiving needs prior to a new cancer diagnosis in a national sample of older adults

IntroductionAs cancer trajectories change due to screening, earlier diagnoses, living longer with illnesses, and new successful treatments, cancer is increasingly a disease of older adults. While cancer diagnoses themselves are very stressful for patients and families, little is known about the health status, functional limitations, and social resources of older patients before they face a new cancer diagnosis. Materials and MethodsUsing the National Health and Aging Trends Study (NHATS), a national survey of older Medicare beneficiaries linked to Medicare claims data, we examined the health characteristics, functional limitations and social and financial resources of older adults before a new diagnosis of lung, breast, prostate or colorectal cancer and how these factors vary by race/ethnicity. ResultsWe identified 274 community-dwelling older adults with incident cancer diagnoses: lung (30.6%), breast (20.3%), prostate (30.8%), and colorectal (18.3%) representing 1,202,920 older Medicare beneficiaries. The sample was 81% Non-Hispanic White, 10% Non-Hispanic Black, and 9% Hispanic/Other. Before diagnosis, patients had an average of three comorbidities and 29% of patients reported poor/fair health. Almost one-third were living alone, 13% received help with at least one activity of daily living (ADL), 11% had probable dementia and nearly one in ten already received financial help from family members. DiscussionBefore an older adult has ever been diagnosed with a major cancer, many face significant health and financial challenges and are dependent on others for care. These needs vary based on cancer type and race/ethnicity and must be considered as clinicians develop individualized care plans for patients alongside caregivers.

An Examination of Downstream Effects of Bereavement on Healthcare Utilization for Surviving Spouses in a National Sample of Older Adults.

While bereavement is associated with increased mortality, it is unclear how bereaved families utilize the healthcare system after the death of their loved ones. The aim of this study was to examine the association between bereavement and healthcare expenditures for surviving spouses. We used data from the Health and Retirement Study, a nationally representative cohort study of older adults linked to Medicare claims. We determined a spouse's total Medicare expenditures 2years before and after their partner's death across six biennial interview waves. Using coarsened exact matching, we created a comparison group of non-bereaved dyads. Costs were wage index- and inflation-adjusted to 2017 dollars. We used generalized linear models and difference-in-differences (DID) analysis to calculate the average marginal effects of bereavement on Medicare spending by gender. We also examined subgroup differences based on caregiver status, cause of death, and length of terminal illness. Our sample consisted of 941 bereaved dyads and a comparison group of 8899 matched dyads. Surviving female spouses (68% of the sample) had a $3500 increase in spending 2years after death (p < 0.05). Using DID analyses, bereavement was associated with a $625 quarterly increase in Medicare expenditures over 2years for women. There was no significant increase in post-death spending for male bereaved surviving spouses. Results were consistent for spouses who survived at least 2years after the death of their spouse (70% of the sample) CONCLUSIONS: Bereavement is associated with increased healthcare spending for women regardless of their caregiving status, the cause of death, or length of terminal illness. Further study is required to examine why men and women have different patterns of healthcare spending relative to the death of their spouses.

Association of Physical Activity on Memory and Executive Function: Population-Based National Sample of Older Adults

The objective of this study was to evaluate the relationship between physical activity and various components related to memory and executive function among older adults. Data from the 2011–2012 and 2013–2014 NHANES were used (N = 2241; 60+ years of age). The Global Physical Activity Questionnaire was utilized to assess recreational engagement in moderate- and vigorous-intensity physical activity. The memory and executive assessments included the CERAD (Consortium to Establish a Registry for Alzheimer’s Disease) Word Learning subset, the animal fluency test, and the digit symbol substitution test (DSST). Vigorous-intensity physical activity was positively associated with trial 1 of the CERAD Word List (β = 0.01; 95% CI, 0.003–0.02), the average of trials 1–3 for the CERAD Word List (β = 0.01; 95% CI, 0.0001–0.02), animal fluency task (β = 0.10; 95% CI, 0.05–0.15), and the DSST (β = 0.19; 95% CI, 0.08–0.29). Older individuals meeting vigorous-intensity physical activity guidelines had superior memory and executive function.

FINANCIAL STRAIN PREDICTS INCIDENT DISABILITY IN OLDER ADULTS IN THE NATIONAL HEALTH AND AGING TRENDS STUDY

Financial strain has been cross-sectionally associated with limitations in self-care activities and mobility. Financial strain may be more readily modified than other measures of socioeconomic status. We tested associations between financial strain and incident disability in a nationally representative sample of adults aged ≥65 years. The National Health and Aging Trends Study annually classified disability based on limitations in mobility (inability to complete the walking speed test), function (unable to walk 3 blocks or 10 stairs, carry 10 pounds, bend over, reach overhead or grasp small objects) and self-care (difficulty dressing, getting around inside the home, getting out of bed, toileting or eating). Baseline (2012) financial strain was classified based on lack of money for housing, utilities, health care, or food. Discrete time survival models tested associations with incident limitations in mobility (n=3434) function (n=2829) and self-care (n=5187) separately (2013 to 2016) among those free of the respective limitation in 2012, adjusting for demographics, income-to-poverty-threshold ratio, education, chronic conditions, BMI, and self-rated health. Baseline sample weights accounted for sampling design and nonresponse. Annual limitation incidence rates ranged 3.0%-6.7% for mobility, 13.4%-23.9% for function, and 12.8%-18.1% for self-care over four years. In adjusted models, financial strain predicted incident limitations in mobility (hazard OR=1.46, 95% CI: 1.02, 2.09), function (hOR= 1.41, 95% CI: 1.01, 1.97), and self-care (hOR=1.99, 95% CI: 1.52, 2.61). These results show that financial strain predicts disability independent of income in a national sample of older adults. Greater attention should be paid to strategies that may reduce financial strain.

Fine Particulate Matter Air Pollution and Incidence of Cognitive Impairment among the Elderly in China

Background/Aim: Long-term exposure to fine particulate matter (PM2.5) has been shown to increase risk of cognitive impairment. However, research on the relationship between exposure to PM2.5and cognitive function is lacking in developing countries,especially in highly polluted areas.The aim of this study is to determine if exposure to PM2.5 is associated with cognitive function in a diverse, national sample of older adults in china.Methods: This analysis included data on5704older adults aged &amp;#8805;65 years from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) in 2008-2011,which randomly selects half of the counties and cities in 23 of China&amp;#8217;s 31 provinces. We used geographic information system to estimate annual average satellite-derived PM2.5 concentration for the geocoded location of participants&amp;#8217; baseline residences enrolled between 2008 and 2011.The cognitive function was assessed with Mini Mental State Evaluation(MMSE)scale. Association between PM2.5 concentration and cognitive impairment was analyzed by logistic regression model．Results: The average age of participants was 79.6years.Logistic regression analysis resultsshowed that a 10&amp;#956;g/m3 increase in PM2.5 concentration was associated with an increased odds of incident impairment, after adjusting for demographic factors and behavioral factors [RR (95% CI): 1.06 (1.01, 1.11)]. The effect is especially significant in men, current alcohol drinker, current smoker, the elder age group and hypertensive patients.Conclusions: PM2.5 was associated with increased risk of cognitive impairment incidence in the elderly of china. Air pollution reduction is a potential measures for reducing the future population burden of age-related cognitive decline, especially in heavy air polluted area.

The Association between Lower Extremity Muscular Strength and Cognitive Function in a National Sample of Older Adults.

BackgroundWe evaluated the association between lower extremity muscular strength and cognition among older adults in the United States.MethodsData from the 1999–2002 National Health and Nutrition Examination Survey was used to identify 1508 older adults, between 60–85 years. Muscle strengthening activities were assessed via self-report. Participation in physical activity was determined from self-report data. The DSST was used to assess participant executive cognitive functioning tasks of pairing and free recall. A Kin-Com MP isokinetic dynamometer (Chatanooga Group Inc.) was used to assess lower extremity strength, expressed as absolute strength (N), relative strength (N/body weight in kg), and high (<245.75 N) vs. low (≤245.75 N) absolute strength based on the median levels of strength.ResultsLower extremity strength (β = 0.01; 95% CI: 0.0008–0.03; p = 0.039) was associated with higher cognitive performance, independent of age, muscle strengthening activities, physical activity and other covariates. In an adjusted multivariate logistic regression model, those with high (vs. low) strength had a 34% reduced odds of having low cognitive function (OR = 0.66; 95% CI: 0.46–0.93; p = 0.02).ConclusionIn this nationally representative sample of older adults, there was a positive association between elevated lower extremity muscular strength and cognitive functioning.