National Social Life, Health, And Aging Project Research Articles

Examining the Longitudinal Relationship Between Olfactory Dysfunction and Frailty in Community-Dwelling, older US Adults.

Olfactory dysfunction is a "canary in the coalmine" for aging conditions. We evaluated olfactory dysfunction as a biomarker of early frailty in older adults living in the United States. Prospective, longitudinal, nationally representative study. National Social Life, Health and Aging Project (NSHAP). We examined data from 1061 community-dwelling older US adults. Odor identification (5-item Sniffin' Stick) and frailty scores were measured at baseline and 5-year follow-up. Multivariate logistic regressions evaluated the association between olfactory dysfunction and frailty at baseline in cross-section and over time in the transition from robust to prefrail to frail, adjusting for confounding factors measured at baseline. Older US adults who were anosmic at baseline were more likely to be frail 5 years later compared to normosmic peers (odds ratio [OR]: 3.83, 95% confidence interval [CI]: 1.10-13.31, P = .035). Examining changes in frailty stage over time, we found that anosmics were more likely to transition from prefrail to frail over 5 years (OR: 3.25, 95% CI: 1.31-8.08, P = .011). Interestingly, hyposmics did not show a similar trajectory toward frailty (P > .05). In contrast, olfactory dysfunction was not associated with frailty in cross-section (OR: 0.90, 95% CI: 0.43-1.89, P = .787, hyposmia; OR: 0.72, 95% CI: 0.15-3.35, P = .673, anosmia). Older US adults with anosmia face higher odds of becoming frail over 5 years, especially those in the prefrail stage. Olfactory dysfunction may serve as a surrogate marker for early-stage neurodegenerative diseases, which are strong contributors to frailty.

Race/ethnicity and the measurement of cognition in NSHAP: Recommendations for robustness.

In this study, we examine the measurement of cognition in different racial/ethnic groups to move towards a less biased and more inclusive set of measures for capturing cognitive change and decline in older adulthood. We use data from Round 2 (N=3377) and Round 3 (N=4777) of the National Social Life, Health, and Aging Project (NSHAP) and examine the study's Survey Adjusted version of the Montreal Cognitive Assessment (MoCA-SA). We employ exploratory factor analyses to explore configural invariance by racial/ethnic group. Using modification indexes, two-parameter item response theory models, and split-sample testing, we identify items that seem robust to bias by race. We test the predictive validity of the full (18-item) and short (4-item) MoCA-SAs using self-reported dementia diagnosis, instrumental activities of daily living (IADLs), proxy reports of dementia, proxy reports of dementia-related death, and National Death Index reports of dementia-related death. We found that four measures out of the 18 used in NSHAP's MoCA-SA formed a scale that was more robust to racial bias. The shortened form predicted consequential outcomes as well as NSHAP's full MoCA-SA. The short form was also moderately correlated with the full form. Although sophisticated structural equation modeling techniques would be preferrable for assuaging measurement invariance by race in NSHAP, the shortened form of the MoCA-SA provides a quick way for researchers to carry out robustness checks and to see if the disparities and associations by race they document are "real" or the product of artifactual bias.

Addressing Cognitive Assessment Disparities Among Hispanic Adults: Adapting the MoCA-SA for Improved Accuracy and Accessibility Among Spanish-speakers.

Hispanic adults display a higher likelihood of early-stage cognitive decline than their White counterparts yet receive fewer clinical diagnoses. This troubling trend highlights the significance of longitudinal surveys like the National Social Life, Health, and Aging Project (NSHAP) in monitoring cognitive changes in aging Hispanics. Using NSHAP's Rounds 2 and 3, we observed notable cognitive score differences between English and Spanish speakers, as assessed by the survey-adapted version of the Montreal Cognitive Assessment (MoCA-SA). Our study aims to discern if statistical adjustments can reduce measurement variance in global cognition scores between these language groups. We applied modification indexes, two-parameter item response theory models, and split-sample testing to pinpoint items that exhibit resilience to language-related bias among our Hispanic sample. From this analysis, an abbreviated version of the MoCA-SA, termed MoCA-SAA, was introduced. Subsequently, we juxtaposed the performance and predictive validity of both MoCA versions against four consequential outcomes indicative of cognitive decline. Our refined methodologies enabled the identification of consistent items across both language cohorts. The MoCA-SAA demonstrated a performance and predictive validity in line with the original MoCA-SA concerning outcomes linked to cognitive deterioration. The translated measures ensure the inclusion of Hispanic Spanish speakers in NSHAP, who might otherwise be overlooked. The statistical adjustment outlined in this study offers a means to mitigate potential measurement disparities when assessing overall cognition. Despite these advancements, we acknowledge persistent issues related to the translation of the MoCA-SA into Spanish that warrant further attention.

The Social Connectedness of Older Adults during the COVID-19 Pandemic: Evidence by Survey Mode and Respondent Dementia.

The COVID-19 pandemic has affected many aspects of social life, especially among older adults who may face cognitive impairments. Concerning this combination of circumstances, the study evaluates the degree to which data collection on social connectedness among older adults might be affected by the social complexities of the COVID-19 pandemic. We use data from the National Social Life, Health and Aging Project (NSHAP), a nationally representative study of community-dwelling older adults in the U.S., which conducted a special multi-mode COVID study between September 2020 and January 2021, in part to examine social impacts of the COVID-19 pandemic and to assess how alternative survey modes performed during the pandemic. Our final sample includes 2,251 older adults, ages 55 and older. Older adults' social connectedness was adversely affected by the pandemic. People reported a tendency to move toward electronic communication and away from in-person contact. Concomitantly, there is some evidence of survey mode effects that are related to electronic communication. Those who elected to participate on the phone, or the internet disproportionately reported using those means of communication with their social network members. Notably, this pattern was stronger among those who did not suffer from dementia, suggesting cognition effects on survey completion. Researchers should remain cognizant of how data on social connections were collected during the COVID-19 pandemic. These findings may indicate the role dementia plays in preventing people from adapting to new social networking realities with alternative means of communication during the pandemic.

Association of alcohol use with olfactory function among older adults

Background/purposeOlfactory dysfunction (OD) has been recognized as an early biomarker for neurodegenerative diseases. Identifying behaviors that increase the risk of OD is crucial for early recognition of neurogenerative diseases. Alcohol consumption can potentially impact olfaction through its neurotoxic effects. This study aims to examine the relationship between alcohol consumption and OD, using data from the National Social Life, Health, and Aging Project (NSHAP). MethodsThis cross-sectional study was conducted on data for 2757 adults from Round 1 of NSHAP. OD was defined as correctly identifying 0–3 odors in the 5-item Sniffin' Sticks test while normal olfactory function was defined as correctly identifying 4–5 odors. Multivariable logistic regression was utilized to examine the association between alcohol consumption and OD, controlling for age, race, and comorbidities. Analyses were weighted to account for the sampling design. ResultsOD was present in 23.1 % of adults. The average age among those with OD was 71.2 ± 7.8 years, compared to 66.9 ± 7.2 years in those with normal olfaction. In terms of alcohol consumption, 31.1 % of adults with OD were light-to-moderate drinkers and 7.7 % were heavy drinkers, compared to 35.6 % light-to-moderate and 7.7 % heavy drinkers in the normal olfaction group. After adjusting for age, gender, race, and education, neither light-to-moderate drinking (aOR: 0.99; 95 % CI: 0.76–1.29) nor heavy drinking (aOR: 1.24; 95 % CI: 0.83–1.85) were significantly associated with OD. ConclusionAlcohol consumption was not associated with OD after controlling for covariates. While this study provides insight into the relationship between alcohol consumption and OD, further research is needed due to conflicting results in previous studies.

Types of bereavement and depressive symptoms among older adults: Does race/ethnicity matter?

To explore racial/ethnic differences in relation between types of bereavement and depressive symptoms among older adults in the USA. The sample limited to racially/ethnically diverse adults aged ≥55 (n = 879) was drawn from the third wave of the National Social Life, Health, and Aging Project (NSHAP). The NSHAP provides self-identified racial/ethnic categories (non-Hispanic Whites, Blacks, and Hispanics) of respondents who were categorized into three groups by experience of bereavement: non-loss, spousal loss, and parental loss. Using the weights, a two-way analysis of covariance with Bonferroni post-test was conducted to explore the main effect of types of loss and race/ethnicity and their interaction effects on depressive symptoms. Spousal loss reported higher levels of depressive symptoms than non-loss or parental loss. Based on the interaction between types of loss and race/ethnicity; however, distinctive patterns were observed. Blacks and Hispanics who lose a parent reported significantly higher levels of depressive symptoms than non-Hispanic Whites did. An increase in depressive symptoms after bereavement manifested distinctively based on racial/ethnic background and the relationship with the deceased. This implies that it is necessary to develop coping strategies concerning race/ethnicity and whom they lose. Geriatr Gerontol Int 2024; 24: 266-272.

Effect of social capital, social support and social network formation on the quality of life of American adults during COVID-19

This study aims to evaluate the effect of social capital (SC), social support (SS), and social network formation (SNF) on the quality of life of American adults during COVID-19. Using a probability sample of American adults aged 49+, 2370 respondents were selected from the National Social Life Health and Aging Project (NSHAP) dataset for analysis using an integrated partial least squares based on structural equation modeling (PLS-SEM)-K-fold cross-validation approach. The analysis showed that social capital assessed using civic engagement, social cohesion, socioeconomic status (SES), social support, and social network formation were significantly and positively associated with American adults’ quality of life during the COVID-19 pandemic. Furthermore, the results showed that using the PLS-SEM and K-fold cross-validation approach produced a medium predictive power of the overall model, confirming the importance of SC, SS, and SNF in predicting quality of life-outcomes. These findings suggest that efforts to promote the well-being of American adults, especially older adults, during the pandemic should focus on strengthening social capital, social support and social network formation.

Does cognitive impairment moderate the relationship between social isolation and anxiety? A 5-year longitudinal study of a nationally representative sample of community residing older adults

BackgroundAnxiety is common in older adults and social isolation is one of the leading factors associated with their anxiety. However, what is unknown is how the relationship between social isolation and anxiety differs by cognitive status. Therefore, this study was conducted to (1) compare the level of social isolation and anxiety in older adults who developed probable dementia and mild cognitive impairment (MCI) to those who maintained normal cognitive function over 5 years; and (2) determine if cognitive impairment moderates the relationship between changes in social isolation and changes in anxiety over 5 years.MethodsA secondary data analysis was conducted using the National Social Life, Health, and Aging Project (NSHAP): Wave 2 (2010–2011) and Wave 3 (2015–2016). The participants were categorized into three groups: Participants who developed probable dementia over 5 years (4.3%), developed probable MCI (19.1%), or maintained normal cognitive function (76.6%). Weighted linear regression analyses with a group interaction were used to examine the moderating effect of cognitive impairment on the relationship between changes in social isolation and anxiety.ResultsAt the 5-year follow up, there were statistically significant differences in social isolation between the three groups (p = 0.043). Regression analyses showed that increased social isolation over time was related to increased anxiety over 5 years regardless of cognitive status after controlling for covariates (p = 0.017).ConclusionsThe relationship between social isolation and anxiety was a universal phenomenon regardless of cognitive status. Tailored interventions targeting both people with or without cognitive impairment are needed to lessen social isolation and anxiety.

Loneliness and Other Factors Associated with Physical Activity in Older Adults with Diabetes: A Cross-Sectional Study.

The purpose of this study was to examine the association of physical activity with socioeconomic conditions, demographic factors, depression, and loneliness among older adults with diabetes in the United States. Using data from Wave 3 of the National Social Life, Health, and Aging Project (NSHAP), we found that male respondents, those with incomes greater than $100,000, and those with less depression were more likely to be physically active among older adults with diabetes. Education level and loneliness were not significant factors influencing physical activity among older adults with diabetes. This suggests that changing gender-based social norms and increasing awareness of the need for physical activity should be considered when designing physical activity interventions for older adults with diabetes and highlights the need for programs to reduce disparities in physical activity opportunities among low-income populations. It also suggests the need to further integrate programs to promote mental health, such as depression, into physical activity interventions.

RACE/ETHNICITY AND THE MEASUREMENT OF COGNITION IN NSHAP: RECOMMENDATIONS FOR ROBUSTNESS

Abstract In this study, we interrogate measurement of cognition by race, in order to move towards a less-biased and more-inclusive set of measures for capturing cognitive change and decline in older adulthood. We use data from Round 2 (N=3377) and Round 3 (N=4777) of the National Social Life Health and Aging Project (NSHAP), and examine the study’s version of the Montreal Cognitive Assessment (MoCA). We employ exploratory factor analyses to explore configural invariance by racial/ethnic group (Non-Hispanic White, Non-Hispanic Black, Hispanic, All else), and then log-likelihood tests of scalar and metric invariance. Using modification indexes we identify items that seem robust to bias by race. We test the predictive validity of the full (18-item) and short (7-item) scales using self-reported dementia diagnosis, Instrumental Activities of Daily Living (IADLs), proxy reports of dementia death, and National Death Index (NDI) reports of dementia death. We found that 7 measures, out of the 18 used in NSHAP’s MoCA, formed a scale that was more robust to racial bias. The shortened form predicted consequential outcomes equally well, compared to NSHAP’s full MoCA. The short form was also highly correlated with the full form, and displayed lower test-retest correlation between Round 2 and 3. Although sophisticated structural equation modeling techniques could be useful for assuaging measurement invariance by race in NSHAP, the shortened form provides a quick way for researchers to carry out robustness checks – to see if the disparities and associations they document are ‘real’ or the product of artifactual bias.

MULTIFACETED LINKS BETWEEN SOCIAL RELATIONSHIPS AND THE DISABLEMENT PROCESS IN LATER LIFE

Abstract While a negative association between social relationships and physical limitations or disability has been reported persistently, the possible reciprocal relationships and pathways through which social relationships affect physical function and disability remain to be explored. This study used longitudinal data from the US Health and Retirement Study (HRS) and the National Social Life, Health, and Aging Project (NSHAP) to examine the multifaceted links between different dimensions of social relationships and physical limitations/disability among older adults in the US. We used Structural Equation Models to explore pathways between social relationships and physical limitations in the HRS and longitudinal residual change models to examine the effects of social relationships on changes in physical limitations between two waves in NSHAP. Results show that for men, greater social integration may lower subsequent physical limitations, whereas, for women, social support may prevent declines in physical function. For both genders, greater physical limitations and disability significantly lower subsequent social integration. This work tested the potential causal benefits of the social relationship hypothesis and selection processes and incorporated different aspects of social relationships. As such, our findings advance the explanations of the association between social relationships and later-life health and help better understand the determinants of the disablement process.

AGING AND SEXUAL RELATIONSHIPS: RECIPROCAL RELATIONS BETWEEN PHYSICAL PLEASURE AND EMOTIONAL SATISFACTION

Abstract Previous research has found significant associations between physical pleasure and emotional satisfaction in sexual relationships. However, much of this research is cross-sectional and has focused on young and middle-aged adults. The present study examined data from the National Social Life, Health, and Aging Project (NSHAP). Physical pleasure and emotional satisfaction were assessed at three points in time (2005/2006; 2010/2011; and 2015/2016). Only data from individuals who were alive at all time points were used in the analysis. Three cohorts were examined: at time 1, the first cohort ranged in age from 57-64, the second cohort from 65-74, and the third cohort from 75-85. We examined reciprocal relations between physical pleasure and emotional satisfaction across time using a Random Intercepts Cross-Lagged Panel Model. The results revealed a positive reciprocal relationship between emotional satisfaction and physical pleasure among the first cohort, with emotional satisfaction at time 1 positively associated with physical pleasure at time 2, which in turn was positively associated with emotional satisfaction at time 3. For the second cohort, physical pleasure at time 2 predicted emotional satisfaction at time 3. Relationships among the two variables were not significant for the third cohort. The implication of this study would be to inform older adults in ongoing sexual relationships on the need to invest in activities that enhance physical pleasure and emotional satisfaction. Future research could examine what variables might account for reciprocal relationships being found for the first as opposed to the third cohort.

SEXUAL FREQUENCY AND COGNITIVE DOMAINS: EVIDENCE FROM THE NATIONAL SOCIAL LIFE, HEALTH, AND AGING PROJECT

Abstract This research draws upon the life course perspective to examine how sexual frequency is related to different cognitive domains among community-dwelling, partnered older adults. I analyzed data from 1,526 respondents across two rounds of the National Social Life, Health, and Aging Project (NSHAP). I tested six cognitive domains: temporal orientation, visuospatial skills, attention, language, executive function, and short-term memory. I ran cross-lagged models to test for reciprocal relationships between sexual frequency and cognitive domain performance. Age-stratified results indicate that more frequent sex was related to better performance on temporal orientation, executive function, attention, and short-term memory domains over time for adults aged 75-90, with no significant results for adults aged 62-74. There was limited evidence that cognitive domain performance was related to later sexual frequency for the 75-90 age group. The results highlight nuanced pathways by which sexuality is tied to the health of older adults. Understanding which cognitive domains may be maintained through more frequent sex is informative for health care practitioners who consider sexual activity as a behavior to prevent cognitive impairment.

INTIMATE RELATIONSHIPS, SOCIAL ISOLATION, AND COGNITION

Abstract This symposium considers the cognitive impacts of a spectrum of social relationships, including both intimate partnerships and, in contrast, social isolation. Drawing on rich data from the Wisconsin Longitudinal Study (WLS), the Health and Retirement Study (HRS), the National Social Life, Health, and Aging Project (NSHAP), and the Mexican Health and Aging Study (MHAS), the papers showcase empirical linkages between older adults’ cognitive health with a set of exposures including marital status and relationship characteristics, social activities, and a lack of social connections. We begin with papers that examine the impact of particular marital relationship attributes and social behaviors on cognition and health. One paper employs the WLS to explore the impact of concordance and discordance in marital couples’ reports of similarity with and closeness to their spouse on cognition, while the second draws on NSHAP to consider the cognitive consequences of various domains of couples’ sexuality. The third paper uses the HRS to examine couples’ co-trajectories of physical, mental, and cognitive health, focusing particularly on how a spouse’s cognitive decline influences the other partner’s subsequent health trajectory. The fourth paper shifts our attention to variation by marital status in the cognitive impacts of leisure activities via data from MHAS, while the fifth focuses specifically socially-isolated older adults in the HRS and highlights variation in the relationship between social isolation and dementia by race and ethnicity. The symposium will conclude with a discussion of future directions for research on the cognitive consequences of relationships, social connections, and social isolation.

USE OF PRESCRIPTION MEDICATIONS WITH SOMNOLENCE AS A POTENTIAL ADVERSE EFFECT AMONG OLDER ADULTS IN THE UNITED STATES

Abstract Over half of community-dwelling older adults experience sleep disorders, with approximately 40% reporting somnolence or/and excessive daytime sleepiness, associated with an increased risk for cognitive impairment and premature mortality. The use and concurrent use of prescription medication with somnolence as an adverse effect may be an overlooked contributor to this growing problem. This study aims to characterize the use or concurrent use of medications with somnolence as an adverse effect and to assess associations between their use and the prevalence of somnolence (excessive daytime sleepiness or sleep duration of ≥9 hours) using data from the National Social Life, Health, and Aging Project (NSHAP) 2010-2011 (N=3,338). Adjusted prevalence was estimated from multivariable logistic regression models adjusted for socio-demographic measures and the number of medications without somnolence as an adverse effect. The estimated prevalence of somnolence was 54% for those reporting use of 3 or more medications with somnolence as an adverse effect vs. 36.5% for those not using such medications. The use of prescription medications with somnolence as a potential adverse effect was prevalent. Concurrent use of medications with somnolence as an adverse effect was associated with a higher prevalence of somnolence. These findings demonstrate the need for more research to understand the impact of concurrent use of medications with similar adverse side effects on OAs’ health and well-being.

LOCAL FAMILY AND FRIEND TIES AND THEIR RELATIONSHIP TO SOCIAL SUPPORT AND STRAIN AMONG OLDER ADULTS

Abstract Family members and friends who live nearby are likely valuable sources of support for older adults. At the same time, local family and friend ties may also be a source of strain as spatial proximity to close ties can generate more intense interactions. Using data from Round 3 (2015-2016) of the National Social Life, Health, and Aging Project (NSHAP) (N=3,615), this study examines how local family and friend ties reported in older adults’ social network roster are associated with instrumental and emotional support and social strain among community-dwelling older adults aged 50 and older. Results from ordered logistic regression models show that having a local friend tie is associated with higher levels of instrumental and emotional support from friends and lower levels of instrumental and emotional support from family. Having a local family tie, on the other hand, is associated with higher levels of instrumental support from family and lower levels of emotional support from friends. Having a local family tie is not related to emotional support from family or instrumental support from friends. Results also indicate that having a local friend tie increases the odds of reporting that friends make too many demands (i.e., higher friend strain) whereas having a local family tie is not a predictor of family strain. Together, results suggest that spatial proximity to friends and, to a lesser degree, family members are linked to how older adults experience social support and strain.

BEING A CAREGIVER DOES NOT INCREASE MORTALITY RISK AT 10-YEAR FOLLOW-UP IN A NATIONAL US SAMPLE

Abstract An increasing number of people are expected to become caregivers of relatives with medical or mental health conditions. The chronic stress of family caregiving has been shown to worsen one’s health, leading to concerns that it may also increase mortality risk. Seminal work showed associations between caregiving and increased mortality risk, but recent population-based studies have disputed this. Our objective was to use longitudinal, nationally representative data to rigorously examine whether caregiver status was associated with 10-year mortality. We used data from the National Social Life Health and Aging Project (NSHAP), a nationally representative study of 2,367 older adults (57-85 y) that combines interviews, surveys, and mortality data. We compared 10-year mortality risk between self-reported caregivers and non-caregivers with and without propensity score matching. Baseline sample included 401 caregivers (68.6±7.6 y) and 1,966 non-caregivers (69.2±7.7 y). Among caregivers, 25.0% had 2+ chronic health conditions, compared to 41.1% of non-caregivers. At the 10-year follow-up, 20.6% of caregivers had died versus 29.6% of non-caregivers (p<.0001). After propensity score matching on demographics, health, and limitations in? activities of daily living, there were no differences in mortality between the groups (p>0.05). Our study suggests no difference in mortality risk based on caregiver status. While family caregivers frequently experience negative impacts on well-being because of their role, it is heartening to know that caregiving may not confer an additional risk of death.

PREDICTING 10 YEAR MORTALITY WITH MACHINE LEARNING: EVIDENCE FROM NATIONAL SOCIAL LIFE, HEALTH, AND AGING PROJECT

Abstract The current academic literature extensively used linear logistic models with social, behavioral, and psychological status to predict mortality. However, few address the interdependency of predictors and the imbalance of targets that adversely bias the results. Using the National Social Life Health and Aging Project (NSHAP), we developed two machine learning models predicting the 10-year mortality of older adults in the US. We first used tree-based algorithms of Decision Tree (DT) that account for the interdependency of the social features and decide the splitting nodes and thresholds using entropy gain conditional on the previous splitting predictor to discern disposition status. Second, we used the Fuzzy Support Vector Machine (FSVM) that regards every sample as a node in high-dimensional vector space and splits the nodes with an optimum plane by finding the best linear combination of features to get an optimum prediction accuracy. Additionally, FSVM addresses the target imbalance problem by conducting a more delicate classification of samples with close predicted probabilities of being alive and deceased. Compared to the accuracy rates achieved by the Logistic Regression, our algorithms perform better on the entire population and the population near the class boundary. We also discussed the social and demographic characteristics of the cases whose disposition statuses were either wrongly predicted as deceased or alive by our algorithms. The findings serve important purposes for public health practitioners in accurately understanding the risk and protective factors of mortality in aging.

On the road to retirement: Predicting nighttime driving difficulty and cessation using self-reported health factors

IntroductionOlder drivers now expect to drive longer than previous cohorts and will make up about 25% of licensed U.S. drivers by 2050. Identifying early predictors of nighttime driving difficulty, a precursor to driving retirement, can inform screening procedures and timely linkage to interventions supporting driving or transitioning to driving cessation. MethodsWe examined self-reported physical and mental health baseline predictors of greater nighttime driving difficulty in five and ten years using weighted multivariate logistic analyses of 2261 drivers, aged 57 to 85, from the National Social Life, Health, and Aging Project (NSHAP). Transition matrix models describe probabilities of having greater, lesser, or the same nighttime driving difficulty after five years based on baseline driving conditions and the significant logistic model factors. We built a transition matrix tool that offers users the ability to calculate expected probabilities of change in nighttime driving difficulty based on the identified salient factors. ResultsFive-year predictors of greater nighttime driving difficulty included perceived poor physical health (OR = 3.75), limitations to activities of daily living (ADLs; OR = 1.97), and clinical levels of depressive and anxiety symptoms (OR = 1.63; OR = 1.71). Excellent physical health (OR = 0.52), mental health (OR = 0.60), and any frequency of physical activity compared to ‘never’ were protective (OR = 0.37–0.51). Physical health, walking pain, and limitations to ADLs were predictive at ten-years. Transition models showed physical health and anxiety were most indicative of greater nighttime driving difficulty at 5-years for those reporting no difficulty at baseline, but limitations to ADLs were more predictive otherwise. ConclusionsLay practitioners could capitalize on the use of self-report screening measures to identify older adults who may experience near-term nighttime driving difficulty. Earlier identification may better guide long-term driving retirement planning or engagement in appropriate health interventions. The transition matrix modeling tool is freely available to facilitate development and validation of related measures.

Evidence for a role of metformin in preventing olfactory dysfunction among older adults.

Olfactory dysfunction (OD) is increasingly recognized as a hallmark of unhealthy aging and is intimately associated with mortality, but therapies remain elusive. Recognizing the increased prevalence of OD in individuals with diabetes, and the potential anti-aging effects of metformin, we studied the association of metformin use with OD. Cross-temporal study of participants from Waves 2 (2010-11) and 3 (2015-16) of the National Social Life, Health, and Aging Project (NSHAP), a nationally representative cohort study of community-dwelling older adults. We included participants with diabetes who had complete data on olfaction and relevant covariates at Wave 2 and were not lost to follow-up at Wave 3. Olfactory identification (OI), the ability to identify the odorant, and olfactory sensitivity (OS), the ability to detect the presence of an odorant, were tested. Weighted multivariable logistic regression was used to study the association between metformin use at Wave 2 (baseline) and odds of having impaired OI/OS at Wave 3, adjusted for age, sex, race/ethnicity, education, smoking, BMI, HbA1c, years since diabetes diagnosis, and insulin use. Among 228 participants with diabetes (mean age=70 years, 53% female, 21% Black), 112 (49%) used metformin at baseline. Relative to nonusers, users had 58% lower odds of impaired OI and 67% lower odds of impaired OS at Wave 3. Among participants with normal baseline OS (N=62), users had 97% lower odds of impaired OS at Wave 3. Metformin use is associated with lower odds of OD among individuals with diabetes, suggesting a potential protective effect on olfaction. Future work including a larger sample and additional information on metformin use is needed to establish whether these findings are independent of diabetic control.