Later-life Outcomes Research Articles

Longitudinal Analysis of Latvian Child Growth: Anthropometric Parameters Dynamics from Birth to Adolescence.

This study provides a comprehensive analysis of the physical development patterns from birth to adolescence, utilizing a longitudinal dataset of 70 children monitored from birth until 17 years of age. The research focuses on the variability of growth trajectories, emphasizing the role of genetic and environmental factors in influencing these patterns. Key findings indicate that most children undergo one or two periods of accelerated growth, with significant variability in the timing and magnitude of these growth spurts. The study also highlights the adaptive nature of growth changes over generations, influenced by ecological, nutritional, and socio-economic conditions. The longitudinal approach reveals critical insights into the timing of peak growth velocities, demonstrating that girls reach their growth peak approximately one year earlier than boys. The analysis of intergenerational growth patterns suggests a significant increase in average height over the century, attributed to genetic diversity and changes in lifestyle and nutrition. This study's findings emphasize the importance of updating physical development standards regularly to reflect the changing genetic and environmental landscape. The variability in growth patterns and their correlation with health outcomes in later life highlights the need for targeted public health strategies that address the underlying socio-economic and environmental determinants of health. This research contributes to the understanding of physical development trajectories and provides a foundation for future studies aimed at optimizing health outcomes from early childhood through adolescence. The primary objective of this article is to meticulously analyze the dynamics of height growth and accurately identify the periods of accelerated bodily development within the context of longitudinal research.

Separating Scarring Effect and Selection of Early-Life Exposures With Genetic Data

Causal life course research examining consequences of early-life exposures has largely relied on associations between early-life environments and later-life outcomes using exogenous environmental shocks. Nonetheless, even with (quasi-)randomized early-life exposures, these associations may reflect not only causation (“scarring”) but also selection (i.e., which members are included in data assessing later life). Investigating this selection and its impacts on estimated effects of early-life conditions has, however, often been ignored because of a lack of pre-exposure data. This study proposes an approach for assessing and correcting selection, separately from scarring, using genetic measurements. Because genetic measurements are determined at the time of conception, any associations with early-life exposures should be interpreted as selection. Using data from the UK Biobank, we find that in utero exposure to a higher area-level infant mortality rate is associated with genetic predispositions correlated with better educational attainment and health. These findings point to the direction and magnitude of selection from this exposure. Corrections for this selection in examinations of effects of exposure on later educational attainment suggest underestimates of 26–74%; effects on other life course outcomes also vary across selection correction methods.

Abstract 62: Association of Cardiovascular Health Trajectories Through Young Adulthood With Later-Life Incident Cardiovascular Disease and Mortality: The Coronary Artery Risk Development in Young Adults (CARDIA) Study

Introduction: Associations of mid-life cardiovascular health (CVH) and incident cardiovascular disease (CVD) are well-studied. Less is known about patterns of young adulthood (YA) CVH, including its changes, and associations with later-life CVD outcomes. Methods: CVH was defined by Life’s Essential 8 (LE8) score. First, we used latent class modeling (SAS Proc Traj) to determine trajectories of continuous CVH scores (0-100) for CARDIA participants with ≥3 CVH measurements in YA (from year [Y]0, mean age 25, to Y20, mean age 45). Second, we examined direction and magnitude of change in CVH status (low, moderate, or high) between 2 CVH measurements (at Y0 and Y20), comparing participants with increased, decreased, or stable CVH status. Outcomes included incident CVD (MI, heart failure, stroke, CVD death) after Y20. Cox proportional hazards regression was used to estimate HRs for associations of YA CVH patterns with incident CVD. Results: There were 4,257 participants in YA (44% female, 48% Black) included. In the trajectory analysis, we identified four distinct CVH trajectory groups ( Figure 1A ): compared to the Persistently-High CVH group, the Moderate-Low-Declining and Moderate-Declining CVH trajectory groups had substantially higher hazards for incident CVD ( Figure 1B ). In the CVH status change analysis (N=2,884; Figure 1B ), compared to Stable High CVH in YA, Stable Low CVH had a 19-fold higher risk for incident CVD, and both increasing and decreasing CVH status in YA had greater risk for incident CVD as well. Conclusions: Trajectories of declining moderate and low CVH in YA had substantially higher risk for later-life incident CVD events. Those with decreasing CVH and those who started with lower CVH and improved it through YA, were also at higher risk. These data suggest that early life CVH and maintaining high CVH through YA are both important for prevention of later-life CVD.

Unequal before death: The effect of paternal education on children’s old-age mortality in the United States

A growing body of research documents the relevance of parental education as a marker of family socio-economic status for children’s later-life health outcomes. A strand of this literature evaluates how the early-life environment shapes mortality outcomes during infancy and childhood. However, the evidence on mortality during the life course and old age is limited. This paper contributes to the literature by analysing the association between paternal education and children’s old-age mortality. We use data from Social Security Administration death records over the years 1988–2005 linked to the United States 1940 Census. Applying a family(cousin)- fixed-effects model to account for shared environment, childhood exposures, and common endowments that may confound the long-term links, we find that having a father with a college or high-school education, compared with elementary/no education, is associated with a 4.6- or 2.6-month-higher age at death, respectively, for the child, conditional on them surviving to age 47.

Increased Likelihood of Dementia with Coexisting Atrophy of Multiple Regions of Interest.

Brain volume is associated with cognitive decline in later life, and cortical brain atrophy exceeding the normal range is related to inferior cognitive and behavioral outcomes in later life. To investigate the likelihood of cognitive decline, mild cognitive impairment (MCI), or dementia, when regional atrophy is present in participants' magnetic resonance imaging (MRI). Multi-center MRI data of 2,545 adults were utilized to measure regional volumes using NEUROPHET AQUA. Four lobes (frontal, parietal, temporal, and occipital), four Alzheimer's disease-related regions (entorhinal, fusiform, inferior temporal, and middle temporal area), and the hippocampus in the left and right hemispheres were measured and analyzed. The presence of regional atrophy from brain MRI was defined as ≤1.5 standard deviation (SD) compared to the age- and sex-matched cognitively normal population. The risk ratio for cognitive decline was investigated for participants with regional atrophy in contrast to those without regional atrophy. The risk ratio for cognitive decline was significantly higher when hippocampal atrophy was present (MCI, 1.84, p < 0.001; dementia, 4.17, p < 0.001). Additionally, participants with joint atrophy in multiple regions showed a higher risk ratio for dementia, e.g., 9.6 risk ratio (95% confidence interval, 8.0-11.5), with atrophy identified in the frontal, temporal, and hippocampal gray matter, than those without atrophy. Our study showed that individuals with multiple regional atrophy (either lobar or AD-specific regions) have a higher likelihood of developing dementia compared to the age- and sex-matched population without atrophy. Thus, further consideration is needed when assessing MRI findings.

Multidimensional Deprivations and Associated Factors Among Older Adults in Urban Geographies of Nigeria: Implications for Poor Health Outcomes in Later Life.

Objectives: Many urban-dwelling older Nigerians are multidimensionally deprived and are unable to meet their daily financial, nutritional, and healthcare needs. This has implications for their health outcomes, yet it has been under-researched. This study assessed the multidimensional deprivation index (MDI) of urban-dwelling older Nigerians and the associated factors. Methods: The study analysed a weighted sample of 5,225 older persons aged ≥60 years from Nigeria's Demographic and Health Survey, 2018. MDI was estimated, and associations were examined using a multilevel multinomial logistic regression model. Results: Nationally, 75% of the older persons were multidimensionally deprived, with 27% severely deprived. Women (36%) were more severely deprived than men (20%). Those in the Northern regions (38%-40%) were the most deprived. Higher MD risk was associated with female gender and older ages ≥70-79years. Conversely, lower risk was associated with households headed by family and residence in educated communities. Community variation accounts for 10.4% and 35.9% of the MD and severe MD risks, respectively. Conclusion: This study suggests socioeconomic interventions that address gender disparities and target highly deprived regions, with consideration for individual and community characteristics.

Imagine Your Life at 25: Gender Conformity and Later-Life Outcomes

Imagine Your Life at 25: Gender Conformity and Later-Life Outcomes

THE ASSOCIATION OF FRAILTY AND MORTALITY IN OLDER ADULTS: A SYSTEMATIC REVIEW AND META-ANALYSIS OF COHORT STUDY

Abstract Frailty is associated with poor health outcomes in later life, improving lifespan and death through different mechanisms. This study aimed to systematically review the epidemiological evidence from cohort studies investigating the association between frailty and all-cause mortality, and to determine if frailty affects mortality in older adults. We searched for studies published and indexed in 4 electronic databases (EMBASE, PubMed, Cochrane Library, and Web of Science) and manual search and identified 28 cohort studies before Dec 31, 2022. We include studies if their design was longitudinal; the exposure of interest was measured frailty; the endpoint of interest was mortality; they provided a risk estimate (i.e., hazard ratio [HR]) and the corresponding 95% CI for the association between frailty and mortality. They used different indexes as their frailty as exposed definitions. Two investigators independently screened the full-text articles for inclusion. We used a random-effects model to obtain pooled HRs. Thirty-one studies were included for qualitative review, of which twenty-eight were eligible for meta-analysis, and included 67,114 individuals from 16 countries. Compared with healthy adults, frail adults had a significantly higher mortality risk. The pooled HR for mortality per increment of 0.1 frailty of community-dwelling adults was 2.33 (95% CI 2.05-2.65; I2 76.9%). The present study demonstrated that frailty was not only significantly related to an increased mortality risk but was also a strong predictor of mortality in community-dwelling adults.

LIFE COURSE TIMING OF ADVERSITY AND DIURNAL CORTISOL IN LATER LIFE

Abstract Exposure to adversity is believed to alter stress sensitive biological processes. One manifestation of this, flatter diurnal cortisol slopes, has been linked to cardiometabolic problems. Questions remain about whether the timing of adversity within the life course influences its effect on cortisol slopes in later life. Two longitudinal cohort studies (Cardiac Rehabilitation and The Experience [CREATE], Tracking Risk Identification for Adult Diabetes [TRIAD]) with identical measures were merged for analysis (merged N = 175, Mage 60.8) using multilevel modeling. Measures included retrospective self-report of childhood trauma (CTQ), major life stressors in adulthood (number and recency of stressful events, affected domains, everyday discrimination), and peak-to-bedtime cortisol slopes (≤12 collected over 15 months). Report of any moderate and severe childhood adversity was not associated with adult cortisol slopes (p&amp;gt;.05). When we probed specific types, emotional abuse was associated with cortisol slopes (b=.006, SE=.003, p=.015). For adult adversity, total number of stressful events (b=.001, SE=.0002, p=.009) and recent stressful events (b=.003, SE=.001, p=.041) were associated with cortisol slopes. When simultaneously modeling all measures of adversity over the life course, number of stressful events in adulthood (b=. 001, SE=.0002, p=.018) and childhood emotional abuse (b=.007, SE=.004, p=.064) were the strongest predictors of flatter diurnal cortisol slopes in adulthood. Given that those reporting childhood adversity were also more likely to have experienced adulthood adversity (r=.08-.39), early life adversity may be an important risk factor for flattened cortisol slopes and associated cardiometabolic outcomes in later life via multiple pathways. Implications for intervention will be discussed.

DETERMINANTS OF POSITIVE MARITAL QUALITY AMONG OLDER HISPANIC ADULTS IN THE US

Abstract Marital Quality can significantly influence a variety of health and well-being outcomes in later life. Yet, relatively little is known about how marital quality is determined across subpopulations given their cultural backgrounds. Social networks and familial relationships are culturally important to Hispanic adults over their life course. Also, the unique characteristics (e.g., high % of immigrants) of older Hispanic adults in the U.S. may make their determinants of marital quality different from others. Considering approximately one in three older Hispanic adults is an immigrant in the U.S., this subpopulation may have relatively small social networks as their family members live in their countries of origin. As such, sub-groups of married older Hispanic adults may depend more on their marital relationships for social and cultural support, compared to other racial and ethnic groups. Framed by socioemotional selectivity theory, this study aimed to investigate determinants of marital quality among older Hispanic adults (age 51 and older). Nationally representative samples of older Hispanic adults (n = 694) were derived from the 2010 Health and Retirement Study (HRS). Results from linear regression analysis indicated that women (b = -0.16, p &amp;lt; 0.05) reported lower positive marital quality than men. There was also a statistically significant negative association between depressive symptoms (b = -0.09, p &amp;lt; 0.05) and positive marital quality. This study further evaluated other marital quality determinants, gender differences, and possible sociocultural explanations.

INFLUENCES OF HAVING COGNITIVE IMPAIRMENT OR DEMENTIA ON SOCIAL ENGAGEMENT AMONG OLDER ADULTS: A SYSTEMATIC REVIEW

Abstract Studies have suggested that promoting and maintaining social engagement are positively associated with various well-being outcomes in later life. One notable barrier to sustaining social engagement in later life is development of cognitive impairment (CI) and/or Alzheimer’s disease and related dementias (ADRD). This study aims to synthesize existing literature exploring the impact of CI and ADRD on social engagement among older adults. We conducted a search of studies written in English language in the following databases: PsychInfo, PubMed, MEDLINE, CINAHL, and The Cochrane Library. Inclusion criteria included: observational studies that were conducted outside of residential long-term care facilities, included social engagement as an outcome variable, and examined the impact of cognitive impairment and/or ADRD on social engagement. Eighteen studies were included for qualitative synthesis. The majority of studies used author-developed scales to measure social engagement. Three utilized formal clinical diagnosis to measure cognitive impairment and ADRD. Twenty unique social activities were included, such as volunteering, attending community groups, and religious services. Four primary themes emerged regarding the relationship between CI/ADRD and social engagement: decreased levels of social engagement, reduced variety of social activities, lowered motivation, and heterogeneity in social engagement. Results suggest that people with CI/ADRD have reduced social engagement, but the evidence is limited due to the inconsistent use of measures for social engagement and CI/ADRD. Future research is needed to develop valid and reliable measures of social engagement that can be used among individuals living with CI/ADRD.

EARLY-LIFE ORIGINS OF LATER-LIFE HEALTH AMONG OLDER BRAZILIANS: DIFFERENCES IN ASSOCIATIONS BY HEALTH CONDITION

Abstract Background A rich body of literature has linked poor childhood health to adverse adult health outcomes in later life. This association, however, has largely been studied in high-income countries. Less attention has been given to other country contexts where childhood exposures and adulthood socioeconomic conditions are vastly different. Brazil represents an important context due to the significant growth in older adult population, significant rise in life expectancy, and rapid industrialization that occurred since the 20th century. Method. Data come from the ELSI-Brazil Study, a nationally representative sample of older Brazilians. Logistic regression was used to predict the association between childhood conditions (socioeconomic adversity and poor health) and adult health conditions (heart conditions, heart failure, diabetes, and stroke). Results Poor child health was positively associated with stroke, heart disease, and heart failure, but was not associated with diabetes or high blood pressure. Poor child socioeconomic status was associated with diabetes and stroke but not associated with heart conditions, heart failure, or high blood pressure. Discussion The importance of childhood conditions for later life remained important in Brazil, but questions remain as to why certain conditions were found to be significant while others were not. Differences may stem from larger contextual changes such as the impact of globalization on food choices during adulthood for these cohorts. This study highlights the significance of contextual and conditional factors in comprehending the multifaceted dynamics underlying the association between early life conditions and later life health.

NEW MEASURES AND POPULATION PREVALENCE OF VISION IMPAIRMENT IN NHATS

Abstract The National Health and Aging Trends Study (NHATS) is a nationally representative panel study of older U.S. adults that in 2021 (Round 11) added to its annual protocol a suite of objective visual function measures consisting of distance visual acuity, near visual acuity, and contrast sensitivity tests. These measures were developed to approximate clinical gold-standard tests, while allowing for administration on a tablet in participants’ homes. The tests were found to have good agreement with clinical gold-standards based on their limits of agreement, correlations, and lack of systematic bias between tests. In the initial 2021 fielding of the NHATS visual function measures, 27.8% (25.5%-30.1%) of U.S. adults over age 70 had one or more visual impairment (VI) (distance VI: 10.3% [8.9%-11.7%]; near VI: 22.3% [20.3%-24.3%]; contrast sensitivity impairment: 10.0% [8.5%-11.4%]), and the prevalence was highest among those who were older, had less education, lower income, and were of Hispanic ethnicity and non-White race. Additionally, the adjusted prevalence ratio for dementia was significantly higher among those with each type of VI compared to those with normal vision (moderate/severe distance VI=1.72 [1.26-2.35]; any near VI=1.40 [1.16-1.69]-; contrast sensitivity impairment =1.31 [1.04-1.66]). Since few other national studies of older adults include objective visual function measures, NHATS now serves as a vital resource for the study of vision epidemiology and the impact of VI and blindness on later-life health outcomes and trajectories.

BIRTHPLACE AND COGNITION AMONG US OLDER ADULTS: EVIDENCE FROM THE HARMONIZED COGNITIVE ASSESSMENT PROTOCOL (HCAP)

Abstract Growing evidence shows that place of birth and related circumstances may impose lasting and multiplicative impacts on a host of late-life outcomes; yet how it affects various domains of cognitive function in late-life is less understood. In this paper, we exploit the comprehensive cognitive assessments in the Health and Retirement Study (HRS) Harmonized Cognitive Assessment Protocol (HCAP) and HRS geographic data at birth to determine to what extent birth location measured at the state level is associated with cognitive status in later life for a representative sample of Americans over age 50 (N=3,324). We found that state of birth significantly influenced various cognitive domains later in life (including episodic memory, executive function, attention, visuospatial function, language fluency and orientation); and the regional rankings tended to be highly consistent across the cognitive assessments in each domain. Regression analysis demonstrated that the geographic disparities in cognition across birth states could be partly explained by the late-life differences in socioeconomic statuses. Nevertheless, Shapley decompositions demonstrated that, after accounting for mid-life to late-life factors, state of birth still contributed 20%-30% of the explained variations in cognitive outcomes. Particularly, foreign-born individuals and those born in the southern states tended to score the lowest on average on each of the cognitive tests/domains and can account for most of the explained differences in cognition. These findings suggest that place of birth may have lasting impacts on disparities in cognition later in life. Public policy should play pivotal roles in leveling the playing field in early life.

Multiple Chronic Conditions and Midlife Cognitive Function in Black and White Adults: The Bogalusa Heart Study

AbstractBackgroundIn late‐life, multiple chronic conditions (MCCs) has been associated with cognitive decline and Alzheimer’s Disease and related dementias. However, this relationship has not been investigated in a middle‐aged population, a time when MCCs first begin to develop, or in rural and low socioeconomic settings, where individuals are at a higher risk of MCCs. We examined the relationship between MCCs and midlife cognitive function among Black and White men and women from a rural, community‐based cohort in Bogalusa, Louisiana.MethodsThis cross‐sectional study includes 1,223 Black (33%) and White (67%) individuals (mean age 48.10 ± 5.26; 59% female) from the Bogalusa Heart Study with a complete neuropsychological (NP) assessment, and no history of stroke. Six chronic conditions were selected from the CMS (Centers for Medicare &amp; Medicaid Services) Data Warehouse, and defined using self‐reported data, medication use, and physiological/laboratory measures (Table 1). MCCs was defined as the coexistence of ≥2 conditions. NP performance was measured by global cognitive z‐scores (GCS) and by domain specific z‐scores for attention and processing, episodic memory, and executive function. All z‐scores were standardized for age, sex, and race. Regression models assessed the association between MCCs and cognitive outcomes, adjusting for alcohol consumption, smoking status, and education.ResultsA total of 66% participants had MCCs; 44.4% (n = 543) had 2 CCs, 17.8% (n = 218) had 3 CCs, and 3.8% (n = 46) had 4+ CCs. Compared to no chronic conditions, having 2,3, and ≥4 CCs was significantly associated with poorer executive function z‐scores after adjusting for covariates (all p’s &lt; 0.05). Having three MCCs had the worst impact on executive function z‐scores (‐0.88(.20), p &lt;0.001) (Table 2). The most prevalent conditions in this group were hypertension, dyslipidemia, and diabetes which co‐occurred in 87.7% (n = 165) of participants with three CCs.ConclusionThis study suggests that the presence of MCCs is associated with lower executive function performance as early as midlife. Hypertension and dyslipidemia commonly occur together and are particularly prevalent in midlife. These findings highlight the importance of addressing chronic conditions earlier in life, a less studied and critical time window for potential prevention of adverse cognitive outcomes in late life.

Cluster‐Derived Psychosocial Phenotypes, Cognitive Outcomes, and AD Plasma Biomarkers of Black and Hispanic/Latino Older Adults Enrolled in HABS‐HD

AbstractBackgroundAlthough Black and Hispanic/Latino older adults are at increased risk for Alzheimer’s disease (AD), there is considerable within‐group heterogeneity in psychosocial factors of risk and resiliency amongst these community members. The present study (1) used cluster analysis on measures of economic/social resources and psychiatric distress to identify distinct subgroups and (2) compared cognitive and AD biomarker outcomes of these groups in an effort to understand pathologic aging among racially/ethnically diverse older adults.MethodBaseline data from 816 Black and Hispanic/Latino participants without dementia enrolled in HABS‐HD were included. Variables in the cluster analysis included: annual income, state area deprivation index, social support, occupational complexity, chronic stress, and symptoms of depression and anxiety. A discriminate function analysis (DFA) tested the extent to which the individual variables predicted cluster‐group membership. ANOVAs and chi‐squared tests compared the groups on demographics. ANCOVAs controlling for age, education, sex, and race/ethnicity examined group differences in subjective cognitive concerns, objective memory and executive functioning composite scores, and plasma AD biomarkers (AB42/40, t‐tau, NfL).ResultThe cluster analysis identified 3 distinct groups: Group 1 was low resource/high distress (n = 215); Group 2 was high resource/low distress (n = 248); and Group 3 was low resource/low distress (n = 353; Figure 1). The DFA correctly classified 95.3% of participants. Results revealed significant group differences in education and the proportion of women and Black adults across the groups (see Table 1). ANCOVAs revealed significant group differences in subjective memory concerns, executive functioning composite, and plasma AD biomarkers; Group 1 consistently displayed poorer cognitive outcomes and more severe AD biomarker patterns relative to Groups 2 and 3, but there no differences in outcomes between Groups 2 and 3. No group differences on the memory composite were observed.ConclusionRisk for AD among racially/ethnically diverse older adults may differ as a function of current levels of resources and psychiatric distress. Group 1 represents individuals with low resources and high levels of distress that may be at increased risk for poor outcomes in late life. Future work should further clarify precise mechanisms of resiliency, such as social support, in Group 3 and explore longitudinal trajectories of cognitive decline across the groups.

Food Insecurity, Memory, and Dementia Among US Adults Aged 50 Years and Older

Despite existing federal programs to increase access to food, food insecurity is common among US older adults. Food insecurity may affect Alzheimer disease and Alzheimer disease-related dementias via multiple mechanisms, yet there is almost no quantitative research evaluating this association. To examine whether food insecurity in older adults is associated with later-life cognitive outcomes. This cohort study of US residents aged 50 years and older from the US Health and Retirement Study was restricted to respondents with food insecurity data in 2013 and cognitive outcome data between calendar years 2014 and 2018. Analyses were conducted from June 1 to September 22, 2023. Food insecurity status in 2013 was assessed using the validated US Department of Agriculture 6-item Household Food Security Module. Respondents were classified as being food secure, low food secure, and very low food secure. Outcomes were dementia probability and memory score (standardized to 1998 units), estimated biennially between 2014 and 2018 using a previously validated algorithm. Generalized estimation equations were fit for dementia risk and linear mixed-effects models for memory score, taking selective attrition into account through inverse probability of censoring weights. The sample consisted of 7012 participants (18 356 person-waves); mean (SD) age was 67.7 (10.0) years, 4131 (58.9%) were women, 1136 (16.2%) were non-Hispanic Black, 4849 (69.2%) were non-Hispanic White, and mean (SD) duration of schooling was 13.0 (3.0) years. Compared with food-secure older adults, experiencing low food security was associated with higher odds of dementia (odds ratio, 1.38; 95% CI, 1.15-1.67) as was experiencing very low food security (odds ratio, 1.37; 95% CI, 1.11-1.59). Low and very low food security was also associated with lower memory levels and faster age-related memory decline. In this cohort study of older US residents, food insecurity was associated with increased dementia risk, poorer memory function, and faster memory decline. Future studies are needed to examine whether addressing food insecurity may benefit brain health.

The Real Me: Insight into Youths with Physical Disabilities’ TranXition to Adulthood through Digital Images

Aims Youths with physical disabilities experience various obstacles in their transition to adulthood which can contribute to poorer health and socioeconomic outcomes in later life, compared to their non-disabled peers. Transitional care offers these youths the necessary support to overcome such obstacles. The objective of this study was to explore participants’ experiential learning in the development of life skills within the transitional care program TranXition, and their perceived contribution of the program to their goal attainment. Methods Data were collected using photo-elicitation. Five participants were recruited from the TranXition program to audio-visually record (photographs or videos) their meaningful experiences in the program and to reflect on them during interviews. Results Participants felt the TranXition program helped them build their self-awareness and self-efficacy, and to feel more confident and skilled, whether at home, in school or in the community. Moreover, they appreciated the program’s group cohesion which facilitated learning life skills from others in order to achieve their goals. Finally, results suggest that group interventions, while important, may need to be complemented by individual consultations. Conclusions Rehabilitation programs in real-world settings, such as the TranXition program, may be a promising adjunct to traditional transitional care for youths with physical disabilities.

Metabolic disorders mediate the relation of miscarriage with cardiovascular diseases.

The extent to which the contribution of pregnancy loss to cardiovascular diseases (CVDs) can be explained by metabolic disorders is poorly elucidated but holds insights for reducing long-term cardiovascular risk. The aim of this study is to investigate the mediating effects of hypertension, diabetes mellitus (DM), and lipoprotein metabolism disorders on the association of miscarriage and stillbirth with coronary heart disease (CHD), stroke, heart failure, atrial fibrillation, and composite outcomes. A total of 163 283 ever-gravid women (age 55.3 ± 7.9 years) from the UK Biobank cohort without established metabolic disorders and CVDs were included and followed from 2007 to 2010 baseline until December 2020. Causal mediation analyses were used to estimate the proportion mediated. Hypertension mediated 11.1% (95% confidence interval, 3.7-18.5%) of the association between a history of miscarriage and incident CHD. Approximately, 9.5% (4.1-14.8%) of the effect of recurrent miscarriages on incident CHD was via hypertension, 8.4% (2.5-14.3%) of the effect was via lipoprotein metabolism disorders, 1.7% (0.5-2.9%) of the effect was via DM, and 10.7% (0.2-21.1%) of the effect of recurrent miscarriages on incident stroke was via hypertension. Hypertension mediated the largest proportion of effect for the atherosclerotic cardiovascular event (15.5% for a history of miscarriage and 9.4% for recurrent miscarriages), followed by lipoprotein metabolism disorders and DM. Hypertension, DM, and lipoprotein metabolism disorders mediated the association between miscarriage and various cardiovascular outcomes in later life. In particular, hypertension mediated a large proportion of the relationship between miscarriage and atherosclerotic CVD.

4 Associations Between Education, Emotional and Instrumental Support, and Cognitive Function in Black, White, and Latinx Older Adults

Objective:Higher education is strongly associated with better cognitive function in older adults. Previous research has also showed that positive psychosocial factors, such as selfefficacy and emotional and instrumental support, are beneficial for late-life cognition. There is prior evidence of a buffering effect of self-efficacy on the relationship between educational disadvantage and poor cognition in older adults, however it is not known if other psychosocial factors modify the schooling-cognition relationship. We hypothesized that higher levels of emotional and instrumental support will diminish the association between lower education and lower cognitive test scores among older adults.Participants and Methods:553 older adults without dementia (42.1% non-Latinx Black, 32.2% non-Latinx White, 25.7% Latinx; 63.2% women; average age 74.4 (SD 4.3)) from the Washington Heights-Inwood Columbia Aging Project. Neuropsychological tests assessed four cognitive domains (language, memory, psychomotor processing speed, and visuospatial function). Self-reported emotional and instrumental support were assessed with measures from NIH Toolbox. Linear regression estimated interactions between education and the two support measures on cognition in models stratified by cognitive domain and racial and ethnic group. Covariates included age, sex/gender, and chronic health conditions (e.g. heart disease, stroke, cancer, etc.).Results:Education was associated with cognition across racial and ethnic groups. For every one year of schooling, the processing speed z-score composite was 0.33 higher among Latinx participants, 0.10 among non-Latinx Black participants, and 0.03 higher among non-Latinx White participants. The education-cognition relationship was generally similar across cognitive domains with larger effects in non-Latinx Black and Latinx participants than in White participants. Low education was associated with slower processing speed among Black participants with low emotional support (B = 0.224, 95% CI [0.014, 0.096]), but there was no association between low education and processing speed among Black older adults with high levels of emotional support (beta for interaction = -.142, 95% CI [-0.061, -0.001]). A similar pattern of results was observed for instrumental support (beta for interaction = -.207, 95% CI [-0.064, 0.010]). There were no interactions between support and education on other cognitive domains or among Latinx and White participants.Conclusions:We found that higher levels of emotional and instrumental support attenuate the detrimental effect of educational disadvantages on processing speed in older Black adults. This may occur via benefits of social capital, which provides access to health resources and knowledge, increased social interaction, an emotional outlet allowing the ability to better cope with stress. Longitudinal analyses are needed to examine temporal patterns of associations. In addition, improving equitable access to high quality schools will improve later-life cognitive outcomes for future generations of older adults. However, for the growing number of Black older adults who will not experience the benefits of structural improvements in the education system, emotional and instrumental support may represent a modifiable psychosocial factor to reduce their disproportionate burden of cognitive morbidity.