Later-life Outcomes Research Articles

Why Men Fare Worse: A Mixed-Methods Study Examining Gender Differences in Nursing Home Resident Quality of Life.

Despite research documenting gender differences in numerous outcomes in later life, we know little about gender differences in quality of life (QoL) for nursing home (NH) residents. This study examines the relationship between gender and residents' QoL, including possible reasons for differences observed. We used a mixed-methods design including surveys with a random sample of Minnesota NH residents using a multidimensional measure of QoL (n = 9,852), resident clinical data, facility-level characteristics (n = 364), interviews with residents (n = 64), and participant observations. We used linear mixed models and thematic analysis of resident interviews and observations to examine possible gender-related differences in residents' QoL. After controlling for individual and facility characteristics, men reported lower overall QoL than women, including significantly lower ratings in several QoL domains. In interviews, men noted being less satisfied with activities than women, having fewer friends, and being less able to rely on family for support. Some women described the NH as a place of respite, but men more often described being dissatisfied with life in the NH and undesirable for long-term living. Our observations were consistent with interview findings but provide additional nuances, such as that some men organized their own social groups. Our findings suggest that men and women experience QoL differently in NHs, with men reporting lower QoL in several domains. Tailoring more activities for men and finding ways to strengthen relationships for men in NHs could help reduce the gender differences in QoL we observed.

Peer Relationships and Depressive Symptoms Among Adolescents: Results From the German BELLA Study.

Background: Poor mental health affects adolescent development and is associated with health and social outcomes in later life. The current study uses cross-sectional data to explore the understudied aspects of peer relationships as a predictor of depressive symptom severity of adolescents in Germany.Method: Data from the German BELLA study were analyzed. We focused on the most recent measurement point of the BELLA study and analyzed data of 446 adolescents (aged 14–17 years). Peer relationship was measured using four items from the internationally established Patient-Reported Outcome Measurement Information System (PROMIS). Depressive symptoms were assessed via seven items of the German version of the Centre for Epidemiological Studies Short Depression Scale (CES-D). Hierarchical linear regression models were computed to explore the association between depressive symptoms and peer relationships. Hierarchical linear regression models served to determine the added predictive effects of each aspect of peer relationships.Result: The regression model showed that 22% of the variance of the severity of depressive symptoms could be explained by the quality of adolescents’ peer relationships (F(1,444) = 125.65, p < 0.001). Peer acceptance has the most substantial unique contribution to peer relationship as a predictor of depressive symptom severity (Change in R2 = 0.05; Change in F = 27.01, p < 0.001). The gender-specific analysis shows different trends for boys and girls.Conclusion: The quality of peer relationships is a significant predictor of adolescents’ depressive symptoms severity. Improved peer acceptance, dependability, and ease of making new friends are significantly associated with reduced depression symptoms for Germany’s adolescent population.

Association between adverse childhood experiences and brain volumes among Japanese community-dwelling older people: Findings from the NEIGE study

BackgroundAdverse childhood experiences (ACEs) can affect later-life health outcomes via brain structural differences. However, there is no sufficient empirical evidence about whether brain morphological differences remain until old ages. ObjectiveWe examined the association between ACEs and brain volumes among older individuals. Participants and settingResidents aged 65–84 years in Tokamachi City, Japan, were randomly recruited, and 491 participants were included in the analysis. MethodsACEs were assessed with a self-reported questionnaire. The volumes of seven brain regions of interests were evaluated via structural magnetic resonance imaging. ResultsIn total, 143 (27.1%) participants experienced one ACE and 33 (6.7%) two or more ACEs. Participants with two or more ACEs had a larger anterior cingulate cortex volume (B = 0.346, 95% confidence interval [CI] = 0.04 to 0.66) and smaller hippocampal (B = −0.287, 95% CI = −0.58 to 0.001) and amygdala (B = −0.313, 95% CI = −0.59 to −0.03) volumes. Interestingly, we observed a distinct association between deprivation and threat. That is, deprivation was associated with a smaller amygdala volume (B = −0.164, 95% CI = −0.32 to −0.01) and threat with a larger anterior cingulate cortex volume (B = 0.401, 95% CI = 0.11 to 0.70). ConclusionsACEs were associated with the volumes of brain regions such as anterior cingulate cortex, hippocampus, and amygdala, which are responsible for emotion and self-regulation in older population. The effect of ACEs on the amygdala was commonly driven by deprivation experiences and that on the anterior cingulate cortex by threat.

How Do Childcare Arrangements Impact Education Outcomes?

A stimulating and nurturing early childhood experience is critical to achieving better educational outcomes in later life. But what are the best childcare arrangements? Is it better to be looked after by family members or a nanny at home, or would care provided by qualified carers in a more structured environment bring additional benefits? A large study by Dr Gabrielle Garon-Carrier, from the Université de Sherbrooke, Quebec, Canada, sought to find answers to these burning questions.

Enriching parent-child play through supported play groups to foster children's self-regulation: Protocol for a randomised control trial

Self-regulation is an important target in early childhood given robust evidence of broad associations with immediate and later-life outcomes, and is thus considered a foundational ability. While research demonstrates the impact the home learning environment has on children's development, there is little guidance for parents to engage in behaviours that promote children's self-regulation development. This protocol presents an intervention program sought to address this gap, enriching parent-child play through supported play groups to foster early self-regulation abilities. The intervention presented here offers a means to effectively, yet efficiently, intervene in non-formal learning contexts.

Reducing Racial Inequality in Access to the Ballot Reduces Racial Inequality in Children's Later-Life Outcomes

Reducing Racial Inequality in Access to the Ballot Reduces Racial Inequality in Children's Later-Life Outcomes

Reducing Racial Inequality in Access to the Ballot Reduces Racial Inequality in Children’s Later-Life Outcomes

Reducing Racial Inequality in Access to the Ballot Reduces Racial Inequality in Children’s Later-Life Outcomes

New Issues in Life Course Research: Which Early-Life Factors Matter for Late-Life Outcomes?

The increased availability of retrospective information about the lives of participants in population panel studies has expanded the range of precursors to include in life course research. However, this also challenges researchers to select among many potential precursors to a late-life outcome and to determine the relative role of factors from different periods in the life course. Each paper in this symposium uses life course information from the Health and Retirement Study (HRS) to examine different late-life outcomes. Speakers will discuss what guided the particular selection of factors and outcome to examine in their study. Sonnega, Helppie-McFall, and Lee focus on indicators of childhood financial and social adversity as potential predictors of early retirement due to poor health. Park, Larkina, and Smith ask if decisions taken in early adulthood about how to balance work-and family-life by individuals and their partners are related to the categories of important life accomplishments older adults report in their life review. Two papers examine precursors of late-life health outcomes. Williams-Farrelly and Smith identified different profiles of physical activity in early- and mid-adulthood. They discuss associations between these profiles and cognitive aging. Whereas social losses, relocation, and multimorbidity are well-documented precursors of Major Depression in old age, Bergmans and Smith asked if poor health in childhood played a distal role. The session concludes with an integrative discussion of issues by Walsemann.

Social Islands: Examining the Intersection of Isolation and Technology Use

Life course theory suggests that social relationships are tied to overall well-being. In the extant literature social isolation negatively impacts physical and mental health outcomes in later life. In this study, we focus specifically on the association between social isolation and older adult’s self-rated health status. We also examine whether and the extent to which technology use augments negative health consequences attributed to isolation. Using data on 3,758 older adults (ages 65+) from the 2018 wave of the Health and Retirement Study, we contribute to current scholarly examinations at the intersection of technology and isolation. We conduct a series of ordinal logistic regressions to estimate the odds of respondents’ higher self-rated health (from poor = 1 to excellent = 5) on subjective measures of social isolation (i.e. feel left out, lack of companionship and isolated from others) in addition to whether respondents live with a partner and have an adult child who lives in close geographic proximity. Preliminary results show that individuals who perceived higher levels of social isolation evaluated their own health status as poorer. We also find that the use of computers for virtual communications corresponds with higher self-rated health statuses, regardless of the proximity of children or other family members. However, a negative interaction between computer use and isolation indicates the positive effects of technology are limited for those who are highly isolated. These findings suggest that technology impacts on health are nuanced, where an overreliance on technology as a substitute may not consistently yield positive outcomes.

Resilience, Purpose in Life, Loneliness, and Associated Medical Costs in Older Adults

Resilience, purpose in life (PIL), and loneliness have been linked, and used to characterize the health and well-being of older adults. Studies demonstrate that higher resilience, PIL, and minimal loneliness are associated with better late-life outcomes. However, research on how these constructs negatively impact medical costs is limited. Using survey and claims data from a large sample of older adults age 65+ (N=4,496), resilience, PIL, and loneliness were examined to determine associations with medical costs. Among study participants, 11% exhibited low resilience, 19% severe loneliness, and 35% low PIL. Low resilience was associated with 24% higher medical costs compared to participants with high resilience, severe loneliness with 20% higher costs compared to participants with no loneliness, and low PIL marginally associated with 12% higher costs compared to participants with high PIL. Interventions targeting resilience, PIL, and loneliness could be beneficial to promoting successful aging and lowering medical costs.

Childhood Background Measures and Their Associations With Later-Life Physical, Mental, and Social Health in the National Social Life, Health, and Aging Project.

We describe each childhood background measure available in the National Social Life, Health, and Aging Project (NSHAP), report preliminary population estimates for each measure by age and gender, and validate the childhood measures by showing that the associations between the NSHAP childhood measures and later-life health outcomes are consistent with previous studies on this topic. Childhood background measures included family life happiness, family structure, parental educational attainment, perceived financial situation, experience of violence, witness of violence, childhood health, and place of birth. We measured self-rated health, depressive symptoms, and social support to assess later-life physical, mental, and social health. Logistic and linear regression models were used for the binary and continuous outcome variables, respectively. Older age groups were more likely than those in younger age groups to report a poor financial situation in childhood, lower parental education, and intact family structure and were less likely to have experienced or witnessed a violent event as a child. Growing up in a happy and well-educated family was associated with better physical, mental, and social health in older ages. NSHAP childhood data included a variety of measures assessing the family social environment during childhood, providing a valuable resource for the study of early-life determinants of health and well-being over the life course.

Building and Using Data Resources for Research on Job Characteristics, Health, and Retirement

A growing literature seeks to understand the relationship between the experience of work and important later-life outcomes. Rich longitudinal measurement of both sides of this equation in datasets such as the Health and Retirement Study (HRS) have made this research possible. These data take the form of self-reported experiences of work (such as physical demands, job flexibility, job satisfaction etc.). Increasingly, researchers are looking to add potentially complementary information on the work environment available in the Occupational Information Network (O*NET) database through a linkage using occupation and industry codes in the survey data. The session talks will describe research conducted using O*NET linked with HRS data as well as ongoing work to create a new data resource that will allow other researchers to undertake research with O*NET-HRS linked data. Each presentation will include some discussion of both the value and limits of using the linkage to O*NET. Carpenter will provide a detailed description a new project linking the 2019 O*NET data to the HRS for public use.This presentation explains the types of variables that will be made available in the O*NET-HRS occupation project and will provide examples for how the measures can be used in longitudinal HRS studies. Using O*NET-HRS linked data, Carr will present on work examining the role of preretirement job complexity in alternative retirement paths and cognitive performance. Helppie-McFall will used the linked data to discuss the role of mismatch between demands of work and workers’ ability to meet those demands in retirement decisions.

The Wisconsin Longitudinal Study: New Cognitive, Genetic, Biological, and Social Data and a Diversifying Sample

The Wisconsin Longitudinal Study (WLS) has followed a sample of one in three Wisconsin high school graduates from the class of 1957 for over 64 years, making it an excellent data source for researchers interested in linking early and midlife characteristics to a wide range of later-life outcomes. The WLS is unique among major studies of aging cohorts for its duration of follow up, the inclusion of siblings, and the combination of rich social and health information. This symposium will provide an overview of the WLS, describe recent data collection and linkages, and introduce ongoing efforts to diversify the educational and racial/ethnic composition of the study sample. WLS data cover nearly every aspect of the participants’ lives from early life socioeconomic background, schooling, family, and work, to physical and mental health, social participation, civic engagement, well-being, and cognition. The study is linked to administrative data including Medicare records, Social Security records, mortality records, and resource data on primary and secondary schools attended by participants as well as characteristics of their employers, industries, and communities of residence. Recent data collection efforts have generated a wealth of new biological and cognitive information, including genetic data collected from saliva and blood samples, measures of the gut microbiome, and derived polygenic scores for educational attainment, cognitive performance, depression, and subjective well-being. The currently-fielding ILIAD effort is implementing rigorous AD diagnostic protocols to track the progression of dementia across cognitive phenotypes. The symposium will conclude with practical information on accessing and using the data.

Ideal cardiovascular health duration and risk of chronic kidney disease and cardiovascular disease

ObjectiveIncreasing number of clinical guidelines are adopting comprehensive cardiovascular risk assessment tools for treatment decision and disease management. Yet, little is known regarding cardiovascular risks associated with the length of...

Urinary metals and metal mixtures and timing of natural menopause in midlife women: The Study of Women's Health Across the Nation.

Exposure to metals and metal mixtures may influence ovarian aging. However, epidemiologic evidence of their potential impact is lacking. We prospectively examined the associations of 15 urinary metal concentrations and their mixtures with natural menopause in the Study of Women's Health Across the Nation Multi-Pollutant Study. The study population consisted of 1082 premenopausal women from multiple racial/ethnic groups, aged 45-56years at baseline (1999-2000), with the median follow-up of 4.1years. Urinary concentrations of 15 metals, including arsenic, barium, cadmium, cobalt, cesium, copper, mercury, manganese, molybdenum, nickel, lead, antimony, tin, thallium, and zinc, were measured at baseline. Natural menopause was defined as the final bleeding episode prior to at least 12months of amenorrhea, not due to surgery or hormone therapy. Cox proportional hazards models were used to examine associations between individual metal concentrations and timing of natural menopause. The associations between metal mixtures and natural menopause were evaluated using elastic net penalized Cox regression, and an environmental risk score (ERS) was computed to represent individual risks of natural menopause related to metal mixtures. The median age at natural menopause was 53.2years. Using the Cox proportional hazards models, the adjusted hazard ratio (HR) (and its 95% confidence interval (CI)) for natural menopause was 1.32 (1.03, 1.67) for arsenic and 1.36 (1.05, 1.76) for lead, comparing the highest with the lowest quartiles of metal concentrations. The predicted ages at natural menopause in the highest and lowest quartiles were 52.7 and 53.5years for arsenic; and 52.9 and 53.8years for lead. A significant association between ERS and menopause was also observed. Women in the highest vs. the lowest quartiles of ERS had an HR of 1.71 (1.36, 2.15), equivalent to a 1.6year earlier median time to natural menopause. This study suggests that arsenic, lead, and metal mixtures are associated with earlier natural menopause, a risk factor for adverse health outcomes in later life.

Effectiveness of digital primary prevention interventions targeting physical activity, motor skills and nutrition in children aged 3–10 years in the setting of day care and primary school: protocol for a systematic review

IntroductionAvailable evidence points to an association of increased screen time and the availability of digital tools during childhood with negative health outcomes in later life. For many years, public discourse...

239 IS ORTHOSTATIC HYPOTENSION ASSOCIATED WITH ALTERED CEREBRAL PERFUSION DURING ACTIVE STANDING?

Abstract Background Orthostatic Hypotension (OH) is associated with poor health outcomes in later life including depression, cognitive impairment, frailty and falls. Whilst it is hypothesised that OH compromises cerebral autoregulation leading to hypoperfusion, this has not been robustly demonstrated to date. This study investigated the association between OH and cerebral perfusion during orthostasis using a non-invasive surrogate of cerebral perfusion, Near Infrared Spectroscopy (NIRS). Methods Four hundred and ninety one participants (58% female, median age 65, IQR 38–92) attending a falls and syncope service underwent measurement of beat-to-beat blood pressure (BP) by finometry and real-time frontal lobe perfusion (% TSI: Tissue Saturation Index) by NIRS during the active stand manoeuvre. We examined the association between OH and change in cerebral perfusion (delta TSI) using mixed-effects linear regression, with adjustment for important clinical covariates. Results Nearly two-fifths of the sample (189/491,38.5%) met criteria for OH occurring between 30 and 120 seconds after standing. Using mixed effects linear regression models, we observed a significant relationship between OH and TSI at the same timepoint (β −0.53, −0.59 to −0.46, p &amp;lt; 0.001) which persisted following adjustment for confounders including age, sex, baseline blood pressure, cerebrovascular and cardiovascular disease, depression/anxiety, diabetes, systolic blood pressure, antihypertensives, and antidepressants (β −0.51, −0.58 to −0.44, p &amp;lt; 0.001). Cerebral perfusion levels differed for those with OH compared to those without. Conclusion OH is independently associated with lower frontal lobe cerebral perfusion. This association may indicate disruption to dynamic cerebral autoregulation and explain the significant link between OH and poor health outcomes.

Investigating a Potential Causal Relationship Between Maternal Blood Pressure During Pregnancy and Future Offspring Cardiometabolic Health.

Observational epidemiological studies have reported that higher maternal blood pressure (BP) during pregnancy is associated with increased future risk of offspring cardiometabolic disease. However, it is unclear whether this association represents a causal relationship through intrauterine mechanisms. We used a Mendelian randomization (MR) framework to examine the relationship between unweighted maternal genetic scores for systolic BP and diastolic BP and a range of cardiometabolic risk factors in the offspring of up to 29 708 genotyped mother-offspring pairs from the UKB study (UK Biobank) and the HUNT study (Trøndelag Health). We conducted similar analyses in up to 21 423 father-offspring pairs from the same cohorts. We confirmed that the BP-associated genetic variants from the general population sample also had similar effects on maternal BP during pregnancy in independent cohorts. We did not detect any association between maternal (or paternal) unweighted genetic scores and cardiometabolic offspring outcomes in the meta-analysis of UKB and HUNT after adjusting for offspring genotypes at the same loci. We find little evidence to support the notion that maternal BP is a major causal risk factor for adverse offspring cardiometabolic outcomes in later life.

Abstract 9501: Duration of Ideal Cardiovascular Health With Risk of Chronic Kidney Disease and Cardiovascular Disease

Introduction: Increasing number of clinical guidelines are adopting comprehensive cardiovascular risk assessment tools for treatment decision and disease management in the context of primary and secondary prevention. Yet, little is known regarding the exact cardiovascular risks associated with length of favorable cardiometabolic health sustenance in midlife. Methods: From the Korean Genome and Epidemiology Study Ansung-Ansan cohort, we included 7,854 middle-aged adults without chronic kidney disease and 7,796 without cardiovascular disease at baseline. Duration of ideal cardiovascular health was the sum of time spent with ideal body mass index, blood pressure, fasting glucose, total cholesterol, non-smoking, alcohol drinking, and physical activity levels. We employed Cox proportional hazards model to assess chronic kidney disease and cardiovascular events risks. Results: The median age of the participants was 50.0 years and 47.9% were male. Over a median follow-up of 15.0 years, 1,401 new chronic kidney disease and 493 new cardiovascular disease occurred. With &lt;5 years group as the reference, multivariable-adjusted hazard ratios [95% confidence intervals] for chronic kidney disease were 0.63 [0.39-0.93] with 5 to 10 years and 0.33 [0.15-0.74] with ≥10 years of ideal cardiovascular health ( P trend, 0.0057). Similarly, participants lived with longer ideal cardiovascular health had significantly lower cardiovascular disease (5 to 10 years, 0.83 [0.54-1.27]; ≥10 years, 0.22 [0.08-0.60]). Subtype-specific analyses indicated negatively graded risks for coronary artery disease ( P trend, 0.0239) and cerebrovascular disease ( P trend, 0.0514). Conclusions: Our findings confer that maintaining favorable health behaviors and clinical cardiometabolic profile in midlife will improve later-life cardiovascular outcomes.

Associations between Adverse Childhood Experiences and the novel inflammatory marker glycoprotein acetyls in two generations of the Avon Longitudinal Study of Parents and Children birth cohort

BackgroundAdverse childhood experiences (ACEs) are associated with increased risk of non-communicable diseases in adulthood, potentially mediated by chronic low-grade inflammation. Glycoprotein acetyls (GlycA) is a marker of chronic and cumulative inflammation. We investigated associations between ACEs and GlycA at different ages, in two generations of the population-based Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort. MethodsALSPAC offspring’s total ACE scores were generated for two age periods using prospectively collected data: 0-7y and 0-17y. GlycA was measured using high-resolution proton nuclear magnetic resonance at mean ages 8y, 18y, and 24y. Sample sizes ranged from: n = 5116 (8y) to n = 3085 (24y). ALSPAC mothers (n = 4634) retrospectively reported ACEs experienced before age 18y and GlycA was assessed at mean age 49y. We used multivariable linear regression to estimate associations between ACEs (total ACE score and individual ACEs) and subsequent GlycA in both samples, adjusting for key confounders. ResultsMean GlycA levels were similar in offspring and mothers and over time. In offspring, there was no evidence that ACEs (total score or individual ACE) were associated with GlycA at age 8y or 18y, or 24y after adjustment for maternal age at birth and parity, maternal marital status, household occupational social class, maternal education, maternal smoking, own ethnicity, sex, and age in months. In mothers, there was evidence of a positive association between the total ACE score and GlycA at age 49y (adjusted mean difference 0.007 mmol/L; 95%CI: 0.003, 0.01). Emotional neglect was the only individual ACE associated with higher GlycA after adjusting for confounders and other ACEs. ConclusionResults suggest the association between ACEs and GlycA may emerge in middle age. Future research should explore the extent to which inflammation in adulthood mediates well-documented associations between ACEs and adverse health outcomes in later life.