Healthy cognitive aging and leisure activities among the oldest old in Japan: Takashima study

Gender, Work, and Leisure in Old Age in China and India

This paper examines how paid and unpaid work affects leisure differently for older women and men in China and India. We use data from the World Health Organization's Study on Global Aging and Health. We find that urban China, with higher levels of public welfare and gender equality, represents the best scenario for older adults' leisure life in developing countries. Although urban Chinese women are disadvantaged relative to urban Chinese men, they still enjoy longer hours of leisure and relaxing leisure than both men and women in rural China, urban India and rural India. Furthermore, the Blinder-Oaxaca decomposition results show gender disparities in unpaid housework to be the primary driver of gender inequalities in leisure in all societies, albeit to varying degrees. These findings highlight the role of public welfare, gender equality, and the gendered consequences of the family support model in shaping older adults' leisure life.

Free Time in Old Age: Does Health Status Determine the Choice of Leisure Activities in Indonesia?

This paper examines which leisure activities appear more attractive to older people, considering health status, disability and demographic-socio-economic and environmental variables. It employed data from Survei Penduduk Antar Sensus (SUPAS), the nationwide survey, conducted in 2015 by Indonesia's national statistical office. The sample selected 228,718 individuals aged 60 years old and above. Leisure activities were differentiated between active, sedentary, and no leisure activities. Health is measured with both health status and disability. Disability measures were adopted from Washington Group Short Set on Functioning-Enhanced (WG-SS Enhanced). Our multinomial regression models confirmed that health status was correlated with the choice of leisure activities in old age. Compared to older persons in good health, those reported in poor health without disruption to daily life were more likely to participate in sedentary or active leisure, but those with disruption to daily life were less likely to do so. Older persons with disability were disadvantaged in participating in either passive or active leisure. However, among all selected variables, employment and source of finance had the highest odds ratios and confounded the relationship between health and leisure activity.

The bi-directional relationships between diversified leisure activity participation and cognitive function in older adults in China: separating between-person effects from within-person effects

OBJECTIVE

To examine the bi-directorial association between diversified leisure activity participation and cognitive function over a 7-year period.

METHODS

Data analyzed was from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), a large-scale longitudinal national study. The baseline survey was conducted in 2011 with follow-up every three years. We traced a total of 2718 participants over a period of 7 years. We used adjusted random intercept cross-lagged panel models (RI-CLPMs) to examine the bi-directorial associations between diversified leisure activity participation and cognitive function.

RESULTS

We observed bi-directorial associations between diversity of leisure activity and cognitive function across waves at the between-person and within-person levels. The adjusted random intercept cross-lagged panel models fitted the data appropriately, and the 3-year cross-lagged effects of prior diversified leisure activity participation on cognitive function (β = 0.058, p < 0.01) and cognitive function on subsequent diversified leisure activity participation (β = 0.047, p < 0.05) were significant. The results remained after adjusting the model for baseline sex, age, educational level, marital status and current residence, the number of chronic diseases, ADL, depressive symptoms, sleep quality, smoking, and drinking.

CONCLUSION

This study suggests that a reciprocal causality relationship between diversified leisure activity participation and cognitive function, indicating a "positive circle" that further promotes cognition over time.

Older adults coping with critical life events - results of the revised demoralization scale in a representative sample of older adulthood

Background

High suicide rates in older adults are a relevant public health concern. Social isolation or widowhood as well as physical decline play a crucial role for suicidality in older adulthood. Previous evidence suggested that demoralization is an important risk factor for suicide. Whether demoralization is a relevant phenomenon in older adulthood which possibly could account for high suicide rates remains unclear.

Methods

Demoralization Scale II (DS-II) scores assessed in a survey of the German general population were investigated with respect to older adults (aged ≥ 65 years). DS-II scores were compared between older (≥ 65 years) and younger (< 65 years) adulthood and between young-old (65-74y), middle-old (75-84y), and old-old (85+y) individuals. We tested the impact of sociodemographic factors on DS-II scores within older adults.

Results

The sample comprised N = 545 adults ≥ 65 years and N = 1922 adults < 65 years. DS-II scores increased in older compared to younger adults (F(1,2465) = 6.1; p = 0.013; d = 0.09) and further from young-old to old-old (Mdiff = 2.7; 95% CI 0.45, 5.46; p = 0.034). One-fourth of individuals ≥ 65 years and almost half of old-old individuals reported DS-II scores above the cut-off > 5. Living with a partner protected from demoralization in old-old individuals.

Discussion

This study provides first evidence for an increased rate of demoralization in very old adults, in particular women, which is partly related to partnership status. We suggest that demoralization is considered as a crucial entity in older adulthood which can be missed by standard psychological screenings.

Internet-Based Conversational Engagement Randomized Controlled Clinical Trial (I-CONECT) Among Socially Isolated Adults 75+ Years Old With Normal Cognition or Mild Cognitive Impairment: Topline Results

BACKGROUND AND OBJECTIVES

Social isolation is a risk factor for cognitive decline and dementia. We conducted a randomized controlled clinical trial (RCT) of enhanced social interactions, hypothesizing that conversational interactions can stimulate brain functions among socially isolated older adults without dementia. We report topline results of this multisite RCT (Internet-based conversational engagement clinical trial [I-CONECT]; NCT02871921).

RESEARCH DESIGN AND METHODS

The experimental group received cognitively stimulating semistructured conversations with trained interviewers via internet/webcam 4 times per week for 6 months (induction) and twice per week for an additional 6 months (maintenance). The experimental and control groups both received weekly 10 minutes telephone check-ins. Protocol modifications were required due to the coronavirus disease 2019 pandemic.

RESULTS

A total of 186 participants were randomized. After the induction period, the experimental group had higher global cognitive test scores (Montreal Cognitive Assessment [primary outcome]; 1.75 points [p = .03]) compared with the control group. After induction, experimental group participants with normal cognition had higher language-based executive function (semantic fluency test [secondary outcome]; 2.56 points [p = .03]). At the end of the maintenance period, the experimental group of mild cognitive impairment subjects had higher encoding function (Craft Story immediate recall test [secondary outcome]; 2.19 points [p = .04]). Measure of emotional well-being improved in both control and experimental groups. Resting-state functional magnetic resonance imaging showed that the experimental group had increased connectivity within the dorsal attention network relative to the control group (p = .02), but the sample size was limited.

DISCUSSION AND IMPLICATIONS

Providing frequent stimulating conversational interactions via the internet could be an effective home-based dementia risk-reduction strategy against social isolation and cognitive decline.

CLINICAL TRIALS REGISTRATION NUMBER

NCT02871921.

A qualitative investigation of health benefits through a modified Taekwondo activity among nursing home residents

BACKGROUND

A few studies suggest that Taekwondo is an effective intervention in increasing physical functions among older adults. This study is intended to focus on a multitude of health benefits of participation in a modified Taekwondo activity for nursing home residents in the U.S.

METHODS

This qualitative study used semi-structured, in-depth interviews with seven participants consisting of 2 males and 5 females older adults from a community nursing home. The interview protocol included content mapping and content mining interview questions. The study followed the five steps of constant comparative analysis.

RESULTS

Four main themes were identified as health benefits resulting from a modified Taekwondo participation: (a) promoting mental health, (b) increasing physical functions, (c) stimulating cognitive abilities, and (d) facilitating positive social interaction.

DISCUSSION

This study indicates modified Taekwondo can be instrumental in promoting their physical functioning, cognitive functioning, social interactions, and mental health. Practical implications and further discussion are addressed in this paper.

Early- to late-life environmental factors and late-life global cognition in septuagenarian and octogenarians: The SONIC study

This study aimed to evaluate cognitively stimulating environments throughout life and to examine direct and indirect associations between these environments and late-life cognition. Early-life education, three domains of work complexity (data, people, and things) based on the longest-held occupation, and engagement in late-life leisure activities (LAs) were assessed. A structural equation model was developed using cross-sectional data of 1721 Japanese older adults in 70 ± 1 and 80 ± 1 years. The model confirmed significant direct effects of work complexity with data and late-life LAs on late-life cognitive performance. The associations of education and work complexity with late-life cognition were mediated through the subsequent environment(s). However, the total effects of work complexity with people and things on late-life cognition were insignificant. The findings suggest that cognitively stimulating activities in adulthood and beyond may lead to individual differences in late-life global cognition. In addition, antecedent complex environments might make subsequent life environments more cognitively stimulating. The results are discussed from the perspectives of cognitive plasticity and environmental complexity.

Indicators and Instruments to Assess Components of Disability in Community-Dwelling Older Adults: A Systematic Review

The epidemiological demands of aging point to the need for characterizing older adults regarding health and disability. This systematic review aims to summarize the indicators (instruments) identifying different components of disability as a result of aging exposition in community-dwelling older adults, considering the International Classification of Functioning, Disability, and Health framework. Taking the PRISMA 2020 recommendations as a reference, studies with community-dwelling older adults, reporting the development and/or age disability modifications were included. Two reviewers analyzed the observational studies searched in the MEDLINE, CINAHL, Web of Science, Scopus, and Embase databases. Of the 137 potentially eligible studies, 49 were included in this review. Several indicators (instruments) demonstrated older adults' disabilities according to the different domains of the ICF. Objective measures assessed Body Structures, Body Functions, and Environmental Factors and included handgrip strength (dynamometry, n = 8), cognitive function (Mini-Mental State examination, n = 7), gait speed (walk test, n = 6), and endurance (Chair stand-test, n = 4). Self-reported measures assessed Activities and Participation, but not the Body Structures, and included the basic and instrumental activities of daily living (ADL) (the Katz Index of ADL, n = 4 studies, the Lawton and Brody Instrumental ADL, n = 4 studies). The summary of the measures gathered can guide researchers and health professionals to select indicators (instruments) to assess and monitor older adults' disabilities resulting from aging exposition, to support the development of new wearables, and to provide improvements to the existing ones, allowing the tailored assessment of different health and disability dimensions.

Factors Associated With Participation in Physical Leisure Activities in Taiwanese Community-Dwelling Older Adults

This study was to identify factors at the intrapersonal, interpersonal, and community levels that relate to physical leisure participation in Taiwanese community-dwelling older adults and to examine their relative importance. We used a cross-sectional study with purposive sampling (N = 160). Physical leisure participation was quantified as the variety, frequency, and duration of participation. Data were analyzed using a series of hierarchical multiple linear regressions. The results showed that higher variety, frequency, or duration of physical leisure participation was associated with older males and with those who reported having better health, fewer depressive symptoms, and greater social support. Intrapersonal- and interpersonal-level factors play a relatively more important role in predicting physical leisure participation than factors at the community level. Understanding factors that relate to these three levels of participation has the potential to inform interventions that are tailored to individual profiles.

Comparing Pathological Risk Factors for Dementia between Cognitively Normal Japanese and Americans

The Alzheimer's Disease Neuroimaging Initiative showed that Japanese had significantly lower brain Aβ burden than Americans among a cognitively normal population. This cross-sectional study aimed to compare vascular disease burden, Aβ burden, and neurodegeneration between cognitively normal elderly Japanese and Americans. Japanese and American participants were matched for age (±4-year-old), sex, and Apolipoprotein E (APOE) genotype. Brain vascular disease burden and brain Aβ burden were measured using white matter lesions (WMLs) and 11C-labeled Pittsburgh Compound B (PiB) retention, respectively. Neurodegeneration was measured using hippocampal volumes and cortical thickness. A total of 95 Japanese and 95 Americans were recruited (50.5% men, mean age = 82). Compared to Americans, Japanese participants had larger WMLs, and a similar global Aβ standardized uptake value ratio (SUVR), cortical thickness and hippocampal volumes. Japanese had significantly lower regional Aβ SUVR in the anterior ventral striatum, posterior cingulate cortex, and precuneus. Cognitively normal elderly Japanese and Americans had different profiles regarding vascular disease and Aβ burden. This suggests that multiple risk factors are likely to be involved in the development of dementia. Additionally, Japanese might have a lower risk of dementia due to lower Aβ burden than Americans. Longitudinal follow-up of these cohorts is warranted to ascertain the predictive accuracy of these findings.

Watching TV and Cognition: The SPAH 2-Year Cohort Study of Older Adults Living in Low-Income Communities

Watching TV is a highly prevalent leisure activity among older adults and, in many cases, the only leisure option of those living in low-income communities. While engaging in leisure activities have proven to protect older adults from cognitive decline, the effects of watching TV on cognition of this population is controversial in the literature. This study investigated the impact of watching TV on global cognitive function, immediate memory, verbal fluency, risk of dementia of amnestic mild cognitive impairment (aMCI) in a cohort of older adults residents of socioeconomically deprived areas of São Paulo, Brazil. We used data from the São Paulo Aging & Health Study (SPAH). Participants aged 65 years or over, with no dementia diagnosis at baseline and who completed the 2-year follow-up assessment were included in this study (n = 1,243). Multivariable linear regression models were performed to assess the effect of watching TV on global cognitive function, immediate memory and verbal fluency. Multivariable logistic regression models were used to evaluate the risk of developing dementia and aMCI. Models were controlled by cognitive performance at baseline, sociodemographic characteristics and functional status. Cognitive performance at baseline and follow-up were similar. Thirty-one participants were diagnosed with dementia, and 23 with aMCI 24 months after inclusion in the study. Watching TV did not show any positive or negative effect on global cognitive function, immediate memory, verbal fluency, risk of dementia and risk of aMCI. It is good news that watching TV did not predict the decline in cognition in elders. However, it is essential to increase opportunities for other leisure activities for low-income and low-educated older adults if we do consider that leisure activities protect cognition decline in older adults. In the coming decades, developing countries will experience the highest burden of dementia and more than fun, public policies to promote leisure activities might be a strategy to alleviate this burden shortly.

Reliability and Validity of the Turkish Version of the Oxford Participation and Activities Questionnaire in Older People

Background

Activities and participation play important roles in the maintenance of healthy aging. The maintenance of these factors optimizes social life to increase the quality of life with aging. However, there is a lack of questionnaires in Turkish to evaluate activity and participation among older people. This study translated and cross-culturally adapted the Oxford Participation and Activities Questionnaire (Ox-PAQ) into Turkish and investigated its psychometric properties in the older adult population.

Methods

The Turkish version of the Ox-PAQ was produced after a translation and back-translation process. The Ox-PAQ was administered to 230 and 60 individuals for construct validity and reliability analyses, respectively. To assess the test-retest reliability of the Turkish Ox-PAQ, the questionnaire was reapplied 7 days after the first interview. Cronbach’s alpha (α) was used to evaluate the internal consistency. The Ox-PAQ was compared to the Short Form-12 and the Katz Index of Independence in Activities of Daily Living Scale to determine its validity.

Results

The Turkish Ox-PAQ showed excellent internal consistency (α=0.98) and test-retest reliability (intraclass correlation coefficient=0.98, 0.96, and 0.97 for the subscales of routine activity level, social engagement, and emotional well-being, respectively). In the validity analysis, factor analysis demonstrated a probable structure of the three factors that together explained 66.35% of the total variance. The Turkish Ox-PAQ was correlated with the other comparison measures used in this study.

Conclusion

The Turkish Ox-PAQ is a reliable and valid questionnaire to evaluate the participation and activity levels of older people (Clinical Trial Number: NCT04368754).

Cognitive Benefits of Activity Engagement among 12,093 Adults Aged over 65 Years

OBJECTIVE

The present study includes two aims: (1) to understand patterns of activity engagement among older Chinese adults; (2) to further investigate associations between activity engagement and cognitive abilities in this population.

METHODS

Latent class analysis was applied to answer the aforementioned research questions across different age ranges while controlling for confounding variables (age, health, socioeconomic status (SES), and living alone). Specifically, five latent classes (non-active, working-active, comprehensive-active, physical-active, and less-active) were identified. Furthermore, associations between the classes of activity engagement and cognition were examined separately in three age groups: less than 80 years (young-old group), 80-99.5 years (old-old group) and more than 100 years (oldest-old group) of age.

RESULTS

Compared with Non-active older individuals, the other classes with a higher probability of engagement in various activities generally showed higher cognitive abilities (including general cognition, orientation, calculation, recall, and language), but not all patterns of active engagement in daily life were positively associated with better cognitive status across different age ranges. In particular, differences in the individuals' cognitive abilities across the four active latent classes were especially obvious in the old-old group as follows: the Comprehensive-active class had higher general cognitive and recall abilities than the other three active classes and higher calculation and language abilities than the Working-active class. In addition, significant sex differences were observed in activity patterns, cognition, and their associations in the young-old and old-old groups. Culture-specific programs should be customized to subgroups of different ages and genders by providing different training or activity modules based on their related dimensions of cognitive decline.

Associations of equol-producing status with white matter lesion and amyloid-β deposition in cognitively normal elderly Japanese

INTRODUCTION

Equol, a metabolite of a soy isoflavone transformed by the gut microbiome, is anti-oxidant and anti-amyloidogenic. We assessed the associations of equol with white matter lesion normalized to total brain volume (WML%) and amyloid beta (Aβ) deposition.

METHODS

From 2016 to 2018, 91 cognitively normal elderly Japanese aged 75 to 89 underwent brain magnetic resonance imaging and positron emission tomography using 11C-Pittsburgh compound-B. Serum equol was measured using stored samples from 2008 to 2012. Equol producers were defined as individuals with serum levels >0. Producers were further divided into high (> the median) and low (≤ the median) producers.

RESULTS

The median (interquartile range) WML% was 1.10 (0.59 to 1.61); 24.2% were Aβ positive, and 51% were equol producers. Equol-producing status (non-producers, low and high) was significantly inversely associated with WML%: 1.19, 0.89, and 0.58, respectively (trend P < .01). Equol-producing status was not associated with Aβ status.

DISCUSSION

A randomized-controlled trial of equol targeting WML volume is warranted.

Importance of Activity Engagement and Neighborhood to Cognitive Function Among Older Chinese Americans

This study investigates the differential associations of activity engagement and perceived neighborhood characteristics (i.e., cohesion, disorder, sense of community) with cognitive measures. Using data of 2,713 Chinese older adults in Chicago, who completed two interviews between 2011 and 2015, we identified three activity domains: reading, social, and games. In general, engagement in more reading and social activities was associated with better baseline cognitive function, but the positive effects tapered off over time in some cases. Neighborhood cohesion had both direct and indirect effects on cognitive function. Engagement in social activities mediated the neighborhood cohesion effects, that is, living in a cohesive neighborhood promoted social activities and consequently benefited cognitive function. Findings speak to the importance of activity engagement and neighborhood cohesion for cognition among the U.S. Chinese older adults. Future research is needed to investigate the longitudinal relationships of activity engagement and environmental factors with cognitive change.

Relationship between subjective memory complaints and social and leisure activities in community-dwelling older people: Toyoake Integrated Care Study

AIM

Subjective memory complaints (SMC) have attracted attention in recent years in relation to the early stages of dementia. However, it is not clear whether SMC are related to social and leisure activities. The aim of this study was to evaluate SMC in relation to activities in community-dwelling older adults.

METHODS

A questionnaire inquiring about SMC and social and leisure activities was sent to 14 850 people aged ≥65 years residing in Toyoake City, as part of the Toyoake Integrated Care Study. After a preliminary analysis, we targeted respondents aged ≥70 years. Therefore, 6685 people were included in the analysis. Three question items were used detecting SMC: the feeling of a memory problem (SMC-1), memory loss pointed out by others (SMC-2) and difficulty in recalling today's date (SMC-3). Logistic regression was carried out to determine the relationship between SMC and activities.

RESULTS

In response to SMC-1, 2 and 3, 45.3%, 13.3% and 23.5% participants, respectively, agreed with the statement. Social and leisure activities were negatively associated with SMC-2 and SMC-3, after controlling for confounding factors (SMC-2: odds ratio 0.76, 95% confidence interval 0.65-0.89; SMC-3: odds ratio 0.79, 95% confidence interval 0.70-0.90). However, a significant increase in participation in social and leisure activities was associated with a positive response to SMC-1 (SMC-1: odds ratio 1.24, 95% confidence interval 1.12-1.38). Conclusion A relationship was observed between SMC and social and leisure activities in community-dwelling older people, although differences in the impact of SMC were seen depending on the question asked. Geriatr Gerontol Int 2020; 20: 867-872.

Socioeconomic disparities in leisure activities over the life course of the oldest-old in China

OBJECTIVE

To identify the socioeconomic factors leading to disparities in participation in leisure activities over the life course among Chinese oldest-old people.

METHODS

Data are from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), a sample of adults aged 80 years or older in the period 1998-2012, featuring 38 312 individuals (58 945 observations).

RESULTS

The younger birth cohorts were found to have significantly higher levels of participation in leisure activities, with a non-linear decrease in age observed for oldest-old men and women. Higher participation levels were significantly related to higher education levels, economic independence and non-manual occupations before retirement among the Chinese oldest-old.

CONCLUSIONS

Leisure activity participation has increased substantially in recent cohorts of Chinese oldest-olds. Those with lower socioeconomic status may represent a disadvantaged population in terms of participation in leisure activities over their life course.

The impact of leisure activities on older adults' cognitive function, physical function, and mental health

Engagement in leisure activities has been claimed to be highly beneficial in the elderly. Practicing such activities is supposed to help older adults to preserve cognitive function, physical function, and mental health, and thus to contribute to successful aging. We used structural equation modeling (SEM) to analyze the impact of leisure activities on these constructs in a large sample of Japanese older adults (N = 809; age range 72–74). The model exhibited an excellent fit (CFI = 1); engaging in leisure activities was positively associated with all the three successful aging indicators. These findings corroborate previous research carried out in Western countries and extend its validity to the population of Eastern older adults. Albeit correlational in nature, these results suggest that active engagement in leisure activities can help older adults to maintain cognitive, physical, and mental health. Future research will clarify whether there is a causal relationship between engagement in leisure activities and successful aging.

Cognitive Performance Among Older Persons in Japan and the United States

OBJECTIVE

To compare cognitive performance among Japanese and American persons, aged 68 years and older, using two nationally representative studies and to examine whether differences can be explained by differences in the distribution of risk factors or in their association with cognitive performance.

DESIGN

Nationally representative studies with harmonized collection of data on cognitive functioning.

SETTING

Nihon University Japanese Longitudinal Study of Aging and the US Health and Retirement Study.

PARTICIPANTS

A total of 1953 Japanese adults and 2959 US adults, aged 68 years or older.

MEASUREMENTS

Episodic memory and arithmetic working memory are measured using immediate and delayed word recall and serial 7s.

RESULTS

Americans have higher scores on episodic memory than Japanese people (0.72 points on a 20-point scale); however, when education is controlled, American and Japanese people did not differ. Level of working memory was higher in Japan (0.36 on a 5-point scale) than in the United States, and the effect of education on working memory was stronger among Americans than Japanese people. There are no differences over the age of 85 years.

CONCLUSION

Even with large differences in educational attainment and a strong effect of education on cognitive functioning, the overall differences in cognitive functioning between the United States and Japan are modest. Differences in health appear to have little effect on national differences in cognition. J Am Geriatr Soc 68:354-361, 2020.

Incidence and predictors of mild cognitive impairment (MCI) within a multi-ethnic Asian populace: a community-based longitudinal study

BACKGROUND

Limited information is available from longitudinal studies regarding the predictors and incidence of MCI in older Asian adults. Thus, a community-based longitudinal study was conducted to determine the incidence of MCI among multi-ethnic older adults in Malaysia. The role of health and lifestyle as predictors of MCI was also examined.

METHODS

Analysis of data obtained from the Towards Useful Aging (TUA) study (2014-2016), wave 1 (baseline) and wave 2 (1½ years of follow-up) was conducted. For the baseline, comprehensive, interview-based questionnaires were administered to 1227 subjects who were 60 years old and above. MCI is a unique transitional state between normal ageing and dementia. MCI characteristics include a decline and disturbance of cognition, minimal impairment of complex activities, ability to perform regular daily functions, and absence of dementia. The incidence of MCI was assessed using comprehensive neuropsychological batteries. The study then performed a logistic regression analysis to examine the effect of each possible predictor of MCI. This analysis began with univariate analyses and a separate review of the effect of every variable. Binary logistic analyses followed hereafter.

RESULTS

During the follow-up after 1½ years, 179 (14.6%) of the participants who did not exhibit MCI at baseline were observed to have developed MCI. Among the participants who did not exhibit MCI at baseline, the incidence rate was 10.5 per 100 person-years. Male sex and lack of engagement in mental activities were predictors of MCI among participants without MCI at baseline.

CONCLUSION

After the 1½-year follow-up, the incidence rate for MCI was considerably high among the respondents. Being male and being less engaged in mental activities were predictors of the occurrence of MCI. Mental activities need to be promoted for the prevention of MCI incidence among older adults.

The Aging Well through Interaction and Scientific Education (AgeWISE) Program

OBJECTIVE

We conducted a randomized controlled trial of the Aging Well through Interaction and Scientific Education (AgeWISE) program, a 12-week manualized cognitive rehabilitation program designed to provide psychoeducation to older adults about the aging brain, lifestyle factors associated with successful brain aging, and strategies to compensate for age related cognitive decline.

METHODS

Forty-nine cognitively intact participants ≥ 60 years old were randomly assigned to the AgeWISE program (n = 25) or a no-treatment control group (n = 24). Questionnaire data were collected prior to group assignment and post intervention. Two-factor repeated-measures analyses of covariance (ANCOVAs) were used to compare group outcomes.

RESULTS

Upon completion, participants in the AgeWISE program reported increases in memory contentment and their sense of control in improving memory; no significant changes were observed in the control group. Surprisingly, participation in the group was not associated with significant changes in knowledge of memory aging, perception of memory ability, or greater use of strategies.

CONCLUSIONS

The AgeWISE program was successfully implemented and increased participants' memory contentment and their sense of control in improving memory in advancing age.

CLINICAL IMPLICATIONS

This study supports the use of AgeWISE to improve perspectives on healthy cognitive aging.

Relationships between socio-clinico-demographic factors and global cognitive function in the oldest old living in the Tokyo Metropolitan area: Reanalysis of the Tokyo Oldest Old Survey on Total Health (TOOTH)

BACKGROUND

Despite a steady increase in life expectancy, a few studies have investigated cross-sectional correlates and longitudinal predictors of cognitive function, a core domain of the successful aging, among socio-clinico-demographic factors in the oldest-old exclusively.

OBJECTIVES

The aims of this study were to examine socio-clinico-demographic characteristics associated with global cognition and its changes in the oldest-old.

METHODS

We reanalyzed a dataset of cognitively preserved community-dwelling subjects aged 85 years and older in the Tokyo Oldest Old Survey on Total Health, a 6-year longitudinal observational study. This study consisted of (1) baseline cross-sectional analyses examining correlates of global cognition (n = 248) among socio-clinico-demographic factors and (2) longitudinal analyses examining baseline predictors for changes of global cognition in 3-year follow-up (n = 195). The Mini-Mental State Examination was used as a screening test to assess global cognition.

RESULTS

At baseline, higher weights were related to higher cognitive function in the oldest-old. The baseline predictors of global cognitive decline in 3-year follow-up were higher global cognition, shorter education period, and lower sociocultural activities and lower instrumental activity of daily living, in this order.

CONCLUSIONS

The present study suggests that it is crucial to attain higher education during early life and avoid leanness or obesity, participate in sociocultural cognitive activities during late life, and maintain instrumental activity of daily living to preserve optimal cognitive function in the oldest-old, which will facilitate developing prevention strategies for cognitive decline and promoting successful aging in this increasing population.

Functional disability among partners and community activity in elderly Japanese: The Ohsaki Cohort 2006 Study

INTRODUCTION

This cross-sectional study aimed to determine association between partners' functional disability and community activity in an elderly Japanese population.

METHODS

A baseline survey was conducted between December 1 st and December 15th, 2006 and included 6600 participants from whom we collected data regarding their participation in community activity and functional disability among their partners. We defined functional disability as receiving certification for long-term care insurance in Japan, and frequent community activity as engaging in community activity more than once a month. Multiple logistic regression analysis was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for frequent community activity based on functional disability among partners. We also conducted additional analyses using three types of community activities (neighborhood associations; sports, exercise, or a hobby; and volunteering for nonprofit organizations) as outcomes.

RESULTS

Multivariate adjusted analysis showed that the OR (95% CI) for frequent community activity was 0.70 (0.54-0.89, P < 0.01) among those whose partners had functional disabilities, compared with those whose partners did not have functional disabilities. This finding remained true even for different types of community activities such as neighborhood activities, sports, exercises, hobbies, and volunteering for nonprofit organizations.

CONCLUSION

In this cross-sectional study of an elderly Japanese population, participants whose partners had functional disabilities were less likely to participate in community activity. We conclude that enhancement of support systems is important to promote participation in community activity, not only for patients with disability but their partners as well.

The association between distance to public amenities and cardiovascular risk factors among lower income Singaporeans

Existing evidence on the association between built environment and cardiovascular disease (CVD) risk factors focused on the general population, which may not generalize to higher risk subgroups such as those with lower socio-economic status (SES). We examined the associations between distance to 5 public amenities from residential housing (public polyclinic, subsidized private clinic, healthier eatery, public park and train station) and 12 CVD risk factors (physical inactivity, medical histories and unhealthy dietary habits) among a study sample of low income Singaporeans aged ≥ 40 years (N = 1972). Using data from the Singapore Heart Foundation Health Mapping Exercise 2013–2015, we performed a series of logistic mixed effect regressions, accounting for clustering of respondents in residential blocks and multiple comparisons. Each regression analysis used the minimum distance (in km) between residential housing and each public amenity as an independent continuous variable and a single risk factor as the dependent variable, controlling for demographic characteristics. Increased distance (geographical inaccessibility) to a train station was significantly associated with lower odds of participation in sports whereas greater distance to a subsidized private clinic was associated with lower odds of having high cholesterol diagnosed. Increasing distance to park was positively associated with higher odds of less vegetable and fruits consumption, deep fried food and fast food consumption in the preceding week/month, high BMI at screening and history of diabetes, albeit not achieving statistical significance. Our findings highlighted potential effects of health-promoting amenities on CVD risk factors in urban low-income setting, suggesting gaps for further investigations.

•

We examined associations between access to 5 amenities and 12 CVD risk factors.

•

Only 2/60 associations were statistically significant.

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Poorer access to train station was associated with lower odds of sports.

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Poorer access to primary care was associated with lower high cholesterol diagnosis.

For how many days and what types of group activities should older Japanese adults be involved in to maintain health? A 4-year longitudinal study

OBJECTIVE

Studies have suggested that frequent participation in social groups contributes to the well-being of older people. The primary aim of this study was to identify the number of days older adults should participate in the activities of social groups to maintain their health for 4 years. This study also aimed to examine whether the effective frequency differs by the type of social group activity.

METHOD

We examined a prospective cohort of 1,320 community-dwelling older adults over 65 years of age, who responded to both a baseline and a follow-up mail survey, in a suburban city of Tokyo, Japan. The dependent variable was the change in functional competence during 4 years. Logistic regression analyses were conducted to examine the effects of participation in the activities of the 5 most common social groups among older Japanese on maintaining functional competence.

RESULTS

Nine hundred and ninety-four participants (76.5%) maintained their functional competence for 4 years. The results of the logistic regression analyses showed that participating in alumni groups less than once a month and being an inactive member were associated with higher odds of maintaining functional competence, after controlling for socioeconomic, demographic and baseline health status. Additionally, the odds of maintaining functional competence for 4 years increased upon participating in volunteer groups once a month or more. These results were also confirmed using logistic regression analysis, even after adjustment for the effects of participation in other social groups.

DISCUSSION

The results indicated the effectiveness of volunteer activities that fulfill a social role in maintaining health. Therefore, older adults should be encouraged to participate in activities of volunteer groups at least once a month. Additionally, older adults can obtain positive health outcomes through less frequent participation in alumni groups, compared with the activities of volunteer groups.

Suicide in older adults: differences between the young-old, middle-old, and oldest old

BACKGROUND

In the limited research into suicides in older adults, they have been treated as a homogenous group without distinguishing between different age groups. This study aimed to compare differences in sociodemographic variables, recent life events, and mental and physical illnesses between three age groups within older adults who died by suicide: young-old (65-74 years), middle-old (75-84 years), and oldest old (85 years and over) in Queensland, Australia, during the years 2000-2012 (N = 978).

METHODS

The Queensland Suicide Register was utilized for the analysis. Annual suicide rates were calculated. Odds ratios with 95% confidence intervals and χ 2 tests for trend were calculated to examine differences between the three groups.

RESULTS

Suicide rates were increasing with age for males, but not for females. Hanging and firearms were the predominant methods of suicides. However, suffocation by plastic bag and drowning as suicide methods increased with age, in contrast firearms and explosives decreased with age. Overall, psychiatric problems, suicidal behavior, legal and financial stressors, and relationship problems decreased significantly with age, meanwhile physical conditions and bereavement increased with age.

CONCLUSION

Suicide across older adulthood is not a homogenous phenomenon. Our findings showed significant differences in the prevalence of potential risk factors within the three different age groups considered. To prevent suicide in older adults would require targeting specific factors for each subgroup while using holistic and comprehensive approaches.

Activity engagement and physical function in old age sample

OBJECTIVES

To describe the patterns of engagement in mental, physical, and social activity (MA, PA, and SA) and to examine the relationship between combined activity engagement and physical function among community-dwelling older adults.

DESIGN

Cross-sectional correlational study.

SETTING

Multiple communities.

PARTICIPANTS

A total of 466 individuals aged 55 years or older.

MEASUREMENTS

Physical function was assessed using grip strength and gait speed. Engagement in PA, MA and SA was obtained from self-report questionnaires.

RESULTS

We identified four classes ("Active PA and MA", "Active MA", "Active PA", and "Inactive") that significantly differed in the frequency of engagement in MA and PA using latent class analysis. SA didn't differ across classes. Controlling for age, the "Active PA and MA", "Active MA", "Active PA" groups displayed similar grip strength that was superior to the "Inactive" group. "Active PA and MA" group had best gait speed relative to other groups, especially "Active MA" and "Inactive" group, while the "Active PA", "Active MA", and "Inactive" group were similar in gait speed.

CONCLUSION

Combined physical and mental activity engagement was associated with better physical function, especially in gait speed. Future interventional research should investigate the combination of both physical and cognitive training to prevent decline of physical function in older adults.

The Effectiveness of Dance Interventions to Improve Older Adults' Health: A Systematic Literature Review

BACKGROUND

Physical inactivity is commonly observed among individuals aged ≥ 60 y. Identified barriers to sedentary older adults beginning activity include low self-efficacy, pre-existing medical conditions, physical limitations, time constraints, and culture. Dancing has the potential to be an attractive physical activity that can be adjusted to fit a target population's age, physical limitations, and culture.

OBJECTIVES

This review examined the benefits to physical health of dance interventions among older adults.

METHODS

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic search using the PubMed database was conducted. Eighteen studies met the inclusion and exclusion criteria and were analyzed for type of intervention, the study's design, participants' demographics, and outcomes, including attrition.

RESULTS

The 18 articles reported on studies conducted in North America, South America, Europe, and Asia. Of the styles of dancing, 6 studies used ballroom, 5 used contemporary, 4 used cultural, 1 used pop, and 2 used jazz. Two studies targeted older adults with pre-existing medical conditions. The average age of participants ranged from 52-87 y. Researchers used a variety of measures to assess effectiveness: (1) 3 of 5 (60%) that used measures to assess flexibility showed significant positive results; (2) 23 of 28 (82%) that used measures of muscular strength and endurance showed significant positive changes; (3) 8 of 9 (89%) that used measures of balance showed significant positive changes; (4) 8 of 10 (80%) that used measures of cognitive ability showed significant positive changes; and (5) the one that measured cardiovascular endurance showed significant positive changes. Only 6 studies reported participation, and they found low attrition.

CONCLUSIONS

The findings suggest that dance, regardless of its style, can significantly improve muscular strength and endurance, balance, and other aspects of functional fitness in older adults. Future researchers may want to analyze the effects of dance on mental health and explore ways to make this intervention attractive to both genders. Standardizing outcome measures for dance would facilitate meta-analysis.

Characteristics associated with willingness to participate in a randomized controlled behavioral clinical trial using home-based personal computers and a webcam

Background

Trials aimed at preventing cognitive decline through cognitive stimulation among those with normal cognition or mild cognitive impairment are of significant importance in delaying the onset of dementia and reducing dementia prevalence. One challenge in these prevention trials is sample recruitment bias. Those willing to volunteer for these trials could be socially active, in relatively good health, and have high educational levels and cognitive function. These participants’ characteristics could reduce the generalizability of study results and, more importantly, mask trial effects. We developed a randomized controlled trial to examine whether conversation-based cognitive stimulation delivered through personal computers, a webcam and the internet would have a positive effect on cognitive function among older adults with normal cognition or mild cognitive impairment. To examine the selectivity of samples, we conducted a mass mail-in survey distribution among community-dwelling older adults, assessing factors associated with a willingness to participate in the trial.

Methods

Two thousand mail-in surveys were distributed to retirement communities in order to collect data on demographics, the nature and frequency of social activities, personal computer use and additional health-related variables, and interest in the prevention study. We also asked for their contact information if they were interested in being contacted as potential participants in the trial.

Results

Of 1,102 surveys returned (55.1% response rate), 983 surveys had complete data for all the variables of interest. Among them, 309 showed interest in the study and provided their contact information (operationally defined as the committed with interest group), 74 provided contact information without interest in the study (committed without interest group), 66 showed interest, but provided no contact information (interest only group), and 534 showed no interest and provided no contact information (no interest group). Compared with the no interest group, the committed with interest group were more likely to be personal computer users (odds ratio (OR) = 2.78), physically active (OR = 1.03) and had higher levels of loneliness (OR = 1.16).

Conclusion

Increasing potential participants’ familiarity with a personal computer and the internet before trial recruitment could increase participation rates and improve the generalizability of future studies of this type.

Trial registration

The trial was registered on 29 March 2012 at ClinicalTirals.gov (ID number NCT01571427).

Dancing for balance: feasibility and efficacy in oldest-old adults with visual impairment

BACKGROUND

Fall risk increases with age and visual impairment, yet the oldest-old adults (>85 years) are rarely studied. Partnered dance improves mobility, balance, and quality of life in older individuals with movement impairment.

OBJECTIVE

The aim of the study was to determine the feasibility and participant satisfaction of an adapted tango program amongst these oldest-old adults with visual impairment. Exploratory analyses were conducted to determine efficacy of the program in improving balance and gait.

METHODS

In a repeated-measures, one-group experimental design, 13 older adults (7 women; age: M = 86.9 years, SD = 5.9 years, range = 77-95 years) with visual impairment (best eye acuity: M = 0.63, SD = 0.6 logMAR) participated in an adapted tango program of twenty 1.5-hour lessons, within 11 weeks. Feasibility included evaluation of facility access, safety, volunteer assistant retention, and participant retention and satisfaction. Participants were evaluated for balance, lower body strength, and quality of life in two baseline observations, immediately after the program and 1 month later.

RESULTS

Twelve participants completed the program. The facility was adequate, no injuries were sustained, and participants and volunteers were retained throughout. Participants reported enjoyment and improvements in physical well-being. Exploratory measures of dynamic postural control (p < .001), lower body strength (p = .056), and general vision-related quality of life (p = .032) scores showed improvements following training.

DISCUSSION

These older individuals with visual impairment benefitted from 30 hours of tango instruction adapted for their capabilities.

Psychological and socioeconomic health of community-dwelling older adults

Different dimensions of health are intertwined. The purposes of this study were: (1) to investigate the psychological and socioeconomic health status of community-dwelling older adults in Taiwan, and (2) to compare the psychological and socioeconomic health differences among people of different age groups, gender, marital status, and exercise habits. Using stratified random sampling, 384 Taiwanese community-dwelling older adults were recruited for this survey research. Based on the Health Model of Older Adults, seven constructs were measured: (1) psychological health: sleep quality, emotional health, cognitive functioning, and health promotion behaviors; (2) socioeconomic health: social engagement, social support, and financial status. Results showed that most participants were in a good state of psychological and socioeconomic health, except that 38.02% of them suffered from sleep disruptions, and the majority of them were not involved in any social group, nor engaged in any volunteer work. Young-old older adults had better psychological and socioeconomic health than middle-old and old-old older adults. Male older adults had better psychological health than female older adults; however, they had less social engagement and social support than female older adults. Married older adults and exercisers performed better in most of the psychological and socioeconomic health indicators than single/widowed older adults and non-exercisers.

Late life leisure activities and risk of cognitive decline

BACKGROUND

Studies concerning the effect of different types of leisure activities on various cognitive domains are limited. This study tests the hypothesis that mental, physical, and social activities have a domain-specific protection against cognitive decline.

METHODS

A cohort of a geographically defined population in China was examined in 2003-2005 and followed for an average of 2.4 years. Leisure activities were assessed in 1,463 adults aged 65 years and older without cognitive or physical impairment at baseline, and their cognitive performances were tested at baseline and follow-up examinations.

RESULTS

High level of mental activity was related to less decline in global cognition (β = -.23, p < .01), language (β = -.11, p < .05), and executive function (β = -.13, p < .05) in ANCOVA models adjusting for age, gender, education, history of stroke, body mass index, Apolipoprotein E genotype, and baseline cognition. High level of physical activity was related to less decline in episodic memory (β = -.08, p < .05) and language (β = -.15, p < .01). High level of social activity was associated with less decline in global cognition (β = -.11, p < .05). Further, a dose-response pattern was observed: although participants who did not engage in any of the three activities experienced a significant global cognitive decline, those who engaged in any one of the activities maintained their cognition, and those who engaged in two or three activities improved their cognition. The same pattern was observed in men and in women.

CONCLUSIONS

Leisure activities in old age may protect against cognitive decline for both women and men, and different types of activities seem to benefit different cognitive domains.

Sociodemographic determinants of leisure participation among elderly in Malaysia

Leisure participation has been proven to be beneficial and has a positive link to successful ageing. This study aims to explore the sociodemographic determinants of leisure participation among the Malaysian elderly. A cross-sectional study was conducted among persons aged 60 years and above, purposively selected from eight health clinics in the state of Selangor. Leisure participation was measured using a validated Leisure Participation Questionnaire specific for Malaysian elderly, consisting of 25 activities, categorized into 4 categories, namely recreational (physical), cognitive, social and productive. Frequency of such participation was measured on a 6-point scale. Its association with sociodemographic variables was examined using inferential and regression analysis. 268 participants were involved in this study (response rate = 100%). The most common daily leisure activities were having conversations while relaxing (78.7%), watching television (74.6%) and reading (63.4%). The least frequently done leisure activities were from the recreational and cognitive categories. The activities were weakly correlated to each other, reflecting the lack of diversity of leisure activities among respondents. Education was the main predictor for leisure participation among elderly, with higher educational level is associated with high RAS (B = 1.020, P < 0.05), CAS (B = 1.580, P < 0.05) and SAS (B = 1.276, P < 0.05). Education level, marital status and locality were important determinants of leisure participation among elderly, with education being the main predictor. Further studies exploring the effective method of educating the ageing society are recommended.

Social networks and subjective wellbeing among older Europeans: does age make a difference?

This inquiry examined whether social networks are associated with wellbeing among older-old people in the same way that they are among younger-old persons. The study focused on family respondents, aged 60 and older, from the second wave of the Survey of Health, Ageing and Retirement in Europe (N=14,728). The statistical analysis regressed two wellbeing measures (the CASP quality of life scale and life satisfaction) on a range of social network variables from three domains: family structure and interaction, social exchange and social engagement. In addition, the inquiry viewed these associations through the lens of age-based interaction terms, controlling for background characteristics, health status and region. The analysis revealed that the associations between subjective wellbeing and social network vary according to age. Among younger-old respondents, aged 60–79, more significant associations were found between social network variables and wellbeing outcomes in comparison to older-old respondents, aged 80 or older. Differences between age groups also emerged with the direction of the associations between social network variables and subjective wellbeing. The study results reveal that social networks do matter in very old age, but not in the same way as among younger-old persons. This finding is one indication of the differences that may emerge between third-age adults and those approaching the fourth age.

Differences in cognitive performance, level of dependency and quality of life (QoL), related to age and cognitive status in a sample of Spanish old adults under and over 80 years of age

The main objective of this study was to analyze the similarities and differences in cognitive performance, level of dependency, cognitive plasticity and QoL in a sample of young-old adults and old-old adults, bearing in mind both the age-group (under or over 80 years) and the cognitive status of the participants. The study population consisted of 220 people living in sheltered accommodation for elderly people in the South of Spain, with an average age of 80.75 years. Participants were evaluated by means of cognitive performance tests, a QoL questionnaire, a depression scale and a dependency assessment scale. The results indicate that the main differences in the variables analyzed are due to the cognitive status of the sample and not to the fact that the participants are under or over 80 years of age. The findings show that major inter-individual differences in this stage of life depend not only on age but also on cognitive status, which is thus an important factor to take into account when working with this sector of the population.

The Meaning of Leisure for Older Adults Living with Vision Loss

Engaging in leisure activities is related to successful aging. Because there are an increasing number of older adults living with vision loss, many of whom struggle to engage in leisure, the aim of this study was to understand the meaning behind leisure activities for older adults who are living with vision loss. Twenty-six individuals with a visual acuity of 20/70 or worse participated in semi-structured interviews and allowed for the observation of engagement in a leisure activity of choice. Three themes regarding leisure and vision loss emerged: a shift in relationships, the influence of vision loss on time use, and achieving meaning through leisure as an important outcome. Discussion focused on implications for practice, emphasizing a need to understand the meaning of an activity to achieve leisure participation outcomes, and the importance of finding ways to enable older adults with vision loss to engage in leisure occupations.

Modifiable Midlife Risk Factors for Late-Life Cognitive Impairment and Dementia

The baby boom generation is approaching the age of greatest risk for cognitive impairment and dementia. There is growing interest in strategies to modify the environment in midlife to increase the probability of maintaining cognitive health in late life. Several potentially modifiable risk factors have been studied in relation to cognitive impairment and dementia in late life, but methodological limitations of observational research have resulted in some inconsistencies across studies. The most promising strategies are maintaining cardiovascular health, engagement in mental, physical, and social activities, using alcohol in moderation, abstaining from tobacco use, and following a heart-healthy diet. Other factors that may influence cognitive health are occupational attainment, depression, personality, exposure to general anesthesia, head injury, postmenopausal hormone therapy, non-steroidal anti-inflammatory medications, and nutritional supplements such as antioxidants. Some long-term observational studies initiated in midlife or earlier, and some randomized controlled trials, have examined the effects of specific cognitive health promotion behaviors in midlife on the risk of cognitive impairment in late life. Overall, these studies provide limited support for risk reduction at this time. Recommendations and challenges for developing effective strategies to reduce the burden of cognitive impairment and dementia in the future are discussed.