The Association Between Spousal Education and Cognitive Ability Among Older Mexican Adults

Spousal education and frailty levels among Chinese older adults: A national longitudinal study

Background

Prior research has identified one's own education level as a risk factor for frailty. However, the association between spousal education and frailty in later life is uncertain. We aim to examine the longitudinal association between spousal education and frailty levels among Chinese older populations.

Methods

3856 participants aged 60 and older from the 2011-2018 China Health and Retirement Longitudinal Study were analyzed. A 54-item deficit cumulative frailty index was developed to evaluate frailty levels at each follow-up. Linear mixed-effects models were used to examine the longitudinal association of spousal education with frailty levels, and whether this association varied by sex and own education level.

Results

Higher spouse education was associated with lower frailty levels, and this association decreased with age. Compared with older adults whose spouses had no formal education, older adults whose spouses had less than middle school education had an 8.82 lower level of frailty (95% CI: 15.05 to -2.58, P < 0.01); those with spouses with middle school education and above had a 23.44 lower level (95% CI: 31.43 to -15.44, P < 0.001). Stratified analysis showed that every additional year of spouse education was also associated with lower frailty levels in non-frail participants at baseline, but stronger among those already frail. The association between high spousal education and lower frailty did not vary by sex or own education.

Conclusion

This study reveals a significant association between having a more educated spouse and lower later-life frailty levels for both older men and women, regardless of one's own educational background. It emphasizes the importance of leveraging educated spouses to prevent and manage frailty.

A national longitudinal dyadic analysis of spousal education and cognitive decline in the United States

Education plays a significant role in shaping cognitive functioning throughout an individual's life. However, existing research has not adequately explored how the educational attainment of the spouse can impact cognitive functioning over time. This study presents one of the first longitudinal analyses of how spousal education is linked to cognitive trajectories of each member within couples during their later life in the United States. Guided by the linked lives perspective, we analyze data from 8370 couples in the Health and Retirement Study spanning from 2000 to 2018. Results from the Actor-Partner Interdependence Model (APIM) integrated with latent growth curve models reveal that cognitive trajectories exhibit a correlation between spouses over time. Moreover, our analysis uncovers gender-specific effects of spousal education on cognition, shedding light on the underlying mechanisms driving this connection. Notably, the lower educational attainment of husbands is associated with a faster cognitive decline in both themselves and their wives. This association is partially explained by economic resources, but not by health and social behaviors. The lower educational attainment of wives is linked to their own faster cognitive decline as well as lower initial cognitive levels of their husbands, in part via economic resources. However, wives' educational attainment is largely unrelated to their husbands' cognitive decline. Intriguingly, wives' education has a more pronounced impact on the health and social behaviors of their husbands than vice versa, although these health and social behaviors do not appear to influence husbands' cognitive decline. In conclusion, these results underscore the importance of considering spousal education in comprehending the complexities of cognitive decline within dyadic relationships.

Declined prevalence, improved awareness and control of hypertension are associated with spousal educational attainment: A mega-data study

Cardiovascular diseases, including hypertension, have posed a serious threat to human health in recent decades. Family-centered health promotion and disease control for the management of hypertension is gaining attention. In this study, we assessed the association between spousal educational attainment (SEA) and hypertension prevalence, awareness, and control, intending to provide new directions for family health care. A total of 71 211 191 reproductive-aged participants from the National Free NFPCP during 2013-2019 were included in the current study. Inverse probability weighting (IPW) via propensity models were used to adjust for the imbalance by SEA. Both multivariable-adjusted ORs and inverse-probability-weighted ORs were used to assess the association between SEA and the prevalence, awareness, and control of hypertension. ORs of prevalence, awareness, and control of hypertension with SEA stratified by sex, age, and residency type were also reported. Compared with participants with SEA of compulsory education, the inverse-probability-weighted ORs for hypertension were 0.97 (0.96-0.97), 0.99 (0.98-1.00), and 0.91 (0.88-0.93) for participants with SEA of senior high, college, and postgraduate, respectively. The corresponding ORs for hypertension awareness were 1.12 (1.10-1.13), 1.15 (1.13-1.16), and 1.38 (1.34-1.41). The increment of hypertension control associated with SEA was only identified in urban areas. Modification analyses revealed that urban participants were observed to have more healthy benefits associated with SEA; additional decreased prevalent hypertension and increased hypertension awareness associated with SEA were observed in wives and husbands respectively. Thus, SEA was associated with decreased prevalent hypertension and increased awareness and control of hypertension. Our findings call for increased participation of spouses in family-centered healthcare, with consideration of modified effects by gender, age, and residency type, to improve chronic disease prevention and control including hypertension.

A nomogram for predicting mild cognitive impairment in older adults with hypertension

BACKGROUND

Hyper- and hypotension increase the risk of cognitive dysfunction. As effective control of blood pressure can reduce the risk of mild cognitive impairment (MCI), early risk assessment is necessary to identify MCI in senile hypertension as soon as possible and reduce the risk of developing dementia. No perfect risk-prediction model or nomogram has been developed to evaluate the risk of MCI in older adults with hypertension. We aimed to develop a nomogram model for predicting MCI in older patients with hypertension.

METHODS

We selected 345 older patients with hypertension in Xixiangtang District, Nanning City, as the modeling group and divided into the MCI (n = 197) and non-MCI groups (n = 148). Comparing the general conditions, lifestyle, disease factors, psychosocial and other indicators. Logistic regression was used to analyze risk factors for MCI in older hypertensive patients, and R Programming Language was used to draw the nomogram. We selected 146 older patients with hypertension in Qingxiu District, Nanning City, as the verification group. The effectiveness and discrimination ability of the nomogram was evaluated through internal and external verification.

RESULTS

Multivariate logistic regression analysis identified 11 factors, including hypertension grade, education level, complicated diabetes, hypertension years, stress history, smoking, physical exercise, reading, social support, sleep disorders, and medication compliance, as risk factors for MCI in older patients with hypertension. To develop a nomogram model, the validity of the prediction model was evaluated by fitting the curve, which revealed a good fit for both the modeling (P = 0.98) and verification groups (P = 0.96). The discrimination of the nomogram model was evaluated in the modeling group using a receiver operating characteristic curve. The area under the curve was 0.795, and the Hosmer-Lemeshow test yielded P = 0.703. In the validation group, the area under the curve was 0.765, and the Hosmer-Lemeshow test yielded P = 0.234.

CONCLUSIONS

We developed a nomogram to help clinicians identify high-risk groups for MCI among older patients with hypertension. This model demonstrated good discrimination and validity, providing a scientific basis for community medical staff to evaluate and identify the risk of MCI in these patients at an early stage.

Rural-Urban Differences in Cognition: Findings From the Advanced Cognitive Training for Independent and Vital Elderly Trial

ObjectivesWe examined associations between three geographic areas (urban, suburban, rural) and cognition (memory, reasoning, processing speed) over a 10-year period. Methods: Data were obtained from 2539 participants in the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) trial. Multilevel, mixed-effects linear regression was used to estimate cognitive trajectories by geographical areas over 10 years, after adjusting for social determinants of health. Results: Compared to urban and suburban participants, rural participants fared worse on all cognitive measures-memory (B = -1.17 (0.17)), reasoning (B = -1.55 (0.19)), and processing speed (B = 0.76 (0.19)) across the 10-year trajectory. Across geographic areas, greater economic stability, health care access and quality, and neighborhood resources were associated with better cognition over time. Discussion: Findings highlight the importance of geographical location when examining cognition later in life. More research examining place-based life experiences is needed to make the greatest impact on geographically diverse communities.

Cognition and Financial Decision-Making in Older Adult Spouses

INTRODUCTION

Age-related decline in executive functioning has been found to negatively impact one's capacity to make prudent financial decisions. The broader literature also speaks to the importance of considering interrelatedness in older spouses' functioning, as these individuals typically represent one's longest and closest relationship that involves an extended history of shared experiences. Accordingly, the aim of the present study was to provide the first examination of whether older adults' financial decision-making capacity is impacted not only by their own but also by their partner's, level of cognitive functioning.

METHOD

Sixty-three heterosexual spousal dyads comprising older adults aged 60-88 participated. The contribution of executive functioning and perceptions of partner's cognitive decline on financial decision-making behavior and financial competency was assessed through two actor-partner interdependence models.

RESULTS

As predicted, for both genders, one's own executive functioning was predictive of one's own financial decision-making capacity. However, of particular interest was the finding that for females (but not males) perceiving greater cognitive decline in their spouse predicted their own (greater) financial competency.

CONCLUSION

Examining whether partner interdependence extends to the realm of financial decision-making is not only a theoretically but also practically important question. These data provide initial insights that such a relationship does exist and highlight further important avenues for future research.

Functional social support and cognitive function in middle- and older-aged adults: a systematic review of cross-sectional and cohort studies

BACKGROUND

Intact cognitive function is crucial for healthy aging. Functional social support is thought to protect against cognitive decline. We conducted a systematic review to investigate the association between functional social support and cognitive function in middle- and older-aged adults.

METHODS

Articles were obtained from PubMed, PsycINFO, Sociological Abstracts, CINAHL, and Scopus. Eligible articles considered any form of functional social support and cognitive outcome. We narratively synthesized extracted data by following the Synthesis Without Meta-Analysis (SWiM) guidelines and assessed risk of bias using the Newcastle-Ottawa Scale (NOS).

RESULTS

Eighty-five articles with mostly low risk-of-bias were included in the review. In general, functional social support-particularly overall and emotional support-was associated with higher cognitive function in middle- and older-aged adults. However, these associations were not all statistically significant. Substantial heterogeneity existed in the types of exposures and outcomes evaluated in the articles, as well as in the specific tools used to measure exposures and outcomes.

CONCLUSIONS

Our review highlights the role of functional social support in the preservation of healthy cognition in aging populations. This finding underscores the importance of maintaining substantive social connections in middle and later life.

SYSTEMATIC REVIEW REGISTRATION

Rutter EC, Tyas SL, Maxwell CJ, Law J, O'Connell ME, Konnert CA, Oremus M. Association between functional social support and cognitive function in middle-aged and older adults: a protocol for a systematic review. BMJ Open;10(4):e037301. https://doi.org/10.1136/bmjopen-2020-037301.

Attitudes toward dementia screening and influential factors in older adults in China

BACKGROUND

Dementia will likely be an ongoing concern for future generations, and according to the World Health Organization, two-thirds of dementia cases are missed diagnoses. We aimed to explore the attitudes of older adults toward dementia screening and the related influencing factors.

METHODS

A multicentre cross-sectional study was conducted. Data were collected using questionnaires between 2020 December and 2021 June from five provinces in China. The study included older adults aged 60 years or older, living in China. A sociodemographic questionnaire and the Perceptions Regarding Investigational Screening for Memory in Primary Care scale were used to assess attitudes toward and influencing factors of dementia screening.

RESULTS

A total of 279 participants completed the questionnaires. The results revealed housing status as a positive factor in the acceptance dimension, while high income was the primary positive factor in the benefits of screening dimension. Having religious beliefs, low income, and never participating in social activities were positive factors for the stigma dimension. Widowed marital status and participation in social activities were negative factors for the independence dimension, while having religious beliefs positively influenced the suffering dimension.

CONCLUSIONS

This study showed that participants held a relatively positive attitude toward dementia screening, although they had concerns about stigma and negative impact on independence. Further studies are required to develop intervention strategies to help older adults improve their attitudes and quality of life, promote cognitive health, and facilitate healthy ageing.

Imputation Procedures for Cognitive Variables in the Mexican Health and Aging Study: Evaluating the Bias from Excluding Participants with Missing Data

Non-response of cognitive data in cohort studies is a barrier to cognitive aging research. We describe the procedures for the imputation of non-responses for cognitive data in the Mexican Health and Aging Study (MHAS). Data came from the 2001-2015 MHAS waves. We also describe the association of cognition with education, age, and other variables in 2015 with and without the imputed values. Between 12.3% and 37.9% of participants were missing data for at least one cognition variable. When we conducted the analysis with and without the imputed values, the relationships between education, age, and cognition were similar in direction and significance, but different in magnitude. Non-response of cognitive data is common and non-random in the MHAS. Investigators should use the data sets that include the imputed values, which are publicly available.

Spousal Educational Attainment and Sleep Duration Among American Older Adults

OBJECTIVES

Sleep has consistently been shown to have a dyadic nature among married older adults; however, less is known about the influence of a spouses' social characteristics on one's own sleep. Focusing on older adults, we examined the association between one's spouses' educational attainment and one's own sleep duration.

METHOD

We used the 2004-2018 National Health Interview Survey (NHIS) to analyze heterosexual married adults aged 50-84 (N = 89,180). Respondents reported typical sleep duration in a 24-hr period, which was categorized as short (≤6 hr), normal (7-8 hr), or long (≥9 hr). We fit multinomial logistic regression models predicting these categories of sleep duration and accounted for demographic, household socioeconomic characteristics, and health/health behaviors. Using interaction terms, we tested if the association varied by the respondent's gender and educational attainment.

RESULTS

Older adults married to spouses with college or more education had significantly lower relative risk of short sleep than those whose spouses had some college, high school, or less than high school education, net of the covariates including their own education. The benefit of higher levels of spousal education was significantly more protective against short sleep for women and more highly educated older adults.

DISCUSSION

Older adults married to spouses with high levels of education reported more favorable sleep durations, but this benefit was significantly stronger for women and the highly educated which has important implications for their aging. These findings suggest that social inequality may condition the dyadic nature of sleep for heterosexual married older adults.