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Arias F, Chen F, Shiff H, Marcantonio ER, Jones RN, Schmitt EM, Metzger E, Fong TG, Travison TG, Inouye SK. Parental Education and Delirium Risk after Surgery in Older Adults. Clin Gerontol 2023; 46:253-266. [PMID: 36001869 PMCID: PMC9928599 DOI: 10.1080/07317115.2022.2111289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Efforts to conceptualize risk factors for postoperative delirium in older adults have focused on the time proximate to the episode, but how early-life exposures influence delirium risk is poorly understood. METHODS An observational cohort of 547 patients aged 70+undergoing major non-cardiac surgery at two academic medical centers in Boston. Demographic characteristics, cognition, parental education, health, and participation in cognitively stimulating activities were assessed prior to surgery. Delirium incidence and severity were measured daily during hospitalization. RESULTS Higher paternal education was associated with significantly lower incidence of delirium (X2(1, N =547)=8.35, p <.001; odds ratio OR=.93, 95% CI, .87 to .98) and inversely associated with delirium severity (r(545)=-.13, p <.001). Higher maternal education was associated with lower delirium incidence but did not reach statistical significance. The effect of paternal education on delirium incidence was independent of the patient's education, estimated premorbid intelligence, medical comorbidities, neighborhood disadvantage, and participation in cognitively stimulating activities (X2(2, N =547)=31.22, p <.001). CONCLUSIONS Examining early-life exposures may yield unique insights into the risks and pathogenesis of delirium. CLINICAL IMPLICATIONS Evaluating long-term factors that increase vulnerability to delirium may improve our ability to calculate risk. It may guide clinical decision-making and inform pre- and post-operative recommendations.
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Affiliation(s)
- Franchesca Arias
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, USA
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, USA
- Harvard Medical School, Boston, USA
| | - Fan Chen
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, USA
- Biostatistics and Data Sciences, Hinda and Arthur Marcus Institute for Aging Research at the Hebrew SeniorLife, Boston, USA
| | - Haley Shiff
- Harvard T. H. Chan School of Public Health, Boston, USA
| | - Edward R. Marcantonio
- Harvard Medical School, Boston, USA
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, USA
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, USA
| | - Richard N. Jones
- Department of Psychiatry and Human Behavior, Brown University, Warren Alpert Medical School, Providence, USA
| | - Eva M. Schmitt
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, USA
| | - Eran Metzger
- Department of Medicine, Hebrew SeniorLife, Boston, USA
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, USA
| | - Tamara G. Fong
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, USA
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, USA
- Harvard Medical School, Boston, USA
| | - Thomas G. Travison
- Harvard Medical School, Boston, USA
- Biostatistics and Data Sciences, Hinda and Arthur Marcus Institute for Aging Research at the Hebrew SeniorLife, Boston, USA
- Department of Medicine and Psychiatry, Harvard Medical School, Boston, USA
| | - Sharon K. Inouye
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, USA
- Harvard Medical School, Boston, USA
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, USA
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Ramirez Surmeier L, Taylor MG, Carr DC. Life Satisfaction and Intergenerational Mobility Among Older Hispanics in the United States. J Aging Health 2023; 35:50-61. [PMID: 35532214 DOI: 10.1177/08982643221100788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To investigate the impact of intergenerational mobility-measured as the difference between one's own and one's father's education level-on overall life-satisfaction among Hispanic, White, and Black older Americans. METHODS Data from the Health and Retirement Study were used to estimate life satisfaction by race/ethnicity using ordinary least squares regression (N = 5,057). RESULTS Hispanic and Black older Americans report greater educational gains relative to their fathers compared to Whites. Despite having the lowest reported education levels, Hispanics report the highest life satisfaction across race/ethnic groups. However, net of education level and other factors, intergenerational mobility decreased rather than increased life satisfaction for Hispanic older Americans. DISCUSSION These results indicate that intergenerational mobility may not confer equal benefits for overall life satisfaction across racial/ethnic groups. As Hispanic individuals continue to achieve higher education levels, it is unclear whether upward mobility will translate to positive or negative assimilation consequences.
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Affiliation(s)
| | - Miles G Taylor
- Pepper Institute on Aging and Public Policy, Florida State University, Tallahassee, FL, USA
| | - Dawn C Carr
- Pepper Institute on Aging and Public Policy, Florida State University, Tallahassee, FL, USA
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Arias F, Alegria M, Kind AJ, Jones RN, Travison TG, Marcantonio ER, Schmitt EM, Fong TG, Inouye SK. A framework of social determinants of health for delirium tailored to older adults. J Am Geriatr Soc 2022; 70:235-242. [PMID: 34693992 PMCID: PMC8742772 DOI: 10.1111/jgs.17465] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/15/2021] [Accepted: 08/21/2021] [Indexed: 01/03/2023]
Abstract
Delirium is a debilitating medical condition that disproportionately affects hospitalized older adults and is associated with adverse health outcomes, increased mortality, and high medical costs. Efforts to understand delirium risk in hospitalized older adults have focused on examining medical comorbidities, pre-existing cognitive deficits, and other clinical and demographic factors present in the period proximate to the hospitalization. The contribution of social determinants of health (SDOH), including social circumstances, environmental characteristics, and early-life exposures, referred as the social exposome, to delirium risk is poorly understood. Increased knowledge about the influence of SDOH will offer a more comprehensive understanding of factors that may increase vulnerability to delirium and poor outcomes. Clinically, these efforts can guide the development and implementation of holistic preventive strategies to improve clinical outcomes. We propose a SDOH framework for delirium adapted for older adults. We provide the definition, description, and rationale for the domains and variables in our proposed model.
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Affiliation(s)
- Franchesca Arias
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research at the Hebrew SeniorLife, Boston, MA
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA
- Harvard Medical School, Boston, MA
| | - Margarita Alegria
- Disparities Research Unit, Massachusetts General Hospital, Boston, MA
- Department of Medicine and Psychiatry, Harvard Medical School, Boston, MA
| | - Amy J. Kind
- Center for Health Disparities Research, University of Wisconsin School of Medicine and Public Health, Madison, WI
- Madison VA Geriatrics Research Education and Clinical Center (GRECC), Middleton VA Hospital, Madison, WI
| | - Richard N. Jones
- Department of Psychiatry and Human Behavior, Brown University, Warren Alpert Medical School, Providence, RI
| | - Thomas G. Travison
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research at the Hebrew SeniorLife, Boston, MA
- Harvard Medical School, Boston, MA
- Biostatistics and Data Sciences, Hinda and Arthur Marcus Institute for Aging Research at the Hebrew Senior Life, Boston, MA
| | - Edward R. Marcantonio
- Harvard Medical School, Boston, MA
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Eva M. Schmitt
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research at the Hebrew SeniorLife, Boston, MA
| | - Tamara G. Fong
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research at the Hebrew SeniorLife, Boston, MA
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA
- Harvard Medical School, Boston, MA
| | - Sharon K. Inouye
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research at the Hebrew SeniorLife, Boston, MA
- Harvard Medical School, Boston, MA
- Department of Medicine and Psychiatry, Harvard Medical School, Boston, MA
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Valge M, Meitern R, Hõrak P. Morphometric traits predict educational attainment independently of socioeconomic background. BMC Public Health 2019; 19:1696. [PMID: 31852467 PMCID: PMC6921596 DOI: 10.1186/s12889-019-8072-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 12/11/2019] [Indexed: 02/08/2023] Open
Abstract
Background Aim of this study is to describe the relationship between anthropometric traits and educational attainment among Estonian schoolchildren born between 1937 and 1962. We asked whether height, cranial volume and face width (a testosterone-dependent trait), measured in childhood predict later educational attainment independently of each other, family socioeconomic position (SEP) and sex. Associations between morphometric traits and education and their interactions with biosocial variables are of scholarly importance because higher education is nearly universally associated with low fertility in women, and often with high fertility in men. Hence, morphometric traits associated with educational attainment are targeted by natural selection and describing the exact nature of these associations is relevant for understanding the current patterns of evolution of human body size. Methods Data on morphometric measurements and family background of 11,032 Estonian schoolchildren measured between seven and 19 years of age were obtained from the study performed by Juhan Aul between 1956 and 1969. Ordinal logistic regression was used for testing the effects of morphometric traits, biosocial variables and their interaction on the cumulative probability of obtaining education beyond primary level. Results Of biosocial variables, family SEP was the most important determinant of educational attainment, followed by the sex, rural vs urban origin and the number of siblings. No significant interactions with morphometric traits were detected, i.e., within each category of SEP, rural vs urban origin and sex, taller children and those with larger heads and relatively narrower faces were more likely to proceed to secondary and/or tertiary education. The effect of height on education was independent of cranial volume, indicating that taller children did not obtain more educations because their brains were larger than those of shorter children; height per se was important. Conclusions Our main finding – that adjusting for other morphometric traits and biosocial variables, morphometric traits still robustly predicted educational attainment, is relevant for understanding the current patterns of evolution of human body size. Our findings suggest that fecundity selection acting on educational attainment could be partly responsible for the concurrent selection for smaller stature and cranial volume in women and opposite trends in men.
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Affiliation(s)
- Markus Valge
- Department of Zoology, University of Tartu, Vanemuise 46, 51014, Tartu, Estonia
| | - Richard Meitern
- Department of Zoology, University of Tartu, Vanemuise 46, 51014, Tartu, Estonia
| | - Peeter Hõrak
- Department of Zoology, University of Tartu, Vanemuise 46, 51014, Tartu, Estonia.
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