Are younger cohorts in the USA and England ageing better?

Impact of adverse childhood experiences on life expectancy with depression in the U.K. population: The mitigating role of educational attainment

BACKGROUND

Adverse childhood experiences (ACEs) are associated with depression in later life.

OBJECTIVE

This study aimed to measure the impact of ACEs on life expectancy with depression (DLE) and to assess how educational attainment affected expectations.

PARTICIPANTS AND SETTING

The study used data on 5597 participants from the English Longitudinal Study of Aging (2006-2013).

METHODS

Depression was assessed through the eight-item short version of the Centre for Epidemiologic Studies Depression. We used discrete-multistate life table models to estimate total life expectancy and life expectancy with depression.

RESULTS

Older adults with ACEs had longer DLE and a higher proportion of remaining life with depression compared with those without ACEs. For example, men aged 60 years with ACEs could expect to live 5.2 (95 % confidence interval (CI): 4.2, 6.2) years with depression compared with 2.8 (95 % CI: 2.3, 3.3) years for men without ACEs. Women aged 60 years who reported ACEs could expect to live 9.4 (95 % CI: 7.6, 11.1) years with depression compared with 6.0 (95 % CI: 5.1, 7.0) years for women without ACEs. With a high level of educational attainment, older adults from younger cohorts with ACEs lived fewer depression years and spent a higher proportion of their life being free of depression than adults with ACEs and had a low level of educational attainment.

CONCLUSION

Our results indicated that ACEs may increase years of life with depression among U.K. adults. Meanwhile, high educational attainment could mitigate the mental health burden associated with ACEs.

Harmonisation of later-life cognitive function across national contexts: results from the Harmonized Cognitive Assessment Protocols

BACKGROUND

The Harmonized Cognitive Assessment Protocol (HCAP) is an innovative instrument for cross-national comparisons of later-life cognitive function, yet its suitability across diverse populations is unknown. We aimed to harmonise general and domain-specific cognitive scores from HCAP studies across six countries, and evaluate reliability and criterion validity of the resulting harmonised scores.

METHODS

We statistically harmonised general and domain-specific cognitive function scores across publicly available HCAP partner studies in China, England, India, Mexico, South Africa, and the USA conducted between October, 2015 and January, 2020. Participants missing all cognitive test items in a given HCAP were excluded. We used an item banking approach that leveraged common cognitive test items across studies and tests that were unique to studies. We generated harmonised factor scores to represent a person's relative functioning on the latent factors of general cognitive function, memory, executive function, orientation, and language using confirmatory factor analysis. We evaluated the marginal reliability, or precision, of the factor scores using test information plots. Criterion validity of factor scores was assessed by regressing the scores on age, gender, and educational attainment in a multivariable analysis adjusted for these characteristics.

FINDINGS

We included 21 144 participants from the six HCAP studies of interest (11 480 women [54·3%] and 9664 [45·7%] men), with a median age of 69 years (IQR 64-76). Confirmatory factor analysis models of cognitive function in each country fit well: 31 (88·6%) of 35 models had adequate or good fit to the data (comparative fit index ≥0·90, root mean square error of approximation ≤0·08, and standardised root mean residual ≤0·08). Marginal reliability of the harmonised general cognitive function factor was high (>0·9) for 19 044 (90·1%) of 21 144 participant scores across the six countries. Marginal reliability of the harmonised factor was above 0·85 for 19 281 (91·2%) of 21 142 participant factor scores for memory, 7805 (41·0%) of 19 015 scores for executive function, 3446 (16·3%) of 21 103 scores for orientation, and 4329 (20·5%) of 21 113 scores for language. In each country, general cognitive function scores were lower with older age and higher with greater levels of educational attainment.

INTERPRETATION

We statistically harmonised cognitive function measures across six large population-based studies of cognitive ageing. These harmonised cognitive function scores empirically reflect comparable domains of cognitive function among older adults across the six countries, have high reliability, and are useful for population-based research. This work provides a foundation for international networks of researchers to make improved inferences and direct comparisons of cross-national associations of risk factors for cognitive outcomes in pooled analyses.

FUNDING

US National Institute on Aging.

Harmonization of Later-Life Cognitive Function Across National Contexts: Results from the Harmonized Cognitive Assessment Protocols (HCAPs)

Background

The Harmonized Cognitive Assessment Protocol (HCAP) is an innovative instrument for cross-national comparisons of later-life cognitive function, yet its suitability across diverse populations is unknown. We aimed to harmonize general and domain-specific cognitive scores from HCAPs across six countries, and evaluate precision and criterion validity of the resulting harmonized scores.

Methods

We statistically harmonized general and domain-specific cognitive function across the six publicly available HCAP partner studies in the United States, England, India, Mexico, China, and South Africa (N=21,141). We used an item banking approach that leveraged common cognitive test items across studies and tests that were unique to studies, as identified by a multidisciplinary expert panel. We generated harmonized factor scores for general and domain- specific cognitive function using serially estimated graded-response item response theory (IRT) models. We evaluated precision of the factor scores using test information plots and criterion validity using age, gender, and educational attainment.

Findings

IRT models of cognitive function in each country fit well. We compared measurement reliability of the harmonized general cognitive function factor across each cohort using test information plots; marginal reliability was high (r> 0·90) for 93% of respondents across six countries. In each country, general cognitive function scores were lower with older ages and higher with greater levels of educational attainment.

Interpretation

We statistically harmonized cognitive function measures across six large, population-based studies of cognitive aging in the US, England, India, Mexico, China, and South Africa. Precision of the estimated scores was excellent. This work provides a foundation for international networks of researchers to make stronger inferences and direct comparisons of cross-national associations of risk factors for cognitive outcomes.

Funding

National Institute on Aging (R01 AG070953, R01 AG030153, R01 AG051125, U01 AG058499; U24 AG065182; R01AG051158).

Greek dental students' perceptions of treating older patients

BACKGROUND AND AIM

The oral problems of the older population are largely undertreated because of various barriers, including negative perceptions and ageist stereotypes, among care providers. The aim of this study was to record the perceptions of Greek dental students of treating older patients.

MATERIALS AND METHODS

An anonymous written questionnaire including two open-ended questions about the positive and negative issues when treating older patients was administered to clinical dental students. A content analysis was conducted to identify the main themes.

RESULTS

A total of 135 students responded to the questionnaire (response rate 88.23%). Five key themes were identified for the facilitating factors and six for the barriers/challenging factors. The facilitating factors of treating older people were the promotion of the patients' health and quality of life, the good interaction and communication with older patients, the dentist's intrinsic reward treating older people, the positive feedback from the patients and the improvement of professional dental competences when treating complex cases. The barriers included communication and cooperation problems, treatment challenges related to disease and disability, patients' negative beliefs about oral health, barriers to accessing dental care, complex and time-consuming treatment plans, and communication and cooperation problems with the patients' carers.

CONCLUSION

A range of facilitating and challenging factors influence dental students' perceptions of treating older patients. More research is necessary on the methods that will enhance their geriatric knowledge and skills, help them overcome the challenges they detected and improve their attitudes and behaviours towards treating older patients.

Baby boomers in Europe: demography, socioeconomic, and health status and oral health needs

The European countries are aging fast. Baby boomers in Europe constitute a diverse population group with several differences in life events and living conditions. The fiscal effects of the aging of European population have led to changes in policies and legislation that largely affect the lives of baby boomers necessitating an increase in their working lives. Furthermore, reforms are planned in the existing health and long-term care systems. Although some baby boomers in Europe face chronic medical conditions, the majority perceive their general health as good or very good. However, approximately one quarter have reported unmet needs for medical care, mainly due to cost or long waiting lists with large variability among different countries. The oral health of baby boomers has improved compared to previous generations particularly related to tooth loss. However, older groups in many countries face an increase in dental caries and periodontal disease. Some baby boomers may enter very old age with many natural teeth, functional impairment, limited ability to perform oral hygiene and an increased demand for more complex dental care as well as domiciliary care. However, in contrast to medical care, dental expenses in Europe are mainly financed with out-of-pocket payments while domiciliary dental care is rarely provided leading to unmet dental care needs for the most vulnerable individuals. Educational interventions for all healthcare professionals, as well as formal and informal carers and the public are required, and appropriate policies and legislations are needed to promote the oral health of the aging European population.

Multilevel analysis of predictors of multiple indicators of childhood vaccination in Nigeria

Background

Substantial inequalities exist in childhood vaccination coverage levels. To increase vaccine uptake, factors that predict vaccination coverage in children should be identified and addressed.

Methods

Using data from the 2018 Nigeria Demographic and Health Survey and geospatial data sets, we fitted Bayesian multilevel binomial and multinomial logistic regression models to analyse independent predictors of three vaccination outcomes: receipt of the first dose of Pentavalent vaccine (containing diphtheria-tetanus-pertussis, Hemophilus influenzae type B and Hepatitis B vaccines) (PENTA1) (n = 6059) and receipt of the third dose having received the first (PENTA3/1) (n = 3937) in children aged 12–23 months, and receipt of measles vaccine (MV) (n = 11839) among children aged 12–35 months.

Results

Factors associated with vaccination were broadly similar for documented versus recall evidence of vaccination. Based on any evidence of vaccination, we found that health card/document ownership, receipt of vitamin A and maternal educational level were significantly associated with each outcome. Although the coverage of each vaccine dose was higher in urban than rural areas, urban residence was not significant in multivariable analyses that included travel time. Indicators relating to socio-economic status, as well as ethnic group, skilled birth attendance, lower travel time to the nearest health facility and problems seeking health care were significantly associated with both PENTA1 and MV. Maternal religion was related to PENTA1 and PENTA3/1 and maternal age related to MV and PENTA3/1; other significant variables were associated with one outcome each. Substantial residual community level variances in different strata were observed in the fitted models for each outcome.

Conclusion

Our analysis has highlighted socio-demographic and health care access factors that affect not only beginning but completing the vaccination series in Nigeria. Other factors not measured by the DHS such as health service quality and community attitudes should also be investigated and addressed to tackle inequities in coverage.

Health research capacity of professional and technical personnel in a first-class tertiary hospital in northwest China: multilevel repeated measurement, 2013-2017, a pilot study

Objectives

To explore the health research capacity (HRC) and factors associated with professional and technical personnel (PTP) in a first-class tertiary hospital in northwest China.

Methods

We collected the repeated measurement data from a first-class tertiary hospital in northwest China between 2013 and 2017. HRC of PTP was assessed by a comprehensive evaluation system and measured by research capacity score (RCS). The participants were divided into research group (RCS >0) and comparison group (RCS = 0); participants of the comparison group were selected by two-stage stratified random sampling. Multilevel model for repeated measures was used to investigate the potential factors associated with HRC.

Results

A total of 924 PTP were included (308 in the research group and 616 in the comparison group). This study found consistent growth in RCS and associated 95% CIs for the hospital during 2013 and 2017. The linear multilevel model showed PTP with a doctorate degree had higher RCS than those with a master’s degree (β, 1.74; P <0.001), bachelor’s degree (β, 2.02; P <0.001) and others without a degree (β, 2.32; P <0.001). Furthermore, the PTP with intermediate (β, 0.13; P = 0.015), vice-high (β, 0.27; P = 0.001) and senior (β, 0.63; P <0.001) professional titles had higher RCS than those with junior positions. Compared with PTP in the administration, those in paediatrics had higher RCS (β, 0.28; P = 0.047) though similar to PTP in other departments. PTP with an administrative position had a higher RCS than those in non-administrative positions (β, 0.26; P <0.001). The RCS increased with the research fund (β, 0.15; P <0.001). However, no associations were found between RCS and sex, age, ethnic, graduate school or technical type.

Conclusions

HRC with associated variation of PTP for the hospital in northwest China increasingly improved and degree, professional title, administrative position, and research fund were related to HRC of PTP. Multi-central prospective studies are needed to clarify the potential relationship of related factors and HRC of PTP.