Association between experiencing low healthcare quality and developing dementia

BACKGROUND

Low healthcare quality has been found to predict the development of a number of illnesses in older adults. However, it has not been investigated as a determinant of dementia. Thus, the goal of this study was to assess whether experiencing low healthcare quality is associated with developing dementia in people aged 60 and older.

METHODS

Participants in the Health and Retirement Study, without dementia and aged 60 and older at baseline, were followed from 2006 to 2019. Experiencing low healthcare quality was assessed at baseline through questions about healthcare discrimination and dissatisfaction with healthcare services. The outcome, development of new cases of dementia, was determined through physician diagnosis or a cognition score compatible with dementia (assessed by the Telephone Interview for Cognitive Status). Cox regression was used to estimate the hazard ratio (HR) of dementia, adjusting for participants' demographic, health, and socioeconomic factors.

RESULTS

Among the 3795 participants included in the cohort, 700 developed dementia. Experiencing low healthcare quality was associated with increased dementia risk over 12 years (unadjusted HR: 1.68, 95% CI: 1.27-2.21, p-value <0.001; fully adjusted HR: 1.50, 95% CI: 1.12-2.01, p-value: 0.006). Healthcare discrimination and dissatisfaction with the healthcare quality received were independently associated with increased dementia risk.

CONCLUSIONS

As predicted, experiencing low healthcare quality was associated with greater dementia risk. To date, most measures to reduce dementia have focused on individual-level behaviors. Our findings suggest that implementing structural changes to improve healthcare quality delivery for older persons could reduce dementia prevalence.

Beneficial Effect of Societal Factors on APOE-ε2 and ε4 Carriers' Brain Health: A Systematic Review

BACKGROUND

Apolipoprotein-E (APOE) ε4 and ε2 are the most prevalent risk-increasing and risk-reducing genetic predictors of Alzheimer's disease, respectively. However, the extent to which societal factors can reduce the harmful impact of APOE-ε4 and enhance the beneficial impact of APOE-ε2 on brain health has not yet been examined systematically.

METHODS

To fill this gap, we conducted a systematic review searching for studies in MEDLINE, Embase, PsycINFO, and Scopus until June 2023, that included: (a) 1 of 5 social determinants of health (SDH) identified by Healthy People 2030, (b) APOE-ε2 or APOE-ε4 allele carriers, (c) cognitive or brain-biomarker outcomes, and (d) studies with an analysis of how APOE-ε2 and/ or APOE-ε4 carriers differ on outcomes when exposed to SDH.

RESULTS

From 14 076 articles retrieved, 124 met the inclusion criteria. In most of the studies, exposure to favorable SDH reduced APOE-ε4's detrimental effect and enhanced APOE-ε2's beneficial effect on cognitive and brain-biomarker outcomes (cognition: 70.5%, n: 74/105; brain-biomarkers: 71.4%, n: 20/28). A similar pattern of results emerged in each of the 5 Healthy People 2030 SDH categories, where finishing high school, having resources to satisfy basic needs, less air pollution, less negative external stimuli that can generate stress (eg, negative age stereotypes), and exposure to multiple favorable SDH were associated with better cognitive and brain health among APOE-ε4 and APOE-ε2 carriers.

CONCLUSIONS

Societal factors can reduce the harmful impact of APOE-ε4 and enhance the beneficial impact of APOE-ε2 on cognitive outcomes. This suggests that plans to reduce dementia should include community-level policies promoting favorable SDH.

Characteristics and Correlates of Ten-Year Trajectories of Posttraumatic Stress Symptoms in Older U.S. Military Veterans

OBJECTIVES

To examine the nature and correlates of 10-year trajectories of posttraumatic stress disorder (PTSD) symptoms in older U.S. military Veterans.

DESIGN AND SETTING

A nationally representative web-based survey of older U.S. Veterans who participated in the National Health and Resilience in Veterans Study over 5 waves between 2011 and 2021.

PARTICIPANTS

A total of 1,843 U.S. Veterans aged 50 and older (mean age = 67).

MEASUREMENTS

PTSD symptoms were assessed using the PTSD Checklist. Self-report measures at baseline assessed sociodemographic characteristics; trauma exposures; psychiatric and substance use disorders; mental, cognitive, and physical functioning; and psychosocial factors including expectations of aging. Latent growth mixture modeling identified the nature and correlates of 10-year PTSD symptom trajectories.

RESULTS

Most of the sample had no/low PTSD symptoms (88.7%), while 6.0% had consistently subthreshold symptoms, 2.7% consistently high symptoms, and 2.6% increasing symptoms. Relative to the no/low symptom group, the subthreshold and high symptom groups reported more medical conditions and cognitive difficulties, with younger age and more lifetime traumatic events additionally linked to the high symptom trajectory. Relative to the no/low symptom group, Veterans with increasing symptoms were more likely to report functional disability and lifetime nicotine use disorder, cognitive difficulties, negative expectations regarding physical and emotional aging, and traumatic events over the study period.

CONCLUSIONS

Despite high rates of trauma exposure, most older Veterans do not evidence symptomatic PTSD trajectories; however, about 11% do. Results underscore the importance of assessing PTSD symptoms in this population and considering longitudinal trajectories as well as associated risk and protective factors.

Children's Residential Proximity, Spousal Presence and Modifiable Risk Factors for Dementia among Older Adults with Cognitive Impairment

Background

Cognitive impairment in older adults poses considerable challenges, and the role of family support becomes increasingly crucial. This study aims to examine the impact of children's residential proximity and spousal presence on the key modifiable risk factors for dementia among older adults with cognitive impairment.

Methods

Utilizing the Health and Retirement Study (HRS) data from 1995 to 2018, we analyzed 14,731 participants (35,840 person-waves) aged 50 and older with cognitive impairment. Family support was characterized based on the presence of a spouse and residential proximity to children. Smoking, depressive symptoms and social isolation were included as the key modifiable risk factors for dementia identified in later life. Using mixed-effects logistic regressions, associations between access to family support and the modifiable risk factors were determined, adjusting for various socio-demographic and health-related factors.

Results

Significant associations were found between access to family support and modifiable risk factors for dementia. Cognitively impaired older adults with less available family support, characterized by distant-residing children and the absence of a spouse, had significantly higher risks of smoking, depressive symptoms, and social isolation. Moreover, we revealed a consistent gradient in the prevalence of the risk factors based on the degree of family support. Relative to older adults with a spouse and co-resident children, those without a spouse and with all children residing further than 10 miles displayed the highest risks of smoking, depressive symptoms, and social isolation.

Conclusion

Access to family support, particularly from spouses and proximate children, plays a protective role against key modifiable risk factors for dementia in older adults with cognitive impairment. The findings highlight the need for bolstering family and social support systems to enhance the well-being of this vulnerable population.

Suicidal Thoughts and Behaviors in Older U.S. Military Veterans: Results From the National Health and Resilience in Veterans Study

OBJECTIVE

To identify the prevalence and correlates associated with suicidal thoughts and behaviors (STBs) in a nationally representative sample of older (55+) US military veterans.

METHODS

Data were analyzed from the 2019-2020 National Health and Resilience in Veterans Study (N = 3,356; mean age = 70.6). Self-report measures of past-year suicidal ideation (SI), lifetime suicide plan, lifetime suicide attempt(s), and future suicide intent were examined in relation to sociodemographic, neuropsychiatric, trauma, physical health, and protective factors.

RESULTS

A total of 6.6% (95% CI = 5.7%-7.8%) of the sample endorsed past-year SI, 4.1% (CI = 3.3%-5.1%) a lifetime suicide plan, 1.8% (CI = 1.4%-2.3%) a lifetime suicide attempt, and 0.9% (CI = 0.5%-1.3%) future suicide intent. Higher levels of loneliness and lower levels of purpose in life were most strongly associated with past-year SI; lifetime history of major depressive disorder with suicide plan and suicide attempt; and frequency of past-year SI and more negative expectations regarding emotional aging with future suicide intent.

CONCLUSION

These findings provide the most up-to-date nationally representative prevalence estimates of STBs among older military veterans in the United States. Several modifiable vulnerability factors were found to be associated with suicide risk in older US military veterans, suggesting that these factors may be targets for intervention in this population.

Role of Positive Age Beliefs in Recovery From Mild Cognitive Impairment Among Older Persons

This cohort study examines the contribution of positive age beliefs to recovery from mild cognitive impairment among older persons.

Societal impact on older persons' chronic pain: Roles of age stereotypes, age attribution, and age discrimination

RATIONALE

In view of the severity and prevalence of chronic pain, combined with the limited success of long-term treatments, there is the need for a more expansive understanding of its etiology. We therefore investigated over time three societal-based potential determinants of chronic pain that were previously unexamined in this connection: negative age stereotypes, age attribution, and age discrimination.

METHODS

The cohort consisted of 1373 Americans aged 55 and older, who participated in four waves of the National Health and Resilience in Veterans Study, spanning seven years.

RESULTS

Consistent with the hypotheses, negative age stereotypes as well as age discrimination predicted chronic pain, and age attribution acted as a mediator between the negative age stereotypes and chronic pain. In a subset of participants who were free of chronic pain at baseline, those who had assimilated negative age stereotypes were 32% more likely to develop chronic pain in the next seven years than those who had assimilated positive age stereotypes.

CONCLUSION

Our finding that the three societal-based and modifiable predictors contributed to chronic pain refutes the widely held belief that chronic pain experienced in later life is entirely and inevitably a consequence of aging.

Implicit and Explicit Dehumanization of Older Family Members: Novel Determinants of Elder Abuse Proclivity

Elder abuse affects one in six older persons globally. Three limitations impede progress in prevention: most research is victim- rather than perpetrator-based; the reliance on explicit, self-reported factors; and failure to account for psychological factors, such as dehumanization, that motivate abuse. The current study addressed these gaps by examining whether implicit and explicit dehumanization of t could explain elder abuse proclivity. In a web-based survey of 585 family caregivers of older persons, dehumanization was found to be prevalent with 51% of the caregivers implicitly and 31% explicitly dehumanizing older persons. As predicted, implicit and explicit dehumanization contributed to elder abuse proclivity (OR = 1.23, 95% CI = 1.02-1.50, p = .03) and (OR = 1.26, 95% CI = 1.05-1.51, p = .01), respectively, after adjusting for relevant covariates including caregiver burden, and caregivers' and care-recipients' health. Developing caregiver-based interventions to humanize older persons may complement ongoing efforts in reducing elder abuse.

When Harry Met Sally: Older Adult Spouses' First Encounter Reminiscing and Well-Being

BACKGROUND AND OBJECTIVES

Interest in reminiscence activities for older adults has grown in recent years, but the benefits of co-reminiscence are not well-known. Drawing from a narrative identity framework, this study examined older adult spouses' co-reminiscence about their first encounters. We hypothesized that perceived closeness and support increase when spouses co-reminisce and that greater perceptions of closeness and support after reminiscing relate to lower depressive symptoms and greater marital satisfaction in daily life.

RESEARCH DESIGN AND METHODS

One hundred and one couples completed questionnaires measuring marital satisfaction and depressive symptoms at home and then participated in a laboratory session in which they co-reminisced about their first encounters. Self-reported perceived support and relationship closeness were obtained before and after reminiscence. t Tests and the Actor Partner Interdependence Model were used to examine hypotheses.

RESULTS

As hypothesized, closeness and perceived support increased from pre- to postreminiscence for husbands and wives. In addition, one's own relationship closeness after reminiscence was positively associated with own marital satisfaction (actor effect). One's perceived support after reminiscence was positively related to spouse's marital satisfaction and negatively associated with their spouse's depressive symptoms (partner effects).

DISCUSSION AND IMPLICATIONS

Findings suggest that co-reminiscence about early relationship development can boost feelings of closeness and support for older adults. Benefiting from co-reminiscence in this way also appears to indicate broader relationship and individual well-being. Brief co-reminiscence activities may nurture late-life relational well-being.

Impact of Media-Based Negative and Positive Age Stereotypes on Older Individuals' Mental Health

OBJECTIVES

During the COVID-19 pandemic, stigmatization of older persons increased in traditional and social media. It was unknown whether this negative messaging could be detrimental to the mental health of older individuals, and whether the relatively uncommon positive messaging about older individuals could benefit their mental health.

METHOD

To address these gaps, we designed age-stereotype interventions based on actual news stories that appeared during the pandemic, and divided them into negative and positive versions of what we term personified (i.e., individual-based) and enumerative (i.e., number-based) age-stereotype messaging. The negative versions of the 2 types of messaging reflected the age stereotype of decline, whereas the positive versions of the 2 types of messaging reflected the age stereotype of resilience.

RESULTS

As expected, the exposure of older individuals to the negative-age-stereotype-messaging interventions led to significantly worse mental health (i.e., more anxiety and less peacefulness), compared to a neutral condition; in contrast, the positive-age-stereotype-messaging interventions led to significantly better mental health (i.e., less anxiety and more peacefulness), compared to a neutral condition. The findings were equally strong for the personified and enumerative conditions. Also as expected, the interventions, which were self-irrelevant to the younger participants, did not significantly impact their mental health.

DISCUSSION

This is the first-known study to experimentally demonstrate that institutional ageism, and statistics that reflect stereotypes about older individuals, can impact mental health. The results demonstrate the need for media messaging aimed at empowering older individuals during the pandemic and beyond.

Impact of structural ageism on greater violence against older persons: a cross-national study of 56 countries

OBJECTIVE

To determine the association between country-level structural ageism and prevalence of violence against older persons.

DESIGN

Country-level ecological study.

SETTING

Structural ageism data were drawn from the nationally representative World Values Survey 2010-2014 (WVS), global databases from the WHO, United Nations and the World Bank. Violence data were based on the Global Burden of Diseases (GBD) study 2017.

PARTICIPANTS

Analysis of 56 countries that represented 63.1% of the world's ageing population aged 60 and over across all six of WHO regions.

EXPOSURE

Structural ageism, following established structural stigma measures, consisted of two components: (1) discriminatory national policies related to older persons' economic, social, civil and political rights, based on the four core components of human rights protection in Madrid International Plan of Action on Aging and (2) prejudicial social norms against older persons, measured by negative attitudes toward older persons in 56 national polls in WVS aggregated to country-level. These components were z scored and combined such that higher score indicated greater structural ageism.

MAIN OUTCOMES AND MEASURES

Prevalence rates of violence per 100 000 persons aged 70 and over in each country was based on extensive epidemiological surveillance data, survey, clinical data and insurance claims in GBD and compiled by the Institute of Health Metrics and Evaluation, University of Washington.

RESULTS

There was a wide variation in levels of structural ageism across countries. As predicted, structural ageism was significantly associated with the prevalence rates of violence in multivariate models (β=205.7, SE=96.3, p=0.03), after adjusting for relevant covariates. Sensitivity analyses supported the robustness of our findings. That is, structural ageism did not predict other types of violence and other types of prejudice did not predict violence against older persons.

CONCLUSIONS

This study provides the first evidence of the association between higher structural ageism and greater violence against older persons across countries.

Successful Aging in Older US Veterans: Results From the 2019-2020 National Health and Resilience in Veterans Study

OBJECTIVE

To identify the current prevalence, and sociodemographic, military, health, and psychosocial correlates of successful aging in older US veterans.

METHODS

Data were analyzed from the 2019-2020 National Health and Resilience in Veterans Study, which surveyed a nationally representative sample of 3,001 US veterans aged greater than or equal to 60 years (mean = 73). Multiple regression and relative importance analyses were conducted to identify key factors associated with successful aging.

RESULTS

A total 79% of older veterans rated themselves as aging successfully. Physical and mental health difficulties emerged as the strongest correlates of successful aging (71% variance explained), while psychosocial factors, most notably perceived resilience, purpose in life, and positive expectations about emotional aging, explained 29% of the variance in this outcome.

CONCLUSIONS

Nearly 4 of 5 US veterans rate themselves as successful agers. Prevention and treatment efforts designed to mitigate physical and mental health difficulties, and promote protective psychosocial factors may help bolster successful aging in this population.

Protective effects of neighborhood community factors on elder abuse in India

Elder abuse impacts one in six older persons globally. Most studies of elder abuse have focused on risk factors rather than protective factors, individual-level factors rather than structural factors, and developed countries rather than developing countries where resources are scarce. The current study addressed these gaps by examining whether neighborhood social cohesion and physical order could be such structural-level protective factors for older persons in India. Our cohort consisted of 541 participants aged 60 and over in the pilot wave of the Longitudinal Aging Study in India. We found that older persons with high neighborhood social cohesion were 38% less likely to experience abuse compared to older persons with low cohesion (OR = 0.62, 95% CI = 0.39-0.99). Similarly, participants with high neighborhood physical order were 48% less likely to experience abuse compared to older persons with low physical order (OR = 0.52, 95% CI = 0.32-0.83). Both models adjusted for relevant covariates. Policies supporting greater cohesion and order in communities could reap significant health benefits for older persons.

Ageism Amplifies Cost and Prevalence of Health Conditions

Background and Objectives

The persistent status of ageism as one of the least acknowledged forms of prejudice may be due in part to an absence of quantifying its costs in economic terms. In this study, we calculated the costs of ageism on health conditions for all persons aged 60 years or older in the United States during 1 year.

Research Design and Materials

The ageism predictors were discrimination aimed at older persons, negative age stereotypes, and negative self-perceptions of aging. Health care costs of ageism were computed by combining analyses of the impact of the predictors with comprehensive health care spending data in 1 year for the eight most-expensive health conditions, among all Americans aged 60 years or older. As a secondary analysis, we computed the number of these health conditions experienced due to ageism.

Results

It was found that the 1-year cost of ageism was $63 billion, or one of every seven dollars spent on the 8 health conditions (15.4%), after adjusting for age and sex as well as removing overlapping costs from the three predictors. Also according to our model, ageism resulted in 17.04 million cases of these health conditions.

Discussion and Implications

This is the first study to identify the economic cost that ageism imposes on health. The findings suggest that a reduction of ageism would not only have a monetary benefit for society, but also have a health benefit for older persons.

When Culture Influences Genes: Positive Age Beliefs Amplify the Cognitive-Aging Benefit of APOE ε2

OBJECTIVES

Most studies of aging cognition have focused on risk factors for worse performance and on either genetic or environmental factors. In contrast, we examined whether 2 factors known to individually benefit aging cognition may interact to produce better cognition: environment-based positive age beliefs and the APOE ε2 gene.

METHOD

The sample consisted of 3,895 Health and Retirement Study participants who were 60 years or older at baseline and completed as many as 5 assessments of cognition over 8 years.

RESULTS

As predicted, positive age beliefs amplified the cognitive benefit of APOE ε2. In contrast, negative age beliefs suppressed the cognitive benefit of APOE ε2. We also found that positive age beliefs contributed nearly 15 times more than APOE ε2 to better cognition.

DISCUSSION

This study provides the first known evidence that self-perceptions can influence the impact of a gene on cognition. The results underscore the importance of combined psychosocial and biological approaches to understanding cognitive function in older adults.

Global reach of ageism on older persons' health: A systematic review

Objective

Although there is anecdotal evidence of ageism occurring at both the structural level (in which societal institutions reinforce systematic bias against older persons) and individual level (in which older persons take in the negative views of aging of their culture), previous systematic reviews have not examined how both levels simultaneously influence health. Thus, the impact of ageism may be underestimated. We hypothesized that a comprehensive systematic review would reveal that these ageism levels adversely impact the health of older persons across geography, health outcomes, and time.

Method

A literature search was performed using 14 databases with no restrictions on region, language, and publication type. The systematic search yielded 13,691 papers for screening, 638 for full review, and 422 studies for analyses. Sensitivity analyses that adjusted for sample size and study quality were conducted using standardized tools. The study protocol is registered (PROSPERO CRD42018090857).

Results

Ageism led to significantly worse health outcomes in 95.5% of the studies and 74.0% of the 1,159 ageism-health associations examined. The studies reported ageism effects in all 45 countries, 11 health domains, and 25 years studied, with the prevalence of significant findings increasing over time (p < .0001). A greater prevalence of significant ageism-health findings was found in less-developed countries than more-developed countries (p = .0002). Older persons who were less educated were particularly likely to experience adverse health effects of ageism. Evidence of ageism was found across the age, sex, and race/ethnicity of the targeters (i.e., persons perpetrating ageism).

Conclusion

The current analysis which included over 7 million participants is the most comprehensive review of health consequences of ageism to date. Considering that the analysis revealed that the detrimental impact of ageism on older persons’ health has been occurring simultaneously at the structural and individual level in five continents, our systematic review demonstrates the pernicious reach of ageism.

Gender differences in short-term cardiovascular effects of giving and receiving support for health concerns in marriage

OBJECTIVE

Little is known about the cardiovascular effects of mutual emotional spousal support given for health concerns. We examined the hypotheses that: (a) mutual support (both spouses giving and receiving support) compared to one-sided or no support, would decrease blood pressure and heart rate in both spouses during a recovery period; and (b) wives would benefit more from mutual support than would husbands. A second aim was to examine gender differences in cardiovascular reactivity, distress, and closeness in response to receiving support regardless of mutuality.

METHOD

In 98 married couples (Age 50+), spouses discussed health concerns and were assigned randomly to one of four conditions: neither spouse received support (n = 26), only the wife received support from the husband (n = 22), only the husband received support from the wife (n = 23), or both received support (n = 27). Systolic and diastolic blood pressure and heart rate were measured during baseline, the discussions, and recovery. Distress, closeness, and support were self-reported. Support quality was observationally coded.

RESULTS

Mutual support did not affect cardiovascular reactivity. When husbands received support from wives, husbands' blood pressure and distress decreased, and both partners' closeness increased. When wives received support, husbands and wives felt closer, but both partners' heart rate remained elevated and wives felt more distressed.

CONCLUSIONS

Receiving support individually may be more important than receiving support mutually for older adult spouses coping with their health concerns. Also, support interventions for couples coping with health conditions should take into account that husbands receive greater benefits from spousal support than wives. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Survival Advantage Mechanism: Inflammation as a Mediator of Positive Self-Perceptions of Aging on Longevity

Objective

Previous studies have found that positive self-perceptions of aging (SPA) are associated with longer survival; however, a biological mechanism was unknown. We examined whether C-reactive protein (CRP), a marker of cumulative stress-related inflammation, mediates the relationship between SPA and survival.

Method

The SPA of participants aged 50 and older in the Health and Retirement Study (N = 4,149) were assessed at baseline. Inflammation was measured by the level of CRP 4 years later. Survival was followed for up to 6 years.

Results

As hypothesized, CRP mediated the impact of SPA on survival. Following the steps of a mediation analysis, positive SPA at baseline predicted lower CRP after 4 years (β = -.29, p = .03) and longer survival in the 2 years following the CRP measurement (β = .20, p =.003); additionally, lower CRP predicted longer survival, after adjusting for positive SPA (β = -.02, p = .0001). All models adjusted for baseline age, CRP, health, sex, race, and education.

Discussion

It was found that lower CRP partially mediates the relationship between positive SPA and longer survival. Hence, this study presents a novel pathway to explain the process by which positive SPA extend longevity.

Accelerated DNA Methylation Aging in U.S. Military Veterans: Results From the National Health and Resilience in Veterans Study

OBJECTIVE

The aim of this study was to identify how a broad range of sociodemographic, military, health, and psychosocial factors relate to accelerated DNA methylation aging (Δ_age) in a large, contemporary, nationally representative sample of male U.S. veterans.

METHODS

Data were analyzed from a sample of U.S. male European-American veterans who participated in the National Health and Resilience in Veterans Study (N = 1,135).

RESULTS

Psychosocial factors of lifetime trauma burden, child sexual trauma, and negative beliefs about aging were independently associated with Δ_age. Three health variables-diabetes, hypertension, and body mass index-emerged as additional correlates of Δ_age.

CONCLUSION

Results of the study build on prior work demonstrating associations between accelerated DNA methylation aging and traumatic stress, highlighting a role for child sexual abuse in particular. They further underscore the importance of targeting negative beliefs about aging, which are modifiable, in prevention efforts designed to forestall accelerated DNA methylation aging.

Active coping shields against negative aging self-stereotypes contributing to psychiatric conditions

RATIONALE

Psychiatric conditions are often falsely considered inherent to aging. We examined whether negative age stereotypes, which older individuals tend to assimilate from the environment across their lifespan, contributed to an increased risk of developing four psychiatric conditions, and, if so, whether this risk was reduced through active coping.

METHOD

The sample consisted of participants aged 55 years and older, free of the psychiatric conditions at baseline, drawn from the National Health and Resilience in Veterans Study, a nationally representative sample. New cases of posttraumatic stress disorder, suicidal ideation, generalized anxiety disorder, and major depressive disorder were assessed during three waves spanning a four-year period.

RESULTS

As predicted, participants holding more-negative age stereotypes were more likely to develop the psychiatric conditions, and their engagement in active coping reduced the risk of their developing these conditions.

CONCLUSION

Our findings suggest that prevention and treatment efforts designed to reduce psychiatric conditions in later life may benefit from bolstering active coping as well as positive age stereotypes.

Idealization of youthfulness predicts worse recovery among older individuals

This study examined whether stereotypes about an out-group could influence physical health. It had been previously shown that positive stereotypes held by older individuals about their in-group benefited physical health. However, the potential impact on physical health from idealizing their out-group, the young, through positive stereotypes had not been studied. The cohort consisted of 189 participants, aged 60 and older, who experienced a cardiovascular event: a myocardial infarction (MI). Participants reported their stereotypes about the young and the old at baseline. Their MI recovery was assessed with a physical-performance battery that was administered at 4 time points across 1 year following the event. As hypothesized, positive stereotypes about the young predicted significantly worse recovery and positive stereotypes about the old predicted significantly better recovery, after adjusting for relevant covariates. Considering out-group idealization as a risk factor could provide an innovative research and clinical tool. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Positive views of aging reduce risk of developing later-life obesity

The obesity epidemic among older adults is expected to continue increasing unless public-health efforts address this age group. Yet, little is known about psychosocial determinants of obesity that relate specifically to older persons. In this study, we investigated for the first time whether self-perceptions of aging (SPA), defined as beliefs about oneself as an older person that are assimilated from society, relate to new cases of obesity. This seemed plausible because older persons who report more-positive SPA tend to engage in more health-promoting behaviors. Our sample consisted of 5702 Americans in the nationally representative Health and Retirement Study who were aged 60 years or older and not obese at baseline. The participants were followed from 2008 to 2014. As predicted, older persons with more-positive SPA, compared to those with more-negative SPA, were significantly less likely to become obese over the next 6 years, after adjusting for relevant covariates. For example, according to our model, a participant with the most-positive SPA score was 27% less likely to become obese than a same-aged peer with an average score on the SPA measure. These findings suggest that interventions aimed at reducing the prevalence of obesity in later life could benefit from targeting SPA.

Benefit of Gender-Affirming Medical Treatment for Transgender Elders: Later-Life Alignment of Mind and Body

PURPOSE

This study examined whether older age moderates the association between gender-affirming medical treatment and quality of life (QOL) among transgender individuals.

METHODS

Transgender men and women from the National Transgender Discrimination Survey who had either recently or never undergone medical treatment were included (n = 2420). A moderation analysis was utilized.

RESULTS

As predicted, participants who initiated medical treatment had higher QOL than those who did not. Age moderated this association. The QOL difference was greater for older than for younger transgender individuals.

CONCLUSION

Among all transgender men and women, gender-affirming medical treatment can be especially beneficial for elders.

Positive Aging Views in the General Population Predict Better Long-Term Cognition for Elders in Eight Countries

Objective: Much of the literature on aging cognitive health has focused on individual determinants, rather than societal ones; in contrast, this study examined whether country-level age status predicts cognitive performance of older individuals over time. Method: Eight countries were examined using a novel combination of country-level age status data from the European Social Survey and individual-level data from the Survey on Health, Ageing, and Retirement in Europe, between 2004 and 2013. Results: We found that more positive age status significantly predicted better performance on three cognitive measures over a 10-year period, after adjusting for relevant covariates. The generalized-linear model nested individuals within countries to account for the multilevel data. Discussion: To our knowledge, this is the first study to report an association between country-level age status and cognitive performance over time. The results suggest that a small change in the perception of old age at the population level could have a significant effect on the cognitive health of older individuals.

Positive age beliefs protect against dementia even among elders with high-risk gene

One of the strongest risk factors for dementia is the ε4 variant of the APOE gene. Yet, many who carry it never develop dementia. The current study examined for the first time whether positive age beliefs that are acquired from the culture may reduce the risk of developing dementia among older individuals, including those who are APOE ε4 carriers. The cohort consisted of 4,765 Health and Retirement Study participants who were aged 60 or older and dementia-free at baseline. As predicted, in the total sample those with positive age beliefs at baseline were significantly less likely to develop dementia, after adjusting for relevant covariates. Among those with APOE ε4, those with positive age beliefs were 49.8% less likely to develop dementia than those with negative age beliefs. The results of this study suggest that positive age beliefs, which are modifiable and have been found to reduce stress, can act as a protective factor, even for older individuals at high risk of dementia.

To Love is to Suffer: Older Adults' Daily Emotional Contagion to Perceived Spousal Suffering

Objectives

For older adults coping with a spouse's chronic condition, greater marital satisfaction may not be entirely protective for psychological health. We examined marital satisfaction and gender as moderators of the association between perceived spousal suffering and daily emotional contagion. Based on empathy-altruism and interdependent self-construal theories, we hypothesized that high marital satisfaction and being female would heighten daily emotional contagion, or within-person associations between perceived spouse suffering and distress to spouse suffering.

Method

Forty-five older adults who had a spouse with a musculoskeletal condition completed daily interviews. Participants reported their marital satisfaction once in the laboratory and then daily perceptions of their spouse's physical suffering and their own distress to spouse suffering via phone at home for 7 days.

Results

Consistent with hypotheses, there were significant within-person effects such that highly satisfied wives experienced heightened emotional contagion on days when they perceived higher than average spouse suffering. Unexpectedly, men who were high in marital satisfaction experienced heightened daily distress irrespective of their perceptions of level of spousal suffering.

Discussion

Marital satisfaction can increase daily emotional contagion to spousal suffering among older couples dealing with chronic conditions. Wives' distress may be more dependent on perceiving high levels of partner suffering compared with husbands' distress.

Buffer against Cumulative Stress

Abstract. Prolonged elevation of cortisol, the primary stress biomarker, is associated with impaired cognitive and physical health. Cortisol tends to increase in later life among most, but not all, older individuals. The current study considered whether this pattern could be explained by more-positive age stereotypes acting as a stress buffer. The 439 participants drawn from the Baltimore Longitudinal Study of Aging provided 1,789 cortisol measurements, from 24-h collections of urine, across 30 years. Among those aged 50 or greater, the cortisol of the more-negative age-stereotype group increased by 44%, whereas the more-positive age-stereotype group showed no increase. Also as expected, there was no association of age stereotypes and cortisol level among the younger participants, for whom the age stereotypes were self-irrelevant. The findings indicate the importance of considering the relationship between both positive and negative stereotypes and stress biomarkers over time.

Image of Aging Scale

The development of the Image of Aging Scale is described. It includes positive and negative images of elders within nine domains. The scale showed good 1-wk. test-retest reliability, internal consistency, and convergent validity.

Wanted Dead or Alive

To determine who is dead or alive, many researchers, policy makers, and corporations have relied on the National Death Index (NDI). This study investigates the impact of using NDI information to establish mortality status upon longevity analyses. A community sample of 694 individuals, enrolled in the Ohio Longitudinal Study of Aging and Retirement in 1975, participated. The authors compared the survival of two groups of these participants: those for whom death information came from clear matches with NDI and those for whom death information was based on both NDI information and supplementary information, such as community informants. Those in the expanded group tended to have significantly shorter survival than those in the strict group. Findings suggest that using limited NDI information alone may falsely increase longevity. Use of NDI offers numerous benefits, but incomplete or inaccurate classification of mortality status may affect study results.

Physical Recovery after Acute Myocardial Infarction: Positive Age Self-Stereotypes as a Resource

We considered whether positive and stable self-stereotypes of stigmatized group members can influence functioning (in contrast, stereotype threat theory suggests these influential self-stereotypes are limited to ones that are negative and situational). Specifically, we examined older individuals' positive age stereotypes after a life-threatening event, an acute myocardial infarction (AMI). Sixty-two persons, aged 50 to 96, participated. As expected, positive age stereotypes were found, even immediately after an AMI, and they did not significantly change over the next seven months. Also as expected, these self-stereotypes predicted physical recovery, after adjusting for potentially relevant covariates. Recovery expectations acted as a mediator. These findings suggest the importance of understanding the role that positive stereotypes may play in the health of stigmatized group members.

A chapter a day: Association of book reading with longevity

Although books can expose people to new people and places, whether books also have health benefits beyond other types of reading materials is not known. This study examined whether those who read books have a survival advantage over those who do not read books and over those who read other types of materials, and if so, whether cognition mediates this book reading effect. The cohort consisted of 3635 participants in the nationally representative Health and Retirement Study who provided information about their reading patterns at baseline. Cox proportional hazards models were based on survival information up to 12 years after baseline. A dose-response survival advantage was found for book reading by tertile (HRT2 = 0.83, p < 0.001, HRT3 = 0.77, p < 0.001), after adjusting for relevant covariates including age, sex, race, education, comorbidities, self-rated health, wealth, marital status, and depression. Book reading contributed to a survival advantage that was significantly greater than that observed for reading newspapers or magazines (tT2 = 90.6, p < 0.001; tT3 = 67.9, p < 0.001). Compared to non-book readers, book readers had a 23-month survival advantage at the point of 80% survival in the unadjusted model. A survival advantage persisted after adjustment for all covariates (HR = .80, p < .01), indicating book readers experienced a 20% reduction in risk of mortality over the 12 years of follow up compared to non-book readers. Cognition mediated the book reading-survival advantage (p = 0.04). These findings suggest that the benefits of reading books include a longer life in which to read them.

Retirement as Meaningful: Positive Retirement Stereotypes Associated with Longevity

Studies examining the association between retirement and health have produced mixed results. This may be due to previous studies treating retirement as merely a change in job status rather than a transition associated with stereotypes or societal beliefs (e.g., retirement is a time of mental decline or retirement is a time of growth). To examine whether these stereotypes are associated with health, we studied retirement stereotypes and survival over a 23-year period among 1,011 older adults. As predicted by stereotype embodiment theory, it was found that positive stereotypes about physical health during retirement showed a survival advantage of 4.5 years (hazard ratio = 0.88, p = .022) and positive stereotypes about mental health during retirement tended to show a survival advantage of 2.5 years (hazard ratio = 0.87, p = .034). Models adjusted for relevant covariates such as age, gender, race, employment status, functional health, and self-rated health. These results suggest that retirement preparation could benefit from considering retirement stereotypes.

A culture-brain link: Negative age stereotypes predict Alzheimer's disease biomarkers

Although negative age stereotypes have been found to predict adverse outcomes among older individuals, it was unknown whether the influence of stereotypes extends to brain changes associated with Alzheimer's disease. To consider this possibility, we drew on dementia-free participants, in the Baltimore Longitudinal Study of Aging, whose age stereotypes were assessed decades before yearly magnetic resonance images and brain autopsies were performed. Those holding more-negative age stereotypes earlier in life had significantly steeper hippocampal-volume loss and significantly greater accumulation of neurofibrillary tangles and amyloid plaques, adjusting for relevant covariates. These findings suggest a new pathway to identifying mechanisms and potential interventions related to the pathology of Alzheimer's disease.

Reactivity to a Spouse's Interpersonal Suffering in Late Life Marriage: A Mixed-Methods Approach

OBJECTIVE

To determine how older adult spouses react to their partners' interpersonal suffering.

METHOD

Spouses of individuals with musculoskeletal pain were recorded describing their partners' suffering while their blood pressure (BP) was monitored. After the account, spouses described their distress. Speeches were transcribed and analyzed with Linguistic Inquiry and Word Count software and coded for interpersonal content. Multivariate regression analyses were conducted with interpersonal content variables predicting BP and distress. Exploratory qualitative analysis was conducted using ATLAS.ti to explore mechanisms behind quantitative results.

RESULTS

Describing partners' suffering as interpersonal and using social (family) words were associated with higher systolic BP reactivity. Husbands were more likely to describe partners' suffering as interpersonal. Qualitative results suggested shared stressors and bereavement-related distress as potential mechanisms for heightened reactivity to interpersonal suffering.

DISCUSSION

Spouses' interpersonal suffering may negatively affect both men and women's cardiovascular health, and older husbands may be particularly affected.

Increasing negativity of age stereotypes across 200 years: evidence from a database of 400 million words

Scholars argue about whether age stereotypes (beliefs about old people) are becoming more negative or positive over time. No previous study has systematically tested the trend of age stereotypes over more than 20 years, due to lack of suitable data. Our aim was to fill this gap by investigating whether age stereotypes have changed over the last two centuries and, if so, what may be associated with this change. We hypothesized that age stereotypes have increased in negativity due, in part, to the increasing medicalization of aging. This study applied computational linguistics to the recently compiled Corpus of Historical American English (COHA), a database of 400 million words that includes a range of printed sources from 1810 to 2009. After generating a comprehensive list of synonyms for the term elderly for these years from two historical thesauri, we identified 100 collocates (words that co-occurred most frequently with these synonyms) for each of the 20 decades. Inclusion criteria for the collocates were: (1) appeared within four words of the elderly synonym, (2) referred to an old person, and (3) had a stronger association with the elderly synonym than other words appearing in the database for that decade. This yielded 13,100 collocates that were rated for negativity and medicalization. We found that age stereotypes have become more negative in a linear way over 200 years. In 1880, age stereotypes switched from being positive to being negative. In addition, support was found for two potential explanations. Medicalization of aging and the growing proportion of the population over the age of 65 were both significantly associated with the increase in negative age stereotypes. The upward trajectory of age-stereotype negativity makes a case for remedial action on a societal level.

Subliminal strengthening: improving older individuals' physical function over time with an implicit-age-stereotype intervention

Negative age stereotypes that older individuals assimilate from their culture predict detrimental outcomes, including worse physical function. We examined, for the first time, whether positive age stereotypes, presented subliminally across multiple sessions in the community, would lead to improved outcomes. Each of 100 older individuals (age=61-99 years, M=81) was randomly assigned to an implicit-positive-age-stereotype-intervention group, an explicit-positive-age-stereotype-intervention group, a combined implicit- and explicit-positive-age-stereotype-intervention group, or a control group. Interventions occurred at four 1-week intervals. The implicit intervention strengthened positive age stereotypes, which strengthened positive self-perceptions of aging, which, in turn, improved physical function. The improvement in these outcomes continued for 3 weeks after the last intervention session. Further, negative age stereotypes and negative self-perceptions of aging were weakened. For all outcomes, the implicit intervention's impact was greater than the explicit intervention's impact. The physical-function effect of the implicit intervention surpassed a previous study's 6-month-exercise-intervention's effect with participants of similar ages. The current study's findings demonstrate the potential of directing implicit processes toward physical-function enhancement over time.

Resiliency Over Time of Elders' Age Stereotypes After Encountering Stressful Events

OBJECTIVE

To examine whether the age stereotypes of older individuals would become more negative or else show resiliency following stressful events and to examine whether age-stereotype negativity would increase the likelihood of experiencing a stressful event (i.e., hospitalization).

METHOD

Age stereotypes of 231 participants, 70 years and older, were assessed across 10 years, before and after the occurrence of hospitalizations and bereavements.

RESULTS

Age-stereotype negativity was resilient despite encountering stressful events. In contrast, more negative age stereotypes were associated with a 50% greater likelihood of experiencing a hospitalization.

DISCUSSION

The robustness of negative age stereotypes was expressed in their capacity to resist change as well as generate it.

Lower prevalence of psychiatric conditions when negative age stereotypes are resisted

Older military veterans are at greater risk for psychiatric disorders than same-aged non-veterans. However, little is known about factors that may protect older veterans from developing these disorders. We considered whether an association exists between the potentially stress-reducing factor of resistance to negative age stereotypes and lower prevalence of the following outcomes among older veterans: suicidal ideation, anxiety, and posttraumatic stress disorder (PTSD). Participants consisted of 2031 veterans, aged 55 or older, who were drawn from the National Health and Resilience in Veterans Study, a nationally representative survey of American veterans. The prevalence of all three outcomes was found to be significantly lower among participants who fully resisted negative age stereotypes, compared to those who fully accepted them: suicidal ideation, 5.0% vs. 30.1%; anxiety, 3.6% vs. 34.9%; and PTSD, 2.0% vs. 18.5%, respectively. The associations followed a graded linear pattern and persisted after adjustment for relevant covariates, including age, combat experience, personality, and physical health. These findings suggest that developing resistance to negative age stereotypes could provide older individuals with a path to greater mental health.

A psychological predictor of elders' driving performance: social-comparisons on the road

Older individuals often believe they can drive better than their contemporaries. This belief is an example of downward social-comparisons; they can be self-enhancing tools that lead to beneficial outcomes. As predicted, we found that drivers who engaged in downward social-comparisons were significantly less likely to have adverse driving events over time, after controlling for relevant factors (p = .02). This effect was particularly strong among women, who tend to experience more negative driving stereotypes (p = .01). The study was based on 897 interviews of 117 elder drivers, aged 70-89 years, over 2 years. Our findings suggest that interventions to reduce adverse driving events among elders could benefit from including a psychological component.

Facebook as a site for negative age stereotypes

Ageism has been found to exist throughout a wide variety of societal institutions. Whether it also exists in social networking sites has not been previously considered. To explore this possibility, we conducted a content analysis of each publicly accessible Facebook group that concentrated on older individuals. The site "Descriptions" of the 84 groups, with a total of 25,489 members, were analyzed. The mean age category of the group creators was 20-29; all were younger than 60 years. Consistent with our hypothesis, the Descriptions of all but one of these groups focused on negative age stereotypes. Among these Descriptions, 74% excoriated older individuals, 27% infantilized them, and 37% advocated banning them from public activities, such as shopping. Facebook has the potential to break down barriers between generations; in practice, it may have erected new ones.

Health advantages of ethnic density for African American and Mexican American elderly individuals

Research suggests that greater ethnic density correlates with worse health among African Americans but better health among Hispanic Americans. These conflicting patterns may arise from Hispanic American samples being older than African American samples. We found that among 2367 Mexican American and 2790 African American participants older than 65 years, ethnic density predicted lower rates of cardiovascular disease and cancer, adjusting for covariates, showing that the health benefits of ethnic density apply to both minority communities.

Memory shaped by age stereotypes over time

OBJECTIVES

Previous studies showed that negative self-stereotypes detrimentally affect the cognitive performance of marginalized group members; however, these findings were confined to short-term experiments. In the present study, we considered whether stereotypes predicted memory over time, which had not been previously examined. We also considered whether self-relevance increased the influence of stereotypes on memory over time.

METHOD

Multiple waves of memory performance were analyzed using individual growth models. The sample consisted of 395 participants in the Baltimore Longitudinal Study of Aging.

RESULTS

Those with more negative age stereotypes demonstrated significantly worse memory performance over 38 years than those with less negative age stereotypes, after adjusting for relevant covariates. The decline in memory performance for those aged 60 and above was 30.2% greater for the more negative age stereotype group than for the less negative age stereotype group. Also, the impact of age stereotypes on memory was significantly greater among those for whom the age stereotypes were self-relevant.

DISCUSSION

This study shows that the adverse influence of negative self-stereotypes on cognitive performance is not limited to a short-term laboratory effect. Rather, the findings demonstrate, for the first time, that stereotypes also predict memory performance over an extended period in the community.

Residual stigma: psychological distress among the formerly overweight

Little is known about the psychological state of those who leave a stigmatized group. We examined individuals who previously belonged to a stigmatized group, the overweight, and then became normal weight. Negative stereotypes, including those relating to obesity, are internalized from the time of childhood onward; therefore, it was assumed they would become lingering self-stereotypes among individuals who were no longer externally targeted. Drawing on a nationally representative sample, we examined for the first time whether formerly overweight individuals are susceptible to any anxiety disorder, any depressive disorder, and suicide attempts. As predicted, the likelihood of any anxiety disorder and any depressive disorder for the formerly overweight group was significantly greater than for the consistently normal-weight group, and not significantly different from the consistently overweight group. Further, the formerly overweight group was significantly more likely to attempt suicide than the other groups. Also as predicted, perceived weight discrimination partially mediated the relationship between weight status and these outcomes. The cohort consisted of 33,604 participants in the United States. The results suggest that losing a self-image shaped by stigma is a more protracted process than losing weight.

Lifetime discrimination associated with greater likelihood of premenstrual dysphoric disorder

OBJECTIVES

To evaluate whether the stressor of perceived discrimination was associated with premenstrual dysphoric disorder (PMDD) and premenstrual symptoms among minority women. This study builds on previous research that found perceived discrimination was positively associated with other psychiatric illnesses.

METHODS

Participants were 2718 Asian, Latina, and black premenopausal women aged 18-40 years who completed the World Mental Health Composite International Diagnostic Interview for the National Latino and Asian American Survey or the National Survey of American Life. Perceived discrimination was assessed with the Everyday Discrimination Scale. DSM-IV-based diagnostic algorithms generated a provisional lifetime diagnosis of PMDD.

RESULTS

Eighty-three percent of the participants reported experiencing discrimination (due to race, gender, age, height or weight, or other reasons) in their lifetimes. The frequency of perceived discrimination was positively associated with PMDD (odds ratio [OR] 1.08, 95% confidence interval [CI] 1.05-1.10) and premenstrual symptoms (OR 1.04, 95% CI 1.02-1.05), independent of demographic covariates and social desirability. Women reporting gender discrimination (OR 5.18, 95% CI 1.80-14.90), race discrimination (OR 4.14, 95% CI 1.54-11.11), and other forms of discrimination (OR 6.43, 95% CI 2.11-19.65) were significantly more likely than women without experiences of discrimination to have PMDD. Subtle discrimination was more strongly associated with PMDD (OR 1.12, 95% CI 1.01-1.23) than was blatant discrimination (OR 1.04, 95% CI 0.94-1.15).

CONCLUSIONS

This study is the first to demonstrate that perceived discrimination is associated with PMDD and premenstrual symptoms. These findings suggest that the prevalence of these conditions may be lessened by reducing discrimination in women's lives.

Posttraumatic stress disorder and trauma characteristics are correlates of premenstrual dysphoric disorder

Posttraumatic stress disorder (PTSD) is often comorbid with premenstrual dysphoric disorder (PMDD) in women; however, it is unclear whether this relationship is driven by the trauma that may lead to PTSD or if PTSD is uniquely associated with PMDD. In this study, we examine trauma and PTSD as independent correlates of PMDD. Researchers conducted a cross-sectional, secondary data analysis of 3,968 female participants (aged 18-40) of the Collaborative Psychiatric Epidemiology Surveys. Women who had a history of trauma with PTSD (odds ratio, OR = 8.14, 95% confidence interval, CI = 3.56-18.58) or a history of trauma without PTSD (OR = 2.84, 95% CI = 1.26-6.42) were significantly more likely than women with no history of trauma to report PMDD. This graded relationship was also observed in association with premenstrual symptoms. Among trauma survivors, PTSD was independently associated with PMDD, although characteristics of participants' trauma history partially accounted for this association. Our study demonstrated that trauma and PTSD were independently associated with PMDD and premenstrual symptoms. Clinicians should be aware that women who present with premenstrual symptomatology complaints may also have a history of trauma and PTSD that needs to be addressed. This pattern of comorbidity may complicate the treatment of both conditions.