Location Matters: The Role of the Neighborhood Environment for Incident Cardiometabolic Disease in Adults Aging With Physical Disability

PURPOSE

People aging with disability may be limited in their ability to engage in healthy behaviors to maintain cardiometabolic health. We investigated the role of health promoting features in the neighborhood environment for incident cardiometabolic disease in adults aging with physical disability in the United States.

DESIGN

Retrospective cohort study.

SETTING

Optum's Clinformatics® Data Mart Database (2007-2018) of administrative health claims.

SUBJECTS

ICD-9-CM codes were used to identify 15 467 individuals with a diagnosis of Cerebral Palsy, Spina Bifida, Multiple Sclerosis, or Spinal Cord Injury.

MEASURES

Cardiometabolic disease was identified using ICD-9-CM/ICD-10-CM codes over 3 years of follow-up. Measures of the neighborhood environment came from the National Neighborhood Data Archive and linked to individual residential ZIP codes over time. Covariates included age, sex, and comorbid health conditions.

ANALYSIS

Cox regression models estimated hazard ratios (HR) for incident cardiometabolic disease. Using a 1-year lookback period, individuals with pre-existing cardiometabolic disease were excluded from the analysis.

RESULTS

Net of individual risk factors, residing in neighborhoods with a greater density of broadband Internet connections (HR = .88, 95% CI: .81, .97), public transit stops (HR = .89, 95% CI: .83, .95), recreational establishments (HR = .89, 95% CI: .83, .96), and parks (HR = .88, 95% CI: .82, .94), was associated with reduced risk of 3-year incident cardiometabolic disease.

CONCLUSION

Findings identify health-promoting resources that may mitigate health disparities in adults aging with disability.

The Atacama Rover Astrobiology Drilling Studies (ARADS) Project

With advances in commercial space launch capabilities and reduced costs to orbit, humans may arrive on Mars within a decade. Both to preserve any signs of past (and extant) martian life and to protect the health of human crews (and Earth's biosphere), it will be necessary to assess the risk of cross-contamination on the surface, in blown dust, and into the near-subsurface (where exploration and resource-harvesting can be reasonably anticipated). Thus, evaluating for the presence of life and biosignatures may become a critical-path Mars exploration precursor in the not-so-far future, circa 2030. This Special Collection of papers from the Atacama Rover Astrobiology Drilling Studies (ARADS) project describes many of the scientific, technological, and operational issues associated with searching for and identifying biosignatures in an extreme hyperarid region in Chile's Atacama Desert, a well-studied terrestrial Mars analog environment. This paper provides an overview of the ARADS project and discusses in context the five other papers in the ARADS Special Collection, as well as prior ARADS project results.

"Please don't let me become a statistic in this grocery store": Civic engagement among older Americans since the COVID-19 pandemic onset

The COVID-19 pandemic disrupted civic life and upended daily routines. Coffee shops, restaurants, recreation centers, parks, and other 'third places' that facilitate communal gathering, interpersonal connection, and meaningful activity closed or operated under tight restrictions. Little is known about longer-term impacts on older adults' civic life since the pandemic's onset. The COVID-19 Coping Study conducted semi-structured interviews in April-July 2021 with 57 adults aged ≥55 across the United States (mean age 71). Reflexive thematic analysis identified heightened sociopolitical tensions and complex community experiences since the pandemic's onset. Participants shared nuanced perceptions of greater physical and emotional distancing, siloed communities, politicized public health adherence, fears of gun violence, and experiences of racial discrimination in shared spaces. Hopeful efforts to re-engage in civic life involved cautious social activities post-vaccination, altered daily routines, and finding a "new normal." The novel results explore how a large sample of racially and socioeconomically diverse older adults perceive and experience American sociopolitical tensions anchored in shared everyday spaces. Results may inform practical opportunities for policymakers and community service providers to strengthen social infrastructure, support wellbeing, and bolster civic life.

The impact of a randomized cash transfer intervention on mortality of adult household members in rural South Africa, 2011-2022

BACKGROUND

Increasing socioeconomic resources through cash transfer payments could help promote healthy longevity. However, research in this area is limited due to endogeneity in cash transfer exposures and limited geographic representation.

METHODS

We leveraged the HPTN 068 randomized cash transfer trial, conducted from 2011 to 2015 in a rural setting in South Africa. We assessed long-term mortality follow-up (until March 2022) on older adult members (n = 3568) of households enrolled in the trial from the complete Agincourt Health and socio-Demographic Surveillance System census of the underlying source population. The trial intervention was a monthly cash payment of 300 Rand conditional on school enrollment of index young women. The payments were split between the young woman (1/3) and their caregiver (2/3). Young women and their households were randomized 1:1 to intervention vs. control. We used Cox PH models to compare mortality rates in older adults living in intervention vs. control households.

FINDINGS

The cash transfer intervention did not significantly impact mortality in the full sample [HR (95% CI): 0.94 (0.80, 1.10)]. However, we observed strong protective effects of the cash transfer intervention among those with above-median household assets [HR (95% CI): 0.66 (0.50, 0.86)] and higher educational attainment [HR (95% CI): 0.37 (0.15, 0.93)].

INTERPRETATION

Our findings indicate that short-term cash transfers can lead to reduced mortality in certain subgroups of older adults with higher baseline socioeconomic status. Future work should focus on understanding the optimal timing, structure, and targets to maximize the benefits of cash transfer programs in promoting healthy aging and longevity.

The Mediating Role of Systemic Inflammation and Moderating Role of Race/Ethnicity in Racialized Disparities in Incident Dementia: A Decomposition Analysis

Background

Exposure to systemic racism is linked to increased dementia burden. To assess systemic inflammation as a potential pathway linking exposure to racism and dementia disparities, we investigated the mediating role of C-reactive protein (CRP), a systemic inflammation marker, and the moderating role of race/ethnicity on racialized disparities in incident dementia.

Methods

In the US Health and Retirement Study (n=5,143), serum CRP was measured at baseline (2006, 2008 waves). Incident dementia was classified by cognitive tests over a six-year follow-up. Self-reported racialized categories were a proxy for exposure to the racialization process. We decomposed racialized disparities in dementia incidence (non-Hispanic Black and/or Hispanic vs. non-Hispanic White) into 1) the mediated effect of CRP, 2) the moderated portion attributable to the interaction between racialized group membership and CRP, and 3) the controlled direct effect (other pathways through which racism operates).

Results

The 6-year cumulative incidence of dementia was 15.5%. Among minoritized participants (i.e., non-Hispanic Black and/or Hispanic), high CRP levels (> 75th percentile or 4.57mcg/mL) was associated with 1.27 (95%CI: 1.01,1.59) times greater risk of incident dementia than low CRP (<4.57mcg/mL). Decomposition analysis comparing minoritized versus non-Hispanic White participants showed that the mediating effect of CRP accounted for 2% (95% CI: 0%, 6%) of the racial disparity, while the interaction effect between minoritized group status and high CRP accounted for 12% (95% CI: 2%, 22%) of the disparity. Findings were robust to potential violations of causal mediation assumptions.

Conclusions

Systemic inflammation mediates racialized disparities in incident dementia.

Effects of Pension Eligibility Expansion on Men's Cognitive Function: Findings from Rural South Africa

Two-thirds of people living with Alzheimer's disease and related dementias (ADRD) live in low- and middle-income countries, and this figure is expected to rise as these populations are rapidly aging. Since evidence demonstrates links between socioeconomic status and slower rates of cognitive decline, protecting older adults' cognitive function in resource-limited countries that lack the infrastructure to cope with ADRD is crucial to reduce the burden it places on these populations and their health systems. While cash transfers are a promising intervention to promote healthy cognitive aging, factors such as household wealth and level of education often confound the ability to make causal inferences on the impact of cash transfers and cognitive function. This study uses a quasi-experimental design, leveraging an exogenous expansion to the Old Age Pension for men in South Africa, to approximate causal associations with cognitive function. We found evidence that there is a potential benefit of cash transfers at an earlier age for older individuals. As such, transfers such as pensions or other forms of direct basic income transfers may hold promise as potential interventions to promote healthy cognitive aging.

THE IMPACT OF THE OLD AGE PENSION EXPANSION ON BLOOD PRESSURE AMONG OLDER MEN IN RURAL SOUTH AFRICA

The impact of improved socioeconomic welfare after retirement on cardiovascular health among older men in low-income settings is unknown. Using natural experiment, we investigated the impact of eligibility for additional Old Age Pension (OAP) income on systolic blood pressure (SBP) among older men in rural South Africa using data from 1,208 men aged ≥60 in the population-representative “Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in Rural South Africa” (HAALSI) cohort. The South African Old Age Pension (OAP) incrementally expanded age eligibility for men from age 65 prior to 2008 to age 60 in 2010. This expansion provided exogenous variation in pension income among men, based on their year of birth. We estimated predicted SBP among the birth cohorts of men who were eligible for one through five extra years of OAP income, using a multivariable linear regression model estimated in those without access to extra pension income (over age 65 when the expansion rolled out) based on covariates. We then estimated mean SBP difference scores among men in each of these five birth cohorts, based on their observed SBP minus predicted SBP. Men in OAP expansion birth cohorts had lower SBP than those who were not exposed to extra pension, although the differences were not statistically significant (5-years estimate = -2.735 (p=0.353) vs. 1-year estimate = 1.633 (p=0.531)). This trend suggests a possible long-term benefit of blood pressure control with greater cumulative pension income among men living in rural, low-income settings.

ACUTE RELATIONSHIPS BETWEEN MENTAL HEALTH AND COGNITIVE FUNCTION AMONG AGING ADULTS DURING THE COVID-19 PANDEMIC

The acute impacts of COVID-19-related mental health concerns on cognitive function among aging adults are unknown. We investigated whether between-person (BP) differences and within-person (WP) changes in loneliness, anxiety, and COVID-19 worry were related to cognitive function and abilities in the COVID-19 Coping Study over nine months from August/September 2020 through April/May 2021 (n=2,262). Marginal structural models accounting for depression as a time-varying confounder and incorporating attrition and sampling weights estimated the BP and WP relationships of loneliness, anxiety, and COVID-19 worry with PROMIS cognitive function and abilities scores over time. In any given month, experiencing a loneliness or anxiety score higher than the sample mean (BP difference) as well higher than one’s personal mean across the nine-month period (WP change) were negatively associated with cognitive function and abilities in that month. Future research should explore long-term impacts of loneliness and anxiety experienced during the pandemic for population cognitive aging.

DOES NEIGHBORHOOD DISADVANTAGE ALTER MEMORY AFTER A CANCER DIAGNOSIS? A US HEALTH AND RETIREMENT STUDY

We aimed to determine the influence of neighborhood socioeconomic status (NSES) on long-term cancer-related memory decline of older adults. Incident cancer diagnosis and memory were assessed in the U.S. Health and Retirement Study (N=15,074, 1998-2016). Proportion of female-headed households with children, households with public assistance income, people with income below poverty, and proportion 16+ years unemployed was categorized into NSES tertiles. Linear mixed-effects models compared the standardized memory trajectories by cancer status and NSES. Cancer-free individuals living in more disadvantaged neighborhoods had worse mean memory function at age 75 and steeper memory declines than participants from less disadvantaged neighborhoods. An incident cancer diagnosis was associated with an acute memory drop at diagnosis for those living in the least disadvantaged neighborhoods. Cancer survivors had better memory prior to but not after diagnosis compared to cancer-free individuals across NSES. These findings could inform future interventions to promote cancer survivor’s long-term aging.

TRENDS IN HOUSEHOLD MATERIAL RESOURCES AND COGNITIVE HEALTH IN A LONGITUDINAL COHORT STUDY OF AGING IN SOUTH AFRICA

Material resources that affect daily living conditions may be salient for cognitive aging in low-income settings, but evidence is limited on this topic. We investigated relationships between long-term trends in household material resources and subsequent cognitive function among 4,580 adults aged ≥40 in a population-representative cohort in Agincourt sub-district, South Africa, from 2001-2015. Household material resources (dwelling materials, water, sanitation, sources of power, modern amenities, and livestock) were assessed biennially from 2001-2013. We evaluated mean resources, volatility in resources, and change in resources over this period in relation to cognitive function in 2014/2015. Higher mean household resources and larger improvements over time in resources were positively associated with subsequent cognitive function, independent of confounders. Findings were largely driven by modern amenities for food preparation, transportation, and communication outside of the household. Access to these amenities may support cognitive aging through boosting nutrition and cognitive reserve and should be investigated further.

PANDEMIC VULNERABILITY AND RESILIENCE: QUANTITATIVE AND QUALITATIVE FINDINGS FROM THE COVID-19 COPING STUDY

The COVID-19 Coping Study aims to investigate social, behavioral, health, and economic impacts of the pandemic on the health and wellbeing of aging Americans. A total of 6,938 adults aged ≥55 were recruited from all 50 US states, the District of Columbia, and Puerto Rico from April-May, 2020, using a multi-frame online recruitment strategy. Participants completed a 20-minute baseline survey and a subset were recruited to complete monthly follow-up surveys for one year. A random subsample of 57 participants completed semi-structured interviews in May-July, 2021. This symposium will share novel mixed-methods insights into the ongoing experiences, perspectives, significant life events, and mental health changes among aging US adults during the COVID-19 pandemic. First, Kobayashi will describe the dynamic, longitudinal relationships between loneliness, anxiety, and COVID-19 worry with cognitive function and abilities. Second, Abrams investigates long-term employment outcomes and mental health trajectories among a particularly vulnerable group of older adults: those who experienced work disruptions and job loss early in the pandemic. Third, Meltzer will share how particular groups of older adults were more likely to report greater closures of key places to socialize in their neighborhoods since the pandemic onset. Fourth, Finlay will present a qualitative thematic analysis of ongoing pandemic sources of risk and vulnerability among marginalized and underserved aging adults. The symposium highlights diverse strengths and resiliencies to cope with adversities of the pandemic. Findings may inform individual- strategies and community-level policies to support aging adults during times of collective stress and trauma.

STRUGGLES AND STRENGTH: A QUALITATIVE STUDY OF DIVERSE VOICES FROM THE COVID-19 COPING STUDY

This paper aims to explore complex realities and nuanced lived experiences in how diverse older adults are making sense of and dealing with the COVID-19 pandemic. We conducted semi-structured video and phone interviews with 57 COVID-19 Coping Study participants (average age 70.7 years, 44% female, 49% white) from May-July 2021. Qualitative thematic analysis identified physical, mental, social, and economic struggles. These included heightened COVID-19 risk given comorbidities, difficulties accessing healthcare, distressing political events, diminished sense of safety, distance to family and support networks, inability to collectively mourn, and exacerbated financial instability. Coping strategies included exercise, hobbies, spirituality, online activities, engaging with family and friends, and self-care practices. Community-level sources of resilience included vaccines, telemedicine, stimulus checks, and community groups/services. These results highlight profound resiliency and strength to cope with adversities of the pandemic and may inform strategies to support underrepresented and underserved older adults during and after the pandemic.

CROSS-NATIONAL VARIABILITY IN SEX/GENDER DIFFERENCES AND LATER-LIFE MEMORY: INDIA AND THE UNITED STATES

Little is known about the extent of sex/gender differences in later-life cognitive health in low-income countries such as India. We compared sex/gender differences in later-life memory, overall and by educational attainment, across men and women aged ≥65 years in India and the United States. Data were from Harmonized Cognitive Assessment Protocols (HCAP) in the population-representative Longitudinal Study of Aging in India (LASI; N=4,096;) and U.S. Health and Retirement Study (HRS; N=3,345). Multiple-group models estimated interactions between sex/gender and educational attainment on harmonized episodic memory scores across countries. In the U.S., women had a memory performance advantage compared to men across all education levels. In India, men had a memory performance advantage compared to women overall, interactions revealed that this advantage was only present among those with no formal education. Among those with at least lower secondary education, women demonstrated an advantage that increased with increasing education.

JOY AND STRESS DURING THE COVID-19 PANDEMIC: FINDINGS FROM THE NATIONAL POLL ON HEALTHY AGING

This poll aimed to better understand the complex impacts of the COVID-19 pandemic on the emotional and mental health of older adults. In August 2021, the National Poll on Healthy Aging surveyed a national sample of adults age 50–80 about joys, stresses, and resilience during the pandemic. Most reported feeling a lot (30%) or some (53%) joy these days, while 17% reported feeling very little or no joy. Reports of joy and stress differed substantially by age, sex, physical health, mental health, and household income. For example, people age 50–64 were more likely to report feeling a lot of stress compared with those age 65–80 (25% vs 13%), as were women compared with men (24% vs 15%). The findings may inform public health and policy efforts to support older adults at-risk for poor emotional and mental health, and help cultivate resilience during and after the pandemic.

SOCIAL PLACES: SHIFTING NEIGHBORHOOD PERCEPTIONS AMONG AGING AMERICANS DURING COVID-19

This study examines individual and community factors related to older adults’ perceived losses in places to socialize with people of similar and different ages in their neighborhoods during COVID-19. In the 11-month wave of the COVID-19 Coping Study from March-April 2021, responses to perceived availability were “Less,” “About the Same,” or “More.” Most respondents reported less availability in places to socialize with those of similar (68.0%) or different (68.4%) ages. Ordinal logistic regressions showed respondents who lived alone perceived less availability in places to socialize with those of similar or different ages than those living with others (ORs 0.67, 95% CI 0.47, 0.97). Those living in metropolitan compared to non-metropolitan areas also perceived less availability in places to socialize with those of similar ages (OR 0.62, 95% CI 0.39, 0.98). These findings enhance our understanding of COVID-19-related losses in community resources that facilitate healthy aging in place.

EDUCATION GRADIENTS IN LATER-LIFE COGNITIVE FUNCTION ACROSS LOW-, MIDDLE-, AND HIGH-INCOME COUNTRIES

Education is positively related to cognitive function. However, educational gradients in cognitive function may vary across older populations with different educational compositions and physical and social environments. We conducted one of the first cross-national comparative studies on educational differences in later-life cognitive function using harmonized data. Multivariable linear regressions were employed to estimate the association between education according to International Standard Classification of Education (ISCED) categories and cognitive function for adults ages 60+ from the United States, England, Mexico, South Africa, India, and China. Cross-country differences were tested using fully interacted models. Controlling for demographics and parental education, we found significant educational gradients in cognitive function in low- and middle-income countries; however, in high-income countries, only those with upper secondary education and above had a consistent cognitive advantage over those with primary education. This study suggests substantial country-level differences in cognitive benefits of educational attainment.

OLDER ADULTS' WORK DISRUPTIONS IN APRIL/MAY 2020: IMPLICATIONS FOR WORK STATUS AND MENTAL HEALTH OVER 6 MONTHS

Using the COVID-19 Coping Study, we sought to determine how work disruptions for older adults in April/May 2020 related to labor force status in September/October 2020 and mental health throughout those six months (N=2,367). One-third of respondents who lost their job in April/May were unemployed at the end of follow-up, while 15% were unemployed after furloughs and 9% after reduced hours/income. One-quarter of those furloughed in April/May were out of the labor force at follow-up – evidence of a potential pathway from furloughs into retirement. Being employed at follow-up was most common after work-from-home in April/May (90%). Multi-level models revealed differences in mental health trajectories over six months according to baseline work disruptions, including persistently high anxiety following job loss and delayed upticks in anxiety and depressive symptoms when working from home. This research provides insights into longer-term economic and mental health ramifications of pandemic-related work disruptions among older workers.

Household Food Insecurity Across Childhood and Attempts at Weight Loss and Weight Gain in Early Adolescence: Findings From a Nationally Representative Study of U.S. Youth

Objectives

To examine the relationships between food insecurity (FI) across childhood and attempts at weight loss and weight gain in early adolescence.

Methods

Data came from the Early Childhood Longitudinal Study, Kindergarten class of 1998–99, a nationally representative cohort of U.S. children. Parents reported household FI using the 18-item U.S. Household Food Security Survey Module when children were in kindergarten, grade 3, grade 5, and grade 8. Children self-reported weight change attempts in grade 8 (options: trying to lose weight, trying to gain weight, trying to stay the same weight, or not trying to do anything about weight). Of 7,558 children with survey weight data, 6,981 were included in the analytic sample after exclusions for missing variables. Poisson regression was used to examine associations between the total number of timepoints with FI (0, 1, 2, or 3–4 timepoints), as well as change in FI status from grade 5 to grade 8, with the prevalence of weight loss and weight gain attempts in grade 8. All models accounted for the complex sampling design and were adjusted for gender, age, race/ethnicity, socioeconomic status, and past history of FI (in models of recent change in FI only).

Results

Overall, 19.8% of children had FI during at least 1 timepoint, with 4.0% experiencing FI during 3–4 timepoints. Compared to experiencing FI at 0 timepoints, experiencing FI at 3–4 timepoints was associated with higher prevalence of weight loss attempts (Prevalence Ratio [PR] 1.24, 95% CI 1.04, 1.47), after adjusting for sociodemographic characteristics. Similarly, recently becoming food insecure (vs. remaining food secure) was associated with higher prevalence of weight loss attempts (PR 1.25, 95% CI 1.03, 1.52). Becoming food secure and remaining food insecure were not associated with attempting weight loss. Associations between FI during childhood and weight gain attempts were non-significant.

Conclusions

Experiencing FI at multiple timepoints across childhood and recently becoming food insecure are associated with greater likelihood of attempting to lose weight in early adolescence. Future research should examine the extent to which these associations are mediated by body mass index and how FI interventions might help prevent the harmful effects of weight loss attempts in this susceptible age group.

Funding Sources

N/A.

Perceptions of the Government’s Response to the Pandemic: Voices From the COVID-19 Coping Study

The COVID-19 pandemic was met with conflicting government strategies in the handling of the virus. Older adults were disproportionately impacted by the pandemic, yet little is known about their perspectives of the government response. Using data collected in September and October, 2020 from the online, nation-wide COVID-19 Coping Study, we conducted qualitative thematic analysis on a subsample of respondents (N=500) proportionate to the age, gender, race/ethnicity, and education of the U.S. population age 55+. Two researchers individually coded a random subsample of 50 open-ended responses to the question “How do you feel about federal government responses to and handling of the COVID-19 pandemic?” Using NVivo qualitative software, the researchers compared codes and reconciled differences to achieve a Kappa score of >0.8. The first author coded the remaining responses using the established coding strategy. Analyses identified themes related to President Trump’s leadership, Congress, the broader federal government, and science. Some participants indicated that the federal government’s response to the pandemic was “inadequate,” “too political,” and “lacking coordination.” Others expressed that the president “did the best he could” or that “it’s not the federal government’s responsibility.” While some praised vaccine development efforts and expressed their appreciation for Dr. Fauci, others expressed scientific distrust. Participants’ perspectives were divergent, reflective of the country’s polarization surrounding COVID-19 policies and practices. Differences in perspectives exist by race/ethnicity, gender, geographic region, and age. Study results can help identify groups of older adults who may need targeted programs and policy support.

Associations Between Comorbidity and Depressive Symptoms During COVID-19: Variation by Social Isolation?

Adults with comorbidities are at high COVID-19 risk and may experience elevated depressive symptoms during the pandemic. We aimed to investigate the associations between comorbidity at pandemic onset and subsequent depressive symptoms and whether social isolation modified this association. Data were from monthly online questionnaires in the COVID-19 Coping Study of US adults aged ≥55 from April/May-September/October 2020 (n=4,383). Depressive symptoms were measured by the 8-item CES-D, and social isolation as “high” vs. “low” based on contact with family, friends, social organizations, and living alone. In multivariable mixed-effects models, comorbidity (≥2 vs. <2 chronic conditions) was associated with greater depressive symptoms at baseline (β=0.50; 95% CI: 0.36-0.64), this association varied negligibly by social isolation. Differences in depressive symptoms by comorbidity status at pandemic onset were consistent over the six-month follow-up. This study indicates that middle-aged and older US adults with comorbidities experienced persistently elevated depressive symptoms during the COVID-19 pandemic.

Physical Isolation and Mental Health Among Older U.S. Adults in the COVID-19 Coping Study

The ongoing COVID-19 pandemic has set an urgent need to understand the impact of physical isolation on mental health. We aimed to investigate the relationships between physical isolation during the period when many US states had shelter-in-place orders (April-May 2020) and subsequent longitudinal trajectories of mental health in middle-aged and older adults (aged 55+, N=3,978) over a six-month follow-up (April to October 2020). We used population and attrition-weighted multivariable linear mixed-effects models. At baseline, 7 days/week of physical isolation (vs. 0 days/week) was associated with elevated depressive symptoms (β=0.82; 95% CI: 0.04-1.60), and all of 1-3, 4-6, and 7 days/week of physical isolation (vs. 0 days/week) were associated with elevated anxiety symptoms and loneliness. Physical isolation was not associated with changes in mental health symptoms over time. These findings highlight the need to prioritize opportunities for in-person connection for middle-aged and older adults when safe to do so.

Memory Aging Phenotypes Among Older Cancer Survivors: A Latent Growth Analysis of the Health and Retirement Study

While cancer survivors experience many long-term health effects, there is limited evidence on the potentially heterogeneous memory aging of older cancer survivors. We identified memory aging phenotypes of older US cancer survivors, and determined sociodemographic and health-related predictors of membership. Data were from 2,755 survivors aged ≥50 in the U.S. Health and Retirement Study (1998 – 2016). Self-reported first incident cancer diagnosis (except non-melanoma skin cancer) and memory (composite immediate and delayed word-list recall score, combined with proxy-reported cognition) were assessed at biennial interviews. Memory aging phenotypes were identified using latent growth curve (LGC) models, with baseline being time of cancer diagnosis. Logistic regression evaluated predictors of group membership. 5 distinct memory aging groups were identified: low memory (n=165, 6.16%); medium-low memory (n=459, 17.1%); medium-high memory (n=733, 27.4%); high memory (n=750, 28.0%); and very high memory (n=571, 21.3%). The low memory group received less chemotherapy compared to the other groups (20.0% vs. 25.5%, 31.7%, 36.8%, 41.5%%, respectively), and had the shortest mean survival time after diagnosis (1.08 vs 2.10, 2.76, 3.37, 4.31 years, respectively). Older age at diagnosis (OR: 1.71, 95%CI: 1.61-1.82), being male (OR: 4.10, 95%CI: 2.82-6.51), having a history of stroke (OR: 4.62, 95%CI: 2.57-8.30) and depression prior to diagnosis (OR: 1.19, 95%CI: 1.05-1.34) were independently associated with being in the low memory group vs. the medium-high memory group. We identified distinct memory aging phenotypes among older cancer survivors. Further research should evaluate the influence of pre-cancer memory and how these phenotypes differ from the general population.

Older Adults’ Worry about COVID-19: Associations with Experiences of COVID-19 Among Social Connections

The COVID-19 pandemic has challenged the physical and mental health of older adults, yet it is unknown how much older adults worry about their own exposure. As older adults are at increased risk for severe complications from COVID-19, understanding patterns of worry may inform public health guidelines and interventions for this age group. We investigated older adults’ worry about COVID-19 in the early months of the pandemic and associations with familial/friend’s diagnosis or disease symptoms. Data comes from the baseline (April/May 2020), one-month, and two-month follow-up surveys from the COVID-19 Coping Study, a national longitudinal cohort study of US adults aged ≥55. We used linear regression models to investigate the association between self-reported familial/friend diagnosis or symptoms with pandemic worry, accounting for demographic factors and individual diagnosis or experience of COVID-19 symptoms. Participants (Baseline=4379, 1 month= 2553, 2 month=2682) were 67 years old on average, 72% were female, 5.7% were non-White, and 80.5% had a college degree. At baseline, 26.6% of participants had friends or family who had been diagnosed or experienced symptoms of COVID-19. Having friends or family diagnosed or with symptoms of COVID-19 (B=0.08, SE=0.04, p&lt;.05), being female (B=0.42, SE=0.03, p&lt;.001), and having higher educational attainment (B=0.06, SE=0.02, p&lt;.001) were significantly associated with greater worry about COVID-19. These associations were consistent over 3 months. Understanding if worry about the pandemic correlates with following public health guidelines is a key next step so intervention strategies can prioritize older adults and their social networks.

Loneliness and Social Connectedness Among Rural Older Adults Since the COVID-19 Pandemic Onset

Rural areas have a higher proportion of older adults aging in place. Rural areas also face structural barriers to supporting social connectedness among older adults, including transportation barriers, greater geographic distances, and access to technological connectivity. This research aims to discuss rural-specific risks of loneliness and social isolation among older adults, as well as rural/urban differences in loneliness and social isolation among older adults using the national COVID-19 Coping Study. Cross-sectional bivariate analyses highlight rural/urban differences in social activities during the pandemic. For example, rural older adults were more likely to use social media daily, compared with urban older adults (67% vs. 61%, p&lt;0.05), but were less likely to have phone or video calls with others daily (21% vs. 26%, p&lt;0.001). We will also share results of differences within rural older adults in loneliness, isolation, and social activities by socio-demographic characteristics in order to design targeted interventions to improve connectedness.

Validation of Self-Reported Cancer Diagnosis by Cognitive Status in the Health and Retirement Study

Exploring the relationship between cognition and cancer is increasingly important as the number of older adults in the US grows. The Health and Retirement Study (HRS) has longitudinal data on cognitive status and self-reported cancer diagnoses, but these self-reports have not been validated. Using HRS linked to Medicare Fee for Service (FFS) claims (1998-2016), we evaluated the validity of self-reported cancer diagnoses (excluding non-melanoma skin) against Medicare claims by respondent cognitive status. We included 8,280 Medicare-eligible HRS participants aged ≥67 with at least 90% FFS coverage. Cognitive status was ascertained from the HRS interview following the date of cancer diagnosis (or reference claim date) using the Langa-Weir method and was classified as normal, cognitive impairment no dementia (CIND), or dementia. We calculated the sensitivity, specificity, and Cohen's kappa for first incident malignant cancer diagnosis by cognitive status group. The majority (76.4%) of participants scored as cognitively normal, 9.6% had CIND, 14.0% had dementia and, overall, 1,478 had an incident cancer diagnosis. Among participants with normal cognition, sensitivity of self-reported cancer diagnosis was 70.2% and specificity was 99.8% (kappa=0.79). Among participants with CIND, sensitivity was 56.7% and specificity was 99.8% (kappa=0.66). Among participants with dementia, sensitivity was 53.0% and specificity was 99.6% (kappa=0.64). Results indicate poor validity of self-reported cancer diagnoses for older adults with CIND or dementia. These findings suggest researchers interested in cancer and cognition should use the HRS-Medicare linkage to ascertain cancer diagnosis from claims, and they highlight the importance of cognitive status in research among older adults.

Loneliness Among US Adults During the Early Phase of the COVID-19 Pandemic: Findings From the COVID-19 Coping Study

We aimed to estimate the prevalence of loneliness and identify the key sociodemographic, employment, living, and health-related risk factors for loneliness among middle-aged and older adults during the early COVID-19 pandemic in the US, when shelter-in-place and social distancing restrictions were in place for much of the country. Data were collected from online questionnaires in the COVID-19 Coping Study, a national study of 6,938 US adults aged 55-110 years, from April 2nd through May 31st, 2020. We estimated the population-weighted prevalence of loneliness (scores of ≥6/9 on the 3-item UCLA Loneliness Scale), overall and according to sociodemographic, employment, living, and health-related factors. We used population-weighted modified Poisson regression models to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) for the associations between these factors and loneliness, adjusted for age, sex, race, ethnicity, and education. Overall, 29.5% (95% CI: 27.9%, 31.3%) of US adults aged 55-110 were considered high in loneliness in April and May, 2020. In population-weighted, adjusted models, loneliness was most frequent among those with depression, those who were divorced or separated, those who lived alone, those diagnosed with multiple comorbid conditions, and individuals who were unemployed prior to the pandemic. In conclusion, we identified subpopulations of middle-aged and older US adults that were highly affected by loneliness during a period when COVID-19 shelter-in-place orders were in place across most of the country. These insights may inform the allocation of recourses to mitigate loneliness during times of restricted activity.

The role of dementia diagnostic delay in the inverse cancer-dementia association

BACKGROUND

Cancer is inversely associated with dementia. Using simulations, we examined whether this inverse association may be explained by dementia diagnosis timing, including death before dementia diagnosis and differential diagnosis patterns by cancer history.

METHODS

We used multistate Markov simulation models to generate cohorts 65 years of age and free of cancer and dementia at baseline; follow-up for incident cancer (all cancers, breast, prostate, and lung cancer), dementia, dementia diagnosis among those with dementia, and death occurred monthly over 30 years. Models specified no true effect of cancer on dementia, and used age-specific transition rates calibrated to US population and cohort data. We varied the average lapse between dementia onset and diagnosis, including non-differential and differential delays by cancer history, and examined observed incidence rate ratios (IRRs) for the effect of cancer on dementia diagnosis.

RESULTS

Non-differential dementia diagnosis delay introduced minimal bias (IRRs=0.98-1.02) for all cancer, breast, and prostate models and substantial bias (IRR=0.78) in lung cancer models. For the differential dementia diagnosis delay model of all cancer types combined, simulation scenarios with ≥20% lower dementia diagnosis rate (additional 4.5-month delay) in those with cancer history versus without yielded results consistent with literature estimates. Longer dementia diagnosis delays in those with cancer and higher mortality in those with cancer and dementia yielded more bias.

CONCLUSIONS

Delays in dementia diagnosis may play a role in the inverse cancer-dementia relationship, especially for more fatal cancers, but moderate differential delays in those with cancer were needed to fully explain the literature-reported IRRs.

Validation of self-reported incident cancer diagnoses in the U.S. Health and Retirement Study: A tool for population-based cancer and aging research

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Background: Population aging and improving cancer survival rates are resulting in a growing population of older cancer survivors in the United States (US). As a result, there is an increasing need for longitudinal, population-representative data for interdisciplinary cancer research among older adults. The US Health Retirement Study (HRS) is an ongoing population-representative cohort of US adults over age 50 that contains rich interview and biomarker data on health during aging. Interviews have collected self-reported cancer diagnoses since 1998, but these self-reports have not been validated. We compared first incident cancer diagnoses self-reported in HRS interviews against diagnostic claims from linked Medicare records. Methods: We examined the validity of first incident cancer diagnoses self-reported in biennial HRS interviews from 2000 through 2016 against ICD-9 and ICD-10 diagnostic claim records among 8,242 HRS participants aged ≥65 with 90% continuous enrollment in fee-for-service Medicare, using the claim records as the gold standard. We calculated the sensitivity, specificity, and k for first incident cancer diagnoses (all cancers combined, excluding non-melanoma skin cancer, and each of bladder, breast, colorectal/anal, uterine, kidney/renal, lung/bronchus, and prostate cancers) cumulatively over the follow-up, and at each biennial study interview. Results: Self-reports of first incident cancer diagnosis (agnostic of site) between 2000 and 2016 had 73.2% sensitivity and 96.2% specificity against Medicare claims (k = 0.73). For site-specific self-reports, sensitivities ranged from 44.7% (kidney) to 75.0% (breast), and specificities ranged from 99.2% (prostate) to 99.9% (bladder, uterine, and kidney). Results were similar in sensitivity analyses restricting to individuals with 100% continuous fee-for-service Medicare enrollment and when restricting to individuals with at least 24 months of Medicare enrollment. Conclusions: Self-reported cancer diagnoses in the HRS have reasonable validity for population-based research on cancer and aging across cancer types. Apart from breast cancer, cancer site specific analyses will greatly benefit from the improved validity of self-report with Medicare claim linkage.

Alcohol use and mental health among older American adults during the early months of the COVID-19 pandemic

We investigated the association of self-reported changes in alcohol consumption with the prevalence of anxiety, depression, and loneliness in the early months of the COVID-19 pandemic among middle-aged and older US adults. Between April and May 2020, 6,938 US adults aged 55+ completed online questionnaires in the COVID-19 Coping Study, a national cohort study of older adults’ mental health and well-being. Multinomial logistic regression estimated self-reported changes in the frequency of alcohol consumption relative to before the pandemic, according to anxiety (5-item Beck Anxiety Inventory), depression (8-item Center for Epidemiologic Studies Depression Scale), and loneliness (3-item UCLA Loneliness Scale). All models were population-weighted and adjusted for confounders. Nearly half (46%) of adults reported drinking 1-7 drinks/week prior to the pandemic, 12% reported drinking 8+ drinks/week, and 42% reported not drinking. One in five adults (21%) reported a change in their alcohol consumption since the start of the pandemic, while 38% indicated they were drinking the same amount, and 42% reported not drinking alcohol. Older adults who screened positive for each of anxiety, depression, and loneliness reported drinking more than usual (OR=1.92; 95% CI: 1.92–1.93 for anxiety; OR=2.67; 95% CI: 2.67–2.68 for depression; OR=2.46; 95% CI: 2.45–2.46 for loneliness), compared to drinking the same as before the pandemic. These results demonstrate potentially negative changes in alcohol intake among middle-aged and older adults experiencing mental health symptomology during the early months of the COVID-19 pandemic.

Cognitive Reserve, Incident Cancer, and Rate of Memory Decline in Later Life

Cognitive reserve (cognitive skills and abilities acquired before onset of brain pathology) helps maintain cognitive function during aging. Cognitive decline after cancer treatment, known as “chemobrain,” is a prevalent outcome among older cancer survivors. It is unknown whether cognitive reserve buffers against acute neuropathological events such as cancer-related cognitive decline. We examined acute and long-term rate of memory decline associated with incident cancer diagnosis by education levels as proxy for cognitive reserve (low: &lt;12 years; intermediate: 12 to &lt;16 years; high: ≥16 years) in 14,449 adults aged 50+ in the US Health and Retirement Study from 1998-2016. Memory (z-scored) was assessed biennially as immediate and delayed word recall combined with proxy assessments. We used adjusted linear mixed models to determine long-term rates of memory decline before and after cancer diagnosis, and acute memory decline immediately after diagnosis (3,248 incident cases), and compared them with corresponding memory trajectories in cancer-free participants. Acute memory decline immediately after diagnosis was larger in those with low (-0.098 SD units, 95% CI: -0.150, -0.045) versus high (-0.038 SD units, 95% CI: -0.084, -0.008) education. Long-term memory decline after cancer was faster in those with low (-1.16 SD units/decade, 95% CI: -1.25, -1.07) versus high (-0.89 SD units/decade, 95% CI: -0.96, -0.82) education. Consistent with previous research showing an inverse cancer-dementia relationship, individuals with cancer had more favorable memory trajectories than cancer-free individuals with similar age and education. Among those with cancer, lower cognitive reserve was associated with greater acute and long-term memory decline after diagnosis.

Incident Cognitive Impairment During Aging in Rural South Africa: Evidence From the HAALSI Cohort, 2014 to 2019

We estimated the incidence of cognitive impairment and its key sociodemographic, social, and health-related predictors at the first longitudinal follow-up of the population-representative “Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa” (HAALSI) cohort of adults aged ≥40 in rural Agincourt, South Africa. Cognitive impairment was defined as scoring ≥1.5 SD below the baseline mean composite time orientation and episodic memory score, or requiring a proxy interview with “fair” or “poor” proxy-reported memory. Activity of daily living (ADL) limitations were compared according to incident cognitive impairment status. Incidence rates (IRs) and rate ratios (IRRs) for cognitive impairment according to sociodemographic, social, and health-related predictors were estimated using Poisson regression with robust standard errors, and weighted to account for mortality. Over a 3.7-year mean follow-up, 309/3,861 at-risk participants newly developed cognitive impairment (IR=24.0/1000 person-years (PY); 95% CI: 21.6-26.8). Incidence increased from IR=9.1/1000 PY (95% CI: 5.5-16.1) among those aged 40-44 at baseline to IR=76.5/1000 PY (95% CI: 63.2-93.4) among those aged 80+. At least one ADL limitation was prevalent in 39% of those with incident cognitive impairment, compared to 7% of non-impaired participants. Incident cognitive impairment did not vary by sex/gender, HIV status, or cardiovascular factors, but was strongly graded according to education, literacy, household assets, employment, marital status, and frequency of alcohol consumption. This study presents one of the first incidence rate estimates for cognitive impairment in sub-Saharan Africa. Social disparities in cognitive impairment were apparent in patterns similar to many high-income countries.

Life-Course Trauma and Later Life Mental, Physical, and Cognitive Health in a Postapartheid South African Population: Findings From the HAALSI study

Objective: To investigate the relationships between exposure to life-course traumatic events (TEs) and later life mental, physical, and cognitive health outcomes in the older population of a rural South African community. Method: Data were from baseline interviews with 2,473 adults aged ≥40 years in the population-representative Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI) study, conducted in 2015. We assessed exposure to 16 TEs, and used logistic regression models to estimate associations with depression, post-traumatic stress disorder (PTSD), activities of daily living disability, and cognitive impairment. Results: Participants reported an average of 5 (SD = 2.4) TEs over their lifetimes. Exposure was ubiquitous across sociodemographic and socioeconomic groups. Trauma exposure was associated with higher odds of depression, PTSD, and disability, but not with cognitive health. Discussion: Results suggest that TEs experienced in earlier life continue to reverberate today in terms of mental health and physical disability outcomes in an older population in rural South Africa.

Rate of Memory Change Before and After Cancer Diagnosis

IMPORTANCE

Patients with a history of cancer, even nonfatal cancers, have lower subsequent Alzheimer disease incidence. An inverse biological link between carcinogenesis and neurodegeneration has been hypothesized, although survival and detection biases are possible explanations.

OBJECTIVE

To compare long-term memory trajectories before and after incident cancer with memory trajectories of similarly aged individuals not diagnosed with cancer.

DESIGN, SETTING, AND PARTICIPANTS

This population-based cohort study included 14 583 US adults born before 1949 with no cancer history from the Health and Retirement Study. Biennial assessments were performed for up to 16 years from 1998 to 2014. Data analysis was performed from January 8 to October 5, 2018.

EXPOSURES

Self-reported physician diagnosis of any cancer (excluding nonmelanoma skin cancer) during follow-up.

MAIN OUTCOMES AND MEASURES

A composite memory score standardized to a mean (SD) of 0 (1) at baseline was based on immediate and delayed word-list recall and proxy assessments. The rate of memory change among people diagnosed with cancer during follow-up before and after diagnosis was compared with rate of memory change in individuals who remained cancer free during follow-up using linear mixed-effect models with random intercepts and slopes.

RESULTS

A total of 14 583 participants were included in the sample (mean [SD] age, 66.4 [10.4] years; 8453 [58.0%] female). The mean (SD) follow-up was 11.5 (5.1) years; 2250 had a cancer diagnosis during follow-up, and 12 333 had no cancer diagnosis during follow-up. The rate of memory decline in the decade before a cancer diagnosis was 10.5% (95% CI, 6.2%-14.9%), which was slower than memory decline in similarly aged cancer-free individuals. For individuals diagnosed at 75 years of age, mean memory function immediately before diagnosis was 0.096 SD units (95% CI, 0.060-0.133 SD units) higher compared with that among similarly aged cancer-free individuals. A new cancer diagnosis was associated with a short-term decline in memory of -0.058 (95% CI, -0.084 to -0.032) SD units compared with memory before diagnosis. After diagnosis, the rate of memory decline was 3.9% (95% CI, 0.9%-6.9%) slower in individuals with cancer than in those without a cancer diagnosis.

CONCLUSIONS AND RELEVANCE

In this study, older individuals who developed cancer had better memory and slower memory decline than did similarly aged individuals who remained cancer free. These findings support the possibility of a common pathologic process working in opposite directions in cancer and Alzheimer disease.

Planned re-laparotomy and the need for optimization of physiology and immunology

Planned re-laparotomy or damage control laparotomy (DCL), first described by Dr. Harlan Stone in 1983, has become a widely utilized technique in a broad range of patients and operative situations. Studies have validated the use of DCL by demonstrating decreased mortality and morbidity in trauma, general surgery and abdominal vascular catastrophes. Indications for planned re-laparotomy include severe physiologic derangements, coagulopathy, concern for bowel ischemia, and abdominal compartment syndrome. The immunology of DCL patients is not well described in humans, but promising animal studies suggest a benefit from the open abdomen (OA) and several human trials on this subject are currently underway. Optimal critical care of patients with OA's, including sedation, paralysis, nutrition, antimicrobial and fluid management strategies have been associated with improved closure rates and recovery.

A novel method of HPV genotyping using Hybrid Capture sample preparation method combined with GP5+/6+ PCR and multiplex detection on Luminex XMAP

A novel DNA detection assay comprising Hybrid Capture sample preparation, GP5+/6+ PCR with modifications and Luminex 100 detection was developed and applied to genotyping of human papillomavirus (HPV) in cervical samples. Target-specific sample preparation was performed using magnetic beads conjugated with Hybrid Capture (HC) antibody. DNA-RNA hybrids were formed between DNA target and RNA probes and captured on HC-beads. DNA on magnetic beads was amplified without elution using consensus GP5+/6+ PCR and then genotyped on Luminex beads using hybridization probes for the 17 high-risk HPV types 16, 18, 26, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68, 73, 82 and an internal control. This new sequence-specific Hybrid Capture sample preparation is fast, efficient and allows direct HPV genotyping by PCR. Compared to traditional non-sequence-specific sample preparation methods, HC sample preparation demonstrated slightly better detection of multiple HPV infections. The clinical utility of this method was demonstrated on cervical samples positive for HR HPV by the Hybrid Capture 2 (hc2) screening assay.

Hepatic acute phase induction of murine beta-galactoside alpha 2,6 sialyltransferase (ST6Gal I) is IL-6 dependent and mediated by elevation of exon H-containing class of transcripts

Hepatic expression of CMP-NeuAc:Gal beta 1,4GlcNAc alpha 2,6-sialyltransferase (ST6Gal I) is induced as part of the acute phase response in mammals by mechanisms that remain poorly understood. Previous work suggests that murine liver ST6Gal I mRNA contains an additional and novel region that is not found on ST6Gal I mRNA from human HepG2 hepatoma cells and from rat liver. This novel region, residing 5' of the common Exon I sequence, is encoded by a discrete upstream exon, Exon H. Here we provide evidence that the Exon H-containing transcript is the murine counterpart of the human and rat ST6Gal I mRNAs transcribed from the hepatic-specific promoter, P1. Exon H-containing ST6Gal I mRNA is expressed in all three mice strains examined: balb/c, C57B46, and 129Sv. Furthermore, murine RNA tissue survey indicates that presence of Exon H-containing transcripts is restricted to the liver. When mice are subjected to subcutaneous injection of turpentine to elicit the hepatic acute phase response, greater than 4-fold elevation in liver ST6Gal I mRNA was observed. Consistent with the view that Exon H-containing transcripts is regulated by the murine P1 promoter, 5'-RACE analysis indicates that the majority of these transcripts contains the Exon H sequence. This is consistent with the view that Exon H-containing transcripts are regulated by the murine P1 region. To assess the mechanism of ST6Gal I response in the hepatic acute phase reaction, mice harboring lesions in both alleles of the IL-6 gene were examined. IL-6(-/-) animals expressed normal levels of ST6Gal I mRNA in liver, with Exon H-containing transcripts remaining the predominant mRNA isoform. However, hepatic ST6Gal I is not elevated upon turpentine injection in the IL-6(-/-) animals. These results indicate that ST6Gal I induction in mouse liver during the acute phase reaction is mediated predominantly by the IL-6 pathway, and results in the induction of the Exon H-containing class of ST6Gal I mRNA that is specific to the liver.