BackgroundAmenable mortality, deaths preventable through timely and effective healthcare, is a widely used indicator of health system performance, yet evidence is lacking on its individual-level determinants in Brazil.MethodsWe used data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil), a representative cohort of adults aged 50 and older. Deaths were classified as amenable using both the Brazilian and the Pan American Health Organization's definitions. Semi-parametric competing risks regression modeled the hazard of amenable death while accounting for non-amenable death as a competing event and adjusting for covariates.ResultsAmong 872 deaths during follow-up, 30% to 39% were classified as amenable, with rates ranging from 2.5 (50-59 yrs) to 32.3 (80+) per 1,000 person-years. Older age, male sex, unpartnered status, lower income, multi-morbidity, and tobacco use were associated with higher risk of amenable mortality.ConclusionsAmenable mortality constitutes a substantial and inequitably distributed share of deaths among older Brazilians.
ObjectiveTo examine whether physical activity (PA) relates to mild cognitive impairment (MCI) both directly and indirectly through depressive symptoms and social isolation, and whether social isolation moderates this association.MethodsThis cross-sectional analysis used data from the 2011-2014 National Health and Nutrition Examination Survey (n = 2,933; ≥60 years). Self-reported PA, depressive symptoms, and social isolation were assessed. MCI was defined as a composite cognitive score greater than one standard deviation below the sample mean.ResultsWeighted path analysis showed that higher PA levels were inversely associated with MCI. Depressive symptoms and social isolation mediated this association. Social isolation moderated the PA-MCI relationship, with the inverse association being most pronounced among individuals with higher isolation levels.ConclusionsPA is associated with MCI in older adults through psychosocial pathways, and social isolation shapes this relationship. Promoting PA may be particularly relevant for those experiencing social isolation.
ObjectivesSibling ties are among the most enduring of all social relationships, so the loss or absence of this long-standing bond may undermine the well-being of older adults. This study examined whether and how disconnectedness from adult siblings (i.e., no contacts/interactions and emotional distance) is linked to older adults' cognitive functioning.MethodsWe use data from four waves of the Wisconsin Longitudinal Study (1993-2020) and structural equation models to prospectively evaluate the association between sibling disconnectedness and cognition, and the extent to which this association is mediated by loneliness. Participants reported on sibling disconnectedness in 1993/age 54 and 2004/age 65, and on loneliness in 2011/age 72. Cognition was evaluated in 2020/age 81.ResultsPersistent sibling disconnectedness was not directly associated with cognitive decline, but it was significantly and indirectly associated with cognition through loneliness.ConclusionsOur findings underscore the importance of sibling relationships as a source of social support and cognitive engagement in midlife.
ObjectivesSocial security benefits are associated with better psychological health among older adults in resource-limited settings, yet the mechanisms underlying this association remain underexplored. We examined the role of healthcare accessibility in the relation between social security benefits and psychological health among older adults in Tanzania.MethodsWe analyzed cross-sectional data from a 2024 survey of Tanzanian adults aged 60 and above (n = 2,012) in four geographic zones. We examined associations using structural equation modeling (SEM) with bias-corrected bootstrapping (5,000 replications). Social security benefits (combining pension and health insurance receipt), self-reported healthcare accessibility, and psychological health (a composite of anxiety and depression symptoms) were included as primary variables.ResultsSocial security benefit receipt was significantly associated with better psychological health (β = -0.106, BCCI: -0.152, -0.060, p < 0.001). Healthcare accessibility was positively associated with psychological health and showed a significant association with the relationship between social security benefits and psychological health (β = -0.057, BCCI: -0.092, -0.022, p < 0.01), consistent with an indirect association in this cross-sectional analysis.ConclusionsHealthcare accessibility plays a significant role in the relation between social security benefits and psychological health, suggesting a pathway through which social security benefits may influence psychological health beyond direct financial mechanisms. These findings point to potential policy considerations, including administrative coordination between pension and health insurance schemes and interventions to improve healthcare accessibility for older adults. For low- and middle-income countries facing rapid population aging, integrated approaches to social security benefits and health systems may help maximize the health returns of social investments.
ObjectivesThis study examined how caregiving intensity, duration, and labor type are associated with physical and mental health among family caregivers (FCGs) across life-course stages.MethodsUsing cross-sectional data from 2,610 FCGs in the 2024 Behavioral Risk Factor Surveillance System, we applied multivariable logistic and linear regression models stratified by life-course stage.ResultsWomen had 65% higher odds of depression than men (aOR = 1.65, 95% CI = 1.22-2.22), consistent across all age groups. Older FCGs who provided care for two or more years showed markedly worse physical health, a pattern consistent with wear-and-tear and cumulative disadvantage frameworks. Midlife FCGs presented a sandwich-generation profile of worse physical health with increased caregiving intensity.ConclusionFindings highlight the need for age-tailored caregiver support and structural reforms, including expanding the Family and Medical Leave Act, wage replacement programs, and a caregiving-linked Medicare benefit.
ObjectivesThis study examined the influence of hearing status and loneliness on verbal fluency trajectories in adults aged 60 years and older, assessing their contributions to baseline performance and longitudinal change over time.MethodsData were drawn from 4,929 participants in the Health and Retirement Study (HRS) with objective hearing assessment in 2018 and three waves of semantic verbal fluency and loneliness measured in 2018, 2020, and 2022. Latent growth curve models were estimated to examine longitudinal change.ResultsVerbal fluency showed a small but statistically significant increase over time, whereas loneliness showed a slight decrease over time. Worse hearing status predicted lower baseline verbal fluency and higher baseline loneliness. The association between hearing status and longitudinal change in verbal fluency was observed in partially adjusted models but was attenuated and did not reach statistical significance after full covariate adjustment.DiscussionThese findings support an association between hearing status and baseline levels of verbal fluency and loneliness, while evidence for longitudinal change in verbal fluency was limited to partially adjusted models.
ObjectivesThis study examined whether education predicts mortality among older adults and whether lifelong learning and family-based social support moderate this association within an embodied cognitive reserve framework.MethodsMIDUS 2 linked to 2016 National Death Index data were analyzed (N = 584; age ≥ 60). Cox proportional hazards models estimated mortality as a function of educational attainment (occupational education index), lifelong learning (PCA-derived factor score), and family-based social support (standardized composite). Interaction terms (education × lifelong learning; education × family support) were modeled to assess buffering effects on the education-mortality link, adjusting for age and sex.ResultsHigher education was associated with lower mortality risk (HR = 0.83, 95% CI [0.73, 0.94]). Lifelong learning strengthened this effect after adjusting for baseline functional limitations. Family-based social support showed a weaker moderating effect.ConclusionsFindings support the embodied cognitive reserve framework, suggesting that lifelong learning enhances the survival benefits of education.
ObjectivesThis study examined whether social engagement mediates the relationship between information and communication technology (ICT) use and depression and anxiety among older Americans.MethodsData came from 5,195 respondents in the 2022 National Health and Aging Trends Study. Multivariate mediation analyses were conducted using bootstrapping and Monte Carlo simulation to estimate indirect effects.ResultsCompared with non-users, ICT users showed greater social engagement and lower depression and anxiety, with social engagement mediating these associations. CT-only use was indirectly associated with lower depression and anxiety through social engagement, whereas IT-only use showed no significant associations.DiscussionFindings suggest that the mental health benefits of ICT use in later life depend on how technology is used. Interactive and communication-oriented technology use, rather than information-only use, may support psychological well-being by fostering social engagement and social connectedness in later life.
IntroductionThis study extends prior work by identifying multidimensional profiles of co-occurring mental health and cognitive symptoms that better reflect the complexity of aging and identify high-risk subgroups with more severe symptom profiles.MethodsThis secondary analysis used Wave II data from the National Social Life, Health, and Aging Project (NSHAP). Latent profile analysis was conducted to identify distinct symptom profiles and examine associated sociodemographic, clinical, and lifestyle characteristics.ResultsA three-profile solution of "Mild," "Moderate," and "Severe" was identified. These profiles differed significantly across sociodemographic characteristics (e.g., age, gender, education, employment, income, and access to technology), clinical factors (self-rated health and chronic conditions), and lifestyle behaviors (physical activity, alcohol use, sleep quality, and social engagement).DiscussionThese findings highlight substantial heterogeneity in mental health and cognitive symptom profiles among older adults and underscore the need for targeted, accessible, and person-centered interventions to support their mental and cognitive well-being.
ObjectivesDiabetes-related chronic kidney disease (CKD) is a common and clinically consequential multimorbidity cluster in later life. This study examined the associations of depressive symptoms (PHQ-9) with diabetes, CKD, coexisting diabetes-CKD, and physical activity (PA).MethodsData came from the 2011-2023 National Health and Nutrition Examination Survey (N = 13,610 adults aged ≥50). Linear regression models were used to answer the research questions.ResultsIn models adjusting for sociodemographic factors and other chronic illnesses, diabetes (B = 0.38, SE = 0.14, p = .007) and coexisting diabetes-CKD (B = 0.58, SE = 0.17, p = .001) were associated with higher depressive symptoms, whereas meeting PA guidelines was associated with lower symptoms (B = -0.86, SE = 0.10, p < .001). The inverse association between PA and depressive symptoms was weaker among individuals with advanced CKD (p = .042).ConclusionsThese findings suggest that depressive symptoms and PA are closely linked in later life, highlighting the importance of supporting combined mental health and exercise interventions for older adults with complex chronic conditions.
ObjectiveTo examine sex differences in the relationship between comorbid anemia and heart failure (HF) with 13-year all-cause mortality in Mexican American older adults aged 75 years and older.MethodsParticipants (N = 1,615) aged ≥75 years were from the Hispanic Established Population for the Epidemiologic Study of the Elderly (2004/05-2016). Participants were categorized by anemia status, HF status, and sex. Cox proportional hazards regression models estimated hazard ratios (HRs) and 95% Confidence Intervals (CIs) for all-cause mortality.ResultsHF only was associated with higher mortality in males (HR = 1.41, 95% CI = 1.12-1.78; p = 0.0039) and females (HR = 1.52, 95% CI = 1.24-1.85; p < 0.0001). Anemia only (HR = 1.54, 95% CI = 1.06-2.23; p = 0.0248) and comorbid anemia and HF (HR = 1.74; 95% CI = 1.00-3.03; p = 0.0484) were associated with higher mortality only in males.ConclusionAnemia and HF were associated with greater mortality risk among older Mexican American males than females.
ObjectivesUsing 2017-2022 Midlife in the United States Biomarker Project data, this study explores the contribution of head injuries to the gender gap in depression and anxiety symptoms.MethodsLinear regression models were used to estimate generation-specific gender differences symptoms. The contribution of head injuries to these differences was explored. In addition, sources of potential confounding were examined.ResultsAmong women, a lifetime head injury is associated with a large increase in symptoms, and within Generation X the association is stronger. There is no association among men. Almost a third of Generation X women report a serious lifetime head injury. The contributions of accidents and sports injuries have increased between cohorts. The association between head injuries and symptoms is robust to numerous potential confounders, including other bodily injuries and trait anxiety.ConclusionHead injuries contribute to the gender gap in depression and especially anxiety.
ObjectivesTo test whether epigenetic aging mediates associations between social connectedness and later cognitive function among U.S. older adults.MethodsUsing Health and Retirement Study data (N = 1,574; mean age = 68.5), we modeled 2014 social connectedness as a latent factor (participation, isolation, loneliness), assessed four DNA methylation clocks in 2016 (DNAmGrimAge, DunedinPoAm, DNAmPhenoAge, Zhang), and cognition in 2018. Survey-weighted regression-with-residuals mediation models adjusted for socio-demographics, smoking, obesity, self-rated health, heart disease, baseline cognition, and complex design.ResultsLower social connectedness predicted poorer 2018 cognition (ATE ≈ -0.047 to -0.048 across models, p < .05). Only DNAmGrimAge showed evidence consistent with mediation (NIE = -0.008, SE = 0.004, p = .041; ≈16% mediated), whereas indirect effects via DunedinPoAm, PhenoAge, and Zhang were not supported (all p > .05).DiscussionFindings provide limited, clock-specific support for epigenetic mediation, with preliminary evidence implicating DNAmGrimAge.
ObjectivesObesity is common among older Black adults, but its underlying drivers, such as neighborhood racial composition (NRC), remain understudied. This study examined the association between NRC and obesity among older Black adults, evaluating the role of individual-level socioeconomic status (SES).MethodsData from the Nashville Stress and Health Study was linked to five-year estimates from the American Community Survey. Obesity was defined as body mass index ≥30 kg/m2. NRC was measured with the Index of Concentration at the Extremes.ResultsAfter adjusting for demographic characteristics and health behaviors, older Black adults living in more Black-concentrated neighborhoods had lower obesity prevalence (PR = 0.76, 95% CI: 0.63-0.93) compared to those in more White-concentrated neighborhoods. However, after controlling for individual-SES this association was not significant (PR = 0.82, 95% CI: 0.65-1.04).ConclusionIndividual-SES may account for the relationship between NRC and obesity among older Black adults.
ObjectivesAlcohol use in later life may pose health risks that are hidden by contemporaneous measures or slowly accumulating outcomes. We examined whether alcohol use predicts subsequent healthcare utilization among midlife and older adults.MethodsUsing 2012-2022 Health and Retirement Study data, we estimated fixed-effects negative binomial models of within-person associations between alcohol use and hospitalizations and doctor visits. Contemporaneous and 2-year lagged alcohol measures were evaluated, and interactions with chronic disease burden were tested.ResultsContemporaneous models consistently showed fewer hospitalizations among drinkers. Lagged models showed a less protective and, for hospitalizations, more adverse pattern two years later. For doctor visits, lagged main effects were less consistent. Prior drinking predicted greater subsequent utilization as chronic conditions increased.DiscussionFindings suggest that recent drinking history may reveal risks not apparent from current drinking alone and may be especially important among older adults with multimorbidity.
ObjectiveThis study examined whether older adults with informal, professional, or both types of care coordinators (CCs) reported different healthcare quality than those without CCs.MethodsData came from the 2016 Health and Retirement Study (n = 1,555) Module 10 on coordinated care. CC type and the helpfulness of professional CCs were independent variables. Outcomes included perceived confusion about care, conflicting advice from different providers, care satisfaction, and person-centered care. All multivariable regression models controlled for sociodemographic and health factors.ResultsParticipants with informal CCs or both informal and professional CCs were more likely to report a lower quality of healthcare compared to participants without any CCs. Among participants who have professional CCs, having more helpful professional CCs was associated with higher quality care and more patient-centered care.ConclusionsFindings suggest that quality of healthcare may depend on the type of CCs involved and their perceived helpfulness.
ObjectiveTo evaluate the covariation of daily positive experiences and alcohol use among a national sample of adults aged 50+ years.MethodsParticipants (N = 1,035; Mage = 61.62; range = 50-83) were non-abstaining adults aged 50+ years who participated in an 8-day diary project in the National Study of Daily Experiences.ResultsMultilevel regression analyses revealed that alcohol use was more likely on days with greater positive affect (OR = 1.32, 95% CI [1.12, 1.56]) and any positive events (OR = 1.25; 95% CI [1.05, 1.48]). When adjusting for positive affect, positive event exposure was not associated with likelihood of alcohol use. Neither positive affect nor positive event exposure significantly predicted drinking level. However, an age moderation effect emerged (b = -0.01; SE = 0.004; p = .02), showing that older age attenuated the association between positive event exposure and drinking level.DiscussionConsistent with patterns observed in younger adults, positive experiences and alcohol use often occur on the same days among adults aged 50+ years.
ObjectiveThis scoping review explores the past decade of research on interventions supporting informal caregivers of community-dwelling older adults.MethodA systematic literature search was conducted in PubMed, Scopus, Web of Science, and PsycINFO. A total of 3408 studies were screened, of which 49 met the criteria for inclusion in this review.ResultsThe majority of interventions targeted dementia caregivers, were individually delivered, and professionally guided. Psychoeducational and psychological support dominated, followed by practical support such as respite care or case management, and remote caregiving support. Most studies tested effectiveness/efficacy and predominantly included women. Interventions tailored to non-dementia caregivers and working caregivers, as well as studies addressing implementation strategies and cost-effectiveness, were largely underrepresented.ConclusionTo move forward, future studies on interventions for informal caregivers of community-dwelling older adults should address diverse caregiving contexts, increase male participation, explore low-resource interventions, and identify strategies for sustainable, cost-effective implementation.
ObjectivesThe older population and prevalence of frailty are increasing worldwide. Understanding how midlife exposures influence frailty risk is increasingly important for public health. This review sought to identify modifiable risk factors present in midlife that are associated with the onset of frailty in later life, aiming to inform earlier prevention strategies.MethodsWe conducted a systematic review of studies examining modifiable risk factors in community-dwelling adults aged 39-64 years, using three databases and strict inclusion criteria, following PRISMA guidelines.ResultsTwenty cohort studies identified 27 modifiable risk factors across six domains; Lifestyle, Psychological, Social, Physical, Environmental, and Biochemical. Lifestyle factors such as physical activity, diet, smoking, alcohol use, and body composition were the most prominent.ConclusionPromoting awareness may empower midlife adults to instigate changes to reduce future frailty risk. Further research should clarify the causal strength of these factors to guide prevention efforts.
ObjectiveSocial relations are considered a critical protective factor for cognitive health yet may differ in form and function across race and ethnic groups.MethodUsing a representative metro-Detroit sample (N = 606), we compared group means to (1) test whether Middle Eastern and North African (MENA) Americans social relations are distinct from other groups and (2) examine links between social relations and cognitive health using structural equation models.ResultsMENA Americans' social relations differed from White and Black Americans. Larger networks and more positive relationship quality were associated with better cognitive health across all groups but particularly among MENA Americans. A lower proportion of women in networks was associated with better cognitive health for White Americans.ConclusionsFindings suggest that the form and function of social relations vary across racial and ethnic groups. Such knowledge is critical in clarifying how social networks may be leveraged to promote cognitive health across groups.
