Background and Objective:Smart health devices (SHDs) can improve hypertension management. Yet, SHD use among racial-ethnic minority older adults remains low, delaying potential benefits and exacerbating health disparities. Knowledge is a key determinant of SHD adoption; however, its influence on SHD use is not well understood. This study examines how knowledge affects SHD use among racial-ethnic minority older adults with hypertension. Research Design and Methods:We conducted an exploratory qualitative study using semi-structured interviews with 20 racial-ethnic minority older patients aged 60+ with hypertension and prescribed a SHD. Thematic and classical content analysis were used to analyze the interview data. Results:Multiple dimensions of knowledge, including prior awareness, sources of information, and gaps in knowledge, were identified as factors in using SHDs. Sixty percent had no knowledge of SHDs prior to being prescribed one. All received education about how to use the SHD from their providers, with many receiving support from others. Gaps in understanding technology, such as how SHDs transmit information, the security of information, and the potential health benefits, were observed. When knowledge gaps were addressed, it resulted in increased SHD utilization as well as improved health behaviors and emotional impacts. Discussion and Implications:Through integrating Critical Race Theory and Andersen's model, this study demonstrates that limited baseline awareness of SHD among racial-ethnic minority older adults is shaped by structural inequities. Provider education and support facilitated SHD engagement. Culturally responsive education, ongoing clinical support, and community-based education are essential to improving SHD utilization and self-monitoring behavior.
Abstract Background and Objectives There is a thorough literature on the mental health consequences of discrimination exposure in adulthood, yet little work to date has situated such experiences within a relational, dyadic context. The present brief report analyzes two-wave longitudinal data from the Health and Retirement Study (HRS; 2018-2022) to determine whether individuals’ own or their intimate partner’s experiences of discrimination were associated with changes to anxiety symptoms, perceived stress, and/or self-esteem over a four-year period. Research Methods and Design Dyadic lagged dependent variable (LDV) models were estimated using a structural equation modeling (SEM) framework with full information maximum likelihood (FIML) methods to address missing data. A total of 1,484 individuals from 742 opposite-gender couples participated at both the 2018 and 2022 waves of data collection and comprised the analytic sample for this study. Results Individuals’ own exposure to everyday discrimination was associated with increased symptoms of anxiety and perceived stress, as well as with reduced self-esteem, over the four-year period. A dyadic partner’s exposure to everyday discrimination was associated with increased anxiety symptoms for men only, though post-hoc Wald tests failed to find a significant gender difference in effects. Discussion and Implications Discrimination is a chronic psychosocial stressor with harmful consequences for mental health of affected individuals even in mid and later life. Moreover, limited evidence suggests that discrimination may have dyadic consequences as well, though these patterns are mixed. Future research is needed to determine interpersonal mechanisms for the findings of interest.
Background and Objectives:This study aimed to determine the prevalence of visuospatial impairment in a nationally representative sample of older adults and identify self- and informant-reported functional measures associated with visuospatial dysfunction. Methods:We analyzed data from 3496 participants aged ≥65 years in the 2016 Harmonized Cognitive Assessment Protocol (HCAP), a sub-study of the Health and Retirement Study. Visuospatial function was assessed using the Consortium to Establish a Registry for Alzheimer's Disease constructional praxis and Mini Mental State Examination pentagon copy tasks. Impairment was defined as a factor score >1.5 SDs below expected relative to a robust normative sample. Cognitive status was classified by HCAP as normal, mild cognitive impairment (MCI), or dementia. Logistic regression models examined associations between visuospatial impairment and functional outcomes, adjusting for demographic, health, and general cognitive factors. Results:Visuospatial impairment was present in 435 participants (11.33%). Among these, 49.85% had MCI, and 39.97% had dementia. Over half of those with MCI and visuospatial impairment had no other cognitive domain affected. Visuospatial impairment was associated with increased odds of self-reported visual difficulty (OR 1.60, 95% CI: 1.20-2.15), difficulty using a map (OR 3.35, 95% CI: 2.35-4.80), and informant-reported navigation difficulties, including getting lost at home (OR 17.30, 95% CI: 8.02-37.31). Associations with driving, map use, and getting lost at home remained significant after adjusting for general cognition. Discussion and Implications:Visuospatial impairment is common among older adults, frequently occurs in isolation in MCI, and is strongly associated with functional limitations, particularly in navigation and driving.
Abstract Background and Objectives Data and code sharing facilitate reproducibility, trust, and efficient reuse of research resources. Growing recognition of their importance among researchers, journals, and funders led the Nathan Shock Centers (NSC) Coordinating Center to propose documenting and supporting data and code sharing in aging research. As a baseline, we characterized data and code sharing practices in NSC-funded research. Research Design and Methods We surveyed articles citing NSC grants published 2017-2022 indexed in PubMed. In full-text screening (n=507), we excluded articles that did not generate or analyze data. For included articles, we classified data/code availability statements as available via repository, supplemental file, inclusion in paper, available on request, explicitly not available, no statement included, or other. We checked articles indicating open data/code to determine whether materials could be located per the provided statement. Results Of 400 articles included, 50% and 92% had no data or code availability statements, respectively. Data statements indicated availability via repository (30%), supplemental files (26%), inclusion in paper (10%), and on request (14%). For code, 6% indicated availability in repositories, and ≤1% each for other categories. Of those indicating open data or code, materials were located for 63% and 81%, respectively. Discussion and Implications Availability statements were absent for about half of articles for data and most for code; when open data or code was claimed, materials were located in most, but not all. Future work will evaluate how these practices improve over time as the NSC Coordinating Center’s support and journal and funder guidelines evolve.
Abstract Background and Objectives Older adults with frailty often experience limitations in activities of daily living (ADL), threatening independence and quality of life. Existing exercise interventions rarely balance therapeutic validity with program adherence, often lacking ADL-specific training, meaningful goal integration, and co-creation with frail older adults. This study developed and evaluated ACTIVE-AGE@home (AA@H), a home-based functional exercise program co-created with frail older adults to address these gaps. Research Design and Methods A mixed-methods study, guided by the Medical Research Council framework, was conducted across four phases. This paper reports phases 1–3: (1) intervention development based on semi-structured interviews exploring barriers and facilitators to physical activity; (2) feasibility testing of intervention acceptability and outcome measures; and (3) a quasi-experimental study comparing AA@H1 (ADL-focused), AA@H2 (higher-intensity progression-focused), and a control group, including process and exploratory outcome evaluation with three-month qualitative follow-up. Results AA@H showed high feasibility and acceptability, with adherence rates of 85.7%-93.3% and no adverse events. Participants valued its personalised, home-based, and goal-oriented approach. Exploratory descriptive analyses showed increases in physical fitness and participation scores in AA@H2, and in ADL scores in AA@H1. Follow-up data revealed limited continuation of structured exercise but sustained gains in confidence, daily functioning, and participation. Discussion and Implications AA@H is a feasible and promising intervention for frail community-dwelling older adults. Findings highlight the importance of combining sufficient training intensity and progression with explicit ADL integration to optimise physical gains and functional transfer. Further optimisation of exercise dose, duration, and behavioural support is needed before large-scale evaluation.
Abstract Background and Objectives This study examined Medicare Part D and Part B drug spending and beneficiary out-of-pocket (OOP) costs among community-dwelling Medicare fee-for-service (FFS) beneficiaries with Alzheimer’s disease and related dementias (ADRD), assessing variation by dual eligibility, state, and Accountable Care Organization (ACO) enrollment. Research Design and Methods We conducted a cross-sectional analysis using the 2022 Medicare Beneficiary Summary File and linked cost and use file. The sample included 1,372,696 community-dwelling Medicare FFS beneficiaries with ADRD, including 575,308 beneficiaries with five or more chronic conditions. Outcomes included annual Medicare payments and beneficiary OOP costs for Parts D and B drugs. Analyses were stratified by dual eligibility duration, state, and ACO enrollment, with adjusted estimates from generalized linear models. Results Medicare Part D drug spending was substantial, increasing with dual-eligibility duration: $8,732-$9,107 among beneficiaries with full-year dual eligibility and exceeding $11,500 among those with 5+ chronic conditions. Beneficiary OOP costs were highest among Medicare-only beneficiaries and markedly lower among dually eligible individuals. Medicare Part B drug spending was highest among Medicare-only beneficiaries and varied widely by state, ranging from $433 to $1,827 among Medicare-only beneficiaries and from $179 to $1,446 among dually eligible beneficiaries. After adjustment, differences in Parts D and B drug spending by ACO enrollment were modest. Discussion and Implications Parts D and B drug costs among Medicare beneficiaries with ADRD vary by dual eligibility and geography. Limited associations with ACO enrollment underscore the need for better medication management integration in value-based care for high-need older adults with ADRD.
Background and Objectives:Correctional populations are ageing rapidly, yet correctional staff often lack the knowledge and attitudinal competencies required to address ageing-related needs. While simulation technologies, such as simulation suits, have demonstrated improvements in cognitive and affective learning outcomes within educational and clinical healthcare settings, their application in correctional training remains unexplored. This study examined the feasibility and exploratory outcomes of a training program incorporating ageing simulation into correctional staff training. Research Design and Methods:A mixed-methods pilot study was conducted with 19 correctional officers working with older incarcerated individuals in Flanders (Belgium) and included experiential learning using the GERT ageing simulation suit. Quantitative pre-post survey data were collected to explore changes in knowledge, attitudes toward older adults, willingness to work with this population, and ageism; qualitative focus groups provided in-depth insights into participants' experiences. Results:Quantitative findings showed limited and variable changes, consistent with the small sample size and exploratory design. However, qualitative findings indicated that the intervention facilitated reflection on ageing-related physical and psychosocial challenges and increased awareness of the lived experience of ageing in prison. Notably, reluctance to engage with the ageing simulation emerged as an important finding, suggesting that emotional and professional resistance may shape engagement with experiential learning. Discussion and Implications:Rather than directly changing attitudes, ageing simulation appeared to function primarily as a catalyst for reflection. These findings highlight the importance of contextual and cultural factors in implementing experiential training in correctional settings and provide initial insights to inform the design of future interventions.
Although climate change poses disproportionate health risks to older adults, studies addressing this critical problem remain scarce and fragmented. As research on the intersection of population aging and climate change effects is increasing, guidance is needed regarding key research priorities for the field. To inform future inquiry, a research-to-practice consensus workshop was convened with 44 multidisciplinary participants, including researchers, practitioners, and policymakers. Using structured small-group discussions and an established priority-setting process, participants critiqued existing research, identified knowledge gaps, and achieved consensus on a research agenda for aging and climate change. Fourteen research priorities included quantifying economic impacts of climate change on older populations, developing evidence-based climate communication strategies, and addressing program access barriers. Additional priorities encompassed healthcare integration, emergency protocols, and disparities research. These findings provide a practice-driven, evidence-informed framework for prioritizing research topics, intervention development, and funding priorities addressing the intersection of aging and climate change.
Abstract Background and Objectives Falls in older adults are a major public health concern, but the mechanistic pathways linking sensory, cognitive, and vascular deficits to falls are poorly understood. We hypothesized that balance acts as a critical mediator, channeling these upstream deficits into functional fall risk. Research Design and Methods Using cross-sectional data from 4,805 community-dwelling adults (≥ 65 years) in the National Health and Aging Trends Study (NHATS) Round 13, we examined predictors of a composite fall-risk score (self-reported past falls and worry about falling). Survey-weighted multiple regression identified direct predictors, while mediation analyses tested the indirect effects of hearing, cognition, and vascular conditions through subjective (self-reported problems) and objective (performance-based) balance measures. Results Subjective balance was the strongest direct predictor of fall risk (β = 0.53, p < 0.001), with additional direct effects from objective balance, depression, anxiety, and heart disease. Notably, hearing ability, cognitive function, and hypertension were not direct predictors of fall risk; their influence was fully or partially mediated by balance, establishing postural control as the primary pathway through which these upstream factors contribute to falls. Discussion and Implications These findings identify a dual-pathway fall risk model driven by subjective and objective balance. While psychological factors and heart disease directly influence fall risk, upstream sensory, cognitive, and hypertensive deficits operate through balance as a convergent mediating pathway. Clinical fall prevention must prioritize subjective and objective balance measures, while managing mental health as a direct threat and addressing sensory and cognitive function as foundational to postural control.
Background and Objectives:Despite emerging evidence showing that older adults have begun engaging social chatbots for companionship in recent years, little is known about the factors influencing their adoption decisions. We developed an age-friendly social chatbot and examined older adults' intention to use it by integrating the Senior Technology Acceptance Model (STAM) with sociorelational factors relevant to human-artificial intelligence (AI) interaction. Research Design and Methods:A final sample of 140 community-dwelling older adults interacted with the chatbot for approximately 20 min and then completed questionnaires assessing their attitudes toward the chatbot, perceptions of the chatbot, and their intention to use it in daily life. Results:Higher control belief (e.g., perceived ease of use and facilitating conditions), one of the STAM factors, predicted higher intention to use the chatbot among older adults, whereas higher self-rated health predicted lower intention. Importantly, the stronger the sociorelational factors (e.g., authenticity; AI social interaction intensity), the higher the intention to use. However, higher levels of anthropomorphism of the chatbot predicted lower intention to use. Incorporating sociorelational factors into the STAM framework accounted for an additional proportion of variance, comparable to STAM factors alone. Discussion and Implications:Our findings suggest that control belief, authenticity, and social interaction intensity with social chatbots are key drivers of adoption intention among older adults. Unmet needs in life may also drive chatbot engagement. However, overly human-like chatbots may deter adoption. Taken together, integrating human-AI interaction factors with the STAM framework is essential when evaluating older adults' adoption of social chatbots.
Background and Objectives:Family members play an essential role in monitoring and advocating for quality of care in assisted living (AL) communities. Despite their importance, few population-based studies have examined how family and facility characteristics influence family satisfaction in AL. We evaluated family and facility characteristics associated with family satisfaction in AL. Methods:Using cross-sectional survey data from the Minnesota Assisted Living Report Card project (2024), we identified resident- and facility-level predictors of AL resident-reported quality of life in 8 domains, including experience, choice, needs, housekeeping, food, environment, staff, and overall satisfaction, using multivariable linear mixed regression with facility-level random intercept to account for facility-level clustering. Results:Among 15 320 family member respondents in licensed AL facilities with more than 5 beds (51.1% of age <65 years, 65.4% female, 92.3% White), mean domain scores ranged from 67.2 (Food) to 82.1 (Overall), indicating generally positive perceptions. Across all domains, lower satisfaction was observed among respondents who are younger, people of color, and female, and among spouses or siblings of residents. Families visiting or communicating less frequently tended to report lower satisfaction with choice and overall satisfaction. Smaller and non-profit facilities received higher ratings across most domains, while facilities in the Twin Cities metropolitan area scored higher than those in the rest of the state. Discussion and Implications:Family satisfaction in AL reflects both family composition and facility context. Policymakers and providers can leverage family satisfaction metrics to inform targeted quality improvement and promote equitable, family-centered care across the AL sector.
Background and Objectives:Although previous research has documented the adverse effects of childhood starvation as a profound early-life adversity, most studies have focused on physical health outcomes or mortality, with limited integration of life-course theory and Bourdieu's capital-based framework. This study examined whether childhood starvation predicted depressive symptoms in later life and further investigated whether these associations were mediated by economic, social, and cultural capital. Research Design and Methods:Data were drawn from the 2018, 2020, and 2023 waves of the China Longitudinal Aging Social Survey. An unbalanced panel dataset comprising 25,852 observations was constructed, with participants being older adults in China. The double machine learning approach was applied to estimate the causal impact of childhood starvation on late-life depressive symptoms and analyze the mediating roles of the 3 types of capital. Results:The findings indicated that (a) individuals who experienced frequent hunger in childhood reported significantly higher levels of depressive symptoms in old age and (b) economic, social, and cultural capital each partially mediated the association between childhood starvation and late-life depressive symptoms. Discussion and Implications:This study advanced life-course scholarship by integrating a capital-based framework to understand the enduring psychological consequences of childhood starvation, linking early adversity to late-life mental health through cumulative depletion of key resources. It identifies capital erosion as a key mechanism and offers implications for policies aimed at reducing childhood food insecurity, strengthening life-course resources, and expanding mental health services.
Abstract Background and Objectives Decisional conflict (DC), or uncertainty about health-related decisions, is common among individuals with advanced chronic kidney disease (CKD), yet little is known about its prevalence and predictors among older African Americans, a population disproportionately affected by CKD. This study examined the prevalence of DC and how personal characteristics, perceived kidney disease knowledge, and clinical factors are associated with DC in this group. Research Design and Methods This was a cross-sectional study involving 125 African American adults aged 50 and older with Stage 4 or 5 CKD who had not yet started dialysis. Participants completed structured telephone interviews to assess DC (Decisional Conflict Scale), perceived CKD knowledge, depressive symptoms, anxiety, comorbidities, and sociodemographic factors. Hierarchical multiple regression analyses were performed to identify predictors of DC. Results Participants reported moderate levels of DC (M = 36.69, SD = 23.2), with approximately 42% scoring above the threshold indicating decisional difficulty. In multivariate analyses, perceived CKD knowledge was the only significant predictor of DC (β = −0.58, p < .001), accounting for a substantial proportion of variance. Personal and clinical characteristics were not significant in the final model. Discussion and Implications Findings highlight the crucial role of perceived knowledge in shaping decision-making among older African Americans with advanced CKD. Interventions that improve disease-specific knowledge during the pre-dialysis period may reduce decisional conflict and promote informed, patient-centered care. Future research should explore tailored educational strategies and structural factors affecting decision-making in this population.
Background and Objectives:China's rapid population aging challenges traditional family-based care arrangements. This study examines heterogeneity in home-based care preferences by assessing how financial support sources, number of children, and children's gender composition are associated with care preferences among older adults in Southwestern China. Research Design and Methods:Data were drawn from the 2023 Chengdu-Chongqing Economic Circle Social Dynamics Survey. The analytic sample included 1,812 adults aged 50 years and older with children. Multinomial logistic regression models estimated associations between financial resources, family structure, and 4 care preference categories: self/spousal home care, child-provided home care, mixed family care at home, and other arrangements. Results:Financial reliance patterns were strongly associated with care preferences. Dependence on adult children for financial support was associated with a higher likelihood of preferring child-provided care, with this association stronger among women than men. Children's gender composition was not significantly associated with care preferences. Larger family size (four or more children) was associated with mixed family care preferences. Discussion and Implications:These findings suggest that financial resources may play a more prominent role than children's gender in shaping care preferences in this population. Women's greater reliance on children is consistent with gendered economic disadvantage in later life. Policies that strengthen pension adequacy and support diverse home-based care arrangements may help address evolving care needs.
Background and Objectives:The risk of depression following newly occurred dementia has not been well studied, particularly in diverse populations. This study aimed to estimate the relative risk of depression after newly occurred dementia or cognitive impairment in a cohort of adults aged ≥50 years. Research Design and Methods:Participants from the Health and Retirement Study with and without newly occurred dementia or cognitive impairment, and free of depression at baseline, were included. Dementia and cognitive impairment were ascertained using the Langa-Weir Classification of cognition, and depression was defined as ≥3 symptoms on the 8-item Center for Epidemiologic Studies Depression Scale. Pooled logistic regression with inverse probability weighting was used to estimate the cumulative incidence of depression following newly occurred dementia and cognitive impairment for up to 10 years. Risk ratios (RRs) with 95% confidence intervals (CIs) were obtained using 1,000 bootstrap samples. Subgroup analyses were conducted by age, sex, and race/ethnicity. Results:Risk of depression was significantly elevated after 2 years in those with newly occurred dementia (RR = 1.62, 95% CI: 1.17-2.03) or newly occurred cognitive impairment (RR = 1.62, 95% CI: 1.45-1.79). Elevated risks persisted throughout the 10-year follow-up. These risks were similar in men and women and significantly elevated in most subgroups. Discussion and Implications:Incident dementia and cognitive impairment were associated with immediate and sustained elevated risk of depression across 10 years of follow-up. These findings highlight the importance of prevention strategies and timely screening for depression in people with newly occurred dementia or cognitive impairment.
Background and Objectives:Rural adults (those residing in nonmetropolitan counties) face persistent barriers to brain-health assessment that may help prevent or delay cognitive decline. This study reports protocol and pilot feasibility findings from year 1 of a 3-year longitudinal project evaluating Building a Rural Aging and Intervention Network: Factors that Impact Trajectories (BRAIN-FIT), a community-embedded program to improve access to multidomain screening and awareness of modifiable dementia risk factors. Research Design and Methods:Using a mixed-methods design, 119 adults aged 45 or older completed a single-day interdisciplinary screening incorporating clinical-standard measures (cardiovascular, physical, lifestyle, social-emotional, sensory, cognitive, and speech-language health), followed by individualized-results review. 63 participants completed a 4-week post-event behavior change evaluation. Results:BRAIN-FIT, delivered across 7 community sites in 3 cities through 18 events, enrolled 163 adults (aged 46-95; M = 67.5) with socioeconomic and clinical heterogeneity. Engagement was strong: 119 consented to longitudinal participation, 95% completed all stations and rated the program highly feasible (3.7-4.4 out of 5). Screening identified prevalent modifiable risk factors: elevated cardiometabolic indicators, reduced physical endurance, sleep disturbance, and sensory impairment. Cognitive and language performance remained largely within functional limits, suggesting engagement during a preventive window. Discussion and Implications:Community-embedded multimodal screening appears to be a viable program for identifying actionable brain-health risk prior to substantial decline. By reaching diverse adults outside traditional care pathways, BRAIN-FIT advances a pragmatic population-health approach to dementia prevention. Longitudinal follow-up will evaluate sustained behavior change, strengthen referral integration, and inform hybrid effectiveness-implementation trials to promote healthier aging trajectories.
Background and Objectives:The long-term effect of persistent financial adversity on cognitive aging remains unclear. We examined how sustained financial hardship across adulthood associates with midlife cognition, cognitive decline, and later-life brain health and whether impacts vary by sex, childhood socioeconomic circumstances (SECs), and genetic risk. Research Design and Methods:Using data from the 1946 British birth cohort (N = 2,759) and its neuroimaging sub-study, Insight 46 (N = 356-468), we linked financial adversity (low household income, financial hardships between ages 26 and 53) with cognitive performance at age 53, cognitive decline from ages 53 to 69, and neuroimaging measures at ages 69-71. We tested moderating roles of sex, childhood SEC, and APOE-ɛ4. Results:Increased exposure to low household income and financial hardships was associated with lower processing speed (-0.07 [-0.13, -0.02] and -0.05 [-0.11, -0.00]) and verbal memory at age 53 (-0.16 [-0.21, -0.11] and -0.10 [-0.15, -0.05]). This was followed by slower verbal memory decline, attributable to lower baseline scores. Persistent low income was associated with greater ventricular volume (b = 4.67 ml [1.01, 8.32]). Stronger associations between financial adversity and brain atrophy were found for male participants, those with lower childhood SEC, and APOE-ɛ4 carriers who were consistently more vulnerable. Discussion and Implications:Persistent financial adversity impacts cognitive performance by midlife and later-life brain atrophy, with larger effects for men, those from disadvantaged childhoods, and individuals with greater genetic risk. Supporting financially vulnerable working-age adults could help prevent dementia in an aging population.
Background and Objectives:The distribution of life expectancy at age 65 (LE65 ) in the United States is characterized by profound sex- and locality-related disparities. Quantifying the disease-specific drivers of these disparities prior to the coronavirus disease 2019 (COVID-19) pandemic provides a critical baseline for understanding subsequent health shocks. Methods:Using CDC WONDER data (1999-2018) and Pollard's decomposition method, we analyzed cause-specific contributions to disparities in LE65, establishing a pre-pandemic baseline for trends in years of life lost (YLL) at age 65. Results:Sex-related disparities (YLLsex) narrowed, particularly in disadvantaged localities, driven by reductions in YLL from macrovascular diseases and lung cancer. Conversely, locality-related disparities (YLLloc) widened, especially for females, due to increasing YLL from Alzheimer's disease and the persistent impacts of diabetes, chronic lower respiratory diseases, and heart failure. This created a pre-existing landscape of vulnerability concentrated in low-LE states. Discussion and Implications:The 2 decades before COVID-19 saw a critical divergence: progress in reducing sex-based gaps was offset by rapidly widening geographic disparities. The systemic failures that drove the increasing burden of chronic conditions in disadvantaged regions likely predetermined the populations most vulnerable to the pandemic's shock. Our findings highlight that building future resilience requires targeted investments to address these specific, pre-existing health challenges.
Background and Objectives:Chronic pain is common in older adults and is associated with psychological distress, including suicidality. In patients with dementia, impaired cognitive and communication may further increase vulnerability. This study aimed to investigate associations between chronic pain and suicidality in hospitalized patients with dementia. Research Design and Methods:This population-based, retrospective cross-sectional study analyzed hospitalizations of patients aged ≥60 years with dementia between 2016 and 2020, extracted from the U.S. Nationwide Inpatient Sample (NIS). Chronic pain, suicide attempts, and suicidal ideations were identified using International Classification of Diseases, Tenth edition-CM diagnostic codes. Propensity score matching (1:4) was performed to balance baseline characteristics, including age, sex, race, dementia type, and major comorbidities. Multivariable logistic regression estimated adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Stratified analyses were conducted by age, dementia type, sex, Charlson comorbidity index (CCI), race, and insurance. Results:After matching, 29,185 hospitalized patients with dementia were analyzed (5,837 with chronic pain; 23,348 without). Chronic pain was significantly associated with higher odds of suicidal ideations (adjusted odds ratio [aOR] = 1.49, 95% CI: 1.30-1.71, p < .001) and suicide attempt (aOR = 2.02, 95% CI: 1.08-3.76, p = .028). Stronger associations were observed among patients aged 60-69 years, those with CCI ≥ 1, without Medicare/Medicaid. Only 16 suicide attempts occurred in the chronic pain group, limiting statistical precision. Discussion and Implications:Chronic pain is associated with increased suicidality in hospitalized older patients with dementia. Longitudinal studies are needed to confirm these findings.
Background and Objectives:Research has suggested that social isolation increases mortality risk. However, findings have been mixed regarding gender differences, and few studies have explored age differences among older adults. We examined whether the association of social isolation and all-cause mortality varied by gender and age and compared two established measures of social isolation. Research Design and Methods:Participants (N = 7,026, age 65+) in the National Health and Aging Trends Study (NHATS) were followed up to 12 years. 2 NHATS-based social isolation measures (Pohl and Cudjoe), both with 3 categories (socially integrated, somewhat isolated, severely isolated), were used. Cox proportional hazards models, adjusted for sociodemographic, health, and health behavior factors, were applied. Interaction terms tested the moderation by gender and age. Results:During follow-up, 2,457 (35.0%) participants died. The 2 social isolation measures had substantial misalignment, with only 36.6% of the sample being classified in the same category. Using Pohl's measure, both somewhat and severely isolated groups had significantly higher mortality risks than socially integrated individuals, and effects were stronger for men than for women. No age interaction was observed. Associations using Cudjoe's measure were non-significant after adjustment. Discussion and Implications:Social isolation hastens death in older adults, particularly among men, but findings depend on how isolation is measured. Measures emphasizing family/friend contact may better capture mortality-related risk. Healthcare providers should consider screening for, and using social prescribing to address, social isolation when treating older patients. Reducing social isolation in older men requires particular attention.
