BACKGROUND:The variability of vital signs thresholds has not been well described in relation to older age and sex assigned at birth. Significant variations may influence clinical interpretation of vital signs, most notably the thresholds at which investigations or treatments are initiated. Our objective was to compare, in stable health status, the percentage of abnormal values (flagging percentage) of standard vital signs thresholds of adults aged 45 years and older and to determine centile-based thresholds by age and sex. METHODS:A retrospective observational study was conducted using data from the Centre for the Integration and Analysis of Medical Data (CITADEL) at the Centre hospitalier de l'Université de Montréal (CHUM), a tertiary care hospital. All inpatients and outpatients, from January 2012 to December 2021, were included. For individuals with multiple visits, a single hospitalization or a single outpatient visit was selected at random for inclusion. To reflect a stable health status, the last vital signs recorded before hospital discharge were selected and in-hospital deaths were excluded. Flagging percentages were identified using a quantile-based approach. Age and sex specific centile-based thresholds were determined by identifying values at the 2.5th and 97.5th centiles. Flagging percentages and centile values for systolic and diastolic blood pressure, heart rate, and temperature were analyzed by age group (45-54, 55-64, 65-74, 75-84, and 85 + years) and sex. RESULTS:The sample comprised 123,420 individuals, including 90,813 inpatients. Flagging percentages for the standard threshold of upper systolic blood pressure (140 mmHg) ranged from 13.3 (12.7-13.9) % (45-54y assigned female at birth (AFAB)) to 39.8 (38.6-41.0) % (85y+ AFAB). Flagging percentages for standard thresholds ranged between 0.1 (0.1-0.2) to 1.2 (1.0-1.4) % for upper temperature (37.8°C), lower temperature (35.0°C), and lower systolic blood pressure (90 mmHg). Across subgroups, the 97.5th centile-based adapted thresholds varied between 158 (156-159) - 178 (177-180) mmHg for upper systolic blood pressure and between 37.2 (37.1-37.2) - 37.3 (37.3-37.3) °C for upper temperature. CONCLUSIONS:Important differences in vital signs flagging percentages may affect their comparability by vital sign, age, and sex. Standard thresholds may need to be reassessed using clinical outcomes to factor age and sex differences.

[This corrects the article DOI: 10.1371/journal.pone.0338213.].

Longitudinal studies are essential for understanding health trajectories, but necessary upgrades to measurement instruments over time may compromise data comparability. The Canadian Longitudinal Study on Aging conducted a measurement comparability study to quantify systematic differences between instruments and derive conversion equations to correct for any differences. Overall, 50 participants aged ≥45 years (52% female) underwent repeated assessments with old and new instruments, including the blood pressure monitor, electrocardiogram (ECG), carotid ultrasound, spirometer, audiometer, tonometer, and dynamometer. Linear mixed-effects models were used to identify systematic differences. Cohen's d was used to assess standardized mean difference, Bland-Altman plots evaluated agreement between instruments, and repeatability was assessed within instruments. Mixed-effects models showed no clinically meaningful difference across instruments, except for systolic blood pressure (SBP), which was on average 5.19 mmHg (95% CI, 2.64-7.74) higher using the new instrument. Cohen's d demonstrated moderate systematic differences for several measures. Repeatability estimates showed good-to-excellent reliability for most measures; however, certain ECG and tonometer parameters showed moderate or poor precision. The results support the utility of conversion equations to account for systematic differences between instruments. The difference in SBP warrants the implementation of a conversion equation, whereas it is unclear for measures with moderate differences.

Longitudinal biomonitoring studies during preconception, pregnancy and early childhood are highly valuable tools for assessing environmental chemical exposures during sensitive windows and their effects on health and development. For the past 15 years, the Maternal-Infant Research on Environmental Chemicals (MIREC) Research Platform has been Canada's flagship study of the long-term effects of early life exposure to environmental chemicals. In light of the evolving scientific and legislative landscapes and need to address emerging research questions, MIREC Platform researchers at Health Canada consulted with scientific investigators of other cohort studies to inform the development of a future preconception or pregnancy longitudinal biomonitoring study. This effort included 1) hybrid consultation meetings on Dec 6, 2024 (Toronto, ON) and Jan 21, 2025 (Ottawa, ON) and 2) a virtual seminar series from October 2024 to June 2025 hosted by the Health Canada MIREC team. Our objective here is to share lessons learned from this consultation. We report on key lessons learned related to the themes of: 1) participant engagement, recruitment and retention, 2) validity and causal inference, and 3) study longevity. While the ultimate goal of this consultation was to inform future longitudinal biomonitoring studies in Canada, the content is largely generalizable and relevant to others planning, modifying, or evaluating observational research in reproductive and environmental epidemiology.

IntroductionPneumococcal vaccination is recommended for older adults and individuals with chronic medical conditions (CMC) due to the high risk of invasive pneumococcal disease in these groups. Despite this, vaccination coverage in Canada remains below the national target of 80%, to be achieved by 2025. We conducted a new analysis of recently released data from the Canadian Longitudinal Study on Aging (CLSA), aimed at providing estimates of pneumococcal vaccine coverage from 2018-2021 among eligible adults, identifying sociodemographic disparities, and exploring changes over time since 2015.MethodsThe CLSA, a nationally representative cohort launched in 2011, recently released data collected during the second follow-up visit (FUP2; 2018-2021). We conducted a cross-sectional analysis of participant self-reported pneumococcal vaccination status, stratified by sociodemographic characteristics, receipt of influenza vaccine in the previous 12 months, and contact with family doctor in the previous 12 months. Logistic regression was used to identify factors associated with being newly vaccinated for pneumococcal disease as reported during FUP2 compared with three years earlier during follow-up 1 (FUP1; 2015-2018). We previously reported pneumococcal vaccination estimates for 2015-2018.ResultsOnly 56.8% (95% CI: 55.8-57.7%; n = 10,530) of eligible study participants aged 65 years and older and 19.3% (95% CI: 18.1-20.5%; n = 4,055) of those aged <65 years with at least 1 chronic medical condition reported having received the pneumococcal vaccine when surveyed between 2018-2021. Males, rural residents, and individuals in certain provinces reported lower vaccination rates. Compared to three years prior, 28.4% of participants aged 65 years and older and 11% of participants aged <65 years with at least one CMC reported being newly vaccinated. Higher odds of being newly vaccinated were observed among individuals who reported having received influenza vaccination in the previous 12 months in both age groups.ConclusionsPneumococcal vaccine coverage among Canadian adults aged 65 and older enrolled in the CLSA increased by only 2% between 2015-2018 and 2018-2021, and no changes were observed among those under the age of 65 with underlying conditions.

Influenza vaccination remains one of the best tools available to prevent severe disease in individuals at high risk of influenza complications. Yet, influenza vaccination among older adults and those at high risk of severe outcomes has remained low in Canada and other countries even when the vaccine is routinely recommended. Assessing the prevalence of influenza vaccination coverage over time and factors associated with missed vaccination can provide evidence to inform efforts to improve coverage. Among adults aged ≥ 65 years and adults aged 49–64 years with one or more chronic medical condition (CMC), we aimed to (1) estimate the prevalence of missed influenza vaccination and (2) evaluate factors associated with missed vaccination using recent data from a large national survey of Canadian adults. We analyzed data collected by the Canadian Longitudinal Study on Aging during follow-up 2 from 2018 to 2021. Participants were asked to self-report whether they received an influenza vaccine in the year prior to completing the survey. We estimated the prevalence of missed vaccination overall and by participant characteristics. We assessed factors associated with missed vaccination using logistic regression and report adjusted odds ratios among adults aged ≥ 65 years and adults aged 49–64 years with ≥ 1 CMC. Among the 18,894 participants surveyed, 27.0

Objectives: Involuntary exit from the labor force can lead to poor health and well-being outcomes. Therefore, the purpose of this research is to better understand the factors that contribute to perceived retirement voluntariness. Methods: We conducted descriptive and multivariable logistic regression analyses using a sample of recent retirees (n = 2080) from the Canadian Longitudinal Study on Aging (CLSA). Results: More than one-quarter (28%) of older workers perceived their retirement to be involuntary. Among 37 possible predictors, 14 directly predicted retirement voluntariness and many more indirectly predicted retirement voluntariness. Only four direct predictors were common to both women and men, retiring because of organizational restructuring/job elimination; disability, health, or stress; financial possibility; and having wanted to stop working. Discussion: Findings suggest the need for employment support, health promotion, work disability prevention, financial education, and support that is sensitive to the differences between women and men to prevent involuntary retirement.

Epigenetic age is a biological metric of overall health and may predict mental health responses to unprecedented stressors. We sought to determine whether epigenetic age acceleration can predict older adults' trajectory of depressive symptoms before and during the COVID-19 pandemic, and whether sex differences exist. Data from baseline (2012-2015), first follow-up (2015-2018), and COVID-19 Baseline survey (April-May 2020) and COVID-19 Exit survey (September-December 2020) of the Canadian Longitudinal Study on Aging were used. Epigenetic age was measured at the study baseline, and depressive symptoms were assessed at each of the four time points using the 10-item Center for Epidemiological Studies Depression Scale (CESD-10). Sex-stratified mixed linear models examined the effect of epigenetic age (measured by DNAmAge and Hannum Age) on changes in CESD-10. The mean participant chronological age at study entry was 63±10 years (46% female). Unexpectedly, younger epigenetic age predicted increases in depressive symptoms from first follow-up to COVID-19 Baseline survey (p's < 0.05) in females only. Higher epigenetic age was not related to changes in CES-10 score during that time period (p's > 0.05). These findings suggest epigenetic age is a biological factor that can identify females at risk for greater negative effects of major life stressors on mental health.

BACKGROUND:The COVID-19 pandemic may have negatively impacted cognition due to pandemic-associated changes in 24-h movement behaviours (i.e., physical activity, sedentary behaviour, and sleep). Whether the pandemic's effects vary by age and sex is unclear. METHODS:We examined those participants (aged 45-85 years) of the Canadian Longitudinal Study on Aging (CLSA) with complete neuropsychological measures at baseline (2011-2015), no dementia/memory disorder, and partial or complete assessments at baseline, 3-year (FU1; 2015-2018), and 6-year follow-up (FU2; 2018-2021). Participants were categorized into pre-pandemic (N = 6174) or intra-pandemic (N = 5181) cohorts by FU2 assessment timing (before/after March 11th, 2020) and stratified by baseline age/sex. Cognition was measured with reliable change indices using: the Rey Auditory-Verbal Learning Test, Mental Alternation Test (MAT), and animal fluency. We indexed physical activity and sedentary behaviour using the Physical Activity Scale for the Elderly (PASE), and self-reported restless sleep. FINDINGS:Compared with their pre-pandemic peers, intra-pandemic men aged 65-85 years had lower animal fluency (-0.40 points, 99 % CI: [-0.72, -0.07]), lower PASE (-16.48 points, 99 % CI: [-24.60, -8.36]) and 14 % higher probability of ≥4 h/day sedentary behaviour (99 % CI: [0.03, 0.26]) at FU2. Intra-pandemic women aged 65-85 years had lower MAT (-0.43 points, 99 % CI: [-0.86, -0.01]) and 12 % higher probability of ≥4 h/day sedentary behaviour (99 % CI: [0.01, 0.23]). There were no between-cohort differences for those aged 45-64 years. Pandemic-related changes in 24-h movement behaviours (FU1 to FU2) were not associated with cognitive changes, regardless of age or sex. INTERPRETATION:The pandemic's effects on cognition and 24-h movement behaviours varied by age and sex; these effects are unrelated.

Background Mitigation of environmental risk factors for neurocognitive disorders could reduce the number of incident cases. We sought to synthesize the literature on environmental risk factors for dementia and mild cognitive impairment. Methods We conducted an umbrella review and meta-analysis. Multiple databases were systematically searched to identify systematic reviews and meta-analyses of longitudinal studies examining environmental risk factors for dementia or mild cognitive impairment. We used random effects multi-level, meta-analytic models to synthesize risk ratios for each risk factor while accounting for overlap in the studies within reviews. As a secondary objective, we examined risk factors for two common phenotypes of dementia: Alzheimer’s disease dementia and vascular dementia. Results A total of 19 reviews containing 37 meta-analyses were included umbrella review. We found 9 factors where exposure was associated with higher risks of all-cause dementia: fine particulate matter, particulate matter, nitrogen dioxide, nitrogen oxides, carbon monoxide, shift work, night shift work, chronic noise, and extremely-low frequency magnetic fields. Neighbourhood greenness was associated with a lower risk of all-cause dementia. In a narrative review, we found that exposure to sulfur dioxide, proximity to roadways, ionizing radiation, aluminum, solvents, pesticides, and environmental tobacco smoke were also associated with dementia. We also found that fine particulate matter, extremely-low frequency magnetic fields, sulfur dioxide, chronic noise, and pesticides were related to Alzheimer’s disease dementia. Fine particulate matter, particulate matter, and chronic noise were related to vascular dementia. No systematic review reported on mild cognitive impairment. Conclusion Achieving stronger air quality targets has the potential to reduce population-level dementia risk. Neighbourhood (i.e., greenness and chronic noise) and occupational (i.e., shift work) characteristics are associated with dementia and are viable public health intervention points. Additional research should examine the relationship between other environmental risk factors and mild cognitive impairment and specific types of dementia.

INTRODUCTION:Research on the health of older Veterans in Canada is an emerging area. Few population-based studies in Canada have included older Veterans as a specific group of interest. This paper describes a cohort of self-identified Veterans within the Canadian Longitudinal Study on Aging (CLSA). MATERIALS AND METHODS:Using data from the CLSA baseline assessment (2011-2015), we describe sociodemographic and health characteristics along with military-related variables in a cohort of Veterans in Canada. We also estimate the number of Canadian and non-Canadian Veterans living in Canada at the time of the CLSA baseline data collection. RESULTS:We estimate that at the CLSA baseline, there were 718,893 (95% confidence interval [CI], 680,033-757,110) Canadian Veterans and 185,548 (95% CI, 165,713-205,100) non-Canadian Veterans aged 45-85 years living in Canada. Veterans were older and predominantly male compared to non-Veterans in the CLSA. Following age and sex adjustment, the distribution of sociodemographic and health characteristics was similar across all groups. The majority (> 85%) of participants in each comparison group reported self-rated general and mental health as excellent, very good, or good. Following age and sex adjustment, most characteristics across groups remained similar. One exception was mental health, where a greater proportion of Veterans screened positive for depression and anxiety relative to non-Veterans. CONCLUSIONS:Using CLSA baseline data, we estimate the number of older Veterans in Canada and present descriptive data that highlight interesting differences and similarities between Veterans and non-Veterans living in Canada. Canadian and non-Canadian Veterans in the CLSA are presented separately, with the latter group having not been previously studied in Canada. This paper presents a snapshot of a cohort of self-identified Veterans within the CLSA at study baseline and highlights the potential of the CLSA as a vehicle for studying the aging Veteran population in Canada for years to come.

This study aimed to develop an efficient data collection and curation process for all drugs and natural health products (NHPs) used by participants to the Canadian Longitudinal Study on Aging (CLSA). The three-step sequential process consisted of (a) mapping drug inputs collected through the CLSA to the Health Canada Drug Product Database (DPD), (b) algorithm recoding of unmapped drug and NHP inputs, and (c) manual recoding of unmapped drug and NHP inputs. Among the 30,097 CLSA comprehensive cohort participants, 26,000 (86.4%) were using a drug or an NHP with a mean of 5.3 (SD 3.8) inputs per participant user for a total of 137,366 inputs. Of those inputs, 70,177 (51.1%) were mapped to the Health Canada DPD, 20,729 (15.1%) were recoded by algorithms, and 44,108 (32.1%) were manually recoded. The Direct algorithm correctly classified 99.4 per cent of drug inputs and 99.5 per cent of NHP inputs. We developed an efficient three-step process for drug and NHP data collection and curation for use in a longitudinal cohort.

As the COVID-19 pandemic impacted mental health, this longitudinal study examined the effect of age-friendly communities (AFC) action plan on older adults’ depressive symptoms. Using the CLSA, the CLSA COVID-19 Questionnaire study, survey of Canadian municipalities, and the census, the depressive symptoms trajectories were modeled with multilevel multinomial regressions. Most respondents (66.1%) had non-depressed trajectories, 28.1% experienced a moderate increase in depressive symptoms, and 5.8% had a depressed trajectory. AFC action plans did not have a protective effect on these trajectories. Being a female, greater loneliness, lower income, ≥2 chronic conditions, inferior social participation, weaker sense of belonging, COVID-19 infection, and pandemic stressors predicted a depressed trajectory. Neighborhood’s deprivation had a weak protective effect on the declining trajectory. Although AFC action plans provided no benefits during the pandemic, volunteers facilitating resource access and social interactions could limit any increase in depressive symptoms.

Abstract Background Influenza vaccination is recommended for those at increased risk of influenza complications and their household contacts to help reduce influenza exposure. Adults who require care often experience health issues that could increase the risk of severe influenza and have close contact with caregivers. Assessing influenza vaccination prevalence in caregivers and care recipients can provide important information about uptake. Objectives We aimed to (1) estimate influenza non-vaccination prevalence and (2) assess factors associated with non-vaccination among caregivers aged ≥ 45 years and among care recipients aged ≥ 65 years. Methods We conducted an analysis of cross-sectional data from the Canadian Longitudinal Study on Aging collected 2015–2018. We estimated non-vaccination prevalence and reported adjusted odds ratios with 95% confidence intervals from logistic regression models to identify factors associated with non-vaccination among caregivers and care recipients. Results Of the 23,500 CLSA participants who reported providing care, 41.4% (95% CI: 40.8%, 42.0%) reported not receiving influenza vaccine in the previous 12 months. Among the 5,559 participants who reported receiving professional or non-professional care, 24.8% (95% CI: 23.7%, 26.0%) reported not receiving influenza vaccine during the same period. For both groups, the odds of non-vaccination were higher for those who had not visited a family doctor in the past year, were daily smokers, and those who identified as non-white. Discussion Identifying groups at high risk of severe influenza and their close contacts can inform public health efforts to reduce the risk of influenza. Our results suggest sub-optimal influenza vaccination uptake among caregivers and care recipients. Efforts are needed to increase influenza vaccination and highlight the direct and indirect benefits for caregiver-care recipient pairs. Conclusion The proportions of both caregivers and care recipients who had not been vaccinated for influenza was high, despite the benefits of vaccination. Influenza vaccination campaigns could target undervaccinated, high-risk groups to increase coverage.

INTRODUCTION:The prevalence of mild and major neurocognitive disorders (NCDs), also referred to as mild cognitive impairment and dementia, is rising globally. The prevention of NCDs is a major global public health interest. We sought to synthesize the literature on potentially modifiable risk factors for NCDs.METHODS:We conducted an umbrella review using a systematic search across multiple databases to identify relevant systematic reviews and meta-analyses. Eligible reviews examined potentially modifiable risk factors for mild or major NCDs. We used a random-effects multi-level meta-analytic approach to synthesize risk ratios for each risk factor while accounting for overlap in the reviews. We further examined risk factors for major NCD due to two common etiologies: Alzheimer's disease and vascular dementia.RESULTS:A total of 45 reviews with 212 meta-analyses were synthesized. We identified fourteen broadly defined modifiable risk factors that were significantly associated with these disorders: alcohol consumption, body weight, depression, diabetes mellitus, diet, hypertension, less education, physical inactivity, sensory loss, sleep disturbance, smoking, social isolation, traumatic brain injury, and vitamin D deficiency. All 14 factors were associated with the risk of major NCD, and five were associated with mild NCD. We found considerably less research for vascular dementia and mild NCD.CONCLUSION:Our review quantifies the risk associated with 14 potentially modifiable risk factors for mild and major NCDs, including several factors infrequently included in dementia action plans. Prevention strategies should consider approaches that reduce the incidence and severity of these risk factors through health promotion, identification, and early management.

Abstract An unintended side-effect of the COVID-19 pandemic has been changes in lifestyle factors which impact middle-aged and older adult cognition – including changes in 24-hour behaviours (i.e., physical activity, sedentary behaviour, and sleep). In a longitudinal analysis of the Canadian Longitudinal Study on Aging (CLSA) tracking cohort, we explored age- and sex-differences in the effects of the COVID-19 pandemic on cognition and 24-hour behaviours, and whether pandemic-related changes in 24-hour behaviours and cognition are associated. We included cognitively healthy participants at baseline (2012-2105), follow-up 1 (FU1; 2015-2018), and follow-up 2 (FU2; 2018-2021), with complete neuropsychological testing data (N=11,355). Cognition and 24-hour behaviours were indexed at each timepoint. Participants were categorized into pre-pandemic (N=6,174) and post-pandemic (N=5,181) cohorts based on whether FU2 assessments occurred before or after COVID-19 pandemic onset (March 11th, 2020). We examined time x cohort changes in cognition and 24-hour behaviours from FU1 to FU2, and if changes in 24-hour behaviours from FU1 to FU2 were associated with changes in cognition. All models were allowed to vary by age and sex. Our results indicated that post-pandemic cohort males and females aged 65+ years had significantly worse cognition and poorer 24-hour behaviours from FU1 to FU2 than their peers in the pre-pandemic cohort (p’s< 0.05). However, changes in 24-hour behaviours from FU1 to FU2 were unassociated with changes in cognition, irrespective of age or sex. Our results highlight that the pandemic negatively impacted 24-hour behaviours and cognition in older adults – although these effects may be unassociated with each other.

The current diagnostic criteria for depression do not sufficiently reflect its heterogeneous clinical presentations. Associations between adverse childhood experiences (ACEs), allostatic load (AL), and depression subtypes have not been extensively studied. Depression subtypes were determined based on clinical presentations, and their relationships to AL biomarkers and ACEs were elucidated in a sample of middle-aged and older adults. Participants from the Canadian Longitudinal Study on Aging who screened positive for depression were included (n=3966). Depression subtypes, AL profiles and ACE profiles were determined with latent profile analyses, and associations between them were determined using multinomial logistic regression. Four depression subtypes were identified: positive affect, melancholic, typical, and atypical. Distinct associations between depression subtypes, stressor profiles and covariates were observed. Among the subtypes compared to positive affect, atypical subtype had the most numerous significant associations, and the subtypes had unique relationships to stressor profiles. Age, sex, smoking status, chronic conditions, marital status, and physical activity were significant covariates. The present study describes distinct associations between depression subtypes and measures of stress (objective and self-reported), as well as related factors that differentiate subtypes. The findings may inform more targeted and integrated clinical management strategies for depression in individuals exposed to multiple stressors.

We investigated the prevalence and population attributable fraction (PAF) of 12 potentially modifiable risk factors for dementia in middle-aged and older Canadians. We conducted a cross-sectional study of 30,097 adults aged 45 to 85 with baseline data from the Canadian Longitudinal Study on Aging (2011‒2015). Risk factors and associated relative risks were taken from a highly cited systematic review. We calculated the prevalence of each risk factor using sampling weights. Individual PAFs were calculated both crudely and weighted for communality, and combined PAFs were calculated using both multiplicative and additive assumptions. Analyses were stratified by household income and repeated at CLSA’s first follow-up (2015‒2018). The most prevalent risk factors were physical inactivity (63.8

Background Older adults have been disproportionately impacted by COVID-19 and related preventative measures undertaken during the pandemic. Given clear evidence of the relationship between loneliness and health outcomes, it is imperative to better understand if, and how, loneliness has changed for older adults during the COVID-19 pandemic, and whom it has impacted most. Method We used “pre-pandemic” data collected between 2015–2018 ( n = 44,817) and “during pandemic” data collected between Sept 29-Dec 29, 2020 ( n = 24,114) from community-living older adults participating in the Canadian Longitudinal Study on Aging. Loneliness was measured using the 3-item UCLA Loneliness Scale. Weighted generalized estimating equations estimated the prevalence of loneliness pre-pandemic and during the pandemic. Lagged logistic regression models examined individual-level factors associated with loneliness during the pandemic. Results We found the adjusted prevalence of loneliness increased to 50.5% (95% CI: 48.0%-53.1%) during the pandemic compared to 30.75% (95% CI: 28.72%-32.85%) pre-pandemic. Loneliness increased more for women (22.3% vs. 17.0%), those in urban areas (20.8% vs. 14.6%), and less for those 75 years and older (16.1% vs. 19.8% or more in all other age groups). Loneliness during the pandemic was strongly associated with pre-pandemic loneliness (aOR 4.87; 95% CI 4.49–5.28) and individual level sociodemographic factors [age < 55 vs. 75 + (aOR 1.41; CI 1.23–1.63), women (aOR 1.34; CI 1.25–1.43), and no post-secondary education vs. post-secondary education (aOR 0.73; CI 0.61–0.86)], living conditions [living alone (aOR 1.39; CI 1.27–1.52) and urban living (aOR 1.18; CI 1.07–1.30)], health status [depression (aOR 2.08; CI 1.88–2.30) and having two, or ≥ three chronic conditions (aOR 1.16; CI 1.03–1.31 and aOR 1.34; CI 1.20–1.50)], health behaviours [regular drinker vs. non-drinker (aOR 1.15; CI 1.04–1.28)], and pandemic-related factors [essential worker (aOR 0.77; CI 0.69–0.87), and spending less time alone than usual on weekdays (aOR 1.32; CI 1.19–1.46) and weekends (aOR 1.27; CI 1.14–1.41) compared to spending the same amount of time alone]. Conclusions As has been noted for various other outcomes, the pandemic did not impact all subgroups of the population in the same way with respect to loneliness. Our results suggest that public health measures aimed at reducing loneliness during a pandemic should incorporate multifactor interventions fostering positive health behaviours and consider targeting those at high risk for loneliness.

Background Prevalence of overall cognitive impairment based on each participant’s performance across a neuropsychological battery is challenging; consequently, we define and validate a dichotomous cognitive impairment/no cognitive indicator (CII) using a neuropsychological battery administered in a population-based study. This CII approximates the clinical practice of interpretation across a neuropsychological battery and can be applied to any neuropsychological dataset. Methods Using data from participants aged 45–85 in the Canadian Longitudinal Study on Aging receiving a telephone-administered neuropsychological battery (Tracking, N = 21,241) or a longer in-person battery (Comprehensive, N = 30,097), impairment was determined for each neuropsychological test based on comparison with normative data. We adjusted for the joint probability of abnormally low scores on multiple neuropsychological tests using baserates of low scores demonstrated in the normative samples and created a dichotomous CII (i.e., cognitive impairment vs no cognitive impairment). Convergent and discriminant validity of the CII were assessed with logistic regression analyses. Results Using the CII, the prevalence of cognitive impairment was 4.3% in the Tracking and 5.0% in the Comprehensive cohorts. The CII demonstrated strong convergent and discriminant validity. Conclusions The approach for the CII is a feasible method to identify participants who demonstrate cognitive impairment on a battery of tests. These methods can be applied in other epidemiological studies that use neuropsychological batteries.