Social Contact Mode and 15-Year Episodic Memory Trajectories in Older Adults With and Without Hearing Loss: Findings From the English Longitudinal Study of Ageing.

OBJECTIVES: Frequent social contact benefits cognition in later life although evidence is lacking on the potential relevance of the modes chosen by older adults, including those living with hearing loss, for interacting with others in their social network. METHOD: 11,418 participants in the English Longitudinal Study of Ageing provided baseline information on hearing status and social contact mode and frequency of use. Multilevel growth curve models compared episodic memory (immediate and delayed recall) at baseline and longitudinally in participants who interacted frequently (offline only or offline and online combined), compared to infrequently, with others in their social network. RESULTS: Frequent offline (B = 0.23; SE = 0.09) and combined offline and online (B = 0.71; SE = 0.09) social interactions predicted better episodic memory after adjustment for multiple confounders. We observed positive, longitudinal associations between combined offline and online interactions and episodic memory in participants without hearing loss (B = 0.50, SE = 0.11) but not with strictly offline interactions (B = 0.01, SE = 0.11). In those with hearing loss, episodic memory was positively related to both modes of engagement (offline only: B = 0.79, SE = 0.20; combined online and offline: B = 1.27, SE = 0.20). Sensitivity analyses confirmed the robustness of these findings. DISCUSSION: Supplementing conventional social interactions with online communication modes may help older adults, especially those living with hearing loss, sustain, and benefit cognitively from, personal relationships.

Positive and negative well-being of older adults with symptomatic peripheral artery disease: A population-based investigation.

OBJECTIVE: We investigated positive and negative subjective well-being in relation to lower-extremity peripheral artery disease (PAD) in a sample of older adults. METHOD: 4760 participants in the English Longitudinal Study of Ageing (ELSA) provided baseline data on symptomatic PAD, sociodemographic characteristics, lifestyle risk factors, and co-morbid conditions. Baseline and two-year follow-up data were available for life satisfaction, quality of life, and depressive symptoms. RESULTS: Participants with PAD symptoms had lower baseline levels of life satisfaction (ß = -0.03, p < .05) and quality of life (ß = -0.04, p < .01), and more depressive symptoms (ß = 0.03, p < .05). These associations remained statistically significant in multivariate analyses. Baseline PAD did not, however, influence well-being levels at two-year follow-up. DISCUSSION: Greater awareness of the potential for chronic vascular morbidity to disrupt the lives of older adults is needed to inform effective multidisciplinary support and interventions that help maintain the quality of life of those affected.

Loneliness, Social Integration, and Incident Dementia Over 6 Years: Prospective Findings From the English Longitudinal Study of Ageing.

OBJECTIVES: Social relationships are important for the maintenance of cognitive function at older ages, with both objective features of social networks and perceived social connections (loneliness) being relevant. There is limited evidence about how different aspects of social experience predict diagnosed dementia. METHODS: The sample comprised 6,677 dementia-free individuals at baseline (2004) from the English Longitudinal Study of Ageing. Baseline information on loneliness, number of close relationships, marital status, and social isolation (contact with family and friends and participation in organizations) was analyzed in relation to incident dementia over an average 6.25 years using Cox regression, controlling for potential confounding factors. RESULTS: Two hundred twenty participants developed dementia during follow-up. In multivariable analyses, dementia risk was positively related to greater loneliness (hazard ratio 1.40, 95% confidence interval 1.09-1.80, p = .008), and inversely associated with number of close relationships (p < .001) and being married (p = .018). Sensitivity analyses testing for reverse causality and different criteria for diagnosing dementia confirmed the robustness of these findings. There was no association with social isolation. DISCUSSION: Dementia risk is associated with loneliness and having fewer close relationships in later life. The underlying mechanisms remain to be elucidated, but efforts to enhance older peoples' relationship quality may be relevant to dementia risk.

Is use of the internet in midlife associated with lower dementia incidence? Results from the English Longitudinal Study of Ageing.

OBJECTIVES: Dementia is expected to affect one million individuals in the United Kingdom by 2025; its prodromal phase may start decades before its clinical onset. The aim of this study is to investigate whether use of internet from 50 years of age is associated with a lower incidence of dementia over a ten-year follow-up. METHODS: We analysed data based on 8,238 dementia free (at baseline in 2002-2004) core participants from the English Longitudinal Study of Ageing. Information on baseline use of internet was obtained through questionnaires; dementia casesness was based on participant (or informant) reported physician diagnosed dementia or overall score on the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Cox proportional hazards regression analysis was used for examining the relationship between internet use and incident dementia. RESULTS: There were 301 (5.01%) incident dementia cases during the follow-up. After full multivariable adjustment for potential confounding factors, baseline internet use was associated with a 40% reduction in dementia risk assessed between 2006-2012 (HR = 0.60 CI: 0.42-0.85; p < 0.05). CONCLUSION: This study suggests that use of internet by individuals aged 50 years or older is associated with a reduced risk of dementia. Additional studies are needed to better understand the potential causal mechanisms underlying this association.

Positive and Negative Experiences of Social Support and Risk of Dementia in Later Life: An Investigation Using the English Longitudinal Study of Ageing.

BACKGROUND: Having a network of close relationships may reduce the risk of developing dementia. However, social exchange theory suggests that social interaction entails both rewards and costs. The effects of quality of close social relationships in later life on the risk of developing dementia are not well understood. OBJECTIVE: To investigate the effects of positive and negative experiences of social support within key relationships (spouse or partner, children, other immediate family, and friends) on the risk of developing dementia in later life. METHODS: We analyzed 10-year follow up data (2003/4 to 2012/13) in a cohort of 10,055 dementia free (at baseline) core participants aged 50 years and over from the English Longitudinal Study of Ageing (ELSA). Incidence of dementia was identified from participant or informant reported physician diagnosed dementia or overall score of informant-completed IQCODE questionnaire. Effects of positive and negative experiences of social support measured at baseline on risk of developing dementia were investigated using proportional hazards regression accommodating interval censoring of time-to-dementia. RESULTS: There were 340 (3.4%) incident dementia cases during the follow-up. Positive social support from children significantly reduced the risk of dementia (hazard ratio, HR = 0.83, p = 0.042, 95% CI: 0.69 to 0.99). Negative support from other immediate family (HR = 1.26, p = 0.011, CI: 1.05 to 1.50); combined negative scores from spouse and children (HR = 1.23, p = 0.046, CI: 1.004 to 1.51); spouse, children, and other family (HR = 1.27, p = 0.021, CI = 1.04 to 1.56); other family & friends (HR = 1.25, p = 0.033, CI: 1.02 to 1.55); and the overall negative scores (HR = 1.31, p = 0.019, CI: 1.05 to 1.64) all were significantly associated with increased risk of dementia. CONCLUSION: Positive social support from children is associated with reduced risk of developing dementia whereas experiences of negative social support from children and other immediate family increase the risk. Further research is needed to better understand the causal mechanisms that drive these associations.

Association of Adherence to a Healthy Diet with Cognitive Decline in European and American Older Adults: A Meta-Analysis within the CHANCES Consortium.

AIM: To examine the association between a healthy diet, assessed by the Healthy Diet Indicator (HDI), and cognitive decline in older adults. METHODS: Data from 21,837 participants aged ≥55 years from 3 cohorts (Survey in Europe on Nutrition and the Elderly, a Concerted Action [SENECA], Rotterdam Study [RS], Nurses' Health Study [NHS]) were analyzed. HDI scores were based on intakes of saturated fatty acids, polyunsaturated fatty acids, mono- and disaccharides, protein, cholesterol, fruits and vegetables, and fiber. The Telephone Interview for Cognitive Status in NHS and Mini-Mental State Examination in RS and SENECA were used to assess cognitive function from multiple repeated measures. Using multivariable-adjusted, mixed linear regression, mean differences in annual rates of cognitive decline by HDI quintiles were estimated. RESULTS: Multivariable-adjusted differences in rates in the highest versus the lowest HDI quintile were 0.01 (95% CI -0.01, 0.02) in NHS, 0.00 (95% CI -0.02, 0.01) in RS, and 0.00 (95% CI -0.05, 0.05) in SENECA with a pooled estimate of 0.00 (95% CI -0.01, 0.01), I2 = 0%. CONCLUSIONS: A higher HDI score was not related to reduced rates of cognitive decline in European and American older adults.

Informal caregiving transitions, subjective well-being and depressed mood: Findings from the English Longitudinal Study of Ageing.

OBJECTIVES: To prospectively investigate the impact of transitions in informal caregiving on emotional well-being over two years in a large population study of older people. METHODS: Information on provision of unpaid care in 2004/2005 and 2006/2007 was available for 6571 participants in the English Longitudinal Study of Ageing. Three well-being domains were also assessed on each occasion: life satisfaction (measured with the Satisfaction with Life Scale); quality of life (assessed with the CASP-19 scale); and depression symptoms (measured using the Centers for Epidemiologic Studies Depression Scale). Multivariable analyses of the impact on well-being of two-year caregiving transitions (caregiving entry and caregiving exit, or continued caring) were conducted separately for spousal/child carers and carers of other family/non-relatives. RESULTS: Compared to non-caregiving, entry into spousal/child caregiving was associated with decline in quality of life (B = -1.60, p < .01) whereas entry into caregiving involving other kin relations increased life satisfaction (B = 1.02, p < .01) and lowered depression symptoms (B = -0.26, p < .05). Contrary to expectations, caregiving exit was related to increased depression in both spousal/child (B = 0.44, p < .01) and non-spousal/child (B = 0.25, p < .05) carers. Continued spousal/child caregiving was also related to decline in quality of life (B = -1.24, p < .05). Other associations were suggestive but non-significant. CONCLUSION: The emotional impact of different caregiving transitions in later life differs across kin relationships; notably, spousal and child carers' well-being was consistently compromised at every stage of their caregiving career over the two-year study period.

Longitudinal Influences of Social Network Characteristics on Subjective Well-Being of Older Adults: Findings From the ELSA Study.

OBJECTIVE: To investigate the influence of social network characteristics on subjective well-being over 6 years in a population sample of older adults. METHOD: A total of 4,116 participants in the English Longitudinal Study of Aging provided baseline data on social network characteristics and potential confounding factors, and complete follow-up data on 2 measures of subjective well-being. RESULTS: Social network size and network contact frequency were positively and independently associated with future life satisfaction and quality of life after controlling for confounding factors, including demographic characteristics, socioeconomic factors, and long-standing illness. In contrast, social network diversity was not independently related to future subjective well-being. CONCLUSION: Different aspects of people's social networks may help sustain levels of subjective well-being in older age. The role of close relationships and frequent contact in later life may be particularly important. These results highlight the need for examining different aspects of social networks for promoting well-being of older people.

Longitudinal associations between social connections and subjective wellbeing in the English Longitudinal Study of Ageing.

OBJECTIVE: The role of social relationships in determining well-being may be particularly salient in ageing populations. There is only limited longitudinal research examining the relationship between different dimensions of social relationships and change in well-being over time. The present analysis explores the association between isolation, loneliness and two measures of subjective well-being over six years using data from the English Longitudinal Study of Ageing. DESIGN: Measures of social relationships were obtained at baseline and associations with well-being over the following six years were analysed using mixed models. MAIN OUTCOME MEASURES: Hedonic and evaluative well-being assessed every two years over the six-year period. RESULTS: Levels of well-being showed a U-shaped relationship with time. At baseline, higher isolation and loneliness were associated with lower levels of hedonic and evaluative well-being. Individuals with high levels of isolation and loneliness initially showed a smaller decrease in evaluative well-being. The subsequent rise in well-being was, however, also diminished in this group. In contrast, loneliness was not associated with rate of change in hedonic well-being, while high levels of isolation were associated with a sustained decrease in hedonic well-being. CONCLUSION: Social isolation and loneliness show different associations with changes in evaluative and hedonic well-being over time.

Antioxidant nutrients and age-related cognitive decline: a systematic review of population-based cohort studies.

PURPOSE: To further inform the debate on the possible cognitive benefits of antioxidant nutrients in the elderly, we systematically reviewed available prospective studies while paying a special attention to their methodological quality. METHODS: This is a systematic review of studies involving major antioxidant nutrients and change in cognitive performance. Abstracts were independently reviewed; studies were selected based on prespecified criteria. Methodological quality of primary studies was assessed using a methodological checklist for cohort studies. Findings were presented using a narrative synthesis and tabulation of results. RESULTS: Eight-hundred and fifty potentially eligible studies were identified; 10 met the inclusion criteria and were retained for data extraction and appraisal. The main supportive evidence came from two studies, both judged to be of high quality: The first observed an accelerated decline in global cognition, attention, and psychomotor speed over 9 years, concomitant to a decrease in plasma selenium levels over the same period; the second study reported a slower rate of global cognitive decline over 3 years in persons in the highest quartile of intake of vitamins C, E, and carotenes. All associations persisted after adjustment for confounding factors. Evidence in favor of beneficial associations of higher dietary intake of vitamin E and flavonoids, as well as higher serum beta carotene levels, came from further studies of only adequate quality. CONCLUSIONS: There is a possibility for protective effects of antioxidant nutrients against decline in cognition in older people although the supportive evidence is still limited in number. This association deserves further examination in additional quality investigations.

Assessing available information on the burden of sepsis: global estimates of incidence, prevalence and mortality.

OBJECTIVE: Sepsis is a complex and hard-to-define condition with many different interactions with other disorders. Presently, there are no estimates of the burden of sepsis and septicaemia at the global level and it was not included in the initial Global Burden of Disease study. Non-maternal sepsis has only recently received attention as a substantial global public health problem. The aim of this study was to assess available data on the burden of non-maternal sepsis, severe sepsis and septic shock in the community and to identify key gaps in information needed to estimate the global burden of sepsis. METHODS: Literature review of English language-based studies reporting on the incidence, prevalence, mortality or case-fatality of sepsis, severe sepsis and septic shock. The available literature was searched using the MEDLINE database of citations and abstracts of biomedical research articles published between 1980 and 2008. FINDINGS: 8 studies reported incidence of sepsis, severe sepsis or septic shock at the national level (4 from the USA and 1 from Brazil, the UK, Norway and Australia). No studies on the incidence, prevalence, mortality or case-fatality from sepsis in developing countries were found. The population sepsis incidence ranged from 22 to 240/100 000 (most plausible estimates ranged from 149 to 240/100 000); of severe sepsis from 13 to 300/100 000 (most of the estimates were between 56 and 91/100 000); and of septic shock 11/100 000. Case-fatality rate depends on the setting and severity of disease. It can reach up to 30% for sepsis, 50% for severe sepsis and 80% for septic shock. While the data were compiled using strict inclusion and exclusion criteria, a degree of uncertainty still exists regarding the reported estimates. CONCLUSION: The few national-level reports available allow only a very crude estimation of the incidence of sepsis in developed countries while there is apparent lack of data from developing countries. A clear and universal definition of sepsis as well as the development of a sound epidemiological framework to begin addressing the magnitude of this problem is urgently needed through research in developing countries.

Prediagnostic concentrations of plasma genistein and prostate cancer risk in 1,605 men with prostate cancer and 1,697 matched control participants in EPIC.

PURPOSE: Data from prospective epidemiological studies in Asian populations and from experimental studies in animals and cell lines suggest a possible protective association between dietary isoflavones and the development of prostate cancer. We examined the association between circulating concentrations of genistein and prostate cancer risk in a case-control study nested in the European Prospective Investigation into Cancer and Nutrition. METHODS: Concentrations of the isoflavone genistein were measured in prediagnostic plasma samples for 1,605 prostate cancer cases and 1,697 matched control participants. Relative risks (RRs) for prostate cancer in relation to plasma concentrations of genistein were estimated by conditional logistic regression. RESULTS: Plasma genistein concentrations were not associated with prostate cancer risk; the multivariate relative risk for men in the highest fifth of genistein compared with men in the lowest fifth was 1.00 (95 % confidence interval: 0.79, 1.27; p linear trend = 0.82). There was no evidence of heterogeneity in this association by age at blood collection, country of recruitment, or cancer stage or histological grade. CONCLUSION: Plasma genistein concentration was not associated with prostate cancer risk in this large cohort of European men.

Migrant mortality from diabetes mellitus across Europe: the importance of socio-economic change.

The first objective of this study was to determine and quantify variations in diabetes mortality by migrant status in different European countries. The second objective was to investigate the hypothesis that diabetes mortality is higher in migrant groups for whom the country of residence (COR) is more affluent than the country of birth (COB). We obtained mortality data from 7 European countries. To assess migrant diabetes mortality, we used direct standardization and Poisson regression. First, migrant mortality was estimated for each country separately. Then, we merged the data from all mortality registers. Subsequently, to examine the second hypothesis, we introduced gross domestic product (GDP) per capita of COB in the models, as an indicator of socio-economic circumstances. The overall pattern shows higher diabetes mortality in migrant populations compared to local-born populations. Mortality rate ratios (MRRs) were highest in migrants originating from either the Caribbean or South Asia. MRRs for the migrant population as a whole were 1.9 (95% CI 1.8-2.0) and 2.2 (95% CI 2.1-2.3) for men and women respectively. We furthermore found a consistently inverse association between GDP of COB and diabetes mortality. Most migrant groups have higher diabetes mortality rates than the local-born populations. Mortality rates are particularly high in migrants from North Africa, the Caribbean, South Asia or low-GDP countries. The inverse association between GDP of COB and diabetes mortality suggests that socio-economic change may be one of the key aetiological factors.