Caregiving centenarians: Cross-national comparison in Caregiver-Burden between the United States and Japan.

Background and Objectives: The personal distress associated with caring for a family member has been well documented; however, questions about the burden of caregiving for centenarians and cross-national differences in the caregiving context, remain unanswered.Research Design and Methods: This study includes reports by caregivers of 538 near-centenarians and centenarians in the U.S. and Japan: 234 from the Georgia Centenarian Study and 304 from the Tokyo Centenarian Study. Basic descriptive and multivariate regression analyses were conducted. Mean levels of caregiver burden and near-centenarian and centenarians' characteristics (as predictors) for caregiver burden were compared between the U.S. and Japan. The near-centenarian and centenarians' functional capacity and personality were assessed as predictors.Results: Differential predictive patterns in caregiver burden were found in the two groups. In the U.S., near-centenarian and centenarians' agreeableness and conscientiousness were negatively associated with caregiver burden; whereas the near-centenarian and centenarians' neuroticism and number of diseases were positively associated with caregiver burden. In Japan, the near-centenarian and centenarians' activities of daily living, openness, and agreeableness were negatively associated with caregiving burden. Interaction effects between functional capacity and personality, on caregiver burden were observed only in the U.S. In the U.S., higher levels of agreeableness and openness significantly changed the level of caregiver burden associated with vision problems and a greater number of diseases.Discussion and Implications: Cross-national comparative predictors of caregiving burden between the two countries emphasized that caring for centenarians should be understood in the caregiving context, as well as the social context.

Brain Α-Tocopherol Concentration is Inversely Associated with Neurofibrillary Tangle Counts in Brain Regions Affected in Earlier Braak Stages: A Cross-Sectional Finding in the Oldest Old.

Objectives: Higher vitamin E status has been associated with lower risk of Alzheimer's disease (AD). However, evidence of the association of vitamin E concentration in neural tissue with AD pathologies is limited. Design: The cross-sectional relationship between the human brain concentrations of α- and γ-tocopherol and the severity of AD pathologies - neurofibrillary tangle (NFT) and neuritic plaque (NP) - was investigated. Setting & Participants: Brains from 43 centenarians (≥ 98 years at death) enrolled in the Phase III of the Georgia Centenarian Study were collected at autopsy. Measurements: Brain α- and γ-tocopherol concentrations (previously reported) were averaged from frontal, temporal, and occipital cortices. NP and NFT counts (previously reported) were assessed in frontal, temporal, parietal, entorhinal cortices, amygdala, hippocampus, and subiculum. NFT topological progression was assessed using Braak staging. Multiple linear regression was performed to assess the relationship between tocopherol concentrations and NP or NFT counts, with and without adjustment for covariates. Results: Brain α-tocopherol concentrations were inversely associated with NFT but not NP counts in amygdala (ß = -2.67, 95% CI [-4.57, -0.79]), entorhinal cortex (ß = -2.01, 95% CI [-3.72, -0.30]), hippocampus (ß = -2.23, 95% CI [-3.82, -0.64]), and subiculum (ß = -2.52, 95% CI [-4.42, -0.62]) where NFT present earlier in its topological progression, but not in neocortices. Subjects with Braak III-IV had lower α-tocopherol (median = 69,622 pmol/g, IQR = 54,389-72,155 pmol/g) than those with Braak I-II (median = 72,108 pmol/g, IQR = 64,056-82,430 pmol/g), but the difference was of borderline significance (p = 0.063). γ-Tocopherol concentrations were not associated with either NFT or NP counts in any brain regions assessed. Conclusions: Higher brain α-tocopherol level is specifically associated with lower NFT counts in brain structures affected in earlier Braak stages. Our findings emphasize the possible importance of α-tocopherol intervention timing in tauopathy progression and warrant future clinical trials.

Long-term exercise patterns and immune function in healthy older women. A report of preliminary findings.

The purpose of this study was to examine the relationship between active versus inactive lifestyle and immunocompetence in older women. A sample of 46 independently dwelling, ambulatory and mentally alert women 60-98 years was examined, 25 who rated themselves as 'active' and 21 who rated themselves as 'inactive'. Lymphocyte subpopulations were analyzed by flow cytometry using selected monoclonal antibodies. The self-reported active subjects (also validated by their current unsolicited participation in a formal exercise class) demonstrated significantly higher percent change in CD25 mitogen stimulated lymphocytes (P = 0.0335) than those who reported themselves to be sedentary.

The information-loss model: a mathematical theory of age-related cognitive slowing.

A model of cognitive slowing is proposed with the following assumption: Information is lost during processing, processing occurs in discrete steps with step duration inversely related to the amount of information currently available, and the effect of aging is to increase the proportion of information lost per step. This model correctly predicts a positively accelerated relation between latencies of older and younger adults and provides a unified account of the effects of task complexity, practice, speed-accuracy tradeoffs, and fluctuations in individual performance. Strong support for the thesis that cognitive slowing is global, and not localized in specific age-sensitive components, is provided by the fact that the model accurately predicts the latencies of older adults on the basis of those of younger adults, without regard to the nature of the task, across a latency range of nearly 2 orders of magnitude.

Changes in alpha rhythm asymmetry during learning of verbal and visuospatial tasks.

Alpha activity in the two cortical hemispheres was examined during learning and overlearning of a verbal and a visuospatial task. Compared to a pretask baseline condition, the amount of alpha activity during the tasks was decreased. An increase in alpha activity was found from learning to overlearning in both tasks. A greater amount of alpha was found in the right hemisphere for both tasks. In addition, no difference in the degree of alpha asymmetry was found between the tasks. This was discussed in light of prior contrary findings. A significant positive correlation was found between change in learning rate and change in alpha asymmetry during the verbal task. An interpretation of this finding was offered in terms of the level of hemispheric activation reflecting the degree of task engagement.

Age-related changes in the neurologic examination of healthy sexagenarians, octogenarians, and centenarians.

Although numerous studies have focused on age-related changes in the nervous system, few have systematically assessed global neurologic examination changes, and even fewer have included the most elderly population, ie, the centenarians. To perform such a study, we developed a quantitative assessment that includes the major components of a standard bedside neurologic evaluation, with special emphasis on cognitive function. First, we demonstrated that the quantitated examination could correctly classify healthy controls and patients with stroke or dementia based on discriminant analysis. This examination was then applied to healthy community-dwelling elderly ranging from 60 to 108 years of age. Significant age-related neurobehavioral changes were apparent across even these most "successfully" aged groups. Analysis of the full pattern of cognitive and neurologic findings provided the most accurate assessment. Pathologic reflexes, reportedly associated with normal aging, occurred infrequently in this healthy geriatric population, suggesting that age-related changes in the neurologic examination may be more accurately interpreted when assessed in conjunction with cognitive status. This quantitative examination may be useful in future population-based studies of neurologic function in the aged.

Assessing neuropsychological changes in pharmacological trials.

This article outlines the reasons that detection of subtle changes in the cognitive system is difficult in geriatric assessment. A new assessment approach is introduced that examines cognitive patterns and facilitates the evaluation of subtle changes.

Metamemorial predictors of memory performance in young and older adults.

The relationship between aspects of knowledge about memory and immediate and delayed recall on prose and word-list tasks was examined. Ss were 100 young and 100 older adults. Vocabulary ability was screened. Memory knowledge was assessed by the Metamemory in Adulthood (MIA) scale and the Short Inventory of Memory Experiences (SIME). Capacity and change measures of the MIA correlated with most dimensions of the SIME for both age groups. The anxiety measure of the MIA correlated with SIME measures only for the young. Regression analyses showed that strategy (MIA) predicted performance only for young adults, change (MIA) predicted performance only for older adults, and capacity (MIA) predicted performance for both age groups. Metamemory variables accounted for equivalent amounts of variance in both prose and word-list tasks, although there was an indication that prediction was slightly better for prose. Future researchers need to address the apparent increase in affect-related predictors of memory performance.

Personality traits and states as predictors of subjective well-being in centenarians, octogenarians, and sexagenarians.

The predictability of personality for psychological well-being in centenarians when compared to sexagenarians and octogenarians was investigated. Multiple regressions were computed to examine the separate and joint effects of personality traits and states upon morale. Results indicated that low tension and high extraversion predicted high morale for centenarians. Guilt was the most important personality state predicting morale for the 60s age group, and control variables gender and health were significant for the 80s age group. The assessment of personality traits and states has important implications for working with centenarians and other older adults to maintain or improve their subjective well-being.

How much and how fast: rapid processing of spoken language in later adulthood.

Speech processing involves rapid decoding and construction of meaning from a transitory acoustic signal. Because older adults have been found to be slower in performing many cognitive tasks, we hypothesized that they may have difficulty in immediate recall for speech of increasing input rate. Two experiments are reported in which both older and younger participants listened to and immediately recalled sentences that were systematically varied in speech rate and number of propositions. Although recall performance of the older adults showed a disproportionate decline when speech rate was increased, older adults, as well as the younger adults, were able to recall sentences of increasing propositional densities. We also found that the tendency to recall a greater proportion of main ideas than details (the levels effect) was enhanced by increased propositional density, and depressed by increased speech rate and increased age. These results are discussed in terms of an age-related change in the rate at which information can be processed in working memory.

Age, variability, and speed: between-subjects diversity.

Two independent data sets were selected to examine the interrelations among reaction time (RT), between-subject variability or diversity (SD), and age. In both data sets, a strong correlation between RT and SD was obtained. This strong correlation was not affected when age was controlled in a partial correlation analysis. On the other hand, a weaker but significant correlation was obtained between age and SD. This correlation was eliminated when RT was controlled in a partial correlation analysis. Our analyses of the two data sets also indicated that the relation between RT and SD is identical for both young and elderly groups. Thus, the greater diversity often observed in performances of older groups is a direct consequence of slowing, rather than an independent effect of advancing age.

Effects of priming in word retrieval.

Three studies were carried out to investigate orthographic and semantic priming effects in word retrieval. In this paradigm a prime is presented prior to the definition of a target word. The task is to produce the target word. We view the process of word retrieval as requiring access from a conceptually organized semantic network to an orthographically and phonemically organized lexical network. Primes that were orthographically (and phonemically) related to the target words were found to facilitate word retrieval. Both semantically related and unrelated primes inhibited word retrieval. Inhibition from both of these sources is attributed in part to the orthographic unrelatedness of these primes. This explanation is shown to be consistent with data from several other word retrieval studies (Brown, 1979; Roediger, Neely, & Blaxton, 1983). The word retrieval task is contrasted with the lexical decision task. It is suggested that the differential effects of orthographic and semantic priming in word retrieval and lexical decision are due to differences in retrieval processing between the two tasks.

Quality of instructions on prescription drug labels: effects on memory and comprehension in young and old adults.

We examined both comprehension of and memory for information on prescription labels as a function of age, memory load, and study time across three experiments with young and old adults. We found that older adults consistently manifested poorer recall of prescription information than young adults; age effects occurred even when participants received unlimited study time; and both young and old adults had substantial difficulty comprehending drug information as it is presented from a pharmacy.

A model of loneliness in older adults.

Loneliness and physical health status in older adults have been correlated strongly but the predictive direction is unclear. This study examined the relationship between personality, cognition, social network, and age modeled as predictors of loneliness in older Americans. Self-assessed health mediated the relationship. The sample consisted of 208 independently living individuals 60 to 106 years of age from the southern region of the United States. Model comparison revealed health did not mediate the relationship significantly but that self-reported loneliness itself mediated between personal characteristics and perceived health. Results indicate anxiety, frequency of telephone contact, and age, but not frequency of face-to-face contact with others or cognitive functioning, affect perceived loneliness. Perceived loneliness mediates the effects of anxiety, frequency of telephone contact, and age on self-assessed health. Feelings of loneliness decrease one's evaluation of physical well-being.

Cognitive functioning in centenarians: a coordinated analysis of results from three countries.

Cognitive functions among centenarians in Japan, Sweden, and the United States are described. Three areas are explored. First, definitions and prevalence of dementia are compared between Japan and SWEDEN: Second, levels of cognitive performances between centenarians and younger age groups are presented. Third, interindividual variations in cognitive performances in centenarians and younger persons are compared in Sweden and the United STATES: The Swedish and Japanese studies show a variation in prevalence of dementia between 40% and 63% with a relatively higher prevalence among women. Part of the variance is probably due to differences in sampling and criteria of dementia. Along with the lower cognitive performance in centenarians, compared with younger age groups, the Swedish and U.S. results show a wider range of performance among centenarians for those semantic or experientially related abilities that tend to be maintained over the adult life span. In contrast, a smaller range of performance is found for centenarians on those fluid or process-related abilities that have shown a downward age-related trajectory of performance. Lower variability is probably due to centenarians reaching the lower performance limit. The conclusions agree with the assumption of a general increase in cognitive differentiation with increasing age, primarily in measures of crystallized intelligence. The conclusions point to the general robustness of results across countries, as well as to the relative importance of cognition for longevity.

A molecular view of coping behavior in older adults.

OBJECTIVES: The purpose of this study was to assess age, gender, ethnicity, and education differences in specific ("molecular") coping behaviors for three older adult age groups. METHODS: Thirty-five specific coping reactions were assessed on the item level for 74 sexagenarians, 70 octogenarians, and 116 centenarians of the Georgia Centenarian Study. RESULTS: A multivariate analysis of covariance revealed significant age group, gender, and education differences for 14 coping reactions. Four items were affected exclusively by age; five were affected only by gender; and three were affected only by education. One item showed age group and education differences; another showed gender and education differences. No ethnicity differences were obtained. The largest effect for an age group difference was found for accepting health problems. DISCUSSION: The findings suggest that a molecular view of specific coping behaviors in reaction to health problems, in addition to global measures of coping, is essential.

Factors of nutritional health-seeking behaviors. Findings from the Georgia Centenarian Study.

Health-seeking behaviors are described by Harris and Guten (1979) as any behavior of an individual that promotes, protects, or maintains one's health, regardless of actual or perceived health status. The purpose of this study was to determine if nutritional health-seeking behavior (Bausell, 1986) comprised one or more factors for older adults (N = 256). Participants were in their 60s (n = 90), 80s (n = 91), and 100+ (n = 75). Exploratory factor analysis indicated that nutritional health-seeking behavior items formed two factors: avoid (i.e., avoiding unhealthy nutritional behavior) and seek (i.e., attempting or seeking healthy nutritional behavior). Multiple regression analysis revealed that risk factors for poor nutritional health-seeking behaviors in older adults include advanced age, low economic resources, and male gender. Protective factors included in the personality factors of self-discipline, enthusiasm, sensitivity, and warmth.

Health and dietary characteristics of supplement users in an elderly population.

The purpose of this study was to investigate the association of health and dietary characteristics with the use of vitamin and mineral supplements in community-dwelling, cognitively intact elders aged in their 60s (n = 89), 80s (n = 92), and 100s (n = 76) who resided in Georgia in the southeastern United States. Elders who were physically active (p = 0.008), had stomach problems (p = 0.042), or used arthritis medication (p = 0.015) were more likely to take a nutritional supplement than elders without these characteristics. Physically active elders were more likely to take calcium (p = 0.004), vitamin E (p = 0.022), and vitamin C (p = 0.046) than non-physically active elders. Compared to non-users, supplement users were also more likely to comply with nutritional health seeking behaviors such as avoiding too much salt, fat, cholesterol, sugar, caffeine, and eating enough fiber, vitamins and minerals from food or supplements, and calcium in foods or supplements. The observation that the use of certain vitamin or mineral supplements is associated with dietary fat intakes, dietary protein intakes, and patterns of alcohol, decaffeinated coffee, and tea consumption suggests that supplement use is one of a cluster of health behaviors. Thus, it may be important that future investigations concerning the impact of supplement use on diseases, such as heart disease or cancer, control for the effects of dietary patterns and physical activity.

Physical health measurement of the older adult: new instrumentation.

The Georgia Centenarian Study examines the biologic, psychologic, and social factors contributing to life satisfaction and successful aging in late adulthood. Three age groups are included, 60 through 69 years, 80 through 89 years, and 100+ years. While the overall theoretical model includes multiple variables, physical health is viewed as critical to successful aging. This article presents an overview of physical health measurement for older persons. Some existing measures of physical health are included in the test battery for the Georgia Centenarian Study; however, the investigators determined the need for the inclusion of a new instrument. This article describes existing measures as well as the rationale and process of development of a new instrument.

[An investigation of age related slowing in cognitive processing speed in a mental rotation task].

The age related slowing in cognitive processing speed was investigated with a mental rotation task. Slope of regression line predicting reaction time from rotation angle was assumed to be an index of mental rotation speed, and the intercept increase when the task was changed standard to mirror image, an index of decision process speed. Three groups were compared: young control (mean age = 19.1), younger elderly (M = 69.5) and older elderly (M = 79.0). In the mental rotation speed, an age difference between the control and older groups, but not between the older groups, was found. However, the decision process speed differed no only between the control and older groups, but also between the two older groups. These findings indicated that the effect of aging was larger on decision process than on mental rotation.