Moderation of associations between weight discrimination and diabetes status by psychosocial factors.

Weight discrimination has adverse effects on health that include increasing the risk factors for developing type 2 diabetes. Preliminary evidence suggests a positive association between weight discrimination and diagnosed diabetes; however, it is unknown whether psychosocial resources may buffer this association. In logistic regressions stratified by gender, we examined links between weight discrimination and diabetes among a nationally representative sample of U.S. adults (the National Social Life, Health, and Aging Project; N = 2,794 adults age 50 and older in 2015-16). We also tested the extent to which trait-resilience and social support from a spouse/partner, family, and friends buffered any observed association. We adjusted for known predictors of diabetes (age, race/ethnicity, Body Mass Index) and conducted sensitivity analyses restricted to men and women with obesity. Net of covariates, in the overall sample, weight discrimination was associated with significantly greater odds of having ever had diabetes among women (OR = 2.00, 95% CI [1.15, 3.47]), but not men. Among women with obesity, weight discrimination was only significantly associated with greater odds of diabetes for those with low resilience (OR = 1.84, 95% CI [1.01, 3.35]). Among men overall, weight discrimination was associated with lower odds of diabetes for those with high family support (OR = 0.03, 95% CI [0.003, 0.25]) as well as those with high friend support (OR = 0.34, 95% CI [0.13, 0.91]); similar effects were observed in men with obesity. These novel findings evince a role for psychosocial resources in buffering associations between weight discrimination and diabetes.

Age differences in mental health from May through August 2020 among U.S. adults: trajectories and the role of pandemic, lifestyle, and social factors.

Objectives: Using nationally representative data among U.S. adults, we assess age differences in changes in mental health both from 2018 to May 2020 and during the pandemic. We also examine factors explaining age differences in mental health.Methods: We analyzed 2018 General Social Survey data (N = 2,348; age 18-89) and three waves of COVID Response Tracking Study data (N = 2,279; age 20-94) spanning May-August 2020. Outcomes included happiness, loneliness, stress, positive affect, and negative affect.Results: U.S. adults reported greater loneliness and less happiness in May 2020 versus 2018. Only loneliness and negative affect changed significantly from May to August 2020, showing declines. Mental health trajectories did not differ significantly by age. Overall, older adults reported lower loneliness, stress, and negative affect than younger adults during 2020. Older age was associated with two factors linked with better mental health: less likelihood of COVID-19 exposure and greater satisfaction with social activities and relationships. However, none of the factors examined herein explained age differences in mental health.Conclusion: Although mental health trajectories during the pandemic were similar across ages, older adults tended to report better mental health than younger adults. Future research should identify factors that explain age differences in mental health that persisted into 2020.

Social capital predicts accelerometry-measured physical activity among older adults in the U.S.: a cross-sectional study in the National Social Life, Health, and Aging Project.

BACKGROUND: Older adults receive important health benefits from more robust social capital. Yet, the mechanisms behind these associations are not fully understood. Some evidence suggests that higher levels of social capital ultimately affect health through alterations in physical activity (PA), but most of this research has relied on self-reported levels of PA. The aim of this study was to determine whether components of social capital, including social network size and composition as well as the frequency of participation in various social and community activities, were associated with accelerometry-measured PA levels in a nationally representative sample of community-dwelling older adults (≥ 62 years). METHODS: We conducted a cross-sectional analysis using data from the wrist accelerometry sub-study (n = 738) within Wave 2 of the National Social, Health, and Aging Project (NSHAP), a population-based longitudinal study that collects extensive survey data on the physical, cognitive, and social health of older adults. Participants' physical activity was measured with a wrist accelerometer worn for 72 consecutive hours. We related seven, self-reported social relationship variables (network size, network proportion friends, and frequencies of socializing with friends and family, visiting with neighbors, attending organized group meetings, attending religious services, and volunteering) to accelerometer-measured PA (mean counts-per-minute) using multivariate linear regression analysis, while adjusting for potential confounders. RESULTS: Larger social networks (p = 0.042), higher network proportion friends (p = 0.013), more frequent visiting with neighbors (p = 0.009), and more frequent attendance at organized group meetings (p = 0.035) were associated with higher PA levels after controlling for demographic and health covariates. Volunteering was significant prior to adjusting for covariates. No significant associations were found between frequencies of socializing with friends and relatives or attendance at religious services and PA. CONCLUSIONS: This study suggests social capital is significantly related to objectively measured PA levels among older adults, and that friendships as well as social participation in groups and with neighbors may be particularly pertinent to PA. These findings expand our understanding of and offer a potential mechanism linking social relationships and overall health among older adults. They also have implications for how we might motivate older adults to be more physically active.

Loneliness in the older adult marriage: Associations with dyadic aversion, indifference, and ambivalence.

Marriage protects against loneliness, but not all marriages are equally protective. While marriage is a highly interdependent relationship, loneliness in marital dyads has received very little research attention. Unlike most studies proposing that positive and negative marital qualities independently affect loneliness at the individual level, we used a contextual approach to characterize each partner's ratings of the marriage as supportive (high support, low strain), ambivalent (high support, high strain), indifferent (low support, low strain), or aversive (low support, high strain), and examined how these qualities associate with own and partner's loneliness. Using couple data from the Wave II National Social Life, Health and Aging Project (N=953 couples), we found that more than half of the older adults live in an ambivalent, indifferent, or aversive marriage. Actor-partner interdependence models showed that positive and negative marital qualities synergistically predict couple loneliness. Spouses in aversive marriages are lonelier than their supportively married counterparts (actor effect), and that marital aversion increases the loneliness of their partners (partner effect). In addition, wives (but not husbands) in indifferent marriages are lonelier than their supportively married counterparts. These effects of poor marital quality on loneliness were not ameliorated by good relationships with friends and relatives. Results highlight the prominent role of the marriage relationship for imbuing a sense of connectedness among older adults, and underscore the need for additional research to identify strategies to help older adults optimize their marital relationship.

Geriatrics training for nurses in a skilled nursing facility: a GWEP feasibility study.

Geriatrics knowledge and expertise is critical to the care of older adults in skilled nursing facilities. However, opportunities for ongoing geriatrics training for nurses working in skilled nursing facilities are often scarce or nonexistent. This feasibility study describes a mixed-methods analysis of nurses' educational needs and barriers to continuing education in a for-profit skilled nursing facility in an underserved, urban environment. Potential mechanisms to overcome barriers are proposed.

Racial and ethnic differences in diurnal cortisol rhythms: are they consistent over time?

BACKGROUND: Prior research indicates that blacks and Hispanics/Latinos have flatter diurnal cortisol declines across the day, a profile associated with poorer health. The stability of racial and ethnic differences in cortisol levels over time is not well understood, and additional research is needed to establish racial and ethnic differences in psychosocial stress levels as related to changes in cortisol levels. METHODS: With data from a community-based study of 152 adults (mean age = 58 years; 53% women; 34% black, 26% Hispanic/Latino), we examined the magnitude of racial and ethnic differences over a 5-year period. Salivary cortisol samples were obtained 3 times per day for 3 days in Years 1, 3, 4, and 5. Life events and chronic stress were assessed by questionnaires in which participants reported on whether they had experienced specific types of events or stress within the past year. Depressive symptoms scales (Center for Epidemiologic Studies of Depression Scale) were also administered annually. Daily cortisol slopes were calculated by subtracting wakeup cortisol from bedtime levels and dividing by hours awake. RESULTS: Increases in psychosocial stress were associated with flatter cortisol slopes among blacks (ß = 0.010) and Hispanics/Latinos (ß = 0.014), although including cardiovascular disease risk factors attenuates associations in blacks (ß = 0.007; p = .125). Higher income predicts a steepening of cortisol rhythms across the study (ß = -0.003; p = .019). CONCLUSIONS: Racial and ethnic differences in diurnal cortisol rhythms are stable over time. However, the magnitude of changes in cortisol levels associated with chronic stress levels may vary by racial and ethnic subgroups.

Loneliness and social behaviours in a virtual social environment.

Feeling lonely motivates people to reconnect with others, but it can also trigger a vicious cycle of cognitions and behaviours that reinforces their loneliness. In this study, we examined the behavioural consequences of loneliness in a virtual social environment. A total of 176 participants navigated a character (protagonist) through a two-dimensional browser game and rated the character's loneliness multiple times during the game. In the first part of the game, another character is introduced as the protagonist's spouse. At one point, the spouse leaves for an undetermined period of time but later returns. Immediately before this separation, higher ascribed loneliness of the protagonist was associated with more frequent interactions with the spouse. After the reunion, however, higher ascribed loneliness was associated with less frequent interactions with the spouse. Ascribed loneliness was not significantly related to the frequency of interactions with others nor to the frequency of solitary activities. These patterns held after controlling for ascribed positive affect. Participants' levels of loneliness were related to the level of ascribed loneliness only when the spouse was present but not when the spouse was absent. In sum, these findings suggest that the conditions that trigger the vicious cycle of loneliness are person- and situation-specific.

Transcript origin analysis identifies antigen-presenting cells as primary targets of socially regulated gene expression in leukocytes.

To clarify the biological rationale for social regulation of gene expression, this study sought to identify the specific immune cell types that are transcriptionally sensitive to subjective social isolation (loneliness). Using reference distributions for the expression of each human gene in each major leukocyte subtype, we mapped the cellular origin of transcripts found to be differentially expressed in the circulating immune cells from chronically lonely individuals. Loneliness-associated genes derived primarily from plasmacytoid dendritic cells, monocytes, and, to a lesser extent, B lymphocytes. Those dynamics reflected per-cell changes in the expression of inducible genes and related more strongly to the subjective experience of loneliness than to objective social network size. Evolutionarily ancient myeloid antigen-presenting cells appear to have evolved a transcriptional sensitivity to socioenvironmental conditions that may allow them to shift basal gene expression profiles to counter the changing microbial threats associated with hostile vs. affine social conditions.

Spatial affect learning restricted in major depression relative to anxiety disorders and healthy controls.

Detecting and learning the location of unpleasant or pleasant scenarios, or spatial affect learning, is an essential skill that safeguards well-being (Crawford & Cacioppo, 2002). Potentially altered by psychiatric illness, this skill has yet to be measured in adults with and without major depressive disorder (MDD) and anxiety disorders (AD). This study enrolled 199 adults diagnosed with MDD and AD (n=53), MDD (n=47), AD (n=54), and no disorders (n=45). Measures included clinical interviews, self-reports, and a validated spatial affect task using affective pictures (IAPS; Lang, Bradley, & Cuthbert, 2005). Participants with MDD showed impaired spatial affect learning of negative stimuli and irrelevant learning of pleasant pictures compared with non-depressed adults. Adults with MDD may use a "GOOD is UP" heuristic reflected by their impaired learning of the opposite correlation (i.e., "BAD is UP") and performance in the pleasant version of the task.

Thinking About One's Subjective Well-Being: Average Trends and Individual Differences.

In two studies, participants reported what they had been thinking about while completing measures of subjective well-being (SWB). These thought reports were analyzed with respect to life domain, valence, and how strongly they were related to actual levels of SWB. Most people focused on their life circumstances (e.g., career) rather than on dispositional predictors (e.g., personality) of SWB. The domains mentioned most frequently (career, family, romantic life) were also the ones that were most strongly related to actual SWB, indicating that most of people think about things that actually contribute to their SWB. Some domains are predominantly mentioned in positive contexts (e.g., family) whereas others are predominantly mentioned in negative contexts (e.g., money). On average, people thought more about positive than about negative things, a result that is magnified for respondents high in extraversion or emotional stability. In sum, these findings provide insight into what people think contributes to their SWB; beliefs that may guide them as they make important decisions.

Unequal loss: Disparities in relational closeness to a COVID-19 death among U.S. older adults.

BACKGROUND: COVID-19 mortality occurred unevenly across U.S. demographic subgroups, leaving some communities harder hit than others. Black and Hispanic/Latino older adults are among those disproportionately affected by COVID-19 mortality, and in turn, COVID-19 bereavement. Because disparities in COVID-19 mortality may extend to COVID-19 bereavement, it is important to understand the incidence of COVID-19 bereavement among older adults at various degrees of relational closeness (e.g., spouse vs. household member vs. friend). METHODS: We used the National Social Health and Aging Project (NSHAP) COVID Study to evaluate disparities in loss of a social network member to COVID-19 among U.S. older adults by race/ethnicity, language, and relational closeness. Multiple logistic regression was used to estimate the likelihood of experiencing a COVID-19 death in one's social network. RESULTS: None of the English-speaking, non-Hispanic White respondents reported the loss of a household member or spouse to COVID-19. English-speaking, non-Hispanic Black and English-speaking, Hispanic older adults were overrepresented in reporting a death at every degree of relational closeness. However, close COVID-19 bereavement was most prevalent among Spanish-speaking older adults of any race. Although Spanish speakers comprised only 4.8% of the sample, half of the respondents who lost a spouse to COVID-19 were Spanish speakers. Language and ethnoracial group disparities persisted after controlling for age, sex, marital status, and education. CONCLUSIONS: Known ethnoracial disparities in COVID-19 mortality extend to COVID-19 bereavement among older adults. Because bereavement impacts health, Black, Latino, and Spanish-speaking communities need greater protection and investment to prevent disparities in bereavement from exacerbating disparities in later-life mental and physical health.

Types of sensory disability are differentially associated with mental health in older US adults over time.

BACKGROUND: Sensory disability in older adults is associated with increased rates of depressive symptoms and loneliness. Here, we examined the impact of hearing, vision, and olfaction disability on mental health outcomes in older US adults. METHODS: We studied respondents from the first three rounds (2005/6, 2010/11, and 2015/16) of the National Social Life, Health and Aging Project, a nationally representative, longitudinal study of older US adults. Sensory function was assessed by structured interviewer ratings (hearing and vision) and objective assessment (olfaction). Cox proportional hazards models and one degree of freedom tests for trend were utilized to analyze the relationships between sensory disability and self-rated mental health, frequent depressive symptoms, frequent perceived stress, frequent anxiety symptoms, and frequent loneliness symptoms over time, adjusting for demographics, health behaviors, comorbidities, and cognitive function. RESULTS: We analyzed data from 3940 respondents over 10 years of follow-up. A greater number of sensory disabilities was associated with greater hazard of low self-rated mental health, frequent depressive symptoms, frequent perceived stress, and frequent loneliness symptoms over time (p ≤ 0.003, all). After adjusting for covariates, older adults with a greater number of sensory disabilities had greater hazard of low self-rated mental health (HR = 1.22, CI = [1.08, 1.38], p = 0.002) and loneliness symptoms (HR = 1.13, CI = [1.05, 1.22], p = 0.003) over time in our tests for trend. In our Cox proportional hazards model, older adults with vision disability had greater hazard of low self-rated mental health (HR = 1.34, 95% CI = [1.05, 1.72], p = 0.02) and loneliness symptoms (HR = 1.21, CI = [1.04, 1.41], p = 0.01). CONCLUSIONS: Older US adults with greater numbers of sensory disabilities face worse subsequent mental health. Future longitudinal studies dissecting the relationship of all five classical senses will be helpful in further understanding how improving sensory function might improve mental health in older adults.

Corrigendum: Home alone together: Differential links between momentary contexts and real-time loneliness among older adults from Chicago during versus before the COVID-19 pandemic.

Studies show that older adults were lonelier during versus before the COVID-19 pandemic. This may be due in part to guidelines particularly recommending that older adults stay at home, given their elevated risk of COVID-19 complications. However, little is known about the extent to which this population experienced greater intensity in momentary loneliness during versus before the pandemic, and how this relates to their real-time contexts. Here, we build upon recent findings from the Chicago Health and Activity Space in Real-Time (CHART) study that revealed associations between momentary contexts and loneliness among older adults. We analyze ecological momentary assessments (EMAs) from both pre- and during COVID-19 among a subsample of CHART respondents (N = 110 older adults age 65-88 in 2020). Pre-pandemic data were collected across three waves from April 2018-October 2019, and pandemic data were collected across three additional waves from June-September 2020. Participants responded to smartphone "pings" (five per day for 7 days per wave; N = 5,506 and N = 7,824 before and during the pandemic, respectively) by reporting their momentary loneliness and context (e.g., home). Findings from multi-level regression models suggest that respondents were lonelier in mid-2020 than in years prior, as well as when at home and alone; they were also more likely to be at home during the pandemic. However, the loneliness-inducing effects of being at home (vs. outside the home) and alone (vs. with others) were weaker during versus before COVID-19. Results provide important nuance to broader trends in loneliness among older adults during the pandemic. Specifically, older adults may have adopted new technologies to support social connectedness. It is also possible that, during a time in which social and physical distancing characterized public health guidelines, these contexts grew less isolating as they became a shared experience, or that publicly shared spaces provided fewer opportunities for social engagement.

Corrigendum: Momentary loneliness among older adults: Contextual differences and their moderation by gender and race/ethnicity.

Studies suggest that loneliness is associated with age. Among older adults, women and Black adults may be at greater risk than men and White adults, respectively. Social and physical contexts are also linked with loneliness. However, little is known about whether and how those of different genders and racial/ethnic groups may experience social and physical contexts differently in terms of their real-time loneliness, and the extent to which these differences may be explained by differential exposure or reactivity to such contexts. We examine (1) how momentary loneliness relates to (a) gender and race/ethnicity and (b) social and physical context; and the extent to which gender and racial/ethnic groups may be (2) differentially exposed to loneliness-related contexts and/or (3) differentially reacting to these contexts. Using multilevel regressions, we analyzed ecological momentary assessments from 342 community-dwelling U.S. older adults from the Chicago Health and Activity Space in Real Time study. In each of three waves of data collection, smartphone "pings" (five per day for 21 days; n = 12,744 EMAs) assessed loneliness, social context (e.g., alone, with a spouse/partner), and location/physical context (e.g., home, at work). Results revealed that men consistently reported greater loneliness intensity than women, including after adjusting for momentary physical and social context. In addition, those momentarily outside the home and/or not alone were less likely to feel lonely than their counterparts. However, the protective effect of being outside of the home (vs. home) was weaker among women and Black and Hispanic older adults, and the protective effect of being with one or more others (vs. alone) was weaker among women. Results are among the first to identify contextual effects on real-time loneliness in older adults and how these associations vary by gender and race/ethnicity. Knowledge regarding momentary variation in loneliness may inform future just-in-time adaptive loneliness interventions in older adulthood.

Linking the 1940 US Census to the NSHAP: Novel Opportunity to Understand the Effects of Childhood Residential Environment on Cognitive Aging.

OBJECTIVE: The 1940 Census is a valuable resource for understanding various aspects of historical populations in the United States. Recently, the National Social Life, Health and Aging Project (NSHAP) integrated 1940 Census data into its extensive dataset, providing researchers with an opportunity to explore new avenues of life course investigation. We leverage the newly-introduced measures of childhood residential environment and evaluate their potential predictive utility in older adult cognitive functioning net of childhood and adulthood characteristics known to be key risk factors for poor cognition. METHOD: We analyzed 777 respondents who were children in 1940 (age<17) that have been linked to the 1940 U.S. Census. We used childhood geographic location, homeownership status, household composition, and parental nativity as predictors. Cognitive function was measured using the Montreal Cognitive Assessment. RESULTS: Regression analysis showed that growing up in an urban area was associated with better cognitive function, while being born in the South was linked to poorer cognitive function, even after controlling for childhood health, parental education, educational attainment, stroke, and smoking status. Additionally, childhood multigenerational household was associated with better cognitive function, and childhood family size was associated with poorer cognitive function. However, these associations became statistically insignificant with the inclusion of educational attainment. We did not find homeownership and parental nativity to be associated with cognitive function. DISCUSSION: The findings may shed light on the potential long-term effects of childhood circumstances on cognitive aging processes. Implications for current literature and directions for future research are discussed.

Prediabetes Progression and Reversion: Social Factors and Racial/Ethnic Differences.

OBJECTIVE: Racial and ethnic minorities are disproportionately affected by diabetes. Social characteristics, such as family structure, social support, and loneliness, may contribute to these health disparities. In a nationally representative sample of diverse older adults, we evaluated longitudinal rates of both progression from prediabetes to diabetes and reversion from prediabetes to normoglycemia. RESEARCH DESIGN AND METHODS: Using the longitudinal Health and Retirement Study (2006-2014), our sample included 2625 follow-up intervals with a prediabetes baseline (provided by 2229 individuals). We analyzed 4-year progression and reversion rates using HbA1c and reported presence or absence of physician-diagnosed diabetes. We utilized chi-square and logistic regression models to determine how race/ethnicity and social variables influenced progression or reversion controlling for comorbidities and demographics. RESULTS: Overall, progression to diabetes was less common than reversion (17% vs. 36%). Compared to Whites, Hispanic/Latino respondents had higher odds of progression to diabetes from prediabetes while Black respondents had lower odds of reversion, adjusting for physical health and demographics. For social variables, Hispanics/Latinos had the highest reliance on and openness with family and the lowest rates of loneliness. The inclusion of social variables in regression models reduced the odds of progression for Hispanics/Latinos but did not alter Black's lower rate of reversion. CONCLUSIONS: Hispanic/Latinos and Blacks not only had different transition pathways leading to diabetes, but also had different social profiles, affecting Hispanic/Latino progression, but not Black reversion. These differences in the influence of social variables on diabetes risk may inform the design of culturally-specific efforts to reduce disparities in diabetes burden.

Race/ethnicity and the measurement of cognition in NSHAP: Recommendations for robustness.

OBJECTIVES: In this study, we examine the measurement of cognition in different racial/ethnic groups to move towards a less biased and more inclusive set of measures for capturing cognitive change and decline in older adulthood. METHODS: We use data from Round 2 (N=3377) and Round 3 (N=4777) of the National Social Life, Health, and Aging Project (NSHAP) and examine the study's Survey Adjusted version of the Montreal Cognitive Assessment (MoCA-SA). We employ exploratory factor analyses to explore configural invariance by racial/ethnic group. Using modification indexes, two-parameter item response theory models, and split-sample testing, we identify items that seem robust to bias by race. We test the predictive validity of the full (18-item) and short (4-item) MoCA-SAs using self-reported dementia diagnosis, instrumental activities of daily living (IADLs), proxy reports of dementia, proxy reports of dementia-related death, and National Death Index reports of dementia-related death. RESULTS: We found that four measures out of the 18 used in NSHAP's MoCA-SA formed a scale that was more robust to racial bias. The shortened form predicted consequential outcomes as well as NSHAP's full MoCA-SA. The short form was also moderately correlated with the full form. DISCUSSION: Although sophisticated structural equation modeling techniques would be preferrable for assuaging measurement invariance by race in NSHAP, the shortened form of the MoCA-SA provides a quick way for researchers to carry out robustness checks and to see if the disparities and associations by race they document are "real" or the product of artifactual bias.

Did Resilience and Socioeconomic Status Predict Older Adults' Finding a Silver Lining in COVID?

Background and Objectives: The coronavirus disease 2019 (COVID-19) pandemic stretched our limits-physically, mentally, and economically. However, some older adults report that it led to positive changes. This study aims to understand whether prepandemic resilience, education, or income predicted older adults' subsequent likelihood of reporting positive changes in their lives during the pandemic. Research Design and Methods: We use data from the National Social Life, Heath, and Aging Project, an ongoing panel study with a COVID-19 ancillary supplement (N = 2,650). Results: The study results aligned with the fundamental cause theory. In demographically adjusted models including resilience, education, and income, as well as the effect of the pandemic on employment and a COVID-disruption score, the odds of reporting any positive change were 2.6 times higher for those with an associate degree (p < .01) and 4.7 times higher for those with a bachelor's or higher (p < .001), compared to those without a high school degree. In contrast, neither resilience nor income was significantly associated with endorsing a positive change. We also categorize specific changes thematically coded from open-ended responses and examine their demographic distributions. Categories include spirituality, home organization, hygiene practices, and increased quality time with others. Discussion and Implications: These findings show that older adults with more education could navigate COVID-19 challenges in a way that improved their perspectives on at least one aspect of their lives.