Informant-Reported Cognitive Decline and Activity Engagement across Four Years in a Community Sample.

BACKGROUND: Subtle age-related cognitive decline may be associated with the capacity to remain engaged in mental, physical, and social activities. Informant reports of cognitive decline potentially provide additional information to psychometric tests on change in everyday cognitive function relevant to activity engagement. OBJECTIVE: To investigate relations between decline in everyday cognitive function as assessed by informant report and activity engagement in community-dwelling older adults. METHODS: A sample of cognitively normal older adults was drawn from the 2 latest waves of the PATH Through Life Study (n = 1,391; mean age 74.5 ± 1.5, 48.4% female). PATH is a 16-year longitudinal cohort study set in the Canberra/Queanbeyan district, Australia. Assessments were carried out at baseline, and at 3 subsequent time-points 4 years apart. At wave-4, the IQCODE, an informant measure of 4-year cognitive decline was provided by a spouse, family member, or friend of each participant. Activity engagement was assessed by the abbreviated RIASEC Mental Activity List, self-reported frequency and duration of physical activity (Whitehall Questionnaire) and the Lubben Social Network Scale that assessed interaction with family/friends. Participants provided demographic information, self-reported health status (SF-12), and responses to the Goldberg Depression Scale. The Symbol Digit Modalities Test (SDMT) and California Verbal Learning Test (CVLT) were used to measure objective 4-year cognitive change. Those with MMSE score of ≤27 were excluded. RESULTS: IQCODE score predicted disengagement from mental activities over 4 years in cognitively healthy adults (ß = -0.056, standard error [SE] = 0.019, p = 0.004). This association was robust to covariate control and change on the SDMT which was also significantly related to mental activity disengagement. In models adjusted for change scores on the SDMT and the CVLT, the IQCODE was associated with less physical (ß = -0.692, SE = 0.24, p = 0.004) and social engagement (ß -0.046, SE = 0.021, p = 0.032), but relationships were attenuated with the inclusion of covariates. CONCLUSION: Informant-reported cognitive decline in a non-clinical sample was linked to activities that support cognitive health. Associations were robust to adjustment for cognitive change scores. Utilising informant reports prior to the manifestation of clinically relevant decline may identify those who would benefit most from personalised activity interventions.

A qualitative study of older and middle-aged adults' perception and attitudes towards dementia and dementia risk reduction.

AIM: To investigate perceptions of dementia and dementia risk reduction held by people without dementia. BACKGROUND: Dementia does not only affect individuals with dementia, but also has an impact on family and friends, society and healthcare professionals. Recent research has identified modifiable risk and protective factors for dementia. However, it is unclear what knowledge people without dementia have about these risk factors and their attitudes towards addressing these risk factors to achieve dementia risk reduction are not known. DESIGN: Qualitative descriptive study using focus group methodology. METHOD: A focus group study was conducted in February 2011 with 34 older adults aged between 52-90 years. The long-table approach was used to identify themes and categorize data on dementia knowledge, risk and attitudes. FINDINGS: Participants correctly identified dementia risk factors as a group. Participants' responses about their perceived likelihood of developing dementia could be classified into three distinctive themes; fear, rational and cynical perceptions. Both fear of developing dementia and the need to improve dementia knowledge were considered major motivators towards adopting healthier lifestyle and health behaviours. Lack of knowledge on risk factors for dementia was identified as a major barrier for behavioural and lifestyle change. CONCLUSION: These findings can be used to develop effective and personalized interventions that increase motivators and reduce barriers by tailoring interventions to individual's dementia risk reduction literacy and motivations to change behaviours. Greater public-health promotion and education about risk and protective factors for dementia are also necessary to increase dementia health literacy and to reduce overall dementia prevalence.

Measuring anxiety about aging across the adult lifespan.

BACKGROUND: The development of instruments to measure aging attitudes is an essential part of research into the role of individual differences in the aging process, giving clarification to the relationship between attitudes and behavior across the lifespan. Here we test the structural validity of Lasher and Faulkender's (1993) Anxiety about Aging Scale (AAS), and explore measurement invariance across age and gender. METHODS: A sample of 783 adults (42% females) age ranging from 20 to 97 years (M = 57.3, SD = 13.66) participated. RESULTS: The first-order four-factor AAS model reflecting the original Lasher and Faulkender (1993) structure showed a better fit to the data than the second-order model. Measurement invariance for both gender and age groups (young adults 20-44 years; mid-aged adults 45-64 years, older adults 65+ years old) was found for three of the factors, but not for all items in the Fear of Losses factor. Structural covariance inequality between the Fear of Losses and Physical Appearance factors was shown between males and females. CONCLUSIONS: Findings indicate that the original AAS measures four distinct dimensions of anxiety about aging. These dimensions were shown to be generally comparable across age and gender, indicating that the AAS is a suitable measure for providing meaningful comparison of anxiety about aging across the lifespan. The exception is the Fear of Losses factor, where items may have differential meanings across groups based on cultural and social attitudes regarding aging and gender.

Determinants of retirement timing expectations in the United States and Australia: a cross-national comparison of the effects of health and retirement benefit policies on retirement timing decisions.

Data from the U.S. Health and Retirement Study (N = 2,589) and the Australian Household Income and Labour Dynamics survey (N = 1,760) were used to compare the macro-level policy frameworks on individual retirement timing expectations for pre-baby boomers (61+ years) and early baby boomers (45 to 60 years). Australian workers reported younger expected age of retirement compared to the U.S. sample. Reporting poor health was more strongly associated with younger expected retirement age in the United States than in Australia. Cohort and gender differences in the United States were found for the effect of private health insurance on younger expected age at retirement. Our results draw attention to how cross-national comparisons can inform us on the effects of policies on retirement expectations among older workers.

The choice of self-rated health measures matter when predicting mortality: evidence from 10 years follow-up of the Australian longitudinal study of ageing.

BACKGROUND: Self-rated health (SRH) measures with different wording and reference points are often used as equivalent health indicators in public health surveys estimating health outcomes such as healthy life expectancies and mortality for older adults. Whilst the robust relationship between SRH and mortality is well established, it is not known how comparable different SRH items are in their relationship to mortality over time. We used a dynamic evaluation model to investigate the sensitivity of time-varying SRH measures with different reference points to predict mortality in older adults over time. METHODS: We used seven waves of data from the Australian Longitudinal Study of Ageing (1992 to 2004; N = 1733, 52.6% males). Cox regression analysis was used to evaluate the relationship between three time-varying SRH measures (global, age-comparative and self-comparative reference point) with mortality in older adults (65+ years). RESULTS: After accounting for other mortality risk factors, poor global SRH ratings increased mortality risk by 2.83 times compared to excellent ratings. In contrast, the mortality relationship with age-comparative and self-comparative SRH was moderated by age, revealing that these comparative SRH measures did not independently predict mortality for adults over 75 years of age in adjusted models. CONCLUSIONS: We found that a global measure of SRH not referenced to age or self is the best predictor of mortality, and is the most reliable measure of self-perceived health for longitudinal research and population health estimates of healthy life expectancy in older adults. Findings emphasize that the SRH measures are not equivalent measures of health status.

Determinants of self-rated health items with different points of reference: implications for health measurement of older adults.

OBJECTIVE: This study assessed whether three commonly used self-rated health (SRH) items (global, age-comparative, and self-comparative) are equivalent measures of health perception for older adults. METHOD: Regression analyses were used to simultaneously contrast the associations between physical, psychological, and social factors relating to health for three SRH items, in a large ( N = 2,034) population-based sample of older adults (65 years and older) from the Australian Longitudinal Study of Aging. RESULTS: Health perceptions were more positive for the age-comparative SRH measure, compared to the pessimistic ratings of the self-comparative measure, particularly for the oldest-old adults. Different patterns of associations between the health factors and SRH measures were found. DISCUSSION: These results show the three SRH items are not equivalent measures of health and cannot be used interchangeably. The reference point of the SRH item has a considerable influence on health perceptions of older adults as it encapsulates unique health information.

An Australian survey of cognitive health beliefs, intentions, and behaviours through the adult life course.

OBJECTIVE: Information is required regarding cognitive health beliefs and behaviours from across the life in order to inform the design of interventions to optimise cognitive health and reduce the risk of cognitive impairment. METHODS: A survey of Australian adults aged 20-89 was administered via Computer Assisted Telephone Interviewing (CATI) software to respondents recruited by random digit dialling (N = 900). Socio-demographic and self-reported health information was collected to investigate associations with cognitive health responses. RESULTS: Alcohol abuse was nominated by the highest proportion of respondents (34.3%) as detrimental for brain health. Fewer than 5% nominated elevated cholesterol, blood pressure, obesity, poor education, or ageing. The most frequently endorsed protective activity was socialising (70%). Socio-demographic factors predicted responses. Age-group differences were apparent in the proportions nominating alcohol (X(2) = 24.2; p < .001), drugs (X(2) = 56.8; p < .001), smoking (X(2) = 13.1; p = .001), nutrition (X(2) = 20.4; p < .001), and mental activity (X(2) = 12.8; p = .002) as relevant to brain health. Activities undertaken for cognitive benefit also differed by age. Across all ages the perceived benefit of activities was not supported by intentions to undertake activities. CONCLUSIONS: Interventions are needed to inform and motivate people across the life-course to undertake behaviours specifically to optimise their cognitive health.

Role of physical activity in the relationship between mastery and functional health.

PURPOSE OF THE STUDY: To examine the influence of mastery, physical activity levels, and subsequent trajectories of domains of functional health across the adult life course. DESIGN AND METHODS: We examined 8-year trajectories of physical functioning (handgrip strength) and functional health (physical [RAND PHC12], psychological [RAND MHC12], and cognitive [processing speed]) in a large Australian sample (n = 7,485 at baseline) of 3 cohorts (20-24, 40-44, and 60-64 years). Within- and between-person indirect effects of physical activity on the relationship between mastery and health were examined using multilevel structural equation models. RESULTS: Mastery was positively related to within-person change in physical and psychological health for all cohorts, and processing speed for the 60s. Between-person mastery was positively associated with all health domains across all cohorts. Physical activity indirectly influenced the between-person relationships between mastery and handgrip strength, physical health, and psychological health in all cohorts, and between mastery and processing speed for the 60s. IMPLICATIONS: Psychological resources are important mechanisms for functional health as they may drive adaptive behaviors such as physical activity. The within-person association connecting mastery with physical and psychological health trajectories provides promise for interventions that foster or improve a sense of mastery. The findings contribute to the understanding of complex relationships between personal resources and behaviors that aid in successful aging across the life span.

Longitudinal change of self-perceptions of aging and mortality.

OBJECTIVE: To understand the association between self-perceptions of aging (SPA) and mortality in late life. Method. The sample (n = 1,507) was drawn from the Australian Longitudinal Study of Aging (baseline age = 65-103 years). We used joint growth curve and survival models on 5 waves of data for a period of 16 years to investigate the random intercept and slope of SPA for predicting all-cause mortality. RESULTS: The unadjusted model revealed that poor SPA at baseline, as well as decline in SPA, increased the risk of mortality (SPA intercept hazard ratio [HR] = 1.21, 95% confidence interval [CI] = 1.13, 1.31; SPA slope HR = 1.17, 95% CI = 1.02, 1.33). This relationship remained significant for the SPA intercept after adjusting for other risk factors including demographics, physical health, cognitive functioning, and well-being. CONCLUSION: These findings suggest that a single measurement of SPA in late life may be very informative of future long-term vulnerability to health decline and mortality. Furthermore, a dynamic measure of SPA may be indicative of adaptation to age-related changes. This supports a "self-fulfilling" hypothesis, whereby SPA is a lens through which age-related changes are interpreted, and these interpretations can affect future health and health behaviors.

Gender differences in alcohol consumption among middle-aged and older adults in Australia, the United States and Korea.

OBJECTIVES: To compare gender differences in alcohol use and the socioeconomic correlates of at-risk drinking among middle-aged and older adults in Australia, the United States (US) and South Korea. METHOD: Data were drawn from large nationally representative surveys of people aged 45 years and older, collected in 2006. RESULTS: Rates of any drinking and at-risk drinking (>14 US standard drinks/week) were higher for males than females in all countries and these gender differences were largest in Korea. Socioeconomic differentials for at-risk drinking varied by country and gender. In the US, at-risk drinking was associated with lower educational levels among men, but higher educational levels among women; in Korea, it was associated with being unpartnered, particularly for women; and in Australia, at-risk drinking was associated with higher income. CONCLUSIONS: Gender-role expectations differ between countries and may influence both the levels at which older adults consume alcohol and the ways in which at-risk drinking is associated with socioeconomic factors. IMPLICATIONS: Heavy alcohol use in middle-aged and older adults is a cause for concern. Health promotion strategies should target older age groups and consider the ways in which gender, marital status and education influence norms and opportunities for risky alcohol use.

Change in health and self-perceptions of aging over 16 years: the role of psychological resources.

OBJECTIVE: Self-perceptions of aging (SPA) are argued to be an indicator of the ability to adapt to heath decline in late life. Our objective was to examine the influence of psychological resources in maintaining positive self-perceptions of aging in the face of declining health in older adults. METHODS: Time-varying change in health (medical conditions), physical functioning (ADLs), and psychological resources (expectancy of control and self-esteem) on change in SPA were examined over 16 years (5 waves) in a large representative sample (N = 1569) of older adults (65 + years at baseline) from the Australian Longitudinal Study of Aging. RESULTS: Multilevel structural equation models revealed mediating effects of psychological resources at the within-person level for the relationship between decline in ADLs and SPA. At the between-person level, the relationship between medical conditions and SPA was not mediated by psychological resources, whereas ADLs and SPA were shown to be indirectly associated through self-esteem and expectancy of control. CONCLUSIONS: Results demonstrate that maintaining self-esteem and an expectancy of personal control can buffer the effects of declining ADLs on perceptions of aging. Findings have clinical implications regarding psychological interventions aimed at improving resilience in older adults, which may ultimately increase health outcomes and quality of life.

The relationship between change in self-perceptions of aging and physical functioning in older adults.

Negative self-perceptions of aging (SPA) have been linked to poor physical health and functioning outcomes in late life, yet the direction of this relationship remain unclear. Using data from the Australian Longitudinal Study of Aging, we investigated the directionality of the dynamic relationship between self-perceptions of aging and physical functioning in 1,212 adults 65 years and above (mean age = 76.89, SD = 6.12) over 5 waves (up to 16 years). Bivariate Dual Change Score Models (BDCSM) revealed that the best fitting model for the data was that which allowed SPA to predict change in physical functioning over time lags of 1 year. The direction of the relationship remained after controlling for age, gender, partner status, residential care, number of medical conditions, self-rated health, and psychological well-being. Findings suggest that more positive SPA may be protective of decline in physical functioning in late life.

Patterns of longitudinal change in older adults' self-rated health: the effect of the point of reference.

OBJECTIVE: This study investigated the effect of the reference point of self-rated health (SRH) items on the trajectory of older adults' subjective health. DESIGN: Seven waves of data from the Australian Longitudinal Study of Ageing (1992 to 2004) were used to determine change in SRH in a large sample (N = 2,081; 49% men) of older adults (65+ years). MAIN OUTCOME MEASURES: Three SRH measures with different points of reference (global vs. age-comparative and self-comparative) were used. RESULTS: Ordinal latent growth models revealed unique patterns of change. Global ratings became more negative in a linear fashion. Self-comparative ratings initially declined; however, the rate of change was found to decelerate over time. Age-comparative ratings showed a gender by age interaction, revealing that women's ratings remained relatively stable, whereas men's ratings were more likely to become more negative with age. CONCLUSION: Findings suggest that the reference point significantly influences how older adults evaluate their health over time. This has implications regarding the use of SRH items and indicates that the reference point is an important consideration in the subjective health assessment of older adults.