Inequalities in accelerated cognitive decline: Resolving observational window bias using nested non-linear regression.

INTRODUCTION: Limited observational windows lead to conflicting results in studies examining educational differences in Alzheimer's disease and related dementias (ADRD) risk, due to observational window bias relative to onset of accelerated cognitive decline. This study tested a novel model to address observational window bias and tested for the presence and sources of disparities in accelerated cognitive declines due to ADRD. METHODS: The sample examined 167,314 cognitive assessments from 32,441 Health and Retirement Study participants. We implemented a parametric non-linear nested longitudinal regression and reported multivariable-adjusted nodal incidence ratios (aNIR). RESULTS: University degrees were associated with lower incidence (aNIR = 0.253, 95% confidence interval [CI] = [0.221 to 0.289], p < 0.001), while black participants had a higher incidence (aNIR = 1.995, [1.858 to 2.141], p < 0.001) of accelerated cognitive decline, adjusting for demographic, sociobehavioral, and medical risk factors. Sex-stratified analyses identified diminished educational returns for women and increased incidence among minoritized women. DISCUSSION: Addressing observational window bias reveals large social inequalities in the onset of accelerated cognitive declines indicative of ADRD. HIGHLIGHTS: This study identifies observational window bias as a source of conflicting results among previous studies of educational achievement in Alzheimer's disease and related dementias (ADRD) disparities. The study locates preclinical accelerated cognitive decline, which is indicative of ADRD while occurring 10+ years prior to symptom onset, as a site to study ADRD disparities that mitigates observational window bias. A novel method, nested non-linear regression, is developed to test for differences in the onset of accelerated cognitive decline. Educational and racial/ethnic disparities are demonstrated in the onset of accelerated cognitive decline, as are their intersecting differences with sex/gender.

Examining emotional intelligence in older adults with chronic pain: a factor analysis approach.

OBJECTIVE: The current study explored whether the three-factor structure of an emotional intelligence measure (attention to emotions, clarity in understanding emotions, and emotion regulation) developed in a sample of college students would replicate in a sample of older adults with chronic pain. METHOD: Confirmatory and exploratory factor analyses were conducted to examine the factor structure of the 30-item Trait Meta-Mood Scale among 340 older adults with knee osteoarthritis. RESULTS: Confirmatory factor analyses indicated that the original three-factor model of emotional intelligence did not fit well with the data for older adults. Exploratory factor analyses revealed a four-factor model of emotional intelligence: (1) confusion, (2) acceptance, (3) rejection, and (4) insight. Correlations between the original and new subscales were explored. CONCLUSION: While the newly derived emotional intelligence scales resembled the original conceptualization of emotional intelligence proposed by Salovey, Mayer, Goldman, Turvey, and Palfai (1995), the current study highlights the differences in emotional intelligence likely representative of older adults with chronic pain.

Pattern Recognition to Objectively Differentiate the Etiology of Cognitive Decline: Analysis of the Impact of Stroke and Alzheimer's Disease.

BACKGROUND: Undetected Alzheimer's disease (AD) and stroke neuropathology is believed to account for a large proportion of decline in cognitive performance that is attributed to normal aging. This study examined the amount of variance in age-related cognitive change that is accounted for by AD and stroke using a novel pattern recognition protocol. METHOD: Secondary analyses of data collected for the Health and Retirement Study (N = 17,579) were used to objectively characterize patterns of cognitive decline associated with AD and stroke. The rate of decline in episodic memory and orientation was the outcome of interest, while algorithms indicative of AD and stroke pathology were the predictors of interest. RESULTS: The average age of the sample was 67.54 ± 10.45 years at baseline, and they completed, on average, 14.20 ± 3.56 years of follow-up. After adjusting for demographics, AD and stroke accounted for approximately half of age-associated decline in cognition (51.07-55.6% for orientation and episodic memory, respectively) and explained variance attributed to random slopes in longitudinal multilevel models. DISCUSSION: The results of this study suggested that approximately half of the cognitive decline usually attributed to normal aging are more characteristic of AD and stroke.

The impact of social interactions and pain on daily positive and negative affect in adults with osteoarthritis of the knee.

This study utilized experience sampling methodology (ESM) to examine the relationship of social interactions with daily pain and mood symptoms in people with osteoarthritis (OA) of the knee. Two hundred sixty-eight adults with physician-diagnosed OA of the knee underwent a baseline in-person interview and subsequent week-long ESM protocol to assess their daily activity patterns, pain, and mood via phone interview four times a day. A coding system was developed to assess presence and type of social interactions based on subject self-report of activity patterns. Multilevel modeling was used to examine between- and within-subject variation in outcomes based on both global and momentary measures of social activities, pain, and mood, while controlling for key demographic and potentially confounding variables. Positive associations were demonstrated between the ratio of positive to negative affect and both global (ß = 0.49, p < .001) and momentary, especially positive (ß = 0.24, p < .05), social activity patterns. Additionally, the association between negative affect and pain (ß = -0.07, p < .01) was attenuated in those with more baseline social interactions. Social interaction has the potential to influence mood in adults with OA of the knee, both on a global scale, and through daily variations in interactions. These interactions seem to be directly related to mood, as well as the apparently attenuating the relationship between pain and depression. Daily social interactions showed a robust positive association with contemporaneous positive affect.

Global Versus Momentary Osteoarthritis Pain and Emotional Distress: Emotional Intelligence as Moderator.

Background: Pain and emotional well-being are complexly associated both globally and in the moment. Emotional regulation strategies may contribute to that complexity by shaping the pain-well-being association. Purpose: Using emotional intelligence (EI) as an integrative conceptual framework, this study probed the role of emotional regulation in the associations of osteoarthritis pain with emotional well-being in varying time frames. Perceived attention to, clarity, and regulation of emotions were examined as predictors of well-being, and as moderators of the well-being-pain association, at global and momentary (within-day) levels. Methods: In a microlongitudinal study, 218 older adults with physician-diagnosed knee osteoarthritis self-reported global pain, depressive symptoms, and EI (mood attention, clarity, and repair). Momentary pain and positive and negative affect were then assessed four times daily for 7 days. EI subscales were examined as moderators of the pain-well-being association at global and momentary levels, controlling demographics and general health. Results: Global and momentary pain were positively associated with mood clarity and negatively with attention, but not with repair. Clarity and repair negatively predicted depression, and buffered effects of pain on depression. Momentary negative affect was negatively predicted by mood clarity and repair; again, clarity and mood repair buffered effects of momentary pain on negative affect. Only mood repair predicted positive affect, with no interactions emerging. Conclusions: Attention to mood states exacerbates the experience of pain in both short and long terms. In contrast, both mood clarity and ability to repair moods appear important to both momentary and longer-term emotional well-being.

Informed choice about breast cancer prevention: randomized controlled trial of an online decision aid intervention.

INTRODUCTION: Tamoxifen and raloxifene are chemopreventive drugs that can reduce women's relative risk of primary breast cancer by 50%; however, most women eligible for these drugs have chosen not to take them. The reasons for low uptake may be related to women's knowledge or attitudes towards the drugs. We aimed to examine the impact of an online breast cancer chemoprevention decision aid (DA) on informed intentions and decisions of women at high risk of breast cancer. METHODS: We conducted a randomized clinical trial, assessing the effect of a DA about breast cancer chemoprevention on informed choices about chemoprevention. Women (n = 585), 46- to 74-years old old, completed online baseline, post-test, and three-month follow-up questionnaires. Participants were randomly assigned to either an intervention group, a standard control group that answered questions about chemoprevention at baseline, or a three-month control group that did not answer questions about chemoprevention at baseline. The main outcome measures were whether women's intentions and decisions regarding chemoprevention drugs were informed, and whether women who viewed the DA were more likely to make informed decisions than women who did not view the DA, using a dichotomous composite variable 'informed choice' (yes/no) to classify informed decisions as those reflecting sufficient knowledge and concordance between a woman's decision and relevant attitudes. RESULTS: Analyses showed that more intervention than standard control participants (52.7% versus 5.9%) made informed decisions at post-test, P <0.001. At the three-month follow-up, differences in rates of informed choice between intervention (16.9%) and both control groups (11.8% and 8.0%) were statistically non-significant, P = 0.067. CONCLUSIONS: The DA increased informed decision making about breast cancer chemoprevention, although the impact on knowledge diminished over time. This study was not designed to determine how much knowledge decision makers must retain over time. Examining informed decisions increases understanding of the impact of DAs. A standard for defining and measuring sufficient knowledge for informed decisions is needed. TRIAL REGISTRATION: ClinicalTrials.gov: NCT00967824

Giving to others and the association between stress and mortality.

OBJECTIVES: We sought to test the hypothesis that providing help to others predicts a reduced association between stress and mortality. METHODS: We examined data from participants (n = 846) in a study in the Detroit, Michigan, area. Participants completed baseline interviews that assessed past-year stressful events and whether the participant had provided tangible assistance to friends or family members. Participant mortality and time to death was monitored for 5 years by way of newspaper obituaries and monthly state death-record tapes. RESULTS: When we adjusted for age, baseline health and functioning, and key psychosocial variables, Cox proportional hazard models for mortality revealed a significant interaction between helping behavior and stressful events (hazard ratio [HR] = 0.58; P < .05; 95% confidence interval [CI] = 0.35, 0.98). Specifically, stress did not predict mortality risk among individuals who provided help to others in the past year (HR = 0.96; 95% CI = 0.79, 1.18), but stress did predict mortality among those who did not provide help to others (HR = 1.30; P < .05; 95% CI = 1.05, 1.62). CONCLUSIONS: Helping others predicted reduced mortality specifically by buffering the association between stress and mortality.

Nicotine and the hallucinating brain: effects on mismatch negativity (MMN) in schizophrenia.

Elevated smoking rates have been noted in schizophrenia, and it has been hypothetically attributed to nicotine's ameliorating abnormal brain processes in this illness. There is some preliminary evidence that nicotine may alter pre-attentive auditory change detection, as indexed by the EEG-derived mismatch negativity (MMN), but no previous study has examined what role auditory verbal hallucinations (AVH) may have on these effects. The objective of this study was to examine MMN-indexed acoustic change detection in schizophrenia (SZ) following nicotine administration and elucidate its association with AVH. Using a modified multi-feature paradigm, MMNs to duration, frequency and intensity deviants were recorded in 12 schizophrenia outpatients (SZ) with persistent AVHs following nicotine (6mg) and placebo administration. Electrical activity was recorded from 32 scalp electrodes; MMN amplitudes and latencies for each deviant were compared between treatments and were correlated with trait (PSYRATS) and state measures of AVH severity and Positive and Negative Syndrome Scale (PANSS) ratings. Nicotine administration resulted in a shortened latency for intensity MMN. Additionally, nicotine-related change in MMN amplitude was correlated with nicotine-related change in subjective measures of hallucinatory state. In summary, nicotine did not affect MMN amplitudes in schizophrenia patients with persistent AVHs, however this study reports accelerated auditory change detection to intensity deviants with nicotine in this group. Additionally, nicotine appeared to induce a generalized activation of the auditory cortex in schizophrenia, resulting in a concurrent increase in intensity MMN amplitude and subjective clarity of AVHs.

Competing Risk Analysis of Time to Communal Residence for Elder Orphans.

Elder Orphans, socially/physically isolated older adults without caregiving support, are of interest in an aging population. Lack of caregivers for Elder Orphans may influence relocation to residential care facilities, including skilled nursing or assisted living facilities, compared to aging in place. Using the National Health and Aging Trends Study (NHATS), Competing Risk Survival Analyses were performed to determine if Elder Orphans or those At Risk for becoming elder orphans had increased risk for residential care relocation over nine NHATS waves (2011-2019). Elder Orphans had significantly higher risk for moving to residential care facilities in unadjusted (SHR = 1.780; p = 0.001) and adjusted (SHR = 1.571; p = 0.043) models. Those At Risk for becoming an elder orphan had significantly decreased risk for residential care residence in unadjusted (SHR = 0.517; p < 0.001) and adjusted (SHR = 0.726; p = 0.037) models. As aging in place becomes prioritized in the US healthcare system, understanding caregiving needs of older adults is vital to their health outcomes.

Elevated C-Reactive Protein in Alzheimer's Disease Without Depression in Older Adults: Findings From the Health and Retirement Study.

We examined the association between differential diagnoses of major stroke and probable Alzheimer's disease (AD) and mixed AD on C-reactive protein (CRP) in older adults with and without depression. Secondary data analyses examined associations between blood-based measures of probable peripheral inflammation using CRP collected from dried blood spots in the Health and Retirement Study, a nationally representative sample of individuals aged 50 and older. A validated pattern-recognition algorithm was utilized to identify cognitive decline indicative of probable AD, mixed AD, and major stroke. Negative binomial regressions were utilized to model concentrations of serologic CRP. On average, participants (N = 4 601) were 70 years old, female, and non-Hispanic White. Mixed AD participants had a 0.26 mg/dL increase in CRP compared to unimpaired participants, controlling for demographics, health behaviors, and comorbidities. Those with mixed AD had 2.14 times increased odds of having high CRP (odds ratio = 2.14 [1.19-3.85]). In analyses stratified by depression, adults with mixed AD and without depression had an additional 0.37 mg/dL increase in CRP (SE = 0.06; p < .001) compared to unimpaired adults. Those with AD without depression had a 0.20 mg/dL increase in CRP (SE = 0.07; p < .01). Age was not associated with increased CRP in nondepressed older adults. Depressed adults with major stroke had a -0.26 mg/dL decrease in CRP (SE = 0.11; p = .02), controlling for hypertension, alcoholic drinks/beverages per week, and smoking status. Concentration modeling revealed that participants with major stroke, probable AD, and probable mixed AD without depression had significantly higher CRP concentrations when compared to unimpaired older adults.

The relationship between cognitive ability and BOLD activation across sleep-wake states.

The sleep spindle, a waxing and waning oscillation in the sigma frequency range, has been shown to correlate with fluid intelligence; i.e. the ability to use logic, learn novel rules/patterns, and solve problems. Using simultaneous EEG and fMRI, we previously identified the neural correlates of this relationship, including activation of the thalamus, bilateral putamen, medial frontal gyrus, middle cingulate cortex, and precuneus. However, research to date has focussed primarily on non-rapid eye movement (NREM) sleep, and spindles per se, thus overlooking the possibility that brain activity that occurs in other sleep-wake states might also be related to cognitive abilities. In our current study, we sought to investigate whether brain activity across sleep/wake states is also related to human intelligence in N = 29 participants. During NREM sleep, positive correlations were observed between fluid intelligence and blood oxygen level dependent (BOLD) activations in the bilateral putamen and the paracentral lobule/precuneus, as well as between short-term memory (STM) abilities and activity in the medial frontal cortex and inferior frontal gyrus. During wake, activity in bilateral postcentral gyri and occipital lobe was positively correlated with short-term memory abilities. In participants who experienced REM sleep in the scanner, fluid intelligence was positively associated with midbrain activation, and verbal intelligence was associated with right postcentral gyrus activation. These findings provide evidence that the relationship between sleep and intellectual abilities exists beyond sleep spindles.

Momentary Associations of Osteoarthritis Pain and Affect: Depression as Moderator.

OBJECTIVES: This research examined main and moderating effects of global depressive symptoms upon in-the-moment associations of pain and affect among individuals with knee osteoarthritis (OA). Effects of depression on short-term change in pain and affect were also examined. METHOD: Older adults with physician-confirmed OA (N = 325) completed a baseline interview tapping global depressive symptoms, followed by an experience sampling protocol that captured momentary pain and affect 4 times daily for 7 days. Multilevel models controlling demographics and health conditions examined main and moderating effects of depression on momentary associations of pain with positive affect (PA) and negative affect (NA). Similar methods addressed short-term change in pain and affect. Auxiliary analyses explored broad associations of depressive symptoms with person-level averages and variability in pain and affect. RESULTS: Global depression predicted current pain, PA, and NA, as well as change in pain and affect over a 3- to 8-h period. Furthermore, both in the moment and over short periods, the association of pain and NA was stronger among persons higher in depressive symptoms. No moderating effect for the PA-pain association was found. Depressive symptoms were also associated with variability in pain and affect, particularly NA. DISCUSSION: Results confirm previous work on the relation of chronic pain with both global depressive symptoms and short-term affect. This research further demonstrates a unique moderating role of depression on the association of momentary pain with NA and suggests that the causal path may be stronger from pain to affect than vice versa.

Women's interest in taking tamoxifen and raloxifene for breast cancer prevention: response to a tailored decision aid.

Although tamoxifen can prevent primary breast cancer, few women use it as a preventive measure. A second option, raloxifene, has recently been approved. The objective of the study was to determine women's interest in tamoxifen and raloxifene after reading a decision aid (DA) describing the risks and benefits of each medication. Women with 5-year risk of breast cancer ≥ 1.66 from two large health maintenance organizations were randomized to receive a DA versus usual care. After reading an on-line DA that discussed the risks and benefits of tamoxifen and raloxifene, women completed measures of risk perception, decisional conflict, behavioral intentions, and actual behavior related to tamoxifen and raloxifene. 3 months following the intervention, 8.1% of participants had looked for additional information about breast cancer prevention drugs, and 1.8% had talked to their doctor about tamoxifen and/or raloxifene. The majority, 54.7%, had decided to not take either drug, 0.5% had started raloxifene, and none had started tamoxifen. Participants were not particularly worried about taking tamoxifen or raloxifene and did not perceive significant benefits from taking these drugs. Over 50% did not perceive a change in their risk of getting breast cancer if they took tamoxifen or raloxifene. After reading a DA about tamoxifen and raloxifene, few women were interested in taking either breast cancer prevention drug.

The distinct role of comparative risk perceptions in a breast cancer prevention program.

BACKGROUND: Comparative risk perceptions may rival other types of information in terms of effects on health behavior decisions. PURPOSE: We examined associations between comparative risk perceptions, affect, and behavior while controlling for absolute risk perceptions and actual risk. METHODS: Women at an increased risk of breast cancer participated in a program to learn about tamoxifen which can reduce the risk of breast cancer. They reported comparative risk perceptions of breast cancer and completed measures of anxiety, knowledge, and tamoxifen-related behavior intentions. Three months later, the women reported their behavior. RESULTS: Comparative risk perceptions were positively correlated with anxiety, knowledge, intentions, and behavior 3 months later. After controlling for participants' actual risk of breast cancer and absolute risk perceptions, comparative risk perceptions predicted anxiety and knowledge, but not intentions or behavior. CONCLUSIONS: Comparative risk perceptions can affect patient outcomes like anxiety and knowledge independently of absolute risk perceptions and actual risk information.

Musical instrument engagement across the life course and episodic memory in late life: An analysis of 60 years of longitudinal data from the Wisconsin Longitudinal Study.

BACKGROUND: As the global burden of dementia increases, the absence of treatment underscores the need for identification of factors that may improve cognitive reserve-the ability to stave off cognitive decline in old age. The beneficial association between musical instrument engagement and episodic memory has been identified in children, young adults, and older adults. Yet, previous studies in musical instrument engagement have rarely examined the potential for adolescence and adulthood exposures to independently improve cognition, nor have they been linked with the rate of memory decline over time in older adults. We investigated whether adolescent musical instrument engagement and continued musical instrument engagement over the adult life course were separately associated with higher episodic memory, as well as rate of decline in a large longitudinal cohort. METHODS: Data were from a prospective cohort of high school graduates from 1957. High school music engagement (HSME) was ascertained through graduate yearbooks and assessed as membership in musical performance groups. A questionnaire was used to assess musical engagement through adulthood (MEA) at ages 35, 55, and 65. The episodic memory score was composed of immediate and delayed recall task scores, and was assessed when participants were aged approximately 65 and 72 years old among 5,718 individuals. Linear mixed models were used to assess the association between music, and memory performance and decline over time. RESULTS: Of high school graduates who participated in the study, 38.1% played music in high school, and 21.1% played music in adulthood. While musical engagement was more common in those who played in childhood, 40% of those who played continuously as an adult did not play in high school. High HSME (B = 0.348, p = 0.049) and continuous MEA (B = 0.424, p = 0.012) were associated with higher memory scores at age 65 after covariate adjustment. When examining memory decline, the benefits of high HSME decreased over time (B = -0.435, p = 0.048), while the rate of decline did not differ between MEA groups. Exploratory models revealed differential benefits for HSME and immediate recall, and MEA and delayed recall. CONCLUSION: This study provides further evidence that musical engagement in childhood or adulthood is associated with non-musical cognitive reserve. These two exposures may act differentially in different domains of episodic memory. Further work is needed to determine the relationship between musicianship and the rate of cognitive decline.

Differential Effects of a Nap on Motor Sequence Learning-Related Functional Connectivity Between Young and Older Adults.

In older adults, motor sequence learning (MSL) is largely intact. However, consolidation of newly learned motor sequences is impaired compared to younger adults, and there is evidence that brain areas supporting enhanced consolidation via sleep degrade with age. It is known that brain activity in hippocampal-cortical-striatal areas is important for sleep-dependent, off-line consolidation of motor-sequences. Yet, the intricacies of how both age and sleep alter communication within this network of brain areas, which facilitate consolidation, are not known. In this study, 37 young (age 20-35) and 49 older individuals (age 55-75) underwent resting state functional magnetic resonance imaging (fMRI) before and after training on a MSL task as well as after either a nap or a period of awake rest. Young participants who napped showed strengthening of functional connectivity (FC) between motor, striatal, and hippocampal areas, compared to older subjects regardless of sleep condition. Follow-up analyses revealed this effect was driven by younger participants who showed an increase in FC between striatum and motor cortices, as well as older participants who showed decreased FC between the hippocampus, striatum, and precuneus. Therefore, different effects of sleep were observed in younger vs. older participants, where young participants primarily showed increased communication in the striatal-motor areas, while older participants showed decreases in key nodes of the default mode network and striatum. Performance gains correlated with FC changes in young adults, and this association was much greater in participants who napped compared to those who stayed awake. Performance gains also correlated with FC changes in older adults, but only in those who napped. This study reveals that, while there is no evidence of time-dependent forgetting/deterioration of performance, older adults exhibit a completely different pattern of FC changes during consolidation compared to younger adults, and lose the benefit that sleep affords to memory consolidation.

Long-term cognitive impairment and functional disability among survivors of severe sepsis.

CONTEXT: Cognitive impairment and functional disability are major determinants of caregiving needs and societal health care costs. Although the incidence of severe sepsis is high and increasing, the magnitude of patients' long-term cognitive and functional limitations after sepsis is unknown. OBJECTIVE: To determine the change in cognitive impairment and physical functioning among patients who survive severe sepsis, controlling for their presepsis functioning. DESIGN, SETTING, AND PATIENTS: A prospective cohort involving 1194 patients with 1520 hospitalizations for severe sepsis drawn from the Health and Retirement Study, a nationally representative survey of US residents (1998-2006). A total of 9223 respondents had a baseline cognitive and functional assessment and had linked Medicare claims; 516 survived severe sepsis and 4517 survived a nonsepsis hospitalization to at least 1 follow-up survey and are included in the analysis. MAIN OUTCOME MEASURES: Personal interviews were conducted with respondents or proxies using validated surveys to assess the presence of cognitive impairment and to determine the number of activities of daily living (ADLs) and instrumental ADLs (IADLs) for which patients needed assistance. RESULTS: Survivors' mean age at hospitalization was 76.9 years. The prevalence of moderate to severe cognitive impairment increased 10.6 percentage points among patients who survived severe sepsis, an odds ratio (OR) of 3.34 (95% confidence interval [CI], 1.53-7.25) in multivariable regression. Likewise, a high rate of new functional limitations was seen following sepsis: in those with no limits before sepsis, a mean 1.57 new limitations (95% CI, 0.99-2.15); and for those with mild to moderate limitations before sepsis, a mean of 1.50 new limitations (95% CI, 0.87-2.12). In contrast, nonsepsis general hospitalizations were associated with no change in moderate to severe cognitive impairment (OR, 1.15; 95% CI, 0.80-1.67; P for difference vs sepsis = .01) and with the development of fewer new limitations (mean among those with no limits before hospitalization, 0.48; 95% CI, 0.39-0.57; P for difference vs sepsis <.001 and mean among those with mild to moderate limits, 0.43; 95% CI, 0.23-0.63; P for difference = .001). The declines in cognitive and physical function persisted for at least 8 years. CONCLUSIONS: Severe sepsis in this older population was independently associated with substantial and persistent new cognitive impairment and functional disability among survivors. The magnitude of these new deficits was large, likely resulting in a pivotal downturn in patients' ability to live independently.

Effects of a tailored activity pacing intervention on pain and fatigue for adults with osteoarthritis.

OBJECTIVE: We examined whether tailored activity pacing intervention was more effective at reducing pain and fatigue than general activity pacing intervention. METHOD: Adults with knee or hip osteoarthritis (N = 32) stratified by age and gender were randomized to receive either tailored or general pacing intervention. Participants wore an accelerometer for 5 days that measured physical activity and allowed for repeated symptom assessment. Physical activity and symptom data were used to tailor activity pacing instruction. Outcomes at 10-week follow-up were pain (Western Ontario and McMaster Universities Osteoarthritis Index) and fatigue (Brief Fatigue Inventory). RESULTS: Compared with general intervention, the tailored group had less fatigue interference (p = .02) and trended toward decreased fatigue severity (p = .09) at 10-wk follow-up. No group differences were found in pain reduction. CONCLUSION: Tailoring instruction on the basis of recent symptoms and physical activity may be a more effective symptom management approach than general instruction given the positive effects on fatigue.

Estimated Prevalence of Elder Orphans Using National Health and Aging Trends Study.

Objectives: By 2050, individuals aged 65 years and older will comprise over 20% of the American population. A portion is at risk for becoming elder orphans: older adults living in the community who lack caregivers or surrogates. Methods: Using the first wave of the National Health and Aging Trends Survey, we estimated the prevalence of older adults who reside in the community, who are socially or physically isolated, and who lack caregivers. Individuals who are "at risk" meet all of these criteria, with the exception that they live with and receive caregiving from their spouse. Results: We estimated the elder orphan prevalence for this population to be 2.62% (2.24-3.00), with an additional 21.29% determined to be at risk. Discussion: As the population of the United States ages, an understanding of the prevalence and demographics of elder orphans will be useful to guide policies and services to assist this population.

Momentary Reports of Fatigue Predict Physical Activity Level: Wrist, Waist, and Combined Accelerometry.

Objective: Fatigue is commonly reported by persons with osteoarthritis (OA) and predicts worse functioning and decreased activity. The current research used a combination of wrist and waist accelerometry along with experience sampling methodology to examine the relationship between reports of fatigue and subsequent physical activity among older adults with knee OA. Method: Two hundred one participants completed an interview followed by a 1-week period during which their activity was monitored and they reported symptoms of pain and fatigue. Multilevel models examined within-subjects versus between-subjects patterns of symptoms and their association with physical activity. Results: Fatigue was the most consistent predictor of lowered physical activity (ß = -20.83, p < .001). Although wrist-worn actigraphs produced higher averaged activity counts than did waist actigraphs (t = 34.68, p < .001), multilevel models showed consistent results regardless of placement. Discussion: Fatigue was a consistent predictor of lowered activity regardless of actigraph location.