Sensory impairment and depressive symptoms among older adults before and during the COVID-19 pandemic.

OBJECTIVES: This study examined the associations between sensory impairment (SI), lack of social contact during the COVID-19 pandemic, and depressive symptoms among Americans aged 50 and above. METHODS: We employed data from the 2018 and 2020 Health and Retirement Study (N = 13,460) to examine four SI groups: no SI, visual impairment (VI) only, hearing impairment (HI) only, and dual sensory impairment (DSI). First, multilevel models were employed to estimate the associations between SI and depressive symptoms before and during the pandemic using the full dataset (N = 13,460). Second, linear regression models were employed to estimate the moderation effect of lack of social contact during the pandemic using the 2020 wave data only (N = 4,133). RESULTS: Among older adults, 15.60% had VI only, 10.16% had HI only, and 9.66% had DSI. All SI groups reported significantly more depressive symptoms than the no SI group. The differences between older adults with VI and DSI and those without SI regarding depressive symptoms narrowed during the pandemic. There was no statistically significant moderation effect of lack of social contact for SI and depressive symptoms. CONCLUSION: Older adults with SI faced mental health challenges and demonstrated psychological resilience during the pandemic. Future research should examine other risk factors that may modify the relationship between SI and mental health during public health crises.

Social Contact, Social Participation, and Emotional Well-Being Among Older Adults During the COVID-19 Pandemic: The Roles of Giving and Receiving Social Support.

This study examined whether social contact, social participation, and social support during the COVID-19 pandemic were associated with depression and anxiety. Data were taken from the 2020 COVID-19 Supplement of the National Health and Aging Trends Study (N = 2,778). Depression and anxiety were regressed on social contact frequency, social participation, and social support. Path analyses were also performed. The results showed that in-person contact was related to lower levels of depression, while in-person contact and attending religious services were related to lower levels of anxiety. Giving and receiving support were associated with higher levels of depression and anxiety. Giving support mediated the link between virtual contact, volunteering, and depression, while receiving support mediated the link between virtual contact and depression. Receiving and giving support mediated the association between virtual social contact, volunteering, and anxiety. During the pandemic, being socially connected provided some benefits in terms of emotional well-being, but in some cases being socially connected did not provide salubrious effects.

Age and Cohort Trends in Formal Volunteering and Informal Helping in Later Life: Evidence From the Health and Retirement Study.

Formal volunteering holds great importance for the recipients of volunteer services, individuals who volunteer, and the wider society. However, how much recent birth cohorts volunteer in middle and late adulthood compared with earlier birth cohorts is not well understood. Even less well-known are the age and cohort trends in informal helping provided to friends and neighbors in later adulthood. Using longitudinal data from the Health and Retirement Study, we estimated age and cohort trends in formal volunteering and informal helping from 1998 to 2018 for a wide range of birth cohorts born between 1909 and 1958. We used multivariate, multilevel models based on Bayesian generalized modeling methods to estimate the probabilities of volunteering and informal helping simultaneously in a single model. Despite having advantages in human and health capital, recent birth cohorts showed volunteering levels in late adulthood that are similar to those of their predecessors. Moreover, more recent birth cohorts were consistently less engaged in informal helping than earlier birth cohorts throughout the observation period. More research is needed to illuminate the sociocultural drivers of changes in helping behaviors and overall prosocial and civic engagement.

Mild Neurocognitive Disorder, Social Engagement, and Falls Among Older Primary Care Patients.

OBJECTIVES: (1) To estimate the association between social engagement (SE) and falls; (2) To examine the relation between mild neurocognitive disorder (MNCD) and falls by different levels of SE. DESIGN: We performed a secondary data analysis using prospective cohort study design. SETTING: Primary care. PARTICIPANTS: A total of 425 older adult primary care patients at risk for mobility decline (N=425). As previously reported, at baseline, 42% of participants exhibit MNCD. MAIN OUTCOME MEASURES: The outcome variable was the number of falls during 2 years of follow-up. Exposure variables at baseline included (1) MNCD identified using a cut-off of 1.5 SD below the age-adjusted mean on at least 2 measures within a cognitive performance battery and (2) SE, which was assessed using the social component of the Late-Life Function and Disability Instrument. High SE was defined as having a score ≥ median value (≥49 out of 100). All models were adjusted for age, sex, education, marital status, comorbidities, and pain status. RESULTS: Over 2 years of follow-up, 48% of participants fell at least once. MNCD was associated with a higher rate of falls, adjusting for the covariates (Incidence Rate Ratio=1.6, 95% confidence interval: 1.1-2.3). There was no significant association between MNCD and the rate of falls among people with high SE. In participants with low SE (having a score less than 49.5 out 100), MNCD was associated with a higher rate of falls as compared with participants with no neurocognitive disorder (No-NCD). CONCLUSIONS: Among participants with low SE, MNCD was associated with a higher rate of falls, but not among participants with high SE. The findings suggest that high SE may be protective against falls among older primary care patients with MNCD.

Frailty, cognitive impairment, and depressive symptoms in Chinese older adults: an eight-year multi-trajectory analysis.

BACKGROUND: Frailty, cognitive impairment, and depressive symptoms are closely interrelated conditions in the aging population. However, limited research has longitudinally analyzed the concurrent trajectories of these three prominent conditions in older adults in China. This study aimed to explore the eight-year trajectories of frailty, cognitive impairment, and depressive symptoms, and to identify individual-level and structural-level factors associated with the trajectories. METHODS: Four waves of data from the China Health and Retirement Longitudinal Study (2011-2018) were used to identify 6,106 eligible older adults. The main measures included frailty by the frailty index constructed using 30 indicators, cognitive impairment by the summary score of immediate and delayed word recall, figure drawing, serial subtraction, and orientation, and depressive symptoms by the Center for Epidemiologic Studies Depression Scale. Multi-trajectory models identified the trajectories of frailty, cognitive impairment, and depressive symptoms over time. Multinomial logistic regression was employed to estimate the associations between individual-level capital factors and one structural factor (hukou and geographic residency) with the identified trajectories, adjusting for demographic characteristics. RESULTS: Four trajectories emerged: (1) worsening frailty, worsening cognitive impairment, depression (14.0%); (2) declining pre-frailty, declining cognition, borderline depression (20.0%); (3) pre-frailty, worsening cognitive impairment, no depression (29.3%); and (4) physically robust, declining cognition, no depression (36.7%). Using the "physically robust, declining cognition, no depression" as the reference, not working, no social activity participant, worse childhood family financial situation, and poorer adult health were most strongly associated with the "worsening frailty, worsening cognitive impairment, depression" trajectory; worse health during childhood had the highest association with the "declining pre-frailty, declining cognition, borderline depression" trajectory; less education, lower household consumption, and rural hukou had the greatest association with the increased likelihood of the "pre-frailty, worsening cognitive impairment, no depression" trajectory. CONCLUSIONS: Findings could inform the understanding of the interrelationship of frailty, cognitive impairment, and depressive symptoms in older adults in China and may help practitioners detect adults at risk for adverse trajectories to implement strategies for proper care.

Cognitive function and cognitive decline among older rural Chinese adults: the roles of social support, pension benefits, and medical insurance.

OBJECTIVES: This study investigated whether social support, pension benefits, and medical insurance coverage are related to cognitive function and decline among older rural Chinese adults and whether depressive symptoms represented a pathway linking these factors with cognitive function. METHODS: Data are taken from three waves of the China Health and Retirement Longitudinal Study (N = 5,135). Cognitive function is assessed with episodic memory and depressive symptoms are assessed with the 10-item CESD Scale. Social support (intergenerational financial transfers, weekly contact with children, perceived availability of future support, and living arrangements), pension benefits, and medical insurance coverage are self-reported measures. Multilevel linear regression models are employed. RESULTS: Intergenerational financial transfers, perceived availability of future support, and pension income are associated with higher levels of cognitive function. Living with others, perceived availability of future support, medical insurance coverage, and pension income are associated with a slower risk of cognitive decline. Depressive symptoms mediated the association between perceived availability of future support, living with others, pension income and level of cognitive function and the link between perceived availability of future support, pension income, and cognitive decline. CONCLUSION: The findings suggested these modifiable factors should be taken into account when screening older adults for possible cognitive impairment and decline. Early interventions may also be helpful by expanding social resources and reducing psychological distress.

Internet use and loneliness among older Chinese adults.

OBJECTIVES: This study examined the association between Internet use and loneliness among Chinese older adults (aged 60+) over a two-year period using nationally representative survey data from China. METHODS: Using data from the 2016 and 2018 waves of the China Longitudinal Ageing Social Survey (N = 8,059), we estimated difference-in-differences regression models to assess the association between Internet use and levels of loneliness over time. RESULTS: Compared to Internet non-users, Chinese older adults who were new Internet users, as well as those who were continuous Internet users, reported lower levels of loneliness over time (B = -0.21, p < 0.001 and B = -0.16, p < 0.001, respectively). Conversely, those Chinese older adults who used the Internet in wave 1 but then disengaged from using the Internet in wave 2 demonstrated an upward trend in loneliness over time, similar to Internet non-users (the estimate of difference-in-differences was non-significant for the comparison between disengaged-users and non-users: B = -0.03, p = 0.42). CONCLUSION: This study provided new evidence to support the potential benefits of Internet use for reducing the risk of loneliness among Chinese older adults. The findings suggested that supporting current Internet users to remain digitally engaged is as important as encouraging Internet non-users to cross the digital divide.

Quantitation of Pax-6 protein in ocular impression cytology samples using an electrochemiluminescence immunoassay.

Paired box protein Pax-6 (oculothrombin) is a transcription factor that plays an important regulatory role in ocular, brain, and pancreatic development. Mutations of the PAX6 gene cause aniridia and Peters anomaly. Reduction in Pax-6 protein is also associated with ocular diseases such as dry eye. An electrochemiluminescence immunoassay method using the Meso Scale Discovery platform was developed to measure Pax-6 protein levels in corneal epithelial cells obtained by impression cytology. Impression cytology involves harvesting ocular epithelial cells by applying a polyethersulfone membrane patch briefly to the ocular surface using a commercially available EYEPRIM™ device. The epithelial cells that adhere to the membrane patch of the EYEPRIM™ device provide a biological sample which can be assayed for Pax-6 protein levels. Assay development identified an antibody pair capable of detecting purified recombinant Pax-6 protein produced in mammalian cells. The optimized assay has a dynamic range of 24 pg mL-1 to 100,000 pg mL-1 and a lower limit of quantification of 24 pg mL-1. Assay selectivity was demonstrated using either HeLa or HEK293 cells transfected with inhibitory RNA. Finally, the method was validated by measuring Pax-6 protein levels in impression cytology acquired samples obtained using the EYEPRIM™ device from rabbit cornea.

Subjective well-being among male veterans in later life: the enduring effects of early life adversity.

OBJECTIVES: This study investigated the association between childhood and young adult adversities and later-life subjective well-being among older male veterans. We also explored whether early-life parent-child relationships and later-life social engagement served as moderators and mediators, respectively. METHODS: Data were from the 2008 to 2012 waves of the Health and Retirement Study for male veterans (N = 2026). Subjective well-being measures included depressive symptoms, self-rated health, and life satisfaction. Linear regression with the Process macro was employed to estimate the relationships. RESULTS: Adverse childhood experiences (ACEs) were positively associated with number of depressive symptoms and negatively related to life satisfaction. Combat exposure, a young adulthood adversity experience, was positively associated with depressive symptoms, but not with self-rated health or life satisfaction. Later-life social engagement mediated the relationship between ACEs and subjective well-being indices. Parent-child relationship quality did not moderate the association between the measures of adversity and any measure of subjective well-being. DISCUSSION: Childhood adversity and combat exposure were related to worse later life subjective well-being. Also, later-life social engagement mediated the association of two early life adversity measures and subjective well-being. Future research should examine subjective well-being and early life adversity for female veterans and should employ more detailed information about combat exposure.

Perceived social isolation, social disconnectedness and falls: the mediating role of depression.

OBJECTIVES: to estimate the association of social disconnectedness and perceived social isolation with the risk of falls and also investigate whether depression mediated this association. METHOD: Biennial longitudinal survey data from 2006 to 2012 waves of the U.S. Health and Retirement Study of adults aged 65 and older (N = 22,153 observations) were examined. The outcome variable was number of self-reported falls over the observation period. Independent variables included social isolation (social disconnectedness, perceived social isolation) and number of depressive symptoms. Generalized Estimating Equation regressions were performed to address the research questions. RESULTS: Regression models indicated that social disconnectedness is associated with a 5% increase in the risk of falls. Perceived social isolation (lack of perceived social support and loneliness combined) was associated with a 33% increase in falls risk. For each increase in the number of depressive symptoms, the risk of falls increased by 13%. Also, the number of depressive symptoms mediated the association between perceived social isolation and risk of falls. CONCLUSION: Our findings were suggestive of the need to consider social isolation when designing falls prevention programs. More research is needed with research designs that address potential endogeneity bias.

Health Behavior Profiles of Korean Baby Boomers.

This study identified profiles of health behaviors among Korean baby boomers and examined a set of individual characteristics associated with these latent profiles. We analyzed a sample of 4,047 middle-aged adults (aged 53-61) from the Korean Baby Boomer Panel Study (2014). Latent profile analysis was used to uncover distinct health behavior profiles, and multinomial regression was performed to investigate the associations between health behavior profiles and predisposing, enabling, and need factors-following from the behavioral models of health behaviors and health services use. Five profiles of health behaviors were identified: (a) low-risk and high-preventive behaviors (50%), (b) low-risk and low-preventive behaviors (35%), (c) moderate-risk and moderate-preventive behaviors (7%), (d) moderate-risk and high-preventive behaviors (6%), and (e) high-risk and low-preventive behaviors (2%). Further, individuals with more enabling and need characteristics, indicated by higher socioeconomic status and greater health concerns, were more likely to engage in healthier profiles.

Home and Community-Based Service Utilization among Older Adults in Urban China: The Role of Social Capital.

Home and community-based service (HCBS) utilization is considered important for older adults who want to maintain their independence and remain in their communities. This study examined the relationship between structural (e.g., citizenship activities, volunteering) and cognitive (e.g., social trust, a sense of belonging) social capital and HCBS utilization among older Chinese adults. We analyzed survey data from 441 community-dwelling older adults in the Gusu district of the city of Suzhou, China in 2015. Quota sampling was used to select respondents. Negative binomial regression was used within the structural equation modeling framework to test the proposed model for HCBS utilization. Structural social capital had a direct association with HCBS utilization, controlling for predisposing, enabling, and need factors in the model. Further, cognitive social capital showed an indirect association with HCBS utilization via structural social capital. The results suggested the importance of establishing intervention programs that foster structural social capital to promote HCBS utilization.

Are Spouses' Sleep Problems a Mechanism Through Which Health is Compromised? Evidence Regarding Insomnia and Heart Disease.

BACKGROUND: Symptoms of insomnia have been widely identified as risk factors for health, including heart disease. Despite the expansive and growing literature on health concordance among coupled individuals, few studies have examined insomnia as a shared risk factor for heart disease among middle-aged and older couples. PURPOSE: This study examined the association between insomnia and incident heart disease among couples. A dyadic modeling approach was employed to investigate the relationships between one's own insomnia and partners' insomnia for the risk of incident heart disease for each partner. METHODS: Data from the 2010, 2012, and 2014 Health and Retirement Study were utilized in a prospective research design (N = 3,221 couples). Actor-partner interdependence models were employed to estimate actor and partner effects of insomnia symptoms for incident heart disease over the 4 year observation period. RESULTS: Insomnia symptoms measured at baseline were related to an increased risk for heart disease for husbands, whereas for wives the association was attenuated after other health measures were controlled. Wives' insomnia was related to an increased risk of incident heart disease for husbands but husbands' insomnia was not related to wives' risk of heart disease. CONCLUSIONS: This study showed how subjective insomnia symptoms among middle-aged and older adults in intimate partnerships are associated with their heart disease risk. Further research is needed to verify the results with objective measures of sleep problems and heart disease.

Intergenerational financial exchange and cognitive impairment among older adults in China.

Objective: This study investigated the relationship between intergenerational financial exchange patterns and cognitive impairment among older Chinese adults. The study also explored potential pathways linking financial exchanges to cognitive health. Method: Data were taken from the 2005 and 2008 Chinese Longitudinal Healthy Longevity Survey. Three patterns of financial exchange (i.e., low receiving, high receiving, and reciprocity) based on a latent profile analysis were examined as predictors. Logistic regression models were employed to analyze variation in the Chinese version of the mini-mental status exam, taking into consideration the financial exchange patterns and a set of covariates. Results: Older adults with a reciprocity exchange pattern with their adult children had a lower likelihood of being cognitively impaired, supporting our hypotheses drawn from social exchange theory. Nutrition was found to mediate the relationship between financial exchange and cognition. Discussion: The inclusion of adequate nutrition intake as a means of maintaining cognitive well-being may help communities and families, as well as older Chinese adults, promote well-being and live a higher quality of life.

Combat exposure, social relationships, and subjective well-being among middle-aged and older Veterans.

OBJECTIVES: This study described the association of subjective well-being with combat exposure and social relationships among middle-aged and older Veteran men in the USA. The stress-buffering hypothesis, which predicts social relationships may moderate the association between combat exposure and subjective well-being, was also examined. METHOD: Data from the 2008 Health and Retirement Study (N = 2961) were used to estimate logistic regression models, focusing on three measures of subjective well-being: depression, life satisfaction, and self-reported health. RESULTS: In the fully adjusted models, there were no statistically significant relationships between combat exposure and the three indicators of subjective well-being. However, compared to Veterans who had lower scores on the social relationship index, Veterans who had higher scores were less likely to be depressed and less likely to report poor or fair health. Veterans who had higher scores on the social relationships index reported higher levels of life satisfaction than those Veterans who had lower scores. There was no evidence for a social relationships buffering effect. CONCLUSION: The results of this study demonstrated that combat exposure did not have a long-term relationship with subjective well-being. Longitudinal research designs with more comprehensive indicators of combat exposure may help researchers better understand some of the underlying complexity of this relationship. Complementary research with samples of women Veterans, as well as samples of Hispanic, and non-Black, non-White Veterans, is also needed.

Intergenerational financial exchange and the psychological well-being of older adults in the Republic of Korea.

OBJECTIVES: This study examined whether the exchange of instrumental support (i.e., financial resources) among older adults and their children was related to the psychological well-being of older Koreans. METHODS: Data from the Korean Longitudinal Study of Ageing were employed. Older adults who were aged 65 and older and who had at least one living child who did not live in the respondent's household were included (N = 3791). Well-being was measured with depressive symptoms (CES-D-10) and life satisfaction. For the direction model of exchange, giving and receiving support was assessed with financial aid (cash and non-cash). For the reciprocity model of exchange, four patterns of financial exchanges were identified: both giving and receiving, receiving only, giving only, and no exchange. RESULTS: The results from the direction model showed that older adults who give financial support were less likely to be depressed and reported higher levels of life satisfaction. The effect of receiving support was not significant for depression but was related to higher levels of life satisfaction. The results from the reciprocity model showed that those who gave and received support had better psychological health compared to those who only received support. CONCLUSIONS: Both giving and receiving were positively related to the psychological well-being of older adults. Our results provide support for identity theory and equity theory as frameworks for understanding intergenerational exchange and well-being of older Koreans.

Expanding access to gerontological education via distance learning: the Management of Aging Services Masters Program at UMass Boston.

This article describes the online Management of Aging Services Masters Program at the University of Massachusetts Boston and reports on a recent Program review. The Program has experienced rapid growth, evolving from seven matriculating students in 2003 to 108 in 2012. It has graduated 125 students and boasts a 78% completion rate. The authors describe the Program and report on faculty and student perceptions of performance. The Program demonstrates sound pedagogical practice for online education, incorporating techniques to foster community and encourage students and faculty interaction. Distance learning holds considerable promise for expanding access to gerontological education to reach future aging services professionals.

Childhood and Midlife Cultural Awareness and Activity Engagement Among Korean Married Couples.

OBJECTIVES: Cultural reproduction theory posits that cultural resources are transmitted across generations, suggesting early parental influences on cultural experiences in adulthood. Further, cultural resources may be transferred within the same generation-through significant others, such as spouses. This study investigates cultural engagement among middle-aged adults, focusing on individual and spousal influences of childhood cultural engagement. METHODS: A sample of 1,271 couples (age 49-66) from the 2012 Korean Baby Boomer Panel Study and the Korean Forgotten Generation Study was analyzed. Each respondent reported the number of arts and cultural activities (e.g., paintings, literature, and classical music) and levels of perceived cultural engagement (i.e., cultural awareness) during childhood and at midlife. Actor-partner interdependence models (APIMs) were estimated to examine how spouses' childhood and midlife cultural engagement were linked within couples. RESULTS: Findings showed that wives reported higher levels of activity participation and cultural awareness in childhood and midlife, compared to husbands. The APIM results indicated that beyond one's own childhood cultural engagement, spouse's childhood cultural awareness was associated with both levels of participation in arts and cultural activities (only for husbands) and cultural awareness (for both husbands and wives) at midlife. DISCUSSION: Cultural activities and awareness can be valuable assets to enhance overall well-being in later life. Given the cross-spousal associations in cultural engagement among Korean middle-aged couples, both spouses' cultural resources need to be considered for the design of interventions and policies to cultivate cultural competence and promote cultural engagement in adulthood.

Pathways Linking Information and Communication Technology Use and Loneliness Among Older Adults: Evidence From the Health and Retirement Study.

BACKGROUND AND OBJECTIVES: This study investigated the association between information and communication technology (ICT) use and loneliness among community-dwelling older adults (aged 65+), as well as the mediating effects of social relations, perceived control, and purpose-in-life. RESEARCH DESIGN AND METHODS: The study used data from the 2014 and 2018 Health and Retirement Study (N = 3,026), employing autoregressive path models with contemporaneous mediation to assess the association of 2 kinds of ICT use, social media communication and general computer use, with loneliness through the pathways of perceived social support, social contact, perceived constraints, and purpose-in-life. RESULTS: Social media communication had a negative association with loneliness. Perceived social support and social contact mediated this association, but not perceived constraints, or purpose-in-life. General computer use did not have a significant total effect on loneliness; however, a significant indirect effect through perceived constraints, purpose-in-life, and social contact was found. DISCUSSION AND IMPLICATIONS: Our findings extended the existing literature regarding the important factors associated with variation in loneliness among older adults. Health programs and ICT solutions could be more effective in mitigating loneliness if they target the root causes of loneliness, including reducing perceptions of constraints and increasing a sense of purpose-in-life, along with strengthening social relationships.

Internet Use and Loneliness Among Urban and Non-Urban Chinese Older Adults: The Roles of Family Support, Friend Support, and Social Participation.

OBJECTIVES: This study investigated the association between internet use and loneliness among older Chinese adults, and the mediating effects of family support, friend support, and social participation. These associations were evaluated in the context of urban and non-urban geographic settings. METHODS: This study used data from the 2018 wave of the China Longitudinal Ageing Social Survey (N = 10,126), examining samples of urban (n = 3,917) and non-urban (n = 6,209) older adults separately. Linear regression and path analysis within a structural equation modeling framework were employed. RESULTS: Internet use was negatively associated with loneliness for both urban and non-urban residing older adults. Family support and social participation mediated the association between internet use and loneliness for both urban and non-urban residing older Chinese adults, but friend support mediated this association only for urban older residents. DISCUSSION: This study shed light on our understanding of the relationship between internet use and loneliness among older adults in the Chinese context. Also, these findings suggested that digital interventions for loneliness should pay special attention to the different characteristics of urban and non-urban dwelling older Chinese adults.