Friendship in Later Life: Thirty Years of Progress and Inequalities.

Studies examining the impact of social change on individual development and aging postulate the growing importance of flexible relationships, such as friendship. Although friendship is well known as a factor of well-being in later life, the prevalence of friendship in older adult networks and its unequal distribution has been examined only in few studies. Through secondary data analysis of two cross-sectional surveys carried out in Switzerland in 1979 and 2011, respectively, the increasing presence of close friends was confirmed. Our results show that this trend was part of a broader lifestyle change after retirement, with increasing social engagements. However, this trend does not include a general decrease in social inequalities in friendship opportunities. Overall, friendship increase among older adults has contributed to a polarization of living conditions, with a majority of active, healthy persons contrasting with a minority of individuals who accumulate penalties.

The longitudinal relation between social reserve and smaller subsequent decline in executive functioning in old age is mediated via cognitive reserve.

OBJECTIVES: Social reserve such as having close friends helps promoting activity engagement in old age. Activity engagement in turn contributes to the accumulation of cognitive reserve and is a key predictor for maintaining executive functioning in aging. We investigated the mediating role of leisure activity engagement in the longitudinal relation between close friends and subsequent change in executive functioning as measured through performance changes in the Trail Making Test (TMT). DESIGN, SETTING, AND PARTICIPANTS: Longitudinal study with 897 older adults tested in two waves 6 years apart, analyzed using latent change score modeling. MEASUREMENTS: TMT parts A and B, leisure activity engagement, and close friends. RESULTS: A larger number of close friends in the first wave of data collection was related to a higher frequency of leisure activities in the first wave. A higher frequency of leisure activities in the first wave significantly predicted a smaller subsequent increase in TMT completion time from the first to the second wave (i.e. a smaller decline in executive functioning). Importantly, 41.3% of the longitudinal relation between a larger number of close friends in the first wave and a smaller subsequent increase in TMT completion time (i.e. a smaller decline in executive functioning) was mediated via a higher frequency of leisure activities in the first wave. CONCLUSIONS: Social reserve such as having close friends may help promoting activity engagement in old age. By enhancing individuals' cognitive reserve, this activity engagement may finally result in smaller subsequent decline in executive functioning in aging.

The relationship of obesity predicting decline in executive functioning is attenuated with greater leisure activities in old age.

Objectives: We investigated the longitudinal relationship between obesity and subsequent decline in executive functioning over six years as measured through performance changes in the Trail Making Test (TMT). We also examined whether this longitudinal relationship differed by key markers of cognitive reserve (education, occupation, and leisure activities), taking into account age, sex, and chronic diseases as covariates.Method: We used latent change score modeling based on longitudinal data from 897 older adults tested on TMT parts A and B in two waves six years apart. Mean age in the first wave was 74.33 years. Participants reported their weight and height (to calculate BMI), education, occupation, leisure activities, and chronic diseases.Results: There was a significant interaction of obesity in the first wave of data collection with leisure activities in the first wave on subsequent latent change. Specifically, obesity in the first wave significantly predicted a steeper subsequent decline in executive functioning over six years in individuals with a low frequency of leisure activities in the first wave. In contrast, in individuals with a high frequency of leisure activities in the first wave, this longitudinal relationship between obesity and subsequent decline in executive functioning was not significant.Conclusion: The longitudinal relationship between obesity and subsequent decline in executive functioning may be attenuated in individuals who have accumulated greater cognitive reserve through an engaged lifestyle in old age. Implications for current cognitive reserve and gerontological research are discussed.

Solving the Puzzle of Cognitive Reserve Effects on Cognitive Decline: The Importance of Considering Functional Impairment.

AIMS: We investigated whether the longitudinal relation between cognitive reserve accumulated across the lifespan and rate of cognitive decline over 6 years differed by the individual's degree of functional impairment. METHODS: We analyzed longitudinal data from 897 older adults (M = 74.33 years) tested on the Trail Making Test (TMT) in 2 waves 6 years apart. RESULTS: There was a significant interaction of functional impairment with cognitive reserve on latent change in cognitive functioning. Specifically, with no functional impairment in the first wave of assessment, greater cognitive reserve accumulated across the lifespan significantly predicted a reduced cognitive decline over 6 years (i.e., smaller increase in TMT completion time). In contrast, with certain functional impairment (in at least some activities) in the first wave, greater cognitive reserve build-up predicted a steeper cognitive decline (i.e., larger increase in TMT completion time). CONCLUSION: Individuals with greater cognitive reserve accumulated across the lifespan show a reduced cognitive decline if they still have relatively little functional impairment, while they will show a steeper decline (compared to individuals with less cognitive reserve) as soon as functional impairment becomes substantial.

The Longitudinal Relationship of Perceived Stress Predicting Subsequent Decline in Executive Functioning in Old Age Is Attenuated in Individuals with Greater Cognitive Reserve.

BACKGROUND: Cognitively stimulating activities contribute to the accumulation of cognitive reserve that is proposed to be instrumental for maintaining cognitive functioning in aging. Adopting a novel, more general conceptual perspective including models of vulnerability, we argue that cognitive reserve may modify the longitudinal association between perceived stress and the rate of subsequent decline in executive functioning. OBJECTIVE: The present study set out to investigate the longitudinal relationship between perceived stress and subsequent decline in executive functioning over 6 years as measured through performance changes in the Trail Making Test (TMT) and whether this longitudinal relationship differed by key markers of cognitive reserve (education, occupation, and leisure activities), taking into account age, sex, and chronic diseases as covariates. METHODS: We used latent change score modeling based on longitudinal data from 897 older adults tested on TMT parts A and B in two waves 6 years apart. Mean age in the first wave was 74.33 years. Participants reported information on perceived stress, education, occupation, leisure activities, and chronic diseases. RESULTS: The longitudinal relationship between greater perceived stress in the first wave of data collection and steeper subsequent decline in executive functioning over 6 years was significantly reduced in individuals who had pursued a higher frequency of leisure activities in the first wave. CONCLUSION: The longitudinal relationship between perceived stress and subsequent decline in executive functioning may be attenuated in individuals who have accumulated greater cognitive reserve through an engaged lifestyle. Implications for current cognitive reserve and gerontological research are discussed.

The relation of low cognitive abilities to low well-being in old age is attenuated in individuals with greater cognitive reserve and greater social capital accumulated over the life course.

Objectives: The present study sets out to investigate the relation of cognitive abilities to well-being and its interplay with key life course proxies of cognitive reserve and social capital in a large sample of older adults.Method: Three thousand eighty older adults served as sample for the present study. Physical well-being (EuroQoL-5D questionnaire) and psychological well-being (Satisfaction with Life Scale) as well as cognitive performance in terms of verbal abilities (Mill Hill vocabulary scale), processing speed (Trail Making Test part A), and cognitive flexibility (Trail Making Test part B) were assessed. Participants reported information on education, occupation, cognitively stimulating leisure activities, the different languages regularly spoken as well as family and close friends.Results: Moderation analyses showed that the relation of cognitive performance to physical and psychological well-being was significantly attenuated in individuals with a higher cognitive level of the first job after education, a larger number of midlife and current cognitively stimulating leisure activities, a larger number of languages regularly spoken, a larger number of significant family members and friends, and more frequent contact with and more confidence in significant family members.Conclusion: Present data suggest that the relation of low cognitive abilities to low well-being in old age is attenuated in individuals with greater cognitive reserve and greater social capital accumulated over the life course.

Distinct effects of cognitive versus somatic anxiety on cognitive performance in old age: the role of working memory capacity.

Objective: The adverse effects of anxiety on cognition are widely recognized. According to Attentional Control Theory, worry (i.e. facet of cognitive anxiety) is the component that is responsible for these effects, and working memory capacity (WMC) plays an important role in regulating them. Despite the increasing importance of this problem with aging, little is known about how these mechanisms interact in old age. In this study, we explored the distinct contributions of the somatic and cognitive components of anxiety to neuropsychological performance, and the potential moderating role of WMC.Method: We administered cognitive tasks testing processing speed, cognitive flexibility and working memory to 605 older adults, who also underwent depression and test anxiety assessments (data from VLV study).Results: Multiple regression analyses showed that cognitive (but not somatic) aspects of anxiety affected cognitive flexibility. The effect of cognitive anxiety on processing speed was moderated by WMC: the anxiety-performance association was lower for participants with greater WMC.Conclusion: Results confirmed the specific role of worry in the anxiety-performance relationship in old age and supported the hypothesis that working memory resources regulates its deleterious effect on cognition. The absence of a moderation effect in the more costly switching task may reflect a limitation of resources with aging.

Cognitive Reserve Mediates the Relation between Openness to Experience and Smaller Decline in Executive Functioning.

AIMS: We investigated the mediating role of leisure activity engagement in the longitudinal relation between openness to experience and subsequent change in executive functioning over 6 years as measured through performance changes in the Trail Making Test (TMT). METHODS: We analyzed longitudinal data from 897 older adults (mean = 74.33 years in the first wave) tested on TMT parts A and B in two waves 6 years apart. Participants reported information on leisure activity engagement and openness to experience. RESULTS: Latent change score modeling revealed that 37.2% of the longitudinal relation between higher openness to experience in the first wave of data collection and a smaller subsequent increase in TMT completion time from the first to the second wave (i.e., a smaller decline in executive functioning) was mediated via a higher frequency of leisure activities in the first wave. CONCLUSION: Individuals with higher openness to experience show greater activity engagement in old age. By enhancing their cognitive reserve, this activity engagement may finally result in smaller subsequent decline in executive functioning.

Cognitive Reserve and Social Capital Accrued in Early and Midlife Moderate the Relation of Psychological Stress to Cognitive Performance in Old Age.

AIMS: The present study set out to investigate the relation of psychological stress to cognitive performance and its interplay with key life course markers of cognitive reserve and social capital in a large sample of older adults. METHODS: We assessed cognitive performance (verbal abilities and processing speed) and psychological stress in 2,812 older adults. The Participants reported information on education, occupation, leisure activities, family, and close friends. RESULTS: Greater psychological stress was significantly related to lower performance in verbal abilities and processing speed. Moderation analyses suggested that the relations of psychological stress to cognitive performance were reduced in individuals with higher education, a higher cognitive level of the first profession practiced after education, a larger number of midlife leisure activities, a larger number of significant family members, and a larger number of close friends. CONCLUSION: Cognitive reserve and social capital accrued in early and midlife may reduce the detrimental influences of psychological stress on cognitive functioning in old age.

The relation of close friends to cognitive performance in old age: the mediating role of leisure activities.

ABSTRACTBackground:From a conceptual point of view, close friends are an important resource for promoting activity engagement in old age. Leisure activity engagement in turn is a key predictor of cognitive performance. Empirically, it remains unclear so far whether leisure activity engagement mediates between having close friends on the one hand and cognitive performance on the other, which we investigated in a large sample of older adults. METHODS: We assessed cognitive performance (Mill Hill vocabulary scale and Trail Making Test (TMT) parts A and B) in 2,812 older adults. Participants reported information on leisure activity engagement and close friends. RESULTS: A larger number of leisure activities and a larger number of close friends were significantly related to better cognitive performance in the Mill Hill vocabulary scale and TMT parts A and B. A larger number of close friends were significantly related to a larger number of leisure activities. The number of leisure activities mediated more than half of the relation of the number of close friends to performance in all three cognitive measures. CONCLUSIONS: Having close friends may be helpful to stimulate and promote activity participation in old age. By enhancing individuals' cognitive reserve, this may finally preserve their cognitive performance level in old age.

The Role of Leisure Activities in Mediating the Relationship between Physical Health and Well-Being: Differential Patterns in Old and Very Old Age.

BACKGROUND: Recently, Paggi et al. [Gerontology 2016;62:450-458] for the very first time showed in a cross-sectional sample of 259 adults aged 18-81 years that the relation of physical health to psychological well-being was mediated via frequency of leisure activity participation. OBJECTIVE: To extend this framework, we followed theories on successful aging and vulnerability to propose to add a differential perspective predicting that certain individuals may be more vulnerable than others and therefore may show differences in the mediation pattern. Specifically, we examined whether mediation patterns were differential in certain populations, such as in old-old (compared to young-old) adults and in individuals who carried out a low (compared to those with a high) number of activities. METHODS: We analyzed data from 3,080 individuals on physical health (number of chronic diseases, subjective health status, and subjective evaluation of change in health over the last 10 years), frequency of participation in 18 leisure activities, and physical and psychological well-being using moderated mediation models with a path model approach that allowed the simultaneous estimation of all model paths, including their significance. RESULTS: We found that the relation of physical health to physical and psychological well-being was mediated via frequency of activity participation. For physical (but not for psychological) well-being, this mediation was more pronounced in old-old (compared to young-old) adults and in individuals who carried out a low (compared to those with a high) number of activities. These moderated mediations were attributable to differential relations of physical health to frequency of activity participation and to differential relations of frequency of activity participation to physical well-being between the investigated moderator levels. CONCLUSION: Present data suggest that participation in leisure activities may play a key role in mediating the relationship between physical health and well-being, particularly in very old age. Findings are discussed with respect to theories of successful aging and differences between physical and psychological well-being.

No cross-sectional evidence for an increased relation of cognitive and sensory abilities in old age.

OBJECTIVES: A key question in gerontological research concerns whether good functioning can be maintained in some cognitive abilities in old age, even if deficits occur in other cognitive or sensory abilities. Our goals were to investigate relations of cognitive and sensory abilities in old age, whether these relations differed in size across old age, and whether this was affected by general cognitive ability (processing speed), educational level, and/or general health status. METHODS: Two thousand eight hundred and twelve older adults (aged 65-101, M = 77.9 years) from the Vivre-Leben-Vivere survey served as cross-sectional sample for the present study. We administered psychometric tests on processing speed (the speed of cognitive processing), cognitive flexibility (the ability to alternate between cognitive operations), and verbal abilities (vocabulary). In addition, we interviewed individuals on their hearing, eyesight, educational level, and general health status. We regressed sizes of relations between abilities (calculated within each 1-year age tranche) on mean age within the corresponding age tranche, with the number of participants within the corresponding age tranche as case weights. RESULTS: We observed a decrease in relations between processing speed and cognitive flexibility in old age that was particularly pronounced in individuals with high educational level (r = -.41). In contrast, we did not find differences in relations between other cognitive and sensory abilities across old age, which held for different levels of general cognitive ability, education, and general health status. CONCLUSION: Present data do not support the view of a generally increased relation of cognitive and sensory abilities in old age.

The Relation of Obesity to Performance in Verbal Abilities, Processing Speed, and Cognitive Flexibility in Old Age: The Role of Cognitive Reserve.

AIMS: The present study set out to investigate the relation of obesity to performance in verbal abilities, processing speed, and cognitive flexibility and its interplay with key correlates of cognitive reserve in a large sample of older adults. METHODS: A total of 2,812 older adults served as a sample for the present study. Psychometric tests on verbal abilities, processing speed, and cognitive flexibility were administered. In addition, individuals were interviewed on their weight and height (to calculate body mass index; BMI), educational attainment, occupation, and engaging in different activities throughout adulthood. RESULTS: Obesity (BMI ≥30) was significantly associated with a lower performance in verbal abilities, processing speed, and cognitive flexibility. Moderation analyses showed that obesity was related to lower processing speed and cognitive flexibility only in individuals with low engagement in activities and low education. Hierarchical regression analyses showed that obesity was not related to any of the three investigated cognitive performance measures when cognitive reserve in early and midlife was taken into account. CONCLUSION: Present data suggest that cognitive reserve accumulated during the life course may reduce the detrimental influences of obesity on cognitive functioning in old age.

The association of educational attainment, cognitive level of job, and leisure activities during the course of adulthood with cognitive performance in old age: the role of openness to experience.

BACKGROUND: The relevance of mental health for everyday life functioning and well-being is crucial. In this context, higher educational attainment, higher cognitive level of one's occupation, and more engaging in stimulating leisure activities have been found to be associated with better cognitive functioning in old age. Yet, the detailed pattern of the potential interplay of such a cognitively engaged lifestyle with personality dimensions, such as openness to experience, in their relations to cognitive functioning remains unclear. METHODS: Two thousand eight hundred and twelve older adults served as sample for the present study. Psychometric tests on verbal abilities and processing speed were administered. In addition, individuals were retrospectively interviewed on their educational attainment, occupation, and regarding 18 leisure activities that had been carried out in mid-life. Moreover, openness to experience was assessed. RESULTS: We found that the effect of openness to experience on cognitive functioning was mediated by educational attainment, cognitive level of job, and engaging in different leisure activities. Data were not better described by alternative moderation models testing for interactive (i.e. dependent) effects of openness to experience and cognitively stimulating engagement. CONCLUSIONS: To explain interindividual differences in cognitive functioning in old age, present data are in line with a mechanism in which individuals with high openness to experience may have been more engaged in stimulating activities in early and mid-life. Possibly by increasing their cognitive reserve throughout adulthood, this may finally enhance their cognitive performance level later in old age.

The association of timing of retirement with cognitive performance in old age: the role of leisure activities after retirement.

BACKGROUND: The role of timing of retirement on cognitive functioning in old age is inconclusive so far. Therefore, the present study set out to investigate the association of timing of retirement with cognitive performance and its interplay with key correlates of cognitive reserve in a large sample of older adults. METHODS: Two thousand two hundred and sixty three older adults served as sample for the present study. Different psychometric tests (Trail Making Test part A (TMT A), Trail Making Test part B (TMT B), Mill Hill) were administered. In addition, individuals were interviewed on their retirement, occupation, educational attainment, and regarding 18 leisure activities that have been carried out after retirement. RESULTS: Earlier retirement (compared to retirement at legal age) was significantly associated with better performance in the TMT A, the TMT B, and the Mill Hill vocabulary test. Moderation analyses showed that in individuals with a moderate number of leisure activities in old age, earlier retirement was related to better cognitive performance, but not in those with a relatively large number of leisure activities. Hierarchical regression analyses revealed that entering leisure activities as additional predictor significantly increased explained variance in the cognitive measures over and above all other investigated markers of cognitive reserve (i.e. occupation and education). CONCLUSIONS: Present data further corroborate the view that leisure activities even in old age may lead to further enrichment effects and thereby may be related to better cognitive functioning. The role of engaging in activities in the context of major life events such as retirement is discussed.

The Association of Leisure Activities in Middle Adulthood with Cognitive Performance in Old Age: The Moderating Role of Educational Level.

BACKGROUND: One of the fundamental challenges for gerontological research is how to maintain and promote intact cognitive functioning in old age. Previous research revealed that high educational level, good health status, and an active lifestyle during adulthood seem to be protective against cognitive impairment in old age. However, up to now, a detailed examination of the interaction of these relations based on a broader variety of activities and considering past and current activities is missing. OBJECTIVE: The present study set out to extend the literature by investigating in more detail the interactions of educational level and health status with a broad variety of past and current leisure activities in their association with cognitive functioning in a large sample of older adults with a wide age range. METHODS: A total of 2,812 older adults (aged 65-101 years) served as the sample for the present study. A test on verbal abilities and one on processing speed were applied. In addition, individuals were retrospectively interviewed regarding their educational level, current general health status, and 18 leisure activities (in terms of currently performed activities and those that had been carried out at the age of 45 years). RESULTS: Regressions indicated that engaging in more current activities and in more activities at the age of 45 years (both analyzed as an overall activity measure) was related to better cognitive performance in old age (r values up to 0.39, p values <0.001). These associations were more pronounced in individuals with a low (compared to a high) educational level. CONCLUSION: Present results suggest that an active lifestyle during middle adulthood may be related to better cognitive functioning in old age, particularly in individuals with a low educational level. These findings are discussed with respect to models of cognitive aging.

Contextual variation in cognitive performance of older adults: Demonstration of an age-of-examiner effect.

Objective: Consistent with research on stereotype threat, when examiners' characteristics make a stereotype of the participant group salient, it can hamper participants' performance. We hypothesized that younger examiners represent a subtle element activating age stereotypes, leading older people to perform worse as examiners' age decreases. Method: We analyzed data from the Survey of Health, Ageing, and Retirement in Europe (SHARE; NParticipants = 32768) and Vivre-Leben-Vivere studies (VLV, Nparticipants = 960), wherein older people were tested at home by examiners of different ages on eight cognitive tasks. Results: Our results indicate that participants' performance on five tasks was positively linked to examiners' age, showing that the older the examiner, the better the participants' performance. Conclusions: These findings could have implications for the current assessment of memory performance among older adults.

Exploring key-stakeholder perceptions on non-communicable disease care during the COVID-19 pandemic in Kenya.

Introduction: over one third of total Disability-Adjusted-Life-Years lost in Kenya are due to non-communicable diseases (NCD). In response, the Government declared significant commitment towards improving NCD care. The COVID-19 pandemic increased the burden on the already overstretched health systems in Kenya. The aims of this study are to assess whether health care providers perceived NCD care to be optimal during the pandemic and explore how to improve responses to future emergencies. Methods: this cross-sectional online survey included healthcare personnel with non-clinical roles (public health workers and policy-makers) and those delivering health care (doctors and nurses). Respondents were recruited between May and September 2021 by random sampling, completed by snowball sampling. Results: among 236 participants (42% in clinical, 58% in non-clinical roles) there was an overall consensus between respondents on NCD care being disrupted and compromised during the pandemic in Kenya. Detracted supplies, funding, and technical resources affected the continuity of NCDs' response, despite government efforts. Respondents agreed that the enhanced personnel capacity and competencies to manage COVID-19 patients were positive, but noted a lack of guidance for redirecting care for chronic diseases, and advocated for digital innovation as a solution. Conclusion: this paper explores the perceptions of key stakeholders involved in the management of NCDs in Kenya to improve planning for future emergency responses. Gaps were identified in health system response and preparedness capacity during the pandemic including the perceived need to strengthen NCD services, with solutions offered to guide resilience efforts to protect the health system from disruption.

An Online Survey of the Perceptions of Clinical and Non-Clinical Professionals on Healthcare for Non-Communicable Diseases and COVID-19 Measures During the Pandemic in Malaysia.

Objectives: This study assesses the opinions of health professionals in Malaysia on the disruption of non-communicable disease (NCD) services during the COVID-19 pandemic from March 2020 to January 2022. Methods: We conducted a cross-sectional online survey with 191 non-clinical public health workers and clinical health service workers in Malaysia from November 2021 to January 2022. Participants were recruited by the Malaysian Ministry of Health using major networks including key experts and practitioners. Secondary respondents were subsequently enrolled through snowballing. Results: The most notable issues raised by the survey participants relate to NCD service disruption, the redirection of NCD care resources, and NCD care being overburdened post-pandemic. Respondents also reported accounts of resilience and prompt reaction from the healthcare system, as well as calls for innovation. Conclusion: Most respondents perceived that the challenges arising from COVID-19 were mostly managed well by the healthcare system, which was able to provide the necessary services to NCD patients during this health emergency. However, the study identifies gaps in the health system response and preparedness capacity, and highlights solutions for strengthening NCD services.

Cognitive Reserve Mediates the Relation between Neighborhood Socio-Economic Position and Cognitive Decline.

Introduction: We investigated the mediating role of leisure activity engagement as marker of cognitive reserve in the relation between neighborhood socio-economic position (SEP) and cognitive decline over 6 years. Methods: The study analyzed longitudinal data from 897 older adults who participated in the two waves (2011 and 2017) of the Vivre-Leben-Vivere (VLV) survey in Switzerland (M = 74.33 years in the first wave). Trail Making Test parts A and B were administered in both waves. Leisure activity engagement was assessed during interviews. Neighborhood SEP was derived from the Swiss Neighborhood Index of Socio-Economic Position (Swiss-SEP), provided by the Swiss National Cohort (SNC). Results: Latent change score modeling revealed that 42.5% of the relationship between higher neighborhood SEP and smaller cognitive decline was mediated via a higher frequency of leisure activities in the first wave. Conclusion: Neighborhood SEP constitutes an important contextual factor potentially influencing the pathways of cognitive reserve accumulation and, therefore, should be taken into account to better understand their effects on cognitive decline in old age.