Serum total tau, neurofilament light, and glial fibrillary acidic protein are associated with mortality in a population study.

BACKGROUND: Total tau (t-tau), neurofilament light (NfL), and glial fibrillary acidic protein (GFAP) are neuronal cytoskeletal biomarkers that may indicate greater risk of poor outcomes in age-related conditions, including mortality. Health disparities experienced by some racial minority subgroups may influence biomarker expression and effects on longevity. We aimed to examine (a) associations of serum t-tau, NfL, and GFAP with overall and cardiovascular mortality and (b) differences in associations by racial background. METHODS: Data came from 1327 older participants from the Chicago Health and Aging Project (CHAP), a longitudinal population-based study. Cox proportional hazards regression models were used to examine associations between concentrations of serum t-tau, NfL, and GFAP biomarker(s) and mortality (overall/cardiovascular mortality based on age at death). Interaction terms were used to examine differences between African-American and European-American participants. Models were adjusted for age, sex, education, the APOE-ε4 allele, body mass index, chronic health conditions, and cognitive and physical functioning. RESULTS: Models showed that fivefold higher concentrations of t-tau (HR = 1.46, 95% CI: 1.27, 1.68), NfL (HR = 2.13, 95% CI: 1.76, 2.58), and GFAP (HR = 1.43, 95% CI: 1.08, 1.90) were separately associated with increased risk of overall mortality, with higher risk in African Americans in t-tau or NfL. In models with all biomarkers, NfL (HR = 2.17, 95% CI: 1.65, 2.85) was associated with risk of overall mortality, with racial differences in t-tau. Higher concentrations of t-tau (HR = 1.32, 95% CI: 1.02, 1.70), NfL (HR = 1.95, 95% CI: 1.40, 2.72), and GFAP (HR = 1.87, 95% CI: 1.18, 2.98) were separately associated with risk of cardiovascular mortality, with racial differences in t-tau, NfL, or GFAP. In combined models, NfL (HR = 1.73, 95% CI: 1.08, 2.78) was associated with cardiovascular mortality. CONCLUSIONS: Serum t-tau, NfL, and GFAP may be early indicators for mortality outcomes among older adults, with racial differences among associations.

A Vulnerability Risk Index of Self-Neglect in a Community-Dwelling Older Population.

BACKGROUND: The only way to systematically screen for self-neglect among older adults is through in-home observations, which are often difficult and unfeasible for healthcare providers. To fill this gap, we need a robust and efficient prognostication tool to better treat and prevent self-neglect among older adults. OBJECTIVES: To develop a predictive index that can be used to assess risk prognostication of the onset of self-neglect among community-dwelling older populations. DESIGN: Two waves of longitudinal data from the Chicago Health and Aging Project (CHAP), collected during 2008 to 2012 with approximately 3-year follow-up intervals. SETTING: Non-Hispanic black or non-Hispanic white community-dwelling older adults in three adjacent neighborhoods in Chicago, IL. PARTICIPANTS: A total of 2885 individuals who were participants of the CHAP study. MEASUREMENTS: The main outcomes are incident self-neglect cases. A total of 86 potential predictors were considered in the domains of sociodemographic and socioeconomic, general well-being, health behavior, medical health, medicine/healthcare, cognitive function, physical well-being, social well-being, and psychological well-being. RESULTS: The 3-year self-neglect incidence rate is 241 (8.4%). A 10-item predictive model (with a c-statistic of 0.76) was developed using stepwise selection in multivariable logistical regression models. After corrections of overfitting by validating in 100 bootstrapping samples, the predictive accuracy of the model dropped to 0.71, suggesting at least moderate overfitting. A point-based risk index was developed based on parameter estimates of each predictive factor in the final logistic model. The index has an area under the receiver operating characteristic curve of 0.76. CONCLUSION: The study developed an efficient index with good predictive ability of self-neglect. Further external validation and impact studies are necessary before practitioners can apply this index to determine risk of self-neglect among other community aging populations. J Am Geriatr Soc 68:809-816, 2020.

Transition in Older Parent-Adult Child Relations in U.S. Chinese Immigrant Families.

BACKGROUND AND OBJECTIVES: The family fundamentally underpins the immigration and acculturation processes. But most existing research on acculturation focuses on individual instead of family experience. Guided by Berry's acculturation theory and Intergenerational Solidarity Theory, this study examined continuity and changes in parent-adult child relations of older Chinese immigrants over a 2-year period, and their implications for older adults' depression and quality of life (QoL). RESEARCH DESIGN AND METHODS: Participants included 2,605 older Chinese immigrants from the Population Study of Chinese Elderly in Chicago (PINE). Latent Transition Analysis (LTA) was used to identify transitions in multidimensional parent-child relations over time. Negative binomial and logistic regressions were used to examine the influence of family transitions on depression and QoL, respectively. RESULTS: LTA revealed five types of family relations: traditional, modified traditional, coresiding-unobligated, independent, and detached. Over 40% of the respondents shifted to a different relation type, with more families classified as modified traditional or independent over time. Transitioning into modified traditional relations or out of detached relations was associated with fewer depressive symptoms and better QoL at the follow-up. Transitioning into independent relation was associated with more depressive symptoms over time. DISCUSSION AND IMPLICATIONS: Parent-child relations among Chinese older immigrants demonstrate significant complexity, including both heterogeneity and fluidity. Better well-being of these older adults seems to stem from the optimal combination of retaining the supportive heritage culture and embracing the host society's instrumental cultural elements. Services to this population need to include the family context in assessment and interventions.

A psychometric assessment of the psychological and social well-being indicators in the PINE study.

OBJECTIVE: This report aims to establish the reliability and validity of five psychological and social well-being indictors in their applications to a U.S. Chinese aging population. METHOD: The Population Study of Chinese Elderly in Chicago (PINE) is a population-based epidemiological study of Chinese older adults in the Greater Chicago area. Internal consistency reliability was assessed by determining the coefficient alpha and inter-item correlation coefficients. Content validity was assessed by bilingual and bicultural study researchers and community leaders. RESULTS: The reliability and validity analysis supported the use of the Chinese version of the psychological and social well-being indicators in the PINE study. The value of Cronbach's alpha for fives scales ranged from .64 to .82, indicating reasonable internal consistency. Content validity was established through intensive review by a panel of experts. DISCUSSION: The instruments discussed in this report are reliable and valid measures to assess key dimensions of psychological and social distress of Chinese older adults.

Accounting for bias due to selective attrition: the example of smoking and cognitive decline.

BACKGROUND: Selective attrition may introduce bias into analyses of the determinants of cognitive decline. This is a concern especially for risk factors, such as smoking, that strongly influence mortality and dropout. Using inverse-probability-of-attrition weights, we examined the influence of selective attrition on the estimated association of current smoking (vs. never smoking) with cognitive decline. METHODS: Chicago Health and Aging Project participants (n = 3713), aged 65-109 years, who were current smokers or never- smokers, underwent cognitive assessments up to 5 times at 3-year interval. We used pooled logistic regression to fit predictive models of attrition due to death or study dropout across the follow-up waves. With these models, we computed inverse-probability-of-attrition weights for each observation. We fit unweighted and weighted, multivariable-adjusted generalized-estimating-equation models, contrasting rates of change in cognitive scores in current versus never-smokers. Estimates are expressed as rates of change in z score per decade. RESULTS: During the 12 years of follow-up, smokers had higher mortality than never-smokers (hazard ratio = 1.93 [95% confidence interval = 1.67 to 2.23]). Higher previous cognitive score was associated with increased likelihood of survival and continued participation. In unweighted analyses, current smokers' cognitive scores declined 0.11 standard units per decade more rapidly than never-smokers' (95% CI = -0.20 to -0.02). Weighting to account for attrition yielded estimates that were 56% to 86% larger, with smokers' estimated 10-year rate of decline up to 0.20 units faster than never-smokers' (95% CI = -0.36 to -0.04). CONCLUSIONS: Estimates of smoking's effects on cognitive decline may be underestimated due to differential attrition. Analyses that weight for the inverse probability of attrition help compensate for this attrition.

Neighborhood socioeconomic conditions are associated with psychosocial functioning in older black and white adults.

We examined neighborhood socioeconomic status (NSES) in relation to depressive symptoms, perceived stress, and hostility in 5770 community-dwelling older black and white adults (mean age=73 years; 62% female) from 3 contiguous neighborhoods covering 82 census block groups in Chicago, IL. NSES was an average of z-scores of four Census 2000 block-group variables: % public assistance, % households earning <$25,000 annually, % with >college degree, and % owner-occupied dwellings valued >$200,000. NSES was inversely related to hostility (beta=-0.305), stress (beta=-0.333), and depressive symptoms (beta=-0.223) (p<0.001) in multi-level mixed-effects regression models adjusted for age, sex, race, and the number of years in the neighborhood. With further adjustment for education, income, marital status, and health conditions, NSES remained associated with depressive symptoms (beta=-0.078) and hostility (beta=-0.133) (p<0.05); the association with hostility was strongest in non-black neighborhoods. Neighborhood social conditions contribute to the psychosocial well-being of older residents; research is needed to investigate pathways through which neighborhoods influence health outcomes in an aging population.

A cross-sectional population-based study of elder self-neglect and psychological, health, and social factors in a biracial community.

OBJECTIVE: Elder self-neglect is an important public health issue; however, its association with psychological, health, and social factors remains unclear. This study aimed to (1) examine the associations between self-neglect severity and psychological, health, and social factors (2) examine the racial/ethnic differences in these associations. METHODS: We conducted a biracial population-based study in a geographically defined community in Chicago: Chicago Health Aging Project. We identified 1094 persons who had been identified by social services agency as suspected elder self-neglect from 1993 to 2005. Self-neglect severity was assessed on a 0-45 scale. The psychological, health, and social factors were assessed using Center for Epidemiological Studies of Depression (CESD), poor mental health, health status, unhealthy days, poor physical health, days away from usual activities, social network, and social engagement. Linear regression was used to assess associations between self-neglect and psychological, health, and social factors. Interaction terms (Self-neglect x Race) were used to assess the black (non-Hispanic black) and white (non-Hispanic white) differences in these associations. RESULTS: There were significant associations between self-neglect severity with health and social factors. After adjusting for confounders, greater self-neglect severity was associated with lower health status (PE = 0.001, p = 0.002), higher unhealthy days (PE = 0.139, p < 0.001), poor physical health (PE = 0.141, p < 0.001), and more days away from usual activities (PE = 0.120, p = 0.030). Interaction term (Self-Neglect x Race) indicates black compared with white older adults, had more days away from usual activities (PE = 0.321, p = 0.045) and lower social engagement (PE = -0.04, p = 0.003). CONCLUSION: Greater self-neglect severity is associated with lower levels of health and social wellbeing. These associations may be stronger for black than white older adults.