Changes in executive function in the Canadian longitudinal study on aging over 3-years: A focus on social determinants of health.

Maintaining executive functions, including planning, inhibition, and decision-making skills, is important for autonomy and activities of daily living. There is a growing body of evidence linking social determinants and cognitive aging, but less is known about the potential role of social determinants in changes in executive functioning over time. Using data from the Canadian Longitudinal Study on Aging (CLSA), a large cohort of mid-aged and older adults, we examined changes in executive function over a 3-year period. Specifically, we focused on the role of social determinants (i.e., social positioning, social support, education) in explaining these changes. Executive function was measured at baseline and follow-up 3 years later using the Mental Alteration Test (MAT). We computed a reliable change index (RCI) and used a multiple linear regression model to examine the associations between known correlates and change in executive function over the 3-year period (n = 29,344). Older age, higher household income, and greater educational attainment predicted declines in executive function. Health factors (e.g., depression symptoms, physical activity levels) and many social determinants (sexual orientation, gender identity, race, and perceived social standing) were not associated with change in executive function. These results suggest that social determinants of health may be related to initial differences in cognitive functioning (i.e., cross-sectional differences) rather than more rapid cognitive aging.

The power of story: Bringing 2SLGBTQ+ digital stories into gerontology settings.

Two-spirit, lesbian, gay, bisexual, trans, and queer or questioning (2SLGBTQ+) older adults are underrepresented in gerontology research and education, impacting the preparedness of health and social care students and professionals working with the diverse aging population. To address this lack of representation of 2SLGBTQ+ older adults in gerontology education, this study explored the use of digital stories as tools for knowledge mobilization and social justice. Digital stories are short videos that pair audio recordings with visuals, including videos, photographs, or artwork. To conduct the study, the research team worked alongside 2SLGBTQ+ older adults to create a suite of three digital stories. These stories were presented at various educational and professional settings in gerontology, and survey and open-feedback responses (n = 147) were gathered from the audience on their perceived impact. Viewers included students, researchers, decision-makers, stakeholders, and citizens. Content analysis was used to analyze the data. From the analysis, digital stories showed the potential to increase viewers' awareness and understanding of 2SLGBTQ+ aging experiences. The format was particularly significant in their learning and enhancing the connection to the content and the storytellers. The findings also suggest that digital stories showed the potential to impact policy and practice for 2SLGBTQ+ communities.

Prospective Associations between Physical Activity and Memory in the Canadian Longitudinal Study on Aging: Examining Social Determinants.

OBJECTIVES: To examine associations between physical activity (PA) and prospectively assessed memory in a cohort of cognitively healthy adults, after accounting for understudied social determinants. METHODS: We used data from the Canadian Longitudinal Study on Aging (CLSA). PA (exposure) and memory (outcome) were assessed using validated measures in 2013-2015 and 2015-2018, respectively. Respondents reported their daily number of hours spent engaging in five different PAs. We conducted multiple imputation and used linear regression (n = 41,394), adjusting for five categories of covariates: demographics, sensory health characteristics, health behaviors, health status, and social determinants (sex/gender, education, income, social support, perceived social standing, race, and sexual orientation). RESULTS: In crude models, nearly every intensity and duration of PA was associated with better memory. In fully adjusted models, protective associations were attenuated; however, some associations held: all durations of walking, most durations of light activities, moderate activities for ≥1 hour, and strenuous activities for 1 to <2 hours. DISCUSSION: Some forms of PA may be associated with better memory. The benefits of higher intensity PA may only be realized after social determinants are addressed.

Perceived Community Age-friendliness is Associated With Quality of Life Among Older Adults.

We examined the positive association between perceived community age-friendliness and self-reported quality of life for older adults. A total of 171 participants, aged 77-96 years, completed a mail-in questionnaire package that included measures of health (SF-36 Physical), social participation (Social Participation Scale), community age-friendliness (Age-Friendly Survey [AFS]), and quality of life (WHO Quality of Life). Hierarchical regression models including age, gender, driving status, finances, health, social participation, and AFS scores explained 8 to 21 per cent of the variance in quality of life scores. Community age-friendliness was a statistically significant variable in all models, accounting for three to six and a half per cent of additional variance in quality of life scores. Although the proportion of variance explained by age-friendliness was small, our findings suggest that it is worthwhile to further investigate whether focused, age-friendly policies, interventions, and communities could play a role towards successful and healthy aging.

Correlates of Memory and Executive Function in Middle-Aged and Older Adults in the CLSA: A Minority Stress Approach.

OBJECTIVES: Maintaining cognitive function is an important component of healthy aging. There is increasing recognition that extraneous factors expedite the typical cognitive aging process. Risk factors for cognitive decline cluster around inequalities and disproportionally affect minority and vulnerable groups. Taking a minority stress approach, we examined the relationship between proxy measures of minority stress and cognitive health in a large sample of Canadians aged 45-85 years. METHODS: Data were drawn from the baseline of the Canadian Longitudinal Study on Aging, a prospective cohort study. Memory (n = 36,849) and executive function (n = 36,266) were assessed using standardized assessment tools. We ran multiple linear regression models with memory and executive function as the outcomes. Explanatory variables included known correlates of cognitive health (i.e., demographic, health, and cognitive reserve) and proxy measures of minority stress (i.e., sexual orientation, race, and perceived social standing). RESULTS: Results were consistent with existing evidence showing that demographic and health variables were associated with cognitive performance. Modifiable health variables, walking, and fruit/vegetable consumption were associated with better cognitive performance, as were cognitive reserve and social support measures. Within the models, racial minority status was consistently associated with lower cognitive performance. As one's perceived social standing within their own community increased, so too did cognitive function. DISCUSSION: These findings identify factors that may put people at risk for cognitive decline. There is a need to support the cognitive health of racialized Canadians and members of other disadvantaged groups, while promoting health equity.

Centering sexual and gender diversity within Compassionate Communities: insights from a community network of LGBTQ2S+ older adults.

BACKGROUND AND RATIONALE: The Compassionate Communities movement emphasizes the importance of illness, disability, dying, caregiving, and grief across the lifespan and highlights the communal responsibility of caring for one another. There is a need to recognize and incorporate the needs of diverse communities within this movement and research on dying, caregiving and grief. An important axis of this diversity is related to individuals' sexual orientation and gender identity. METHODS: As part of the early phases of Healthy End of Life Project Ottawa, a Compassionate Communities, community-based, participatory action research project, we held focus groups with older members of lesbian, gay, bisexual, transgender, queer, and two-spirit communities. Nine older lesbian, gay, bisexual, transgender, queer, and two-spirit people participated in the focus groups (mean age = 72 years). Data were analysed using an inductive, reflexive thematic approach. RESULTS: Through an iterative analysis process, we identified themes related to lifecourse experiences of trauma, the need for safety within care contexts, the importance of relationships and connection, as well as participants' ability to ask for and receive help. A core tenet of Compassionate Communities involves responding to the needs of diverse communities with respect to aging, end-of-life, and grief. Our findings emphasize the importance of incorporating the voices of diverse sexual and gender identities and promoting health equity within Compassionate Community initiatives.

Sexual orientation as a social determinant of suicidal ideation: A study of the adult life span.

OBJECTIVE: Rates of suicide attempts are highest among younger ages and women, and especially elevated among sexual minorities (lesbian, gay, and bisexual [LGB] people). We examined the prevalence of lifetime suicide ideation among sexual minorities and sought to determine whether this relationship depended on age and gender. METHOD: Using data from the Annual Component of the 2015-2016 Canadian Community Health Survey (CCHS), participants were asked whether they had seriously contemplated suicide (lifetime suicidal ideation: yes/no). In adjusted multiple logistic regression analyses, we entered a sexual orientation by gender and age (three-way) interaction. RESULTS: There was evidence of an interaction between sexual orientation, gender, and age on lifetime suicidal ideation (Wald χ2 : p = 0.009); the strength of the relationship between sexual orientation and suicidal ideation varied by gender and age. Lesbian/gay and bisexual respondents of both genders were more likely to report suicidal ideation across the life span, when compared to heterosexuals. This finding was strongest for bisexual respondents. CONCLUSION: The results highlight the relevance of sexual orientation as a social determinant of lifetime suicidal ideation. Suicide prevention and surveillance efforts should take into consideration that sexual minorities, especially bisexual persons, disproportionately consider harming themselves when compared to the heterosexual population.

"We Live in a Wonderful Country, Canada, but ": Perspectives From Older LGBTQ Ontarians on Visibility, Connection, and Power in Care and Community.

This research investigated the health and aging experiences of 21 lesbian, gay, bisexual, trans, and queer (LGBTQ) adults, aged 60 to 79 years, to identify their service and support needs. Participants engaged in focus groups in four locations in Ontario, Canada. Data were analyzed using inductive thematic approach. Participants anticipated age-related losses and expected a greater use of and dependence on health/social care services. Despite greater LGBTQ visibility and inclusive care, participants perceived care services and facilities as unsafe and without competent support. Participants described employing positive strategies to overcome discrimination, contributing to participants' health and aging experiences.

Physical and mental health inequalities among aging lesbian, gay, and bisexual Canadians: cross-sectional results from the Canadian Longitudinal Study on Aging (CLSA).

OBJECTIVE: International estimates suggest the presence of health inequalities among older sexual minorities (i.e., individuals who identify as lesbian, gay, or bisexual and are 65 years old or above). In this study, we investigated the presence of health inequalities among aging lesbian and bisexual females, as well as aging gay and bisexual males in Canada. METHODS: We used baseline data from the Canadian Longitudinal Study on Aging (CLSA) Tracking and Comprehensive cohorts to cross-sectionally compare self-reported physical and mental health indicators by sex and sexual orientation. Within our analysis sample of 51,208 Canadians 45 years old and over, 2% (n = 1057) of respondents identified as lesbian, gay, or bisexual. RESULTS: Compared to heterosexual female peers, lesbian and bisexual females had greater odds of heavy drinking (AOR = 1.8, 95% CI = 1.3-2.4) and being a former smoker (AOR = 1.5, 95% CI = 1.2-1.9). Gay and bisexual males had greater odds of reporting a diagnosis of cancer (AOR = 1.5, 95% CI = 1.0-1.9) and currently smoking (AOR = 1.5, 95% CI = 1.1-2.0), compared to heterosexual males. Female and male sexual minorities had greater odds of reporting mood disorders (including depression) and anxiety disorders relative to heterosexual peers of the same sex. CONCLUSION: These findings highlight the importance of considering both sex and sexual orientation when developing approaches to support the physical and mental health of a diverse aging population in Canada.

Staying Out of the Closet: LGBT Older Adults' Hopes and Fears in Considering End-of-Life.

Canada is experiencing population aging, and given the heterogeneity of older adults, there is increasing diversity in late life. The purpose of this study was to help fill the research gaps on LGBT aging and end-of-life. Through focus groups, we sought to better understand the lived experience of older LGBT individuals and to examine their concerns associated with end-of-life. Our analysis highlights the idea that identifying as LGBT matters when it comes to aging and end-of-life care. In particular, gender identity and sexual orientation matter when it comes to social connections, in the expectations individuals have for their own care, and in the unique fear related to staying out of the closet and maintaining identity throughout aging and end-of-life. This study underscores the need to consider gender identity and sexual orientation at end-of-life. In particular, recognition of intersectionality and social locations is crucial to facilitating positive aging experiences and end-of-life care.

Assessment of Drivers with Alzheimer's Disease in High Demand Driving Situations: Coping with Intersections in a Driving Simulator.

Intersections are one of the most complex and cognitively demanding driving situations. Individuals with dementia and, more precisely, Alzheimer's disease (AD), may face additional challenges negotiating intersections given the nature of their cognitive decline, which often includes deficits of attention. We developed a comprehensive evaluation scheme to assess simulated driving performance at intersections. The evaluation scheme captured all types of errors that could occur during preparation (i.e., prior to the intersection), execution (i.e., during the intersection), and recovery (i.e., after the intersection). Using the evaluation scheme, intersection behaviour in a driving simulator among 17 drivers with mild AD was compared to that of 21 healthy controls. The results indicated that across all types of intersections, mild AD drivers exhibited a greater number of errors relative to controls. Drivers with mild AD made the most errors during the preparation period leading up to the intersection. These findings present a novel approach to analyzing intersection behaviour and contribute to the growing body of research on dementia and driving.

Fluctuating attentional demand in a simulated driving assessment: the roles of age and driving complexity.

OBJECTIVE: The purpose of the study was to explore age differences in attentional demand in response to driving situations of varying complexity within the context of a simulated assessment protocol. It was hypothesized that as road complexity increased, an indicator of attentional demand (i.e., latency to respond to a secondary task) would increase and, independent of the road complexity, older adults would exhibit greater attentional demand in comparison with younger and middle-aged drivers. METHODS: Drivers from 3 age categories (i.e., young, middle-aged, and older) completed an assessment protocol in a STISIM driving simulator (Systems Technology, Inc., Hawthorne, CA) during which participants responded to a series of strategically placed secondary tasks (i.e., peripheral detection tasks, PDTs). Situations where secondary tasks occurred were grouped according to whether they were straight-road, crossing-path, or lane-change events. Two global indices of driving safety as well as several cognitive measures external to the driving simulator were also collected. RESULTS: The results supported the hypothesis in that complex driving situations elicited greater attentional demand among drivers of all ages. Older adults showed greater attentional demand in comparison to young and middle-aged adults even after controlling for baseline response time. Older drivers also scored poorer on a global measure of driving safety. CONCLUSIONS: The findings are highly consistent with the literature on road complexity and attention that show that increased driving complexity is associated with poorer performance on tasks designed to concurrently assess attention, an effect that is more pronounced for older drivers. The results point to intrinsic and extrinsic factors that contribute to motor vehicle collisions (MVCs) among older drivers. The relevance of these findings is discussed in relation to interventions and future research aimed at improving road safety.