Prospective exploration of the role of combined internalizing symptoms in self-reported memory among older adults during the COVID-19 pandemic.

OBJECTIVES: A growing literature suggests depression and anxiety increase risk of cognitive decline. However, few studies have examined their combined effects on cognition, among older adults, especially during periods of high stress. METHOD: Based on a sample of community dwelling older adults (N = 576), we evaluated the effects of pre-pandemic anxiety and depressive symptoms, obtained in September 2018, to changes in self-reported memory (SRM) assessed 3 months into the COVID-19 pandemic. RESULTS: In separate models, we found participants with depression scores at least 1-SD above the mean and participants with anxiety scores at least 2-SD above the mean to report a significant decline in SRM. Moderation analyses revealed those with high depressive symptoms (at or above the mean) showed a decrease in SRM regardless of anxiety. The extent to which high pre-pandemic anxiety symptoms influenced SRM is dependent on whether pre-pandemic depression was at or above the mean. CONCLUSIONS: Pre-pandemic depression predicted a decline in SRM regardless of anxiety. Moderation analyses revealed that the extent to which anxiety symptoms influenced SRM was dependent on depression being at or above the mean. Those with high anxiety and depression are at highest risk of experiencing cognitive consequences related to stressful exposures like COVID-19.

History of childhood mistreatment and the psychological health consequences of COVID-19 for older adults.

OBJECTIVES: We examine the associations between childhood mistreatment (emotional abuse, physical abuse, sexual abuse, and emotional neglect) and older adults' changes in depressive symptoms from before to during the COVID-19 pandemic (September 2018-June 2020). METHODS: Using a community-based sample of older adults in North Florida (N = 581), we used ordinary least-squares regression to estimate associations between childhood mistreatments and depressive symptoms in June 2020, controlling for baseline symptoms and demographic characteristics. Additional models tested whether emotion regulation and social support attenuated associations between childhood mistreatments and depressive symptoms. RESULTS: Older adults exposed to emotional neglect in childhood saw a greater increase in depressive symptoms than those who did not experience childhood mistreatment. Those reporting childhood physical abuse had higher baseline depressive symptoms, but they did not increase during the pandemic. These associations remained stable after controlling for emotion regulation and social support, coping resources thought to contribute to linkages between childhood mistreatment and psychological health in adulthood. CONCLUSION: Childhood mistreatment might inform the psychological consequences of major stressors in later life. Thus, early life interventions for children experiencing mistreatment could be especially important for long-term psychological health outcomes and responses to major stressful events. Identifying older people with histories of childhood mistreatment could also help clinicians gauge patients' risk of psychological decline during times such as the COVID-19 pandemic and tailor psychological health interventions.

Prediction of COVID-19-related distress: the role of anxiety and resiliency.

OBJECTIVES: Among older adults, anxiety is a likely risk factor for COVID-19-related distress, whereas psychological resilience may attenuate the negative impact of the pandemic. In this longitudinal study, we hypothesized that pre-pandemic anxiety would predict higher COVID-19-related distress, whereas resiliency would predict lower distress. Further we hypothesized that resilience would moderate the association between anxiety and distress. METHODS: Pre-pandemic data (July 2018) was obtained from a community sample of older adults and included measures of anxiety and resiliency. We conducted a follow-up survey (n = 571) during the pandemic (June 2020) and evaluated COVID-19-related distress. We used OLS regression to test our hypotheses. RESULTS: Anxiety symptoms predicted higher COVID-19-related distress; resiliency predicted lower distress. Resiliency did not moderate the association between anxiety and distress. High levels of resiliency, compared to low levels, attenuated the influence of anxiety on COVID-19-related distress, but only among those with low-to-moderate levels of anxiety. CONCLUSION: Older adults with anxiety may be more susceptible to COVID-19 related distress. Interventions that increase resilience, may mitigate distress, and promote healthy aging for those with low-to-moderate anxiety. Further research, however, is needed to help those older adults with high anxiety contend with such adverse experiences and build on psychological resources.

A longitudinal examination of the protective effect of resilience against anxiety among older adults with high COVID-related worry.

This longitudinal study of community dwelling older adults (N = 453) examined consequences of COVID-related worries on changes in anxiety symptoms before relative to during the pandemic. We further evaluated if pre-COVID psychological resilience (PR) buffered the impact of COVID-related worry. Pre-COVID data were collected in September 2018. COVID-related worry and COVID anxiety symptoms were collected in October 2020 (Wave 2). Controlling for pre-COVID anxiety symptoms, we examined if COVID-related worries (e.g. I'm worried that I might die from COVID-19) were associated with increased anxiety symptoms, and whether pre-COVID PR moderated the association between COVID-related worries and prospective increases in anxiety symptoms. COVID-related worries were associated with increased anxiety symptoms (ß = 0.005, p < .01), whereas pre-COVID PR was associated with a decrease in anxiety symptoms (ß = -0.029, p < .05). PR moderated the association; COVID-related worries were associated with greater increases in anxiety symptoms among those with low pre-COVID PR (Model η2 = 0.35). Thus, the extent to which COVID-related worries influenced psychological health was dependent on pre-COVID levels of PR. We conclude the combined vulnerabilities of low pre-COVID PR and high COVID-related worries significantly increased the psychological consequences of COVID-19 for our sample of older adults.

Cognitive reappraisal, emotional suppression, and depressive and anxiety symptoms in later life: The moderating role of gender.

OBJECTIVES: Although socioemotional selectivity (SST) suggests that people experience more positive affect as they age, symptoms of anxiety and depression persist and are often greater in older women than men. Coping strategies may influence the extent to which older adults experience these symptoms. The purpose of the current study is to examine possible gender differences in the use of an adaptive (cognitive reappraisal (CR) and a maladaptive (emotive suppression (ES) emotion regulation strategy in relation to depressive and anxiety symptoms. METHOD: Our study uses cross-sectional data drawn from a community sample of older adults (60+; n = 906). We used OLS regression and moderation analyses to test our study hypotheses. RESULTS: Gender moderated the association between CR in both depressive and anxiety symptoms. Women reported greater use of CR relative to men. Further, CR use was negatively related to symptoms of anxiety and depression in women, but not men. In contrast, men used ES more frequently than women, though older men and women's use of ES was unrelated to anxiety or depressive symptoms. CONCLUSION: Our findings provide initial evidence that greater CR use in older women is related to lower symptoms of both anxiety and depression relative to older men. Age-related increases in CR use (e.g. SST) among women may serve to decrease anxiety and depression symptoms. Findings suggest decreasing anxiety and depressive symptoms via CR may benefit older women more than older men. Future research is needed to identify the coping strategies that are most beneficial for men.

Cognitive reappraisal and the association between depressive symptoms and perceived social support among older adults.

OBJECTIVES: There is an association between depression and diminished social support; indeed, interpersonal dysfunction is often a central feature of depression. The purpose of this study is to examine the role that an emotion regulation (ER) strategy, cognitive reappraisal, plays in influencing the association between depressive symptoms and perceived social support in older adults. METHOD: Data for this cross-sectional study come from a community-based survey of older adults (60+, N = 910). We examined the effects of depressive symptoms and cognitive reappraisal on perceived social support. We then examined the potential moderating role of cognitive reappraisal on the association between depressive symptoms and perceived social support. RESULTS: Depressive symptoms were associated with lower levels of perceived social support. Cognitive reappraisal was associated with higher levels of perceived social support. Cognitive reappraisal moderated the negative consequences of depressive symptoms on perceived social support. Whereas depressive symptoms had a negative effect on perceived social support, the negative effect was greater for those with lower levels of cognitive reappraisal compared to those with higher levels of cognitive reappraisal. DISCUSSION: ER strategies may play a role in attenuating the negative consequences of depressive symptoms on social support in older age. It may be possible to help individuals maintain social support in later life, even in the face of mental health challenges, if they cultivate ER skills.

Typologies of older adult companion animal owners and non-owners: moving beyond the dichotomy.

Objectives: Research on the influence of companion animals (CA) on the health of older adults has yielded contradictory results. Selection factors, leading to heterogeneity both between and within groups of CA owners and non-owners, likely bias results. We conduct analyses to identify typologies of owners and non-owners. Methods: Using data on older adults (60+) from the 2012 Health and Retirement Study (HRS), and the HRS companion animal module, (owners = 478) and (non-owners = 624), we conducted latent class analyses (LCA). We used key demographic, health, daily engagement, and pet characteristic variables to complete our analyses. Results: Analyses revealed five clusters of CA owners and four clusters of non-owners. Health and CA related characteristics distinguishing clusters suggest important sources of variability and reflect qualitatively different profiles of owners and non-owners. We also found CA owners were more likely than non-owners to be high on neuroticism and to be less extroverted than non-owners-but again there was considerable within group variability. Implications: Factors that select people into pet ownership not only work individually to characterize ownership, they create distinct typologies of CA owners and non-owners that likely contribute to subsequent health outcomes. In order to determine if having a CA is beneficial to health in later life and for whom, future research should consider selection factors like those identified in the typologies. Statistical analyses, such as LCA, that can adequately account for these selection factors is necessary to avoid biases in the interpretation of results.

Putamen Volume Differences Among Older Adults: Depression Status, Melancholia, and Age.

BACKGROUND: Individuals with major depressive disorder (MDD) may exhibit smaller striatal volumes reflecting deficits in the reward circuit. Deficits may change with age and be more pronounced among the melancholic subtype. Limited research has investigated striatal volume differences in older adults and by depression subtypes. METHOD: We used baseline data from the Neurocognitive Outcomes of Depression in the Elderly study. We examined volumetric differences in the putamen and caudate nucleus among older adults (60 years and older), comparing healthy control participants (n = 134) to depressed participants (n = 226), and comparing nonmelancholic depressed participants (n = 93) to melancholic depressed participants (n = 133). Group-by-age interactions were examined. RESULTS: There were no significant group differences for the caudate nucleus. For the left putamen, investigation of the significant group-by-age interaction revealed that volume size was greater for the healthy controls compared to the depressed participants but only at younger ages (60-65 years); group differences diminished with increasing age. Examining volume by depression subtype revealed that the melancholic depressed participants had a smaller left putamen compared to the nonmelancholic depressed participants. Anhedonia symptoms were related to both smaller left and right putamen. CONCLUSION: Structural abnormalities in reward regions may underlie the anhedonic phenotype. Volume loss associated with MDD may attenuate in older age.

When Emotional Pain Becomes Physical: Adverse Childhood Experiences, Pain, and the Role of Mood and Anxiety Disorders.

OBJECTIVE: We examined the association between retrospective reports of adverse childhood experiences (ACEs) and painful medical conditions. We also examined the mediating and moderating roles of mood and anxiety disorders in the ACEs-painful medical conditions relationship. METHOD: Ten-year longitudinal data were obtained from the National Comorbidity Surveys (NCS-1, NCS-2; N = 5001). The NCS-1 obtained reports of ACEs, current health conditions, current pain severity, and mood and anxiety disorders. The NCS-2 assessed for painful medical conditions (e.g., arthritis/rheumatism, chronic back/neck problems, severe headaches, other chronic pain). RESULTS: Specific ACEs (e.g., verbal and sexual abuse, parental psychopathology, and early parental loss) were associated with the painful medical conditions. Baseline measures of depression, bipolar disorder, and posttraumatic stress disorder were also associated with the number of painful medical conditions. Anxiety and mood disorders were found to partially mediate the ACEs-painful medical conditions relationship. We determined through mediation analyses that ACEs were linked to an increase in anxiety and mood disorders, which, in turn, were associated with an increase in the number of painful medical conditions. We determined through moderation analyses that ACEs had an effect on increasing the painful medical conditions at both high and low levels of anxiety and mood disorders; though, surprisingly, the effect was greater among participants at lower levels of mood and anxiety disorders. CONCLUSION: There are pernicious effects of ACEs across mental and physical domains. Dysregulation of the hypothalamic-pituitary-adrenal stress response and the theory of reserve capacity are reviewed to integrate our findings of the complex relationships.

The long-term impact of combat exposure on health, interpersonal, and economic domains of functioning.

PURPOSE: Wartime combat exposure is linked to a broad array of negative outcomes. The current study identified potential differences between middle-to-older aged men exposed to combat and those not exposed for physical health, interpersonal, and economic functioning over 10 years. Post-traumatic stress disorder (PTSD) and social support were examined as moderators between combat exposure and outcomes. METHODS: Data from the National Comorbidity Survey, baseline and 10-year follow-up, were utilized. Only men aged 50-65 at follow-up (N = 727) were included. Group differences between combat and non-combat men were examined. Regression analyses were performed to examine relationships between earlier combat and health, interpersonal, and economic outcomes over time, while controlling for important covariates. RESULTS: Combat-exposed men were at increased risk for asthma, arthritis/rheumatism, lung diseases, headaches, and pain; they also had greater marital instability. However, combat-exposed men reported economic advantages, including higher personal earnings at follow-up. For combat-exposed men, PTSD did not increase risk for headaches; however, PTSD in non-combat men was associated with increased risk for headaches at follow-up. Whereas combat-exposed men with higher levels of social support were less likely to report chronic pain at follow-up, there were no group differences in pain at lower levels of social support. IMPLICATIONS: Individuals who experience combat may be susceptible to later health and marital problems; however, as combat-exposed men age, they demonstrate some resilience, including in economic domains of life. Given that consequences of combat may manifest years after initial exposure, knowledge of combat exposure is necessary to inform treatments and the delivery of disability benefits.

In my end is my beginning: developmental trajectories of adverse childhood experiences to late-life suicide.

OBJECTIVES: Converging evidence suggests that the sequelae of adverse childhood experiences (ACEs) including childhood abuse (e.g., sexual, physical, emotional/verbal abuse, neglect) and other ACE (e.g., family dysfunction, parental loss, parental psychopathology, substance abuse, incarceration, and domestic violence) have pronounced effects on suicidal behaviors (suicidal ideation, attempts, and death by suicide) in older age. There are fundamental changes in the developmental trajectory of biological, psychological and behavioral processes that result from ACE and that exert influence throughout the life span. Different moderators and mediators may affect the extent and nature of the relationship. However, the literature on the specific mechanisms whereby ACE affects suicidality in later life has not been well identified. METHOD: We review and draw from extant multidisciplinary evidence to develop a heuristic framework through which to understand how ACE may lead to suicide in later life. RESULTS: Proposed mechanisms span biological factors (neurological, gene-environment), psychiatric and health functioning, and psychosocial development (cognitive biases, coping resources, interpersonal deficits). Evidence suggests that ACEs affect each of these constructs, and it is likely in the interaction of these constructs with late-life stressors that suicidality in older adulthood emerges. CONCLUSION: ACEs have persistent and multifaceted effects on suicidality in late life. This association is due to multi-varied pathways. It is believed that the explanatory framework developed herein--in which biological, psychological and behavioral factors are organized, and the role of late-life stressors is highlighted--will spark further scientific inquiry into this important area.

The new DSM-5 diagnosis of mild neurocognitive disorder and its relation to research in mild cognitive impairment.

The Diagnostic Statistical Manual-5 (DSM-5) has included a category named the neurocognitive disorder which was formally known in DSM-IV as 'dementia, delirium, amnestic, and other cognitive disorders'. The DSM-5 distinguishes between 'mild' and 'major' neurocognitive disorders. Major neurocognitive disorder replaces the DSM-IV's term 'dementia or other debilitating conditions'. A pivotal addition is 'mild neurocognitive disorder (mNCD)' defined by a noticeable decrement in cognitive functioning that goes beyond normal changes seen in aging. It is a disorder that may progress to dementia - importantly, it may not. Presently, our understanding of mNCD is derived from research on mild cognitive impairment (MCI). Whereas there is currently no clear treatment for mNCD, many experimental therapies now and into the future will focus upon secondary prevention, namely decreasing the risk of progression to major NCD. In this article, we will focus on mNCD by reviewing the relevant literature on MCI. We will review the research on the incidence and prevalence of MCI, conversion rates from MCI to dementia, risk factors for conversion of MCI to dementia, comorbidity of MCI with other neuropsychiatric disorders (NPS), and the development of treatment strategies for neuropsychiatric disorders in MCI. The presence of NPS is common among individuals with MCI and is an important risk for progression to dementia. However, there has been little research on effective treatments for NPS in MCI. Clinicians and investigators must determine if the treatment of the NPS in mNCD will improve quality of life and help reduce the progression of the cognitive impairment.

Differences between suicide attempters and nonattempters in depressed older patients: depression severity, white-matter lesions, and cognitive functioning.

OBJECTIVES: The population of older adults with major depressive disorder (MDD) has the highest rate of suicide. White-matter brain lesions (WML) are a potential biologic marker for suicidality in young and middle-aged adults and are correlated with cognitive impairment in older adults. In this study of older patients with MDD, we examined 1) if a history of suicide attempts was associated with a more severe course of MDD; 2) if WML are a biologic marker for suicide; and 3) if suicide attempt history is associated with cognitive impairment mediated by WML. SETTING: Data from the Neurocognitive Outcomes of Depression in the Elderly study. PARTICIPANTS: Depressed patients (60+) who had ever attempted suicide (n = 23) were compared with depressed patients (60+) who had not attempted suicide (n = 223). MEASUREMENTS: Baseline and follow-up assessments were obtained for depressive symptoms (every 3 months) and cognitive functioning (every 6 months) over 2 years. Three magnetic resonance imaging scans were conducted. RESULTS: At baseline, suicide attempters reported more severe past and present symptoms (e.g., depressive symptoms, current suicidal thoughts, psychotic symptoms, earlier age of onset, and more lifetime episodes) than nonattempters. Suicide attempters had more left WML at baseline, and suicide attempt history predicted a greater growth in both left and right WML. WML predicted cognitive decline; nonetheless, a history of suicide attempt was unrelated to cognitive functioning. CONCLUSIONS: Severity of depressive symptoms and WML are associated with suicide attempts in geriatric depressed patients. Suicide attempts predicted neurologic changes, which may contribute to poorer long-term outcomes in elder attempters.

Melancholia in later life: late and early onset differences in presentation, course, and dementia risk.

OBJECTIVES: Depression is a risk factor for cognitive decline and dementia. This risk may vary with age of onset and depression subtype. Late onset depression (LOD, 60 years and older) is associated with more cognitive decline, whereas early onset depression (EOD, before 60 years) is associated with more residual depressive symptoms. Potential differences may reflect divergent etiologies. These onset differences, however, have not been examined in the melancholic subtype of depression in older adults. METHODS: Data were obtained from the Neurocognitive Outcomes of Depression in the Elderly study. Participants (N = 284, 73% EOD-melancholic (EOD-M) and 27% LOD-melancholic (LOD-M)) were followed up over 3 years. Factor analyses examined differences in baseline depressive symptoms. Hierarchical linear growth curve models examined changes in depressive symptoms (Montgomery-Asberg Depression Rating Scale) and cognition (mini mental state examination). An annual clinical review panel assigned diagnoses of dementia. RESULTS: The LOD-M participants had more vegetative symptoms at baseline. LOD-M exhibited greater cognitive decline but fewer residual depressive symptoms than EOD-M. Among participants who remained in the study for at least 1 year, in uncontrolled analyses, a greater percentage of LOD-M compared with EOD-M developed dementia (23.0% vs. 7.8%). Whereas in logistic analyses, controlling for baseline demographics, age at onset remained a predictor of dementia, the odds ratio suggested that the effect was relatively small. CONCLUSIONS: The EOD-M and LOD-M participants have a different presentation and course. LOD-M may represent a syndrome of neuropsychiatric deterioration with expression of both depressive symptoms and cognitive decline.

Stress, race, and APOE: understanding the interplay of risk factors for changes in cognitive functioning.

OBJECTIVES: Biological and environmental factors are thought to contribute to the development of cognitive decline (CD). The Apolipoprotein E (APOE) ϵ4 allele is the greatest known genetic risk factor. The current study focused on the extent to which environmental factors, specifically stress, influence the relationship between the APOE allele and cognitive functioning and whether this relationship is stronger for African-Americans compared to Caucasians. METHODS: Participants consisted of community-dwelling older adults from the Duke Established Populations for Epidemiologic Studies of the Elderly (N = 4,162). Data were drawn from two waves, which were three years apart. Cognitive functioning was assessed at both waves using the Short Portable Mental Status (SPMSQ). RESULTS: Whereas there was no main effect of stress, there was a significant interaction between APOE status and stressful life events, such that increased stress in individuals with an ϵ4 allele lead to more errors on the SPMSQ than individuals with no allele. Inconsistent with predictions, there was a significant interaction between stress and race such that increased stressful events predicted CD in Caucasians but not African-Americans. CONCLUSIONS: Recent stressful late-life events have a greater impact on the cognitive status of individuals with an ϵ4 allele. While Caucasians appear to be less vulnerable to cognitive losses at lower levels of stress, as the number of stressful life events increases that advantage disappears for Caucasians.

The influence of prior rape on the psychological and physical health functioning of older adults.

OBJECTIVES: Older adults who have experienced traumatic events earlier in life may be especially vulnerable to additional challenges associated with aging. In a cross-sectional study of older females, the present study examines whether a history of rape is associated with current psychological and health problems. METHOD: This study used existing data from the female respondents (N = 1228) in the National Social Life, Health, and Aging Project (NSHAP), a national probability sample of adults between the ages of 57 and 85 interviewed in their homes. It was determined whether or not the participant experienced forced sexual contact since the age of 18. Measures of psychological health (e.g., scales of depression, anxiety, and loneliness), the presence or absence of a number of serious health problems, and a one-item measure of self-esteem were obtained. RESULTS: Adult rape occurred in 7% of the sample. On average, 36 years had elapsed since the rape had occurred. Using structural equation modeling (SEM), rape was associated with lower self-esteem, psychological, and physical health functioning. Self-esteem partially mediated the association between rape and psychological functioning, but not health functioning. These associations were significant even after controlling for participant characteristics and risky health behaviors. CONCLUSIONS: Mechanisms linking prior rape to psychological and health problems in older age are discussed, as well as treatment recommendations for symptomatic older adults.

Sleep Quality as a Critical Pathway Between Adverse Childhood Experiences and Multimorbidity and the Impact of Lifestyle.

OBJECTIVES: This study aims to establish the effects of ACEs on multimorbidity through sleep quality and investigate whether lifestyle factors (e.g., eating habits and exercise) may influence this relationship among middle-aged and older adults. METHODS: Participants were drawn from a cross-sectional sample of community dwelling older adults (N = 276, 55+) and three waves of data from the Midlife in the United States study (MIDUS, N = 843). We examined the direct and indirect effects of ACEs, sleep quality, and health conditions, as well as the conditional effects of physical activity and eating habits. RESULTS: Across both samples, sleep quality mediated the relationship between ACEs and chronic health conditions. Moderating effects of unhealthy eating and physical activity differed between samples. DISCUSSION: Sleep quality is an important pathway connecting ACEs and adult multimorbidity, and health behaviors may provide targets for intervention particularly in older adults.

Early childhood abuse and late-life suicidal ideation.

OBJECTIVES: In younger populations childhood sexual and physical abuse have been found to be associated with suicidal ideation. Such associations have not been examined among older adults. SETTING: Data from the National Comorbidity Study-Replication (NCS-R). PARTICIPANTS: Older adults (60+, N = 1610) from the NCS-R sample. MEASUREMENTS: Suicidal ideation occurring after the age of 60 was assessed. Early-life factors were assessed including childhood physical and sexual abuse and parent's internalizing and externalizing symptoms. Participants' internalizing and externalizing symptoms were also assessed. RESULTS: Logistic regression analysis showed that male gender, mother's internalizing symptoms and childhood physical and sexual abuse were associated with suicidal ideation. The association between child abuse and suicidal ideation was mediated by participants' externalizing symptoms. CONCLUSIONS: Health care workers should screen for suicidal ideation among older adults. In particular, older males with externalizing disorders and a history of child abuse may be at a heightened risk for suicidal ideation.