Longitudinal Quantiles of Frailty Trajectories Considering Death: New Insights into Sex and Cohort Differences in the Reference Curves for Frailty Progression of Older European.

BACKGROUND: Most previous studies of frailty trajectories in older adults focus on the average trajectory and ignore death. Longitudinal quantile analysis of frailty trajectories permits the definition of reference curves, and the application of mortal cohort inference provides more realistic estimates than models that ignore death. METHODS: Using data from individuals aged 65 or older (n = 25 446) from the Survey of Health, Ageing, and Retirement in Europe (SHARE) from 2004 to 2020, we derived repeated values of the Frailty Index (FI) based on the accumulation of health deficits. We applied weighted Generalized Estimating Equations to estimate the quantiles of the FI trajectory, adjusting for sample attrition due to death, sex, education, and cohort. RESULTS: The FI quantiles increased with age and progressed faster for those with the highest level of frailty (ß^a0.9 = 0.0229, p < .001; ß^a0.5 = 0.0067, p < .001; H0: ßa0.5=ßa0.9, p < .001). Education was consistently associated with a slower progression of the FI in all quantiles (ß^ae0.1 = -0.0001, p < .001; ß^ae0.5 =-0.0004, p < .001; ß^ae0.9 = -0.0003, p < .001) but sex differences varied across the quantiles. Women with the highest level of frailty showed a slower progression of the FI than men when considering death. Finally, no cohort effects were observed for the FI progression. CONCLUSIONS: Quantile FI trajectories varied by age, sex, education, and cohort. These differences could inform the practice of interventions aimed at older adults with the highest level of frailty.

Transitions across states with and without difficulties in performing activities of daily living and death: a longitudinal comparison of ten European countries.

Ageing has been related to the onset of disability and dependency in older adults. There is a need to better understand the disability and dependency trajectories of older adults and their relationship with socio-demographic characteristics and institutional or cultural context. This study analyses the role of age, sex, education and self-perceived health in disability, dependency and death transitions, addressing the heterogeneity across European countries and inconsistencies when using different measures of disability. Multi-state models were adjusted to evaluate the role of risk and protective factors in the transitions to disability, dependency and death. Difficulties in performing activities of daily living (ADLs) assess disability and dependency states. Data were from the Survey of Health, Ageing and Retirement in Europe conducted in 2004-2013, considering individuals aged 65 and older at baseline from Austria, Belgium, Denmark, France, Germany, Italy, the Netherlands, Spain, Sweden and Switzerland. The results showed that transitions to disability and dependency varied with age, sex, education and self-perceived health. The probability of transition to disability and dependency states increases until the age of 70 for all countries. However, there was heterogeneity in the disability and dependency trajectories with ageing between men and women. In most countries, women live with difficulties and may need help for longer than men. Care policies should consider sex differences to decrease the burden of care of informal caregivers, particularly in countries where care systems are absent or partially developed and a high level of family obligations to care needs exist.

Latent dependency classes according to the need for help: a population-based analysis for the older population.

BACKGROUND: Older adults living in the community may have daily needs for help to perform different types of activities. In developing countries, older adults face the additional challenge of lacking sufficient economic means to face their increasing needs with ageing, and health and social policies may be under pressure. The aim of this study was to assess dependency in the older population from a developing country using a latent class approach to identify heterogeneity in the type of activities in which dependent older adults require help. METHODS: In this cross-sectional evaluation of dependency, we considered individuals aged 60 years and older from a nationally representative study (N = 5138) in Uruguay. We fitted latent class regressions to analyse dependency, measured by the need for help to perform Activities of Daily Living, adjusted by sociodemographic characteristics. RESULTS: Four latent classes were identified, 86.4% of the individuals were identified as non-dependent, 7.4% with help requirements to perform instrumental activities while individuals in the other two classes need help to perform all types of activities with different degrees (4.3 and 1.9%). Less educated women are more likely to be in the group with needs in instrumental activities. CONCLUSIONS: The heterogeneous patterns of dependency have to be addressed with different services that meet the specific needs of dependent older adults.

Personality predictors of cognitive dispersion: A coordinated analysis of data from seven international studies of older adults.

OBJECTIVES: Dispersion in cognitive test performance within a single testing session is proposed as an early marker of poor brain health. Existing research, however, has not investigated factors that may explain individual differences in cognitive dispersion. We investigate the extent to which the Big Five personality traits are associated with cognitive dispersion in older adulthood. METHOD: To promote transparency and reliability, we applied preregistration and conceptual replication via coordinated analysis. Drawing data from seven longitudinal studies of aging (Ntotal = 33,581; Mage range = 56.4-71.2), cognitive dispersion scores were derived from cognitive test results. Independent linear regression models were fit in each study to examine personality traits as predictors of dispersion scores, adjusting for mean cognitive performance and sociodemographics (age, sex, education). Results from individual studies were synthesized using random effects meta-analyses. RESULTS: Synthesized results revealed that openness was positively associated with cognitive dispersion, 0.028, 95% CI [0.003, 0.054]. There was minimal evidence for associations between cognitive dispersion and the other personality traits in independent analyses or meta-analyses. Mean cognitive scores were negatively associated with cognitive dispersion across the majority of studies, while sociodemographic variables were not consistently associated with cognitive dispersion. CONCLUSION: Higher levels of openness were associated with greater cognitive dispersion across seven independent samples, indicating that individuals higher in openness had more dispersion across cognitive tests. Further research is needed to investigate mechanisms that may help to explain the link between openness and cognitive dispersion, as well as to identify additional individual factors, beyond personality traits, that may be associated with cognitive dispersion. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Dependency Change with Aging and Associated Factors in Uruguay: A Cohort Study.

OBJECTIVES: To assess the heterogeneity of transitions toward dependency in older adults and to explore the robustness of results to different operationalizations of dependency. METHOD: Using data from people aged 60 years and older from a national representative study in Uruguay (Encuesta Longitudinal de Protección Social, N = 5071), we fitted multinomial regressions adjusted by sociodemographic and health characteristics to model transitions into dependency and death. We used a harder operationalization with basic activities of daily living (Katz-dependency) and Comprehensive-dependency with basic, instrumental, and advanced activities. RESULTS: Increasing age (RRR = 1.08, CI = [1.05; 1.12], p < .001) and having comorbidities (RRR = 2.16, CI = [1.31; 3.57], p = .003) increased the risk of transition from nondependent to dependent using Katz-dependency. Women with at least two chronic conditions have increased risk of Comprehensive-dependency (RRR = 1.79, CI = [1.15; 2.80], p = .010). DISCUSSION: Inconsistencies in findings emerged when evaluating transitions into dependency with the different measures, which may have social care implications.

Intencionalidad del embarazo y cuidados prenatales en Uruguay / Pregnancy intention and antenatal care services in Uruguay / Intencionalidade da gravidez e cuidado pré-natal no Uruguai

Resumen: Introducción: desde hace algunos años el número de embarazos no intencionales en Uruguay ronda el 40%; esta cifra es alta en comparación con otros países que también tienen baja fecundidad y da cuenta de las dificultades de acceso y uso eficaz de métodos anticonceptivos modernos. Además, varios estudios evidencian que los embarazos no intencionales están vinculados con cuidados prenatales insuficientes y peores desempeños de los recién nacidos respecto a los nacimientos resultantes de embarazos intencionales. Objetivo: analizar la asociación entre intencionalidad de los embarazos y los cuidados prenatales en Uruguay a partir del estudio de su incidencia sobre la captación temprana del embarazo y las prácticas no saludables durante la gestación (fumar y tomar alcohol). Método: se consideran los nacimientos no intencionales y a destiempo (no buscados en ese momento) como dos grupos de tratamiento y se comparan con el grupo de nacimientos intencionales. Se examina el efecto neto de la intencionalidad del embarazo sobre las prácticas de salud durante la gestación utilizando técnicas de Propensity Score Matching (PSM). Se utilizan datos provenientes de la Encuesta de Nutrición, Desarrollo Infantil y Salud (ENDIS), un estudio de panel que recoge información desde 2013 de madres con hijos de entre 0 y 3 años en hogares ubicados en localidades urbanas de Uruguay (mayores a 5.000 habitantes). Resultados: antes de realizar el emparejamiento por PSM, las diferencias entre grupos de intención de embarazos fueron significativas para captación temprana y haber fumado, mientras que haber bebido alcohol no se asoció a diferencias significativas entre grupos de intención de los embarazos.

Summary: Introduction: in Uruguay, the number of unintended pregnancies has been around 40% for several years. This is rather a high percentage if compared to other countries who also have low fertility rates and evidences difficulties in access to modern contraceptive methods or using them effectively. Likewise, several studies evidence unintended pregnancies are related to insufficient antenatal care services and worse outcome in the new-borns when compared to births resulting from intentional pregnancies. Objective: to study the relationship between pregnancy intentionality and antenatal care services in Uruguay, based on an analysis of its impact on the early engagement of pregnancies and non-healthy practices during pregnancy (smoking and alcohol consumption). Method: unintended and untimely births (not sought at that time) were included in the study as two treatment groups, and they are compared to the group of intentional births. The net effect of pregnancy intention on health practices during pregnancy was examined using the de Propensity Score Matching (PSM) techniques. We used data delivered by the Nutrition, Child Development and Health Survey, a panel study that has been collecting information from mothers of children between 0 and 3 years old who live in urban localities of Uruguay (with over 5,000 inhabitants) since 2013. Results: Prior to the PSM matching, the differences in early engagement and smoking were significant between pregnancy intention groups, whereas alcohol consumption was not associated to significant differences between pregnancy intention groups.

Resumo: Introdução: há anos, o número de gestações não intencionais no Uruguai gira em torno de 40%; este número é alto em comparação com outros países que também têm baixa fecundidade e explica as dificuldades de acesso e uso de métodos anticoncepcionais modernos. Além disso, diversos estudos mostram que a gravidez não intencional está associada ao pré-natal insuficiente e piores parâmetros do recém-nascido em comparação com o nascimento decorrente da gravidez intencional. Objetivos: analisar a associação entre intencionalidade da gravidez e assistência pré-natal no Uruguai, a partir do estudo de sua incidência na detecção precoce da gravidez e práticas não saudáveis durante a gravidez (tabagismo e etilismo). Método: os nascimentos não intencionais e prematuros (não desejados no momento) são considerados dois grupos de tratamento e comparados com o grupo de partos intencionais. O efeito líquido da intencionalidade da gravidez sobre as práticas de saúde durante a gravidez é examinado usando técnicas de correspondência de pontuação de propensão (PSM). São utilizados os dados da Pesquisa de Nutrição, Desenvolvimento Infantil e Saúde (ENDIS), um estudo de painel que coleta informações desde 2013 de mães com filhos de 0 a 3 anos em domicílios localizados em áreas urbanas do Uruguai (mais de 5.000 habitantes). Resultados: antes de realizar a comparação por PSM, as diferenças entre os grupos de intenção de gravidez foram significativas para recrutamento precoce e tabagismo, enquanto ter bebido álcool não foi associado a diferenças significativas entre os grupos de intenção de gravidez.

Cognitive Dispersion Is Not Associated with Cerebrospinal Fluid Biomarkers of Alzheimer's Disease: Results from the European Prevention of Alzheimer's Dementia (EPAD) v500.0 Cohort.

BACKGROUND: Cognitive dispersion, variation in performance across cognitive domains, is posited as a non-invasive and cost-effective marker of early neurodegeneration. Little work has explored associations between cognitive dispersion and Alzheimer's disease (AD) biomarkers in healthy older adults. Even less is known about the influence or interaction of biomarkers reflecting brain pathophysiology or other risk factors on cognitive dispersion scores. OBJECTIVE: The main aim of this study was to examine whether higher cognitive dispersion was associated with cerebrospinal fluid (CSF) levels of amyloid-ß (Aß42), total tau (t-tau), phosphorylated tau (p-tau), and amyloid positivity in a cohort of older adults at various severities of AD. A secondary aim was to explore which AD risk factors were associated with cognitive dispersion scores. METHODS: Linear and logistic regression analyses explored the associations between dispersion and CSF levels of Aß42, t-tau, and p-tau and amyloid positivity (Aß42 < 1000 pg/ml). Relationships between sociodemographics, APOEɛ4 status, family history of dementia, and levels of depression and dispersion were also assessed. RESULTS: Dispersion did not emerge as associated with any of the analytes nor amyloid positivity. Older (ß= -0.007, SE = 0.002, p = 0.001) and less educated (ß= -0.009, SE = 0.003, p = 0.009) individuals showed greater dispersion. CONCLUSION: Dispersion was not associated with AD pathology, but was associated with age and years of education, highlighting individual differences in cognitive aging. The use of this metric as a screening tool for existing AD pathology is not supported by our analyses. Follow-up work will determine if dispersion scores can predict changes in biomarker levels and/or positivity status longitudinally.

Importance of modelling decisions on estimating trajectories of depressive symptoms and co-morbid conditions in older adults: Longitudinal studies from ten European countries.

BACKGROUND: International comparisons of trajectories of depressive symptoms in older adults are scarce and longitudinal associations with co-morbid conditions not fully understood. OBJECTIVE: To compare trajectories of depressive symptoms from participants living in 10 European Countries and identify ages at which the associations of co-morbid conditions with these trajectories become more relevant. METHODS: Latent growth curve models were fitted to depressive symptoms scores from participants of the Survey of Health and Retirement in Europe (SHARE) initiative (combined n = 21,253) and co-morbid conditions modelled as time varying covariates. To identify the ages at which the association between co-morbid conditions and depressive symptoms was significant the Johnson-Neyman (JN) technique was used. RESULTS: The shape of depressive symptoms trajectories varied between countries, and was highly dependent on modelling decisions. The association between the average number of co-morbidities reported over time and depressive symptoms was consistent and positive across countries and ages. CONCLUSION: International differences in ageing-related trajectories of depressive symptoms emerged. The longitudinal association of co-morbid conditions with trajectories of depressive symptoms was found, but the results overall suggest that modelling decisions could greatly influence the outcomes, and should thus be interpreted with caution.