How Social Connection and Engagement Relate to Functional Limitations and Depressive Symptoms Outcomes After Stroke.

BACKGROUND: Stroke commonly leads to disability and depression. Social connection and engagement can be protective against functional decline and depression in the general population. We investigated the effects of social connection and engagement on trajectories of function and depressive symptoms in stroke. METHODS: This is a longitudinal study, which included 898 participants with incident stroke from the HRS study (Health and Retirement Study) between 1998 and 2012. Multilevel modeling was used to examine associations of social connection and engagement with changes in functional limitations in instrumental activities of daily living (IADLs) and depressive symptoms over time. Models controlled for age, gender, education, and race/ethnicity. Moderation analyses examined whether high social connection and engagement reduced depressive symptoms for survivors with high IADL impairment. RESULTS: Social connection and engagement were generally associated with fewer IADL limitations and depressive symptoms at the time of stroke and after stroke. For example, participants who felt lonely and did not provide help to others before stroke had more IADL limitations. Prestroke volunteering was associated with less increase in IADL limitations with stroke and increase in having friends and providing help to others compared with one's prestroke status were associated with fewer IADL limitations after stroke. For depressive symptoms, participants who felt lonely and did not have a friend or partner before stroke had more depressive symptoms, and participants who had children residing nearby before stroke showed less increase in depressive symptoms. Moderation effects were not found for social connection and engagement on high IADL impairment and depressive symptoms. CONCLUSIONS: Findings suggest that social connection and engagement may reduce the negative physical and psychological outcomes of stroke, both at baseline and after stroke. Efforts to enhance social engagement and diminish loneliness may both enhance population well-being and enhance resilience and recovery from stroke and other illnesses.

Associations of perceived stress, depressive symptoms, and caregiving with inflammation: a longitudinal study.

OBJECTIVES: Higher inflammation has been linked to poor physical and mental health outcomes, and mortality, but few studies have rigorously examined whether changes in perceived stress and depressive symptoms are associated with increased inflammation within family caregivers and non-caregivers in a longitudinal design. DESIGN: Longitudinal Study. SETTING: REasons for Geographic And Racial Differences in Stroke cohort study. PARTICIPANTS: Participants included 239 individuals who were not caregivers at baseline but transitioned to providing substantial and sustained caregiving over time. They were initially matched to 241 non-caregiver comparisons on age, sex, race, education, marital status, self-rated health, and history of cardiovascular disease. Blood was drawn at baseline and approximately 9.3 years at follow-up for both groups. MEASUREMENTS: Perceived Stress Scale, Center for Epidemiological Studies-Depression, inflammatory biomarkers, including high-sensitivity C-reactive protein, D dimer, tumor necrosis factor alpha receptor 1, interleukin (IL)-2, IL-6, and IL-10 taken at baseline and follow-up. RESULTS: Although at follow-up, caregivers showed significantly greater worsening in perceived stress and depressive symptoms compared to non-caregivers, there were few significant associations between depressive symptoms or perceived stress on inflammation for either group. Inflammation, however, was associated with multiple demographic and health variables, including age, race, obesity, and use of medications for hypertension and diabetes for caregivers and non-caregivers. CONCLUSIONS: These findings illustrate the complexity of studying the associations between stress, depressive symptoms, and inflammation in older adults, where these associations may depend on demographic, disease, and medication effects. Future studies should examine whether resilience factors may prevent increased inflammation in older caregivers.

"How Social Connection and Engagement Relate to Functional Limitations and Depressive Symptoms Outcomes After Stroke".

Background: Stroke commonly leads to disability and depression. Social connection and engagement can be protective against functional decline and depression in the general population. We investigated the effects of social connection and engagement on trajectories of function and depressive symptoms in stroke. Methods: Participants were 898 individuals with incident stroke from the Health and Retirement Study between 1998-2012. Multilevel modeling was used to examine associations of social connection and engagement with changes in functional limitations in instrumental activities of daily living (IADLs) and depressive symptoms over time. Models controlled for age, gender, education, and race/ethnicity. Moderation analyses examined whether high social connection and engagement reduced depressive symptoms for survivors with high IADL impairment. Results: Social connection and engagement were generally associated with fewer IADL limitations and depressive symptoms at the time of stroke and after stroke. For example, participants who felt lonely and did not provide help to others before stroke had more IADL limitations. Pre-stroke volunteering was associated with less increase in IADL limitations with stroke and increase in having friends and providing help to others compared to one's pre-stroke status were associated with fewer IADL limitations after stroke. For depressive symptoms, participants who felt lonely and did not have a friend or partner before stroke had more depressive symptoms, and participants who had children residing nearby before stroke showed less increase in depressive symptoms. Moderation effects were not found for social connection and engagement on high IADL impairment and depressive symptoms. Conclusions: Findings suggest that social connection and engagement may reduce the negative physical and psychological outcomes of stroke, both at baseline and after stroke. Efforts to enhance social engagement and diminish loneliness may both enhance population well-being and enhance resilience and recovery from stroke and other illnesses.

Music Engagement and Episodic Memory Among Middle-Aged and Older Adults: A National Longitudinal Analysis.

OBJECTIVES: The objective of this study was to examine associations between music engagement and episodic memory for more than 12 years in a nationally representative sample of middle- and older-aged adults in the United States. METHODS: This study is based on a secondary analysis of data from a sample (N = 5,021) of cognitively normal adults from the Health and Retirement Study (2006-2018). Episodic memory was measured by immediate and delayed recall tasks. Music engagement was classified as none, passive (i.e., listening to music), active (i.e., singing and/or playing an instrument), or both (i.e., listening to music and singing or playing an instrument). RESULTS: Compared with those with no music engagement, respondents who reported both passive and active engagement performed 0.258 points better at baseline on episodic memory tasks. This group also performed better across time with scores that declined by 0.043 points fewer per study visit. Additionally, compared to those with no music engagement, participants with passive music engagement had scores that declined by 0.023 points fewer per visit. There were no significant differences in performance at baseline for those with passive or active music engagement, or across time for those with active engagement. DISCUSSION: The results of this study suggest that engaging in both passive and active music engagement may be superior to engaging with music only passively or actively and that engaging in music both ways may be able to protect against age-related declines in episodic memory. Future research should examine whether community-based music engagement interventions can affect this trajectory of decline.

Mind-Body Practice, Personality Traits, and Cognitive Performance: A 10-Years Study in US Adults.

It is widely established that physical activity is associated with better cognitive outcomes, and accumulating evidence suggests that mind-body practice (MBP, e.g., movement therapies such as yoga) may yield similar benefits. Personality is related to both daily activities and cognition, but its role in the association between MBP and cognition is not well understood. Using data from waves 2 and 3 (2004-2014) of the Midlife in the United States (MIDUS) study, the current study examines bidirectional temporal associations between personality traits, MBP, and cognition in healthy adults (N = 2050). We applied a cross-lagged regression analysis to examine bidirectional effects between MBP, Big Five personality traits, and two cognitive domains (episodic memory and executive function) and controlled for relevant variables (sociodemographic factors, health, and functional status) at wave 2. MBP at baseline was independently associated with more favorable change in episodic memory, but not in executive function, both before and after including control variables. Also, episodic memory and executive function at baseline were related to increase in MBP. The findings show that MBP and cognitive function predict each other over time. There is also some evidence for cognition and personality associations over time; however, personality traits are not related to subsequent MBP.

The Role of Social Connection/Engagement in Episodic Memory Change in Stroke.

BACKGROUND AND OBJECTIVES: Positive associations between social connection/engagement and cognitive function are well documented. However, little is known about whether social connection/engagement can buffer the impact of serious brain injury such as stroke on cognitive functioning. RESEARCH DESIGN AND METHODS: Participants were 898 individuals with incident stroke from the Health and Retirement Study between 1998 and 2012. Multilevel modeling was used to examine how social connection/engagement was associated with episodic memory pre- and poststroke. Models controlled for age, gender, education, race/ethnicity, number of health conditions, and functional health. RESULTS: Participants who were lonely prestroke recalled significantly fewer words at the time of stroke, and participants who had children residing within 10 miles prestroke showed significantly less decline in word recall over time. Participants who provided help to others prestroke showed less stroke-related decline in word recall. Within-person increase in partnered status, having friends, and helping others were related to better word recall in the poststroke period. DISCUSSION AND IMPLICATIONS: Higher prestroke levels of social connection/engagement predicted better episodic memory at stroke, a smaller decline in episodic memory with stroke, and less decline in episodic memory over time. Increases in social connection/engagement from pre- to poststroke also predicted better poststroke episodic memory. Beyond the widely documented benefits of social connection/engagement to well-being, they may also increase cognitive stimulation and cognitive reserve and thus contribute to stroke recovery in the cognitive domain. Social connection/engagement is an important and modifiable risk factor in older adults.

Association Between Music Engagement and Episodic Memory Among Middle-Aged and Older Adults: A National Cross-Sectional Analysis.

OBJECTIVES: To determine whether music engagement influences middle-aged and older adults' performance on episodic memory tasks. METHOD: Secondary data analysis of a sample (N = 4,592) of cognitively healthy adults from the 2016 Health and Retirement Study was used for this study. Multivariable regression models were used to analyze the cross-sectional differences in performance on tasks of episodic memory between participants who listened to music (n = 3,659) or sang or played an instrument (n = 989). RESULTS: On average, participants recalled 10.3 words out of a possible 20. Regression analyses showed that both listening to music and singing or playing an instrument were independently associated with significantly better episodic memory. DISCUSSION: The findings provide the first population-based evidence that music engagement is associated with better episodic memory among middle-aged and older adults. Future studies should examine whether the relationship between music engagement and episodic memory can be replicated in other populations and that the association persists in longitudinal studies.

Using blood test parameters to define biological age among older adults: association with morbidity and mortality independent of chronological age validated in two separate birth cohorts.

Biomarkers defining biological age are typically laborious or expensive to assess. Instead, in the current study, we identified parameters based on standard laboratory blood tests across metabolic, cardiovascular, inflammatory, and kidney functioning that had been assessed in the Berlin Aging Study (BASE) (n = 384) and Berlin Aging Study II (BASE-II) (n = 1517). We calculated biological age using those 12 parameters that individually predicted mortality hazards over 26 years in BASE. In BASE, older biological age was associated with more physician-observed morbidity and higher mortality hazards, over and above the effects of chronological age, sex, and education. Similarly, in BASE-II, biological age was associated with physician-observed morbidity and subjective health, over and above the effects of chronological age, sex, and education as well as alternative biomarkers including telomere length, DNA methylation age, skin age, and subjective age but not PhenoAge. We discuss the importance of biological age as one indicator of aging.

Movement-based mind-body practices and cognitive function in middle-aged and older adults: Findings from the Midlife in the United States (MIDUS) study.

OBJECTIVES: Cognitive function is a key component of healthy aging. While conventional physical activities (walking, jogging, etc.) have been shown to support physical and cognitive health in late-life, it remains unclear whether traditional Eastern movement-based mind-body practices (MBP) have long-term cognitive benefits above and beyond conventional leisure physical activities. This study examines the relationship between movement-based MBP and cognitive function in middle-aged and older adults during a 10-year follow-up period. METHODS: We used data from Waves 2 (2004-05) and 3 (2013-14) of the Midlife in the United States (MIDUS) study. MIDUS initially surveyed a national probability sample of community-living adults aged 24-75 years in 1995 (Wave 1). Tests of cognitive functioning measuring executive function and episodic memory were added in Wave 2 and repeated in Wave 3. We estimated multivariable linear regression models to examine the effect of MBP (Wave 2) on the episodic memory and executive function (Wave 3) while controlling for covariates (sociodemographic factors, health, and cognitive function at Wave 2). RESULTS: A total of 2097 individuals aged 42-92 years (M = 64 ±â€¯11, 56 % women) were included. After controlling for sociodemographic factors, health and functional status, and prior levels of cognitive function, engaging in MBP was independently associated with a smaller decline in episodic memory (b = 0.11, p = .03), but not executive function (b=0.03, p = .34). DISCUSSION: The findings provide the first large population-based evidence supporting the cognitive benefits of MBP over a 10-year period among middle-aged and older adults. Future research should examine whether MBP are effective non-pharmacological intervention to attenuate age-related cognitive decline.

Moody and thin-skinned? The interplay of neuroticism and momentary affect in older romantic couples.

Neuroticism is associated with heightened reactivity to social stressors. However, little is known about the micro-processes through which neuroticism shapes - and is shaped by - affective experiences in close relationships. We examine the extent to which momentary affect is coupled with one's relationship partner, whether the strength of this coupling differs depending on levels of neuroticism, and whether this coupling and partner's overall level of positive or negative affect prospectively contribute to differential (rank-order) changes in neuroticism. Older couples (N = 82, aged 67-93 years) rated their momentary affect six times per day for one week and provided ratings of trait neuroticism at baseline and 18 months later. Multilevel models revealed that among individuals high in neuroticism, individual positive affect was more closely coupled with partner positive affect compared with individuals low in neuroticism. Moreover, neuroticism decreased over time in those participants who showed a higher degree of coupling with partner positive affect and also had a partner with higher overall positive affect. In contrast, neuroticism increased in individuals whose partner had lower overall positive affect. Similar effects were not observed for negative affect. Our findings highlight how relationship partners contribute to daily affective experiences and longer-term changes in neuroticism.

Alzheimer's Association Project VITAL: A Florida Statewide Initiative Using Technology to Impact Social Isolation and Well-Being.

Lack of social engagement and the resulting social isolation can have negative impacts on health and well-being, especially in senior care communities and for those living with dementia. Project VITAL leverages technology and community resources to create a network for connection, engagement, education, and support of individuals with dementia and their caregivers, and explores the impact of these interventions in reducing feelings of social isolation and increasing mood among residents during the COVID-19 pandemic. Through two phases, 600 personalized Wi-Fi-enabled iN2L tablets were distributed to 300 senior care communities (55% assisted living communities, 37% skilled nursing communities, 6% memory care communities, and 2% adult family-care homes) to connect and engage residents and their families. Different phases also included Project ECHO, a video-based learning platform, Alzheimer's Association virtual and online education and support for family caregivers, evidence-based online professional dementia care staff training and certification, and Virtual Forums designed to explore ways to build sustainable, scalable models to ensure access to support and decrease social isolation in the future. Tablet usage was collected over an 11-month period and an interim survey was designed to assess the effectiveness of the tablets, in preventing social isolation and increasing mood among residents during the COVID-19 pandemic. A total of 105 care community staff (whose community used the tablets) completed the survey and overall, these staff showed a high level of agreement to statements indicating that residents struggled with loneliness and mood, and that the tablet was useful in improving loneliness and mood in residents and allowing them to stay in touch with family and friends. Additional positive results were seen through a variety of other responses around the tablets and Project ECHO. Overall, the tablets were shown to be an effective way to engage residents and connect them with friends and family, as well as being a useful tool for staff members. A third phase is currently underway in the homes of people with dementia and their family caregivers, which includes tablets and direct access to Alzheimer's Association virtual and online education and support programs.

Mind-body practices in U.S. adults: Prevalence and correlates.

OBJECTIVES: Mind-body practices (MBP), such as Yoga or Tai-Chi, have increased in popularity in the past 25 years in the US. These activities may help promote a less sedentary lifestyle and may have positive effects on health. The objective of the present study is to understand the prevalence and trends of MBP in US adults and the factors associated with their use in a population-based adult lifespan sample. METHODS: We used data from three waves of the Midlife in the United States (MIDUS) survey (1995, 2005, and 2015), a population-based longitudinal study of community-dwelling adults. Only data from participants with valid observations across three waves (N = 2262) aged 24-74 years at baseline (M = 46; SD = 11) were used. We examined the prevalence of MBP, longitudinal patterns, and correlates of MBP use over 20 years. RESULTS: Rates of MBP use were relatively stable over time in this sample, with 20%, 17%, and 18% of participants using MBP at wave 1, 2, and 3, respectively. A number of sociodemographic and health variables were independently related to frequency of MBP use over 20 years: Women, participants with higher levels of education, never married participants, and participants who suffered from multiple chronic health conditions were more likely to use MBP. DISCUSSION: Our findings suggest that MBP may provide an opportunity for physical activity for individuals suffering from chronic health conditions. More research is needed to understand whether this, in turn, results in better health outcomes for these individuals.