Alcohol Consumption in Later Life and Mortality in the United States: Results from 9 Waves of the Health and Retirement Study.

BACKGROUND: Alcohol consumption in later life has increased in the past decade, and the relationship between alcohol consumption and mortality is controversial. Recent studies suggest little, if any, health benefit to alcohol. Yet most rely on single-time point consumption assessments and minimal confounder adjustments. METHODS: We report on 16 years of follow-up from the Health and Retirement Study (HRS) cohorts born 1931 to 1941 (N = 7,904, baseline mean age = 61, SD = 3.18). Respondents were queried about drinking frequency/quantity. Mortality was established via exit interviews and confirmed with the national death index. Time-varying confounders included but were not limited to household assets, smoking, body mass index, health/functioning, depression, chronic disease; time-invariant confounders included baseline age, education, sex, and race. RESULTS: After adjustment, current abstainers had the highest risk of subsequent mortality, consistent with sick quitters, and moderate (men: HR = 0.74, 95% CI: 0.60 to 0.91; women: HR = 0.82, 95% CI: 0.63 to 1.07) drinking was associated with a lower mortality rate compared with occasional drinking, though smokers and men evidenced less of an inverse association. Quantitative bias analyses indicated that omitted confounders would need to be associated with ~4-fold increases in mortality rates for men and ~9-fold increases for women to change the results. CONCLUSIONS: There are consistent associations between moderate/occasional drinking and lower mortality, though residual confounding remains a threat to validity. Continued efforts to conduct large-scale observational studies of alcohol consumption and mortality are needed to characterize the changing patterns of consumption in older age.

How to Measure Population Aging? The Answer Is Less than Obvious: A Review.

Usually, population aging is measured to inform fiscal and social planning because it is considered to indicate the burden that an elderly population presents to the economic, social security, and health systems of a society. Measures of population aging are expected to indicate shifts in the distribution of individuals' attributes (e.g., chronological age, health) within a population that are relevant to assessing the burden. We claim that chronological age - even though it is the attribute most broadly used - may frequently not be the best measure to satisfy this purpose. A distribution of chronological age per se does not present a burden. Rather, burdens arise from the characteristics that supposedly or actually accompany chronological ages. We posit that in addition to chronological age, meaningful measures of population aging should reflect, for instance, the distribution of economic productivity, health, functional capacities, or biological age, as these attributes may more directly assess the burden on the socioeconomic and health systems. Here, we illustrate some limitations of measures of population aging based on each kind of measure, including chronological age, and review alternative measures that may better inform fiscal, social, and health planning.

As You Sow, So Shall You Reap: Gender-Role Attitudes and Late-Life Cognition.

Some studies have found that women outperform men in episodic memory after midlife. But is this finding universal, and what are the reasons? Gender differences in cognition are the result of biopsychosocial interactions throughout the life course. Social-cognitive theory of gender development posits that gender roles may play an important mediating role in these interactions. We analyzed country differences in the gender differential in cognition after midlife using data from individuals age 50 and above ( N = 226,661) from 27 countries. As expected, older women performed relatively better in countries characterized by more equal gender-role attitudes. This result was robust to cohort differences as well as reverse causality. The effect was partially mediated by education and labor-force participation. Cognition in later life thus cannot be fully understood without reference to the opportunity structures that sociocultural environments do (or do not) provide. Global population aging raises the importance of understanding that gender roles affect old-age cognition and productivity.

Wisdom and Psychosocial Functioning in Later Life.

We investigated the connection between wisdom-related performance, personality, and generativity to further the understanding of how they are interrelated. Our sample consisted of 163 men and women 68-77 years of age, mostly White, and predominantly middle class. Wisdom was assessed with the performance-based Berlin Wisdom Paradigm, with the remaining measures being mostly self-report. As hypothesized, on the zero-order level, wisdom-related performance (WRP) was positively associated with (a) growth, a personality component indexed by Openness to Experience, psychological mindedness, and a sense of well-being derived from growth, purpose in life, and autonomy; (b) adjustment, a personality component associated with life satisfaction, high levels of Agreeableness and Conscientiousness, low Neuroticism, a sense of well-being derived from positive relations with others, self-acceptance, and environmental mastery; and (c) a generative concern for the welfare of others. Latent path analysis indicated that the bivariate associations between adjustment and wisdom and between generativity and wisdom were mediated by growth. Wise individuals are characterized by their ability to balance different personal strengths and interests, an integration that occurs, however, within the context of a dominant personality style marked by the pursuit of maturity through personal growth.

The value of "negative" appraisals for resilience. Is positive (re)appraisal always good and negative always bad?

In contrast to the PASTOR model by Kalisch et al. we point to the potential negative long-term effects of positive (re)appraisals of events for resilience. This perspective posits that emotional reactions to events provide important guidelines as to which events, environments, or social relations should be sought out and which ones should be avoided in the future.

Optimization of women's health before conception when pregnancy has been postponed.

OBJECTIVES: In the industrialized world, the mean age at which mothers give birth to their first child has increased. The purpose of this article was to review the available evidence in order to optimize preconception care in women who have postponed childbearing to the later years of the reproductive life cycle. METHODS: Review of literature. RESULTS: There is a paucity of evidence and rigorous studies to advise mothers on the potential interventions for optimizing pregnancy outcome. CONCLUSIONS: Evidence-based guidelines for advising women who postponed childbearing are scant, and further research in this important area is urgently needed.

Psychological wisdom research: commonalities and differences in a growing field.

Wisdom represents a fruitful topic for psychological investigations for at least two reasons. First, the study of wisdom emphasizes the search for the continued optimization and the further cultural evolution of the human condition. Second, it exemplifies the collaboration of cognitive, emotional, and motivational processes. The growth and scope of psychological wisdom research over the past few decades demonstrate that it is possible to investigate this complex construct with empirical rigor. Since the 1970s, five main areas have been established: lay definitions of wisdom, conceptualizing and measuring wisdom, understanding the development of wisdom, investigating the plasticity of wisdom, and applying psychological knowledge about wisdom in life contexts.

A New Path to Address Multimorbidity? Longitudinal Analyses of Retirement Sequences and Chronic Diseases in Old Age.

Chronic disease and multimorbidity are growing health challenges for aging populations, often coinciding with retirement. We examine late-life predictors of multimorbidity, focusing on the association between retirement sequences and number of chronic diseases. We modeled the number of chronic diseases as a function of six types of previously identified 10-year retirement sequences using Health and Retirement Study (HRS) data for 7,880 Americans observed between ages 60 to 61 and 70 to 71. Our results show that at baseline, the adjusted prevalence of multimorbidity was lowest in sequences characterized by late retirement from full-time work and highest in sequences characterized by early labor-force disengagement. Age increases in multimorbidity varied across retirement sequences, though overall differences in prevalence persisted at age 70 to 71. Earlier life disadvantages did not moderate these associations. Findings suggest further investigation of policies that target health limitations affecting work, promote continued beneficial employment opportunities, and ultimately leverage retirement sequences as a novel path to influence multimorbidity in old age.

Modifiable Resources and Resilience in Racially and Ethnically Diverse Older Women: Implications for Health Outcomes and Interventions.

Introduction: Resilience-which we define as the "ability to bounce back from stress"-can foster successful aging among older, racially and ethnically diverse women. This study investigated the association between psychological resilience in the Women's Health Initiative Extension Study (WHI-ES) and three constructs defined by Staudinger's 2015 model of resilience and aging: (1) perceived stress, (2) non-psychological resources, and (3) psychological resources. We further examined whether the relationship between resilience and key resources differed by race/ethnicity. Methods: We conducted a secondary analysis on 77,395 women aged 62+ (4475 Black or African American; 69,448 non-Hispanic White; 1891 Hispanic/Latina; and 1581 Asian or Pacific Islanders) who enrolled in the WHI-ES, which was conducted in the United States. Participants completed a short version of the Brief Resilience Scale one-time in 2011. Guided by Staudinger's model, we used linear regression analysis to examine the relationships between resilience and resources, adjusting for age, race/ethnicity, and stressful life events. To identify the most significant associations, we applied elastic net regularization to our linear regression models. Findings: On average, women who reported higher resilience were younger, had fewer stressful life events, and reported access to more resources. Black or African American women reported the highest resilience, followed by Hispanic/Latina, non-Hispanic White, and Asian or Pacific Islander women. The most important resilience-related resources were psychological, including control of beliefs, energy, personal growth, mild-to-no forgetfulness, and experiencing a sense of purpose. Race/ethnicity significantly modified the relationship between resilience and energy (overall interaction p = 0.0017). Conclusion: Increasing resilience among older women may require culturally informed stress reduction techniques and resource-building strategies, including empowerment to control the important things in life and exercises to boost energy levels.

Income inequality and its relationship with loneliness prevalence: A cross-sectional study among older adults in the US and 16 European countries.

BACKGROUNDS: The prevalence of loneliness increases among older adults, varies across countries, and is related to within-country socioeconomic, psychosocial, and health factors. The 2000-2019 pooled prevalence of loneliness among adults 60 years and older went from 5.2% in Northern Europe to 24% in Eastern Europe, while in the US was 56% in 2012. The relationship between country-level factors and loneliness, however, has been underexplored. Because income inequality shapes material conditions and relative social deprivation and has been related to loneliness in 11 European countries, we expected a relationship between income inequality and loneliness in the US and 16 European countries. METHODS: We used secondary cross-sectional data for 75,891 adults age 50+ from HRS (US 2014), ELSA (England, 2014), and SHARE (15 European countries, 2013). Loneliness was measured using the R-UCLA three-item scale. We employed hierarchical logistic regressions to analyse whether income inequality (GINI coefficient) was associated with loneliness prevalence. RESULTS: The prevalence of loneliness was 25.32% in the US (HRS), 17.55% in England (ELSA) and ranged from 5.12% to 20.15% in European countries (SHARE). Older adults living in countries with higher income inequality were more likely to report loneliness, even after adjusting for the sociodemographic composition of the countries and their Gross Domestic Products per capita (OR: 1.52; 95% CI: 1.17-1.97). DISCUSSION: Greater country-level income inequality was associated with higher prevalence of loneliness over and above individual-level sociodemographics. The present study is the first attempt to explore income inequality as a predictor of loneliness prevalence among older adults in the US and 16 European countries. Addressing income distribution and the underlying experience of relative deprivation might be an opportunity to improve older adults' life expectancy and wellbeing by reducing loneliness prevalence.

Sociohistorical Change in Urban Older Adults' Perceived Speed of Time and Time Pressure.

OBJECTIVES: Perceptions of time are shaped by sociohistorical factors. Specifically, economic growth and modernization often engender a sense of acceleration. Research has primarily focused on one time perception dimension (perceived time pressure) in one subpopulation (working-age adults), but it is not clear whether historical changes extend to other dimensions (e.g., perceived speed of time) and other subpopulations, such as older adults who are no longer in the workforce and experience age-related shifts in time perception. We therefore examined sociohistorical and age-related trends in two dimensions of time perception in two cohorts of urban older adults. METHOD: Using propensity score matching for age and education, samples were drawn from the Berlin Aging Study (1990-1993, n = 256, Mage = 77.49) and the Berlin Aging Study-II (2009-2014, n = 248, Mage = 77.49). Cohort differences in means, variances, covariance, and correlates of perceived speed of time and time pressure were examined using multigroup SEM. RESULTS: There were no cohort differences in the perceived speed of time, but later-born cohorts reported more time pressure than earlier-born cohorts. There were no significant age differences, but perceptions of speed of time were more heterogeneous in the 1990s than in the 2010s. Cohorts did not differ in how time perceptions were associated with sociodemographic, health, cognitive, and psychosocial correlates. DISCUSSION: These findings document sociohistorical trends toward greater perceived time pressure and reduced heterogeneity in perceived speed of time among later-born urban adults. Conceptualizations of social acceleration should thus consider the whole adult life span.

Healthy retirement begins at school: educational differences in the health outcomes of early transitions into retirement.

The literature on socio-economic variations in the association between retirement timing and health is inconclusive and largely limited to the moderating role of occupation. By selecting the sample case of Mexico where a sizeable number of older adults have no or very little formal education, this study allows the moderating role of education to be tested properly. Drawing on panel data for 2,430 individuals age 50 and over from the Mexican Health and Aging Study (MHAS) and combining propensity score matching models with fixed-effects regressions, this article investigates differences in the health effects of retirement timing between older adults with varying years of education. Subjective health is measured using a self-reported assessment of respondents' overall health and physical health as a reverse count of doctor-diagnosed chronic diseases. The results indicate that early transitions into retirement are associated with worse health outcomes, but education fully compensates for the detrimental association with subjective and physical health, while adjusting for baseline health, demographics and socio-economic characteristics. In conclusion, formal education during childhood and adolescence is associated with a long-term protective effect on health. It attenuates negative health consequences of early retirement transitions. Policies and programmes promoting healthy and active ageing would benefit from considering the influence of formal education in shaping older adults' health after the transition into retirement.

Acute Effects of a Perturbation-Based Balance Training on Cognitive Performance in Healthy Older Adults: A Pilot Study.

Aging is accompanied by an alteration in the capacity to ambulate, react to external balance perturbations, and resolve cognitive tasks. Perturbation-based balance training has been used to induce adaptations of gait stability and reduce fall risk. The compensatory reactions generated in response to external perturbations depend on the activation of specific neural structures. This suggests that training balance recovery reactions should show acute cognitive training effects. This study aims to investigate whether exposure to repeated balance perturbations while walking can produce acute aftereffects that improve proactive and reactive strategies to control gait stability and cognitive performance in healthy older adults. It is expected that an adaptation of the recovery reactions would be associated with increased selective attention and information processing speed. Twenty-eight healthy older adults were assigned to either an Experimental (EG) or a Control Group (CG). The protocol was divided in 2 days. During the first visit, all participants completed the Symbol Digit Modalities Test (SDMT) and the Trail Making Test (TMT). During the second visit, a cable-driven robot was used to apply waist-pull perturbations while walking on a treadmill. The EG was trained with multidirectional perturbations of increasing intensity. The CG walked for a comparable amount of time with cables on, but without experiencing perturbations. Before and after the training, all participants were exposed to diagonal waist-pull perturbations. Changes in gait stability were evaluated by comparing the distance between the heel of the leading leg and the extrapolated Center of Mass (Heel-XCoM Distance-HXD) at perturbation onset (PON) and first compensatory heel strike (CHS). Finally, the cables were removed, and participants completed the SDMT and the TMT again. Results showed that only the EG adapted the gait stability (p < 0.001) in reaction to diagonal perturbations and showed improved performance in the SDMT (p < 0.001). This study provides the first evidence that a single session of perturbation-based balance training produce acute aftereffects in terms of increased cognitive performance and gait stability in healthy older adults. Future studies will include measures of functional activation of the cerebral cortex and examine whether a multi-session training will demonstrate chronic effects.

Cross-country differences in age trends in alcohol consumption among older adults: a cross-sectional study of individuals aged 50 years and older in 22 countries.

BACKGROUND AND AIMS: Age-related changes in physiological, metabolic and medication profiles make alcohol consumption likely to be more harmful among older than younger adults. This study aimed to estimate cross-national variation in the quantity and patterns of drinking throughout older age, and to investigate country-level variables explaining cross-national variation in consumption for individuals aged 50 years and older. DESIGN: Cross-sectional observational study using previously harmonized survey data. SETTING: Twenty-two countries surveyed in 2010 or the closest available year. PARTICIPANTS: A total of 106 180 adults aged 50 years and over. MEASUREMENTS: Cross-national variation in age trends were estimated for two outcomes: weekly number of standard drink units (SDUs) and patterns of alcohol consumption (never, ever, occasional, moderate and heavy drinking). Human Development Index and average prices of vodka were used as country-level variables moderating age-related declines in drinking. FINDINGS: Alcohol consumption was negatively associated with age (risk ratio = 0.98; 95% confidence interval = 0.97, 0.99; P-value < 0.001), but there was substantial cross-country variation in the age-related differences in alcohol consumption [likelihood ratio (LR) test P-value < 0.001], even after adjusting for the composition of populations. Countries' development level and alcohol prices explained 31% of cross-country variability in SDUs (LR test P-value < 0.001) but did not explain cross-country variability in the prevalence of heavy drinkers. CONCLUSIONS: Use and harmful use of alcohol among older adults appears to vary widely across age and countries. This variation can be partly explained both by the country-specific composition of populations and country-level contextual factors such as development level and alcohol prices.

Physical and motor fitness are both related to cognition in old age.

The benefits of fitness for cognitive performance in healthy older adults have repeatedly been demonstrated. Animal studies, however, have revealed differential relationships between physical and motor fitness and brain metabolism. We therefore investigated whether for older humans different dimensions of fitness are differentially associated with cognitive performance and brain activation patterns. Seventy-two participants (mean age 68.99 years, SD = 3.66; 52 females) completed four psychometric tests reflecting two primary abilities of higher cognitive functioning (executive control, perceptual speed) and a battery of fitness tests comprising two fitness dimensions (physical and motor fitness). We found that not only physical fitness indexed by cardiovascular fitness and muscular strength, but also motor fitness including movement speed, balance, motor coordination and flexibility showed a strong association with cognitive functioning. Additionally, functional brain imaging data revealed that physical and motor fitness were differentially related to cognitive processes. Results are discussed with regard to the compensation hypothesis and potential consequences for intervention work.

The positive plasticity of adult development: Potential for the 21st century.

We are living longer than ever before in human history. But longer lives are at the same time a gift and a challenge for individuals and society alike. Longer lives highlight an extraordinary feature of the human species and, that is, the capacity to intentionally or unintentionally positively modify their own development and aging. This positive plasticity of human development and aging is based on the fact that human aging is neither biologically nor contextually determined. Instead, development and aging are the result of perpetual interactions between biological, sociocultural forces and a given person's behaviors. Rethinking adult development implies that research needs to intensify its efforts to investigate and uncover the conditions and mechanisms facilitating the positive plasticity of adult development and aging. We need to accumulate scientific knowledge about which trajectories of constellations of sociocultural and physical context characteristics, a person's behavioral patterns and genetic endowment are apt to optimize aging. Research examples from cognitive and personality functioning are presented to illustrate the positive plasticity of adult development as well as its limits. Cohort- and country-comparative long-term longitudinal data including physiological as well as behavioral measures besides sociodemographic information and information pertaining to the physical environment are needed to gain a deeper understanding of how to leverage the positive plasticity of human aging. Such evidence is then in a position to provide specific and therefore effective evidence to inform social policy as well as life(style) choices. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Novel information processing at work across time is associated with cognitive change in later life: A 14-year longitudinal study.

This study examined whether the degree of novel information processing at work (NPW) attenuates cognitive aging across 14 years for adults 50+ in the United States and how NPW links with job complexity. To answer these questions, we used data (N = 4,252) from the Health and Retirement Study. Detailed information on occupational characteristics from O*Net between 2000 and 2014 was used to assess NPW and matched with participants' occupational codes across time. Multilevel transition models were employed to estimate the relationship between NPW and cognitive functioning across time and to explore the moderating effect of cognitive level. Our results showed that exposure to more NPW across time attenuates cognitive decline as indicated by immediate word recall and serial 7s performance, while adjusting for baseline age, leisure, volunteering activities, cognition at previous wave, and other covariates. This buffering effect of NPW is reduced but sustained when controlling for change in job complexity, indicating that, as expected, NPW and job complexity are linked. We also found that particularly for workers with lower levels of cognitive performance, exposure to NPW across 14 years was linked with less decline in serial 7s performance (controlling for job complexity). This, however, was not the case for immediate word recall performance, which asks for further study. Overall, our findings suggest that mental stimulation through NPW is one mechanism (in the work context) that buffers cognitive decline. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Neural processing of arousing emotional information is associated with executive functioning in older adults.

Evidence suggests that reduced bottom-up processing due to aging-related brain deterioration needs to be considered when trying to understand how cognitive resources and processing arousing emotional information are associated in old age. Moreover, cognitive resources have been shown to decrease in older adults while high interindividual variability in cognitive functioning at higher ages is one of the hallmarks of cognitive aging research. It has been suggested that individual variations of biological aging trajectories contribute to described large interindividual differences in old age. Using fMRI, we investigated the relationship between executive functioning and bottom-up processing of arousing emotional information in 77 older participants (57 female) between 62 and 79 years (M = 68.7 years., SD = 3.7 years.). As expected, in older adults with low levels of executive functioning, for both negative and positive emotional stimuli we found reduced arousal-modulated BOLD signals in different brain areas, including bilateral premotor area (BA 6), dorsolateral prefrontal cortex, inferior parietal lobule, and left putamen, as well as reduced functional connectivity of amygdala and visual cortex with various other brain regions. Our results further indicate, that processing of negative and positive valence items might be affected in different ways. We conclude that attenuated bottom-up processing of arousing information in older adults with low levels of executive functioning might be the result of impaired pathways rather than of an impaired specific structure like the amygdala. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Resilience and CVD-protective Health Behaviors in Older Women: Examining Racial and Ethnic Differences in a Cross-Sectional Analysis of the Women's Health Initiative.

Little is known about the relationship between self-reported psychological resilience (resilience) and health behaviors shown to reduce the risk of cardiovascular disease (CVD). This study examines the associations between resilience and CVD-related risk factors, such as diet, smoking, physical activity, sleep, and alcohol consumption among older American women from diverse backgrounds. METHODS: A cross-sectional secondary analysis was conducted on 77,395 women (mean age 77 years, Black (N = 4475, 5.8%), non-Hispanic white (N = 69,448, 89.7%), Latina (N = 1891, 2.4%), and Asian or Pacific Islander (N = 1581, 2.0%)) enrolled in the Women's Health Initiative Extension Study II. Resilience was measured using an abbreviated version of the brief resilience scale. Multivariable logistic regression models were used to evaluate the association between resilience and health behaviors associated with risk for CVD, while adjusting for stressful life events and sociodemographic information. To test whether these associations varied among racial/ethnic groups, an interaction term was added to the fully adjusted models between resilience and race/ethnicity. RESULTS: High levels of resilience were associated with better diet quality (top 2 quintiles of the Healthy Eating Index 2015) (OR = 1.22 (95% Confidence Interval (1.15-1.30)), adhering to recommended physical activity (≥ 150 min per week) (1.56 (1.47, 1.66)), sleeping the recommended hours per night (7-9) (1.36 (1.28-1.44)), and moderate alcohol intake (consuming alcoholic drink(s) 1-7 days per week) (1.28 (1.20-1.37)). The observed association between resilience and sleep is modified by race/ethnicity (p = 0.03). CONCLUSION: Irrespective of race/ethnicity, high resilience was associated with CVD-protective health behaviors. This warrants further investigation into whether interventions aimed at improving resilience could increase the effectiveness of lifestyle interventions.

Cross-country and historical variation in alcohol consumption among older men and women: Leveraging recently harmonized survey data in 21 countries.

BACKGROUND: Alcohol consumption causes greater harm in older than younger adults. As the population ages, understanding cross-country and time-varying drinking patterns of older adults is of critical importance. Available evidence relies primarily on ecological data. METHODS: We harmonized survey data for 179,881 adults age 50+ observed repeatedly between 1998 and 2016 in 21 countries. Next, we estimated historical variation in consumption across countries (overall and stratified by gender and age group 50-64/65+). RESULTS: On average, 51.95 % of older adults consumed any alcohol over the observed period. For 13 countries, the proportion of older adults who drink increased (mean annual increase: 0.76 percent points). Heavy drinking (men drinks/day>3 or binge>5, women drinks/day>2 or binge>4) peaked at 23.54 % for England in 2010 and lifetime abstainers at 69.65 % for China in 2011. Across countries and among drinkers, consumption frequency was 2.57 days/week, the number of standard drink units when drinking was 2.57, and the average number of drinks/day over a week was 1.12. Consumption patterns varied substantially across countries and historical time. Overall probability and frequency of consumption were higher in men than women, with the largest gaps observed in 2011 for China, but gender gaps decreased (even reversed) in the young old and varied across country and time. CONCLUSIONS: Wide variation in older adults' alcohol consumption across countries and time suggests that broad scale prevention and intervention efforts can be harnessed for potential population-level health benefits. Further variation by gender and age reflect physiological and social factors simultaneously shaping alcohol consumption.