Evaluating the Cumulative Impact of Childhood Misfortune: A Structural Equation Modeling Approach.

Most studies of the early origins of adult health rely on summing dichotomously measured negative exposures to measure childhood misfortune (CM), neglect, adversity, or trauma. There are several limitations to this approach, including that it assumes each exposure carries the same level of risk for a particular outcome. Further, it often leads researchers to dichotomize continuous measures for the sake of creating an additive variable from similar indicators. We propose an alternative approach within the structural equation modeling (SEM) framework that allows differential weighting of the negative exposures and can incorporate dichotomous and continuous observed variables as well as latent variables. Using the Health and Retirement Study data, our analyses compare the traditional approach (i.e., adding indicators) with alternative models and assess their prognostic validity on adult depressive symptoms. Results reveal that parameter estimates using the conventional model likely underestimate the effects of CM on adult health outcomes. Additionally, while the conventional approach inhibits testing for mediation, our model enables testing mediation of both individual CM variables and the cumulative variable. Further, we test whether cumulative CM is moderated by the accumulation of protective factors, which facilitates theoretical advances in life course and social inequality research. The approach presented here is one way to examine the cumulative effects of early exposures while attending to diversity in the types of exposures experienced. Using the SEM framework, this versatile approach could be used to model the accumulation of risk or reward in many other areas of sociology and the social sciences beyond health.

Digital technology use and depressive symptoms among older adults in Korea: beneficial for those who have fewer social interactions?

OBJECTIVES: Our study examines the relationship between digital technology use and depressive symptoms among older Koreans and whether social interaction moderates the relationship. METHODS: The data were drawn from the 2017 Survey of Living Conditions and Welfare Needs of Korean Older Persons, a nationally representative survey. Digital technology use was measured by the number of digital functions that respondents perform with their electronic devices. Social interactions were measured by the frequencies of face-to-face and remote connections with friends or neighbors. Relationships were estimated with multiple regression analyses. RESULTS: Digital technology use was inversely associated with depressive symptoms even after adjusting for covariates including cognitive function. Both remote and face-to-face connections with friends or neighbors were associated with fewer depressive symptoms. An interaction between digital technology use and remote contact also was detected: the effect of digital technology use on depressive symptoms was more beneficial for older adults with infrequent remote contact with friends or neighbors than for those with frequent remote contact. CONCLUSION: Findings suggest that digital technology use can reduce depressive symptoms of older adults, especially those who have fewer social interactions. Educating older adults to increase their digital literacy level and use of remote interactions may improve their psychological wellbeing, perhaps even during times of a viral pandemic.

A pedagogical strategy addressing an unmet need: Making the biology of aging an accessible part of interdisciplinary gerontology education.

In an age of specialization, obstacles to interdisciplinary training and integrated intellectual growth are expected. One such obstacle to graduate-level training in gerontology is the challenge of making the biology of aging accessible to nonbiologists. In this article, the authors' aim is to share 15 years of experience developing a pedagogical strategy that situates the biology of aging as an accessible part of interdisciplinary gerontology education for nonbiologists and biologists alike. The approach hinges on a four-pronged learning opportunity-four course offerings-that places high priority on exactitude with language and sees development of an attitude of precision with language as essential to intellectual growth. By inspiring students to master language in the key of B-Biology of Aging-we unleash a versatile method for developing cross-disciplinary discoverers prepared for a lifetime of seeing and reporting.

Childhood Disadvantage and Health Problems in Middle and Later Life: Early Imprints on Physical Health?

Drawing from cumulative inequality theory, we examine the relationship between childhood disadvantage and health problems in adulthood. Using two waves of data from Midlife Development in the United States, we investigate whether childhood disadvantage is associated with adult disadvantage, including fewer social resources, and the effect of lifelong disadvantage on health problems measured at the baseline survey and a 10-year follow-up. Findings reveal that childhood socioeconomic disadvantage and frequent abuse by parents are generally associated with fewer adult social resources and more lifestyle risks. Health problems, in turn, are affected by childhood disadvantage and by lifestyle risks, especially smoking and obesity. Not only was early disadvantage related to health problems at the baseline survey, but childhood socioeconomic disadvantage and frequent abuse also were related to the development of new health problems at the follow-up survey. These findings reveal the imprint of early disadvantage on health decades later and suggest greater attention to resources, even during midlife, can interrupt the chain of risks.

Genetic and Environmental Overlap Between Childhood Maltreatment and Adult Physical Health.

Past research demonstrates a phenotypic relationship between childhood maltreatment and adult health problems. Explanations of this association usually point to either: (a) a direct causal link, whereby exposure to early stress disrupts biological functioning during sensitive periods of development; or (b) an indirect effect operating through socioeconomic attainment, poor health behaviors, or some other pathway leading from childhood to adulthood. The current study examined whether the association between childhood maltreatment and adult health reflects genetic or environmental mediation. Using a large sample of adult American twins, we separately estimated univariate biometric models of child maltreatment and adult physical health, followed by a bivariate biometric model to estimate genetic and environmental correlations between the two variables. We found that a summary count of chronic health conditions shared non-trivial genetic overlap with childhood maltreatment. Our results have implications for understanding the relationship between maltreatment and health as one of active interplay rather than a simple cause and effect model that views maltreatment as an exogenous shock.

Social network properties and self-rated health in later life: comparisons from the Korean social life, health, and aging project and the national social life, health and aging project.

BACKGROUND: This paper has two objectives. Firstly, it provides an overview of the social network module, data collection procedures, and measurement of ego-centric and complete-network properties in the Korean Social Life, Health, and Aging Project (KSHAP). Secondly, it directly compares the KSHAP structure and results to the ego-centric network structure and results of the National Social Life, Health, and Aging Project (NSHAP), which conducted in-home interviews with 3,005 persons 57 to 85 years of age in the United States. METHODS: The structure of the complete social network of 814 KSHAP respondents living in Township K was measured and examined at two levels of networks. Ego-centric network properties include network size, composition, volume of contact with network members, density, and bridging potential. Complete-network properties are degree centrality, closeness centrality, betweenness centrality, and brokerage role. RESULTS: We found that KSHAP respondents with a smaller number of social network members were more likely to be older and tended to have poorer self-rated health. Compared to the NSHAP, the KSHAP respondents maintained a smaller network size with a greater network density among their members and lower bridging potential. Further analysis of the complete network properties of KSHAP respondents revealed that more brokerage roles inside the same neighborhood (Ri) were significantly associated with better self-rated health. Socially isolated respondents identified by network components had the worst self-rated health. CONCLUSIONS: The findings demonstrate the importance of social network analysis for the study of older adults' health status in Korea. The study also highlights the importance of complete-network data and its ability to reveal mechanisms beyond ego-centric network data.

Early Origins of Frailty: Do Later-Life Social Relationships Alter Trajectories of Decline?

Objectives: Social relationships are widely regarded as salubrious, but do they mediate the influence of childhood experiences on frailty in later life? Drawing from cumulative inequality theory, we assess the influence of childhood experiences and adult relationships on frailty trajectories. Methods: We analyzed data from the Health and Retirement Study to examine the influence of six domains of childhood experiences and social relationships on frailty trajectories over 8 years. Mediation analyses were completed with structural equation models. Results: Risky adolescent behavior, chronic disease, and impairments during childhood are associated directly with higher risk of initial frailty, but not over time. More social roles and higher social support mediate the relationship between childhood experiences and frailty, and the effect of more social roles continues over time. Discussion: This study provides compelling evidence that supportive social relationships mediate the risk and severity of frailty in later life associated with noxious childhood experiences.

Disparities in Stress Exposure and Later-Life Disability.

Background and Objectives: Drawing from cumulative inequality theory and the weathering hypothesis, this study examined the relationship between life-course stress exposure (measured cumulatively and by domains) and the onset of disability in later life among White, Black, U.S.-born Hispanic, and foreign-born Hispanic older adults. Research Design and Methods: Cross-sectional and longitudinal models were estimated using nationally representative data from the Health and Retirement Study (N = 11,483). We used logistic regression models to examine associations between stress exposure and Wave 1 disability (i.e., occurrence), and Weibull-accelerated failure-time models to examine the relationship between stress exposure and age of onset of disability 12-14 years later (i.e., incidence). We tested for moderation between stress and disability by race, ethnicity, and Hispanic nativity. Results: At Wave 1, higher odds of disability occurrence were associated with cumulative stress burden (CSB; odds ratio [OR] = 4.93, 95% confidence interval [CI]: 2.95-8.23). In a model specifying domains of stressors, disability occurrence was associated with childhood financial strain (OR = 1.22, CI: 1.01-1.46), lifetime traumatic events (OR = 1.92, CI: 1.41-2.62), neighborhood disadvantage (OR = 1.32, CI: 1.01-1.73), and major lifetime discrimination (OR = 1.64, CI: 1.12-2.41). Over time, earlier onset of disability was associated with CSB (ß = -0.39), childhood traumatic events (ß = -0.16), adult financial strain (ß = -0.17), everyday discrimination (ß = -0.15), and major lifetime discrimination (ß = -0.13). The effect of childhood traumatic events on the transition to disability was stronger for U.S.-born Hispanic adults than White adults (occurring 33% earlier). Discussion and Implications: To reduce racial, ethnic, and nativity disparities in disability, it is important to consider the historical and structural disadvantages associated with stress exposure across the life course. It is also important to acknowledge that nativity influences stratification processes associated with disparities in racial and ethnic health trajectories.

Educational Inequalities in Dual-Function Life Expectancy.

OBJECTIVES: This study investigates educational inequalities in dual functionality, a new concept that captures a combination of physical and cognitive functioning, both of which are important for independent living and quality of life. METHODS: Using data from the Health and Retirement Study and the National Health Interview Survey Linked Mortality Files, we define a measure of dual functionality based on the absence of limitations in activities of daily living and dementia. We estimate age-graded dual-function rates among adults 65+ and age-65 dual-function life expectancy across levels of education stratified by gender. RESULTS: In their mid-60s, 67% of women with less than a high school degree manifest dual functionality as compared with over 90% of women with at least a 4-year college degree. A similar pattern holds among men. These education-based gaps in dual functionality remain across later life, even as dual-function rates decline at older ages. Lower dual-function rates among older adults with less education translate into inequalities of 6.7 and 7.3 years in age-65 dual-function life expectancy between men and women, respectively, with at least a 4-year college degree compared to their counterparts with less than a high school degree. DISCUSSION: Older adults, particularly women, with less than a high school degree are estimated to live a smaller percentage of their remaining years with dual functionality compared with older adults with at least a college degree. These inequalities have implications for the distribution of caregiving resources of individuals, family members, and the broader healthcare community.

Is Early-Life Enrichment Associated With Better Cognitive Function Among Older Adults? Examining Home and School Environments.

Objectives: We examine whether early-life enrichment, involving varied and stimulating activities to enhance cognitive function during childhood and adolescence, is associated with cognitive function in later life and whether the benefits persist over time. Methods: Growth curve models were used to examine up to five waves of data from the Health and Retirement Study-a nationally representative survey of adults 50 years and older (N = 10,070). We constructed separate measures of early-life enrichment to distinguish sources of influence (i.e., enriched home environment and enriched school environment). Global cognitive function was assessed with a modified version of the Telephone Interview for Cognitive Status. Results: Greater enrichment in each environment was incrementally associated with better cognitive function at baseline, but enrichment was not associated with change in cognitive function over time. Discussion: Receiving enrichment from multiple environments during sensitive periods of cognitive development may be advantageous for cognitive functioning in later life.

Race, everyday discrimination, and cognitive function in later life.

Discrimination is pernicious in many ways, but there are inconsistent findings regarding whether it is harmful to cognitive function in later life. To address the inconsistency, we use two closely related concepts of everyday discrimination to predict cognitive trajectories in a diverse sample. Using data from the Health and Retirement Study (HRS), we examine whether the frequency of discrimination, measured at baseline with six questions, is related to poorer cognitive function and change in function over time (2008-2016). Age at baseline ranged from 53 to 100. Growth curve models of initial cognitive function and change in function were estimated. Everyday global discrimination was associated with poorer initial cognition and slower declines over time, and these relationships were not moderated by race and ethnicity. By contrast, the relationship between everyday racial discrimination and cognition was moderated by race: more frequent everyday racial discrimination was associated with better initial cognitive function among Black adults but not among Hispanic and White adults. Discrimination is a multifaceted concept, and specific types of discrimination manifest lower or higher cognitive function during later life for White, Black, and Hispanic adults.

Racial-Ethnic Disparities in Dual-Function Life Expectancy.

BACKGROUND: This study develops a new concept, dual functionality, that integrates physical and cognitive function. We use the concept to define a measure of dual-function life expectancy (2FLE) and assess racial-ethnic inequalities in aging. METHODS: Drawing on data from the National Health Interview Survey Linked Mortality Files and the Health and Retirement Study, we define dual functionality as having no limitations in activities of daily living and being free of dementia. We use this measure and Sullivan life tables to estimate age-50 total life expectancy and age-50 2FLE for women and men across 4 racial-ethnic and nativity groups. RESULTS: At ages 50-54, between 79.0% (95% CI: 73.5, 84.5) and 87.6% (95% CI: 84.0, 91.2) of (non-Hispanic) Black, foreign-born Hispanic, and U.S.-born Hispanic women and men remain dual functional as compared with 90.4% (95% CI: 89.3, 91.4) and 91.4% (95% CI: 90.2, 92.5) of (non-Hispanic) White women and men, respectively. These and corresponding racial-ethnic disparities in dual functionality through ages 85 and older translate into substantial inequalities in 2FLE. For instance, the Black-White gap in age-50 2FLE is 6.9 years (95% CI: -7.5, -6.4) for women and 6.0 years (95% CI: -6.6, -5.4) for men. CONCLUSIONS: Black, foreign-born Hispanic, and U.S.-born Hispanic older adults are estimated to live a smaller percentage of their remaining years with dual functionality than White older adults. These results reveal stark racial-ethnic inequalities in aging that have significant implications for quality of life, caregiving, and health needs.

Dual Functionality in Later Life.

Gerontologists have long shown interest in both longevity and quality of life during later life, but considerable debate has ensued as scholars sought to integrate the two. Drawing from research on the topics of exceptional longevity, successful aging, and active life expectancy, we propose the concept of dual functionality to examine how humans reach advanced ages while maintaining physical and cognitive function. Dual functionality refers to being free of both physical and cognitive impairment. The loss of dual functionality challenges social networks to respond to the functional loss and is a harbinger of additional losses. Evidence of change in the percent of the older population maintaining dual functionality would be helpful for evaluating public health policies to aid quality of life during later life. This article is based on the first author's Robert W. Kleemeier Award Lecture at The Gerontological Society of America 2022 Annual Scientific Meeting.

Subjective Memory Decline Predicts Incident Cognitive Impairment Among White-But Not Black or Hispanic-Older Adults.

BACKGROUND AND OBJECTIVES: This study investigates whether subjective memory decline (SMD) in a racially diverse sample of older adults without cognitive impairment at baseline is associated with incident cognitive impairment during a 12-year follow-up period. RESEARCH DESIGN AND METHODS: With panel data from a national sample (N = 9,244) of cognitively intact Black, White, and Hispanic Americans 65 years or older in 2004, we examine if SMD is associated with the loss of normal cognition by 2016. Cognitive status was assessed every 2 years with a modified version of the Telephone Interview for Cognitive Status to identify the transition from normal cognition to cognitive impairment. RESULTS: Estimates from Weibull accelerated failure-time models reveal that SMD is associated with earlier incident cognitive impairment (time ratio = 0.96, p < .05). In subsequent models stratified by race-ethnicity, this association was evident among White respondents (time ratio = 0.95, p < .01) but not among Black, U.S.-born Hispanic, or foreign-born Hispanic respondents. DISCUSSION AND IMPLICATIONS: Given that the prognostic validity of SMD differs by race and ethnicity, caution is warranted when using it as a screening or clinical tool in diverse populations.

Is gerontology ready for accreditation?

The authors review widely accepted criteria for program accreditation and compare gerontology with well-established accredited fields including clinical psychology and social work. At present gerontology lacks many necessary elements for credible professional accreditation, including defined scope of practice, applied curriculum, faculty with applied professional credentials, and resources necessary to support professional credentialing review. Accreditation with weak requirements will be dismissed as "vanity" accreditation, and strict requirements will be impossible for many resource-poor programs to achieve, putting unaccredited programs at increased risk for elimination. Accreditation may be appropriate in the future, but it should be limited to professional or applied gerontology, perhaps for programs conferring bachelor's or master's degrees. Options other than accreditation to enhance professional skills and employability of gerontology graduates are discussed.

Disciplinary Roots of 300 Top-Ranked Scientific Contributors to Gerontology: From Legacy to Enriching Our Discovery.

Gerontology is viewed by many as a multidisciplinary field of inquiry, but which disciplines have had the greatest impact on research in the field? Combining data from a composite score incorporating multiple citation indicators with information on the highest degree, we examine the disciplinary origins of the 300 top-ranked scholars in gerontology. Despite efforts for gerontology to be distinct from geriatrics, more than 30 percent of the most influential scholars in gerontology during the past 6 decades hold a degree in medicine. Other fields of the leading contributors to gerontology include psychology, sociology, biology, biochemistry, and genetics. Although the disciplinary origins of gerontology will likely shift in the coming decades, we conclude that biomedical sciences are likely to remain core to the development of gerontology. To build on the scientific contributions of leading scholars in gerontology, future research should reflect conceptual precision and scientific innovation while prioritizing methodological rigor and transparency.

Life Course Stressors and Functional Limitations in Later Life Among White, Black, and Hispanic Adults: Deleterious, Hardening, or Benign?

OBJECTIVES: Although striking racial and ethnic disparities in health are manifest during later life, they may be rooted in early-life exposures. Drawing from cumulative inequality theory, we investigate whether life course stressors are associated with the risk of later-life functional limitations and whether this relationship differs by race and ethnicity. METHODS: We utilize longitudinal data from the Health and Retirement Study to test whether child and adult stressors predict trajectories of the occurrence and severity of functional limitations among a diverse sample of older adults. RESULTS: Child and adult stressors are associated with greater occurrence and severity of functional limitations during later life. Mediation analyses reveal the indirect influence of child stressors via adult stressors on occurrence and severity of functional limitations; however, the indirect effects are slightly stronger for Black and Hispanic adults than their White counterparts. DISCUSSION: Child stressors, in and of themselves, do not increase functional limitations among Black and Hispanic people but are associated with greater adult stress exposure, predisposing them to more functional limitations. Results suggest that childhood stressors are associated with distinct social pathways to functional limitations among White, Black, and Hispanic older adults.

Volunteer Engagement and Systemic Inflammation: Does Helping Others Benefit Oneself?

BACKGROUND AND OBJECTIVES: Although research on the health benefits of volunteering has proliferated, most studies are cross-sectional and rely on self-reported measures of health. Drawing from role theory, the objectives of this study are to examine if (a) volunteering engagement is related to systemic inflammation in later life, as measured by C-reactive protein (CRP); (b) the effect of volunteering varies by age; and (c) volunteering is related to change in CRP over time. RESEARCH DESIGN AND METHODS: This study uses 4 waves of data from the Health and Retirement Study, a nationally representative survey of adults 50 years or older. Nested linear regression models were used to examine the relationship between volunteer engagement and CRP concentration in later life. Residualized regression models were used to examine the effects of volunteer engagement on change in CRP. RESULTS: Results revealed that volunteering is modestly associated with lower CRP concentration, but only for respondents 65+. Highly engaged volunteers had lower CRP than both mid-level and nonvolunteers. Longitudinal analyses revealed a leveling of the beneficial effect of volunteering by age, indicative of reduced returns among the oldest respondents in our sample. DISCUSSION AND IMPLICATIONS: These results support previous studies that volunteering, and doing so at a high engagement level, is associated with slightly lower levels of CRP. Leaders in medicine, public health, and social services should consider implementing volunteering programs for older adults.

Measuring Physical Activity Regulatory Styles and Identity Among Adults 55 Years or Older.

Objectives. The purpose of this study was to examine the psychometric properties of modified versions of the Behavioral Regulation in Exercise Questionnaire and Exercise Identity Scale for use with adults ages ≥55 years to measure regulatory styles and identity related to physical activity. Methods. Participants [Mage = 66.29 years (SD = 7.06)] answered an online questionnaire twice across a four-week timescale. We assessed measurement invariance and convergent and divergent validity based on relations between regulatory styles, identity, and physical activity. Results. Both measures were invariant across gender and time, and findings support the convergent and divergent validity of the scales. Notably, a two-factor model of identity representing role identity and physical activity beliefs provided the best fit, and physical activity beliefs was more strongly related to introjected regulation. Discussion. Taken together, there is evidence that these modified scales are suitable for use with adults ages ≥55 years.

Childhood Stressors, Relationship Quality, and Cognitive Health in Later Life.

OBJECTIVES: The rising prevalence of cognitive impairment, Alzheimer's disease, and related disorders signals the need for a better understanding of how social factors may affect cognitive health for millions of Americans. Drawing from cumulative inequality theory, we aim to understand the implications of a stressful childhood on social relationships and cognitive health in later life. METHODS: This study utilizes longitudinal data (2006-2016) from the Health and Retirement Study to examine pathways, both direct and indirect through social relationships in adulthood, from childhood stressors to cognitive health trajectories over time. RESULTS: Respondents reporting a greater number of stressors in childhood had worse cognitive health over time, but those negative effects were not as steep as time progressed. Early-life stressors are also associated with less social support and more social strain in adulthood which, in turn, are associated with initial cognitive health. Finally, pathway analyses confirm that childhood stressors are indirectly associated with initial cognitive health through social strain and social support. DISCUSSION: Findings reveal that a stressful childhood creates chains of risks that have lifelong implications for cognitive health, both directly and indirectly by creating obstacles for developing healthy and supportive social relationships.