Trends in decayed teeth among middle-aged and older adults in the United States: socioeconomic disparities persist over time.

OBJECTIVES: While trends in tooth loss among older adults have been well documented and show a decline over the last few decades, little is known about trends in tooth decay which may lead to tooth loss. The study aim was to examine trends in tooth decay among adults ages 50 years and older in the United States and determine whether these trends were consistent across demographic and socioeconomic subgroups of middle-aged and older adults. METHODS: Secondary analysis of data collected through detailed oral health examinations in the National Health and Nutrition Examination (NHANES) surveys 1988-1994 and 1999-2004. Tooth decay was measured as active caries. Multivariable associations were estimated using negative binomial regression models. RESULTS: Averaged over time, the mean number of decayed teeth was 0.54. Rates of decay remained stable over time. Males, non-Hispanic Blacks, Mexican-Americans, and those of other race/ethnicity as well as those with fewer years of education and lower levels of income had more decayed teeth. The increased number of decayed teeth for Mexican-Americans and those of other race/ethnicity was due in part to differing levels of education and income. Trends over time did not vary by any of these demographic and socioeconomic characteristics. Trends in the number of decayed teeth did not meaningfully change when the numbers of missing and filled teeth were controlled. CONCLUSIONS: Although studies have shown the number of middle-aged and older Americans experiencing tooth loss has decreased over time, trends in tooth decay have remained relatively stable, with socioeconomic disparities persisting over time.

Racial/Ethnic Differences in Trajectories of Cognitive Function in Older Adults.

OBJECTIVE: The objective of this study is to (a) examine racial/ethnic differences in trajectories of cognitive function and (b) evaluate the role of education and health behaviors (physical activity [PA] and smoking) as mediators of racial/ethnic differences in the rate of decline in cognitive function in older adults. METHOD: Data for this study came from the Health and Retirement Study ( n = 3,424). Hierarchical linear models were used to define the trajectory of cognitive function between 2002 and 2008. Participants were classified based on PA as non-vigorously active, intermittent vigorously active, and consistently vigorously active. RESULTS: After adding education, the Hispanic's and Black's disparities in cognitive performance were slightly attenuated (Hispanics, ß = -1.049, p < .001; Blacks, ß = -3.397, p < .001) but were still different from Whites. Smoking was not associated with the cognition intercept or rate of decline. DISCUSSION: We found education had a partial mediating effect on racial differences in levels of cognition but not on the rate of change over time.

Socioeconomic Status and the Trajectory of Body Mass Index Among Older Japanese: A Nationwide Cohort Study of 1987-2006.

OBJECTIVES: This research analyzed the body mass index (BMI) level and rate of change, and their association with socioeconomic status among older Japanese adults. METHODS: Data came from a national sample of over 4,800 Japanese adults aged 60 and older at baseline, with up to 7 repeated observations over a period of 19 years (1987-2006). Hierarchical linear modeling was used to analyze the intrapersonal and interpersonal differences in BMI. RESULTS: Average BMI among older Japanese was 22.26 at baseline and decreased with an accelerating rate over time. Relative to those with less education, BMI among older Japanese with more education was lower and it declined linearly at a faster rate over time. In contrast, higher household income at baseline was associated with a higher level of BMI but similar rates of decline over time. Furthermore, we found no evidence for age variations in the SES-BMI linkage as predicted by prior investigators. DISCUSSION: These findings provide new insights into the complex relationship between socioeconomic factors and BMI, and help to inform the design of health policies and interventions related to weight control among older adults with diverse socioeconomic backgrounds.

Trajectories of depressive symptoms and oral health outcomes in a community sample of older adults.

OBJECTIVE: Adverse outcomes associated with chronic depressive symptoms are of clinical importance. The objective was to identify subgroups of older adults based on their trajectories of depressive symptoms over a 10-year period and determine if these subgroups predicted oral health outcomes. METHODS: The sample was 944 adults aged 65+ who participated in the oral health module of the the Health and Retirement Survey in 2008. Depressive symptoms were measured with a modified version of the Center for Epidemiologic Studies-Depression (CES-D) scale. Latent class trajectory analysis was used to identify distinct subgroups of elders based on their CES-D scores from 1998-2008. Group membership was used to predict self-rated oral health, overall mouth condition (problems with bleeding gums, gum sensitivity, and food avoidance), and edentulism in 2008. RESULTS: Three distinct subgroups were identified using zero-inflated Poisson regression models: (i) minimal depressive symptoms over the study period (43%), (ii) low but generally stable level of depressive symptoms (41%), and (iii) moderate symptoms and higher CES-D scores than the other groups over the 10 years (16%). Controlling for demographic and health variables and edentulism status, having a trajectory of moderate symptoms was associated with poorer mouth condition (p < 0.0001) and poorer self-rated oral health (p = 0.0003) compared with those with minimal symptoms. Having low levels of depressive symptoms was not significantly associated with these two outcomes. Group membership was not significantly associated with the probability of edentulism. CONCLUSIONS: Chronic moderate depressive symptoms are associated with poorer oral health in older adults.

Trajectories of Body Mass Index and Their Associations With Mortality Among Older Japanese: Do They Differ From Those of Western Populations?

Few studies have focused on the relationship between the trajectories of long-term changes in body mass index (BMI; weight (kg)/height (m)(2)) and all-cause mortality in old age, particularly in non-Western populations. We evaluated this association by applying group-based mixture models to data derived from the National Survey of the Japanese Elderly, which included 4,869 adults aged 60 or more years, with up to 7 repeated observations between 1987 and 2006. Four distinct BMI trajectories were identified: "low-normal weight, decreasing" (baseline BMI = 18.7; 23.8% of sample); "mid-normal weight, decreasing" (baseline BMI = 21.9; 44.6% of sample); "high-normal weight, decreasing" (baseline BMI = 24.8; 26.5% of sample); and "overweight, stable" (baseline BMI = 28.7; 5.2% of sample). Survival analysis with an average follow-up of 13.8 years showed that trajectories of higher BMI were associated with lower mortality. In particular, relative to those with a mid-normal weight, decreasing BMI trajectory, those with an overweight, stable BMI trajectory had the lowest mortality, and those with a low-normal, decreasing BMI trajectory had the highest mortality. In sharp contrast with prior observations from Western populations, BMI changes lie primarily within the normal-weight range, and virtually no older Japanese are obese. The association between BMI trajectories and mortality varies according to the distribution of BMI within the population.

Cardiometabolic Risk, Socio-Psychological Factors, and Trajectory of Grip Strength Among Older Japanese Adults.

OBJECTIVE: To examine the association between cardiometabolic risk (percent body fat [BF%], triglycerides [TG], high-density lipoprotein [HDL]-cholesterol, hemoglobin A1c [HbA1c]), socio-psychological factors (education and self-rated health [SRH]), and trajectories of grip strength (GS) in older adults. METHOD: Longitudinal 8-year data from 1,381 Japanese adults aged 65 years or above were analyzed using hierarchical linear models, stratified according to gender. RESULTS: GS declined following a linear trajectory. In both genders, higher BF% was associated with weaker GS, but not with the rate of decline. GS trajectory did not correlate with baseline TG, HDL-C, or HbA1c. Cardiometabolic factors mediated educational differences in GS intercept in both genders. In women, better SRH predicted stronger GS. The effect of SRH was robust to adjustments for cardiometabolic risk. DISCUSSION: In older adults, GS and its rate of decline are selectively associated with both cardiometabolic risk and socio-psychological characteristics. Cardiometabolic risk mediates educational disparities in GS but not differences in subjective assessments of health.

Socioeconomic stratification and multidimensional health trajectories: evidence of convergence in later old age.

OBJECTIVES: This research sought to examine socioeconomic stratification in the joint trajectories of physical, emotional, and cognitive functioning among older Americans and how it differs by age groups. METHODS: We used data from a nationally representative sample of 9,237 Americans age 65 or older from the Health and Retirement Study, who were observed biennially from 1998 to 2010. Joint trajectories of physical, emotional, and cognitive functioning were characterized using a group-based mixture model. We then applied multinomial logistic regression analysis to evaluate their linkages with socioeconomic status and how the linkages differ by age groups. RESULTS: We identified four distinct patterns of joint changes in physical, emotional, and cognitive functioning over time. Accounting for 29.3%, 23.5%, 24.5%, and 22.6% of the older Americans, respectively, these trajectory patterns characterized groups of individuals experiencing minimal to severe levels of impairment and deterioration. Lower education, income, and net worth were associated with trajectories featuring greater impairment or more rapid deterioration in these functional dimensions. Disparities based on education, however, attenuated in later old age, whereas health benefits associated with higher income and higher net worth persisted into advanced age. DISCUSSION: Distinct patterns of joint trajectories of physical, emotional, and cognitive functioning exist in old age. There were significant socioeconomic differences in the joint trajectories, with education-based inequality in health converging in later old age. Further research identifying strategies to alleviate the disproportionate burden of poor multidimensional health trajectories in lower socioeconomic groups is important.

Does Social Support Buffer the Effect of Financial Strain on the Trajectory of Smoking in Older Japanese? A 19-Year Longitudinal Study.

OBJECTIVES: Although there is extensive research on the stress-buffering effects of social support on health, there is little understanding of this effect on health behaviors such as smoking, particularly during old age. This study aimed to estimate the effect of financial strain and the stress-buffering effect of social support, on the trajectory of smoking over an extended period of time among older Japanese. METHOD: Data came from a national sample of more than 4,800 adults, aged 60 and older in Japan, with up to 7 repeated observations between 1987 and 2006 (16,669 observations). Hierarchical linear modeling was used to analyze the intrapersonal and interpersonal differences in smoking. RESULTS: Higher financial strain at baseline was associated with greater amount of smoking, and a slower rate of decline, after adjusting for sociodemographic attributes. Greater instrumental support partially offset the deleterious effect of financial strain on the rate of decline in smoking. DISCUSSION: Our findings add a dynamic dimension to understanding the relationship among financial strain, social support, and smoking in old age. This knowledge is significant when designing health policies and interventions regarding health behaviors in late life.

Social stratification, oral hygiene, and trajectories of dental caries among old Americans.

OBJECTIVE: This study analyzed how oral hygiene (i.e., brushing, rinsing, and flossing) influences the trajectories of dental caries (i.e., numbers of decayed, missing, and filled teeth) among older Americans within the context of social stratification. METHOD: Data came from Piedmont Dental Study that involved a sample of 810 older Americans who were dentate in 1988 with up to four repeated observations through 1994. Hierarchical linear models were used for data analysis. RESULTS: Brushing, flossing, and rinsing were associated with the trajectories of dental caries in distinct ways. In addition, oral hygiene was correlated with race, education, household income, and use of dental care. The effects of brushing and flossing on decayed and missing teeth remained robust, even when socio-demographic and health attributes were controlled. Conversely, socioeconomic disparities in dental caries persisted, when oral hygiene was adjusted. DISCUSSION: Both social stratification and oral hygiene need to be considered in promoting oral health.

How does the trajectory of multimorbidity vary across Black, White, and Mexican Americans in middle and old age?

OBJECTIVES: This research examines intra- and interpersonal differences in multiple chronic conditions reported by Americans aged 51 and older for a period up to 11 years. It focuses on how changes in multimorbidity vary across White, Black, and Mexican Americans. METHODS: Data came from 17,517 respondents of the Health and Retirement Study (1995-2006) with up to 5 repeated observations. Hierarchical linear models were employed to analyze ethnic variations in temporal changes of reported comorbidities. FINDINGS: Middle-aged and older Americans have on average nearly 2 chronic diseases at the baseline, which increased to almost 3 conditions in 11 years. White Americans differ from Black and Mexican Americans in terms of level and rate of change of multimorbidity. Mexican Americans demonstrate lower initial levels and slower accumulation of comorbidities relative to Whites. In contrast, Blacks showed an elevated level of multimorbidity throughout the 11-year period of observation, although their rate of change slowed relative to Whites. DISCUSSION: These results suggest that health differences between Black Americans and other ethnic groups including White and Mexican Americans persist in the trajectory of multimorbidity even when population heterogeneity is adjusted. Further research is needed concerning the impact of health disadvantages and differential mortality that may have occurred before middle age as well as exploring the role of nativity, the nature of self-reported diseases, and heterogeneity underlying the average trajectory of multimorbidity for ethnic elders.

Multiple trajectories of depressive symptoms in middle and late life: racial/ethnic variations.

This research aims to identify distinct courses of depressive symptoms among middle-aged and older Americans and to ascertain how these courses vary by race/ethnicity. Data came from the 1995-2006 Health and Retirement Study which involved a national sample of 17,196 Americans over 50 years of age with up to six repeated observations. Depressive symptoms were measured by an abbreviated version of the Center for Epidemiologic Studies Depression scale. Semiparametric group based mixture models (Proc Traj) were used for data analysis. Six major trajectories were identified: (a) minimal depressive symptoms (15.9%), (b) low depressive symptoms (36.3%), (c) moderate and stable depressive symptoms (29.2%), (d) high but decreasing depressive symptoms (6.6%), (e) moderate but increasing depressive symptoms (8.3%), and (f) persistently high depressive symptoms (3.6%). Adjustment of time-varying covariates (e.g., income and health conditions) resulted in a similar set of distinct trajectories. Relative to White Americans, Black and Hispanic Americans were significantly more likely to be in trajectories of more elevated depressive symptoms. In addition, they were more likely to experience increasing and decreasing depressive symptoms. Racial and ethnic variations in trajectory groups were partially mediated by SES, marital status, and health conditions, particularly when both interpersonal and intrapersonal differences in these variables were taken into account.

Ethnic differences in the dynamics of depressive symptoms in middle-aged and older Americans.

OBJECTIVE: This study examined differences in the trajectory of depressive symptoms between Hispanic, Black, and White Americans in middle and old age. METHOD: Data came from a national sample of Americans with up to 6 repeated assessments spanning 11 years. Hierarchical linear models with time-varying covariates were used. RESULTS: Hispanics started with the worst depressive symptomatology, followed by Black Americans, whereas White Americans had the fewest symptoms. These differences, however, diminished over time. More importantly, net of socioeconomic and health differentials, the depressive symptoms trajectory did not differ between Blacks and Whites, whereas Hispanics still started with worse symptoms and had a greater rate of reduction in symptomatology compared to Whites. DISCUSSION: Significant ethnic differences exist in both the intercept and rate of change in depressive symptoms in middle-aged and older Americans. These variations are substantially confounded by socioeconomic and health differentials.

Evolving self-rated health in middle and old age: how does it differ across Black, Hispanic, and White Americans?

OBJECTIVE: This research focuses on ethnic variations in the intraindividual changes in self-rated health. METHOD: Data came from the Health and Retirement Study involving up to 6 repeated observations between 1995 and 2006 of a national sample of 18,486 Americans above 50 years of age. Hierarchical linear models were employed in depicting variations in self-rated health across White, Black, and Hispanic Americans. RESULTS: Subjective health worsened over time albeit moderately. Relative to younger persons, older individuals rated their health poorer with a greater rate of deteriorating health. With reference to ethnic variations in the intercept and slope of perceived health, White Americans rated their health most positively, followed by Black Americans, with Hispanics rating their health least positively. This pattern held even when socioeconomic status, social networks, and prior health were adjusted. DISCUSSION: Significant ethnic differences exist in the evolvement of self-rated health in middle and late life. Further inquiries may include analyzing ethnic heterogeneities from a person-centered perspective, health disparities across subgroups of Hispanics, effects of neighborhood attributes, and implications of left truncation.

Ethnicity and changing functional health in middle and late life: a person-centered approach.

OBJECTIVES: Following a person-centered approach, this research aims to depict distinct courses of disability and to ascertain how the probabilities of experiencing these trajectories vary across Black, Hispanic, and White middle-aged and older Americans. METHODS: Data came from the 1995-2006 Health and Retirement Study, which involved a national sample of 18,486 Americans older than 50 years of age. Group-based semiparametric mixture models (Proc Traj) were used for data analysis. RESULTS: Five trajectories were identified: (a) excellent functional health (61%), (b) good functional health with small increasing disability (25%), (c) accelerated increase in disability (7%), (d) high but stable disability (4%), and (e) persistent severe impairment (3%). However, when time-varying covariates (e.g., martial status and health conditions) were controlled, only 3 trajectories emerged: (a) healthy functioning (53%), moderate functional decrement (40%), and (c) large functional decrement (8%). Black and Hispanic Americans had significantly higher probabilities than White Americans in experiencing poor functional health trajectories, with Blacks at greater risks than Hispanics. CONCLUSIONS: Parallel to the concepts of successful aging, usual aging, and pathological aging, there exist distinct courses of changing functional health over time. The mechanisms underlying changes in disability may vary between Black and Hispanic Americans.

Gender differences in functional status in middle and older age: are there any age variations?

OBJECTIVES: The present study examines gender differences in changes in functional status after age 50 and how such differences vary across different age groups. METHODS: Data came from the Health and Retirement Study, involving up to six repeated observations of a national sample of Americans older than 50 years of age between 1995 and 2006. We employed hierarchical linear models with time-varying covariates in depicting temporal variations in functional status between men and women. RESULTS: As a quadratic function, the worsening of functional status was more accelerated in terms of the intercept and rate of change among women and those in older age groups. In addition, gender differences in the level of functional impairment were more substantial in older persons than in younger individuals, although differences in the rate of change between men and women remained constant across age groups. DISCUSSION: A life course perspective can lead to new insights regarding gender variations in health within the context of intrapersonal and interpersonal differences. Smaller gender differences in the level of functional impairment in the younger groups may reflect improvement of women's socioeconomic status, greater rate of increase in chronic diseases among men, and less debilitating effects of diseases.

Intertwining courses of functional status and subjective health among older Japanese.

OBJECTIVES: We sought to depict how trajectories of functional status are related to the average changes in self-rated health and its underlying trajectories. METHODS: Data came from a five-wave panel study of a national sample of 2,200 Japanese older adults between 1987 and 1999. We employed hierarchical linear models and multinomial logistic regression to depict the interrelationships among patterns of temporal change in functional status and self-rated health. RESULTS: Trajectories of functional status were associated with the average age-related changes in subjective health (i.e., linear and nonlinear slopes). Furthermore, there were significant correlations between the courses of functional health and those of self-rated health. Finally, recovery from poor self-rated health was characterized by having poor health and functional ability at baseline. DISCUSSION: Researchers can generalize prior observations of the association between functional status and subjective health at one or more points in time to their long-term trajectories. These findings provide further insights into understanding the dynamics between two key dimensions of health among older adults in Japan.

How does self-assessed health change with age? A study of older adults in Japan.

OBJECTIVE: This research examines how the trajectories of self-rated health evolve among elderly Japanese individuals and how socioeconomic status (SES), social relations, and baseline health differentiate these trajectories. METHODS: Data came from a five-wave panel study of a national sample of 2,200 Japanese old adults between 1987 and 1999. Hierarchical linear models and cluster analysis were employed to depict major patterns of temporal changes in self-rated health. RESULT: Overall perceived health becomes worse, but only slightly, between ages 60 and 85, whereas it appears to improve a little bit after age 85. Underlying the observed age norm are four subtrajectories including constant good health, early onset of perceived health decline, late onset of perceived health decline, and a course of recovery from poor self-assessed health. DISCUSSION: Diverse subjective health trajectories exist in old age, extending well into the 90s. Prior observations of the effects of SES, social relations, and baseline health on health states and transitions can now be extended to trajectories of subjective health. Our analysis of Japanese data provides important benchmarks for comparisons with observations made in other developed nations.

Changes in functional status among older adults in Japan: successful and usual aging.

This research aimed to chart the trajectories of functional status in old age in Japan and to assess how self-rated health and cognitive functioning differentiate these trajectories and account for interpersonal differences. Data came from a 5-wave panel study of a national sample of 2,200 Japanese older adults between 1987 and 1999. The sample as a whole showed an accelerated increase in functional limitations with age. approximated by a quadratic function. More important, 3 major trajectories of functional change were identified: (a) minimal functional decrement, (b) early onset of functional impairment. and (c) late onset of functional impairment. These findings may serve as useful benchmarks for observations derived from other developed nations.

Gender differences in old age mortality: roles of health behavior and baseline health status.

This research aims to further current understanding of gender differences in old age mortality. In particular, it assesses the relative importance of health behavior and baseline health conditions in predicting the risk of dying, and how their effects differ between elderly men and women. Data for this research came from a prospective study of a national sample of 2,200 older adults in Japan from 1987 to 1999. Hazard rate models were employed to ascertain the interaction effects involving gender and health behavior (i.e., smoking and drinking) and baseline health status. Gender differences in old age mortality in the Japanese are quite pronounced throughout all of our models. In addition, interaction effects of gender and smoking, functional limitation, and cognitive impairment, indicate that females in Japan suffer more from these risk factors than do their male counterparts. Failure to adjust for population heterogeneity may lead to a significant underestimation of female advantage in survival. The inclusion of health behavior and health status measures only offsets a limited proportion of this gender differential. The increased mortality risk due to smoking, functional limitation, and cognitive impairment among elderly Japanese women suggests that narrowing of gender gap in mortality may be due to not only changes in the levels of these risk factors but also their differential effects on men and women.