Sex and gender differences in risk scores for dementia and Alzheimer's disease among cisgender, transgender, and non-binary adults.

INTRODUCTION: Few studies have explored dementia risk according to sex and gender including for transgender and non-binary adults. This study evaluated dementia risk factors and risk scores among cisgender, transgender, and non-binary adults. METHODS: Observational data were drawn from the 2019 Behavioral Risk Factor Surveillance System. A matched-cohort approach was used to develop sex (male, female) and gender identity cohorts (cisgender men, cisgender women, transgender men, transgender women, and non-binary adults) for comparison. Dementia risk scores were calculated using established mid-life and late-life risk score algorithms. RESULTS: Males had higher overall mid-life dementia risk, and lower late-life Alzheimer's disease risk compared to females. Transgender men, transgender women, and non-binary adults had higher overall late-life risk compared to both cisgender men and women. DISCUSSION: Future research is needed to build the evidence base for specific risk factors that may be contributing to higher overall risk among understudied and underserved gender groups. HIGHLIGHTS: Using data from the 2019 Behavioral Risk Factor Surveillance System, this matched-cohort study found that those assigned female at birth had lower overall mid-life dementia risk and higher overall late-life Alzheimer's disease (AD) risk compared to those assigned male at birth. Transgender men, transgender women, and non-binary adults all showed higher overall late-life AD risk compared to cisgender men and cisgender women. Between-group differences were found in the incidence of specific risk and protective factors for dementia and AD.

Gaawaadhi Gadudha: understanding how cultural camps impact health, well-being and resilience among Aboriginal adults in New South Wales, Australia-a collaborative study protocol.

INTRODUCTION: The health and well-being of Aboriginal Australians is inextricably linked to culture and Country. Our study challenges deficit approaches to health inequities by seeking to examine how cultural connection, practice and resilience among Aboriginal peoples through participation in 'cultural camps' held on sites of cultural significance promotes health and well-being. METHODS AND ANALYSIS: The study will be undertaken in close collaboration and under the governance of traditional cultural knowledge holders from Yuwaalaraay, Gamilaraay and Yuin nation groups in New South Wales, Australia. Three cultural camps will be facilitated, where participants (n=105) will engage in activities that foster a connection to culture and cultural landscapes. A survey assessing connection to culture, access to cultural resources, resilience, self-rated health and quality of life will be administered to participants pre-camp and post-camp participation, and to a comparative group of Aboriginal adults who do not attend the camp (n=105). Twenty participants at each camp (n=60) will be invited to participate in a yarning circle to explore cultural health, well-being and resilience. Quantitative analysis will use independent samples' t-tests or χ2 analyses to compare camp and non-camp groups, and linear regression models to determine the impact of camp attendance. Qualitative analysis will apply inductive coding to data, which will be used to identify connections between coded concepts across the whole data set, and explore phenomenological aspects. Results will be used to collaboratively develop a 'Model of Cultural Health' that will be refined through a Delphi process with experts, stakeholders and policymakers. ETHICS AND DISSEMINATION: The study has ethics approval from the Aboriginal Health and Medical Research Council (#1851/21). Findings will be disseminated through a combination of peer-reviewed articles, media communication, policy briefs, presentations and summary documents to stakeholders.

A Technology-Enriched Approach to Studying Microlongitudinal Aging Among Adults Aged 18 to 85 Years: Protocol for the Labs Without Walls Study.

BACKGROUND: Traditional longitudinal aging research involves studying the same individuals over a long period, with measurement intervals typically several years apart. App-based studies have the potential to provide new insights into life-course aging by improving the accessibility, temporal specificity, and real-world integration of data collection. We developed a new research app for iOS named Labs Without Walls to facilitate the study of life-course aging. Combined with data collected using paired smartwatches, the app collects complex data including data from one-time surveys, daily diary surveys, repeated game-like cognitive and sensory tasks, and passive health and environmental data. OBJECTIVE: The aim of this protocol is to describe the research design and methods of the Labs Without Walls study conducted between 2021 and 2023 in Australia. METHODS: Overall, 240 Australian adults will be recruited, stratified by age group (18-25, 26-35, 36-45, 46-55, 56-65, 66-75, and 76-85 years) and sex at birth (male and female). Recruitment procedures include emails to university and community networks, as well as paid and unpaid social media advertisements. Participants will be invited to complete the study onboarding either in person or remotely. Participants who select face-to-face onboarding (n=approximately 40) will be invited to complete traditional in-person cognitive and sensory assessments to be cross-validated against their app-based counterparts. Participants will be sent an Apple Watch and headphones for use during the study period. Participants will provide informed consent within the app and then begin an 8-week study protocol, which includes scheduled surveys, cognitive and sensory tasks, and passive data collection using the app and a paired watch. At the conclusion of the study period, participants will be invited to rate the acceptability and usability of the study app and watch. We hypothesize that participants will be able to successfully provide e-consent, input survey data through the Labs Without Walls app, and have passive data collected over 8 weeks; participants will rate the app and watch as user-friendly and acceptable; the app will allow for the study of daily variability in self-perceptions of age and gender; and data will allow for the cross-validation of app- and laboratory-based cognitive and sensory tasks. RESULTS: Recruitment began in May 2021, and data collection was completed in February 2023. The publication of preliminary results is anticipated in 2023. CONCLUSIONS: This study will provide evidence regarding the acceptability and usability of the research app and paired watch for studying life-course aging processes on multiple timescales. The feedback obtained will be used to improve future iterations of the app, explore preliminary evidence for intraindividual variability in self-perceptions of aging and gender expression across the life span, and explore the associations between performance on app-based cognitive and sensory tests and that on similar traditional cognitive and sensory tests. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/47053.

Fear of Heterosexism Among Sexuality and Gender Diverse Staff and Students.

Fear of heterosexism-as distinct from actual experiences of heterosexism-plays a significant role in staff and students lives on campus. Ambient workplace heterosexism provides a context for staff and students about what to expect from their peers and colleagues, and shapes the daily activities of those who perceive heterosexism as a regulating force. In this article, we consider the psychometrics of the Fear of Heterosexism Scale (FoHS), which was integrated into a campus climate survey of Western Sydney University staff and students (N = 3,106; n = 412). This scale was considered in relation to a range of associated factors, including perceived safety on campus, bystander efficacy, responsibility to intervene, and awareness of lesbian, gay, bisexual, transgender, intersex, queer/questioning, asexual, and many other terms such as nonbinary and pansexual (LGBTIQA+) issues. In turn, the results of the FoHS are considered across a range of demographic factors such as gender, sexuality, role, dis/ability, and membership of campus-based support organizations. Supporting the findings from the initial operationalization of the FoHS by Fox and Asquith in 2018, this research identifies the consequences of fear of heterosexism on daily activities and engagement with study/work. Understanding the factors associated with fear of heterosexism is critical in creating more inclusive and respectful university environments.

Associations Between Planned Exercise, Walking, Incidental Physical Activity, and Habit Strength in Older People: A Cross-Sectional Study.

Habits play an important role in physical activity (PA) engagement; however, these associations in older people are not well understood. The present study aimed to investigate the relationship between engagement in types of PA and their automaticity in older people, using an observational, cross-sectional design. Current hours engaged in planned exercise (excluding walking), planned walking, and incidental activities and the automaticity of those PA behaviors were measured in 127 community-dwelling Australians aged 65 years and older via an online questionnaire. After controlling for demographic and health factors (age, gender, education level, body mass index, history of falls, and anxiety and depression symptoms), higher automaticity scores were associated with more hours undertaking planned walking and incidental activity but not planned exercise. Although preliminary, these findings indicate that the role of habit in maintaining PA in older people may, therefore, differ depending on the type of activity.

Association between decision-making under risk conditions and on-road driving safety among older drivers.

Objective: Despite theoretical models emphasizing the likely importance of adaptive decision-making to maintaining safety on the roads, there has been a lack of research investigating this topic. This exploratory study aimed to determine if decision-making under risk conditions, as measured by the Game of Dice Task (GDT), can explain additional variance in on-road driving safety beyond other well-validated predictors. Method: Two hundred and thirty-nine cognitively normal Australian drivers aged 65-96 completed demographic and health questionnaires, vision testing, a neurocognitive test battery assessing cognitive flexibility, cognitive interference, episodic memory, verbal working memory, verbal fluency, and visuospatial function, the GDT-a lab-based assessment of decision-making under risk conditions, validated off-road driver screening measures and an on-road driving assessment along a standard route in urban traffic conditions administered by a trained Occupational Therapist (OT). Results: The number of risky choices made, but not the number of strategy changes, across trials of the GDT independently predicted on-road safety ratings after controlling for visual acuity, cognitive test performance, and off-road driver screening measures, B = -.146, 95% CI [-.276 to -.016]. Conclusion: Overall, this study offers the first evidence that decision-making is related to older adults' on-road driving safety, and makes recommendations for future research exploring the contribution of decision-making to on-road safety. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The role of cognition and reinforcement sensitivity in older adult decision-making under explicit risk conditions.

Introduction: Previous research has suggested that individual differences in executive functions, memory and reinforcement sensitivity are associated with performance on behavioral decision-making tasks. Decision-making performance may also decline with age, however there is a lack of research on the interplay of cognitive and affective processes, and their impact on older adult decision-making. This study examined associations between executive functions, memory and reinforcement sensitivity on the Game of Dice Task (a measure of decision-making under explicit risk) among older adults.Method: One thousand and two older adults without cognitive impairment (aged 72-78 years) participated as part of an Australian longitudinal cohort study (the Personality and Total Health Through Life study). Decision-making sub-types were identified through cluster analysis and multinomial logistic regression was used to assess associations with measures of cognition and reinforcement sensitivity.Results: Cluster analysis identified three decision-making sub-types, which we label "advantageous," "disadvantageous" and "switching." Multivariate analyses found that relative to the mid-performing "switching" sub-type, advantageous decision-makers were more likely to be younger, male and have higher scores on a test of verbal learning. Disadvantageous decision-makers were more likely to have poorer scores on some components of executive function (set shifting, but not working memory or inhibitory control), although this effect was partly attenuated by a measure of reinforcement sensitivity (reward responsiveness).Conclusion: These results indicate that specific components of learning and executive functions are influential in decision-making under explicit risk among a sample of older adults.

Effects of Age on Emotion Regulation, Emotional Empathy, and Prosocial Behavior.

OBJECTIVES: The degree to which older adults experience emotional empathy and show subsequent prosocial behavior versus experience personal distress in response to another's distress remains unclear. METHOD: Young (n = 40; 17-29 years) and older (n = 39; 61-82 years) adults watched videos of individuals expressing pain or no pain. Pain mimicry was recorded using facial electromyography. Participants were then asked if they would spend the remaining time helping the experimenter. Self-reported tendency to suppress or reappraise emotion was assessed, as well as trait and state emotional empathy and personal distress. RESULTS: Pain mimicry was associated with reduced trait suppression in older adults. In both age groups, greater emotional empathy, averaged across video condition, was associated with increased helping. In addition, relative to young adults, older adults reported more personal distress and emotional reactivity in response to the videos but were just as willing to help. They also put more effort into helping. DISCUSSION: These findings contribute to clarification of mixed previous evidence regarding the experience of emotional empathy in young versus older adulthood. We discuss the importance of considering additional subcomponents of empathy such as emotion regulation, while also accounting for the relevance of the empathy induction to each age group.

Gender, mental health and ageing.

This article presents a broad narrative review of the epidemiological evidence on how and why the mental health of older adults varies by gender. We draw upon international research literatures spanning gerontology and population mental health, as well as major reports from global health agencies. Compared with older men, older women are more likely to experience common mental disorders such as depression and anxiety, although the gender gap is smaller than it is at younger ages. In contrast, the mortality-related impacts of poor mental health, including suicide, are more severe for older men. These gendered patterns vary by country and other social contexts. Factors proposed to account for these findings include cultural and social norms, differentiation of gender roles, disadvantage and (dis)empowerment across the life course, and the coping styles of older men. However, little research has explicitly tested these explanations. Research to date has overwhelmingly focused on identifying differences in the mental health of older men and women. Notably, most studies have been restricted to binary comparisons, lacking the data to disentangle sex and gender dynamics, and few studies have examined the mental health of minority gendered adults in later life. Finally, there remains a need for high-quality population-based research into the mental health of those aged over 80 that includes coverage of people living in residential aged care settings.

Validation of the Emotion Regulation Questionnaire in older community-dwelling adults.

OBJECTIVE: To examine the psychometric properties of the Emotion Regulation Questionnaire (ERQ) among a sample of older community-dwelling males and females and to also assess gender differences in the association between emotion regulation and positive and negative affect. METHOD: The ERQ and the Positive and Negative Affect Schedule-10 were administered to 252 older adults (age range 60-89 years; 48.4% female). RESULTS: The two ERQ subscales, reappraisal and suppression, were internally consistent. Reappraisal was positively correlated with positive affect among both genders, and negatively correlated with negative affect among older women only. Suppression was positively correlated with negative affect among older men only and unrelated to positive affect for both genders. Confirmatory factor analysis showed that a two-factor solution fits the data from both genders. CONCLUSION: The results provide evidence to support the ERQ for use with older adults, while identifying clinically important gender differences in the associations between emotion regulation tendencies and affect in older age. PRACTITIONER POINTS: Reliability and validity of the 10-item Emotion Regulation Questionnaire is supported for use among older adults. Suppression positively correlated with negative affect among older men but not older women. Reappraisal negatively correlated with negative affect among older women but not men. The current data from a community-dwelling population may not generalize to older adults with clinical disorders.

Systematic review and meta-analysis of age-related differences in instructed emotion regulation success.

The process model of emotion regulation (ER) is based on stages in the emotion generative process at which regulation may occur. This meta-analysis examines age-related differences in the subjective, behavioral, and physiological outcomes of instructed ER strategies that may be initiated after an emotional event has occurred; attentional deployment, cognitive change, and response modulation. Within-process strategy, stimulus type, and valence were also tested as potential moderators of the effect of age on ER. A systematic search of the literature identified 156 relevant comparisons from 11 studies. Few age-related differences were found. In our analysis of the subjective outcome of response modulation strategies, young adults used expressive enhancement successfully (g = 0.48), but not expressive suppression (g = 0.04). Response modulation strategies had a small positive effect among older adults, and enhancement vs suppression did not moderate this success (g = 0.31 and g = 0.10, respectively). Young adults effectively used response modulation to regulate subjective emotion in response to pictures (g = 0.41) but not films (g = 0.01). Older adults were able to regulate in response to both pictures (g = 0.26) and films (g = 0.11). Interestingly, both age groups effectively used detached reappraisal, but not positive reappraisal to regulate emotional behavior. We conclude that, in line with well-established theories of socioemotional aging, there is a lack of evidence for age differences in the effects of instructed ER strategies, with some moderators suggesting more consistent effectiveness for older compared to younger adults.