Race/ethnicity and the measurement of cognition in NSHAP: Recommendations for robustness.

OBJECTIVES: In this study, we examine the measurement of cognition in different racial/ethnic groups to move towards a less biased and more inclusive set of measures for capturing cognitive change and decline in older adulthood. METHODS: We use data from Round 2 (N=3377) and Round 3 (N=4777) of the National Social Life, Health, and Aging Project (NSHAP) and examine the study's Survey Adjusted version of the Montreal Cognitive Assessment (MoCA-SA). We employ exploratory factor analyses to explore configural invariance by racial/ethnic group. Using modification indexes, two-parameter item response theory models, and split-sample testing, we identify items that seem robust to bias by race. We test the predictive validity of the full (18-item) and short (4-item) MoCA-SAs using self-reported dementia diagnosis, instrumental activities of daily living (IADLs), proxy reports of dementia, proxy reports of dementia-related death, and National Death Index reports of dementia-related death. RESULTS: We found that four measures out of the 18 used in NSHAP's MoCA-SA formed a scale that was more robust to racial bias. The shortened form predicted consequential outcomes as well as NSHAP's full MoCA-SA. The short form was also moderately correlated with the full form. DISCUSSION: Although sophisticated structural equation modeling techniques would be preferrable for assuaging measurement invariance by race in NSHAP, the shortened form of the MoCA-SA provides a quick way for researchers to carry out robustness checks and to see if the disparities and associations by race they document are "real" or the product of artifactual bias.

Corrigendum: Home alone together: Differential links between momentary contexts and real-time loneliness among older adults from Chicago during versus before the COVID-19 pandemic.

Studies show that older adults were lonelier during versus before the COVID-19 pandemic. This may be due in part to guidelines particularly recommending that older adults stay at home, given their elevated risk of COVID-19 complications. However, little is known about the extent to which this population experienced greater intensity in momentary loneliness during versus before the pandemic, and how this relates to their real-time contexts. Here, we build upon recent findings from the Chicago Health and Activity Space in Real-Time (CHART) study that revealed associations between momentary contexts and loneliness among older adults. We analyze ecological momentary assessments (EMAs) from both pre- and during COVID-19 among a subsample of CHART respondents (N = 110 older adults age 65-88 in 2020). Pre-pandemic data were collected across three waves from April 2018-October 2019, and pandemic data were collected across three additional waves from June-September 2020. Participants responded to smartphone "pings" (five per day for 7 days per wave; N = 5,506 and N = 7,824 before and during the pandemic, respectively) by reporting their momentary loneliness and context (e.g., home). Findings from multi-level regression models suggest that respondents were lonelier in mid-2020 than in years prior, as well as when at home and alone; they were also more likely to be at home during the pandemic. However, the loneliness-inducing effects of being at home (vs. outside the home) and alone (vs. with others) were weaker during versus before COVID-19. Results provide important nuance to broader trends in loneliness among older adults during the pandemic. Specifically, older adults may have adopted new technologies to support social connectedness. It is also possible that, during a time in which social and physical distancing characterized public health guidelines, these contexts grew less isolating as they became a shared experience, or that publicly shared spaces provided fewer opportunities for social engagement.

Corrigendum: Momentary loneliness among older adults: Contextual differences and their moderation by gender and race/ethnicity.

Studies suggest that loneliness is associated with age. Among older adults, women and Black adults may be at greater risk than men and White adults, respectively. Social and physical contexts are also linked with loneliness. However, little is known about whether and how those of different genders and racial/ethnic groups may experience social and physical contexts differently in terms of their real-time loneliness, and the extent to which these differences may be explained by differential exposure or reactivity to such contexts. We examine (1) how momentary loneliness relates to (a) gender and race/ethnicity and (b) social and physical context; and the extent to which gender and racial/ethnic groups may be (2) differentially exposed to loneliness-related contexts and/or (3) differentially reacting to these contexts. Using multilevel regressions, we analyzed ecological momentary assessments from 342 community-dwelling U.S. older adults from the Chicago Health and Activity Space in Real Time study. In each of three waves of data collection, smartphone "pings" (five per day for 21 days; n = 12,744 EMAs) assessed loneliness, social context (e.g., alone, with a spouse/partner), and location/physical context (e.g., home, at work). Results revealed that men consistently reported greater loneliness intensity than women, including after adjusting for momentary physical and social context. In addition, those momentarily outside the home and/or not alone were less likely to feel lonely than their counterparts. However, the protective effect of being outside of the home (vs. home) was weaker among women and Black and Hispanic older adults, and the protective effect of being with one or more others (vs. alone) was weaker among women. Results are among the first to identify contextual effects on real-time loneliness in older adults and how these associations vary by gender and race/ethnicity. Knowledge regarding momentary variation in loneliness may inform future just-in-time adaptive loneliness interventions in older adulthood.

Unequal loss: Disparities in relational closeness to a COVID-19 death among U.S. older adults.

BACKGROUND: COVID-19 mortality occurred unevenly across U.S. demographic subgroups, leaving some communities harder hit than others. Black and Hispanic/Latino older adults are among those disproportionately affected by COVID-19 mortality, and in turn, COVID-19 bereavement. Because disparities in COVID-19 mortality may extend to COVID-19 bereavement, it is important to understand the incidence of COVID-19 bereavement among older adults at various degrees of relational closeness (e.g., spouse vs. household member vs. friend). METHODS: We used the National Social Health and Aging Project (NSHAP) COVID Study to evaluate disparities in loss of a social network member to COVID-19 among U.S. older adults by race/ethnicity, language, and relational closeness. Multiple logistic regression was used to estimate the likelihood of experiencing a COVID-19 death in one's social network. RESULTS: None of the English-speaking, non-Hispanic White respondents reported the loss of a household member or spouse to COVID-19. English-speaking, non-Hispanic Black and English-speaking, Hispanic older adults were overrepresented in reporting a death at every degree of relational closeness. However, close COVID-19 bereavement was most prevalent among Spanish-speaking older adults of any race. Although Spanish speakers comprised only 4.8% of the sample, half of the respondents who lost a spouse to COVID-19 were Spanish speakers. Language and ethnoracial group disparities persisted after controlling for age, sex, marital status, and education. CONCLUSIONS: Known ethnoracial disparities in COVID-19 mortality extend to COVID-19 bereavement among older adults. Because bereavement impacts health, Black, Latino, and Spanish-speaking communities need greater protection and investment to prevent disparities in bereavement from exacerbating disparities in later-life mental and physical health.

Moderation of associations between weight discrimination and diabetes status by psychosocial factors.

Weight discrimination has adverse effects on health that include increasing the risk factors for developing type 2 diabetes. Preliminary evidence suggests a positive association between weight discrimination and diagnosed diabetes; however, it is unknown whether psychosocial resources may buffer this association. In logistic regressions stratified by gender, we examined links between weight discrimination and diabetes among a nationally representative sample of U.S. adults (the National Social Life, Health, and Aging Project; N = 2,794 adults age 50 and older in 2015-16). We also tested the extent to which trait-resilience and social support from a spouse/partner, family, and friends buffered any observed association. We adjusted for known predictors of diabetes (age, race/ethnicity, Body Mass Index) and conducted sensitivity analyses restricted to men and women with obesity. Net of covariates, in the overall sample, weight discrimination was associated with significantly greater odds of having ever had diabetes among women (OR = 2.00, 95% CI [1.15, 3.47]), but not men. Among women with obesity, weight discrimination was only significantly associated with greater odds of diabetes for those with low resilience (OR = 1.84, 95% CI [1.01, 3.35]). Among men overall, weight discrimination was associated with lower odds of diabetes for those with high family support (OR = 0.03, 95% CI [0.003, 0.25]) as well as those with high friend support (OR = 0.34, 95% CI [0.13, 0.91]); similar effects were observed in men with obesity. These novel findings evince a role for psychosocial resources in buffering associations between weight discrimination and diabetes.

Relating depression, anxiety, stress and loneliness to 5-year decline in physical function and frailty.

OBJECTIVES: While depression has been associated with physical function decline and worsening frailty in older adults, the impact of other mental health symptoms on physical function and frailty is unknown. The study objective was to determine whether depression, perceived stress, loneliness, and anxiety symptoms affect 5-year physical function and frailty trajectories of older adults. METHODS: The National Social Life, Health, and Aging Project (NSHAP) is a nationally-representative study of adults born between 1920 and 1947. The analysis included data collected in 2010-11 and 2015-16. Mental health symptoms were quantified using NSHAP's measures of anxiety (range:0-21), perceived stress (0-8), depression (0-22), and loneliness (0-6); higher scores indicated worse symptoms. We regressed 2015-16 3 m usual walk time, five-repeated chair stand time or an adapted frailty phenotype scale (0-4) separately on each 2010-11 mental health scale, adjusting for baseline physical function or frailty, demographics, and comorbidities. RESULTS: In separate models, every one-point increase on the depression or perceived stress scales was associated with, respectively, a 0.06 s slower (95 % CI: 0.03, 0.10) or 0.09 s slower (95 % CI: 0.01, 0.16) 5-year walk time. Every one-point increase on the depression or perceived stress scales was associated with a 0.15 s slower (95 % CI: 0.06, 0.23) or 0.16 s slower (95 % CI: 0.02, 0.29) 5-year chair stand time. Every one-point increase on the depression scale predicted 0.06 higher log odds of having a worse frailty score 5 years later. Only depression's association with 3 m walk time and chair stands remained significant in models including all four mental health scales. DISCUSSION: Older adults with more depression and to a lesser extent stress symptoms may experience faster physical function decline and worsening frailty. Future work exploring and addressing the mechanisms underlying these relationships are warranted.

Did Resilience and Socioeconomic Status Predict Older Adults' Finding a Silver Lining in COVID?

Background and Objectives: The coronavirus disease 2019 (COVID-19) pandemic stretched our limits-physically, mentally, and economically. However, some older adults report that it led to positive changes. This study aims to understand whether prepandemic resilience, education, or income predicted older adults' subsequent likelihood of reporting positive changes in their lives during the pandemic. Research Design and Methods: We use data from the National Social Life, Heath, and Aging Project, an ongoing panel study with a COVID-19 ancillary supplement (N = 2,650). Results: The study results aligned with the fundamental cause theory. In demographically adjusted models including resilience, education, and income, as well as the effect of the pandemic on employment and a COVID-disruption score, the odds of reporting any positive change were 2.6 times higher for those with an associate degree (p < .01) and 4.7 times higher for those with a bachelor's or higher (p < .001), compared to those without a high school degree. In contrast, neither resilience nor income was significantly associated with endorsing a positive change. We also categorize specific changes thematically coded from open-ended responses and examine their demographic distributions. Categories include spirituality, home organization, hygiene practices, and increased quality time with others. Discussion and Implications: These findings show that older adults with more education could navigate COVID-19 challenges in a way that improved their perspectives on at least one aspect of their lives.

Can Digital Communication Protect Against Depression for Older Adults With Hearing and Vision Impairment During COVID-19?

OBJECTIVES: During social isolation imposed by the coronavirus disease 2019 (COVID-19) pandemic, older adults with impaired hearing and vision potentially experienced more communication challenges, increasing their risk for poor mental health. Digital communication (e.g., video calls, e-mail/text/social media) may alleviate in-person isolation and protect against depression. We addressed this question using data from the National Social Life, Health, and Aging Project, a nationally representative panel study of community-dwelling older adults. METHOD: Two thousand five hundred fifty-eight adults aged 55 and older comprised the analytic sample. Interviewer rating at baseline (2015-2016) classified those with vision impairment (VI) or hearing impairment (HI). Olfactory impairment (OI) was measured by objective testing. During COVID-19 (2020-2021), respondents reported how often they contacted nonhousehold family or friends and whether this was by phone, e-mail/text/social media, video, or in-person. They also quantified the frequency of depressive feelings. RESULTS: Older adults with VI or HI but not OI at baseline were significantly less likely to report regular use of video calling and e-mail/text/social media during the pandemic compared to those without impairment. Sensory impairments did not affect the frequency of phone or in-person communication. Adults with VI or HI were more likely to experience frequent depressive feelings during COVID-19. Video calls mitigated this negative effect of VI- and HI-associated depressive feelings in a dose-dependent manner. DISCUSSION: Among communication modalities, video calling had a protective effect against depressive feelings for people with sensory impairment during social isolation. Improving access to and usability of video communication for older adults with sensory impairment could be a strategy to improve their mental health.

Age differences in mental health from May through August 2020 among U.S. adults: trajectories and the role of pandemic, lifestyle, and social factors.

Objectives: Using nationally representative data among U.S. adults, we assess age differences in changes in mental health both from 2018 to May 2020 and during the pandemic. We also examine factors explaining age differences in mental health.Methods: We analyzed 2018 General Social Survey data (N = 2,348; age 18-89) and three waves of COVID Response Tracking Study data (N = 2,279; age 20-94) spanning May-August 2020. Outcomes included happiness, loneliness, stress, positive affect, and negative affect.Results: U.S. adults reported greater loneliness and less happiness in May 2020 versus 2018. Only loneliness and negative affect changed significantly from May to August 2020, showing declines. Mental health trajectories did not differ significantly by age. Overall, older adults reported lower loneliness, stress, and negative affect than younger adults during 2020. Older age was associated with two factors linked with better mental health: less likelihood of COVID-19 exposure and greater satisfaction with social activities and relationships. However, none of the factors examined herein explained age differences in mental health.Conclusion: Although mental health trajectories during the pandemic were similar across ages, older adults tended to report better mental health than younger adults. Future research should identify factors that explain age differences in mental health that persisted into 2020.

Home alone together: Differential links between momentary contexts and real-time loneliness among older adults from Chicago during versus before the COVID-19 pandemic.

Studies show that older adults were lonelier during versus before the COVID-19 pandemic. This may be due in part to guidelines particularly recommending that older adults stay at home, given their elevated risk of COVID-19 complications. However, little is known about the extent to which this population experienced greater intensity in momentary loneliness during versus before the pandemic, and how this relates to their real-time contexts. Here, we build upon recent findings from the Chicago Health and Activity Space in Real-Time (CHART) study that revealed associations between momentary contexts and loneliness among older adults. We analyze ecological momentary assessments (EMAs) from both pre- and during COVID-19 among a subsample of CHART respondents (N = 110 older adults age 65-88 in 2020). Pre-pandemic data were collected across three waves from April 2018-October 2019, and pandemic data were collected across three additional waves from June-September 2020. Participants responded to smartphone "pings" (five per day for 7 days per wave; N = 5596 and N = 7826 before and during the pandemic, respectively) by reporting their momentary loneliness and context (e.g., home). Findings from multi-level regression models suggest that respondents were lonelier in mid-2020 than in years prior, as well as when at home and alone; they were also more likely to be at home during the pandemic. However, the loneliness-inducing effects of being at home (vs. outside the home) and alone (vs. with others) were weaker during versus before COVID-19. Results provide important nuance to broader trends in loneliness among older adults during the pandemic. Specifically, older adults may have adopted new technologies to support social connectedness. It is also possible that, during a time in which social and physical distancing characterized public health guidelines, these contexts grew less isolating as they became a shared experience, or that publicly shared spaces provided fewer opportunities for social engagement.

Loneliness from Young Adulthood to Old Age: Explaining Age Differences in Loneliness.

Prior research in non-U.S. samples has found a complex nonlinear relationship between loneliness and age. This research has shown that established predictors of loneliness - poor health, being unmarried, living alone, and having infrequent social interactions - help to explain age differences in loneliness. However, while some variables were found to be universal predictors of loneliness at all ages, others were relevant in specific age groups only. In this study, we describe age differences in frequency of loneliness from age 18 to 89+ years in the U.S., and examine age differences in predictors of loneliness from age-specificity and age-normative perspectives. We used cross-sectional nationally representative data from the General Social Survey (N = 2,477) and found a nonlinear relationship between age and loneliness that closely resembles prior research. However, we found no evidence for age-specific predictors of loneliness. Household income, household size, marital status, health, and frequency of socializing were "universal" predictors of loneliness; their associations with loneliness did not differ in strength with age. Our hypothesis that individuals who deviated from age-specific norms would experience more intense loneliness was not supported. Implications for research and loneliness interventions are discussed.

Resilience and Social Support-Giving Scales: Conceptual and Empirical Validation.

OBJECTIVES: This report introduces National Social Life, Health, and Aging Project (NSHAP) data users to 2 new measures-one that assesses older adults' resilience, defined as personal attributes that indicate an adaptive reserve that can be drawn on during adversity, and a second that expands on existing measures of social support received from others to also assess social support given to close others. METHOD: Data from 4,604 NSHAP respondents born 1920-1965 were used to conduct psychometric analyses and validation of our measures of resilience and social support-giving. RESULTS: Scale reliabilities were acceptable for the 4-item resilience scale, and the 2-item scales for family support-giving and friend support-giving. The 2 spousal support-giving items did not cohere well as a single scale. The resilience scale exhibited significant correlations with criterion validation variables, even after adjusting for correlated personality traits. The support-giving scales, and the spousal support-giving items, also exhibited significant correlations with criteria, and with the resilience scale, even after adjusting for social support receipt. Scale means exhibited demographic differences. DISCUSSION: The resilience and social support-giving measures have acceptable psychometric characteristics (with the exception of spousal support-giving), convergent validity, and predictive utility net of related variables. NSHAP data users are offered several suggestions (key points) in the use of these measures in future research.

Analyzing Birth Cohorts With the National Social Life, Health, and Aging Project.

OBJECTIVES: In this article, we seek to provide assistance to those who might want to use data from the National Social Life, Health, and Aging Project (NSHAP) Rounds 1-3 to compare those born in different cohorts. We outline 2 theoretical models that underlie the design of NSHAP-the life course model and the birth cohorts model-and review examples of social and political changes that may have differentially affected cohorts of older adults. Then we present 2 ways that NSHAP data might be used to compare cohorts, show examples of analyses of cohort differences in measures in NSHAP, and discuss features of the data that might affect their use for this purpose. METHODS: Round 3 of the NSHAP added a group of respondents born between 1948 and 1965, the Baby Boom. Together with data from an earlier cohort, interviewed in Rounds 1-3, these data allow analysis of birth cohorts of older adults in the United States. We show examples of some approaches. RESULTS: Our age-matched cohort differences approach included all observations where the respondent was aged 57-67 at the time of interview in different time periods (3,816 observations overall; 2,316 for the Silent Generation cohort and 1,500 for the Baby Boom cohort). Our second approach, age, period, and cohort effects, models the effects of age and birth year using restricted cubic splines, with one model excluding the linear effect of birth year, and the other excluding the linear effect of period. We present examples of analyses using each of these methods. DISCUSSION: We describe features of the NSHAP data of which researchers should be aware when conducting cohort analyses with these data.

Momentary loneliness among older adults: Contextual differences and their moderation by gender and race/ethnicity.

RATIONALE: Studies suggest that loneliness is associated with age. Among older adults, women and Black adults may be at greater risk than men and White adults, respectively. Social and physical contexts are also linked with loneliness. However, little is known about whether and how those of different genders and racial/ethnic groups may experience social and physical contexts differently in terms of their real-time loneliness, and the extent to which these differences may be explained by differential exposure or reactivity to contexts. OBJECTIVE: We examine (1) how momentary loneliness relates to (a) gender and race/ethnicity and (b) social and physical context; and the extent to which gender and racial/ethnic groups may be (2) differentially exposed to loneliness-related contexts and/or (3) differentially reacting to these contexts. METHODS: Using multilevel regressions, we analyzed ecological momentary assessments from 342 community-dwelling U.S. older adults from the Chicago Health and Activity Space in Real Time study. In each of three waves of data collection, smartphone "pings" (five per day for 21 days; n = 12,793 EMAs) assessed loneliness, social context (e.g., alone, with a spouse/partner), and location/physical context (e.g., home, at work). RESULTS: Men consistently reported greater loneliness intensity than women, including after adjusting for momentary physical and social context. Older adults momentarily outside the home and/or not alone were less likely to feel lonely than their counterparts. However, the protective effect of being outside of the home (vs. home) was weaker among women and Black and Hispanic older adults, and the protective effect of being with one or more others (vs. alone) was weaker among women. CONCLUSIONS: Results are among the first to identify contextual effects on real-time loneliness in older adults and how these associations vary by gender and race/ethnicity. Knowledge regarding momentary variation in loneliness may inform future just-in-time adaptive loneliness interventions in older adulthood.

The epidemiology of social isolation and loneliness among older adults during the last years of life.

BACKGROUND: Social isolation and loneliness are critical to the health of older adults, but they have not been well-described at the end of life. OBJECTIVES: To determine the prevalence and correlates of social isolation and loneliness among older adults in the last years of life. DESIGN: Nationally representative, cross-sectional survey. SETTING: Health and Retirement Study, 2006-2016 data. PARTICIPANTS: Adults age > 50 interviewed once in the last 4 years of life (n = 3613). MEASUREMENTS: We defined social isolation using a 15-item scale measuring household contacts, social network interaction, and community engagement, and frequent loneliness using the 3-item UCLA Loneliness Scale. We used multivariable logistic regression to determine their adjusted prevalence by time prior-to-death and by subgroups of interest. RESULTS: Approximately 19% experienced social isolation, 18% loneliness, and 5% both in the last 4 years of life (correlation = 0.11). The adjusted prevalence of social isolation was higher for individuals nearer to death (4 years: 18% vs 0-3 months: 27%, p = 0.05) and there was no significant change in loneliness (4 years: 19% vs 0-3 months: 23%, p = 0.13). Risk factors for both isolation and loneliness included (p < 0.01): low net-worth (Isolation: 34% vs 14%; Loneliness: 29% vs 13%), hearing impairment (Isolation: 26% vs 20%; Loneliness: 26% vs 17%), and difficulty preparing meals (Isolation: 27% vs 19%; Loneliness: 29% vs 15%). Factors associated with loneliness, but not social isolation, included being female, pain, incontinence, and cognitive impairment. CONCLUSIONS: Social isolation and loneliness are common at the end of life, affecting 1 in 4 older adults, but few experience both. Rates were higher for older adults who were poor and experienced functional or sensory impairments. Results can inform clinical efforts to identify and address end-of-life psychosocial suffering and health policies which prioritize social needs at the end of life.

Association of Loneliness With Falls: A Study of Older US Adults Using the National Social Life, Health, and Aging Project.

Objectives: Falls represent a significant cause of morbidity and mortality in older adults, and are more common among those living alone. We aimed to determine if there is an association between loneliness and falls. Methods: Participants were surveyed in three waves separated by 5 years. We used the three-item UCLA Loneliness Scale to measure loneliness. Results: Data from 2337 respondents, with both loneliness and fall data in at least two consecutive waves, were included. Over three waves, 51% respondents reported a fall and 23% reported ≥ two falls. In multivariate analysis, the odds of having ≥ one fall 5 years later increased by a factor of 1.11 per one point increase on the loneliness scale (OR = 1.11, 95% CI 1.04, 1.19; p < .01). Discussion: Lonely older adults have increased odds of future falls. Strategies for combating loneliness in older adults may help reduce fall-related morbidity and mortality.