"I'm not a risk taker": Risk Perceptions of Nursing Home Residents With Dementia.

BACKGROUND: Persons living with Alzheimer's disease and related dementia (ADRD) in nursing homes (NH) are often excluded from conversations about their health/safety. These omissions impinge on personhood and the rights to have care preferences heard and honored. While persons with ADRD maintain the ability to communicate their preferences long after their decision-making abilities are affected, little is known about how persons with ADRD understand the risks associated with their preferences. METHODS: As part of a larger focused ethnography, in-depth interviews and an adapted risk propensity questionnaire explored the risk perceptions of NH residents with ADRD (N=7) associated with their preferences for care and activities of daily living. RESULTS: Residents generally self-identified as risk avoiders (M=3.2±1.84) on the risk propensity scale and were able to rate risk associated with preferences described within 5 thematic categories: 1) participation in decision-making, 2) risk awareness, 3) paying attention to safety, 4) reliance on nursing home staff and family, and 5) impacts on quality of life and quality of care. DISCUSSION: Results suggest NH residents with ADRD can express risk surrounding their preferences and should be encouraged to participate in discussions about their health and safety.

Increased frequency of light physical activity during midlife and old age buffers against cognitive declines.

Although it is well established that moderate-to-vigorous physical activity (MVPA) buffers against declines in cognitive health, less is known about the benefits of light physical activity (LPA). Research on the role of LPA is crucial to advancing behavioral interventions to improve late life health outcomes, including cognitive functioning, because this form of physical activity remains more feasible and amenable to change in old age. Our study examined the extent to which increases in LPA frequency protected against longitudinal declines in cognitive functioning and whether such a relationship becomes pronounced in old age when opportunities for MVPA are typically reduced. We analyzed 9-year data from the national Midlife in the United States Study (n = 2,229; Mage = 56 years, range = 33-83; 56% female) using autoregressive models that assessed whether change in LPA frequency predicted corresponding changes in episodic memory and executive functioning in middle and later adulthood. Increases in LPA frequency predicted less decline in episodic memory (ß = 0.06, p = .004) and executive functioning (ß = 0.14, p < .001) over the 9-year follow-up period, even when controlling for moderate and vigorous physical activity. Effect sizes for moderate and vigorous physical activity were less than half that observed for LPA. Moderation models showed that, for episodic memory, the benefits of increases in LPA frequency were more pronounced at older ages. Findings suggest that increases in LPA over extended periods of time may help slow age-related cognitive declines, particularly in later life when opportunities for MVPA are often diminished.

Purpose in Life and Cognitive Function: Evidence for Momentary Associations in Daily Life.

Background and Objectives: Purpose in life is associated with healthier cognitive outcomes in older adulthood. This research examines within-person dynamics between momentary purpose and cognitive function to provide proof of concept that increases in purpose are associated with better cognitive performance. Research Design and Methods: Participants (N = 303; 54% female; Mage = 51.71, SD = 7.32) completed smartphone-based momentary assessments of purpose and short cognitive tasks 3 times a day for 8 days. Results: In moments when participants felt more purpose driven than their average, they had faster processing speed (b = -1.240, SE = 0.194; p < .001), independent of person, temporal, and contextual factors and practice effects. Momentary purpose was unrelated to visual working memory performance (b = -0.001, SE = 0.001; p = .475). In contrast to purpose, momentary hedonic affect (e.g., happiness) was unrelated to momentary cognition. Discussion and Implications: Feeling more momentary purpose may support faster processing speed in daily life. Such evidence provides stage 0 support for a purpose-based intervention for healthier cognition, which may be particularly useful in middle adulthood and the transition to older adulthood before the onset of cognitive impairment.

Preserving What Matters: Longitudinal Changes in Control Over Interpersonal Stress and Noninterpersonal Stress in Daily Life.

OBJECTIVES: Theoretical perspectives on aging suggest that when people experience declines in later life, they often selectively focus on maintaining aspects of their lives that are most meaningful and important to them. The social domain is one of these selected areas. The current study examines people's reports of control over their daily stressors over 10 years, predicting that the declines in control that are often observed in later life will not be observed for stressors involving interpersonal conflict and tensions with social partners. METHODS: Adults ranging from 35 to 86 years old at baseline (N = 1,940), from the National Study of Daily Experiences, reported control over interpersonal and noninterpersonal daily stressors across 8 consecutive days at 2 time points, about 10 years apart. RESULTS: Findings from multilevel models indicate that for noninterpersonal stressors, perceived control decreased over time. In contrast, perceived control over interpersonal conflicts and tensions remained robust over time. No cross-sectional baseline age differences were found for levels of interpersonal and noninterpersonal stressor control. DISCUSSION: Results are consistent with socioemotional selectivity and underscore the importance of interpersonal relationships in later adulthood. Understanding how people select and preserve certain aspects of control in their daily life can help guide efforts toward maximizing gains and minimizing losses in domains that matter most to people as they grow older.

Pretreatment relationship characteristics predict outcomes from an uncontrolled trial of intensive, multicouple group PTSD treatment.

Cognitive behavioral conjoint therapy for posttraumatic stress disorder (CBCT for PTSD; Monson & Fredman, 2012) is associated with improvements in patients' and partners' mental health and relationship satisfaction. Some pretreatment relationship characteristics have predicted CBCT for PTSD outcomes for patients, but findings were limited to a single community sample consisting primarily of female patients with male partners. A better understanding of whether pretreatment relationship characteristics predict outcomes in other patient populations and whether there are partners who may be particularly responsive to couple therapy for PTSD could optimize treatment matching. This study investigated whether pretreatment partner accommodation and relationship satisfaction predicted patient and partner treatment outcomes from an uncontrolled trial of an abbreviated, intensive, multicouple group version of CBCT for PTSD conducted with 24 active-duty military or veteran couples (96% male patients/female partners). In general, changes in patients' PTSD and comorbid symptoms and relationship satisfaction did not vary by pretreatment partner accommodation or patients' own pretreatment relationship satisfaction. In contrast, pretreatment relationship characteristics predicted partner outcomes. Partners who engaged in higher levels of accommodation pretreatment and partners who reported lower levels of pretreatment relationship satisfaction experienced greater declines in psychological distress following treatment. Also, partners who began the study relationally distressed exhibited significant increases in relationship satisfaction following treatment, whereas those who were not relationally distressed did not. Findings suggest that improvements generally do not vary by pretreatment relationship characteristics for patients, whereas partners who begin treatment with elevated relationship risk factors may be especially likely to experience improvement across outcomes. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Does the Cognitive Change Index Predict Future Cognitive and Clinical Decline? Longitudinal Analysis in a Demographically Diverse Cohort.

Background: The Cognitive Change Index (CCI) is a widely-used measure of self-perceived cognitive ability and change. Unfortunately, it is unclear if the CCI predicts future cognitive and clinical decline. Objective: We evaluated baseline CCI to predict transition from normal cognition to cognitive impairment in nondemented older adults and in predementia groups including, subjective cognitive decline, motoric cognitive risk syndrome, and mild cognitive impairment. Different versions of the CCI were assessed to uncover any differential risk sensitivity. We also examined the effect of ethnicity/race on CCI. Methods: Einstein Aging Study participants (N = 322, Mage = 77.57±4.96, % female=67.1, Meducation = 15.06±3.54, % non-Hispanic white = 46.3) completed an expanded 40-item CCI version (CCI-40) and neuropsychological evaluation (including Clinical Dementia Rating Scale [CDR], Montreal Cognitive Assessment, and Craft Story) at baseline and annual follow-up (Mfollow - up=3.4 years). CCI-40 includes the original 20 items (CCI-20) and the first 12 memory items (CCI-12). Linear mixed effects models (LME) and generalized LME assessed the association of CCI total scores at baseline with rate of decline in neuropsychological tests and CDR. Results: In the overall sample and across predementia groups, the CCI was associated with rate of change in log odds on CDR, with higher CCI at baseline predicting faster increase in the odds of being impaired on CDR. The predictive validity of the CCI broadly held across versions (CCI-12, 20, 40) and ethnic/racial groups (non-Hispanic black and white). Conclusions: Self-perception of cognitive change on the CCI is a useful marker of dementia risk in demographically/clinically diverse nondemented samples. All CCI versions successfully predicted decline.

Cardiac autonomic function is preserved in young adults with major depressive disorder.

The prevalence of major depressive disorder (MDD) is highest in young adults and contributes to an increased risk of developing future cardiovascular disease (CVD). However, the underlying mechanisms remain unclear. The studies examining cardiac autonomic function that have included young unmedicated adults with MDD report equivocal findings, and few have considered the potential influence of disease severity or duration. We hypothesized that heart rate variability (HRV) and cardiac baroreflex sensitivity (BRS) would be reduced in young unmedicated adults with MDD (18-30 yr old) compared with healthy nondepressed young adults (HA). We further hypothesized that greater symptom severity would be related to poorer cardiac autonomic function in young adults with MDD. Heart rate and beat-to-beat blood pressure were continuously recorded during 10 min of supine rest to assess HRV and cardiac BRS in 28 HA (17 female, 22 ± 3 yr old) and 37 adults with MDD experiencing current symptoms of mild-to-moderate severity (unmedicated; 28 female, 20 ± 3 yr old). Neither HRV [root mean square of successive differences between normal heartbeats (RMSSD): 63 ± 34 HA vs. 79 ± 36 ms MDD; P = 0.14] nor cardiac BRS (overall gain, 21 ± 10 HA vs. 23 ± 7 ms/mmHg MDD; P = 0.59) were different between groups. In young adults with MDD, there was no association between current depressive symptom severity and either HRV (RMSSD, R2 = 0.004, P = 0.73) or cardiac BRS (overall gain, R2 = 0.02, P = 0.85). Taken together, these data suggest that cardiac autonomic dysfunction may not contribute to elevated cardiovascular risk factor profiles in young unmedicated adults with MDD of mild-to-moderate severity.NEW & NOTEWORTHY This study investigated cardiac autonomic function in young unmedicated adults with major depressive disorder (MDD). The results demonstrated that both heart rate variability and cardiac baroreflex sensitivity were preserved in young unmedicated adults with MDD compared with healthy nondepressed young adults. Furthermore, in young adults with MDD, current depressive symptom severity was not associated with any indices of cardiac autonomic function.

Epigenetic Age Acceleration and Chronological Age: Associations With Cognitive Performance in Daily Life.

DNA methylation-derived epigenetic clocks offer the opportunity to examine aspects of age acceleration (ie, the difference between an individual's biological age and chronological age), which vary among individuals and may better account for age-related changes in cognitive function than chronological age. Leveraging existing ambulatory cognitive assessments in daily life from a genetically diverse sample of 142 adults in midlife, we examined associations between 5 measures of epigenetic age acceleration and performance on tasks of processing speed and working memory. Covarying for chronological age, we used multilevel models to examine associations of epigenetic age acceleration (Horvath 1, Horvath 2, Hannum, PhenoAge, and GrimAge clocks) with both average level and variability of cognitive performance. Positive age acceleration (ie, epigenetic age greater than chronological age) was associated with poorer mean processing speed (Horvath 1 and 2) and working memory (GrimAge). Higher chronological age was also associated with poorer mean processing speed and working memory performance. Further, positive age acceleration was generally associated with greater intraindividual variability in working memory and processing speed tasks, whereas being chronologically older was associated with less intraindividual variability. Although further work is needed, our results indicate age acceleration effects have comparable or greater size as those for chronological age differences, suggesting that epigenetic age acceleration may account for additional risk and interindividual variation in cognitive performance above chronological age.

Perceived control across the adult lifespan: Longitudinal changes in global control and daily stressor control.

Perceived control is an important psychosocial resource for health and well-being across the lifespan. Global control (i.e., overall perceived control) decreases over time in studies following people every few years to upwards of 10 years. Changes across wider intervals of the lifespan, however, have yet to be examined. Further, how perceived control changes for specific aspects of daily life, such as stressors, remains comparatively less clear. Using data from the Midlife in the United States National Study of Daily Experiences (NSDE, N = 1,940, M = 56.25 years, SD = 12.20, 57% female), we examined longitudinal changes in global control across 20 years and daily stressor control across 10 years. Global control was assessed in the first wave of the NSDE (∼1996). In follow-up waves, conducted in ∼2008 and ∼2017, participants again not only reported their global control but also reported their perceived control over stressors they experience across 8 consecutive days. Longitudinal analyses revealed differential change trajectories for global control across 20 years and stressor control across 10 years (ps < .001). Global control declined for younger and older adults but stayed relatively stable for individuals in midlife. The rate of decline in daily stressor control was steeper than the decline in global control and did not vary by age at baseline. In addition, declines were amplified among individuals with higher global control at baseline. Results suggest that daily stressor control is a specific aspect of control beliefs that follows a different rate of change than global control. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Physical activity and cognitive function: moment-to-moment and day-to-day associations.

BACKGROUND: The beneficial effect of acute physical exercise on cognitive performance has been studied in laboratory settings and in long-term longitudinal studies. Less is known about these associations in everyday environment and on a momentary timeframe. This study investigated momentary and daily associations between physical activity and cognitive functioning in the context of everyday life. METHODS: Middle-aged adults (n = 291, aged 40-70) were asked to wear accelerometers and complete ecological momentary assessments for eight consecutive days. Processing speed and visual memory were assessed three times per day and self-rated evaluations of daily cognition (memory, thinking, and sharpness of mind) were collected each night. The number of minutes spent above the active threshold (active time) and the maximum vector magnitude counts (the highest intensity obtained) before each cognitive test and at a daily level were used as predictors of momentary cognitive performance and nightly subjective cognition. Analyses were done with multilevel linear models. The models were adjusted for temporal and contextual factors, age, sex, education, and race/ethnicity. RESULTS: When participants had a more active time or higher intensity than their average level within the 20 or 60 minutes prior to the cognitive test, they performed better on the processing speed task. On days when participants had more active time than their average day, they rated their memory in the evening better. Physical activity was not associated with visual memory or self-rated thinking and sharpness of mind. CONCLUSIONS: This study provides novel evidence that outside of laboratory settings, even small increases in physical activity boost daily processing speed abilities and self-rated memory. The finding of temporary beneficial effects is consistent with long-term longitudinal research on the cognitive benefits of physical activity.

Individual differences in frequency and impact of daily memory lapses: results from a national lifespan sample.

BACKGROUND: Everyday memory problems are believed to increase with age, leading many researchers to focus on older ages when examining reports of memory lapses. However, real world memory lapses are ubiquitous across the adult lifespan, though less is known about the types of problems and their impacts at younger ages. The current study examined occurrence and impacts of memory lapses using daily diaries in a broad age range and whether characteristics of lapses varied across age, gender, or education level. METHODS: Using an 8-day daily diary protocol, 2,018 individuals (ages 25-91) provided reports of their experiences of two types of daily memory lapses (retrospective and prospective) as well as the impact those lapses had on their emotional and functional well-being that day. Using multilevel modeling, we examined the likelihood of reporting memory lapses and their impacts on daily life and whether these depended on age, gender, or education level. RESULTS: Participants reported lapses on approximately 40% of days; retrospective memory lapses were significantly more likely than prospective lapses. Older ages and higher education level were related to greater likelihood of reporting retrospective lapses. Women (compared to men) were more likely to report prospective memory lapses. Women also tended to report greater impacts of their memory lapses. Lower education levels were related to greater impacts of memory lapses compared to higher education levels. Interestingly, age was not related to impacts of lapses. DISCUSSION: Our results indicate that memory lapses are common across the lifespan and that those individuals more likely to report lapses are not necessarily those that experience the greatest impacts of those lapses on daily life. Additional work is needed to understand the daily experience of memory lapses and how they differentially affect individuals regardless of age, gender, and education. CONCLUSIONS: Memory lapses are an important aspect of daily life across the lifespan and require measurement in an individual's real-world environments. Better measurement of these experiences will allow the development of more sensitive measures of changes in cognitive functioning that may impact an individual's ability to live independently.

Testing an Intervention to Improve Posthospital Outcomes in Persons Living With Dementia and Their Family Care Partners.

Background and Objectives: Hospitalized persons living with dementia are at risk for functional decline, behavioral symptoms of distress, and delirium, all persisting in the postacute period. In turn, family care partners (FCPs) experience increased anxiety and lack of preparedness for caregiving, compounding existing strain and burden. Family-centered Function-focused Care (Fam-FFC) purposefully engages FCPs in assessment, decision-making, care delivery, and evaluation of function-focused care during and after hospitalization (within 48 hours of discharge, weekly telephone calls for a total of 7 additional weeks, then monthly for 4 months). The objective of this study was to test the efficacy of Fam-FFC. Research Design and Methods: A cluster randomized controlled trial included 455 dyads of persons living with dementia and FCPs in 6 medical units in 3 hospitals. Patient outcomes included return to baseline physical function, behavioral symptoms of distress, depressive symptoms, and delirium severity. Family care partner measures included preparedness for caregiving, anxiety, strain, and burden. Results: Multilevel level modeling demonstrated that the likelihood of returning to baseline function across time for Fam-FFC participants was twice that of the control group by the end of 6 months (OR = 2.4, p = .01, 95% CI 1.2-4.7). Family-centered Function-focused Care was also associated with fewer symptoms of distress (b = -1.1, SE = 0.56, p = .05) but no differences in the amount of moderate physical activity, depressive symptoms, and delirium severity. Preparedness for caregiving increased significantly only from 2 to 6 months (b = 0.89, SE = 0.45, d = 0.21, overall p = .02) in the intervention group, with no group differences in anxiety, strain, and burden. Discussion and Implications: Family-centered Function-focused Care may help prevent some of the postacute functional decline and behavioral symptoms in hospitalized persons living with dementia. Further research is needed to promote sustained improvements in these symptoms with more attention to the postacute needs of the care partner.

Older adults' self-reported prospective memory lapses in everyday life: Connections to inflammation and gender.

OBJECTIVE: Limited research has focused on the association between inflammatory markers and features of subjective cognitive functioning among older adults. The present work examined links between inflammation and a specific subjective cognitive report: prospective memory (PM), or our memory for future intentions, such as attending an appointment or taking medication. METHOD: We assessed self-reported PM lapses using a two-week ecological momentary assessment (EMA) diary protocol via smartphone as well as levels of blood-based inflammation among 231 dementia-free older adults (70-90 years, 66% women) enrolled in the Einstein Aging Study. RESULTS: Overall, PM lapses were largely unrelated to inflammatory markers. However, a significant gender difference was observed in the link between basal levels of interleukin (IL)-8 and PM lapses: higher levels of basal IL-8 were associated with more PM lapses among men (estimate = 0.98, 95%CI: [0.43, 1.53], p < .001) but not women (estimate = -0.03, 95%CI: [-0.45, 0.39], p = .826). No other significant relationships between PM lapses and basal or stimulated (ex vivo) cytokine levels (IL-1ß, IL-4, IL-6, IL-8, IL-10, tumor necrosis factor-alpha [TNF-α]) or C-reactive protein (CRP) emerged. CONCLUSION: Elevated levels of IL-8 in older men may possibly be an early indicator of neurodegeneration that relates to PM performance. Future studies should continue to examine PM and inflammation across genders to identify possible mechanisms through which these constructs may indicate neurodegeneration and dementia risk.

How Does Exposure to Dementia Relate to Subjective Cognition? A Systematic Review.

Background and Objectives: Subjective cognitive decline (SCD) may be indicative of future objective cognitive decline. However, factors other than objective cognitive performance may influence SCD. This review addresses whether family history or close, nonfamilial exposure to dementia is associated with self-reported SCD. Research Design and Methods: Searches were conducted in PubMed, PsycINFO, Web of Science, and the Dissertations and Theses database. Eligible articles included measures of self-reported cognition for community-dwelling middle-aged or older adults (40+ years) not diagnosed with dementia, and who had either a family history of dementia, a family member, spouse, or close friend with dementia. The quality of evidence was evaluated using the LEGEND Appraisal Tool. Evidence was synthesized narratively. Results: A total of 32 articles were included, with 28 rated as good quality. Across studies, the relationship between dementia exposure and SCD was inconsistent. A significant association between exposure and SCD was found in 6 studies; however, 17 reviewed studies found no evidence of a relationship. The remaining 9 studies found mixed associations. Modifying factors that could potentially influence these associations were exploratorily identified among studies to provide context to our results. These factors included dementia worry, emotional closeness, and measurement sensitivity. Discussion and Implications: Findings of this review suggest that both first-degree relatives and spouses of persons with dementia may have an increased likelihood of reporting SCD, although the current heterogeneity in definitions of exposure to dementia and SCD may influence these findings. In addition to the relationship between dementia exposure and SCD, future research should examine potential modifiers, including meaning attributed to exposure, as identifying how these perceptions affect cognition may promote early intervention.

Within-person associations between alcohol use and memory lapses among middle-aged and older adults.

INTRODUCTION: Alcohol use has been linked to impairment in both short- and long-term measures of objective memory. However, limited research has investigated the association between alcohol use and subjective memory in everyday life. The study purpose was to investigate within- and between-person associations between daily alcohol use and prospective (i.e., forgetting an intended task) and retrospective (i.e., forgetting something learned in the past) memory lapses among middle-aged and older adults. METHODS: Participants (n = 925; Mage = 55.2) were non-abstaining adults from the Midlife in the United States (MIDUS) study or the MIDUS Refresher who participated in an 8-day telephone diary asking about their daily experiences. RESULTS: Multilevel models revealed that within-individuals, heavier-than-usual alcohol use (i.e., having more drinks than one's daily average number of drinks) was associated with greater odds of reporting any memory lapses (odds ratio [OR] 1.06; 95% confidence interval [CI] 1.01, 1.12), while associations at the between-person level were nonsignificant (OR 1.07; 95% CI 0.99, 1.16). When assessing retrospective and prospective lapses separately, alcohol use was only associated with prospective lapses and only at the between-person level (OR 1.10; 95% CI 1.01, 1.19). Finally, alcohol use was unassociated with reported irritation or interference from memory lapses (p > 0.05). DISCUSSION AND CONCLUSIONS: Heavier-than-usual alcohol use may have acute effects on daily memory functioning. Future studies should assess how alcohol use relates to an individual's ability to meet daily cognitive demands, as these findings may have critical implications for harm reduction efforts targeting daily functioning among older adults.

A latent profile analysis of blackout drinking behavior among young adults.

BACKGROUND: Blackout drinking, or alcohol-induced memory loss during a drinking occasion, is associated with additional negative alcohol-related outcomes. Brief motivational interventions targeting higher-risk alcohol use behavior have largely ignored blackout drinking. Including personalized information on blackout drinking could maximize intervention impact. To move toward incorporating content on blackout drinking in prevention and intervention materials, it is imperative to understand individual-level differences in blackout drinking. The current study aimed to identify latent profiles of young adults based on blackout drinking experiences and to examine person-level predictors and outcomes associated with profile membership. METHOD: Participants were 542 young adults (ages 18-30) who reported 1+ past-year blackout episodes. Fifty-three percent of participants were female and 64% identified as non-Hispanic/Latinx white. RESULTS: Four latent profiles were identified based on blackout drinking frequency, blackout intentions, blackout expectancies, and age of first blackout: Low-Risk Blackout (35% of the sample), Experimental Blackout (23%), At-Risk Blackout (16%), and High-Risk Blackout (26%). Profiles varied by demographic, personality, and cognition- and alcohol-related behaviors. Notably, At-Risk and High-Risk Blackout profiles had the highest alcohol use disorder risk, most memory lapses and cognitive concerns, and highest levels of impulsivity traits. CONCLUSIONS: Findings support the multifaceted nature of blackout drinking experiences and perceptions. Profiles were differentiated across person-level predictors and outcomes, which identify potential intervention targets and individuals at heightened alcohol-related risk. A more comprehensive understanding of the heterogeneity of blackout drinking characteristics may be useful for early detection and intervention of problematic alcohol use predictors and patterns among young adults.

Relationship Support and Strain among Sexual Minority Women: Changes across Cohorts from 1995 to 2013.

Sexual minority women are granted more rights today than ever before. However, it is unclear how the relationships of sexual minority women have changed compared to previous decades. Additionally, a large body of work has focused on women's same-sex (e.g., lesbian) relationships without accounting for the unique experiences of bisexual women in their relationships. The current study utilizes two national samples of heterosexual, lesbian, and bisexual women to address these gaps, one cohort from 1995 and a second from 2013. We performed analyses of variance (ANOVAs) to examine the effects of sexual orientation, cohort, and their interaction on relationship support and strain. On average, relationships exhibited higher quality in 2013 than in 1995. When considered together, lesbian and bisexual women exhibited higher relationship support than heterosexual women in 1995, but not 2013. Importantly, examining lesbian and bisexual women as separate groups revealed that bisexual women's relationships were on average characterized by lower support and higher strain than lesbian women. Simple effects indicated that bisexual women in 2013 were at the highest risk for diminished relationship quality, while lesbian and heterosexual women's relationships were either stable or improved in this more recent cohort. Implications for clinical practice as well as future research on sexual minority women is discussed.

Patient-provider communication about cognition and the role of memory concerns: a descriptive study.

BACKGROUND: Early identification of cognitive impairment is an important part of health promotion in aging. However, many older adults do not seek help for cognitive problems until their ability to function independently is substantially impacted. The purpose of this descriptive study was to explore older adults' experiences with patient-provider communication specific to cognition as well as compare barriers and facilitators between those with and without memory concerns. METHODS: We conducted an online survey with individuals aged 65 + years (n = 409; mean age = 71.4(4.73); 54% female; 79% non-Hispanic White), purposively sampled to include those with and without memory concerns. Questionnaires included measures of subjective memory decline (SMD), memory concerns, past healthcare experiences, as well as open-ended questions regarding patient-provider communication about cognition. Content analysis was used to code open-ended responses. Logistic regression was used to examine differences in facilitators and barriers to communication among three groups: no SMD (n = 130), SMD without memory concerns (n = 143), and SMD with memory concerns (n = 136). RESULTS: Only 16.6% of participants reported discussing cognition with a healthcare provider. Of the remaining 83.4%, approximately two-thirds would be open to such discussions in certain circumstances, most frequently if they had worsening memory problems. Over half of participants reported that their provider had never offered cognitive testing. Compared to the no SMD and SMD without memory concerns groups, participants reporting SMD with memory concerns were more likely to: (1) discuss cognition if their healthcare provider initiated the conversation, and (2) avoid discussions of cognitive problems due to fears of losing independence. CONCLUSIONS: We found that most participants, including those reporting SMD with memory concerns, had never discussed cognition with their healthcare providers. Patient-reported barriers and facilitators to communication about cognition differed in several areas based on SMD status and the presence or absence of memory concerns. Consideration of these differences can guide future efforts to improve early identification of subtle cognitive changes that would benefit from further monitoring or intervention.

Daily implementation of health-protective behaviors and family life during the early months of the COVID-19 pandemic.

The coronavirus disease (COVID-19) pandemic has necessitated the use of health-protective behaviors (HPB), such as social distancing, staying at home, frequent handwashing, and wearing facemasks to mitigate the transmission of disease. An investigation of interpersonal costs associated with the use of HPB can help inform strategies to promote their sustained implementation. This study examined the daily associations between the implementation of HPB and family functioning and assessed moderation by coparenting quality, economic strain, and the number of days that state-level stay-at-home policies had been in effect, during the early days of the pandemic. Mothers and fathers from 155 families with children who were 9 years old, on average, completed daily reports of HPB, parental stress, and family relationship quality over eight consecutive days in April or May of 2020. Hierarchal linear models showed that HPB was associated with increased levels of parental stress and interparental conflict. Negative coparenting relations exacerbated the next-day association between HPB and interparental conflict. HPB was also associated with increased levels of parent-child and interparental closeness, but these linkages dissipated for families who had spent more days under state-level stay-at-home policies. Although crucial for public health, the implementation of HPB may have detrimental short-term effects on daily family life. Family support and interventions are necessary to minimize the psychosocial burden of these important public health measures and increase their sustained adherence.

Associations between blackout drinking and self-reported everyday cognition among young adults.

INTRODUCTION: Blackout drinking, or alcohol-induced memory loss during at least some part of a drinking occasion, is common among young adults and associated with negative alcohol-related consequences. One potential unique effect of blackout drinking episodes could be prolonged, general difficulties forming new memories through impairments in encoding, storage, or retrieval. The current study examined preliminary associations between blackout drinking and self-reported everyday cognitive functioning (i.e., memory lapses, non-memory cognitive difficulties, cognitive concerns) among a sample of young adults. We also examined the moderating role of key factors linked to blackout drinking: gender and frequent simultaneous alcohol and cannabis use. METHODS: Participants (N = 479; 53% women) were aged 18-30 who reported past-year blackout drinking. Participants completed an online survey through Qualtrics Panels. RESULTS: More frequent blackout experiences were found to be significantly related to more memory lapses, more non-memory cognitive difficulties, and more cognitive concerns even after controlling for typical alcohol use behavior. Men and individuals reporting frequent simultaneous use indicated stronger relationships between blackout drinking frequency and cognitive outcomes. DISCUSSION AND CONCLUSIONS: Findings add to the growing body of literature supporting the uniquely hazardous effects of blackout drinking and identify individuals at heightened risk of harms. Given that associations between blackout drinking frequency and everyday cognitive functioning were identified even among a young adult sample suggests that blackout drinking may be a risky behavior that links to poorer cognitive functioning.