Beyond the Individual: Evidence Linking Neighborhood Trust and Social Isolation Among Community-Dwelling Older Adults.

Loneliness and social isolation are significant public health problems. However, the community and neighborhood factors that contribute to this pandemic are less examined. Adopting a neighborhood resource-based social capital theory, we examined whether neighborhood trust was associated with older Americans' loneliness, number of friends, and perceived support from friends. We analyzed two waves of longitudinal data from the Health and Retirement Study, with a sample of 5,817 Americans aged 50 years and older. We used first difference models to analyze the data and controlled for potential confounders including perceived support from family and health status. Increases in the perception that neighbors are trustworthy and helpful were associated with statistically significant decreases in loneliness and increases in perceived social support from friends over a 4-year period. Findings have implications for conceptualizing social capital and for potential interventions targeting interpersonal trust and reducing loneliness and social isolation.

Social Support From Family and Friends, Educational Attainment, and Cognitive Function.

This study assessed the extent to which associations between perceived and received social support from family and friends and changes in older adults' cognitive function were moderated by educational attainment. Sibling pairs in the Wisconsin Longitudinal Study (WLS) (N = 4,297) completed a survey about social support in 2011 and a cognitive battery in 2011 and 2020. Participants' mean age in 2020 was 80.2 years old. Multilevel linear regressions indicated that perceived, but not received, support from friends was associated with better cognitive function 9 years later. Perceived family support was cognitively advantageous for older adults at most levels of educational attainment. However, among postgraduates, perceived family support was unrelated to cognitive function. That the association between perceived support and cognitive function differs based on educational attainment gives interventionists additional information needed to identify groups of older adults most susceptible to cognitive impairment.

Lifetime Abuse Victimization and Prospective Health Outcomes in Older Adults.

Objectives: The current study examined the associations between lifetime abuse victimization and prospective health outcomes in late adulthood. Methods: Data from 4907 older adults (mean age = 80) from the Wisconsin Longitudinal Study were analyzed. Multivariate analyses examined the associations of lifetime abuse victimization with depression, physical health status, and memory. Results: Greater exposure to lifetime abuse was associated with a significantly higher risk of depression (OR = 1.13, CI: [1.08, 1.19], p < .001) and a greater number of limitations in physical functioning (b = .08, SE = .02, p < .001), but not with memory performance (b = .01, SE = .14, p > .05). Discussion: Our results support the interrelations of interpersonal violence across the life course and the lasting health effects of exposure to lifetime abuse. Findings highlight the need for a life course-based, trauma-informed approach in prevention and intervention programs for older adults.

Age integration in the social convoys of young and late midlife adults.

Homophily on the basis of age is a notable characteristic of social convoys across the life course. Ties to older and younger persons, therefore, are both unusual and potentially provide unique social support resources. This study examined relationships with older, younger, and same-aged non-kin ties among young and late midlife adults. Data came from the University of California Berkeley Social Networks Study (UCNets), a sample of 485 people aged 21-30 and 674 people aged 50-70. A majority of non-kin ties were to people whose age was within 5 years of the participant's own age, although the majority was much larger for young adults (81 %) than late midlife adults (52 %). Younger and older ties often came from different social settings (school, work, religious organizations, and neighborhoods) than same-aged ties, and there were also some cohort differences in the social settings that produced younger, older, and same-aged ties. Younger and older ties also provided different forms of social support than did ties to same-aged persons. Again, the functions of younger and older ties varied by cohort. Implications for life course studies are discussed.

Body Mass Index and Memory Across 18 Years in the Wisconsin Longitudinal Study.

BACKGROUND: Body weight is a modifiable risk factor for dementia, but results have been mixed as to the ages at which normal body weight is markedly preferable to overweight or obesity. This study assessed the association between change in body mass index (BMI) over 2 periods of the life course with change in memory between the ages of 65 and 72 for males and females. METHODS: Participants were 3 637 White high school graduates, born in 1939, from the Wisconsin Longitudinal Study. The statistical analyses were fixed-effects regression models, with moderation terms to test for sex differences. One set of models examined change in BMI between ages 54 and 65, and the other set examined change in BMI between ages 65 and 72. In both cases, cognitive change occurred between ages 65 and 72. RESULTS: Greater increases in BMI were associated with a greater decline in immediate recall for females only, both contemporaneously and following a lag. Increases in BMI were associated with greater contemporaneous-but not lagged-declines in both delayed recall and digit ordering for both males and females. CONCLUSIONS: The present study adds to the evidence that for White, high school educated Americans, weight gain in midlife and young-old age is a risk factor for memory decline. Results vary according to the timing of the weight gain, the aspect of memory measured, and participant sex.

Weighing in: qualitative explorations of weight restoration as recovery in anorexia nervosa.

BACKGROUND: Anorexia Nervosa (AN) continues to capture the public's imagination, centered around physical appearance, particularly weight. Clinical conceptions of AN also emphasize weight. The objective of this study was to explore how individuals with lived AN experience thought about the role of weight in illness and recovery. METHODS: The current study employed a grounded theory approach through qualitative inductive inquiry and analysis of 150 anonymous narratives, exploring firsthand experience of AN and recovery of adult individuals, based in the United States of America. RESULTS: Individuals with AN histories contested intersecting popular cultural and medical presumptions of their health and illness positioned in weight. Respondents indicated that while weight does not measure recovery, it matters to recovery in unanticipated ways. Others' expectations for a low weight served as a gatekeeper to various forms of social and institutional support. Respondents felt that the weight obsessions of other people made it difficult to earn the illness legitimacy to access sufficient care. CONCLUSIONS: Research findings bear implications for future AN research, advocacy, and clinical practice, as respondents pivot research emphasis from weight as a sociocultural motivation for AN, to weight as a sociocultural obstacle to AN recovery.

The manuscript describes the results of inductive, grounded theory analysis of 150 narratives, with the aim to explore what researchers most need to know about the role of weight in anorexia nervosa (AN) and recovery. Sociological theories of AN have focused on the sociocultural context in which people experience AN. We reframe that sociocultural focus using the perspectives of individuals with AN experience, who challenge weight and appearance-based understandings of AN. This study offers important insights surrounding perceived appearances of AN and recovery, motivations for AN, and barriers to healing. Voices of individuals with AN are important to hear to better understand recovery, low rates of treatment completion, and high rates of suicide in AN.

Life course linkages between enriching early-life activities and later life cognition: Evidence from the Wisconsin Longitudinal Study.

Prior research suggests that participation in enriching early-life activities (EELAs) has long-term benefits for cognitive health and aging. This study aims to examine the life course processes underlying these associations by drawing on theoretical models from life course epidemiology. Specifically, we tested sensitive-period effects, social pathways, and selection effects as potential explanations for linkages between greater participation in EELAs and better later life cognition. We drew on data from the Wisconsin Longitudinal Study (WLS), which is among the longest-running cohort studies in the U.S. that has followed graduates (all identified as non-Hispanic White) from Wisconsin high schools since 1957. We used prospective measures of key variables, including information from high school yearbooks, with assessments of cognitive performance at ages 65 and 72. Results from multilevel modeling indicated that greater participation in cognitively oriented extracurricular activities (but not physically nor socially oriented activities) was associated with both better language/executive functioning and memory at age 65. Although the size of these associations was reduced when accounting for other cognitive resources in adolescence (childhood socioeconomic status and adolescent cognitive ability) and in midlife (adult socioeconomic status and formal group participation), there remained small, yet statistically robust, associations. We did not find robust associations between greater EELA engagement and slower rates of decline in cognition between ages 65 and 72, nor did we find evidence of gender differences. Results suggest that for this cohort of older adults, EELA participation is part of life course "protective chains," whereby exposures to assets at one point in the life course increase the likelihood of subsequent exposures, each sequentially and in their own right, toward better later life cognition. We discuss how results support the importance of policies and practices to promote healthy cognitive development among youth for the long-term cognitive health of a rapidly aging U.S. population.

The Importance of Feeling Understood in Marital Conversations about End-of-Life Health Care.

This study investigates processes within marital discussions about end-of-life medical treatment preferences. The associations among marital quality, the perception of having been understood following discussion, and intentions for whom to appoint as a health care surrogate are addressed. Data from 2,969 white married couples in their mid-60s are analyzed. Four-fifths of primary respondents reported that their partners understood their preferences extremely well. Primary respondents' perceptions of high marital quality were associated with feeling extremely well understood. In turn, feeling understood partially mediated the relationship between perceptions of marital quality and the intention to appoint the partner as durable power of attorney for health care (DPAHC). Implications for research on marital communication and quality end-of-life health care are discussed.

"I Want That Life a Lot How on Earth Do I Get That?" Examining Challenges for Men With Barth Syndrome in Their Transitions to Adulthood.

vFor youth with life-limiting chronic illnesses, transitioning to adulthood in line with age-norms may be difficult due to symptom severity and shortened survival. This study explores whether individuals with Barth syndrome (BTHS), a condition uniquely characterized by extreme prognostic uncertainty, experience similar or different challenges compared to youth with other conditions. During focus groups with adults with BTHS (n = 12) and caregivers (n = 13), participants reported that the ability to independently manage one's health condition, the social/emotional impacts of BTHS, and the ability to set goals in the context of future uncertainty challenge their transition to adulthood. This aligns with prior research, indicating that prognostic uncertainty may hinder long-term goal setting in BTHS. Implications of these findings include providing strategies for identifying meaningful alternative goals for individuals with chronic illnesses to target, promoting increased autonomy earlier in youth, and fostering coping strategies to manage non-disease related impacts.

College Selectivity and Later-Life Memory Function: Evidence From the Wisconsin Longitudinal Study.

Research has shown a consistent association between college completion and laterlife cognition. We extend this work by examining whether college selectivity-the achievement level required to gain admission to a college-is associated with memory functioning more than 50 years later. We analyze data from 10,317 participants in the 1957-2011 Wisconsin Longitudinal Study to examine the relationship between college selectivity and later-life memory. Models control for childhood, midlife socioeconomic status, and later-life health and adjust for selection bias. Selective college attendance was associated with small benefits in memory at age of 72 even after accounting for socioeconomic status in both childhood and midlife and later-life health. The results of this study suggest that college selectivity may be an important component of the education-cognitive functioning relationship that has modest implications for intracohort differences in later-life cognition.

Using Mixture Modeling to Construct Subgroups of Cognitive Aging in the Wisconsin Longitudinal Study.

OBJECTIVES: Longitudinal surveys of older adults increasingly incorporate assessments of cognitive performance. However, very few studies have used mixture modeling techniques to describe cognitive aging, identifying subgroups of people who display similar patterns of performance across discrete cognitive functions. We employ this approach to advance empirical evidence concerning interindividual variability and intraindividual change in patterns of cognitive aging. METHOD: We drew upon data from 3,713 participants in the Wisconsin Longitudinal Study (WLS). We used latent class analysis to generate subgroups of cognitive aging based on assessments of verbal fluency and episodic memory at ages 65 and 72. We also employed latent transition analysis to identify how individual participants moved between subgroups over the 7-year period. RESULTS: There were 4 subgroups at each point in time. Approximately 3 quarters of the sample demonstrated continuity in the qualitative type of profile between ages 65 and 72, with 17.9% of the sample in a profile with sustained overall low performance at both ages 65 and 72. An additional 18.7% of participants made subgroup transitions indicating marked decline in episodic memory. DISCUSSION: Results demonstrate the utility of using mixture modeling to identify qualitatively and quantitatively distinct subgroups of cognitive aging among older adults. We discuss the implications of these results for the continued use of population health data to advance research on cognitive aging.

Insufficient Advance Care Planning? Correlates of Planning Without Personal Conversations.

OBJECTIVES: Advance care planning (ACP) typically comprises formal preparations (i.e., living will and/or durable power of attorney for health care) and informal discussions with family members and health care providers. However, some people complete formal documents without discussing them with others. If they become incapacitated, their appointed decision makers may lack guidance on how to interpret or enact their formal wishes. We document the prevalence and correlates of this partial approach to ACP. METHOD: Using multinomial logistic regression models and data from a U.S. sample of 4,836 older adults in the 2018 wave of the National Health and Aging Trends Study (NHATS), this brief report evaluated associations between social integration indicators and the odds of completing (a) both discussions and formal plans (two-pronged ACP), (b) discussions only, (c) no ACP, and (d) formal ACP only (reference category). We adjust for demographic and health characteristics established as correlates of ACP. RESULTS: A minority (15%) of NHATS participants reported formal plans without having discussed them. Indicators of social isolation (e.g., smaller social networks and fewer social activities) increased the odds of engaging in formal planning only compared to two-pronged ACP. Socioeconomic disadvantage and probable dementia reduced the odds of having end-of-life conversations, whether as one's only preparation or in tandem with formal preparations. DISCUSSION: Socially isolated persons are especially likely to do formal planning only, which is considered less effective than two-pronged ACP. Health care professionals should recognize that older adults with few kin may require additional support and guidance when doing ACP.

Perceived Hearing Loss, Social Disengagement, and Declines in Memory.

A growing body of evidence suggests that age-related hearing loss is related to changes in older adults' memory. We test the hypothesis that the association is due to social disengagement following the onset of perceived hearing loss. At ages 65 (2004) and 72 years (2011), 3,986 participants from the Wisconsin Longitudinal Study (WLS) self-reported on hearing problems and several types of social engagement and completed three tests of memory. We estimated fixed effects regression models. Perceived hearing loss was related to significant decline in memory. Declines in frequency of in-person social contact were also associated with declining memory, but there was no evidence of a mechanism wherein reductions in social engagement explained the association between perceived hearing loss and memory decline. We conclude that self-reported hearing loss and social disengagement are likely independent risk factors for memory loss among older adults.

Is College Completion Associated with Better Cognition in Later Life for People Who Are the Least, or Most, Likely to Obtain a Bachelor's Degree?

OBJECTIVES: Drawing on insights from theorizing on cumulative dis/advantage (CDA), we aimed to advance understanding of educational attainment as a protective factor for later-life cognition by examining whether associations between obtaining a bachelor's degree and later-life cognition differ according to individuals' likelihood of completing college based on characteristics in adolescence. METHODS: We conducted a propensity score analysis with data from the Wisconsin Longitudinal Study (WLS). Measures to predict college completion were assessed prospectively in adolescence, and a global measure of later-life cognition was based on cognitive assessments at age 65. RESULTS: College completion by age 25 (vs high school only) was associated with better later-life cognition for both men and women. Among men specifically, associations were stronger for those who were less likely as adolescents to complete college. DISCUSSION: Results indicate the utility of a CDA perspective for investigating the implications of interconnected early life risk and protective factors for later-life cognition, as well as ways in which college education can both contribute to, as well as mitigate, processes of CDA.

Sticks and Stones: Perceived Age Discrimination, Well-Being, and Health Over a 20-Year Period.

This study examines associations between perceived day-to-day age discrimination, positive well-being, and physical health over a 20-year span. Data came from all three waves of the National Survey of Midlife Development in the United States (1995-2014). Generalized structural equation modeling was used to analyze 6,016 observations of 3,102 participants and test associations between age discrimination and (a) psychological well-being and positive affect, and (b) self-rated health, instrumental activities of daily living, and chronic conditions. Associations were also examined between the well-being measures and all three health outcomes. Between-persons and within-persons effects were modeled separately but simultaneously. Both between-persons and within-persons results revealed numerous significant associations between age discrimination and physical health, although results were stronger between-persons. Moreover, hypothesized associations of age discrimination with well-being, and of well-being with physical health, were supported both between- and within-persons. Findings suggest diminished well-being may be one mechanism whereby age discrimination harms health.

Childhood Socioeconomic Status and Later Life Cognition: Evidence From the Wisconsin Longitudinal Study.

Objectives:This study examined childhood socioeconomic status (SES) as a predictor of later life cognition and the extent to which midlife SES accounts for associations. Methods: Data came from 5,074 participants in the Wisconsin Longitudinal Study. Measures from adolescence included parents' educational attainment, father's occupational status, and household income. Memory and language/executive function were assessed at ages 65 and 72 years. Results: Global childhood SES was a stronger predictor of baseline levels of language/executive function than baseline memory. Associations involving parents' education were reduced in size and by statistical significance when accounting for participants' midlife SES, whereas associations involving parental income and occupational status became statistically nonsignificant. We found no associations between childhood SES and change in cognition. Discussion: Findings contribute to growing evidence that socioeconomic differences in childhood have potential consequences for later life cognition, particularly in terms of the disparate levels of cognition with which people enter later life.

School Context in Adolescence and Cognitive Functioning 50 Years Later.

To advance understanding of how social inequalities from childhood might contribute to cognitive aging, we examined the extent to which school context in adolescence was associated with individuals' cognitive performance more than 50 years later. Using data from 3,012 participants in the Wisconsin Longitudinal Study (WLS), we created an aggregate measure of school-level structural advantage, with indicators such as the proportion of teachers who had at least five years of teaching experience and spending per pupil. Multilevel models indicated that secondary school advantage was associated with small benefits in language/executive function at age 65 among older adults who had lower academic achievement in secondary school. Findings suggest that school advantage is a developmental context of adolescence that has modest implications for intracohort differences in aspects of later life cognition.

The Role of Current Family Relationships in Associations Between Childhood Abuse and Adult Psychological Functioning.

OBJECTIVES: Childhood abuse has long-term negative effects on adult psychological well-being. This study examined whether and how adults with a history of childhood abuse may experience poor psychological functioning partly due to aspects of current family relationships. METHOD: We estimated multilevel mediation models using 3 waves of longitudinal data from 3,487 participants in the study of Midlife Development in the United States. Outcomes measured included negative affect, life satisfaction, and psychological well-being. We included aspects of family relationships as mediators: perceived support, perceived strain, frequency of contact, and hours of providing instrumental and emotional support. RESULTS: Multilevel mediation models showed that childhood verbal and physical abuse negatively affected diverse aspects of family relationships in later adulthood (i.e., less perceived support, more perceived strain, less frequent contact, and fewer hours of providing instrumental support). We also found that less perceived support and more family strain significantly mediated the associations between childhood abuse and all 3 psychological functioning outcomes. DISCUSSION: Childhood abuse appears to hinder perceived availability of family support in adulthood, which may undermine the psychological functioning of adults with a history of childhood abuse. To improve their psychological health, interventions should focus on facilitating supportive and functional family relationships.

Extracurricular Involvement in High School and Later-Life Participation in Voluntary Associations.

Objectives: Scholars have identified participation in voluntary associations as a central component of civic engagement for younger and older people alike. However, there has been little longitudinal examination of how such participation potentially fluctuates across multiple periods of the life course, as well as the extent to which involvement in youth is associated with participation in later life. Method: We used data from the Wisconsin Longitudinal Study-which is among the oldest and most comprehensive cohort studies in the United States to date. Respondents reported their voluntary association participation periodically between the ages of approximately 36 and 72 years. Data collected from high school yearbooks were used to examine whether histories of extracurricular involvement in adolescence were associated with patterns of voluntary association participation across adulthood. Results: Results from growth curve models indicated that, on average, voluntary association participation peaked in midlife and declined into the 60s and early 70s. Nevertheless, levels of participation were consistently higher among individuals with greater extracurricular involvement in high school, and the rate of decline in participation from midlife to young-old age was also less steep for these individuals. Discussion: Findings support conceptualizing voluntary association participation among older adults as part of life course trajectories of participation, with influences originating as early as adolescence.