Sexual Obligation and Perceived Stress: A National Longitudinal Study of Older Adults.

Objectives: This study examines the relationship between sexual obligation and perceived stress among older adults in the United States.Methods: Using longitudinal data from three waves of the National Social Life, Health, and Aging Project (NSHAP), our sample included 1,477 partnered, sexually-active respondents aged 57 to 85 at the baseline survey. We estimated mixed-effects models to test how feelings of sexual obligation are related to changes in perceived stress score.Results: Sexual obligation was positively associated with perceived stress score. The positive relationship between sexual obligation and perceived stress score became stronger over the study period among older men, although it remained relatively stable among older women. Relationship quality only partially explains this relationship.Conclusions: Feeling more obligated to have sex had a significantly greater effect on older men's perceived level of stress over time than older women's. This association became marginally significant after relationship quality was controlled for, suggesting that relationship quality was a key explanatory factor for the gendered patterns in sexual obligation's linkage to stress. These results highlight the importance of understanding gendered sexuality among aging older adults within the context of their relationship.Clinical Implications: Older adults' feelings of sexual obligation can manifest in their daily stress experience. Clinicians seeking to lower older adults', in particular older men's, stress levels should address the context of their sexual life and if they feel obligated to have sex, along with the positive and negative aspects of their relationship, as these could elevate their stress levels over time.

Exploring the contingent associations between functional limitations and depressive symptoms across residential context: a multilevel panel data analysis.

Objectives: This study examines the multilevel relationship between functional limitations and depressive symptoms among community-dwelling US older adults, and how it is moderated by community environmental characteristics (neighborhood fear, social cohesion, structural disadvantage and residential stability).Method: Data come from two waves of National Social Life, Health and Aging Project (NSHAP) collected in 2005/2006 and 2010/2011, consisting of 2,261 individuals aged 57-85 (mean = 68.5; SD = 7.5) nested in 100 regional areas. Two-level hierarchical linear models are fitted to test if and to what extent limited physical capacity and neighborhood measures are interactively related to depressive symptoms.Results: Adjusting for confounders (e.g. age, gender, education, employment status, social support), we find a significant positive relationship between functional limitations and depressive symptoms. At the aggregate level, socially cohesive neighborhoods are negatively related to depression. Several cross-level interactions are also observed. First, the association between poor functional health and depression is greater in neighborhoods perceived to be less safe. It is also stronger in places with more structural disadvantages. Lastly, the physical impairment-depression link is more pronounced where there is higher residential stability, i.e., greater proportion of long-term residents.Conclusion: Our study bridges an important empirical gap in the literature. Prior studies have rarely investigated how the connection between functional limitations and depressive symptoms among older adults is conditioned by neighborhood characteristics. By using multilevel analysis of population-based longitudinal data, we show that physical space (neighborhood community) plays a critical role in understanding this important, yet understudied, relationship.

Does loneliness 'get under the skin'? Associations of loneliness with subsequent change in inflammatory and metabolic markers.

Objectives: To expand existing knowledge about the associations of late-life loneliness with subsequent change in inflammation as well as with metabolic dysregulation, using national representative longitudinal data. The current analysis also explores age, gender, and race differences in these pre-disease pathways. Method: The analysis is based on data from the 2005-06 and 2010-11 waves of the National Social Life, Health, and Aging Project (NSHAP)-a longitudinal survey conducted among a representative sample of community-dwelling Americans aged 57-85. Adjusted logistic regression models were used to examine associations of loneliness with changes in C-reactive protein (CRP), Glycated hemoglobin (HbA1c), Body Mass Index (BMI), Waist Circumference (WC), and metabolic burden. Results: Loneliness was found to be associated with a change for the worse in most of the metabolic bio-markers. Specifically, lonely older adults had 39%-71% higher odds of developing prospective risk levels in three out of the four metabolic bio-markers that were measured: HbA1c, BMI, and metabolic burden. Salient differences by race were found in this regard. Whereas loneliness was not significantly associated with HbA1c risk levels and BMI among the Whites, the prospective risk of high HbA1c was more than five times greater and the risk of high BMI scores was three times greater among Hispanics who experienced loneliness than among the not-lonely Hispanic group. Conclusions: The robust impact of loneliness on prospective changes for the worse in levels of various metabolic bio-markers that are closely associated with morbidity highlights the need for prevention, coping with, and reducing loneliness.

Mediation analysis of relationships between chronic inflammation and quality of life in older adults.

BACKGROUND: This article summarizes exploratory analyses of relationships between chronic inflammation, its physical consequences, and quality of life (QoL). It summarizes key findings from preliminary analyses, and contextualizes these results with extant sociomedical literature to recommend directions for future research. METHODS: Cross-sectional data from the National Social Life, Health, and Aging Project (NSHAP) were used to explore these relationships. Inflammation was assessed via the biomarker C-reactive protein (CRP). We examined associations between CRP levels and two different domains of QoL: happiness with life in general and happiness with intimate relationships. We used ordinal logistic regression with companion OLS models and Sobel-Goodman tests to assess potential mediation, and also conducted a variety of sensitivity analyses. RESULTS: Findings suggest that mediation pathways for the overall association between chronic inflammation and QoL may differ markedly across particular outcome constructs. Specifically, it shows mediation potential for the clinical sequelae of chronic inflammation in frameworks using happiness as an outcome measure, but not in those using relationship satisfaction. Disability appears to mediate the effect of inflammation by 27 %; chronic pain appears to exert a similar mediation effect of 21 %. CONCLUSIONS: Pain and disability linked to chronic inflammation appear to play a small but significant mediating role in the overall reduction in QoL observed among older adults with biomarker evidence of chronic inflammation. We note that these patterns are best framed as dynamic elements of a complex causal fabric, rather than powerful determinants that override other factors contributing to QoL. Hypotheses for further exploration using longitudinal data from the NSHAP are thus offered, pending availability of Wave III data in future years.

Sexual Contact in Childhood, Revictimization, and Lifetime Sexual and Psychological Outcomes.

Using data from the 2010 to 2011 wave of the National Social Life, Health, and Aging Project-a nationally representative probability sample of older U.S. adults-this study queried distinctive linkages of mild and of severe childhood sexual contact with lifetime sexual and psychological outcomes among women and men aged 60-99 years (N = 3283). In addition, we examined stratification of these associations by sexual revictimization (forced sex and/or harassment). Among women, sequelae of childhood contact seemed consistently negative for the mild rather than severe variant-but only in the co-presence of revictimization-a pattern that may have remained obscured in previous analysis of event effects. Men's results suggested lifelong eroticizing but not psychological effects of this early experience-with the co-presence of revictimization potentially enhancing rather than lowering their mental health. Overall, findings appeared to reflect gendered patterns of risk-with mild childhood contact potentially channeling women but not men into revictimization and finally to elevated sexuality and poor mental health in late life. Early sexual experiences should thus be conceptualized not as singular events, but as part of a lifelong career with regularities and rhythms that may influence their pathogenic potential.

Linking the 1940 US Census to the NSHAP: Novel Opportunity to Understand the Effects of Childhood Residential Environment on Cognitive Aging.

OBJECTIVE: The 1940 Census is a valuable resource for understanding various aspects of historical populations in the United States. Recently, the National Social Life, Health and Aging Project (NSHAP) integrated 1940 Census data into its extensive dataset, providing researchers with an opportunity to explore new avenues of life course investigation. We leverage the newly-introduced measures of childhood residential environment and evaluate their potential predictive utility in older adult cognitive functioning net of childhood and adulthood characteristics known to be key risk factors for poor cognition. METHOD: We analyzed 777 respondents who were children in 1940 (age<17) that have been linked to the 1940 U.S. Census. We used childhood geographic location, homeownership status, household composition, and parental nativity as predictors. Cognitive function was measured using the Montreal Cognitive Assessment. RESULTS: Regression analysis showed that growing up in an urban area was associated with better cognitive function, while being born in the South was linked to poorer cognitive function, even after controlling for childhood health, parental education, educational attainment, stroke, and smoking status. Additionally, childhood multigenerational household was associated with better cognitive function, and childhood family size was associated with poorer cognitive function. However, these associations became statistically insignificant with the inclusion of educational attainment. We did not find homeownership and parental nativity to be associated with cognitive function. DISCUSSION: The findings may shed light on the potential long-term effects of childhood circumstances on cognitive aging processes. Implications for current literature and directions for future research are discussed.

Cognitive Impairment Leads to Increased Feelings of Sexual Obligation Among a National Longitudinal Sample of Sexually Active Adults Aged 62 and Older.

BACKGROUND AND OBJECTIVES: We work from a gendered life-course perspective to examine the relationship between cognitive impairment and feelings of sexual obligation among U.S. older adults. RESEARCH DESIGN AND METHODS: Data are drawn from 2 rounds of the National Social Life, Health, and Aging Project (2010/2011 and 2015/2016). The analytic sample includes 575 sexually active respondents aged 62-86 at baseline. Cognitive impairment is measured using a survey-adapted version of the Montreal Cognitive Assessment, with categories of normal, mild cognitive impairment, and dementia. We estimate cross-lagged models to test the potential reciprocal relationships between cognitive impairment and feelings of sexual obligation. RESULTS: Older adults with dementia at baseline had significantly higher odds of sexual obligation 5 years later than their peers with normal cognition at baseline, after adjusting for gender, race/ethnicity, education, income, age, marital status, self-rated health, depression, comorbidities, and sexual obligation at baseline. We find no evidence of a reciprocal relationship, as sexual obligation at baseline did not predict later cognitive status. DISCUSSION AND IMPLICATIONS: Older adults with dementia often remain sexually active after their 60s, and many of them feel obligated to have sex with their partner. Our study highlights the importance of understanding the context of their sexual lives. The quality of their sexual relationship, such as whether they feel a duty to maintain their earlier sexual activity or please their partner, and the health implications of sexual obligation should be considered alongside the increase of older adults with dementia.

Social network-structural position and obesity: Evidence from a national study.

This study expands on research on the social-structural bases of obesity by examining the role played by individuals' positions within their egocentric social networks in shaping body mass index. We argue that individuals' tendency to be a bridge between otherwise unconnected people can affect body mass index. Furthermore, health-specific resources flowing through their networks might interact with this network-structural position to shape this association. Using multivariate analyses of recent nationally representative data on older Americans, we find that occupying a bridging position within a network is negatively related to the likelihood of being obese. Moreover, people who have this bridging potential tend to benefit more from health-related knowledge in their networks than those who do not have it. Our findings underscore the importance of considering social network position and the functional specificity of ties in understanding the structural bases of health problems like obesity. We close by discussing implications of these findings for future work on obesity including potential insights into important health disparities.

Ongoing Refinement and Innovation in the Data Collection Protocols of the Third Round of the National Social Life, Health, and Aging Project.

OBJECTIVES: The third round (R3) of the National Social Life, Health, and Aging Project, a nationally representative, longitudinal survey of community-residing older adults, consisted of 4,777 in-person interviews and 6,100 completed visits to households to identify newly eligible respondents. It revisited respondents from the first rounds (Cohort 1), born in the years 1920 through 1947, and added new respondents (Cohort 2) born in the years 1948 through 1965. Coresidential romantic partners of both cohorts were also eligible. Data collection included in-person questionnaires, up to 11 biomeasures, and a self-administered, postinterview paper questionnaire. METHODS: Questionnaire domains included social network and social support, elder mistreatment, physical health, cognitive function, romantic partners and sexuality, fertility and menopause, mental health, and employment and finances. Biomeasure collection included height, weight, waist circumference, blood pressure and heart rate, timed walk, balance, chair stands, smell, saliva passive drool in a tube (cortisol, dehydroepiandrosterone, estradiol, progesterone, testosterone), dried blood spots (C-reactive protein, Epstein-Barr virus antibodies, high-density lipoprotein cholesterol, hemoglobin, glycosylated hemoglobin [HbA1c], total cholesterol), and accelerometry (sleep patterns and physical activity). A brief questionnaire also collected data on respondents who were deceased or in too poor health to participate. RESULTS: Measures such as response and cooperation rates are provided to evaluate the design and implementation. DISCUSSION: This article describes innovation in the development and implementation of R3, the recruitment of a new cohort of respondents, and fidelity to prior rounds' study design and data collection procedures.

Formal and informal social participation and elder mistreatment in a national sample of older adults.

BACKGROUND/OBJECTIVES: Older adults' susceptibility to mistreatment may be affected by their participation in social activities, but little is known about relationships between social participation and elder mistreatment. DESIGN: Cross-sectional analysis. SETTING/PARTICIPANTS: National probability sample of older community-dwelling U.S. adults interviewed in 2015-2016, including 1268 women and 973 men (mean age 75 years and 76 years, respectively; 82% non-Hispanic white). MEASUREMENTS: Frequency of participation in formal activities (organized meetings, religious services, and volunteering) and informal social activities (visiting friends and family) was assessed by questionnaire. Elder mistreatment included emotional (four items), physical (two items), and financial mistreatment (two items) since age 60. Multivariable logistic regression examined associations between each type of social participation and elder mistreatment among men and women, adjusting for age, race/ethnicity, education, and comorbidity. RESULTS: Forty percent of women and 22% of men reported at least one form of mistreatment (emotional, physical, or financial). Women reporting at least monthly engagement in formal social activities were more likely to report emotional mistreatment (adjusted odds ratio (AOR) 1.59, 95% confidence interval (CI) 1.09-2.33). Among men, monthly organized meeting attendance was associated with increased odds of emotional mistreatment (AOR 1.34, 95% CI 1.01-1.93). Weekly informal socializing was inversely associated with emotional mistreatment (AOR 0.59, 95% CI 0.44-0.78) and financial mistreatment (AOR 0.59, 95% CI 0.42-0.85) among women. CONCLUSION: In this national cohort, older adults who were frequently engaged in formal social activities reported similar or higher levels of mistreatment than those with less frequent organized social participation. Older women with regular informal contact with family or friends were less likely to report some kinds of mistreatment. Strategies for detecting and mitigating elder mistreatment should consider differences in patterns of formal and informal social participation and their potential contribution to mistreatment risk.

Comparing loneliness in England and the United States, 2014-2016: Differential item functioning and risk factor prevalence and impact.

The purpose of this study is to compare mean levels of loneliness, and correlates of loneliness, among older adults in the U.S. and England. Comparisons are conducted after attending to comparability of the loneliness measure between countries based on tests for discriminatory capacity and differential item functioning of the 3-item UCLA Loneliness Scale. Cross-sectional data from the 2015-16 wave of the National Social Life, Health and Aging Project (NSHAP) and the 2014-2015 wave of the English Longitudinal Study on Ageing (ELSA) were analyzed using graded item response models and multiple indicators and multiple causes (MIMIC) models. Risk factors included demographic variables, health characteristics, and social characteristics that were harmonized across surveys. Because of differences in the racial-ethnic composition of the U.S. and England, analyses were limited to white respondents (N = 2624 in NSHAP; N = 6639 in ELSA). Only respondents born 1925-1965 were included in analyses. Discriminatory capacity was evident in each item being able to distinguish a lonely from a nonlonely individual. Differential item functioning (DIF) was evident in country differences in the likelihood of endorsing the "lack companionship" item at a given level of trait loneliness, and in DIF among marital status, education, and gender subgroups that were comparable across countries. Overall loneliness levels are equivalent in England and the U.S. Risk factor impact did not differ between countries, but differences in risk factor prevalence between countries combined to produce a net result of slightly lower mean levels of loneliness in older adults in England than in the U.S. after risk factor adjustment. The fact that the impact of risk factors were similar across countries suggests that evidence of successful interventions in one country could be leveraged to accelerate development of effective interventions in the other.

Volunteering, Subjective Sleep Quality, and Chronic Inflammation: A 5-Year Follow-Up of the National Social Life, Health, and Aging Project.

Studies indicate that the benefits of volunteering may extend to biological risk factors in disease development including chronic inflammation, though the pathway through which volunteer activity predicts chronic inflammation remains unclear. The current project focuses on the link between volunteering and C-reactive protein (CRP) as a measure of chronic inflammation, while paying a particular attention to sleep quality as a pathway. Using panel data from the National Social Life, Health, and Aging Project (N = 1,124), the present study examined whether sleep quality operates indirectly linking volunteer activity and CRP (indirect pathway), compensates for the lack of volunteerism (moderation-compensation), or regulates the benefits of volunteering on CRP (moderation-regulation). The findings suggest sleep quality as a compensatory pathway, in that sufficient sleep buffers the inflammatory effect of lack of volunteerism. The findings show that helping others may be beneficial for the helpers in terms of chronic inflammation and sleep quality as interconnected health outcomes.

Direct and Indirect Pathways From Social Support to Health?

OBJECTIVES: We aimed to investigate potential direct and indirect pathways linking social support and health, while considering mental health and chronic inflammation as inter-related outcomes. The study also contributes to the literature through testing potential bidirectional relationships between social support, mental health, and chronic inflammation. METHODS: This study uses Structural Equation Modeling and two waves of the National Social Life, Health, and Aging Project (NSHAP), including 1,124 community-living older adults aged 57-85 years at Wave 1 (2005). RESULTS: Analyses show that social support influenced mental health indirectly through better self-esteem. Moreover, social support was associated with lower levels of chronic inflammation but chronic inflammation did not influence social support. DISCUSSION: The growing number of older adults with an aging population urgently calls for a greater understanding of factors influencing their physical and mental health. The results of this study demonstrate the importance of social support in older adults' health, while specifically focusing on understudied indirect pathways from social support to health.

Exploring Black-White Differences in the Relationship Between Inflammation and Timing of Menopause.

Understanding the biosocial context of menopausal timing offers insight into social and health inequalities. Prior research on inflammatory chronic conditions suggests that inflammation may predict how early women experience menopause. We explore the ability of black race to moderate the overall relationship between chronic inflammation and timing of menopause. We use data from the National Social Life, Health, and Aging Project on inflammation, age of last menstruation, and race as well as relevant social and medical covariates. We conduct event history modeling to predict age at menopause by inflammatory biomarker levels. Using interaction analysis, we investigate whether being black may shape the overall relationship between inflammation status and menopause timing. Our analyses find no significant statistical interactions between black race and inflammation in predicting menopausal onset. However, we do identify independent correlational relationships between inflammation and black race (r = 0.136) and between menopausal timing and black race (r = -0.129) as well as inflammation (r = -0.138) that emerge as significant in corresponding regression models. We conclude that race probably does not moderate associations between inflammation and menopause. Yet, we also note that the original parameter estimate for black race's impact on menopausal onset (HR = 1.29, p < 0.05) becomes non-significant in a model that includes inflammation (HR = 1.06, p < 0.01). To translate our findings into policy and practice implications, we present alternate conceptualizations of black-white disparity in the inflammation-menopause relationship and recommend future research using mediation modeling.

Does Inflammation Mediate Relationships Between Racial Identity and Onset of Menopause Among US Adults?

We assess how well differences in ethnoracial background may predict timing of menopause among females in the USA and whether or not inflammatory biomarker levels appear to mediate these overall associations. We use data from the National Social Life, Health, and Aging Project (NSHAP) to model apparent net effects from race on menopausal onset, as well as possible mediating influences from the inflammatory biomarker C-reactive protein (CRP). Using continuous time event history analysis, we assess and frame overall relationships between race and menopausal age. We use structural equation modeling to assess potential mediating effects from CRP and to estimate direct and indirect components of these apparent effects. Our findings suggest that on average, black females experience menopause earlier than their peers of other racial backgrounds, and have higher inflammatory biomarker levels. Both black race and higher CRP have negative and significant direct associations with menopausal age. CRP appears to partially mediate the overall association between black race and earlier menopause. This apparent mediation persists with statistical controls for income, education, and body mass index. Our study concludes with recommendations for future research on racial identity, inflammation, and menopausal onset. We focus our recommendations on intersectional forms of inequality that may affect black females in later life.

Psychosocial distress and inflammation: Which way does causality flow?

OBJECTIVES: This study queried causal direction in linkages of inflammation with psychosocial distress. METHODS: Data were from the 2005-2006 and 2010-2011 waves of the U.S. National Social Life, Health, and Aging Project. Inflammation was indicated by C-reactive protein, and distress by depression, anxiety, as well as stress. Autoregressive cross-lagged panel models were used to examine causal direction. RESULTS: Rather than being an outcome of psychosocial distress, inflammation was a predictor of it. Linkages were gender differentiated, with inflammation seeming to induce depression among men but stress among women. DISCUSSION: Contrary to previous literature, inflammation may not be a mechanism through which psychosocial distress gets "under the skin" to cause cardiovascular and metabolic issues. Rather, it may be a node through which social pathologies and life events influence both mental health and physiological problems.

Continuity and innovation in the data collection protocols of the second Wave of the National Social Life, Health, and Aging Project.

BACKGROUND: The second Wave (W2) of the National Social Life, Health, and Aging Project (NSHAP), a nationally representative, longitudinal survey of older adults now between the ages of 62 and 90, conducted approximately 3,400 interviews. Selected coresidential romantic partners as well as W1 panel nonrespondents were selected for W2. Data collection included in-person questionnaires, up to 15 biomeasures, and a post-interview questionnaire. METHODS: A proxy questionnaire also collected data on respondents that were deceased or in too poor health to participate in W2. Biomeasure collection included height, weight, hip and waist circumference, blood pressure, heart rate, and preventricular contraction, timed walk and chair stands, smell, saliva collection using a Salivette (cortisol), saliva passive drool in a tube (dehydroepiandrosterone, estradiol, progesterone, testosterone), dried blood spots (Epstein-Barr virus antibody titers, C-reactive protein, glycosylated hemoglobin, hemoglobin, cholesterol, high-density lipoprotein), whole blood in a microtainer (cytokines), urine (creatinine, vasopressin, oxytocin), Oragene (genotype), respondent-administered vaginal swabs (bacterial vaginosis,yeast, and vaginal cell cytology), and Actiwatch (sleep patterns and activity). RESULTS: Measures, such as response and cooperation rates, are also provided to evaluate design and implementation. DISCUSSION: This article describes both innovation in the development and implementation of W2 as well as fidelity to W1 study design and data collection procedures.

Personality measures in the National Social Life, Health, and Aging Project.

OBJECTIVES: Provide recommendations for researchers on the use of the Big Five personality battery in the National Social Life, Health, and Aging Project (NSHAP), and ensure that the battery does proxy the Big Five. Also, describe the levels of Big Five traits across gender and age. METHOD: We used an Exploratory Structural Equation Model (ESEM) to analyze NHSAP's personality battery, comparing NSHAP with the National Longitudinal Study of Midlife in the United States (MIDUS) and the Health and Retirement Study (HRS). RESULTS: ESEM revealed a 5-factor structure in the NSHAP battery, but with considerable cross-loadings. When these cross-loadings were not included in the model, model fit notably worsened. Reliabilities of Big Five scales were comparable to the HRS and MIDUS, even though NSHAP's battery is shorter. Women were considerably more Agreeable than men, although this gender gap closed among the oldest in the sample (80 years or older). DISCUSSION: Researchers will be able to make use of NSHAP's personality battery to examine a range of social, biological, and psychological factors at older ages, in light of individuals' general traits. We recommend models which allow for cross-loadings.

Sample design, sample augmentation, and estimation for Wave 2 of the NSHAP.

OBJECTIVES: The sample for the second wave (2010) of National Social Life, Health, and Aging Project (NSHAP) was designed to increase the scientific value of the Wave 1 (2005) data set by revisiting sample members 5 years after their initial interviews and augmenting this sample where possible. METHOD: There were 2 important innovations. First, the scope of the study was expanded by collecting data from coresident spouses or romantic partners. Second, to maximize the representativeness of the Wave 2 data, nonrespondents from Wave 1 were again approached for interview in the Wave 2 sample. RESULTS: The overall unconditional response rate for the Wave 2 panel was 74%; the conditional response rate of Wave 1 respondents was 89%; the conditional response rate of partners was 84%; and the conversion rate for Wave 1 nonrespondents was 26%. DISCUSSION: The inclusion of coresident partners enhanced the study by allowing the examination of how intimate, household relationships are related to health trajectories and by augmenting the size of the NSHAP sample size for this and future waves. The uncommon strategy of returning to Wave 1 nonrespondents reduced potential bias by ensuring that to the extent possible the whole of the original sample forms the basis for the field effort. NSHAP Wave 2 achieved its field objectives of consolidating the panel, recruiting their resident spouses or romantic partners, and converting a significant proportion of Wave 1 nonrespondents.