Search

Studies have suggested that adults with gallbladder disease have increased risk of type 2 diabetes. This prospective cohort study assessed the risk of type 2 diabetes in postmenopausal women with gallbladder disease. Data from women enrolled in the Women’s Health Initiative from 1993 to 2005, aged 50–79 years (mean = 63.2; standard deviation, 7.2), were analyzed. Cox proportional hazards regression models were used to estimate the risk of type 2 diabetes associated with gallbladder disease. There were 8,896 new cases of type 2 diabetes after 1,025,486 person-years of follow-up. Gallbladder disease was significantly associated with type 2 diabetes (hazard ratio = 1.52; 95% confidence interval (CI): 1.38,1.67). The observed risk of type 2 diabetes in women with both gallbladder disease and central obesity was 37% higher than expected (relative excess risk due to interaction = 0.37, 95% CI: 0.11,0.63) on the additive scale. The hazard ratios for type 2 diabetes associated with gallbladder disease were 1.25 (95% CI: 1.19,1.32) and 1.48 (95% CI: 1.34,1.63) in women with and without central obesity, respectively, on the multiplicative scale. Results of this study support further studies to determine whether interventions in older women with gallbladder disease would reduce type 2 diabetes risk, especially among those with central obesity. Future research should examine the pathophysiological basis of the association between gallbladder disease and type 2 diabetes.

Background Older women have faced significant disruptions in social connections during the coronavirus disease 2019 pandemic. Whether loneliness increased or whether a change in loneliness from pre- to intrapandemic period was associated with mental health during the pandemic is unknown. Methods Older women (n = 27 479; mean age 83.2 [SD: 5.4] years) completed surveys in mid-2020, including questions about loneliness, living arrangements, changes in social connections, and mental health. Loneliness was also previously assessed in 2014–2016. We examined whether loneliness changed from the pre- to intrapandemic period and explored factors associated with this change. In multivariable models, we investigated the association of changes in loneliness and social connections with mental health. Results Loneliness increased from pre- to intrapandemic levels. Factors associated with worsening loneliness included older age, experiencing stressful life events, bereavement, histories of vascular disease and depression, and social connection disruptions. Factors associated with a decrease in loneliness included identifying as Black, engaging in more frequent physical activity, being optimistic, and having a higher purpose in life. A 3-point increase in loneliness scores was associated with higher perceived stress, higher depressive, and higher anxiety symptoms. Social connection disruptions showed modest or no associations with mental health. Conclusions Loneliness increased during the pandemic in older women and was associated with higher stress, depressive, and anxiety symptoms. Our findings point to opportunities for interventions targeting lifestyle behaviors, well-being, disrupted social connections, and paying closer attention to those with specific medical and mental health histories that may reduce loneliness and improve mental health.

Caregiving has been associated with an increased risk for poor mental health and quality of life, particularly when caregiving circumstances are stressful (1,2). Stressful conditions are often related to more frequent provision of care and to greater disability in the care recipient (2,3). The psychological and physical stresses of caregiving may lead to declines in physical health over time, and therefore, greater frequency of care provision may indicate greater risk for poor outcomes. However, studies have also reported a beneficial effect of caregiving on physical health, cognition, and mortality (4–8). Caregiving may promote the maintenance of physical function through regular physical activity as part of daily care activities (5,9) and may provide positive psychological benefits (10–12). Studies of informal caregiving have traditionally been grounded in stress frameworks that predict poor health outcomes from provision of caregiving and greater caregiving burden (13). In contrast, the Healthy Caregiver Hypothesis posits that individuals who become and remain caregivers may be healthier and more physically robust, resulting in better health outcomes for caregivers when compared with noncaregivers (4,9); this may be particularly true for those caregivers providing more frequent care. Longitudinal research is necessary to address this possibility (14). Declines in physical function in older adults, particularly women, have been shown to negatively affect health and increase risk of disability (15,16). Assessments of the relation of caregiving with changes in physical function over time are sparse and findings are inconsistent (5,9,17,18). Low-frequency, but not high-frequency caregiving, was associated with poorer overall physical functioning over 2 years in a biracial cohort of older women (9). Caregiving was also associated with incident mobility limitations in older white, but not black, adults (5). In contrast, caregiving was not associated with walking speed over 1 year follow-up (17) or with incident frailty in a biracial cohort of adults aged 65 years or older (18). These inconsistencies may be due to different outcome measures, sample selection, or to the observational nature of these studies. Studies using population-based samples have generally found a smaller effect of caregiving on health outcomes relative to convenience samples (2). Further, as caregiving status is not randomized, differences in baseline characteristics of the caregivers and noncaregivers may lead to biased effect estimates (19). In addition, differential attrition through death or drop-out by caregiver status may affect estimates (20). We assessed changes in performance-based measures of physical functioning among noncaregivers and low- or high-frequency caregivers over 6 years using data from the Women’s Health Initiative clinical trials. We used weighting procedures to mitigate some of the inherent biases in observational studies of exposures such as caregiving that cannot be evaluated in intervention studies, including differences in baseline characteristics and in loss to follow-up (19,20). We hypothesized a decline in physical function among caregivers relative to noncaregivers after accounting for selection and attrition by weighting.

BACKGROUND Examine the independent and joint effects of geriatric syndromes (GS) and cardiometabolic diseases (CMDs) on functional impairment. METHODS Cross-sectional analysis of baseline data from the Women's Health Initiative, including 62,829 women aged 65 years or older. GS (urinary incontinence, falls, and depression measured by the shortened Center for Epidemiological Studies-Depression scale/Diagnostic Interview Schedule screening instrument) and CMD (coronary artery disease, coronary heart failure, and diabetes) were self-reported. Physical and social functioning and general health subscales of the Short Form-36 dichotomized at the median for the study sample were used to assess functional impairment. Additive interaction between burden of GS and CMD was assessed using logistic regression models. RESULTS Forty-three percent of women had at least one GS; 14.1% had at least one CMD; and 6.9% had at least one of each. Compared with women with no GS or CMD, women with one or more GS but no CMD were as likely to have physical functioning impairments (odds ratio [OR] = 1.79; 95% confidence interval [CI] = 1.73, 1.86) as those with CMD alone (OR = 1.97; CI = 1.84, 2.10). The association with social functioning was stronger for GS alone (OR = 2.10; CI = 2.02, 2.18) compared with CMD (OR = 1.60; CI = 1.50, 1.71). The association with general health was stronger for CMD alone (OR = 2.15; CI = 2.01, 2.29) compared with GS (OR = 1.68; CI = 1.62, 1.74). Significant interactions between GS and CMD were observed for all functional measures with 20%-30% of observed ORs attributable to additive interaction. CONCLUSION GSs alone are associated with functional impairment in older women; the association is stronger in the presence of even one CMD.