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Objectives "SuperAgers" are generally defined as people 80+ years old with episodic memory performance comparable to those 20 years younger. Limited knowledge exists to describe characteristics of SuperAgers, with even less known about Hispanic SuperAgers. Methods We examined indicators of cognitive, physical, and psychological resilience in relation to the likelihood of being a SuperAger using data from 2 population-based studies of Hispanic older adults (Puerto Rican Elderly: Health Conditions [PREHCO] Study; Health and Retirement Study [HRS]). SuperAgers were defined as (1) ≥80 years old, (2) recall scores ≥ the median for Hispanic respondents aged 55–64, and (3) no cognitive impairment during the observation period. Overall, 640 PREHCO participants and 180 HRS participants were eligible, of whom 45 (7%) and 31 (17%) met SuperAging criteria. Results Logistic regressions controlling for age and sex demonstrated that higher education (PREHCO: odds ratio [OR] = 1.20, p  < .001; HRS: OR = 1.14, p  = .044) and fewer instrumental activities of daily living limitations (PREHCO: OR = 0.79, p  = .019; HRS: OR = 0.58, p  = .077; cognitive resilience), fewer activities of daily living limitations (PREHCO: OR = 0.72, p  = .031; HRS: OR = 0.67, p  = .068; physical resilience), and fewer depressive symptoms (PREHCO: OR = 0.84, p  = .015; HRS: OR = 0.69, p  = .007; psychological resilience) were associated with SuperAging, although not all results reached threshold for statistical significance, presumably due to low statistical power. Additionally, known indicators of physical health (e.g. chronic conditions and self-rated health) did not relate to SuperAging. Discussion Increasing access to education and recognizing/treating depressive symptoms represent potential pathways to preserve episodic memory among older Hispanic adults. [ABSTRACT FROM AUTHOR]

Background and Objectives Sleep disorders often predict or co-occur with cognitive decline. Yet, little is known about how the relationship unfolds among older adults at risk for cognitive decline. To examine the associations of sleep disorders with cognitive decline in older adults with unimpaired cognition or impaired cognition (mild cognitive impairment and dementia). Research Design and Methods A total of 5,822 participants (M age = 70) of the National Alzheimer's Coordinating Center database with unimpaired or impaired cognition were followed for 3 subsequent waves. Four types of clinician-diagnosed sleep disorders were reported: sleep apnea, hyposomnia/insomnia, REM sleep behavior disorder, or "other." Cognition over time was measured by the Montreal Cognitive Assessment (MoCA) or an estimate of general cognitive ability (GCA) derived from scores based on 12 neuropsychological tests. Growth curve models were estimated adjusting for covariates. Results In participants with impaired cognition, baseline sleep apnea was related to better baseline MoCA performance (b  = 0.65, 95% confidence interval [95% CI] = [0.07, 1.23]) and less decline in GCA over time (b  = 0.06, 95% CI = [0.001, 0.12]). Baseline insomnia was related to better baseline MoCA (b  = 1.54, 95% CI = [0.88, 2.21]) and less decline in MoCA over time (b  = 0.56, 95% CI = [0.20, 0.92]). Furthermore, having more sleep disorders (across the 4 types) at baseline predicted better baseline MoCA and GCA, and less decline in MoCA and GCA over time. These results were only found in those with impaired cognition and generally consistent when using self-reported symptoms of sleep apnea or insomnia. Discussion and Implications Participants with sleep disorder diagnoses may have better access to healthcare, which may help maintain cognition through improved sleep. [ABSTRACT FROM AUTHOR]

Objectives: Nursing home (NH) residents' capacity to communicate deteriorates with dementia. Consequently, NHs with high proportions of people living with dementia (PLWD) may receive fewer resident complaints, and/or investigating complaints may be challenging. We assessed NHs' proportion of PLWD in relation to total and substantiated complaints. Methods: Data were from the ASPEN Complaints/Incident Tracking System and the Certification and Survey Provider Enhanced Reports (2017). NHs (N = 15,499) were categorized based on high (top-10%), medium (middle-80%), and low (bottom-10%) dementia prevalence. Negative binomial Poisson regression assessed complaint patterns in relation to NHs' high/low (vs. medium) proportions of PLWD and other facility/resident characteristics. Results: Compared to NHs with medium-dementia prevalence, NHs with low proportions of PLWD had higher total (average marginal effect [AME] = 0.16, p < 0.001) and substantiated (AME = 0.30, p < 0.001) complaints, whereas NHs with high proportions of PLWD had fewer total (AME= −0.07; p < 0.05) and substantiated (AME= −0.11, p < 0.05) complaints. Also, NHs' profit status, chain-affiliation, size, staffing, and resident ethnicity were associated with total and substantiated complaints. Conclusion: The association between high proportions of PLWD and lower NH complaints suggests either that these NHs have higher overall quality or that complaints are underreported. Regardless, surveyors and families may need more involvement in monitoring higher dementia prevalence facilities. [ABSTRACT FROM AUTHOR]

Background: Retirement represents a crucial transitional period for many adults with possible consequences for cognitive aging. We examined trajectories of cognitive change before and after retirement in Black and White adults. Methods: Longitudinal examination of up to 10 years (mean = 7.1 ± 2.2 years) using data from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study–a national, longitudinal study of Black and White adults ≥45 years of age. Data were from 2226 members of the REGARDS study who retired around the time when an occupational ancillary survey was administered. Cognitive function was an average of z‐scores for tests of verbal fluency, memory, and global function. Results: Cognitive functioning was stable before retirement (Estimate = 0.05, p = 0.322), followed by a significant decline after retirement (Estimate = −0.15, p < 0.001). The decline was particularly pronounced in White (Estimate = −0.19, p < 0.001) compared with Black (Estimate = −0.07, p = 0.077) participants, twice as large in men (Estimate = −0.20, p < 0.001) compared with women (Estimate = −0.11, p < 0.001), highest among White men (Estimate = −0.22, p < 0.001) and lowest in Black women (Estimate = −0.04, p = 0.457). Greater post‐retirement cognitive decline was also observed among participants who attended college (Estimate = −0.14, p = 0.016). While greater work complexity (Estimate = 0.92, p < 0.05) and higher income (Estimate = 1.03, p < 0.05) were related to better cognitive function at retirement, neither was significantly related to cognitive change after retirement. Conclusion: Cognitive functioning may decline at an accelerated rate immediately post‐retirement, more so in White adults and men than Black adults and women. Lifelong structural inequalities including occupational segregation and other social determinants of cognitive health may obscure the role of retirement in cognitive aging. [ABSTRACT FROM AUTHOR]

Innovative memory paradigms have been introduced to capture subtle memory changes in early Alzheimer's disease (AD). We aimed to examine the associations between different indexes of the challenging Memory Binding Test (MBT) and hippocampal volume (HV) in a sample of individuals with subjective cognitive decline (SCD; n = 50), amnestic mild cognitive impairment (aMCI) due to AD (n = 31), and cognitively normal (CN) older adults (n = 29) recruited from the Czech Brain Aging Study, in contrast to traditional verbal memory tests. Both MBT free and cued recall scores in immediate and delayed recall conditions were associated with lower HV in both SCD and aMCI due to AD, whereas in traditional verbal memory tests only delayed recall scores were associated with lower HV. In SCD, the associations with lower HV in the immediate recall covered specific cued recall indexes only. In conclusion, the MBT is a promising test for detecting subtle hippocampal-associated memory decline during the predementia continuum. [ABSTRACT FROM AUTHOR]

Background: Nursing home (NH) residents are vulnerable to mortality after natural disasters. We examined NH residents' excess all-cause mortality associated with Hurricane Harvey, a unique disaster with long-lasting flooding effects. We also explored how mortality differed between short-stay and longstay residents and by chronic conditions. Methods: We conducted a retrospective observational study of Texas NH residents, comparing 30- and 90-day mortality among residents exposed to Hurricane Harvey in August 2017 to residents not exposed in the same location and time period during the previous 2 years. Data came from the Minimum Data Set Assessments and the Medicare Beneficiary Summary File. We used linear probability models to examine the association between hurricane exposure and mortality, adjusting for resident demographics, clinical acuity, and NH fixed effects. Models were stratified by short-stay and long-stay status. We also described differences in mortality by residents' chronic conditions. Results: In 2017, 18,479 Texas NH residents were exposed to Hurricane Harvey. Exposure to Hurricane Harvey was not significantly associated with 30-day mortality. However, 7.6% (95% CI: 7.2, 7.9) of long-stay residents died 90 days after exposure to Harvey, compared to 6.3% (95% CI: 6.0, 6.7) during 2015. Apparently, this effect was driven by chronic obstructive pulmonary disease (COPD) as approximately 9.2% of these residents died within 90 days after Harvey landing compared to 7.2% in 2015 (p < 0.01). Conclusions: Hurricane exposure appears to have significant consequences for mortality among long-stay NH residents, which appear to materialize over the long-term (90 days post-hurricane in our study) and may not be apparent immediately (30 days post-hurricane in our study). NH residents with COPD may be particularly vulnerable to increased mortality risk following hurricane exposure. The results highlight the need to pay special attention to mortality risk in NH residents, particularly those with COPD, following hurricane exposure. [ABSTRACT FROM AUTHOR]

Background: Dementia syndrome is one of the most devastating conditions in older adults. As treatments to stop neurodegeneration become available, accurate and timely diagnosis will increase in importance. One issue is that cognitive performance sometimes does not match the corresponding level of neuropathology, affecting diagnostic accuracy. Cognitive reserve (CR), which can preserve cognitive function despite underlying neuropathology, explains at least some variability in cognitive performance. We examined the influence of CR proxies (education and occupational position) on the relationship between hippocampal or total gray matter volume and cognition. Methods: We used data from the Czech Brain Aging Study. Participants were clinically confirmed to be without dementia (n = 457, including subjective cognitive decline and amnestic mild cognitive impairment) or with dementia syndrome (n = 113). Results: For participants without dementia, higher education magnified the associations between (a) hippocampal volume and executive control (b = 0.09, p = 0.033), (b) total gray matter volume and language (b = 0.12, p < 0.001), and (c) total gray matter volume and memory (b = 0.08, p = 0.018). Similarly, higher occupational position magnified the association between total gray matter volume and (a) attention/working memory (b = 0.09, p = 0.009), (b) language (b = 0.13, p = 0.002), and (c) memory (b = 0.10, p = 0.013). For participants with dementia, the associations between hippocampal (b = -0.26, p = 0.024) and total gray matter (b = -0.28, p = 0.024) volume and visuospatial skills decreased in magnitude with higher education. Conclusion: We found that the association between brain volume and cognitive performance varies based on CR, with greater CR related to a stronger link between brain volume and cognition before, and a weaker link after, dementia diagnosis. [ABSTRACT FROM AUTHOR]

Study Objectives: Sleep is a modifiable risk factor for cardiovascular conditions. Holistic examination of within-person, multidimensional sleep patterns may offer more detailed information about the sleep-cardiovascular condition link, including who is more vulnerable to both. This study aimed to identify common sleep phenotypes in adulthood, establish the validity of the phenotypes in relation to cardiovascular conditions, and explore sociodemographic and background characteristics of the phenotypes. Methods: Across two independent samples of adults (N1 = 4600; N2 = 2598) from the Midlife in the United States Study, latent class analysis (LCA) extracted sleep phenotypes using five key self-reported sleep dimensions. Log-binomial regression was used to determine whether sleep phenotypes differentially predicted cardiovascular conditions, adjusting for known risk factors. LCA with covariates was used to compare sociodemographic characteristics of the identified sleep phenotypes. Results: Four sleep phenotypes were identified consistently across the two samples: good sleepers, nappers, dissatisfied/inefficient sleepers, and irregular sleepers. Compared to good sleepers (reference), dissatisfied/inefficient sleepers exhibited a higher risk of cardiovascular conditions in both samples (RRSample1: 29%, RRSample2: 53%) and consisted of relatively more racial/ethnic minorities. Nappers exhibited a higher risk of cardiovascular conditions in one sample (RRSample1: 38%) and consisted of more women and older adults. Irregular sleepers exhibited no significantly different cardiovascular risk and were relatively younger. Conclusions: Common sleep phenotypes in adulthood exhibit differential risks for cardiovascular conditions. Cooccurring sleep dissatisfaction and inefficiency, in particular, may relate to increased risk of cardiovascular conditions. Certain sociodemographic groups (racial minorities, women, older adults) disproportionately fit within high-risk sleep phenotypes. [ABSTRACT FROM AUTHOR]

Background: Musculoskeletal pain alters physiological function, which may be evidenced as early as middle age. Previous research has concluded that middle-aged adults are a high-risk group for musculoskeletal pain and report functional limitations similar to older adults. However, few studies have examined the relationships between musculoskeletal pain and physical function, using objective performance measures in a sample of racially and socioeconomically diverse adults. Thus, this study examined musculoskeletal pain in relation to physical function in middle-aged (30-64 years) White and Black adults and investigated whether the relationship varied by sociodemographic characteristics.Methods: This cross-sectional examination incorporated data from the Healthy Aging in Neighborhoods of Diversity across the Life-Span Study. Participants (n = 875) completed measures of musculoskeletal pain and objective measures of physical performance (ie, lower and upper body strength, balance, and gait abnormalities). Physical performance measures were standardized to derive a global measure of physical function as the dependent variable.Results: Approximately, 59% of participants identified at least 1 pain sites (n = 518). Multivariable regression analyses identified significant relationships between greater musculoskeletal pain and poorer physical function (β = -0.07, p = .031), in mid midlife (β = -0.04, p = .041; age 40-54) and late midlife (β = -0.05, p = .027; age 55-64).Conclusions: This study observed that musculoskeletal pain was associated with poorer physical function within a diverse group of middle-aged adults. Future research should longitudinally explore whether chronic musculoskeletal pain identified at younger ages is associated with greater risk for functional limitation and dependence in later life. [ABSTRACT FROM AUTHOR]

Objectives:Hospitalizations for physical health problems can cause great mental health challenges. We examined risk factors and expenditures for early readmission for inpatient psychiatric treatment following a hospitalization for a non-psychiatric condition. Method:We used eight years of Florida Medicaid enrollment and claims data for (FY 2003–2011) as well as data obtained from the Florida Center for Health Information and Policy Analysis, Inpatient Hospital Database, to identify episodes of hospitalization for all Medicaid-enrolled older adults. There were a total of 781,660 index hospitalizations for non-behavioral health-related hospitalizations, 2690 (0.3%) of which resulted in a behavioral health-related rehospitalization within 30 days after discharge. We estimated the relative risk of early rehospitalization using Cox proportional hazards regression. Results:Participants (n= 276,254) were 76.8 ± 8.3 years old; 68.4% female and 43.5% White. As expected, we found that having a preexisting behavioral health disorder (including severe mental illness, substance use disorder, or dementia) greatly increased the risk of readmission. We also found that male gender increased the risk of early readmission. Older age, being Black and having one or more comorbid medical conditions as identified by the Charlson Index were associated with substantially reduced risk. Conclusion: Identifying hospitalized patients with psychiatric conditions, as well as those who are relatively young within this age group, male, White rather than Black or of other race, alcohol abusers, and those without comorbid conditions, and providing them with care to address their behavioral needs may help in efforts to reduce early rehospitalizations for psychiatric conditions. [ABSTRACT FROM AUTHOR]

Background: Survival reflects the accumulation of multiple influences experienced over the life course. Given the amount of time usually spent at work, the influence of work may be particularly important. We examined the association between work-related stress in midlife and subsequent mortality, investigating whether sense of coherence modified the association. Methods: Self-reported work-related stress was assessed in 1393 Swedish workers aged 42-65 who participated in the nationally representative Level of Living Survey in 1991. An established psychosocial job exposure matrix was applied to measure occupation-based stress. Sense of coherence was measured as meaningfulness, manageability and comprehensibility. Mortality data were collected from the Swedish National Cause of Death Register. Data were analyzed with hazard regression with Gompertz distributed baseline intensity. Results: After adjustment for socioeconomic position, occupation-based high job strain was associated with higher mortality in the presence of a weak sense of coherence (HR, 3.15; 1.62-6.13), a result that was stronger in women (HR, 4.48; 1.64-12.26) than in men (HR, 2.90; 1.12-7.49). Self-reported passive jobs were associated with higher mortality in the presence of a weak sense of coherence in men (HR, 2.76; 1.16-6.59). The link between work stress and mortality was not significant in the presence of a strong sense of coherence, indicating that a strong sense of coherence buffered the negative effects of work-related stress on mortality. Conclusions: Modifications to work environments that reduce work-related stress may contribute to better health and longer lives, especially in combination with promoting a sense of coherence among workers. [ABSTRACT FROM AUTHOR]

Objectives: We examined the influence of postretirement leisure activity on longitudinal associations between work complexity in main lifetime occupation and trajectories of cognitive change before and after retirement. Methods: Information on complexity of work with data, people, and things, leisure activity participation in older adulthood, and four cognitive factors (verbal, spatial, memory, and speed) was available from 421 individuals in the longitudinal Swedish Adoption/Twin Study of Aging. Participants were followed for an average of 14.2 years (SD = 7.1 years) and up to 23 years across eight cognitive assessments. Most of the sample (88.6%) completed at least three cognitive assessments. Results: Results of growth curve analyses indicated that higher complexity of work with people significantly attenuated cognitive aging in verbal skills, memory, and speed of processing controlling for age, sex, and education. When leisure activity was added, greater cognitive and physical leisure activity was associated with reduced cognitive aging in verbal skills, speed of processing, and memory (for cognitive activity only). Discussion: Engagement in cognitive or physical leisure activities in older adulthood may compensate for cognitive disadvantage potentially imposed by working in occupations that offer fewer cognitive challenges. These results may provide a platform to encourage leisure activity participation in those retiring from less complex occupations. [ABSTRACT FROM AUTHOR]

Objective: This study aims to examine the real-world effectiveness of a computer-assisted cognitive behavioral therapy (CBT) protocol relative to treatment as usual (TAU) among anxious children presenting at community mental health centers.Methods: One hundred children (7-13 years) with clinically significant anxiety were randomized to receive either 12 weekly computer-assisted CBT sessions or TAU for an equivalent duration. Assessments were conducted by independent evaluators at screening/baseline, midtreatment, posttreatment, and 1-month followup (for computer-assisted CBT treatment responders).Results: There were significant between-group effects favoring the computer-assisted CBT condition on primary anxiety outcomes. Thirty of 49 (61.2%) children randomized to computer-assisted CBT responded to treatment, which was superior to TAU (6/51, 11.8%). Relative to TAU, computer-assisted CBT was associated with greater reductions in parent-rated child impairment and internalizing symptoms, but not child-rated impairment and anxiety and depressive symptoms. Treatment satisfaction and therapeutic alliance in those receiving computer-assisted CBT was high. Treatment gains in computer-assisted CBT responders were maintained at 1-month followup.Conclusions: Within the limitations of this study, computer-assisted CBT is an effective and feasible treatment for anxious children when used in community mental health centers by CBT-naïve clinicians. [ABSTRACT FROM AUTHOR]

Background We examined indicators of job strain in relation to level and change in episodic memory in the years leading up to as well as following retirement. Methods Our analyses centre on 3779 individuals from the nationally representative Health and Retirement Study (baseline age 57.3 years) who reported gainful employment in an occupation for 10+ years prior to retirement, and who were assessed for episodic memory performance over up to 20 years (median 8 waves over 16 years). We used ratings from the Occupational Information Network (O*Net) to score occupations for job control and job demands, and to measure job strain (job demands/job control). Results Controlling for sociodemographic characteristics, depressive symptoms, and cardiovascular disease, less job control and greater job strain were not significantly associated with change in episodic memory in the period leading up to retirement, but were associated with significantly poorer episodic memory at retirement and an accelerated rate of decline in episodic memory following retirement. The results did not vary for men and women or by self-employment status. Conclusions Job strain expressed mainly as low job control is linked to poorer episodic memory at retirement and more decline after retirement. Job characteristics appear to have implications for cognitive ageing independent of relevant confounds. [ABSTRACT FROM AUTHOR]

Objective. To examine whether occupational complexity of working with data or people, and cognitive or social leisure activity at midlife predicted cognition in advanced old age. Methods. We used 810 eligible participants from Longitudinal Study of Living Conditions of the Oldest Old, a Swedish nationally representative study of individuals aged 77+ with cognitive assessments (an abridged version of the Mini-Mental State Exam) administered in 1992 and 2002 and linked to information about their midlife occupation and leisure activities collected in 1968 and 1981. A bootstrapping technique was applied to examine the direct and interactive associations of occupational complexity and leisure activity with late-life cognition. Results. Controlling for demographic and health-related factors from childhood, midlife, and late life, we found that greater work complexity, both with people and with data, and greater participation in cognitive or social leisure activities independently related to better late-life cognitive scores. The complexity-cognition link was moderated by leisure activity such that the cognitive benefit related to the complexity of work—especially complexity of working with people—was rendered insignificant when participation in leisure activities—especially social activities—was above average. Discussion. Results are discussed in terms of using work complexity to compensate for lack of leisure activity as well as in terms of promoting leisure engagement to compensate for long-term cognitive disadvantage imposed by working in less challenging occupations. [ABSTRACT FROM PUBLISHER]

Objectives To determine if individuals with adolescent idiopathic scoliosis (AIS) present with significant cerebellar dysfunction and hypermobility when compared with healthy controls. Methods International Cooperative Ataxia Rating Scale (ICARS), pendulum reflexes, and 10 hypermobility tests according to Janda were assessed in 11 subjects with radiologically confirmed structural idiopathic scoliosis and in 11 individuals without scoliosis. Results Idiopathic scoliosis group scored significantly worse in gait and posture ICARS subscale (P = 0.014) and in total ICARS (P = 0.021). There was no significant difference in pendulum reflexes between the groups. Comparing with the healthy controls, the AIS group presented with significant hypermobility in head rotation (P = 0.038) and forward bend tests (P = 0.041). Total evaluation of all 10 hypermobility tests approached statistical significance (P = 0.051) with the AIS group, demonstrating greater hypermobility. Conclusions Signs of cerebellar dysfunction and hypermobility were identified in subjects with idiopathic scoliosis, which may be an important aspect in rehabilitation. [ABSTRACT FROM AUTHOR]

This article identifies the arrest trajectories of youth from ages 12 through 24 years old and tests hypotheses derived from Moffitt's developmental taxonomic theory of crime concerning the impact of various emotional disturbances on the specific trajectories of the youth involved. The study uses exclusively administrative data sets and includes a gender and racially diverse sample of 10,360 youth (30.7 % females) who were arrested at least once between ages 12 and 24 in the early 2000s. Latent class growth analysis was employed in order to identify distinct arrest trajectories of youth in the sample. Multinomial logistic regression was used to identify diagnostic and other characteristics associated with membership in the specific trajectories predicted by Moffitt's theory. Five trajectory classes were identified, 3 of which were consistent with taxonomic theory including high and classic adolescence limited trajectory classes and a 'snared adolescence limited class' described more recently by Moffitt. The distribution of youth among the 5 classes was very different for those with and without emotional disturbances. Youth with emotional disturbances in their late adolescent years were more likely to fall into the high arrest trajectory class and much less likely to fall into the low arrest trajectory class. Compared to youth without an emotional disturbance, youth with psychotic disorders were more than twice as likely to fall into the high as into the low arrest trajectory class. Youth with disruptive behavior disorders were more than twice as likely to fall into the high and intermediate classes as into the low trajectory class. Anxiety and depressive disorders were not associated with significantly greater likelihood of falling into any one of the trajectory classes. Youth in the snared adolescence limited class were more likely than those in the classic adolescence limited class to be male, black versus white and in the foster care enrollment category lending some support to Moffitt's conceptualization of this class as an adolescence limited class composed of youth who are snared by involvement in the criminal justice and or social services systems. Implications of these results for public policy and the study of adolescence are discussed. [ABSTRACT FROM AUTHOR]

Objective: To explore the role of working conditions in the association between socioeconomic position and health after retirement age using over 20 years follow-up. Method: Two Swedish nationally representative Level of Living Surveys (total N = 1,131) were used. Ordered logistic regression was used to assess the association between socioeconomic position and health (self-rated health, psychological distress, musculoskeletal pain, circulatory problems, physical and cognitive impairment). The role of physical and psychological working conditions was also assessed. Results: Lower socioeconomic position was associated with more adverse physical, but not psychological, working conditions. Physical working conditions partially explained the differences in physical impairment and musculoskeletal pain in old age attributed to socioeconomic position, but not differences in self-rated health, circulatory problems, psychological distress, and cognitive impairment. Socioeconomic position was a stronger correlate of health than psychological working conditions alone. Discussion: Improving physical working conditions may be important for reducing the influence of socioeconomic position on health after retirement. [ABSTRACT FROM PUBLISHER]

We examined whether recognition of facial emotional expression would be affected in amnestic mild cognitive impairment (aMCI). A total of 50 elderly persons met the initial inclusion criteria; 10 were subsequently excluded (Geriatric Depression Score > 5). 22 subjects were classified with aMCI based on published criteria (single domain aMCI [SD-aMCI], n = 10; multiple domain aMCI [MD-aMCI], n = 12); 18 subjects were cognitively normal. All underwent standard neurological and neuropsychological evaluations as well as tests of facial emotion recognition (FER) and famous faces identification (FFI). Among normal controls, FFI was negatively correlated with Mini-Mental Status Examination scores and positively correlated with executive function. Among patients with aMCI, FER was correlated with attention/speed of processing. No other correlations were significant. In a multinomial logistic regression model adjusted for age, gender, and education, a poorer score on FER, but not on FFI, was associated with greater odds of being classified as MD-aMCI (odds ratio [OR], 3.82; 95% confidence interval [CI], 1.05-13.91; p = 0.042). This association was not explained by memory or global cognitive score. There was no association between FER or FFI and SD-aMCI (OR, 1.13; 95% CI, 0.36-3.57; p = 0.836). Therefore, FER, but not FFI, may be impaired in MD-aMCI. This implies that in MD-aMCI, the tasks of FER and FFI may involve segregated neurocognitive networks. [ABSTRACT FROM AUTHOR]

Purpose of the study: Studies have shown that patient safety culture (PSC) is poorly developed in nursing homes (NHs), and, therefore, residents of NHs may be at risk of harm. Using Donabedian’s Structure–Process–Outcome (SPO) model, we examined the relationships among top management’s ratings of NH PSC, a process of care, and safety outcomes. Design and Methods: Using top management’s responses from a nationally representative sample of 3,557 NHs on the 2008 Nursing Home Survey on PSC, the Online Survey, Certification, and Reporting Database, and the Minimum Data Set, we examined the relationships among the three components of Donabedian’s SPO model: structure (PSC), a process of care (physical restraints), and patient safety outcomes (residents who fell). Results: Results from generalized estimating equations indicated that higher ratings of PSC were significantly related to lower prevalence of physical restraints (odds ratio [OR] = 0.997, 95% confidence interval [CI] = 0.995–0.999) and residents who fell (OR = 0.999, 95% CI = 0.998–0.999). Physical restraint use was related to falls after controlling for structural characteristics and PSC (OR = 1.698, 95% CI = 1.619–1.781). Implications: These findings can contribute to the development of PSC in NHs and promote improvements in health care that can be measured by process of care and resident outcomes. [ABSTRACT FROM PUBLISHER]

Objectives. The present study investigated patterns of self-reported driving habits among healthy older adults over 5 years, as well as characteristics that distinguished subgroups with different patterns. Methods. Participants were drivers from the control group of the Advanced Cognitive Training for Independent and Vital Elderly study at the baseline assessment (N = 597). The outcome was a composite of driving frequency, driving space, and perceived driving difficulty. Growth mixture models identified classes of participants with different baseline scores and change trajectories, and classes were compared in terms of baseline sensory, physical, and cognitive functioning. Results. A 3-class model was indicated, consisting of 2 classes with intercept differences and stability over time, “above-average stable” (39%) and “average stable” drivers (44%), and 1 class with a lower intercept and negative slope, “decreasers” (17%). Relative to stable drivers, decreasers exhibited significantly more depressive symptoms and poorer self-rated health, balance, everyday functioning, and speed of processing after controlling for age and education (p < .05). Discussion. The majority of older drivers maintained their driving over time at different levels, whereas a subgroup of individuals with poorer baseline functioning self-regulated by reducing their driving. Future studies should determine how such patterns affect driving safety. [ABSTRACT FROM PUBLISHER]

Objectives To examine job control, job demands, social support at work, and job strain (ratio of demands to control) in relation to risk of any dementia, Alzheimer's disease ( AD), and vascular dementia ( VaD). Design Cohort study. Setting The population-based Study of Dementia in Swedish Twins. Participants Two hundred fifty-seven people with dementia (167 AD, 46 VaD) and 9,849 without. Measurements Dementia diagnoses were based on telephone screening for cognitive impairment followed by in-person clinical examination. An established job exposure matrix was matched to main occupation categories to measure work characteristics. Results In generalized estimating equations (adjusted for the inclusion of complete twin pairs), lower job control was associated with greater risk of any dementia (odds ratio ( OR) = 1.17, 95% confidence interval ( CI) = 1.04-1.31) and VaD specifically ( OR = 1.39, 95% CI = 1.07-1.81). Lower social support at work was associated with greater risk of dementia ( OR = 1.15, 95% CI = 1.03-1.28), AD ( OR = 1.14, 95% CI = 1.00-1.31), and VaD ( OR = 1.28, 95% CI = 1.02-1.60). Greater job strain was associated with greater risk of VaD only ( OR = 1.28, 95% CI = 1.02-1.60), especially in combination with low social support ( OR = 1.35, 95% CI = 1.11-1.64). Age, sex, and education were controlled for. Work complexity, manual work, and vascular disease did not explain the results. No differences in work-related stress scores were observed in the 54 twin pairs discordant for dementia, although only two pairs included a twin with VaD. Conclusion Work-related stress, including low job control and low social support at work, may increase the risk of dementia, particularly VaD. Modification to work environment, including attention to social context and provision of meaningful roles for employees, may contribute to efforts to promote cognitive health. [ABSTRACT FROM AUTHOR]

Purpose of the study: To examine the relationship between county-level Medicaid home- and community-based service (HCBS) waiver expenditures and the prevalence of low-care residents in Florida nursing homes (NHs). Design and Methods: The present study used a cross-sectional design. We combined two data sources: NH facility–level data (including characteristics of the facility and its residents) and county-level market characteristics (including HCBS waiver expenditures) for 653 Florida NHs in 2007. Low-care was defined as residents who require no physical assistance in any of the 4 late-loss activities of daily living (bed mobility, toileting, transferring, and eating). We estimated a 2-level hierarchical linear model (HLM) to examine the relationship between Medicaid HCBS waiver expenditures and the prevalence of low-care residents while accounting for resident assessment, facility-, and county-level covariates. Results: All Florida counties offered 2 statewide waivers, and 33 counties offered one or more of the 4 regional Medicaid HCBS waivers in 2007. Per-month beneficiary expenditures ranged from $755 to $1,778. The average Florida NH had 120 beds, and 8.0% of its residents were classified as low-care. Results from the HLM model showed that a $10,000 increase in per-enrollee HCBS waiver expenditures was associated with a 3.5 percentage point reduction in low-care resident prevalence (p = .03). Implications: The findings suggest that Medicaid HCBS waiver programs may reduce the prevalence of low-care residents in NHs. Future studies should evaluate whether Medicaid HCBS waiver programs are effective in promoting community-living among low-care residents and mitigating the growth in long-term care expenditures. [ABSTRACT FROM PUBLISHER]

Objectives. We used data from SWEOLD, a Swedish nationally representative study of individuals aged 77 years or older, to examine midlife indicators of job strain in relation to cognitive performance and impairment. Methods. In all, 827 participants completed an abridged 11-point version of the Mini-Mental State Examination in-person in 1992 and/or 2002 and had self-reported and/or occupation-based scores for job control and demands from data collected in 1968. Seventeen percent scored below the cutoff for cognitive impairment. Results. Controlling for age, sex, education, self-rated health, and year of cognitive screening, low self-reported and occupation-based job control at midlife was associated with poorer cognitive performance later (ps < .001). For the occupation-based measure, low job control was also associated with greater likelihood of impairment, whereas having an active job (high job control/high job demands) was associated with better cognitive performance and lower likelihood of impairment (ps < .01). Childhood environment, midlife depressive symptoms, and social activity had limited influence, whereas the influence of both adulthood socioeconomic position and work complexity on these results was more pronounced. Discussion. Job control at midlife, by itself and in combination with job demands, may influence cognitive functioning later above and beyond demographic variables and other occupational characteristics. [ABSTRACT FROM PUBLISHER]