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Introduction: Mechanisms underlying social determinants of stroke and dementia are unclear and brain-derived neurotrophic factor (BDNF) may contribute as a molecular link. Methods: Using the Framingham Study, we examined social relationship measures as predictors of higher serum BDNF level and cumulative incidence of stroke and dementia. Results: Among 3294 participants, controlling for age and sex, isolation trended with lower BDNF (odds ratio = 0.69 [0.47–1.00]). Participants with more companionship had reduced risk for stroke (hazard ratio [HR] = 0.59 [0.41–0.83]) and dementia (HR = 0.67 [0.49–0.92]). Greater emotional support was associated with higher BDNF (odds ratio = 1.27 [1.04–1.54]), reduced dementia risk (HR = 0.69 [0.51–0.94], and among smokers, reduced stroke risk (HR = 0.23 [0.10–0.57]). Associations persisted after additional adjustments. BDNF partly mediated the total effect between emotional support and dementia risk. Conclusions: Availability of social support appears to be associated with increased BDNF levels and, in certain subsets, reduce risk of subsequent dementia and stroke, thus warranting study of these pathways to understand their role in neuroprotection.

Objectives. There is considerable evidence that social networks are strongly related to survival and other health outcomes. However, findings regarding the effect of social networks on disability outcomes have been inconsistent. This study examines this relationship with respect to the fisk of developing disability and recovering from disability. Methods. Data come from a community-based sample of the New Haven population aged 65 years and older, with nine annual interviews conducted between 1982 and 1991. Disability was measured by a 6-item index of activities of daily living (ADL), and a 3-item Rosow-Breslau index, with disability defined as impairment in one or more tasks on each measure. Social network variables were constructed for each of four domains of ties: children, relatives, friends, and a confidant, and a summary measure of total social networks. A Markov model was used to estimate one-year disability transitions averaged across all 8 intervals, after controlling for sociodemographic and health-related variables. Results. Total social networks was associated with a significantly reduced risk of developing ADL disability ([Beta] = -0.009, p < .01), and a significantly increased likelihood of ADL recovery ([Beta] = 0.017, p < .01). Emotional and instrumental support did not affect the protective effect of social networks against disability, but partially accounted for their effect on enhanced recovery. Network variables related to relatives and friends were significantly associated with disability and recovery risks, but those related to children or a confidant were not. The associations with disability transitions as measured by the Rosow-Breslau index were generally smaller and nonsignificant. Discussion. The findings lend further support for the role of social relationships in important health outcomes in old age. They suggest that being 'embedded' in a social network of relatives and friends reduces risk for ADL disability, and enhances recovery from ADL disability.

Objective: To identify the unmet needs for HIV prevention among older adults in rural South Africa. Methods: We analyzed data from a population-based sample of 5059 men and women aged 40 years and older from the study Health and Aging in Africa: Longitudinal Studies of INDEPTH Communities (HAALSI), which was carried out in the Agincourt health and sociodemographic surveillance system in the Mpumalanga province of South Africa. We estimated the prevalence of HIV (laboratory-confirmed and self-reported) and key sexual behaviors by age and sex. We compared sexual behavior profiles across HIV status categories with and without age–sex standardization. Results: HIV prevalence was very high among HAALSI participants (23%, 95% confidence interval [CI]: 21 to 24), with no sex differences. Recent sexual activity was common (56%, 95% CI: 55 to 58) across all HIV status categories. Condom use was low among HIV-negative adults (15%, 95% CI: 14 to 17), higher among HIV-positive adults who were unaware of their HIV status (27%, 95% CI: 22 to 33), and dramatically higher among HIV-positive adults who were aware of their status (75%, 95% CI: 70 to 80). Casual sex and multiple partnerships were reported at moderate levels, with slightly higher estimates among HIV-positive compared to HIV-negative adults. Differences by HIV status remained after age–sex standardization. Conclusions: Older HIV-positive adults in an HIV hyperendemic community of rural South Africa report sexual behaviors consistent with high HIV transmission risk. Older HIV-negative adults report sexual behaviors consistent with high HIV acquisition risk. Prevention initiatives tailored to the particular prevention needs of older adults are urgently needed to reduce HIV risk in this and similar communities in sub-Saharan Africa.

Prior studies examining the association between self-reported experiences of racial/ethnic discrimination and obesity have had mixed results and primarily been cross-sectional. This study tests the hypothesis that an increase in self-reported experiences of racial/ethnic discrimination predicts gains in waist circumference and body mass index in Black and White women and men over eight years. In race/ethnicity- and gender-stratified models, this study examined whether change in self-reported experiences of racial/ethnic discrimination predicts changes in waist circumference and body mass index over time using a fixed-effects regression approach in SAS statistical software, providing control for both measured and unmeasured time-invariant covariates. Between 1992–93 and 2000–01, self-reported experiences of racial/ethnic discrimination decreased among 843 Black women (75% to 73%), 601 Black men (80% to 77%), 893 White women (30% to 23%) and 856 White men (28% to 23%). In fixed-effects regression models, controlling for all time-invariant covariates, social desirability bias, and changes in education and parity (women only) over time, an increase in self-reported experiences of racial/ethnic discrimination over time was significantly associated with an increase in waist circumference (β=1.09, 95% CI: 0.00–2.19, p=0.05) and an increase in body mass index (β=0.67, 95% CI: 0.19–1.16, p=0.007) among Black women. No associations were observed among Black men and White women and men. These findings suggest that an increase in self-reported experiences of racial/ethnic discrimination may be associated with increases in waist circumference and body mass index among Black women over time. [ABSTRACT FROM PUBLISHER]

Background Prior evidence suggests that caregiving may increase risk of cardiovascular disease (CVD) onset. This association has never been examined in a nationally (USA) representative sample, and prior studies could not fully control for socioeconomic confounders. This paper seeks to estimate the association between spousal caregiving and incident CVD in older Americans. Methods Married, CVD-free Health and Retirement Study respondents aged 50+ years (n=8472) were followed up to 8 years (1669 new stroke or heart disease diagnoses). Current caregiving exposure was defined as assisting a spouse with basic or instrumental activities of daily living ≥14 h/week according to the care recipients' report in the most recent prior biennial survey; we define providing ≥14 h/week of care at two consecutive biennial surveys as 'long-term caregiving'. Inverse probability weighted discrete-time hazard models with time-updated exposure and covariate information (including socioeconomic and cardiovascular risk factors) were used to estimate the effect of caregiving on incident CVD. Results Caregiving significantly predicted CVD incidence (HR=1.35, 95% CI 1.06 to 1.68) in the population overall. Long-term caregiving was associated with double the risk of CVD onset (HR=1.95, 95% CI 1.19 to 3.18). This association for long-term care givers varied significantly by race (p<0.01): caregiving predicted CVD onset for white (HR=2.37, 95% CI 1.43 to 3.92) but not for non-white (HR=0.28, 95% CI 0.06 to 1.28). Conclusions Spousal caregiving independently predicted risk of CVD in a large sample of US adults. There was significant evidence that the effect for long-term care givers differs for non-whites and white. [ABSTRACT FROM AUTHOR]

Objectives. We investigated the association between employment status and depressive symptoms among Korean individuals according to age and gender. Methods. Data were obtained from a subsample of 3,907 men and 4,914 women aged 45 years and older without any severe disabilities who participated in the 2006 cross-sectional baseline survey of the Korean Longitudinal Study of Aging (KLoSA). We compared depressive symptoms as determined by the Center for Epidemiological Studies-Depression 10-item scale, adjusting for socioeconomic status, physical and cognitive function, and chronic disease. Using multiple regression analysis, we determined both age- and gender-specific differences associated with depressive symptoms and employment status. Results. Employment was associated with fewer depressive symptoms among middle-aged men but not among older men. Unemployment was associated with more depressive symptoms among middle-aged women but not among older women. Conclusion. Work role did not provide any benefit for depressive symptoms among older men and women. We discuss the increased depressive symptoms among older employed men and the differential association of employment status with age and gender in the context of Korean social structure. [ABSTRACT FROM PUBLISHER]

Background: It is not known whether depression is a cause or consequence of progressive cognitive decline. We assessed the relationship between depressive symptoms and subsequent cognitive decline in the community-dwelling elderly population. Methods: Data were from a population-based cohort study that enrolled 2812 noninstitutionalized elderly residents of New Haven, Conn, and followed them with in-home visits in 1982, 1985, 1988, and 1994. Cognitive function was assessed with the Short Portable Mental Status Questionnaire (SPMSQ). Response to the SPMSQ was scored as high, medium, and low, and cognitive decline was defined as a transition to a lower category. Depressive symptoms were measured with the Center for Epidemiological Studies Depression Scale. Results: An elevated level of depressive symptoms was associated with an increased risk of incident cognitive decline among medium SPMSQ performers (3-year odds ratio [OR], 1.72; 95% confidence interval [CI], 1.04-2.82, P=.03; 6-year OR, 2.40; 95% CI, 1.33-4.34; P=.004; 12-year OR, 1.65; 95% CI, 0.62-4.38; P=.31) but not among high performers (3-year OR, 0.93; 95% CI, 0.62-1.39; P=.71; 6-year OR, 1.03; 95% CI, 0.67-1.58; P=.90; 12-year OR, 1.26; 95% CI, 0.59-2.71; P=.55), after adjustment for age, sex, race, education, income, housing type, functional disability, cardiovascular profile, and alcohol use. Conclusions: Depressive symptoms, particularly dysphoric mood, presage future cognitive losses among elderly persons with moderate cognitive impairments. However, the data do not provide support for the hypothesis that depressive symptoms are associated with the onset or rate of cognitive decline among cognitively intact elderly persons. [ABSTRACT FROM AUTHOR]

Objectives. Hip fractures can have devastating effects on the lives of older individuals. We determined the frequency of occurrence of hip fracture and the baseline factors predicting death and institutionalization at 6 months after hip fracture. Methods. A representative cohort of 2812 individuals aged 65 years and older was followed prospectively for 6 years. Hip fractures were identified, and the occurrence of death and institutionalization within 6 months of the fracture was determined. Prefracture information on physical and mental function, social support, and demographic features and in-hospital data on comorbid diagnoses, fracture site, and complications were analyzed to determine predictors of death and institutionalization after hip fracture. Results. Of 120 individuals suffering a hip fracture. 22 (18%) died within 6 months and 35 (29%) were institutionalized at 6 months. The predictors of death in multiple logistic regression included fracture site, a high number of complications, and poor baseline mental status. The primary predictor of institutionalization was poor baseline mental status. Conclusions. The frequency of death, institutionalization, and loss of function after hip fracture should prompt a reevaluation of the current approach to this problem. [ABSTRACT FROM AUTHOR]