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The study aims to characterize physical activity (PA) participation by intensity and examine the biopsychosocial correlates among middle-aged and older adults with chronic kidney disease (CKD) in China. Data were examined from the 2011 China Health and Retirement Longitudinal Study. The percentages of participation in vigorous, moderate, and light activity among participants with CKD were 22.7%, 42.1%, and 76.3%, respectively. The participants were less likely to engage in vigorous and moderate PA if they were 70 years of age or older, were not married/partnered, were unemployed, lived in urban areas, had an advanced stage of disease, had heart disease, and/or experienced mobility limitations. The magnitude of the associations between biophysical factors and PA participation was small for light PA. The higher the intensity of regular PA, the less likely older adults with CKD were to participate. Practitioners could consider the psychosocial characteristics of the older adults with CKD and facilitate their participation in PA.

Objective To examine which components of a culturally tailored community health worker (CHW) intervention improved glycemic control and intermediate outcomes among Latina/o and African American participants with diabetes. Methods The sample included 326 African American and Latina/o adults with type 2 diabetes in Detroit, MI. CHWs provided interactive group diabetes self-management classes and home visits, and accompanied clients to a clinic visit during the 6-month intervention period. We used path analysis to model the processes by which each intervention component affected change in diabetes self-efficacy, diabetes-related distress, knowledge of diabetes management, and HbA1c. Results The group-based healthy lifestyle component was significantly associated with improved knowledge. The group-based self-management section was significantly associated with reduced diabetes-related distress. Intervention class attendance was positively associated with self-efficacy. Diabetes self-management mediated the reductions in HbA1c associated with reductions in diabetes distress. Conclusions Path analysis allowed each potential pathway of change in the intervention to be simultaneously analyzed to identify which aspects of the CHW intervention contributed to changes in diabetes-related behaviors and outcomes among African Americans and Latinas/os. Practice Implications Findings reinforce the importance of interactive group sessions in efforts to improve diabetes management and outcomes among Latina/o and African American adults with diabetes.

While America is nominally the “land of opportunity”, it is more so for some than others. Those in the lowest and next-to-lowest class quintiles are especially disadvantaged. Numerous efforts to be helpful seem to have not worked well probably due to a lack of opportunities and misaligned interventions. For the most part, residents in these classes seem to be stuck in their positions. This paper hypothesizes that “status crystallization” in the bottom quintiles (low on income, low on wealth, low educational attainment, and manual/episodic low status work/job) creates a “quadruple helix” of intertwined deficits that can “lock” individuals and families in a poverty position. This “mobility lock” contributes to the persistence of poverty status in spite of numerous social programs and health services. These five variables—income, wealth, educational attainment, occupation type and health—are all forms of personal capital that contribute to the opportunities for social mobility in the United States. High values on these variables act as “compound interest”, accelerating mobility; low values function as the opposite—sort of the “payday loan”: effectively trapping those individuals in lower and ever decreasing status. However, as discussed in this article (and by others), personal capital alone does not sufficiently predict opportunities for social mobility in the United States. Social capital—or the networks of relationships that contribute to living and working in a given society—provide and enhance opportunities for social and economic mobility. As pointed out by Raj Chetty and others, the conditional probability of upward mobility is also enhanced by geographic location, or “opportunity areas”. Higher opportunity places shared qualities associated with upward mobility: good schools, greater levels of social cohesion, many two-parent families, low levels of income inequality and little residential segregation either by class or race (Gareth Cook, 2019, The Atlantic). Low values on these factors may tend to co-exist in some areas and become “impediment areas” as opposed to mobility enhancement ones.

BackgroundFalls are the leading cause of injury-related mortality among older adults in the United States, but incidence and risk factors for fall-related mortality remain poorly understood. This study compared fall-related mortality incidence rate estimates from a nationally representative cohort with those from a national vital record database and identified correlates of fall-related mortality.MethodsCause-of-death data from the National Death Index (NDI; 1999–2011) were linked with eight waves from the Health and Retirement Study (HRS), a representative cohort of U.S. older adults (N = 20,639). Weighted fall-related mortality incidence rates were calculated and compared with estimates from the Centers for Disease Control and Prevention (CDC) vital record data. Fall-related deaths were identified using International Classification of Diseases (Version 10) codes. Person-time at risk was calculated from HRS entry until death or censoring. Cox proportional hazards models were used to identify individual-level factors associated with fall-related deaths.ResultsThe overall incidence rate of fall-related mortality was greater in HRS–NDI data (51.6 deaths per 100,000; 95% confidence interval: 42.04, 63.37) compared with CDC data (42.00 deaths per 100,000; 95% confidence interval: 41.80, 42.19). Estimated differences between the two data sources were greater for men and adults aged 85 years and older. Greater age, male gender, and self-reported fall history were identified as independent risk factors for fall-related mortality.ConclusionIncidence rates based on aggregate vital records may substantially underestimate the occurrence of and risk for fall-related mortality differentially in men, minorities, and relatively younger adults. Cohort-based estimates of individual fall-related mortality risk are important supplements to vital record estimates.

Nearly one in three adults aged 65 and older live alone in the U.S. Despite this increasing trend, there remains little understanding regarding the relationship between living alone and physical activity (PA) in older adulthood. Is living alone a risk factor for lower levels of PA among older adults? The effects of living arrangements on health behaviors could differ by gender; however, findings from prior studies on this topic have been mixed or inconclusive. This is one of few studies to examine whether PA is associated with living alone (vs. living with others) and whether the association differs by gender using longitudinal data. Our data were drawn from 2006-2014 Psychosocial and Lifestyle Questionnaire of the Health and Retirement Study, a nationally representative sample of older adults in the U.S. (N=17371, mean age=75.4). PA was measured repeatedly using metabolic equivalents of task (MET) estimated values accounting for the vigor and frequency of self-reported PA (range 0-31). Using mixed-effects linear regression, we found that living alone was significantly associated with higher levels of PA (Coeff.: 0.41, p

This study identifies risk and protective factors for falls among older, community-dwelling African Americans. Drawing upon the biopsychosocial perspective, we conducted a series of sex- and age-adjusted multinomial logistic regression analyses to identify the correlates of fall events among older African Americans. Our sample consisted of 1,442 community-dwelling African Americans aged 65 and older, participating in the 2010–2012 rounds of the Health and Retirement Study. Biophysical characteristics associated with greater relative risk of experiencing single and/or multiple falls included greater functional limitations, poorer self-rated health, poorer self-rated vision, chronic illnesses (high blood pressure, diabetes, cancer, lung disease, heart problems, stroke, and arthritis), greater chronic illness comorbidity, older age, and female sex. Physical activity was negatively associated with recurrent falls. Among the examined psychosocial characteristics, greater depressive symptoms were associated with greater relative risk of experiencing single and multiple fall events. Implications for clinicians and future studies are discussed.

Falls are a leading cause of nursing home admission, hospitalization, and disability among older adults; however, there is little research that examines risk and protective factors for falls among older men specifically. Our study is among the first to investigate fall events and racial and ethnic differences in fall risk among older men using a population-based sample. We analyzed data from 44269 community-dwelling men from the Health and Retirement Study aged 65 and older. We used multinomial logistic regression analyses to examine risk and protective factors for single and recurrent (2+) self-reported fall profiles at baseline (1998–2000) and longitudinally (1998–2014). We examined fall events by race/ethnicity (non-Hispanic white, African American, and Hispanic/Latino), controlling for health and socio-demographic characteristics. In baseline analyses, African American men were less likely than non-Hispanic White men to experience single and multiple fall events, compared to no falls (RRR: 0.68, p=0.03), (RRR: 0.63, p=0.01) respectively. Longitudinally, African American and Hispanic men were less likely to experience multiple falls than their non-Hispanic White male counterparts. Divorced (RR:0.66, p=0.01) and widowed (RRR:0.72, p=0.00) men were also less likely to experience multiple falls than those who were married/partnered. Finally, consistent with other population-based studies, older age, ADL limitations, greater depressive symptoms, and presence of comorbidities were associated with a higher relative risk of single and/or recurrent falls across follow-up. This study has the potential to inform clinical practice and falls prevention programs through identification of risk and protective factors of single and recurrent falls among older, community dwelling men.

Physical activity (PA) is an effective strategy for diabetes management and is central to the diabetes regimen. However, many older adults with type 2 diabetes (DM2) do not engage in regular PA. This is the first study to examine diagnosis-related transitions in PA among a population-based sample of middle-aged and older-adults in the U.S. We examined associations between PA changes and DM2 diagnosis among 2,394 participants aged 51+ in the Health and Retirement Study diagnosed with DM2 between 2006–14. PA was measured with metabolic equivalents of task (MET) estimated values accounting for vigor and frequency of self-reported PA. Piecewise mixed models were centered at diagnosis to examine changes in MET values and rate of decline in METs over time. We then tested whether these changes differed by age at diagnosis, race/ethnicity, gender, or education. PA declined as participants aged. DM2 diagnosis was followed by a significant increase in METs (0.50 MET, SE: 0.20, p

Objectives This study examined the impact of everyday discrimination (both racial and non-racial) on the mental health of older African Americans. Methods This analysis is based on the older African American subsample of the National Survey of American Life (NSAL) (n = 773). We examined the associations between everyday discrimination and both general distress and psychiatric disorders as measured by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Six dependent variables were examined: lifetime mood disorders, lifetime anxiety disorders, any lifetime disorder, number of lifetime disorders, depressive symptoms as measured by the 12-item Center for Epidemiological Scale of Depression (CES-D), and serious psychological distress as measured by the Kessler 6 (K6). Results Overall, racial and non-racial everyday discrimination were consistently associated with worse mental health for older African Americans. Older African Americans who experienced higher levels of overall everyday discrimination had higher odds of any psychiatric disorder, any lifetime mood disorder, any lifetime anxiety disorder, and more lifetime DSM-IV disorders, in addition to elevated levels of depressive symptoms and serious psychological distress. These findings were similar for both racial discrimination and non-racial discrimination. Conclusions This study documents the harmful association of not only racial discrimination, but also non-racial (and overall) discrimination with the mental health of older African Americans. Specifically, discrimination is negatively associated with mood and anxiety disorders as well as depressive symptoms and psychological distress. Copyright © 2016 John Wiley & Sons, Ltd.

Objective This study examined the influence of church- and family-based social support on depressive symptoms and serious psychological distress among older African Americans. Methods The analysis is based on the National Survey of American Life. Church- and family-based informal social support correlates of depressive symptoms (CES-D) and serious psychological distress (K6) were examined. Data from 686 African Americans aged 55 years or older who attend religious services at least a few times a year are used in this analysis. Results Multivariate analysis found that social support from church members was significantly and inversely associated with depressive symptoms and psychological distress. Frequency of negative interactions with church members was positively associated with depressive symptoms and psychological distress. Social support from church members remained significant but negative interaction from church members did not remain significant when controlling for indicators of family social support. Among this sample of churchgoers, emotional support from family was a protective factor and negative interaction with family was a risk factor for depressive symptoms and psychological distress. Conclusion This is the first investigation of the relationship between church- and family-based social support and depressive symptoms and psychological distress among a national sample of older African Americans. Overall, the findings indicate that social support from church networks was protective against depressive symptoms and psychological distress. This finding remained significant when controlling for indicators of family social support.

This study examined the correlates of objective social isolation from extended family members and friends among older adults. The analysis is based on the older adult sub-sample of the National Survey of American Life (n = 1321). Multinomial logistic regression analyses examined race/ethnicity, demographics, functional health and family and friend network factors as correlates of objective isolation from family and friends. Only 4.47% of respondents were objectively isolated from both their extended family and friends, 10.82% were isolated from their friends, and 7.43% were isolated from their family members. Men were more likely to be objectively isolated from both family and friends and older adults who live with others were significantly more likely to be objectively isolated from their friends. When controlling for subjective social isolation, the two measures of functional health were significantly associated with objective social isolation. In particular, higher levels of self-care impairment decreased the risk of being objectively isolated from friends only, whereas higher mobility impairment was associated with an increased likelihood of being objectively isolated from friends only. Subjective evaluations of social isolation from family and friends were consistently associated with being objectively isolated from family and friends. There were no significant differences between African-Americans, Black Caribbeans and non-Hispanic Whites in objective isolation. These and other findings are discussed in detail.

The increasing prevalence of chronic kidney disease (CKD) become a health problem in China and worldwide. Physical activity can improve physical functioning and slow the decline in kidney function. However, less is known on correlates of physical activity among early stages of CKD. The current study used the data from China Health and Retirement Longitudinal Study to examine physical activity with different intensities and its correlates among Chinese middle-aged to older adults with chronic kidney disease. Based on eGFR less than 60 mL/min per 1.73 m2, 1089 adults older than 40 years old and completed the measure of physical activity were identified. Overall, 28.7% of adults with CKD participated in vigorous-intensity activities, and 50.1% and 78.7% participated in moderate- and light-intensity activities in a week, respectively. Multivariate logistic regression analysis indicated that older age (>80 years old), being female, living in city, receiving higher education (high school or more), being single/widowed/divorced, no employment, perceiving higher financial burden, having functional limitation in at least one aspect, having diabetes and heart disease contributed to lower participation in vigorous-intensity activities. Living in city, no employment, and having functional limitation in at least one aspect significantly predicted the lower engagement in moderate-intensity activities. However, socio-demographics and comorbidity exerted little effect on engagement in light-intensity activities. Since effect of physical activities on health can vary with the intensity of activities, it is recommended to consider the correlates of physical activity with different intensity in promoting the engagement in physical activity among older adults with CKD.

Few studies have examined the health-related consequences of gardening among older adults. This scoping review summarizes and characterizes current research that examines the relationship between physical health and participation in planned gardening activities, including establishing, maintaining, or caring for plants. Six databases were searched. Eligible studies were published between 2000 and 2013, were published in English, and assessed different aspects of physical health (e.g., functional ability, energy expenditure, injury) for older adults who had participated in a planned gardening activity. Of the eight eligible studies identified with these criteria, four assessed energy expenditures and four assessed physical functioning. Studies assessing energy expenditures documented that the majority of gardening tasks were classified into low-to-moderate intensity physical activity. The current literature does not provide sufficient evidence of the physical functioning consequences of gardening. Future studies should consider how specific gardening interventions help older adults meet physical activity guidelines.

Older adults are the fastest growing segment of the world population. Older adults are also at heightened risk of chronic conditions (such as diabetes, heart disease, and cancer) and specific geriatric conditions (such as cognitive impairment, frailty, and falls). Research studies have examined the relationship between fruit and vegetable intake and subsequent health outcomes and the correlates of fruit and vegetable intake in the U.S. population. However, relatively few studies have specifically examined health impacts and correlates of fruit and vegetable intake among older adults, who have unique biophysical and socioeconomic circumstances. Evidence is reviewed to (1) describe findings related to consumption and chronic, geriatric, and other health outcomes among older adults and (2) describe patterns in fruit and vegetable consumption among older adults and how these patterns vary within and among populations. This review addresses specific barriers faced by older adults in obtaining and consuming fruits and vegetables in community settings. Recommendations for practice and policy are discussed.

Background: Falls present a major challenge to active aging, but the relationship between neighborhood factors and falls is poorly understood. This study examined the relationship between fall events and neighborhood factors, including neighborhood social cohesion (sense of belonging, trust, friendliness, and helpfulness) and physical environment (vandalism/graffiti, rubbish, vacant/deserted houses, and perceived safety walking home at night). Methods: Data were analyzed from 9259 participants over four biennial waves (2006-2012) of the Health and Retirement Study (HRS), a nationally representative sample of adults aged 65 and older in the United States. Results: In models adjusting for demographic and health-related covariates, a one-unit increase in neighborhood social cohesion was associated with 4% lower odds of experiencing a single fall (odds ratio (OR): 0.96, 95% confidence interval (CI): 0.93-0.99) and 6% lower odds of experiencing multiple falls (OR: 0.94, 95% CI: 0.90-0.98). A one-unit increase in the physical environment scale was associated with 4% lower odds of experiencing a single fall (OR: 0.96, 95% CI: 0.93-0.99) and with 5% lower odds of experiencing multiple falls (OR: 0.95, 95% CI: 0.91-1.00) in adjusted models. Conclusions: The physical and social neighborhood environment may affect fall risk among community-dwelling older adults. Findings support the ongoing need for evidence-based fall prevention programming in community and clinical settings.

This study examined whether or not direct social support is associated with long-term health among middle-aged and older adults with diabetes mellitus.Direct social support was assessed at baseline (2003) for 1,099 adults with type 2 diabetes mellitus from the Health and Retirement Study. Self-reported health status was examined at baseline and in 4 biennial survey waves (2003-2010). A series of ordinal logistic regression models examined whether or not the 7-item Diabetes Care Profile scale was associated with a subsequent change in health status over time. Additional analyses examined whether or not individual components of direct social support were associated with health status change.After adjusting for baseline covariates, greater direct social support as measured by the Diabetes Care Profile was associated with improved health outcomes over time; however, this trend was not significant (p = .06). The direct social support measures that were associated with improved health over follow-up were support for taking medicines (odds ratio [OR] = 1.22), physical activity (OR = 1.26), and going to health care providers (OR = 1.22; all p.05).Interventions that specifically target improving specific aspects of diabetes social support may be more effective in improving long-term health than less targeted efforts.

Objective: To examine the relationship between health care access and diabetes management among a geographically diverse sample of American Indians (AIs) aged 50 and older with type 2 diabetes. Method: We examined the relationship between access to care and diabetes management, as measured by HbA1c, using 1998-1999 data from the Strong Heart Family Study. A series of bivariate and multivariate linear models examined the relationships between nine access-related variables and HbA1c levels. Results: In bivariate analyses, out-of-pocket costs were associated with higher HbA1c levels. No other access-related characteristics were significantly associated with diabetes management in bivariate or in multivariate models. Discussion: Access-related barriers were not associated with worse diabetes management in multivariate analyses. The study concludes with implications for clinicians working with AI populations to enhance opportunities for diabetes management.

To examine the relationship between fruit and vegetable intake, physical activity, and all-cause mortality in older women.Six Cox proportional hazards models examined independent and additive relationships between physical activity, carotenoids, and all-cause mortality. Additional models tested whether physical activity and carotenoids were conjointly related to mortality. Models were adjusted for age, education, and race and ethnicity.Baltimore, Maryland.Seven hundred thirteen women aged 70 to 79 participating in the Women's Health and Aging Studies.Total serum carotenoids, a marker of fruit and vegetable intake, and physical activity were measured at baseline. Physical activity was measured according to kilocalorie expenditure.During 5 years of follow-up, 82 (11.5%) participants died. Measured continuously, physical activity improved survival (HR = 0.52, 95% CI = 0.41-0.66, P.001). The most active women were more likely to survive than the least physically active women (HR = 0.28, 95% CI = 0.13-0.59, P.001). Continuous measures of carotenoids improved survival (HR = 0.67, 95% CI = 0.51-0.89, P = .01). Women in the highest tertile of total carotenoids were more likely to survive those in the lowest (HR = 0.50, 95% CI = 0.27-0.91, P = .03). When examined in the same model, continuous measures of physical activity (HR = 0.54, 95% CI = 0.42-0.68, P.001) and carotenoids (HR = 0.76, 95% CI = 0.59-0.98, P = .04) predicted survival during follow-up.The combination of low total serum carotenoids and low physical activity, both modifiable risk factors, strongly predicted earlier mortality. These findings provide preliminary support that higher fruit and vegetable intake and exercise improve survival.

This study investigated the relationship between social support (including instrumental support, emotional support, social interaction, social space, and family networks) and diet quality, as indicated by serum carotenoid levels.The sample consisted of participants in the Women's Health and Aging Study with longitudinal carotenoid data (n=325). We performed regression analyses using baseline indicators of social support and changes in social support to determine whether baseline levels and/or change in levels of social support predict changes in serum carotenoid levels. Social support changes were measured over 1 year from baseline to follow-up round 1. Carotenoid level changes were established from follow-up round 1 to round 2. To determine whether or not regression to the mean was driving these results, we performed an analysis that included baseline and change levels of social support indicators.At baseline, the frequency of leaving one's home was associated with a decrease in carotenoid levels. Leaving one's home more frequently predicted an increase in carotenoid levels and attending fewer activities predicted a decrease in carotenoid levels.In older, community-resident disabled women, baseline levels of social support did not consistently predict diet quality. However, change in social support predicted both positive and negative change in diet quality and thus provides supportive evidence that social activity and family interaction may play meaningful roles in the maintenance of diet quality among functionally compromised older women. Further research is necessary to more fully understand the impact of multiple forms of social supports on the diet quality of older adults.

Problem statement: Men and women experience pronounced differences in functional decline as they age. The mechanisms behind these differences remain unclear, particularly among chronically ill populations. Drawing on the theory of the disablement process, this research examines sex differences in functional decline, focusing on two mechanisms suggested by the literature to partially mediate these disparities: health behaviors and social support. Approach: Data from diabetics aged 50 and older from the Health and Retirement Study (n = 2,493) were examined for change in functional status over a 10-year period. Multivariate longitudinal multi-level models were conducted to analyze (1) health behavior (2) social support; and (3) a full model with health behavior and social support together, followed by a separate analysis using sex interaction terms. Results: Women and men both experienced functional decline over time. In the models that examined health behaviors and social support separately, women experienced steeper rates of decline. In the full model (which included health behaviors and social support together), men experienced a steeper rate of decline relative to women. The analyses suggest that it is the combination of health and social characteristics (largely through engagement in socially supportive activities that promote health) that are protective against functional decline. Conclusion/Recommendations: As diabetic men experienced a steeper rate of functional decline than diabetic women once health behaviors and social support were both held constant, future research must examine (a) how these protective factors operate in tandem to protect against disablement of women with diabetes; and (b) how clinical and social policy can promote multi-pronged interventions to improve health behaviors in supportive contexts. Such research will benefit from multi-disciplinary collaborations.

In all societies needs and wants regularly exceed resources. Thus societies are always in deficit; demand always exceeds supply and “balancing the budget” is a constant social problem. To make matters somewhat worse, research suggests that need- and want-fulfillment tends to further stimulate the cycle of want-seeking rather than satiating desire. Societies use various resource-allocation mechanisms, including price, to cope with gaps between wants and resources. Social exploitation is a second mechanism, securing labor from population segments that can be coerced or convinced to perform necessary work for free or at below-market compensation. Using practical examples, this article develops a theoretical framework for understanding social exploitation. It then offers case examples of how different segments of the population emerge as exploited groups in the United States, due to changes in social policies. These exploitative processes have been exacerbated and accelerated by the economic downturn that began in 2007.

Objective: To examine the prevalence, correlates, persistence, and treatment-seeking related to symptoms of eating disorders (EDs) in a random sample of college students. Participants: A random sample of students at a large university were recruited for an Internet survey in Fall 2005 and a follow-up survey in Fall 2007. Methods: ED symptoms were measured using the SCOFF screen and adjusted for nonresponse using administrative data and a nonresponse survey. Results: 2,822 (56%) students completed the baseline survey. Among undergraduates the prevalence of positive screens was 13.5% for women and 3.6% for men. Among students with positive screens, 20% had received past-year mental health treatment. In the follow-up sample (N = 753), ED symptoms at baseline significantly predicted symptoms 2 years later. Conclusions: Symptoms of EDs were prevalent and persistent among college students in this study. These findings suggest that brief screens can identify a large number of students with untreated EDs.

High levels of circulating advanced glycation end products (AGE) are associated with cardiovascular disease, diabetes, chronic kidney disease, and increased mortality, but factors that influence levels of circulating AGE are not well known. Our objective was to characterize the relationship between serum carboxymethyl-lysine (CML), a major circulating AGE, and body composition in adults. In a cross-sectional study, total body DXA was performed and serum CML was measured in 592 adults, aged 26-93 y, from the Baltimore Longitudinal Study of Aging. Median (25th, 75th percentile) CML concentrations were 2.26 (1.86, 2.67) μmol/L. Total fat mass [β = -0.17 (95% CI -0.10, -0.24); P < 0.0001], truncal fat mass [β = -0.17 (95% CI -0.10, -0.25); P < 0.0001], and appendicular fat mass [β = -0.13 (95% CI -0.05, -0.20); P = 0.001] per 1 SD increase were inversely associated with serum CML in separate multivariate linear regression models, adjusting for age, sex, BMI, systolic blood pressure, TG, HDL cholesterol, and renal function. Lean body mass was not independently associated with serum CML. These findings suggest that serum CML concentration is strongly affected by body fat, possibly because CML is preferentially deposited in fat tissue or because adipocytes affect the metabolism of AGE.

A high dietary intake of fruit and vegetables has been shown to be protective for health. Neighborhood socioeconomic differences may influence the consumption of carotenoid-rich foods, as indicated by serum carotenoid concentrations. To test this hypothesis, we examined the relationship between neighborhood socioeconomic status (SES) and serum carotenoid concentrations in a population-based sample of community-dwelling women, aged 70–79 y, who participated in the Women’s Health and Aging Study II in Baltimore, Maryland. Neighborhood socioeconomic Z-scores were derived from characteristics of the census block of the participants. Serum carotenoid concentrations were measured at baseline and at 18, 36, 72, 98, and 108 mo follow-up visits. Neighborhood Z-scores were positively associated with serum α-carotene (P = 0.0006), β-carotene (P = 0.07), β-cryptoxanthin (P = 0.03), and lutein+zeaxanthin (P = 0.004) after adjusting for age, race, BMI, smoking, inflammation, and season. There was no significant association between neighborhood Z-score and serum lycopene. Older, community-dwelling women from neighborhoods with lower SES have lower serum carotenoid concentrations, which reflect a lower consumption of carotenoid-rich fresh fruits and vegetables.

The authors analyzed the association between downward social mobility in subjective social status among 3,056 immigrants to the United States and the odds of a major depressive episode. Using data from the National Latino and Asian American Study (2002–2003), the authors examined downward mobility by comparing immigrants’ subjective social status in their country of origin with their subjective social status in the United States. The dependent variable was the occurrence of a past-year episode of major depression defined according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria. Logistic regression models were used to control for a variety of sociodemographic and immigration-related characteristics. Analyses suggested that a loss of at least 3 steps in subjective social status is associated with increased risk of a depressive episode (odds ratio = 3.0, 95% confidence interval: 1.3, 6.6). Other factors independently associated with greater odds of depression included Latino ethnicity, female sex, having resided for a longer time in the United States, and being a US citizen. The findings suggest that immigrants who experience downward social mobility are at elevated risk of major depression. Policies or interventions focused only on immigrants of low social status may miss another group at risk: those who experience downward mobility from a higher social status.

Objectives. Social support is generally conceptualized as health promoting; however, there is little consensus regarding the mechanisms through which support is protective. Illness support has been proposed to promote regimen adherence and subsequent prevention of health decline. We hypothesize that (a) support for regimen adherence is negatively associated with self-reported health decline among older diabetic adults and that (b) regimen adherence is negatively associated with health decline among older diabetic adults. Methods. We used the Health and Retirement Study data on individuals over the age of 60 years with type 2 diabetes mellitus ( n = 1,788), examining change in self-reported health status over a 2-year period using binomial and cumulative ordinal logistic regression models. Results. Diabetic support is not signifi cantly associated with health decline, but it is strongly associated with adherence to health-promoting activities consisting of a diabetic regimen. Therefore, the extent to which one receives illness support for a given regimen component is highly positively associated with adhering to that component, although this adherence does not necessarily translate into protection against perceived decline in health. Conclusions. Illness-related support appears to be a mechanism through which social support matters in the diabetic population. Although this relationship did not extend to prevention of health status decline among diabetics, the relationship between support and illness management is promising .

This study examined the impact of everyday discrimination (both racial and non-racial) on the mental health of older African Americans.This analysis is based on the older African American subsample of the National Survey of American Life (NSAL) (n = 773). We examined the associations between everyday discrimination and both general distress and psychiatric disorders as measured by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Six dependent variables were examined: lifetime mood disorders, lifetime anxiety disorders, any lifetime disorder, number of lifetime disorders, depressive symptoms as measured by the 12-item Center for Epidemiological Scale of Depression (CES-D), and serious psychological distress as measured by the Kessler 6 (K6).Overall, racial and non-racial everyday discrimination were consistently associated with worse mental health for older African Americans. Older African Americans who experienced higher levels of overall everyday discrimination had higher odds of any psychiatric disorder, any lifetime mood disorder, any lifetime anxiety disorder, and more lifetime DSM-IV disorders, in addition to elevated levels of depressive symptoms and serious psychological distress. These findings were similar for both racial discrimination and non-racial discrimination.This study documents the harmful association of not only racial discrimination, but also non-racial (and overall) discrimination with the mental health of older African Americans. Specifically, discrimination is negatively associated with mood and anxiety disorders as well as depressive symptoms and psychological distress. Copyright © 2016 John WileySons, Ltd.

Examine influences of diabetes-specific social support (D-SS) and depressive symptoms on glycemic control over time, among adults randomized to a diabetes self-management education and support (DSME/S) intervention or usual care.Data were from 108 African-American and Latino participants in a 6-month intervention trial. Multivariable linear regression models assessed associations between baseline D-SS from family and friends and depressive symptoms with changes in HbA1c. We then examined whether baseline D-SS or depression moderated intervention-associated effects on HbA1c.Higher baseline D-SS was associated with larger improvements in HbA1c (adjusted ΔHbA1c -0.39% for each +1-point D-SS, p=0.02), independent of intervention-associated HbA1c decreases. Baseline depressive symptoms had no significant association with subsequent HbA1c change. Neither D-SS nor depression moderated intervention-associated effects on HbA1c.Diabetes self-management education and support programs have potential to improve glycemic control for participants starting with varying levels of social support and depressive symptoms. Participants starting with more support for diabetes management from family and friends improved HbA1c significantly more over 6 months than those with less support, independent of additional significant DSME/S intervention-associated HbA1c improvements. Social support from family and friends may improve glycemic control in ways additive to DSME/S.

Background Preventing falls and fall-related injuries among older adults is a public health priority. The Stopping Elderly Accidents, Deaths, and Injuries (STEADI) tool was developed to promote fall risk screening and encourage coordination between clinical and community-based fall prevention resources; however, little is known about the tool’s predictive validity or adaptability to survey data. Methods Data from five annual rounds (2011–2015) of the National Health and Aging Trends Study (NHATS), a representative cohort of adults age 65 years and older in the USA. Analytic sample respondents (n=7392) were categorised at baseline as having low, moderate or high fall risk according to the STEADI algorithm adapted for use with NHATS data. Logistic mixed-effects regression was used to estimate the association between baseline fall risk and subsequent falls and mortality. Analyses incorporated complex sampling and weighting elements to permit inferences at a national level. Results Participants classified as having moderate and high fall risk had 2.62 (95% CI 2.29 to 2.99) and 4.76 (95% CI 3.51 to 6.47) times greater odds of falling during follow-up compared with those with low risk, respectively, controlling for sociodemographic and health-related risk factors for falls. High fall risk was also associated with greater likelihood of falling multiple times annually but not with greater risk of mortality. Conclusion The adapted STEADI clinical fall risk screening tool is a valid measure for predicting future fall risk using survey cohort data. Further efforts to standardise screening for fall risk and to coordinate between clinical and community-based fall prevention initiatives are warranted.

Falls are a leading cause of nursing home admission and hospitalization among older adults; however, there is surprisingly little research that examines risk and protective factors for falls among community-dwelling older men. Our study is the first to investigate fall events among older men—and to examine racial and ethnic differences in fall risk among men—using a population-based sample.

Objective: Identify individual- and place-based factors associated with diagnosed diabetes and forgone medical care among those diagnosed with diabetes. Background: Diabetes affects millions of individuals globally. In the U.S. alone the prevalence rate of diagnosed diabetes has more than doubled over the past 20 years (4.2% in 1994 to 10% in 2014). Methods: The Behavioral Risk Factor Surveillance System (2011–2015) was used to identify factors associated with self-reported diabetes diagnoses (ever diagnosed) among U.S. adults. Logistic regression modeled: (1) the likelihood of having diabetes; (2) the likelihood of forgone medical care among those with diabetes, given appropriate medical care has been linked to preventing complications associated with diabetes. Results: Rates of diabetes remained relatively stable from 2011 to 2015. The likelihood of diabetes was higher (p < 0.01) among racial and ethnic minority groups, men, those with lower incomes and those with lower education. Place-based disparities indicating a higher likelihood of having a diagnosis of diabetes were found for those living in rural areas (urban versus rural, unadjusted OR = 0.844–0.908; p < 0.01) and those living in the South (North, Midwest, and Western/Pacific regions versus the South, unadjusted OR = 0.794–0.889; p < 0.01). Similar results were found with forgone medical care among those diagnosed with diabetes being more likely in the South (North, Midwest, and Western/Pacific regions versus the South, unadjusted OR = 0.542–0.819). In fully-adjusted analyses, the prevalence of diabetes and forgone medical care among those diagnosed with diabetes was higher for those with lower incomes, from several racial/ethnic minority groups, and in the South versus most other regions. Conclusions: Identifying at-risk groups informs targets for prevention and assists efforts to address chronic disease self-management among those already diagnosed with diabetes.

The purpose of this article is to examine whether or not subjective social status contributes to diabetes diagnosis and disease discovery experiences. Eighteen diabetic women participated in semi-structured interviews. Interview transcripts were reviewed and coded using interpretative phenomenological analysis. Several general themes emerged from the data analysis: subjective social status shaped different experiences through (a) situations of diabetes discovery (including the circumstances and stage of diabetes at the time of diagnosis), (b) the degree to which participants considered diabetes to be manageable, (c) the extent of diabetes-related knowledge and experience before diagnosis, and (d) opportunities to gain knowledge shortly thereafter. Due to these constraints, lower subjective social status individuals had particularly adverse disease discovery experiences. The findings are consistent with the theory of constrained choices. Implications for practitioners and for future research are discussed.

Objective: The objective of this study was to examine racial/ethnic differences in the probability and frequency of falls among adults aged 65 and older. Method: Using data from the Health and Retirement Study (HRS) from 2000 to 2010, the authors conducted random-intercept logistic and Poisson regression analyses to examine whether race/ethnicity predicted the likelihood of a fall event and the frequency of falls. Results: The analytic sample included 10,484 older adults. Baseline analyses showed no significant racial/ethnic differences in the probability or number of falls. However, in the longitudinal random-intercept models, African Americans had significantly lower odds (0.65) of experiencing at least one fall compared with non-Hispanic Whites. Among fallers, African Americans had significantly fewer falls (24%) than non-Hispanic Whites, controlling for health and sociodemographic covariates (all ps < .05). Latinos did not differ from non-Hispanic Whites in the likelihood or number of falls. Discussion: African Americans are less likely to experience initial or recurrent falls than non-Hispanic Whites.

Background. Aging is a complex multifactorial process characterized by accumulation of deleterious changes in cells and tissues, progressive deterioration of structural integrity and physiological function across multiple organ systems, and increased risk of death. Methods. We conducted a review of the scientific literature on the relationship of advanced glycation end products (AGEs) with aging. AGEs are a heterogeneous group of bioactive molecules that are formed by the nonenzymatic glycation of proteins, lipids, and nucleic acids. Results. Humans are exposed to AGEs produced in the body, especially in individuals with abnormal glucose metabolism, and AGEs ingested in foods. AGEs cause widespread damage to tissues through upregulation of inflammation and cross-linking of collagen and other proteins. AGEs have been shown to adversely affect virtually all cells, tissues, and organ systems. Recent epidemiological studies demonstrate that elevated circulating AGEs are associated with increased risk of developing many chronic diseases that disproportionally affect older individuals. Conclusions. Based on these data, we propose that accumulation of AGEs accelerate the multisystem functional decline that occurs with aging, and therefore contribute to the aging phenotype. Exposure to AGEs can be reduced by restriction of dietary intake of AGEs and drug treatment with AGE inhibitors and AGE breakers. Modification of intake and circulat ing levels of AGEs may be a possible strategy to promote health in old age, especially because most Western foods are processed at high temperature and are rich in AGEs.

The international community has raised concerns regarding the extent to which countries have implemented laws and policies to support the rights and wellbeing of children. This study evaluates the progress of least-developed countries (LDCs) and middle-income countries (MICs) in developing such legislation. Surveys were sent to 131 UNICEF country offices. Items included efforts to promote family preservation and family ties, family-based care over institutionalization, and child participation in placement decisions. A total of 68 surveys were returned, reflecting a 52 percent response rate (LDC, n = 25; MIC, n = 43). Legislation that addressed abuse and neglect of children, maternity leave, removal of children from the family, family care, adoption, and guardianship was widespread. Chi-square tests indicated that MICs had a substantially higher number of laws and policies related to child allowances, school feeding programs, maternity leave, and day care.

Background There are pervasive racial and socioeconomic differences in health status among older adults with type 2 diabetes. The extent to which racial/ethnic and socioeconomic disparities unfold to differential health outcomes has yet to be investigated among older adults with diabetes. This study examines whether or not race/ethnicity and SES are independent predictors of steeper rates of decline in self-rated health among older adults in the U.S. with type 2 diabetes. Methods The study population was a subset of diabetic adults aged 65 and older from the Health and Retirement Study. Respondents were followed up to 16 years. Multilevel cumulative logit regression models were used to examine the contributions of socioeconomic indicators, race/ethnicity, and covariates over time. Health decline was measured as a change in self-reported health status over the follow-up period. Results Relative to whites, blacks had a significantly lower cumulative odds of better health status over time (OR: 0.61, p < .0001). Hispanics reported significantly lower cumulative odds better health over time relative to whites (OR: 0.59, p < .05). Although these disparities narrowed when socioeconomic characteristics were added to the model, significant differences remained. Including socioeconomic status did not remove the health effects of race/ethnicity among blacks and Hispanics. Conclusions The author found that race/ethnicity and some socioeconomic indicators were independent predictors of health decline among older adults with diabetes.