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OBJECTIVES: Growing evidence suggests that religiosity is an important social determinant of health, including cognitive health. Yet most prior work focused on older adults or was conducted in racially and denominationally homogeneous regional samples. This study investigates the association of religious service attendance in midlife with cognitive function later in midlife. METHODS: Using data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, a racially and geographically diverse prospective cohort study, we explored the association of religious service attendance in midlife with cognitive function 5 years later. Cognitive function was measured using four cognitive tests administered by CARDIA technicians. Multivariable linear regression was used for analyses. Primary analyses controlled for sociodemographics, physical health, depression, and prior religious involvement. Sensitivity analyses additionally controlled for baseline cognition and social support. RESULTS: Our study population included 2,716 participants (57.2% female, 44.9% Black, and mean age 50). In primary analyses, attending services more than weekly (compared to never) in midlife was associated with better global cognition (β = 0.14 standard deviations, 95% [confidence interval] CI = 0.02, 0.26) and verbal memory (β = 0.17 standard deviations, 95% CI = 0.04, 0.30), but not with processing speed (β = 0.04 standard deviations, 95% CI = -0.08, 0.16). A reverse association was observed with executive function (β = -0.16 standard deviations, 95% CI = -0.30, -0.02). Most findings persisted in analyses accounting for loss to follow-up via inverse probability weighting. DISCUSSION: Our findings suggest that frequent involvement in religious services at midlife is associated with better global cognition and verbal memory but worse executive function. There was no association with processing speed.

Imputation or likelihood-based approaches to handle missing data assume the data are missing completely at random (MCAR) or missing at random (MAR). However, little research has examined the missingness pattern before using these imputation/likelihood methods. Three missingness mechanisms -- MCAR, MAR, and not missing at random (NMAR) -- can be tested using information on research design, disciplinary knowledge, and appropriate methods. This study summarized six commonly used statistical methods to test the missingness mechanism and discussed their application conditions. We further applied these methods to a two-wave longitudinal dataset from the Health and Retirement Study (N = 18,747). Health measures met the MAR assumptions although we could not completely rule out NMAR. Demographic variables provided auxiliary information. The logistic regression method demonstrated applicability to a wide range of scenarios. This study provides a useful guide to choose methods to test missingness mechanisms depending on the research goal and nature of the data.

Housing insecurity has been shown to be associated with worse mental health. However, previous studies mostly examined one aspect of housing insecurity (e.g., affordability), and few focused on older adults. This study examined the relationship between perceived housing problems and depressive symptoms among middle-aged and older Americans. Data from the Health and Retirement Study between 2006 and 2018 were used. A total of 7,119 respondents (aged 50+ at baseline in 2006) were followed up every 4 years. Respondents self-reported the status, severity, and duration of their housing problems. Depressive symptoms were assessed by the Center for Epidemiological Studies-Depression Scale. Mixed-effect models examined the association between perceived housing problems and depressive symptoms. Results show about 5%-7% of respondents had housing problems during every study visit and 5.73% of them experienced persistent housing problems over 12 years. Having housing problems was associated with a higher risk of depressive symptoms (incidence risk ratio = 1.29, 95% CI = 1.23, 1.36). A dose–response relationship was observed in the severity and duration of housing problems, with a greater increase of depressive symptoms risk among those experiencing more severe or prolonged housing problems. The dose–response pattern highlighted the importance of early intervention and persistent assistance to those experiencing housing problems. [ABSTRACT FROM AUTHOR]

The decades-long one-child policy in China has led to a growing number of older individuals with only one child. The Elderly Family Planning Subsidy (EFPS) policy was introduced to provide extra financial support to this group and was expanded nationwide in 2012. This study investigated the relationship between EFPS use and health among EFPS-eligible older Chinese using data from the China Health and Retirement Longitudinal Study. A total of 1,981 respondents were eligible for EFPS (i.e. aged 60 and above, had only one child, or were rural residents with two daughters). Respondents self-reported if they received EFPS in 2011, 2013, and 2015 and were followed up to 2018. Propensity score matching was used to match EFPS non-users with users based on their probability of using EFPS. Among the EFPS-eligible respondents, 256 (12.92%) used the benefit. Analysis revealed no significant differences between EFPS users and non-users with respect to mortality and other health outcomes (i.e. self-reported health, cognition, activities of daily living, chronic diseases, and depressive symptoms). Findings do not provide evidence that EFPS improved the short-term health of older Chinese with only one child. [ABSTRACT FROM AUTHOR]

Polysocial risk scores were recently proposed as a strategy for improving the clinical relevance of knowledge about social determinants of health. Our objective in this study was to assess whether the polysocial risk score model improves prediction of cognition and all-cause mortality in middle-aged and older adults beyond simpler models including a smaller set of key social determinants of health. We used a sample of 13 773 individuals aged ≥50 years at baseline from the 2006-2018 waves of the Health and Retirement Study, a US population-based longitudinal cohort study. Four linear mixed models were compared: 2 simple models including a priori–selected covariates and 2 polysocial risk score models which used least absolute shrinkage and selection operator (LASSO) regularization to select covariates among 9 or 21 candidate social predictors. All models included age. Predictive accuracy was assessed via R 2 and root mean-squared prediction error (RMSPE) using training/test split validation and cross-validation. For predicting cognition, the simple model including age, race, sex, and education had an R 2 value of 0.31 and an RMSPE of 0.880. Compared with this, the most complex polysocial risk score selected 12 predictors (R 2 = 0.35 and RMSPE = 0.858; 2.2% improvement). For all-cause mortality, the simple model including age, race, sex, and education had an area under the receiver operating characteristic curve (AUROC) of 0.747, while the most complex polysocial risk score did not demonstrate improved performance (AUROC = 0.745). Models built on a smaller set of key social determinants performed comparably to models built on a more complex set of social "risk factors." [ABSTRACT FROM AUTHOR]

The study compared care source typologies for older adults in China and the United States. Data from the 2014 U.S. Health and Retirement Study and the 2013 China Health and Retirement Longitudinal Study were used. The respondents included community-dwelling older adults aged 65 years or older with at least one limitation in activities of daily living (ADLs) or instrumental ADLs (IADLs) (N China = 2476, N US = 2898). Respondents reported whether they received assistance from spouse, child/grandchild, relatives, others, and formal helpers. Latent class analysis and multinomial logistic regression were applied. Four classes were identified in China and the U.S, separately. In both countries, ADLs and IADLs were strong determinants of care source typologies. Care sources were more diverse and included formal assistance among older Americans. Older Chinese relied largely on their spouses and children/grandchildren for support. Policy efforts are needed to expand formal long-term services and supports, particularly in China. [ABSTRACT FROM AUTHOR]

Objective: Mental health issues among older adults have been widely reported during the COVID-19 pandemic. This study examines the relationship between material hardship and three mental health measures among older Americans. Method: Data are from the Health and Retirement Study collected between 2020 and 2021. Respondents ages ≥ 50 years (N = 1,504) reported whether they had experienced seven types of material hardship (e.g., missed rent or mortgage payments) and self-assessed their mental health (i.e., depressive symptoms, anxiety, and loneliness). We used confounder-adjusted regression models to examine the associations of the sum and each specific type of material hardship with mental health. Results: About 26% of respondents (mean age = 69.36 , 65% female, 63% non-Hispanic white) experienced at least one type of material hardship during the pandemic. The number of material hardships was associated with more depressive symptoms and higher levels of anxiety and loneliness. Among the types of difficulties, having trouble buying food was negatively associated with mental health scores. Conclusion: Material hardship during the pandemic, especially food insecurity, was a significant mental health stressor among older Americans. Targeted supportive interventions and services for disadvantaged older adults may mitigate mental health burdens during public health crises, such as pandemics. [ABSTRACT FROM AUTHOR]

This study examined the long-term impact of spouse caregiving on insomnia symptoms, compared to propensity-score matched non-caregivers. Health and Retirement Study data between 2006 and 2018 were used. Caregivers (n = 403) were respondents (aged 50+) who assisted their heterosexual spouses in performing (instrumental) activities of daily living at baseline. Non-caregivers were matched using a propensity score matching procedure based on baseline characteristics. Insomnia symptoms were measured every 4 years for both groups. Poisson mixed-effect models estimated the association between caregiver status and insomnia symptoms. Compared to matched non-caregivers, caregivers had similar severity of insomnia symptoms at baseline (${{\rm{\beta }}_{{\rm{caregiver}}}}$ β caregiver = 0.018, 95% CI = −0.089, 0.124) and reported a similar yearly change rate (${{\rm{\beta }}_{{\rm{caregiver}} \times {\rm{time}}}}$ β caregiver × time = −0.008, 95% CI = −0.017, 0.001). No moderation effects of care-recipients' dementia status and social support were significant. In this study sample, there is no evidence that spouse caregivers, specifically those who performed light duties, experience more severe insomnia symptoms than non-caregivers. Spouse caregiving, especially in a light-duty capacity, may not be detrimental to the caregivers' sleep health. More data are needed regarding insomnia in spouse caregivers with heavy duties of care to fully assess the health impact of the caregiving experience. [ABSTRACT FROM AUTHOR]

Objectives Using a dyadic approach, this study examined the mediating effect of depressive symptoms on the longitudinal relationships between husbands' and wives' memory trajectories and their prospective disability status. Methods Longitudinal data from the Health and Retirement Study 2004–2018 were used. Older (aged 50+) heterosexual couples who had no limitations in the activity of daily living at the baseline (2004) were included (N = 1,310). Latent class growth analysis grouped wives and husbands into distinct memory trajectories in 2004–2014. A structural equation model examined the actor and partner effects of memory trajectories on depressive symptoms in 2016 and disability status in 2018. The mediating effect of depressive symptoms was tested. Results A total of 4 distinct memory trajectories were found: persistently high, high and slow decline, moderate and slow decline, and low and rapid decline. Only the wife's low and rapid decline memory trajectory predicted her own more depressive symptoms (β = 0.588, 95% CI: 0.209, 0.967) and her husband's more depressive symptoms (β = 0.326, 95% CI: 0.004, 0.648). Meanwhile, depressive symptoms had strong and significant actor effects on disability (β = 0.046, 95% CI: = 0.036, 0.057 for wives; β = 0.060, 95% CI: = 0.046, 0.074 for husbands). Discussion The wife's low and rapid declin e trajectory was associated with her own and her husband's more depressive symptoms, which in turn increased the disability risk for both partners. Timely identification and treatment of memory decline among wives have the potential to mitigate couples' depressive symptoms and, ultimately, disability risks. [ABSTRACT FROM AUTHOR]

Objectives: Studies on the interdependence of couples' health behaviors and subsequent cognitive outcomes remain limited. Methods: Longitudinal data from the China Health and Retirement Longitudinal Study (2011–2018) were used (N = 1869 heterosexual couples). Latent class analysis identified the dyadic pattern of health behaviors in 2011 (i.e., alcohol consumption, smoking, and physical inactivity). Stratified Cox models examined the association of latent classes with risk of developing memory-related disorders in 2013–2018. Results: Three classes were identified: class 1 (21.25%, only husband smoke, and both active), class 2 (47.55%, both inactive, neither drink nor smoke), and class 3 (31.20%, both drink and smoke, and both active). Couples' sedentary lifestyle was associated with an increased risk of memory-related disorders among both husbands and wives. Conclusion: Couples were moderately concordant in their physical activity but weakly in smoking and drinking. Couple-based interventions, especially promoting physical activity, may reduce cognitive aging among middle-aged and older Chinese couples. [ABSTRACT FROM AUTHOR]

This study compared the associations of child–parent relationships with older adults' multidimensional health in the United States and China. Two waves of data from the US Health and Retirement Study and its sister study in China (2012–2015) were used (2174 non-Hispanic [NH] White Americans and 4467 Chinese). Linear regression models were conducted for cross-sectional and longitudinal comparisons. Results showed most child–parent relationships had nonsignificant associations with NH White Americans' health. In contrast, closer child–parent relationships were linked to fewer depressive symptoms and better cognitive function among Chinese. Co-residence was associated with poorer health among older Chinese. Over a 2-year period, living nearby was linked to poorer cognitive function among NH White Americans and fewer depressive symptoms among Chinese. Having weekly contact was predictive of better cognition among Chinese. This study revealed cross-cultural differences in the associations between child–parent relationships and older adults' health. Family relationships in accordance with Chinese culture could improve health. [ABSTRACT FROM AUTHOR]

Objectives: This study examined whether trajectories of depressive symptoms of one spouse are associated with the other spouse's memory. Methods: Longitudinal data from the Health and Retirement Study (2004–2016) were used (N = 5690 heterosexual couples). Latent-class growth analysis and structural equation models examined the actor and partner effects of depressive symptom trajectories on memory. Results: Four depressive symptom trajectories were identified (i.e., persistently low, increasing, decreasing, and persistently high). Compared to the low trajectory group, the increasing and persistently high trajectories were associated with worse memory for both men and women. While none of the wives' depressive symptom trajectories was significantly associated with husbands' memory (p >.05), husbands' decreasing trajectory was linked to wives' better memory (β = 0.498, 95% CI = 0.106, 0.890). Discussion: Older adults with increasing and persistently high depressive symptoms may experience worse memory. Psychosocial interventions targeting depressive symptoms among older men may be beneficial to their spouses' memory. [ABSTRACT FROM AUTHOR]