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Objectives: This study investigates the association of the cumulative burden of anxiety-only, depression-only, and comorbid anxiety and depression symptoms with (a) incident self-care or household activities impairment among those with no baseline self-care or household activities impairment, respectively, or (b) change in status of self-care or household activities impairment among those with baseline impairment.Methods: This study consists of participants (N = 4619) from the National Health and Aging Trends Study, a longitudinal study that examines a nationally representative sample of US adults aged 65 years and older. Outcomes included incident or change in self-care or household activity impairment. Primary independent variables were yearly counts of screening positive for clinically significant symptoms for anxiety-only, depression-only, or co-occurring anxiety and depression. Multivariable logistic regression models examined incident impairment and change in impairment status.Results: Yearly counts of anxiety-only symptoms were associated with incident impairment in self-care and household activities and less improvement in self-care functioning. Yearly counts of depression-only symptoms were associated with incident impairment in self-care and household activities. Yearly counts of co-occurring symptoms of anxiety and depression were associated with incident impairment in self-care and household activities, less improvement in self-care activities, and worsening impairment in household activities.Conclusions: This study finds that the cumulative burden of co-occurring anxiety and depression symptoms is associated with incident impairment in functioning, persistent self-care impairment, and deterioration in household activity impairment. These findings emphasize the importance of managing late-life anxiety and depressive symptoms, which are treatable, frequently co-occur, and contribute to disability. [ABSTRACT FROM AUTHOR]

Objective: The objective of the study is to examine whether the risk of having clinically significant depressive symptoms following a heart attack or stroke varies by the presence of a close social contact.Methods: The National Health and Aging Trends Study is a nationally representative longitudinal survey of US Medicare beneficiaries aged 65 and older initiated in 2011. A total of 5643 older adults had information on social contacts at baseline and depressive symptoms at the 1-year follow-up interview. The two-item Patient Health Questionnaire identified clinically significant depressive symptoms. Interview questions examined social contacts and the presence of self-reported heart attack or stroke during the year of follow-up.Results: A total of 297 older adults reported experiencing a heart attack and/or stroke between their baseline and follow-up interviews. In regression analyses accounting for sociodemographics, baseline depressive symptoms, medical comorbidity, and activities of daily living impairment, older adults with no close social contacts had increased odds of depressive symptoms at follow-up after experiencing a heart attack or stroke, while those with close social contacts had increased odds of depressive symptoms at follow-up after experiencing a stroke, but not a heart attack.Conclusions: Older adults have increased odds of having depressive symptoms following a self-reported stroke, but only those with no close social contacts had increased odds of depressive symptoms following a heart attack. Social networks may play a role in the mechanisms underlying depression among older adults experiencing certain acute health events. Future work exploring the potential causal relationships suggested here, if confirmed, could inform interventions to alleviate or prevent depression among at risk older adults. Copyright © 2017 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background: While low social support is a risk factor for mental illness, anxiety and depression's relationship with social impairment specifically resulting from a medical condition is poorly understood. We hypothesize that when a medical illness makes it difficult for people to form and maintain close relationships with others, they will be at increased risk for anxiety and depression.Methods: Two nationally representative surveys, the National Comorbidity Survey-Replication and National Latino and Asian American Study, included 6805 adults with at least one medical illness and information on social impairment attributed to a medical condition. The Composite International Diagnostic Interview evaluated a 12-month history of anxiety and depressive disorders.Results: 8.2% of our sample had at least moderate difficulty in forming and maintaining close relationships due to a medical condition. In bivariate analyses, younger age, Latino ethnicity, less education, worse financial status, more chronic illnesses, physical health and discomfort, and problems with mobility, home management, and self-care were associated with this social impairment. In multivariable analyses accounting for possible confounders, there was a dose-dependent relationship between social impairment and the prevalence of anxiety and depression.Limitations: Data are cross-sectional and our analyses are therefore unable to determine cause-and-effect relationships.Conclusions: Among adults with one or more medical conditions, social impairment attributed to medical illness was associated with a significantly greater odds of anxiety and depression. Further clarification of this relationship could inform more targeted, personalized interventions to prevent and/or alleviate mental illness in those with chronic medical conditions. [ABSTRACT FROM AUTHOR]

Background: Frailty assessment provides a means of identifying older adults most vulnerable to adverse outcomes. Attention to frailty in clinical practice is more likely with better understanding of its prevalence and associations with patient characteristics. We sought to provide national estimates of frailty in older people.Methods: A popular, validated frailty phenotype proposed by Fried and colleagues was applied to 7,439 participants in the 2011 baseline of the National Health and Aging Trends Study, a national longitudinal study of persons aged 65 and older. All measures drew on a 2-hour in-person interview. Weighted estimates of frailty prevalence were obtained.Results: Fifteen percent (95% CI: 14%, 16%) of the older non-nursing home population is frail, and 45% is prefrail (95% CI: 44%, 47%). Frailty is more prevalent at older ages, among women, racial and ethnic minorities, those in supportive residential settings, and persons of lower income. Independently of these characteristics, frailty prevalence varies substantially across geographic regions. Chronic disease and disability prevalence increase steeply with frailty. Among the frail, 42% were hospitalized in the previous year, compared to 22% of the prefrail and 11% of persons considered robust. Hip, back, and heart surgery in the last year were associated with frailty. Over half of frail persons had a fall in the previous year.Conclusions: Our findings support the importance of frailty in late-life health etiology and potential value of frailty as a marker of risk for adverse health outcomes and as a means of identifying opportunities for intervention in clinical practice and public health policy. [ABSTRACT FROM AUTHOR]

Purpose: A primary goal for aging policy is to optimize independence in later life. We estimate the cross-sectional association between physical and social challenge in the home environment and use of assistive devices (AD) for mobility in the home, controlling for lower extremity physical performance (short physical performance battery [SPPB]) and other factors. Design and Methods: Data are from the Women’s Health and Aging Study I, a prospective study of the factors related to physical disability in a sample of moderately to severely disabled older women. We describe these associations in the baseline sample overall and also within subsets who do and do not have both a baseline and a 3-year follow-up observation. Results: On average, physical challenge in the home environment is inversely associated with level of AD use (p < .05) in the overall sample, independent of SPPB, living alone, and other factors. We do not find a significant (p < .05) association between social challenge and the level of AD use in the overall sample. Findings by follow-up responder status were similar (with minor variability). Implications: Future cohorts who are better educated and more receptive to technology may confront challenges in the home environment that limit their ability to age in place. Our findings suggest that the physical challenges of the home are significantly related to AD use. Future analyses that explore the mechanisms of the home environment as a source of challenges to independent functioning could help in the design of future interventions for these cohorts as they age. [ABSTRACT FROM PUBLISHER]

Objective To evaluate the association between multisystem physiological dysfunction and depressive symptom severity in the US older adults. Methods We examined 2405 adults of age 60 years and older by using the data from the 2005-2008 National Health and Nutrition Examination Survey. We constructed a summary score of 'physiological dysfunction,' encompassing cardiovascular function, glucose regulation, liver function, and renal function. Overall depressive symptoms were obtained from the 9-item Patient Health Questionnaire depression scale, and factor analysis was used to derive affective and somatic symptom scores. We employed multiple linear regression models to estimate associations between physiological dysfunction scores and affective, somatic, and overall depressive symptoms, while adjusting for demographic, socioeconomic factors, and other potentially confounding factors. Results Greater multisystem physiological dysfunction scores were associated with an increased severity of overall, affective, and somatic depressive symptoms. These associations persisted after adjusting for all covariates: beta = 0.23 (95% confidence interval (CI) = 0.13, 0.32); beta = 0.08 (95% CI = 0.04, 0.11); beta = 0.12 (95% CI = 0.06, 0.18), respectively. Conclusions Our results suggest that the multisystem physiological dysfunction is associated with late-life depressive symptoms. Additional longitudinal studies of links between allostatic load, psychosocial stress events throughout the life course, and late-life depressive symptoms may shed further light on this association. Copyright © 2012 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective: To assess whether loss of consistency or systematic measurement error is introduced by allowing older individuals to use a cane during measurement of self-selected walking speed (SSWS).Study Design and Setting: Observational study of women aged 65+ (Women's Health and Aging Study I, n=1,002).Results: Of individuals who use a cane in daily life, 201 (50.76%) did not use an aid during testing. The Coefficient of Variation was low in individuals who reported cane use in daily life but did not use one in testing (10.72%), and did not vary substantially if a cane was used (12.04%). The Intra-Class Correlation Coefficient was high: 0.958 for those who reported cane use in daily life but did not use one during testing and 0.962 for those who used a cane. In both groups, Bland-Altman plots revealed a small systematic difference between the first and second trials. There was no evidence of effect modification of the association between SSWS and mobility disability by cane use during testing.Conclusion: This observational study found neither evidence of poorer consistency nor increased measurement bias in SSWS recorded while using a cane compared to using no assistive device. [ABSTRACT FROM AUTHOR]

Abstract: Natural disasters, such as earthquakes, can have deleterious consequences for physical and psychological health. In this study, we investigate variability in resilience to depressive symptoms in the aftermath of a massive earthquake that struck Taiwan in 1999. We analyze data on 1160 older individuals from a national, longitudinal survey with interviews before and after the earthquake. This survey contains extensive information on physical and cognitive function, depressive symptoms, socio-demographic characteristics and earthquake-related exposure and experiences. We estimate regression models to identify risk factors associated with the presence of depressive symptoms after the disaster, controlling for health status and the presence of depressive symptoms beforehand. We pay special attention to how socio-demographic factors moderate the psychological impact of the earthquake. Results indicate that persons of low socioeconomic status (SES), socially isolated individuals, and women reported higher levels of depressive symptoms than their respective counterparts, as did persons who experienced damage to their homes. The psychological effects of damage were strongest among those aged 54–70. The findings suggest that people who experience damage to their home during a disaster are at risk of experiencing depressive symptoms, with the elderly being more resilient than the near-elderly. [Copyright &y& Elsevier]

Abstract: The theory of allostatic load [McEwen, B.S., Stellar, E., 1993. Stress and the individual: mechanisms leading to disease. Arch. Intern. Med. 153, 2093–2101] describes how the cumulative experience of emotional challenges and stressful events over the life course may take a significant physiological toll on multiple interrelated systems of the body. Various summary measures of these effects have been proposed in the literature, but few studies focus on systematically evaluating them. We use data from a population-based sample of older Taiwanese to compare the explanatory power and cross-sectional predictive performance of several measures of allostatic load for diverse health outcomes. We find that choices regarding which biomarkers to include in a summary measure and how the measure is formed have modest effects across the basic prediction models we evaluate. Our findings suggest that count-based summary measures incorporating risk at both high and low tails and measures that preserve the continuous properties of the biological variables are strategies that may yield stronger predictions of a wider array of health outcomes than other measures. These fundamental insights are useful for researchers in search of empirical formulations of allostatic load and for those who are focused on the development of improved measurement strategies. [Copyright &y& Elsevier]

We investigate how biological markers of individual responses to stressful experiences are associated with profiles of physical and mental functioning in a national sample of middle-aged and elderly Taiwanese. Data come from a population-based sample of middle-aged and elderly Taiwanese in 2000. The data combine rich biological measures with self-reported information on physical and mental health. Grade of membership methods are used to summarize functional status, and multinomial logit models provide information on the association between biological measures and function. The analysis identifies significant associations between biomarkers of stressful experience and profiles of physical and mental functioning. The estimates reveal the potential importance for health of both low and high values of biological parameters. The findings point to directions for future research regarding development of aggregate measures of cumulative dysregulation across multiple physiological systems. [ABSTRACT FROM AUTHOR]

Objective To account for variations in death rates in population subgroups of the USA. Methods Factors associated with age-adjusted death rates in 366 metropolitan and non-metropolitan areas of the United States were examined for 1990-92. The rates ranged from 690 to 1108 per 100 000 population (mean = 885 ± 78 per 100 000). Findings Least squares regression analysis explained 71% of this variance. Factors with the strongest independent positive association were ethnicity (African-American), less than a high school education, high Medicare expenditures, and location in western or southern regions. Factors with the strongest independent negative associations were employment in agriculture and forestry, ethnicity (Hispanic) and per capita income. Conclusion Additional research at the individual level is needed to determine if these associations are causal, since some of the factors with the strongest associations, such as education, have long latency periods. [ABSTRACT FROM AUTHOR]

An academic partnership between a university and an upstate New York school serving students with intellectual and developmental disabilities established a research-driven, weekly onsite asymptomatic COVID-19 testing protocol supplemented by symptomatic testing. The research team, including school leadership, met at least weekly to address implementation issues, impacts of changing pandemic and regulatory requirements, and interpretation and dissemination of findings. The dynamic partnership resulted in 380 participants, more than 16 000 polymerase chain reaction tests, and additional research studies. (Am J Public Health. 2024;114(S5):S384–S387. https://doi.org/10.2105/AJPH.2024.307687) [ABSTRACT FROM AUTHOR]

Background: This study examined the correlation of classroom ventilation (air exchanges per hour (ACH)) and exposure to CO2 ≥1,000 ppm with the incidence of SARS-CoV-2 over a 20-month period in a specialized school for students with intellectual and developmental disabilities (IDD). These students were at a higher risk of respiratory infection from SARS-CoV-2 due to challenges in tolerating mitigation measures (e.g. masking). One in-school measure proposed to help mitigate the risk of SARS-CoV-2 infection in schools is increased ventilation. Methods: We established a community-engaged research partnership between the University of Rochester and the Mary Cariola Center school for students with IDD. Ambient CO2 levels were measured in 100 school rooms, and air changes per hour (ACH) were calculated. The number of SARS-CoV-2 cases for each room was collected over 20 months. Results: 97% of rooms had an estimated ACH ≤4.0, with 7% having CO2 levels ≥2,000 ppm for up to 3 hours per school day. A statistically significant correlation was found between the time that a room had CO2 levels ≥1,000 ppm and SARS-CoV-2 PCR tests normalized to room occupancy, accounting for 43% of the variance. No statistically significant correlation was found for room ACH and per-room SARS-CoV-2 cases. Rooms with ventilation systems using MERV-13 filters had lower SARS-CoV-2-positive PCR counts. These findings led to ongoing efforts to upgrade the ventilation systems in this community-engaged research project. Conclusions: There was a statistically significant correlation between the total time of room CO2 concentrations ≥1,000 and SARS-CoV-2 cases in an IDD school. Merv-13 filters appear to decrease the incidence of SARS-CoV-2 infection. This research partnership identified areas for improving in-school ventilation. [ABSTRACT FROM AUTHOR]

Simple Summary: Patients with brain tumors often experience changes in memory and other aspects of thinking. Many may also have difficulty with social cognition, affecting the abilities that facilitate social behavior and maintain social relationships; however, the data are limited. Whether treatments such as cranial radiation can impact social cognition is not well-studied. We sought to understand how radiation dose exposure to the amygdala–orbitofrontal network, which subserves social cognition and emotion recognition, impacted performance on an emotion recognition task. We found that radiation dose to the amygdala and associated structures was associated with performance on an emotion recognition task, including longer response times with increasing radiation doses. Radiation techniques that reduce the dose to the amygdala-orbitofrontal network may decrease side effects for patients receiving cranial radiation. Background: Although data are limited, difficulty in social cognition occurs in up to 83% of patients with brain tumors. It is unknown whether cranial radiation therapy (RT) dose to the amygdala–orbitofrontal network can impact social cognition. Methods: We prospectively enrolled 51 patients with low-grade and benign brain tumors planned for cranial RT. We assessed longitudinal changes on an emotion recognition task (ERT) that measures the ability to recognize emotional states by displaying faces expressing six basic emotions and their association with the RT dose to the amygdala–orbitofrontal network. ERT outcomes included the median time to choose a response (ERTOMDRT) or correct response (ERTOMDCRT) and total correct responses (ERTHH). Results: The RT dose to the amygdala–orbitofrontal network was significantly associated with longer median response times on the ERT. Increases in median response times occurred at lower doses than decreases in total correct responses. The medial orbitofrontal cortex was the most important variable on regression trees predicting change in the ERTOMDCRT. Discussion: This is, to our knowledge, the first study to show that off-target RT dose to the amygdala–orbitofrontal network is associated with performance on a social cognition task, a facet of cognition that has previously not been mechanistically studied after cranial RT. [ABSTRACT FROM AUTHOR]

Cancer-related cognitive impairment (CRCI) has not been objectively assessed in chronic lymphocytic leukemia (CLL). It is currently unclear how much of CRCI is attributable to disease, treatment, or both. We used CLL as a novel model to study the differential roles of disease and treatment in CRCI. One hundred and fifty CLL patients (100 treatment-naïve and 50 chemotherapy-treated) including 84 patients with higher-risk of CLL progression completed objective neuropsychological tests. Sociodemographic-adjusted linear regression models examined cognitive outcomes in relation to risk and treatment. Higher-risk patients recalled two fewer words on a memory task (β = −1.8, 95%CI –3.3,−0.3) and took 15 s longer on an executive function task (β = 15.4, 95%CI 3.1, 27.6) than lower-risk patients, independent of treatment. Treated patients reported greater cognitive difficulties than treatment-naive patients (β = −6.1, 95%CI –10.1, −2.2) but did not perform worse on objective measures. Higher-risk patients experienced impairments in executive function and memory suggesting that disease biology contributes to CRCI independent of treatment. [ABSTRACT FROM AUTHOR]

Introduction: Patients with atopic dermatitis (AD) are uniquely susceptible to a number of serious viral skin complications, including eczema herpeticum (EH), caused by herpes simplex virus. This study explored the associations between biomarkers of epithelial barrier dysfunction, type 2 immunity, Staphylococcus aureus infection, and S. aureus-specific immunoglobulin responses in a cohort of AD subjects with and without a history of EH (EH+ and EH−, respectively). Methods: A total of 112 subjects with AD (56 EH+, 56 EH−), matched by age and AD severity, were selected from a registry of over 3000 AD subjects. Logistic regression was used to test the association between history of S. aureus skin infection and history of EH, while controlling for a number of confounders. Results: Compared to those without a history of S. aureus skin infection, subjects with a history of S. aureus skin infection were found to have more than sixfold increased odds of having a history of EH (6.60, 95% confidence interval [CI]: 2.00–21.83), after adjusting for history of other viral skin infections (molluscum contagiosum virus, human papillomavirus), serum total IgE, and IgG against the S. aureus virulence factor SElX. Conclusions: These findings indicate an important relationship between S. aureus skin infections and EH. [ABSTRACT FROM AUTHOR]

Abstract Objectives Our article's primary objective is to examine whether rehabilitation providers can predict which patients discharged from skilled nursing facility (SNF) rehabilitation will be successful in their transition to home, controlling for sociodemographic factors and physical, mental, and social health characteristics. Design Longitudinal cohort study. Setting and Participants One hundred-twelve English-speaking adults aged 65 years and older admitted to 2 SNF rehabilitation units. Measures Our outcome is time to "failed transition to home," which identified SNF rehabilitation patients who did not successfully transition from the SNF to home during the study. Our primary independent variable consisted of the prediction of medical providers, occupational therapists, physical therapists, and social workers about the likely success of their patients' SNF-to-home transition. We also examined the association of sociodemographic factors and physical, mental, and social health with a failed transition to home. Results The predictions of occupational and physical therapists were associated with whether patients successfully transitioned from the SNF to their homes in bivariate [hazard ratio (HR) = 4.96, P =.014; HR = 10.91, P =.002, respectively] and multivariate (HR = 5.07, P =.036; HR = 53.33, P =.004) analyses. The predictions of medical providers and social workers, however, were not associated with our outcome in either bivariate (HR = 1.44, P =.512; HR = 0.84, P =.794, respectively) or multivariate (HR = 0.57, P =.487; HR = 0.54, P =.665) analyses. Living alone, more medical conditions, lower physical functioning scores, and greater depression scores were also associated with time to failed transition to home. Conclusions/Implications These findings suggest that occupational and physical therapists may be better able to predict post-SNF discharge outcomes than are other rehabilitation providers. Why occupational and physical therapists' predictions are associated with the SNF-to-home outcome whereas the predictions of medical providers and social workers are not is uncertain. A better understanding of the factors informing the postdischarge predictions of occupational and physical therapists may help identify ways to improve the SNF-to-home discharge planning process. [ABSTRACT FROM AUTHOR]

Abstract Objectives Our study examines factors associated with patient-reported outcomes in functioning among Medicare beneficiaries who reported receiving rehabilitation services in a nursing home or inpatient (ie, hospital or rehabilitation facility) setting in the prior year. Design Data are from the 2015 and 2016 rounds of the National Health and Aging Trends Study (NHATS), a longitudinal study of a nationally representative sample of Medicare beneficiaries aged 65 years and older. Setting and Participants A total of 479 participants in the 2016 sample who reported receiving rehabilitation services in a nursing home or inpatient setting in the past year. Measures Bivariate and logistic regression analyses examined the association of demographic, socioeconomic status, and health variables (from the 2015 interview) and rehabilitation characteristics (from the 2016 interview) with patient-reported improvement in "functioning and ability to do activities" while receiving rehabilitation services in the past year. Results Among Medicare beneficiaries who received rehabilitation services in nursing home or inpatient settings, 33.4% (weighted percent) reported no improvement in functioning while they were receiving rehabilitation. In a regression analysis that accounted for demographics, those with a high school education or less (compared with those with a college degree), instrumental activities of daily living impairments, certain primary conditions for rehabilitation, less than 1-month total duration of rehabilitation services, and no outpatient rehabilitation services had greater odds of reporting no improvement. Conclusions/Implications Our weighted sample represents approximately 2.3 million Medicare beneficiaries who received rehabilitation services in nursing home or inpatient settings. In this sample, 1 in 3 reported no improvement in functioning, with differences in patient-reported outcomes across socioeconomic status, health status, and rehabilitation characteristics domains. Consideration of characteristics across these domains may be clinically pertinent, but investigation as to why these differences are present and whether services can be optimized to further improve patient-reported outcomes is warranted. [ABSTRACT FROM AUTHOR]

To evaluate the association between latency and neonatal morbidity for pregnancies with expectant management of PPROM ≥34 w. A retrospective cohort of singletons with PPROM from 2011 to 2016. Exposure was defined as latency (period from diagnosis of PPROM to delivery) and was analyzed as a count variable (i.e. number of days) and binary variable (≥7 days and <7 days; ≥21 days and <21 days). Primary outcome was composite neonatal morbidity defined as need for respiratory support, culture positive neonatal sepsis, and/or neonatal antibiotics >72 h. Fisher's exact test, chi-square test, Mann–Whitney U and binary logistic regression tests were performed with p<.05 considered significant. Of 813 pregnancies, 104 met inclusion criteria: 73 (70.2%) pregnancies with PPROM diagnosed at <34 weeks and 31 (29.8%) pregnancies with PPROM diagnosed ≥34 weeks. A total of 58 (55.8%) pregnancies had a latency of ≥7 days and 46 (44.2%) had a latency <7 days. There was no difference in composite neonatal morbidity for latency ≥7 d versus <7 d (aOR 0.92; 95% CI 0.30–2.82) or latency as a count variable (aOR 0.70; 95% CI 0.23–2.13). However, a latency ≥21 d was associated with increased composite neonatal morbidity (aOR 10.24, 95% CI 1.42–73.99). In pregnancies with PPROM expectantly managed ≥34 w, a latency of ≥7 d is not associated with significant differences in neonatal morbidity. However, different latency thresholds may be more clinically relevant for late preterm pregnancies. The increase in composite neonatal morbidity associated with a latency >21 days should be an area of future investigation and may suggest there is a population of pregnancies with PPROM which may not benefit from expectant management past 34 weeks. [ABSTRACT FROM AUTHOR]

Abstract: The allostatic load model has been used to quantify the physiological costs of the body's response to repeated stressful demands and may provide a useful, integrative perspective on the various correlates of late-life depressive symptoms. We interviewed 125 Rochester, NY adults, ranging in age from 67 to 94years. We employed an allostatic load score as a measure of multisystem dysfunction in hypothalamic–pituitary–adrenal axis function, immune function, anabolic activity, and cardiovascular activity. Overall, affective, and somatic depressive symptom scores were computed using the 20-item Center for Epidemiologic Studies Depression Scale. Multiple linear regression models were used to estimate associations between allostatic load scores and affective, somatic, and overall depressive symptoms. Among our sample of mean age 76.1years, the one-week prevalence of clinically significant depressive symptoms was 12.8%. In models adjusting for demographic, socioeconomic, and health-related factors, higher allostatic load scores were associated with elevated scores for overall, affective, and somatic depressive symptoms: beta=1.21 (95% CI=0.38, 2.05); beta=0.14 (95% CI=0.040, 0.24); beta=0.60 (95% CI=0.23, 0.97), respectively. Our results suggest that allostatic load measure is associated with late-life depressive symptoms. This association appears to be of clinical significance, as the magnitude of the effect size was comparable (but opposite in direction) to that of antidepressant use. Future research should examine the inter-relationships of allostatic load, psychological stress, and late-life depressive symptoms. [Copyright &y& Elsevier]

Background: The effectiveness of implantable cardioverter-defibrillators (ICDs) on reducing mortality has not been well studied in patients with long QT syndrome (LQTS).Objectives: This study aimed to assess the survival benefits of ICDs in the overall LQTS population and in subgroups defined by ICD indications.Methods: This study included 3,035 patients (597 with ICD) from the Rochester LQTS Registry with a QTc ≥470 milliseconds or confirmed LQTS mutation. Using multivariable Cox proportional hazards models, the risk of all-cause mortality, all-cause mortality before age 50 years, and sudden cardiac death (SCD) were estimated as functions of time-dependent ICD therapy. Indication subgroups examined included patients with: 1) nonfatal cardiac arrest; 2) syncope while on beta-blockers; and 3) a QTc ≥500 milliseconds and syncope while off beta-blockers.Results: During the 118,837 person-years of follow-up, 389 patients died (137 before age 50 years, and 116 experienced SCD). In the entire population, patients with ICDs had a lower risk of death (HR: 0.54; 95% CI: 0.34-0.86), death before age 50 years (HR: 0.29; 95% CI: 0.14-0.61), and SCD (HR: 0.22; 95% CI: 0.09-0.55) than patients without ICDs did. Patients with ICDs also had a lower risk of mortality among the 3 indication subgroups (HR: 0.14; 95% CI: 0.06-0.34; HR: 0.27; 95% CI: 0.10-0.72; and HR: 0.42; 95% CI: 0.19-0.96, respectively).Conclusions: ICD therapy was associated with a lower risk of all-cause mortality, all-cause mortality before age 50 years, and SCD in the LQTS population, as wells as with a lower risk of all-cause mortality in indication subgroups. This study provides evidence supporting ICD implantation in patients with high-risk LQTS. [ABSTRACT FROM AUTHOR]

Low socioeconomic status (SES) is associated with increased risk for adverse health outcomes; those with low SES are thought to experience greater environmental disadvantage and exposure to chronic stress over the life course. The effects of chronic stress on health have been measured by cortisol levels and variations in their diurnal pattern. However, the patterns of association between SES and cortisol have been equivocal in older adults. This paper examined in 98 older adults participating in the Brain Health Substudy of the Baltimore Experience Corps Trial baseline patterns of diurnal variation in salivary cortisol associated with lower versus higher SES using total income and perceived SES relative to others. For each measure, participants stratified into lower versus higher SES showed a more blunted rate of decline in diurnal salivary cortisol over the day in adjusted models ( P values ≤ 0.05). There were no SES-related differences in awakening cortisol, cortisol-awakening response, or area under the curve. These findings confirm prior evidence of a biologic pathway through which socioeconomic disadvantage is linked to biologic vulnerability, and through which the impact of volunteer service in Experience Corps may be measured. [ABSTRACT FROM AUTHOR]

Abstract: Studies have indicated that personality may be associated with inflammatory markers such as Interleukin (IL)-6. One pathway between personality and IL-6 may be health behaviors and conditions resulting in inflammation, while an alternate pathway involves activation of stress–response systems. In a clinical trial sample of 200 older adults, we examined associations between personality traits at baseline and three measures of IL-6 spanning 34weeks of follow-up. Results indicate that IL-6 remained very stable over time, and that higher Conscientiousness and Openness were associated with lower IL-6 across the entire 34week period. Goal striving was the active subcomponent of Conscientiousness, while aesthetic interests was the active subcomponent of Openness in IL-6 associations. Common health behaviors and chronic illness accounted for only a portion of these effects, suggesting that other behavioral and/or physiological processes may also predispose some persons to inflammation. Personality phenotype may provide useful prognostic information for inflammation. Older adults lower in Conscientiousness and Openness constitute a target population for anti-inflammatory interventions. Openness and Conscientiousness predicts 32-week patterns of Interleukin-6 in older persons. [Copyright &y& Elsevier]

Researchers have had a longstanding interest in understanding the determinants of mortality. This article examines the impact of a broad array of biological markers, together with self-reports of physical and mental health status, on the probability of dying for older adults. The estimates are derived from logistic regression models based on data from a national survey in Taiwan. The analysis confirms previous studies demonstrating the effects of clinical measures related to metabolic syndrome on mortality and identifies detrimental effects of neuroendocrine and immune-system markers. The results reveal that biomarkers provide independent explanatory power in the presence of self-reported health measures. The associations between biomarkers and mortality found here provide new avenues for projecting future mortality and elucidating differences in longevity across populations. [ABSTRACT FROM AUTHOR]

Millions of older adults receive rehabilitation services every year, which aim to restore, maintain, or limit decline in functioning. We examine whether lower reported well-being prior to receiving rehabilitation services is associated with increased odds of worsening anxiety symptoms, depressive symptoms, and impairment in self-care and household activities following rehabilitation. Data come from the National Health and Aging Trends Study (NHATS), an annual survey of a nationally representative sample of Medicare beneficiaries aged 65 years and older. Our sample consists of 811 NHATS participants who, in the 2015 interview, had information on well-being and, in the 2016 interview, reported receiving rehabilitation services in the prior year. In multivariable logistic regression analyses, compared to the highest quartile, those in the lowest quartile of well-being at baseline have increased odds of having worsening depressive symptoms (OR = 9.25, 95% CI: 3.78–22.63) and worsening impairments in self-care activities (OR = 2.39, 95% CI: 1.12–5.11). Our findings suggest that older adults with the lowest levels of baseline well-being may be susceptible to having worsening depressive symptoms and impairment in self-care activities following rehabilitation services. Examination on whether consideration of well-being during the rehabilitation process could lead to better mental health and functional outcomes following rehabilitation is needed. [ABSTRACT FROM AUTHOR]

Introduction: "Frailty" has attracted attention for its promise of identifying vulnerable older adults, hence its potential use to better tailor geriatric health care. There remains substantial controversy, however, regarding its nature and ascertainment. Recent years have seen a proliferation of frailty assessment methods. We argue that the development of frailty assessments should be grounded in "validation"-the process of substantiating that a measurement accurately and precisely measures what it intends, identify unresolved measurement issues, and highlight measurement-related considerations for clinical practice.Methods: Principles for validating frailty measures are elucidated. We follow principles-articulated, for example, by Borsboom-in which a construct must be clearly defined and then analyses undertaken to substantiate that a measurement accurately and precisely measures what it intends. Key elements are content validity, criterion validity, and construct validity, with an emphasis on the latter.Results: We illustrate the principles for a physical frailty phenotype construct.Conclusions: Unresolved conceptual issues include the roles of intersecting concepts such as cognition, disease severity, and disability in frailty measurement, conceptualization of frailty as a state versus a continuum, and the potential need for dynamic measures and systems concepts in furthering understanding of frailty. Clinical considerations include needs to distinguish interventions designed to address frailty "symptoms" versus underlying physiology, improve "prefrailty" measures intended to screen individuals early in their frailty progression, address feasibility demands, and further visioning followed by rigorous efficacy research to address the landscape of potential uses of frailty assessment in clinical practice. [ABSTRACT FROM AUTHOR]

Objective To investigate the psychosocial etiology of physical frailty by examining the influence of chronic stress and perceived control. Method Using population-based samples of older adults from the Health and Retirement Study, this study employed structural equation modeling in cross-sectional (N = 5,250) and longitudinal (N = 2,013) samples to estimate the effects of chronic stress and socioeconomic status (SES) on baseline frailty and change in frailty status over 4 years and the extent to which perceived control mediates or moderates effects of chronic stress. Results Perceived control fully mediated effects of chronic stress and partially mediated effects of SES on both baseline frailty and change in frailty. Multigroup analyses revealed that the mediating role of perceived control was consistent across age, gender, and racial/ethnic subgroups. There was no evidence to support a moderating role of perceived control in the chronic stress and frailty relationship. Discussion Findings provide novel evidence for a mediating role of perceived control in pathways linking SES and chronic stress to frailty, further underscoring the importance of psychosocial constructs to the development and progression of frailty in older adults. [ABSTRACT FROM AUTHOR]

Demographic studies of mortality often emphasize the two ends of the lifespan, focusing on the declining hazard after birth or the increasing risk of death at older ages. We call attention to the intervening phase, when humans are least vulnerable to the force of mortality, and consider its features in both evolutionary and historical perspectives. We define this quiescent phase (Q-phase) formally, estimate its bounds using life tables for Swedish cohorts born between 1800 and 1920, and describe changes in the morphology of the Q-phase. We show that for cohorts aging during Sweden's demographic and epidemiological transitions, the Q-phase became longer and more pronounced, reflecting the retreat of infections and maternal mortality as key causes of death. These changes revealed an underlying hazard trajectory that remains relatively low and constant during the prime ages for reproduction and investment in both personal capital and relationships with others. Our characterization of the Q-phase highlights it as a unique, dynamic, and historically contingent cohort feature, whose increased visibility was made possible by the rapid pace of survival improvements in the nineteenth and twentieth centuries. This visibility may be reduced or sustained under subsequent demographic regimes. [ABSTRACT FROM AUTHOR]

Purpose: Participation in social and community activities that require leaving one's home is important to older adults; however, many older adults have difficulty or are unable to leave their dwellings, and little is known from national samples about issues related to remaining active outside the home or the barriers faced by these older adults.Design and Methods: We used the National Health and Aging Trends Study, a nationally representative study of older adults (n = 7197), to understand the following: (1) the importance that homebound and semi-homebound adults place on involvement in social or community activities, (2) their current level of involvement, and (3) reported barriers to participation.Results: Despite the heavy burden of functional limitations, depression, pain, and falls, homebound adults reported that activities outside the home were important to them ranging from 25.2 % (attend clubs) to 70.0 % (visit family). Similarly, semi-homebound older adults had a strong interest in such participation, including visiting friends and family (81.8 %), attending religious services (72.6 %), and going out for enjoyment (72.5 %). Many homebound adults reported health (42.9-64.1 % depending on the activity) and transportation (12.2-18.2 %) as barriers to participation. Semi-homebound adults also identified health (23.8-41.0 %) and transportation (6.5-10.2 %) as participation barriers.Implications: This information can be useful in designing community programs that will foster meaningful social and community engagement for older adults, which may improve their quality of life. [ABSTRACT FROM AUTHOR]

Objectives. Studies of late-life disablement typically address the role of advancing age as a factor in developing disability, and in some cases have pointed out the importance of time to death (TTD) in understanding changes in functioning. However, few studies have addressed both factors simultaneously, and none have dealt satisfactorily with the problem of missing data on TTD in panel studies. Methods. We fit latent-class trajectory models of disablement using data from the Health and Retirement Study. Among survivors (~20% of the sample), TTD is unknown, producing a missingdata problem. We use an auxiliary regression equation to impute TTD and employ multiple imputation techniques to obtain final parameter estimates and standard errors. Results. Our best-fitting model has 3 latent classes. In all 3 classes, the probability of having a disability increases with nearness to death; however, in only 2 of the 3 classes is age associated with disability. We find gender, race, and educational differences in class-membership probabilities. Discussion. The model reveals a complex pattern of age- and time-dependent heterogeneity in late-life disablement. The techniques developed here could be applied to other phenomena known to depend on TTD, such as cognitive change, weight loss, and health care spending. [ABSTRACT FROM AUTHOR]

Abstract: Smoking prevalence for those ages 45–65 is higher than the national average and the number of mid-life and older smokers is expected to increase as baby boomers age. Cessation, even after age 65, confers health benefits. Both physiologic and psychological mechanisms support use of physical activity (PA) as a coping tool for quitting and improving health. This study focused on use of PA for coping with urges to smoke, factors associated with use, and whether use of PA was associated with abstinence at 12months for 799 smokers ages 50 and older. Only 11.6% used PA for coping, with walking the most common PA. Females were more likely to use PA relative to males. Though in the predicted direction, use of PA was not significantly associated with 12-month abstinence. Male gender and higher baseline self-efficacy to quit were associated with 12month abstinence. Encouraging use of PA during smoking cessation does not impede quitting and may improve health outcomes. Further research on whether PA increases abstinence with a larger sample of mid-life and older adults is indicated. [Copyright &y& Elsevier]

Few studies have addressed changes in physical activity participation over time among the elderly. The authors hypothesized that there were distinct trajectories of physical activity level over time and identifiable predictors of such trajectories, as well as that the maintenance of regular physical activity, even below recommended levels, was associated with lower mortality risk. Using longitudinal data (1994–2009) from 433 initially high-functioning older women aged 70–79 years at baseline, a joint latent class and survival mixture model identified 4 activity trajectory classes: always active (16.6%), fast declining (19.2%), stable moderate (32.3%), and always sedentary (31.9%). Obesity, coronary artery disease, chronic obstructive pulmonary disease, depressive symptoms, low self-efficacy, mobility disability, and low energy were associated with sedentary behavior and/or a fast decline in activity. Women in the fast declining and always sedentary classes had hazard ratios for death of 2.34 (95% confidence interval: 1.20, 4.59) and 3.34 (95% confidence interval: 1.72, 6.47), respectively, compared with the always active class; no mortality difference was found between the stable moderate and always active groups (hazard ratio = 1.24, 95% confidence interval: 0.63, 2.47). Our findings suggest that physical activity does not have to be vigorous to be beneficial and that the gain may be the greatest among women who reported the lowest levels of activity. [ABSTRACT FROM PUBLISHER]

Objectives To determine effect size and acceptability of a multicomponent behavior and home repair intervention for low-income disabled older adults. Design Prospective randomized controlled pilot trial. Setting Participants' homes. Participants Forty low-income older adults with difficulties in one or more activities of daily living ( ADLs) or two or more instrumental activities of daily living ( IADLs). Intervention The Community Aging in Place, Advancing Better Living for Elders ( CAPABLE), coordinated occupational therapy, nursing, and handyman visits, was compared with attention-control visits. The intervention consisted of up to six visits with an occupational therapist, up to four visits with a nurse, and an average of $1,300 in handyman repairs and modifications. Each intervention participant received all components of the intervention clinically individualized to risk profile and goals. Each attention-control participant received the same number of visits as the intervention participants, involving sedentary activities of their choice. Measurement Primary outcome: difficulty in performing ADLs and IADLs. Secondary outcomes: health-related quality of life and falls efficacy. Results Thirty-five of 40 adults (87%) completed the 6-month trial, and 93% and 100% of the control and intervention group, respectively, stated that the study benefited them. The intervention group improved on all outcomes. When comparing mean change in the intervention group with mean change in the control group from baseline to follow-up, the CAPABLE intervention had effect sizes of 0.63 for reducing difficulty in ADLs, 0.62 for reducing difficulty in IADLs, 0.89 for quality of life, and 0.55 for falls efficacy. Conclusion The CAPABLE intervention was acceptable to participants and feasible to provide and showed promising results, suggesting that this multicomponent intervention to reduce disability should be evaluated in a larger trial. [ABSTRACT FROM AUTHOR]

Background. Few studies focus on "preclinical" warning signs associated with mortality. In this article, we investigate associations between all-cause mortality and two clusters of biological risk factors: (i) standard clinical measures related to cardiovascular disease and metabolic function; and (ii) nonclinical measures pertaining to hypothalamic-pituitary-adrenal axis activity, sympathetic nervous system activity, and inflammatory response. Methods. Data come from the 2000 Social Environment and Biomarkers of Aging Stud,. a national sample of Taiwanese persons aged 54 years or older; 1497 persons were interviewed in their homes, and 1023 participated in a hospital examination. The analysis is based on 927 respondents with complete information. Logistic regression models describe the association between biomarkers and the 3-year probability of dying. Results. Although both groups of biomarkers are significantly associated with mortality, the model with neuroendocrine and immune biomarkers has better explanatory and discriminatory power than the one with clinical measures. The association between these nonclinical measures and mortality remains strong after adjustment for the clinical markers, suggesting that the physiological effects of the nonclinical biomarkers are broader than those captured by the cardiovascular and metabolic system measures included here. Conclusions. Nonclinical markers are likely to provide warning signs of deteriorating health and function beyond what can be learned from conventional markers. Our findings are consistent with those of recent studies that (i) demonstrate the importance of neuroendocrine and immune system markers for survival, and (ii) indicate that standard clinical variables are less predictive of mortality in older than in younger populations. [ABSTRACT FROM AUTHOR]

The allostatic load framework postulates that an important pathway connecting the social environment with health involves biological responses to stressful stimuli and the subsequent dysregulation of interrelated physiological systems. We formulate a new measure for cumulative physiological dysregulation using a grade of membership model estimated with biodemographic data from a national sample of older Taiwanese persons. We investigate associations between the measure and physical, psychological, and cognitive function. The results provide insights into the relationships between a set of biological profiles and various health outcomes, identify limitations of earlier approaches, and underscore next steps in the development of improved for mulations of physiological dysregulation. [ABSTRACT FROM AUTHOR]

Introduction: Implantable Cardioverter Defibrillators (ICD) are an important treatment option for Long QT syndrome (LQTS) patients at high risk of cardiac arrest. The aim of the study was to assess the effect of ICDs in reducing mortality in the overall LQTS population and in subgroups defined by ICD indications. Methods: This study included 3035 subjects (597 ever had an ICD) from the Rochester-based LQTS Registry with a QTc ≥ 470 ms or a confirmed LQTS mutation. Using multivariable Cox models with follow-up starting from 1 year of age, we assessed the relative risk of overall mortality, mortality censored at 50 years of age, and sudden cardiac death (SCD) associated with time-varying ICD status. The effect of ICD on the risk of mortality by subgroups (prior aborted cardiac arrest [ACA], prior syncope while on beta blockers, and all others without these two indications) was assessed by including interaction terms of the time-varying ICD status and the time-varying indication groups. Results: There were 389 deaths including 116 SCDs during a follow-up of 118,837 person-years. Those with an ICD had a 46% lower risk of death than those without an ICD (HR=0.54, 95%CI: 0.33 - 0.86), adjusted for other risk factors. The ICD HRs for mortality censored at 50 years of age and SCD were 0.25 (95%CI: 0.11 - 0.56) and 0.17 (95%CI: 0.06 - 0.50), respectively. Among those with prior ACA, ICD patients had an 82% lower risk of death than non-ICD patients (HR=0.18, 95%CI: 0.07 - 0.46). Among those with prior syncope on beta-blockers, ICD patients had a 57% (approaching statistical significance) lower risk of death (HR=0.43, 95%CI: 0.18 - 1.08) than non-ICD patients. Among other patients with no prior ACA nor syncope on beta-blockers, there was no evidence of a mortality benefit of ICD (Figure 1). Conclusions: ICD was associated with reduced risk of mortality and SCD in LQTS patients. The results by time-varying indication groups support the current recommendation regarding ICD implantation in LQTS patients. [ABSTRACT FROM AUTHOR]

The authors comment on the connection between remaining lifetime and the trajectory of late-life disability. Few critics have argued that using time to death (TTD) as a predictor of disability confuses the direction of causality. They said the author's our approach to imputation of TTD among censored observations is not valid because TTD is not missing at random (MAR).

Abstract: Purpose: This study examines whether and how report of a change in walking behavior, incident PCMD, predicts subsequent reduction in walking activity. Materials and methods: Data are from a prospective study of 436 community-dwelling women age 70–79 years. Outcome measures include subjective and objective measures of walking ability at 3 years. Principal results: Incident PCMD is associated with the loss of walking abilities at 3-years, regardless of baseline physical impairment. Compared to women without, women with incident PCMD at 1.5 years after baseline were 2.7 (95%CI 1.4–7.2) times more likely to report that they no longer walk outdoors at least 8 blocks and 4.9 (1.9–13.1) times more likely to report new difficulty walking. Incident PCMD was also associated with declines in objective outcomes. Incident PCMD is an independent marker of subsequent decreased walking activity. Major conclusions: Incident PCMD appears to be a target for programs to prevent declines in walking activity in older adults. [Copyright &y& Elsevier]