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Persistent infections, such as cytomegalovirus (CMV), herpes simplex virus-1 (HSV-1), Helicobacter pylori (H. pylori), and Toxoplasma gondii (T. gondii), are common in the U.S. but their prevalence varies by socioeconomic status. It is unclear if early or later life socioeconomic position (SEP) is a more salient driver of disparities in immune control of these infections. Using data from the Sacramento Area Latino Study on Aging, we examined whether early or later life SEP was the strongest predictor of immune control later in life by contrasting two life course models, the critical period model and the chain of risk model. Early life SEP was measured as a latent variable, derived from parental education and occupation, and food availability. Indicators for SEP in later life included education level and occupation. Individuals were categorized by immune response to each pathogen (seronegative, low, medium and high) with increasing immune response representing poorer immune control. Cumulative immune response was estimated using a latent profile analysis with higher total immune response representing poorer immune control. Structural equation models were used to examine direct, indirect and total effects of early life SEP on each infection and cumulative immune response, controlling for age and gender. The direct effect of early life SEP on immune response was not statistically significant for the infections or cumulative immune response. Higher early life SEP was associated with lower immune response for T. gondii, H. pylori and cumulative immune response through pathways mediated by later life SEP. For CMV, higher early life SEP was both directly associated and partially mediated by later life SEP. No association was found between SEP and HSV-1. Findings from this study support a chain of risk model, whereby early life SEP acts through later life SEP to affect immune response to persistent infections in older age.

Purpose: This longitudinal study examines the association between physical function decline and the risk of elder self-neglect in a community-dwelling population. Design and Methods: Of the 5,570 participants in the Chicago Health Aging Project, 1,068 were reported to social services agency for suspected elder self-neglect from 1993 to 2005. The primary predictor was objectively assessed physical function using decline in physical performance testing. Secondary predictors were assessed using the decline in self-reported Katz, Nagi, and Rosow-Breslau scales. Outcome of interest was elder self-neglect. Logistic and linear regression models were used to assess these associations. Results: After adjusting for confounding factors, every 1-point decline in physical performance testing was associated with increased risk of reported elder self-neglect (odds ratio [OR], 1.05, confidence interval [CI], 1.03-1.07, p less than 0.001). Decline in Katz (OR, 1.05, CI, 1.00-1.10, p less than 0.05) and decline in Rosow-Breslau (OR, 1.19, CI, 1.11-1.27, p less than 0.001) were associated with increased risk of reported elder self-neglect. Decline in physical performance testing (standardized parameter estimate [PE]: 0.19, SE: 0.06, p = 0.002), Katz (PE: 0.65, SE: 0.14, p less than 0.001), Nagi (PE: 0.48, SE: 0.14, p less than 0.001), and Rosow-Breslau (PE: 0.57, SE: 0.21, p = 0.006) scales were associated with increased risk of greater self-neglect severity. Implications: Decline in physical function was associated with increased risk of reported elder self-neglect and greater self-neglect severity in this community-dwelling population.

We examined the relation of level of cognition to survival in a biracial community population of more than 10,000 older persons. At baseline, participants completed 4 cognitive tests from which a composite global cognitive measure was derived. During up to 14 years of follow-up (mean = 6.9 years), 4201 people died (41.6%). Higher level of cognitive function was associated with increased survival even after controlling for health related and lifestyle variables. The association did not differ between African Americans and whites; it was stronger in older than younger persons; and it was especially pronounced for perceptual speed. The results underscore the importance of cognition to survival in old age. (Contains 2 tables and 2 figures.)

Purpose: This longitudinal study examines the association between physical function decline and the risk of elder self-neglect in a community-dwelling population. Design and Methods: Of the 5,570 participants in the Chicago Health Aging Project, 1,068 were reported to social services agency for suspected elder self-neglect from 1993 to 2005. The primary predictor was objectively assessed physical function using decline in physical performance testing. Secondary predictors were assessed using the decline in self-reported Katz, Nagi, and Rosow--Breslau scales. Outcome of interest was elder self-neglect. Logistic and linear regression models were used to assess these associations. Results: After adjusting for confounding factors, every 1-point decline in physical performance testing was associated with increased risk of reported elder self-neglect (odds ratio [OR], 1.05, confidence interval [CI], 1.03-1.07, p < .001). Decline in Katz (OR, 1.05, CI, 1.00-1.10, p < .05) and decline in Rosow--Breslau (OR, 1.19, CI, 1.11-1.27, p < .001)were associated with increased risk of reported elder self-neglect. Decline in physical performance testing (standardized parameter estimate [PE]: 0.19, SE: 0.06, p = .002), Katz (PE: 0.65, SE: 0.14, p < .001), Nagi (PE: 0.48, SE: 0.14, p < .001), and Rosow-Breslau (PE: 0.57, SE: 0.21, p = .006) scales were associated with increased risk of greater self neglect severity. Implications: Decline in physical function was associated with increased risk of reported elder self-neglect and greater self-neglect severity in this community-dwelling population. Key Words: Self-neglect, Physical function decline, Longitudinal study doi: 10.1093/geront/gnp164

Background. The current study was designed to examine the cross-sectional association between perceived discrimination and blood pressure (BP) in a sample of older African American and white adults. We hypothesized that perceived discrimination would be associated with higher levels of BP and that this association would be stronger for older African Americans compared with whites. Methods. Participants were 4,694 (60% African American, 60% women) community-dwelling older adults. Perceived discrimination and other relevant risk factors were assessed via interview, and BP was measured using standard sphygmomanometers. Multivariate linear regression models were conducted to test associations among race, perceived discrimination, and BE Results. In models adjusted for age, sex, race, and education, perceived discrimination was not associated with higher levels of systolic blood pressure (p = .10) but was associated with higher levels of diastolic blood pressure (DBP) (p = .01). Further analyses revealed that the association between perceived discrimination and DBP was present in older African Americans (p = .0003) but not whites (p = .46). Results persisted after adjusting for relevant risk factors. Conclusions. Findings suggest that discrimination may be a unique risk factor for elevated DBP in older African Americans. Because these findings are cross-sectional, additional research is needed to determine whether the observed associations persist over time. Key Words: Discrimination (psychology)--Blood pressure African Americans--Whites--Aging--Prejudice.

Objectives. Drawing from collective efficacy and social disorganization theories, we developed and validated measures of neighborhood-level social processes. Methods. Data came from 2 large, population-based cohort studies of urban-dwelling older adults, the Chicago Neighborhood and Disability Study (CNDS, n = 3,882) and the Baltimore Memory Study (BMS, n = 1,140). Data on neighborhood social processes were collected from residents using a standardized instrument identical in the 2 studies. We used confirmatory factor analysis and descriptive statistics to explore reliability and validity of the neighborhood-level measures. Results. Confirmatory factor analysis indicated 2 latent factors: social cohesion and exchange (i.e., observations of and interactions with neighbors) and social and physical disorder (i.e., neighborhood problems and unsafe conditions). Neighborhood-level measures of cohesion and disorder showed moderate to high levels of internal consistency (alphas = .78 and .85 in CNDS and .60 and .88 in BMS). Inter-resident agreements were low (intra-neighborhood correlation coefficients = .08 and. 11 in CNDS and .05 and .33 in BMS). Cohesion showed a modest, positive association with a composite measure of neighborhood socioeconomic status (SES). Disorder showed a strong, negative association with neighborhood SES. Conclusions. Findings provide initial evidence of the reliability and construct validity of these neighborhood-level social process measures. Key Words: Neighborhood social context--Social capital--Socioeconomic status--Collective efficacy--Social disorganization theory.

Objectives. We examined the relation of individual-level perceived discrimination to mortality in a biracial, population-based sample. Methods. Participants were 4154 older adults from the Chicago Health and Aging Project who underwent up to 2 interviews over 4.5 years. Perceived discrimination was measured at baseline, and vital status was obtained at each follow-up and verified through the National Death Index. Results. During follow-up, 1166 deaths occurred. Participants reporting more perceived discrimination had a higher relative risk of death (hazard ratio [HR]= 1.05; 95% confidence interval [CI] = 1.01, 1.09). This association was independent of differences in negative affect or chronic illness and appeared to be stronger among Whites than among Blacks (Whites: HR = 1.12; 95% CI = 1.04, 1.20; Blacks: HR=1.03; 95% CI=0.99, 1.07). Secondary analyses revealed that the relation to mortality was related to discriminatory experiences of a more demeaning nature and that racial differences were no longer significant when the sample was restricted to respondents interviewed by someone of the same race. Conclusions. Perceived discrimination was associated with increased mortality risk in a general population of older adults. The results suggest that subjective experience of interpersonal mistreatment is toxic in old age. This study adds to a growing literature documenting discrimination as an important social determinant of health.

Objectives. Although there is substantial evidence of declining prevalence of disability among the older population during the late 1980s and 1990s, evidence on trends in the underlying dynamics of disability is lacking. For this study, we estimated models of transitions between discrete disability and vital states that incorporated simple linear time trends. Methods. We analyzed data from the 1982-1994 interviews of the New Haven Established Populations for Epidemiologic Studies of the Elderly study and used three alternative measures of disability status. We estimated separate models of disability prevalence and disability transitions by gender. Results. Eleven of 12 estimated trends in transition rates were statistically significant. For men and women, and for three alternative disability indicators, we found downward trends in rates of both onset of and recovery from disability among people aged 75 and older. We did not find any consistent pattern of trends in disability among those aging into the 75 and older group during this period. Discussion. Our findings are consistent with declining population-level disability prevalence only if any downward trend in onset outweighs the downward trend in recovery. These findings axe also consistent with a trend toward more severe disability problems among the disabled population.

Objectives. Although disability levels have been declining in older adults, there is little current information on racial differences in disability. Methods. Our data came from a longitudinal, population-based study of 6,158 Black and White adults aged 65 and older from the south side of Chicago. Data were collected during three face-to-face interviews between 1993 and 2002. We ascertained disability using three self-report measures and a performance-based measure of physical function. Using longitudinal data analysis, we examined overall racial differences in disability and the degree to which they varied by age and gender. Results. After an average of 6 years of follow-up, Blacks reported significantly higher disability levels than Whites after adjustment for age and sex. There was a significant increase in disability during follow-up on all four measures. Racial differences in disability did not vary consistently by age at baseline or over time but were greater among women. Findings were largely similar for serf-reported and performance-based measures of disability. Adjustment for socioeconomic status substantially reduced racial differences in disability, although some of the differences remained significant, especially among women. Conclusions. Racial disparities in disability have not been eliminated, are greater among women, and have their origins earlier in adulthood.

This study examines racial differences in depressive symptoms among older adults over time. The subjects were 4,275 community-dwelling persons aged 65 and older (62% Black) who participated in the Chicago Health and Aging Project (CHAP) during a period of 9 years. Depression was measured using a summary score of the 10-item Center for Epidemiologic Studies--Depression scale (CES-D). We modeled depressive symptoms using the method of General Estimating Equations and a Poisson error structure. We found a significant race effect at baseline with Blacks reporting approximately 60% more symptoms than Whites ([beta] = 0.467 on the log scale, p < .001). The differences were larger for men than for women. After controlling for age, sex, time, education, income, and related interaction terms, the baseline race effect was reduced by almost half ([beta] = 0.225, p < .001) but remained robust. The racial differences increased slightly over time. Our findings support heightened awareness of depression in older Black populations.

Background. Parkinsonian signs in patients without Parkinson's disease are often undetected but occur frequently in older people, and are often considered benign. We measured the association between parkinsonism and subsequent disability. Methods. We conducted a prospective, longitudinal, community-based population study in East Boston, Massachusetts, using a stratified random sample of 455 community residents, aged 65 years and older. Four categories of parkinsonian signs were measured at baseline: bradykinesia, gait disturbance, rigidity, and tremor. Parkinsonism was defined as the presence of two or more categories of parkinsonian signs, and cases of Parkinson's disease were excluded from analyses. Disability was assessed annually over a mean of 4.7 years using the Katz. Rosow-Breslau, and Nagi disability measures. Results. Parkinsonism at baseline strongly predicted subsequent disability as assessed with the three disability measures (on the Katz measure, [beta] = -1.30, p < .001). On average, a person with parkinsonism had a disability level at follow-up equal to that of a comparable person approximately 16.7 years for men and 8 years for women. The rate of developing disability for persons with parkinsonism increased each year; on the Katz measure, participants with parkinsonism declined on average 16.4% faster than those without. Gait impairment and bradykinesia strongly predicted subsequent disability; tremor and rigidity did not. The effect of parkinsonism was attenuated but still persistent in persons with coexistent moderate-to-severe cognitive impairment or stroke. Conclusions, Parkinsonism strongly predicts progressive disability in the older community population and has a marked aging effect on disability level.

Objectives. This study examined the differences in levels of social networks and social engagement between older Blacks and Whites and racial differences in rates of change in social resources over time. Methods. The sample consisted of 5,102 Blacks and Whites, aged 65 and older, from the Chicago Health and Aging Project, who underwent up to three interviews during an average of 5.3 years of follow-up. Repeated measures of social networks were based on the number of children, relatives, and friends seen at least once a month. Social engagement was measured at each interview with four items related to social and productive activity. Random effects models were fitted to test the effect of race on social resources and change in resources over time. Results. Blacks had smaller social networks and lower levels of social engagement than Whites. Racial differences in these resources were stable during follow-up. Socioeconomic status reduced racial differences in social engagement but not social networks. Discussion. The findings provide evidence for lower levels of social resources among older Blacks. There was little evidence that racial differences were the result of greater decline during old age itself.

We examined the relation of personality to mortality in 883 older Catholic clergy members (69% women). At baseline, they completed the NEO Five-Factor Inventory, which assesses the five principal dimensions of personality. They were followed for a mean of 5.1 years, during which 182 deaths occurred. Risk of death was nearly doubled in those with a high neuroticism score (90th percentile) compared with a low score (10th percentile) and was approximately halved in those with a high conscientiousness score compared with a low score. Findings for extraversion were mixed, and neither agreeableness nor openness was strongly related to mortality. The results suggest that personality is associated with mortality in old age.

Objectives. Although measures of physical function are predictive of future disability, little is known about the short-term impact of changes in physical function on disability. Methods. Data from 93 of the 102 women who participated in the Weekly Substudy of the Women's Health and Aging Study (WHAS) were used to explore the association of changes in physical function with disability. The WHAS Substudy included 24 weekly assessments of three standard performance tests and self-reported disability in activities of daily living (ADLs) and basic mobility. Results. Using random-effects models, we found small but significant (ps < .01) changes in ADL and mobility disability during weekly follow-up. Baseline performance scores were significantly associated with both ADL and mobility disability (ps < .001), accounting for 27% and 36% of the between-person variability in each type of disability, respectively. After adjustment for baseline scores, change in performance scores was significantly associated with ADL disability ([beta] = 0.08, p < .01) and mobility disability ([beta] = 0.12, p < .001), but accounted only for a small proportion ( Discussion. Basic physical functions account for a substantial proportion of the heterogeneity in ADL and mobility disability among older disabled women, but have a relatively small impact on short-term changes in either type of disability. Effective prevention of disability may require attention to a wider array of risk factors than just limitations in basic physical functions.

BACKGROUND: Physical disability is common though not inevitable in older age and has direct bearing on a person's ability to perform activities essential for self-care and independent living. Air pollution appears to increase the risk of several chronic diseases that contribute to the progression of disability. OBJECTIVE: We evaluated long-term exposure to traffic-related air pollution (TRAP) in relation to progression in physical disability. METHODS: We conducted our investigation within the Chicago Health and Aging Project. We measured participants' exposures to TRAP using two surrogates: residential proximity to major roads (1993 onwards) and ambient concentrations of oxides of nitrogen (NO# 1999 onwards), predicted via a geographic information systems-based spatiotemporal smoothing model (cross-validation [R.sup.2] = 0.87) that incorporated community-based monitoring and resolved intraurban exposure gradients at a spatial scale of tens of meters. Participants' lower-extremity physical ability was assessed every 3 years (1993-2012) via tandem stand, chair stand, and timed walking speed. RESULTS: In multivariable-adjusted analyses (n = 5,708), higher long-term NO# exposure was associated with significantly faster progression in disability. Compared with the 5-year decline in physical ability score among participants in the lowest quartile of NO# exposure, decline among those in the highest exposure quartile was 1.14 units greater (95% confidence interval [CI]: -1.86, -0.42), equivalent to 3 additional years of decline among those in the lowest exposure quartile. The association was linear across the continuum of NO# exposure: per 10-ppb increment in exposure, the 5-year decline in physical ability score was 0.87 unit greater (95% CI: -1.35, -0.39). Proximity to a major road was not associated with disability progression (n = 9,994). CONCLUSIONS: These data join a growing body of evidence suggesting that TRAP exposures may accelerate aging-related declines in health. http://dx.doi.org/10.1289/ehp.1510089, Introduction Aging-related physical disability has become a critical health concern because of its high associated health care costs and because of the rapidly growing number of older Americans (Administration on [...]

This study examines the prevalence of functional disability (limitation in at least one basic activity of daily living) among elderly Black and White community residents in the New Haven (n = 2812) and North Carolina (n = 4162) sites of the Established Populations for Epidemiologic Studies of the Elderly (EPESE). In New Haven, elderly Blacks, particularly women below age 75, had a higher prevalence of disability compared with Whites, which was partially attributable to a higher prevalence of chronic conditions. In North Carolina, Blacks had only a slightly higher risk of being disabled than Whites, and this was fully accounted for by differences in socioeconomic status. Black-White differences in the prevalence of functional disability reveal geographic variation. (Am J Public Health. 1995; 85:994-998), Elderly blacks are more likely to have functional disabilities than whites. Researchers compared data on elderly living in two different geographic areas. One group consisted of 2748 people aged 65 and over living in New Haven and the other group consisted of 4162 elderly persons living in North Carolina, half in an urban county. Interviews were conducted in 1982 and 1986, respectively. Blacks were more likely to have difficulty with daily living than whites, but the gap was smaller in North Carolina than in New Haven. In both areas disabled elderly blacks tended to be younger, less educated, poorer, and have more mental disability. Elderly black women tended to weigh more and were more likely to have two or more chronic conditions. Socioeconomic factors accounted completely for the increased likelihood of disability among North Carolina blacks but not among New Haven blacks. The discrepancy between whites and blacks tended to increase with age, especially among women.

Introduction: Exposure to noise might influence risk of Alzheimer's disease (AD) dementia. Methods: Participants of the Chicago Health and Aging Project (≥65 years) underwent triennial cognitive assessments. For the 5 years preceding each assessment, we estimated 5227 participants' residential level of noise from the community using a spatial prediction model, and estimated associations of noise level with prevalent mild cognitive impairment (MCI) and AD, cognitive performance, and rate of cognitive decline. Results: Among these participants, an increment of 10 A‐weighted decibels (dBA) in noise corresponded to 36% and 29% higher odds of prevalent MCI (odds ratio [OR] = 1.36; 95% confidence interval [CI], 1.15 to 1.62) and AD (OR = 1.29, 95% CI, 1.08 to 1.55). Noise level was associated with worse global cognitive performance, principally in perceptual speed (–0.09 standard deviation per 10 dBA, 95% CI: –0.16 to –0.03), but not consistently associated with cognitive decline. Discussion: These results join emerging evidence suggesting that noise may influence late‐life cognition and risk of dementia. [ABSTRACT FROM AUTHOR]

Objectives. We examined the association of structural and functional aspects of social relationships with change in disability, and the degree to which race modifies these associations. Methods. Data are from a population-based sample of 4,136 African Americans and Whites aged [is greater than or equal to] 65 living in North Carolina. Disability data were collected during seven consecutive yearly interviews and summarized in two outcome measures. Measures of social relationships included five measures representing network size, extent of social interaction, and specific type of relationships, as well as instrumental and emotional support. Weighted proportional odds models were fitted to model disability as a function of baseline social network and support variables, and the interaction of each variable with follow-up time. Results. Network size and social interaction showed significant negative associations with disability risks, which did not vary by race, or as a function of time. Social interaction with friends was associated with a reduced risk for disability, but social interaction with children or relatives was not related to disability. Instrumental support was associated with a significantly increased disability risk, with a greater adverse effect among Whites than African Americans. Emotional support was not associated with disability, but a protective effect for ADL disability was found after controlling for its intercorrelation with instrumental support. Discussion. The findings provide further evidence for the role of social relationships in the disablement process, although not all types of social relationships may be equally beneficial. Furthermore, these associations may be more complex than simple causal effects. There were few racial differences in the association of social relationships with disability, with the possible exception of instrumental support, which may allude to possible sociocultural differences in the experience of instrumental support exchanges.

Objectives. Increasing age, socioeconomic factors, and declining function and health have been linked to driving cessation, but little is known about the consequences of stopping driving. This study was designed to test the hypothesis that driving cessation leads to a decline in out-of-home activity levels. Methods. In 1989 a survey of driving practices was administered to surviving noninstitutionalized members of the New Haven Established Populations for Epidemiologic Studies of the Elderly (EPESE) cohort. Of 1,316 respondents, 502 were active drivers as of 1988, 92 had stopped driving between 1982 and 1987, and 722 never drove or stopped before 1982. Information on sociodemographic and health-related variables came from in-home EPESE interviews in 1982, 1985, and 1988, and from yearly phone interviews. Activity was measured at all three in-home interviews, and an activity measure was created based on self-reported participation in nine out-of-home activities. A repeated measures random-effects model was used to test the effect of driving cessation on activity while controlling for potential confounders. Results. Driving cessation was strongly associated with decreased out-of-home activity levels (coefficient-1.081, standard error 0.264, p [is less than] .001) after adjustment for sociodemographic and health-related factors. Discussion. The potential consequences of driving limitations or cessation should be taken into account when advising older drivers and developing alternative transportation strategies to help maintain their mobility.

Objective: Physical and cognitive activities are associated with slower cognitive decline. Few studies have examined racial differences in these associations, however. The aim of this study was to examine the association of physical and cognitive activities with level and change in cognitive function among black and white participants. A secondary aim was to explore observed differences between black and white participants using post hoc analyses based on education and cognitive function levels.Methods: Data came from a longitudinal study of 7,742 (63% black and 61% female) participants assessed three times over an average of 9.5 years. At baseline, each participant reported number of hours of leisure time physical activity (categorized using quartiles) and rated frequency of participation in cognitively stimulating activities (range: 0-4). A standardized measure of cognition was derived from tests of memory, perceptual speed, and orientation.Results: Of the 7,742 participants, 2,322 (30%) reported no physical activity. Cognitive decline was slower by about 20% (95% CI: 13%-27%) among whites with physical activity above 1.25 hours compared with those with no physical activity, but showed no significant decrease in cognitive decline relative to those with no physical activity among blacks. Further post hoc analysis revealed cognitive decline to be slower by about 29% (95% CI: 20%-38%) among blacks and whites with higher education and above average baseline cognition. A 1-point increase in cognitive activity frequency decreased cognitive decline by 8% (95% CI: 3%-14%) among blacks and by 14% (95% CI: 7%-20%) among whites.Conclusions: The benefits of higher physical activity on cognitive decline was observed among whites, and among blacks with higher education and above average baseline cognitive function. Nevertheless, the protective effect of cognitive activity seems to be independent of education and baseline cognitive function among both blacks and whites. [ABSTRACT FROM AUTHOR]