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Prior research indicates that APOE-e4 allele(s) and working without compensation may be independently associated with risk for cognitive decline. This study investigated whether the interaction of type of work (paid versus unpaid) and presence of APOE-e4 allele(s) was associated with cognitive dysfunction in women in mid- and late-life. Participants included 340 females (mean age = 74.7 years) from the Alzheimer's Disease Neuroimaging Initiative (ADNI) dataset. A two-way ANOVA to assess the simple main effects of type of work and APOE-e4 allele status on cognition as well as their interaction was performed. A two-way ANCOVA including age, education, and marital status as covariates was also conducted. The presence of one or two APOE-e4 allele(s) and unpaid work was associated with greater cognitive dysfunction. A significant interaction effect revealed engagement in paid work, regardless of the presence of APOE-e4 allele(s), was associated with better cognitive functioning. Consistent with prior literature, women who engage in unpaid forms of labor for the majority of their life may be at higher risk for cognitive decline, regardless of presence of APOE-e4 allele(s). Further research is needed to identify the factors related to unpaid labor that may increase risk for cognitive dysfunction. [ABSTRACT FROM AUTHOR]

Suicide in late life is a public health concern. Determining profiles of psychiatric/medical comorbidity in those who attempt while engaged in mental health services may assist with prevention. We identified comorbidity profiles and their association with utilization, means, and fatality in a national sample who attempted suicide. Using latent class analysis, all patients aged ≥ 65 from the Department of Veterans Affairs (VA) healthcare services (2012–2018) last seen in mental health prior to suicide attempt were included. Diagnoses and attempt data were obtained from VA and Center for Medicare & Medicaid Services, VA Suicide Prevention Applications Network, and VA National Mortality Data Repository. 2,269 patients were clustered into three profiles, all with high probability of depression. Profiles included minimal comorbidity (50.4%), high medical comorbidity (28.6%), and high (psychiatric/medical) comorbidity (21.0%). Over half (61.7%) attempted suicide within one week of their visit. The class with highest comorbidity had lowest proportion of fatal attempts, while minimal comorbidity class had highest proportion. Older patients last seen in mental health prior to suicide attempt were characterized by depression and varying additional comorbidity and attempt-related factors. Findings have implications for risk assessment and intervention in mental health settings, beyond depression. [ABSTRACT FROM AUTHOR]

This cohort study examines the association of frailty with risk of suicide attempt and suicide death in a nationwide sample of US veterans aged 65 years or older. Key Points: Question: Is frailty a factor associated with risk for suicide attempts? Findings: In this cohort study of 2 858 876 US veterans aged 65 years or older, risk of suicide attempt was higher in patients with all levels of frailty (prefrailty and mild, moderate, and severe frailty) compared with those without frailty. Risk of lethal suicide attempt was associated with lower levels of frailty. Meaning: The findings suggest that additional suicide prevention efforts should be directed toward patients with frailty complications associated with risk for suicide attempts and lethality. Importance: Frailty is associated with reduced physiological reserve, lack of independence, and depression and may be salient for identifying older adults at increased risk of suicide attempt. Objectives: To examine the association between frailty and risk of suicide attempt and how risk differs based on components of frailty. Design, Setting, and Participants: This nationwide cohort study integrated databases from the US Department of Veterans Affairs (VA) inpatient and outpatient health care services, Centers for Medicare & Medicaid Services data, and national suicide data. Participants included all US veterans aged 65 years or older who received care at VA medical centers from October 1, 2011, to September 30, 2013. Data were analyzed from April 20, 2021, to May 31, 2022. Exposures: Frailty, defined based on a validated cumulative-deficit frailty index measured using electronic health data and categorized into 5 levels: nonfrailty, prefrailty, mild frailty, moderate frailty, and severe frailty. Main Outcomes and Measures: The main outcome was suicide attempts through December 31, 2017, provided by the national Suicide Prevention Applications Network (nonfatal attempts) and Mortality Data Repository (fatal attempts). Frailty level and components of the frailty index (morbidity, function, sensory loss, cognition and mood, and other) were assessed as potential factors associated with suicide attempt. Results: The study population of 2 858 876 participants included 8955 (0.3%) who attempted suicide over 6 years. Among all participants, the mean (SD) age was 75.4 (8.1) years; 97.7% were men, 2.3% were women, 0.6% were Hispanic, 9.0% were non-Hispanic Black, 87.8% were non-Hispanic White, and 2.6% had other or unknown race and ethnicity. Compared with patients without frailty, risk of suicide attempt was uniformly higher among patients with prefrailty to severe frailty, with adjusted hazard ratios (aHRs) of 1.34 (95% CI, 1.27-1.42; P <.001) for prefrailty, 1.44 (95% CI, 1.35-1.54; P <.001) for mild frailty, 1.48 (95% CI, 1.36-1.60; P <.001) for moderate frailty, and 1.42 (95% CI, 1.29-1.56; P <.001) for severe frailty. Lower levels of frailty were associated with greater risk of lethal suicide attempt (aHR, 1.20 [95% CI, 1.12-1.28] for prefrail veterans). Bipolar disorder (aHR, 2.69; 95% CI, 2.54-2.86), depression (aHR, 1.78; 95% CI, 1.67-1.87), anxiety (aHR, 1.36; 95% CI, 1.28-1.45), chronic pain (aHR, 1.22; 95% CI, 1.15-1.29), use of durable medical equipment (aHR, 1.14; 95% CI, 1.03-1.25), and lung disease (aHR, 1.11; 95% CI, 1.06-1.17) were independently associated with increased risk of suicide attempt. Conclusions and Relevance: This cohort study found that among US veterans aged 65 years or older, frailty was associated with increased risk of suicide attempts and lower levels of frailty were associated with greater risk of suicide death. Screening and involvement of supportive services across the spectrum of frailty appear to be needed to help reduce risk of suicide attempts. [ABSTRACT FROM AUTHOR]

Background: Cognitive impairment (CI) is a key feature of late life depression (LLD), but the contribution of underlying neurodegenerative pathology remains unclear.Objective: To evaluate cognitive dysfunction in LLD relative to a sample of nondepressed (ND) older adults with matched levels of memory impairment and amyloid-β (Aβ) burden.Methods: Participants included 120 LLD and 240 ND older adults matched on age, education, sex, Mini-Mental State Exam, mild cognitive impairment diagnosis, and PET Aβ burden.Results: LLD showed higher rates of impairment relative to ND with 54.6% of the LLD sample demonstrating impairment in at least one cognitive domain compared to 42.9% of controls (H = 7.13, p = 0.008). LLD had poorer performance and higher rates of impairment on Rey Auditory Verbal Learning Test learning and memory compared to controls. In the overall sample, Aβ positivity was associated with worse performance on Logical Memory I (p = 0.044), Logical Memory II (p = 0.011), and Trail Making Test -B (p = 0.032), and APOEɛ4 genotype was associated with worse performance on Logical Memory I (p = 0.022); these relationships did not differ between LLD and ND.Conclusion: LLD showed higher rates of CI driven by focal deficits in verbal learning and memory. Alzheimer's disease (AD) biomarkers were associated with worse performance on timed set-shifting and story learning and memory, and these relationships were not impacted by depression status. These findings suggest that AD may account for a portion of previously reported multi-domain CI in LLD and highlight the potential for AD to confound studies of cognition in LLD. [ABSTRACT FROM AUTHOR]

Frailty and disability are commonly found in Late Life Depression (LLD) and have been associated with increased depression severity, health comorbidities and mortality. Additionally, physical frailty has been associated with suicide in later life, independent of presence of a mood disorder. The objective of our study was to assess the associations of physical frailty and functional disability with suicidal ideation, controlling for depression severity and demographic factors, in an older depressed sample. This study used data from community-dwelling older adults with major depression. Eligible participants were ≥ 65 years old, completed measures of depression symptom severity (Hamilton Depression Rating Scale-24 item; HDRS-24), current suicidal ideation (Geriatric Suicide Ideation Scale; GSIS), and physical frailty/functional capacity measures. Participants were 88 older adults with a mean age of 71.5 (SD = 6.0) and 66% of the sample was female. Poorer performance on frailty measures of gait speed (B =.239, p =.003) and muscle weakness (B = −.218, p =.01) were significantly associated with higher levels of suicidal ideation, independent of depression severity and demographic factors. Functional disability was also significantly related to suicide ideation, specifically impairment in financial capacity (B = −.290, p =.008), social interaction (B =.408, p <.001), and communication skills (B =.373, p =.001). Our findings show that, in LLD, frailty and functional disability are significantly associated with higher levels of suicide ideation, independent of depression symptom severity. [ABSTRACT FROM AUTHOR]

Objectives: To assess the relationships of somatic and anxiety symptoms of depression with functional disability in a sample of older adults with late life depression. Method: Data were analyzed from 78 older adults aged 65–88 with current major depression. Somatic and anxiety symptoms from the 24-item Hamilton Depression Rating Scale (HDRS) were summed to create variables measuring severity of these symptoms. Other symptoms of depression were also assessed using the remaining items of the HDRS. Current physical health burden was assessed using the Functional Comorbidity Index (FCI). Disability was measured with the Late Life Function and Disability Instrument (LLFDI) total limitation score. A linear regression analysis was performed to assess the association of somatic and anxiety symptoms with disability independent of other factors. Results: The model accounted for 26.6% of variance in disability, (F(6,51) = 3.1, p =.01). Somatic (B = −1.9, p =.004) and anxiety (B = −3.7, p =.04) symptoms of depression were significantly associated with disability. Other depressive symptoms and physical illness burden were not associated with disability. Discussion: In older adults with major depression, somatic and anxiety symptoms of depression are associated with disability. Identification and treatment to remission of these symptoms may improve functional outcomes among older depressed adults. [ABSTRACT FROM AUTHOR]

Assess the relationship of cognitive impairment to disability, accounting for depression severity and frailty, among older adults with late-life depression (LLD). Data were analyzed from 78 community-dwelling older adults with LLD and without dementia (age M = 71.9; SD = 6.1). Cognitive functioning was assessed using a comprehensive neuropsychological battery. Depression severity was measured using the 17-item Hamilton Depression Rating Scale (HDRS; cutoff ≥15). Frailty was assessed using several motor tests. The World Health Organization Disability Assessment Schedule (WHO-DAS) measured disability status. A linear regression analysis was performed to identify relationships of cognition, frailty and depression severity with disability. The average number of impaired cognitive tests was 2.0 (SD = 1.9), with 28.2% of participants showing no impaired scores. On average participants reported depression severity of 17.3 (SD = 3.6), and disability total score of 15.1 (SD = 6.9). The regression model accounted for 25.1% of the variance in disability, with only depression severity significantly predicting disability status. Burden of cognitive impairment and frailty were not predictive of disability in this sample. In this sample, only depression severity was associated with increased disability. These findings have implications for intervention in LLD, as depression severity may represent a more modifiable risk factor for disability. [ABSTRACT FROM AUTHOR]

Objective: Cognitive reserve has been linked to functional ability, and depression has been shown to be associated with more functional impairment in older adults. While cognitive reserve and depression are associated and have each been shown to impact functional impairment, the independent impact of cognitive reserve on functional ability after accounting for depressive symptoms has not been explored. For the purpose of this study, years of education served as a proxy for cognitive reserve, which is consistent with the literature. It was predicted that higher levels of education would be associated with better functional ability regardless of age and severity of depressive symptoms. Participants and Methods: Participants (ages 55 to 90) were drawn from the Alzheimer's Disease Neuroimaging Initiative (N=3407); participants with major depression were not included. Subsyndromal depressive symptoms were measured using the Geriatric Depression Scale (GDS < 6) and functional impairment was assessed using the Functional Activities questionnaire. A three-stage hierarchical regression was conducted with functional ability as the dependent variable. Results: Age, entered at stage one of the regression model, was a significant predictor (F(1,1427) =49.75, p<.001) and accounted for 3.4% of the variance in functional ability. Adding depressive symptoms to the regression model led to a significant increase in variance explained (F(1,1426) = 64.57, p<.001), accounting for an additional 4.2% of the variance in functional ability. Adding years of education to the regression model explained an additional 1.4% of variance in functional ability and this increase in variance explained was significant (F(1,1425) = 22.53, p<.001). Conclusions: Cognitive reserve (operationalized as higher levels of education) was associated with higher functional ability even after accounting for age and depressive symptoms. [ABSTRACT FROM AUTHOR]

Objective: Prior research supports retirement may negatively impact cognitive functioning. The current study examined the relationship between retirement status and the level of cognitive dysfunction amongst individuals with Alzheimer's disease (AD). For the purpose of this study, it was predicted that there would be significantly higher levels of cognitive dysfunction in retired participants after controlling for age. Participants and Methods: Participants (ages 65 to 91) were drawn from the Alzheimer's Disease Neuroimaging Initiative (ADNI). The sample included 110 participants who were retired and 111 participants who were not retired. Cognitive dysfunction was assessed using the cognitive subscale of the modified Alzheimer's Disease Assessment Scale (ADAS). A one-way ANCOVA analysis was conducted with cognitive dysfunction as the dependent variable and the age of the participants as a covariate. Results: The results of the one-way ANCOVA showed being retired was a significant predictor of greater cognitive dysfunction amongst individuals with AD after controlling for age (F(df=1, 218) = 231.143, p = <.001, p <.05) and accounted for 52% of the variance in the level of cognitive dysfunction. Conclusions: Being retired is associated with higher levels of cognitive dysfunction in AD after accounting for the effects of age. As such, continued cognitive activity may slow the progression of cognitive declines amongst individuals with AD who are retired. There is a need for future longitudinal research to determine how late retirement may delay the progression of cognitive decline in AD by controlling for other moderator factors such as genetics and work-related stress. [ABSTRACT FROM AUTHOR]

Objectives: Perceived stress is emerging as a potential contributing factor in suicide-related ideation in older adults. We hypothesized higher levels of perceived stress would be associated with increased self-reported suicidal ideation independent of depressive symptom severity. Methods: This study used data from community-dwelling older adults aged ≥65 with a current diagnosis of major depression. Eligible participants completed measures of depression symptom severity (Hamilton Depression Rating Scale-17 item), current suicidal ideation (Geriatric Suicide Ideation Scale), and perceived stress (Perceived Stress Scale). Results: Participants were 225 older adults with a mean age of 71.4 (SD = 5.6). Sixty-five percent of the sample was female. Fifteen percent of the variance in suicidal ideation was accounted for by lower education (p =.03), male sex (p =.03) and higher current perceived stress (p <.001). Specifically, stress accounted for 12% of the variance. Conclusions: Perceived stress is an important avenue to increase identification of individuals with a higher risk of suicide-related ideation among older adults with a current diagnosis of major depression. Clinical Implications: Screening for perceived stress may allow for improved screening and prevention of suicidal activity in depressed older adults. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To identify comorbidity profiles of older patients last seen in primary care before a suicide attempt and assess attempt and clinical factors (eg, means and lethality of attempt) associated with these profiles. DESIGN: Cohort study and latent class analysis using Department of Veterans Affairs (VA) national data (2012‐2014). SETTING: All VA medical centers in the United States. PARTICIPANTS: A total of 2131 patients 65 years and older who were last seen by a primary care provider before a first documented suicide attempt. MEASUREMENTS: Fatal suicide attempt and means were identified using the National Suicide Data Repository. Nonfatal attempt was defined using the National Suicide Prevention Applications Network. Medical and psychiatric diagnoses and other variables were determined from electronic medical records. RESULTS: Patients (mean age = 74.4 y; 98.2% male) were clustered into five classes based on medical and psychiatric diagnoses: Minimal Comorbidity (23.2%); Chronic Pain‐Osteoarthritis (30.1%); Depression‐Chronic Pain (22.9%); Depression‐Medical Comorbidity (16.5%); and High Comorbidity (7.3%). The patients in the Minimal Comorbidity and Chronic Pain‐Osteoarthritis classes were most likely to attempt fatally compared with classes with a higher burden of comorbidities. Overall, 61% of the sample attempted fatally, and 82.5% of suicide decedents used firearms. CONCLUSION: This study provides evidence that most comorbidity profiles (>50%) in primary care patients attempting suicide were characterized by minimal depression diagnoses and fatal attempts, mostly with firearms. These findings suggest that more than a depression diagnosis contributes to risk and that conversations about firearm safety by medical providers may play an important role in suicide intervention and prevention. J Am Geriatr Soc 67:2553–2559, 2019 [ABSTRACT FROM AUTHOR]

Objectives: Impairment in financial capacity is an early sign of cognitive decline and functional impairment in late life. Cognitive impairments such as executive dysfunction are well documented in late-life major depression; however, little progress has been made in assessing associations of these impairments with financial incapacity. Methods: Participants included 95 clinically depressed and 41 nondepressed older adults without dementia. Financial capacity (assessed with the Managing Money scale of the Independent Living Scale), cognitive functioning (comprehensive neuropsychological evaluation), and depression severity (Hamilton Depression Rating Scale – 24) were assessed. T tests were used to assess group differences. Linear regression was used to analyze data. Results: Depressed participants performed significantly lower on financial capacity (t = 2.98, p <.01). Among depressed participants, executive functioning (B =.24, p <.05) was associated with reduced financial capacity, controlling for age, gender, education, depression severity, and other cognitive domains. Conclusions: Our results underscore the importance of assessing financial capacity in older depressed adults as they are likely vulnerable to financial abuse even in the absence of dementia. It will be valuable to assess whether treatment for depression is an effective intervention to improve outcomes. [ABSTRACT FROM AUTHOR]

Objective: Use latent class analysis (LCA) to identify patterns of cognitive functioning in a sample of older adults with clinical depression and without dementia and assess demographic, psychiatric, and neurobiological predictors of class membership. Method: Neuropsychological assessment data from 121 participants in the Alzheimer's Disease Neuroimaging Initiative-Depression project (ADNI-D) were analyzed, including measures of executive functioning, verbal and visual memory, visuospatial and language functioning, and processing speed. These data were analyzed using LCA, with predictors of class membership such as depression severity, depression and treatment history, amyloid burden, and APOE e4 allele also assessed. Results: A two-class model of cognitive functioning best fit the data, with the Lower Cognitive Class (46.1% of the sample) performing approximately one standard deviation below the Higher Cognitive Class (53.9%) on most tests. When predictors of class membership were assessed, carrying an APOE e4 allele was significantly associated with membership in the Lower Cognitive Class. Demographic characteristics, age of depression onset, depression severity, history of psychopharmacological treatment for depression, and amyloid positivity did not predict class membership. Conclusion: LCA allows for identification of subgroups of cognitive functioning in a mostly cognitively intact late life depression (LLD) population. One subgroup, the Lower Cognitive Class, more likely to carry an APOE e4 allele, may be at a greater risk for subsequent cognitive decline, even though current performance on neuropsychological testing is within normal limits. These findings have implications for early identification of those at greatest risk, risk factors, and avenues for preventive intervention. [ABSTRACT FROM AUTHOR]

Aims: In neuropsychological evaluations, it is often difficult to ascertain whether poor performance on measures of validity is due to poor effort or malingering, or whether there is genuine cognitive impairment. Dunham and Denney created an algorithm to assess this question using the Medical Symptom Validity Test (MSVT). We assessed the ability of their algorithm to detect poor validity versus probable impairment, and concordance of failure on the MSVT with other freestanding tests of performance validity. Methods: Two previously published datasets (n = 153 and n = 641, respectively) from outpatient neuropsychological evaluations were used to test Dunham and Denney's algorithm, and to assess concordance of failure rates with the Test of Memory Malingering and the forced choice measure of the California Verbal Learning Test, two commonly used performance validity tests. Results: In both datasets, none of the four cutoff scores for failure on the MSVT (70%, 75%, 80%, or 85%) identified a poor validity group with proportionally aligned failure rates on other freestanding measures of performance validity. Additionally, the protocols with probable impairment did not differ from those with poor validity on cognitive measures. Conclusions: Despite what appeared to be a promising approach to evaluating failure on the easy MSVT subtests when clinical data are unavailable (as recommended in the advanced interpretation program, or advanced interpretation [AI], of the MSVT), the current findings indicate the AI remains the gold standard for doing so. Future research should build on this effort to address shortcomings in measures of effort in neuropsychological evaluations. [ABSTRACT FROM AUTHOR]

Objective: The US population of older adults is growing, with an increase in diseases like cancer. As cancer rates increase, there is a concomitant increase in adverse correlates, such as cognitive impairment and depressive symptomatology. In order to develop appropriate interventions, it is vital to assess relationships among cancer, depressive symptoms and cognitive functioning. Methods: The sample consisted of 403 older adults with cancer diagnoses from the Health and Retirement Study. Using latent class growth analysis, longitudinal data were explored. The goals were to investigate trajectories of cognitive functioning, and to identify whether depressive symptoms and demographic factors predicted membership in the cognitive classes. Results: Three classes of cognitive functioning best fit the data: High, Middle and Low Recall, fairly stable trajectories from pre-diagnosis to a period four years after diagnosis. More depressive symptoms after diagnosis (but not prior) significantly predicted membership in the Low Recall class. Depressive symptoms did not distinguish between the High and Middle Recall classes. Conclusion: Depressive symptomatology is thought to affect cognition in late life. We found that depressive symptoms after a cancer diagnosis, but not before, successfully differentiated between those who had Low Recall from those with Middle and High Recall. Implications are discussed. [ABSTRACT FROM AUTHOR]

Objective: The US population of older adults is growing, with an increase in diseases like cancer. As cancer rates increase, there is a concomitant increase in adverse correlates, such as cognitive impairment and depressive symptomatology. In order to develop appropriate interventions, it is vital to assess relationships among cancer, depressive symptoms and cognitive functioning. Methods: The sample consisted of 403 older adults with cancer diagnoses from the Health and Retirement Study. Using latent class growth analysis, longitudinal data were explored. The goals were to investigate trajectories of cognitive functioning, and to identify whether depressive symptoms and demographic factors predicted membership in the cognitive classes. Results: Three classes of cognitive functioning best fit the data: High, Middle and Low Recall, fairly stable trajectories from pre-diagnosis to a period four years after diagnosis. More depressive symptoms after diagnosis (but not prior) significantly predicted membership in the Low Recall class. Depressive symptoms did not distinguish between the High and Middle Recall classes. Conclusion: Depressive symptomatology is thought to affect cognition in late life. We found that depressive symptoms after a cancer diagnosis, but not before, successfully differentiated between those who had Low Recall from those with Middle and High Recall. Implications are discussed. [ABSTRACT FROM AUTHOR]

Eating pathology is generally considered to affect females during adolescence and early adulthood. However, in recent years, there has been an increased recognition that disordered eating occurs in middle-aged and elderly women and that the presentation is similar to that of eating disorders in younger women. In the research presented here, results of an Internet survey of older adult women (N = 245; aged 60-90 years) indicate that the factors significantly associated with eating pathology--perfectionism, depression, and sociocultural pressures to be thin--closely parallel those reported for both younger and middle-aged women. [ABSTRACT FROM AUTHOR]

Background: Vocabulary scores tend to be significantly related to education in heterogeneous groups of older adults, even after controlling for confounding variables. However, there may be other factors that impinge on cognitive functioning for certain demographic groups, particularly those whose educational opportunities were limited, and who may have experienced considerable stress as a result of their minority status.Objectives: This study sought to explore possible predictors of vocabulary scores among African American and White older adults.Method: In this study, samples of African American (N = 165) and White (N = 146) community-dwelling older adults reported their level of education, perceived health status, and number of stressful life events, and were administered the Wechsler Adult Intelligence Scale–Revised (WAIS–R) Vocabulary subtest.Results: Among the White participants, level of education was the only significant predictor of vocabulary score after controlling for perceived health and exposure to stress. Among African American participants, education was also a significant predictor of vocabulary score. However perceived health and number of stressful life events were also significantly predictors of vocabulary score.Conclusions: Findings indicate that for certain cohorts of older adults, especially those who may have experienced stressful life circumstances and health disparities as a result of racial inequality, education may not be the only variable that predicts verbal intelligence. The importance of investigating cognitive functioning within a broader sociocultural context is discussed. [ABSTRACT FROM PUBLISHER]

Objective: Latent Class Analysis (LCA) was used to classify a heterogeneous sample of neuropsychology data. In particular, we used measures of performance validity, symptom validity, cognition, and emotional functioning to assess and describe latent groups of functioning in these areas.Method: A data-set of 680 neuropsychological evaluation protocols was analyzed using a LCA. Data were collected from evaluations performed for clinical purposes at an urban medical center.Results: A four-class model emerged as the best fitting model of latent classes. The resulting classes were distinct based on measures of performance validity and symptom validity. Class A performed poorly on both performance and symptom validity measures. Class B had intact performance validity and heightened symptom reporting. The remaining two Classes performed adequately on both performance and symptom validity measures, differing only in cognitive and emotional functioning. In general, performance invalidity was associated with worse cognitive performance, while symptom invalidity was associated with elevated emotional distress.Conclusions: LCA appears useful in identifying groups within a heterogeneous sample with distinct performance patterns. Further, the orthogonal nature of performance and symptom validities is supported. [ABSTRACT FROM PUBLISHER]

Objective: The impact of multiple major life stressors is hypothesized to reduce the probability of resilience and increase rates of mortality. However, this hypothesis lacks strong empirical support because of the lack of prospective evidence. This study investigated whether experiencing multiple major health events diminishes rates of resilience and increases rates of mortality using a large population-based prospective cohort. Method: There were n = 1,395 individuals sampled from the Health and Retirement Study (HRS) and examined prospectively from 2 years before 4 years after either single or multiple health events (lung disease, heart disease, stroke, or cancer). Distinct depression and resilience trajectories were identified using latent growth mixture modeling (LGMM). These trajectories were compared on rates of mortality 4 years after the health events. Results: Findings indicated that 4 trajectories best fit the data including resilience, emergent postevent depression, chronic pre-to-post depression, and depressed prior followed by improvement. Analyses demonstrate that multiple health events do not decrease rates of resilience but do increase the severity of symptoms among those on the emergent depression trajectory. Emergent depression increased mortality compared with all others but among those in this class, rates were not different in response to single versus multiple health events. Conclusions: Multiple major stressors do not reduce rates of resilience. The emergence of depression after health events does significantly increase risk for mortality regardless of the number of events. [ABSTRACT FROM AUTHOR]

Background: The associated risk of Alzheimer's disease linked to the APOE‐e4 gene is similar in males and females. However, there is a disproportionate rate of Alzheimer's in women (two‐thirds) compared to men. Mayeda et al. (2020) found that women who worked for pay during early adulthood and midlife, whether married or unmarried, had a slower rate of memory decline in later life compared to women who did not work for pay. Although there has been much research on the association between type of paid work or work environment and dementia; for instance, work complexity, job control, and job strain, there has been little research that includes unpaid work in ascertaining its effect on women and neurocognitive functioning later in life. This study aims to find the interaction between paid work and the APOE‐e4 gene in predicting the risk for Alzheimer's disease (operationalized as ADAS13 total score at baseline) in women. Method: A two‐way ANOVA was performed using data at initial visit from the Alzheimer's Disease Neuroimaging Initiative (ADNI) database for 340 female participants. Result: There were significant main effects for APOE‐e4 gene on ADAS‐Cog‐13 total score (F (2,334) = 4.697, p =.010) as well as paid work on ADAS‐Cog‐13 total score (F (1,334) = 5.450, p =.020). The interaction between APOE‐e4 gene and paid work on ADAS‐Cog‐13 total was not significant (F (2,334) = 215.725, p =.091). Conclusion: APOE‐e4 gene as well as unpaid work are independently linked to higher scores on the ADAS‐Cog‐13 (Alzheimer's Disease Assessment Scale) for women. There is no interaction between APOE‐e4 gene and type of work on ADAS‐Cog‐13 scores for women. [ABSTRACT FROM AUTHOR]

Objectives: In this study, the authors explore how the association between religiousness and psychological distress varies by religious affiliation. Prior work has shown that the association between religious belief and psychological distress is stronger for Christians than Jews, while religious activity is associated with lower psychological distress for both groups. Methods: Interviews were conducted using a community sample of 143 Christian and Jewish older adults, ages 65 and over. Quantitative measures were used to assess levels of organizational and intrinsic religiosity, as well as symptoms of depression and anxiety. Results: Christians who are highly involved in the organizational aspects of their religion report fewer depressive symptoms than Jews who have high levels of organizational religiosity, and the opposite is the case at lower levels of organizational religiosity. No significant group differences were found in the relationship between religiousness and anxiety. Conclusions: The results of this study indicate a difference between Jews and Christians in the reasons that they turn to their respective religious services, particularly in late life. [ABSTRACT FROM AUTHOR]

Social support and mastery can protect against psychological distress in late life, carrying implications for theory and intervention. However, some groups have not been well studied, with African Americans receiving less empirical attention, especially in regard to their satisfaction with social support. In this study, samples of African American and White American community-dwelling older adults reported their perceived mastery, degree of psychological distress, and social support. A model investigating the separate relationships of these variables by race explained significantly more variance than a model for all participants combined. For both groups, mastery was significantly associated with lower psychological distress. However, among White Americans, social support was significantly associated with lower distress, while among African Americans, there was no relationship between satisfaction with social support and distress. The findings indicate that social support and mastery are important variables to consider in their relationship to psychological distress in later life and that diverse racial groups may display differing relationships among these variables. [ABSTRACT FROM AUTHOR]

Older veterans have the highest number of lives lost to suicide, make up majority of the veteran population, and are highly likely to experience conditions (e.g., chronic pain, sleep disorders, musculoskeletal) associated with commonly prescribed medications that are potential markers for suicide risk (hereafter referred to as "high-risk" drug categories), including benzodiazepines, sedative-hypnotics, opioids, antidepressants, antipsychotics, and antiepileptics. The research presented in this session will highlight important patterns in high-risk drug prescribing and use and related outcomes in late life. The presentations will highlight various groups of older veterans that may be important to consider and, yet, neglected in the polysubstance and polypharmacy and suicide prevention conversation, including those who recently attempted suicide, veterans with late-life posttraumatic stress disorder (PTSD), and older veterans transitioning from prison to community. Drs. Maust and Morin will present findings on polypharmacy prescribing and use of high-risk medications in late life. First, drawing from the literature and his own research studies, Dr. Maust will provide a big picture overview of trends in polypharmacy among older adults in the U.S., including older veterans. Next, Dr. Morin will describe high-risk profiles of use in the 90 days prior to a first documented suicide attempt among veterans >=65 years who attempted suicide between 2012 and 2014, using Veterans Health Administration (VHA) medical record data. In addition, she will examine associations of these profiles with diagnostic, lethality, and utilization factors. Drs. Byers and Barry will speak about more specific subgroups of older veterans, with recommendations for possible intervention to reduce suicide, unintended death by overdose, and substance use disorder (SUD)-related emergency department (ED) visits and hospitalizations, emphasizing importance of care transition models for prevention. Dr. Byers will present a cohort study of veterans >=50 years seen in VHA. Findings provide evidence that late-life PTSD increases risk of suicide attempts and suicide by overdose (and accidental and undetermined death), independent of comorbid disorders. Furthermore, findings will be presented about the relationship of late-life PTSD to cause-specific high-risk drugs. Finally, Dr. Barry will provide an example of increased risk for SUD-related ED visits and hospitalizations (found in the literature to be strongly associated with suicide attempts) among older veterans transitioning from prison to community. Findings show that those re-entering society following prison sentence are at significantly higher risk for SUD-related ED visit or hospitalization compared to matched controls. These results highlight urgent need for assistance during this vulnerable period of transition. [ABSTRACT FROM AUTHOR]