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Objectives: Hearing and vision impairments are associated with cognitive decline and dementia risk. Explanations for this include age‐related processes impacting on sensory and cognitive function (common cause), or sensory impairments having a direct or indirect impact on cognition via social engagement, depression and physical activity (cascade). We tested whether associations between hearing, vision and episodic memory were mediated by allostatic load, social engagement, depression and physical activity. Methods: We used structural equation modelling with cross‐sectional data from the USA (n = 4746, aged 50–101), England (n = 4907, aged 50–89) and Ireland (4292, aged 50–80) to model factors related to the common cause (indexed by allostatic load) and the cascade hypothesis with respect to cognitive ability (episodic memory). Results: Poorer hearing/vision was associated with lower social engagement, depression and sedentary lifestyle. Poor vision was not related to allostatic load, and poor hearing was associated with allostatic load in only one data set, contributing to a common‐cause hypothesis. Lower social engagement, depression and a sedentary lifestyle were associated with poorer episodic memory, contributing to the cascade hypothesis. Using effect estimates to calculate the proportion of the total effects mediated by the combined mediator variables, up to two fifths of the relationship between hearing and vision with episodic memory can be explained by the mediators. Conclusions: The association between hearing, vision and episodic memory is mediated by allostatic load, social engagement, depression, and physical activity. The finding that social engagement, depression, and physical activity mediate the association between sensory abilities and cognitive function supported the cascade hypotheses. Interventions to improve healthy lifestyle, reduce depression and foster social engagement of older people with sensory impairments are likely to be beneficial in preventing cognitive decline and dementia. [ABSTRACT FROM AUTHOR]

Background Hearing and vision difficulties are some of the most common deficits experienced by older adults. Having either visual or hearing difficulties increases the risk of comorbidity, disability, and poor quality of life. So far, however, few studies have examined the association between vision and hearing difficulties on life expectancy without activities of daily living (ADL) or instrumental ADL (IADL) limitations (LEWL). Methods Data came from the English Longitudinal Study of Ageing and the Health and Retirement Study in the United States from 2002 to 2013. The outcome was defined as reporting 2+ limitations with ADL/IADL. Life expectancy was estimated by discrete-time multistate life table models for hearing and vision difficulties separately as well as for combined vision and hearing difficulties by sex and age. Results Thirteen percent of men in England and the United States had ADL/IADL limitations, whereas, for women, it was 16% and 19% in England and the United States. At all ages, either vision or hearing difficulty was associated with shorter LEWL compared to no difficulties. Dual sensory difficulty (vision and hearing) reduced LEWL by up to 12 years in both countries. At the ages of 50 and 60 in England, hearing difficulty was associated with fewer years lived without ADL/IADL limitations than vision difficulty. In contrast, in the United States, vision difficulty led to fewer years lived without ADL/IADL limitations than hearing difficulty. Conclusions The implementation of strategies to reduce the prevalence and incidence of vision and hearing difficulties has the potential to increase the number of years spent without ADL/IADL limitations. [ABSTRACT FROM AUTHOR]

Background frailty is a condition of reduced function and health due to ageing processes and is associated with a higher risk of falls, hospitalisation, disability and mortality. Objective to determine the relationship between household wealth and neighbourhood deprivation with frailty status, independently of demographic factors, educational attainment and health behaviours. Design population-based cohort study. Setting communities in England. Subjects in total 17,438 adults aged 50+ from the English Longitudinal Study of Ageing. Methods multilevel mixed-effects ordered logistic regression was used in this study. Frailty was measured using a frailty index. We defined small geographic areas (neighbourhoods) using English Lower layer Super Output Areas. Neighbourhood deprivation was measured by the English Index of Multiple Deprivation, grouped into quintiles. Health behaviours included in this study are smoking and frequency of alcohol consumption. Results the proportion of respondents who were prefrail and frail were 33.8% [95% confidence interval (CI) 33.0–34.6%] and 11.7 (11.1–12.2)%, respectively. Participants in the lowest wealth quintile and living in the most deprived neighbourhood quintile had 1.3 (95% CI = 1.2–1.3) and 2.2 (95% CI = 2.1–2.4) times higher odds of being prefrail and frail, respectively, than the wealthiest participants living in the least deprived neighbourhoods Living in more deprived neighbourhood and poorer wealth was associated with an increased risk of becoming frail. Those inequalities did not change over time. Conclusions in this population-based sample, living in a deprived area or having low wealth was associated with frailty in middle-aged and older adults. This relationship was independent of the effects of individual demographic characteristics and health behaviours. [ABSTRACT FROM AUTHOR]

Background Previous research has shown older adults experience dynamic changes in frailty status. This study aimed to determine the occurrence of sustained frailty remission and how remission is associated with falls risk. Methods Participants who contributed data to the analysis were in the English Longitudinal Study of Ageing from Waves 1 to 8 (2002–2017). Frailty was defined across waves using the frailty index and categorised into robust, pre-frail and frail. We classified participants who improved their frailty category from Wave 1 (2002) to Wave 2 (2004) and sustained/improved category again into Wave 3 (2006) and compared them with those who were either robust or frail across Waves 1–3. Cox proportional hazard modelling was used to determine the risk of incident falls reported at Waves 4–8, with results expressed as hazard ratios and 95% confidence intervals. Results Of 2,564 participants, 389 (15·2%) improved frailty category and sustained this during Waves 2–3, 1,489 (58·1%) remained robust and 686 (26·8%) remained frail during Waves 1–3. During the 10-year period (Waves 4–8), a total of 549 participants reported a fall. Compared with those who remained frail during Waves 1–3, those who with sustained frailty remission had a lower risk of future falls (HR 0·41; 95% CI = 0·36–0·45). Conclusions Frailty remission is possible and can be sustained across 5 years. There is a lower risk of future falls in those who sustain frailty remission compared with those who remain frail. [ABSTRACT FROM AUTHOR]

Objective This study aimed to investigate the relationships between trajectories of change in self-reported hearing over eight years with subsequent effects on cognition, measured using episodic memory. Methods Data were drawn from 5 waves (2008–2016) of the English Longitudinal Study of England (ELSA) and the Health and Retirement Study (HRS), involving 4,875 individuals aged 50+ at the baseline in ELSA and 6,365 in HRS. The latent growth curve modelling was used to identify trajectories of hearing over eight years, and linear regression models were performed to investigate the relationship between hearing trajectory memberships and episodic memory scores, controlling for confounding factors. Results Five trajectories of hearing (stable very good, stable fair, poor to fair/good, good to fair, and very good to good) were retained in each study. Individuals whose hearing remains suboptimal and those whose hearing deteriorates within suboptimal levels throughout eight years have significantly poorer episodic memory scores at follow-up than those with stable very good hearing. Conversely, individuals whose hearing declines but is within an optimal category at baseline do not see significantly poorer episodic memory scores than those with consistently optimal hearing. There was no significant relationship between individuals whose hearing improved from suboptimal baseline levels to optimal by follow-up and memory in ELSA. However, analysis using HRS data shows a significant improvement for this trajectory group (−1.260, P  < 0.001). Conclusions Either stable fair or deterioration in hearing is associated with worse cognitive function, both stable good or improving hearing is associated with better cognitive function specifically episodic memory. [ABSTRACT FROM AUTHOR]

Introduction: This study examined the long-term influence of loneliness and social isolation on mental health outcomes inmemory assessment service (MAS) attendees and their care partners, with a focus on interdependence and bidirectionality. Methods: Longitudinal data from 95 clinic attendees with cognitive impairment, and their care partners (dyads), from four MAS in the North of England were analyzed. We applied the actor-partner interdependence model, seeking associations within the dyad. At baseline and 12-month follow-up, clinic attendees and care partners completed measures of loneliness and social isolation, depression, and anxiety. Results: Social isolation at baseline was more prevalent in care partners compared to MAS attendees. Social isolation in MAS attendees was associated with higher anxiety symptoms (β = 0.28, 95% confidence intervals [CIs] = 0.11 to 0.45) in themselves at 12 months. We found significant positive actor and partner effects of loneliness on depression (actor effect: β=0.36, 95% CIs=0.19 to 0.53; partner effect: β=0.23, 95% CIs = 0.06 to 0.40) and anxiety (actor effect: β = 0.39, 95% CIs = 0.23 to 0.55; partner effect: β = 0.22, 95% CIs = 0.05 to 0.39) among MAS attendees 1 year later. Loneliness scores of the care partners have a significant and positive association with depressive (β = 0.36, 95% CIs = 0.19 to 0.53) and anxiety symptoms (β = 0.32, 95% CIs = 0.22 to 0.55) in themselves at 12 months. Discussion: Loneliness and social isolation in MAS clinic attendees had a downstream effect on their own and their care partners' mental health. This highlights the importance of including care partners in assessments of mental health and social connectedness and expanding the remit of social prescribing in the MAS context. [ABSTRACT FROM AUTHOR]

Background: COVID-19 vaccination in many countries, including England, has been prioritised primarily by age. However, people of the same age can have very different health statuses. Frailty is a commonly used metric of health and has been found to be more strongly associated with mortality than age among COVID-19 inpatients. Methods: We compared the number of first vaccine doses administered across the 135 NHS Clinical Commissioning Groups (CCGs) of England to both the over 50 population and the estimated frail population in each area. Area-based frailty estimates were generated using the English Longitudinal Survey of Ageing (ELSA), a national survey of older people. We also compared the number of doses to the number of people with other risk factors associated with COVID-19: atrial fibrillation, chronic kidney disease, diabetes, learning disabilities, obesity and smoking status. Results: We estimate that after 79 days of the vaccine program, across all Clinical Commissioning Group areas, the number of people who received a first vaccine per frail person ranged from 4.4 (95% CI 4.0-4.8) and 20.1 (95% CI 18.3-21.9). The prevalences of other risk factors were also poorly associated with the prevalence of vaccination across England. Conclusions: Vaccination with age-based priority created area-based inequities in the number of doses administered relative to the number of people who are frail or have other risk factors associated with COVID-19. As frailty has previously been found to be more strongly associated with mortality than age for COVID-19 inpatients, an age-based priority system may increase the risk of mortality in some areas during the vaccine roll-out period. Authorities planning COVID-19 vaccination programmes should consider the disadvantages of an age-based priority system. [ABSTRACT FROM AUTHOR]

• Higher education attainment and wealth were linked to lower C-reactive protein levels in England. • Socio-economic status had no significant association with C-reactive protein in Indonesia. • Engaging in physical activities is related to lower CRP levels in both countries. The levels of health enjoyed by individuals vary according to socio-economic status, and inflammation has been proposed as one pathway through which socio-economic status influences health in high-income countries. However, little is known regarding the social determinants of inflammation in low- and middle-income countries. This study investigated the association between socio-economic status and C-reactive protein (CRP) in England and Indonesia. This study used data from 4923 respondents aged 50+ in the English Longitudinal Study of Ageing and from 1812 respondents from the Indonesian Family Life Survey at baseline. The sources of information on individuals' education attainment, wealth, CRP and other covariates were ELSA Waves 2, 4 and 6, and IFLS Waves 4 and 5. Linear mixed models were performed to identify the longitudinal relationships between socio-economic status and CRP, and joint models were used to deal with bias in longitudinal ageing surveys due to attrition. Respondents with high school education (β = −0.036, p < 0.01) or college degree or higher (β = −0.127, p < 0.01) in England had lower CRP levels. Being wealthy is correlated with lower CRP levels in England (middle: β = −0.073, p < 0.01; wealthiest: β = −0.133, p < 0.01). Being wealthy and having higher education were related with higher level of CRP in Indonesia. However, those significant relationships vanished when health behaviour and health status were included in the analysis. The relationships between socio-economic status and CRP proved to be different in England and Indonesia. Encouraging healthy lifestyles among older adults with low socio-economic status may be the main focus of efforts toward healthy ageing in England and other developed countries. However, in Indonesia and other developing countries, attention is also required to older adults in wealthier socio-economic groups. [ABSTRACT FROM AUTHOR]

Evening-oriented sleep timing preferences have been associated with risk of diabetes, cardiovascular diseases, obesity, psychiatric disorders, and increased mortality. This research aims to explore the relationship between diurnal preferences (chronotype), daily habits, metabolic health, and mortality, using longitudinal data from The University of Manchester Longitudinal Study of Cognition in Normal Healthy Old Age (6375 participants at inception, recruited in the North of England) with a long follow-up period (up to 35.5 years). Mixed models were used to investigate the influence of aging, socio-demographic, and seasonal factors on sleep timing. Results show that sleep timing shifted towards earlier time with aging. Test seasons influence chronotype of older adults but working schedules challenge seasonality of sleep timing. Moreover, the season of birth may set chronotype in adulthood. Individual chronotype trajectories were clustered using latent class analysis and analyzed against metabolic health and mortality. We observed a higher risk of hypertension in the evening-type cluster compared to morning-type individuals (Odds ratio = 1.88, 95%CI = 1.02/3.47, p =.04). Evening-type cluster was also associated with traits related to lower health such as reduced sport participation, increased risk of depression and psychoticism personality, late eating, and increased smoking and alcohol usage. Finally, Cox regression of proportional hazards was used to study the effects of chronotype on longevity after adjusting for sleep duration, age, gender, smoking, alcohol usage, general health, and social class. The survival analysis (82.6% censored by death) revealed that evening-type chronotype increased the likelihood of mortality (Hazard ratio = 1.15, 95%CI = 1.04/1.26, p =.005). Taken together, chronotype is influenced by aging and seasonal effects. Evening-type preference may have detrimental outcomes for human well-being and longevity. [ABSTRACT FROM AUTHOR]

Subjective social status has a known association with health, whereby better health outcomes are observed for those with higher perceived status. In this research, we offer new evidence on the status–health relationship using a rigorous methodological approach that considers both observed and unobserved confounders. We use 5 waves of data spanning 15 years from the English Longitudinal Study of Ageing and derive a measure of allostatic load with biomarkers as an objective measure of health. We apply 'within–between' panel regression models. Models reveal the expected association between subjective status and health when comparing participants (the 'between' estimate), but no association when examining temporal variation within participants (the 'within' estimate). When controlling for personality traits including optimism, and parental education, the 'between' association between subjective status and allostatic load is reduced but does not disappear. Person-level confounders play some role in explaining the observed link between subjective status and health. The exact nature of the link, including the role of psychological pathways and early-life confounders, remains a question for future research. • Subjective social status has a known association with health outcomes. • We re-test this association with overtime data and biomarkers to measure health. • Higher status is associated with better health. • Overtime analysis within individuals shows no link between status and health. [ABSTRACT FROM AUTHOR]

This study aims to examine whether maternal smoking, birth weight, birth month and breastfeeding are associated with COVID-19 infection and hospitalisation. Maternal smoking was positively associated with COVID-19 infection. Breastfeeding was negatively associated with COVID-19 infection. The odds of being hospitalised due to COVID-19 were higher among those who had lower birthweight and mothers who were smoking during pregnancy. [ABSTRACT FROM AUTHOR]

Objectives: Frequent social contact benefits cognition in later life although evidence is lacking on the potential relevance of the modes chosen by older adults, including those living with hearing loss, for interacting with others in their social network., Method: 11,418 participants in the English Longitudinal Study of Ageing provided baseline information on hearing status and social contact mode and frequency of use. Multilevel growth curve models compared episodic memory (immediate and delayed recall) at baseline and longitudinally in participants who interacted frequently (offline only or offline and online combined), compared to infrequently, with others in their social network., Results: Frequent offline (B = 0.23; SE = 0.09) and combined offline and online (B = 0.71; SE = 0.09) social interactions predicted better episodic memory after adjustment for multiple confounders. We observed positive, longitudinal associations between combined offline and online interactions and episodic memory in participants without hearing loss (B = 0.50, SE = 0.11) but not with strictly offline interactions (B = 0.01, SE = 0.11). In those with hearing loss, episodic memory was positively related to both modes of engagement (offline only: B = 0.79, SE = 0.20; combined online and offline: B = 1.27, SE = 0.20). Sensitivity analyses confirmed the robustness of these findings., Discussion: Supplementing conventional social interactions with online communication modes may help older adults, especially those living with hearing loss, sustain, and benefit cognitively from, personal relationships., (© The Author(s) 2021. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objectives: Accumulating evidence points to a relationship between hearing function and cognitive ability in later life. However, the exact mechanisms of this relationship are still unclear. This study aimed to characterise latent cognitive trajectories in recall memory and identify their association with subsequent risk of hearing impairment., Methods: We analysed data from the English Longitudinal Study of Ageing Wave 1 (2002/03) until Wave 7 (2014/15). The study population consisted of 3,615 adults aged 50+ who participated in the first wave of the English Longitudinal Study of Ageing, who had no self-reported hearing impairment in Wave 1, and who underwent a hearing test in Wave 7. Respondents were classified as having hearing impairment if they failed to hear tones quieter than 35 dB HL in the better ear., Results: The trajectories of recall memory scores were grouped using latent class growth mixture modelling and were related to the presence of hearing impairment in Wave 7. Models estimating 1-class through 5-class recall memory trajectories were compared and the best-fitting models were 4-class trajectories. The different recall memory trajectories represent different starting points and mean of the memory scores. Compared to respondents with the highest recall memory trajectory, other trajectories were increasingly likely to develop later hearing impairment., Conclusions: Long-term changes in cognitive ability predict hearing impairment. Further research is required to identify the mechanisms explaining the association between cognitive trajectories and hearing impairment, as well as to determine whether intervention for maintenance of cognitive function also give benefit on hearing function among older adults., Competing Interests: The authors have declared that no competing interests exist.

Objective: This study examines the relationships between hearing impairment and cognitive function among older adults, and whether that association is mediated by loneliness and social isolation., Methods: Data were drawn from English Longitudinal Study of Ageing (ELSA) wave two (2004/2005) until wave seven (2014/2015). The study sample consisted of 8,199 individuals aged 50 years or older. Cognitive function was measured using episodic memory. We performed analysis using a generalized structural equation modeling (GSEM) technique., Results: GSEM analysis shows that the direct effect of hearing impairment on episodic memory was negative and significant (β = -0.29, p <0.001). Loneliness and social isolation mediated that effect. Hearing impairment was positively associated with loneliness (β = 0.10, p <0.001) and social isolation (β = 0.04, p <0.001). Loneliness (β = -0.08, p <0.001) and social isolation (β = -0.09, p = 0.001) were significantly associated with lower memory scores., Conclusion: The link between hearing impairment and episodic memory was partly mediated by loneliness and social isolation. Interventions to improve the social networks of older adults with hearing impairment are likely to be beneficial in preventing cognitive decline. Thus, the importance of maintaining social relationships among older adults, especially those with hearing impairment is highlighted., (Copyright © 2019 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.)

Background: Difference in life expectancy between males and females has been suggested to rest on sex difference in physiological dysregulation. But allostatic load, a physiological index, has not been carefully examined for an extended period beyond middle age. We aim to draw longitudinal trajectories of allostatic load in a national sample of older Americans and Britons; also to examine sex-based trajectories and factors behind their differences., Methods: We studied men and women aged ≥50 years participating in the Health and Retirement Study Waves 8-11, 2006-2012 (N = 15,583 person-years) and the English Longitudinal Study of Ageing Waves 2, 4 and 6, 2004-2012 (N = 14,765 person-years). Because of the difference in provenance, we included different number of biomarkers to calculate allostatic load in HRS and ELSA. In HRS we used 8 biomarkers (systolic and diastolic blood pressure, haemoglobin A1c, high-density lipoprotein, total cholesterol, waist circumference, cystatin C, and C-reactive protein), while ELSA allostatic load was constructed from 10 biomarkers (systolic and diastolic blood pressure, haemoglobin A1c, high-density lipoprotein, total cholesterol, waist circumference, BMI, triglyceride, fibrinogen and C-reactive protein). A growth curve model was fitted to repeated observations of allostatic load, demographic characteristics, socioeconomic position, comorbidities and health behaviours (smoking, drinking, and physical exercise). To account for attrition, a joint model was applied., Results: The analysis showed that allostatic load increases linearly with age in the U.S. However, there are different levels for males and females. In England allostatic load follows such different paths that their trajectories cross in later life., Conclusions: Sex-based trajectories of allostatic load showed distinct female advantage and are mostly consistent with female advantage in life expectancy.

Background: Obesity is becoming a global problem, rather than one found only in developed countries. Although recent studies have suggested a detrimental effect of obesity on cognition, studies of the relationship between obesity and cognition among older adults have been limited to developed countries. We aimed to examine the associations between central obesity, as measured by waist circumference, and cognition level in adults aged 50 years and older in England and Indonesia., Methods: We used linear regression models to analyse these associations and multiple imputation to manage missing data. The 2006 English Longitudinal Study of Ageing Wave 3 is the source of data from England, while data from Indonesia is sourced from the 2007 Indonesian Family Life Survey Wave 4., Findings: Centrally obese respondents had lower cognition levels than non-centrally obese respondents in England. In contrast, central adiposity had a statistically significant positive association with cognition in Indonesia. Higher levels of education and higher economic status were associated with higher cognitive ability, while age was associated with lower cognition in both countries. Elevated C-reactive protein (CRP) concentrations and smoking behaviour, both linked to higher risk of obesity, were negatively associated with cognitive ability among older adults in England, but they had no statistically significant association with cognition among Indonesians., Interpretation: The contradictory findings on obesity and cognition in England and Indonesia not only create a puzzle, but they may also have different policy implications in these countries. Reducing the prevalence of obesity may be the main focus in England and other developed countries to maintain older adults' cognition. However, Indonesia and other developing countries should place more emphasis on education, in addition to continued efforts to tackle the double burden of malnutrition, in order to prevent cognitive impairment among older adults.