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ObjectivesTo characterize the extent to which brief cognitive assessments administered in the population-representative U.S. Health and Retirement Study (HRS) and its International Partner Studies can be considered to be measuring a single, unidimensional latent cognitive function construct.MethodsCognitive function assessments were administered in face-to-face interviews in 12 studies in 26 countries (N = 155,690), including the U.S. HRS and selected International Partner Studies. We used the time point of the first cognitive assessment for each study to minimize differential practice effects across studies and documented cognitive test item coverage across studies. Using confirmatory factor analysis models, we estimated single-factor general cognitive function models and bifactor models representing memory-specific and nonmemory-specific cognitive domains for each study. We evaluated model fits and factor loadings across studies.ResultsDespite relatively sparse and inconsistent cognitive item coverage across studies, all studies had some cognitive test items in common with other studies. In all studies, the bifactor models with a memory-specific domain fit better than single-factor general cognitive function models. The data fit the models at reasonable thresholds for single-factor models in 6 of the 12 studies and for the bifactor models in all 12 of the 12 studies.DiscussionThe cognitive assessments in the U.S. HRS and its International Partner Studies reflect comparable underlying cognitive constructs. We discuss the assumptions underlying our methods, present alternatives, and future directions for cross-national harmonization of cognitive aging data.

Abstract Background Cardiovascular inflammation is a key contributor to the development of atherosclerosis and the prediction of cardiovascular events among healthy women. An emerging literature suggests biomarkers of inflammation vary by geography of residence at the state-level, and are associated with individual-level socioeconomic status. Associations between cardiovascular inflammation and state-level socioeconomic conditions have not been evaluated. The study objective is to estimate whether there are independent associations between state-level socioeconomic conditions and individual-level biomarkers of inflammation, in excess of individual-level income and clinical covariates among healthy women. Methods The authors examined cross-sectional multilevel associations among state-level socioeconomic conditions, individual-level income, and biomarkers of inflammation among women (n = 26,029) in the Women's Health Study, a nation-wide cohort of healthy women free of cardiovascular diseases at enrollment. High sensitivity C-reactive protein (hsCRP), soluble intercellular adhesion molecule-1 (sICAM-1) and fibrinogen were measured between 1993 and 1996. Biomarker levels were examined among women within quartiles of state-level socioeconomic conditions and within categories of individual-level income. Results The authors found that favorable state-level socioeconomic conditions were correlated with lower hsCRP, in excess of individual-level income (e.g. state-level real per capital gross domestic product fixed effect standardized Βeta coefficient [Std B] -0.03, 95% CI -0.05, -0.004). Individual-level income was more closely associated with sICAM-1 (Std B -0.04, 95% CI -0.06, -0.03) and fibrinogen (Std B -0.05, 95% CI -0.06, -0.03) than state-level conditions. Conclusions We found associations between state-level socioeconomic conditions and hsCRP among healthy women. Personal household income was more closely associated with sICAM-1 and fibrinogen than state-level socioeconomic conditions. Additional research should examine these associations in other cohorts, and investigate what more-advantaged states do differently than less-advantaged states that may influence levels of cardiovascular inflammation among healthy women.

Adverse birth outcomes put children at increased risk of poor future health. They also put families under sudden socioeconomic and psychological strain, which has poorly understood consequences. We tested whether infants experiencing an adverse birth outcome-low birthweight or prematurity, as well as lengthy hospital stays-were more likely to be evicted in early childhood, through age 5 years. We analyzed 5,655 observations contributed by 2,115 participants in the Fragile Families and Child Wellbeing Study-a national, randomly sampled cohort of infants born in large US cities between 1998 and 2000-living in rental housing at baseline. We fitted proportional hazards models using piecewise logistic regression, controlling for an array of confounders and applying inverse probability of selection weights. Having been born low birthweight or preterm was associated with a 1.74-fold increase in children's hazard of eviction (95% confidence interval: 1.02, 2.95), and lengthy neonatal hospital stays were independently associated with a relative hazard of 2.50 (95% confidence interval: 1.15, 5.44) compared with uncomplicated births. Given recent findings that unstable housing during pregnancy is associated with adverse birth outcomes, our results suggest eviction and health may be cyclical and co-constitutive. Children experiencing adverse birth outcomes are vulnerable to eviction and require additional supports.

Abstract Background We investigated whether lack of perceived neighborhood safety due to crime, or living in high crime neighborhoods was associated with incident mobility disability in elderly populations. We hypothesized that low-income elders and elders at retirement age (65 – 74) would be at greatest risk of mobility disability onset in the face of perceived or measured crime-related safety hazards. Methods We conducted the study in the New Haven Established Populations for Epidemiologic Studies of the Elderly (EPESE), a longitudinal cohort study of community-dwelling elders aged 65 and older who were residents of New Haven, Connecticut in 1982. Elders were interviewed beginning in 1982 to assess mobility (ability to climb stairs and walk a half mile), perceptions of their neighborhood safety due to crime, annual household income, lifestyle characteristics (smoking, alcohol use, physical activity), and the presence of chronic co-morbid conditions. Additionally, we collected baseline data on neighborhood crime events from the New Haven Register newspaper in 1982 to measure local area crime rates at the census tract level. Results At baseline in 1982, 1,884 elders were without mobility disability. After 8 years of follow-up, perceiving safety hazards was associated with increased risk of mobility disability among elders at retirement age whose incomes were below the federal poverty line (HR 1.56, 95% CI 1.02 – 2.37). No effect of perceived safety hazards was found among elders at retirement age whose incomes were above the poverty line. No effect of living in neighborhoods with high crime rates (measured by newspaper reports) was found in any sub-group. Conclusion Perceiving a safety hazard due to neighborhood crime was associated with increased risk of incident mobility disability among impoverished elders near retirement age. Consistent with prior literature, retirement age appears to be a vulnerable period with respect to the effect of neighborhood conditions on elder health. Community violence prevention activities should address perceived safety among vulnerable populations, such as low-income elders at retirement age, to reduce future risks of mobility disability.

Abstract Background An examination of where in the income distribution income is most strongly associated with risk of mortality will provide guidance for identifying the most critical pathways underlying the connections between income and mortality, and may help to inform public health interventions to reduce socioeconomic disparities. Prior studies have suggested stronger associations at the lower end of the income distribution, but these studies did not have detailed categories of income, were unable to exclude individuals whose declining health may affect their income and did not use methods to determine exact threshold points of non-linearity. The purpose of this study is to describe the non-linear risks of all-cause and cause-specific mortality across the income distribution. Methods We examined potential non-linear risk of mortality by family income level in a population that had not retired early, changed jobs, or changed to part-time work due to health reasons, in order to minimize the effects of illness on income. We used data from the US National Health and Nutrition Examination Survey (1988–1994), among individuals age 18–64 at baseline, with mortality follow-up to the year 2001 (ages 25–77 at the end of follow-up, 106 037 person-years of time at risk). Differential risk of mortality was examined using proportional hazard models with penalized regression splines in order to allow for non-linear associations between mortality risk and income, controlling for age, race/ethnicity, marital status, level of educational attainment and occupational category. Results We observed significant non-linear risks of all-cause mortality, as well as for certain specific causes of death at different levels of income. Typically, risk of mortality decreased with increasing income levels only among persons whose family income was below the median; above this level, there was little decreasing risk of mortality with higher levels of income. There was also some variation in mortality risk at different levels of income by cause and gender. Conclusion The majority of the income associated mortality risk in individuals between the ages of 18–77 in the United States is among the population whose family income is below the median (equal to $20,190 in 1991, 3.2 times the poverty level). Efforts to decrease socioeconomic disparities may have the greatest impact if focused on this population.

ObjectiveTo test the hypothesis that life course patterns of employment, marriage, and childrearing influence later-life rate of memory decline among women, we examined the relationship of work-family experiences between ages 16 and 50 years and memory decline after age 55 years among US women.MethodsParticipants were women ages ≥55 years in the Health and Retirement Study. Participants reported employment, marital, and parenthood statuses between ages 16 and 50 years. Sequence analysis was used to group women with similar work-family life histories; we identified 5 profiles characterized by similar timing and transitions of combined work, marital, and parenthood statuses. Memory performance was assessed biennially from 1995 to 2016. We estimated associations between work-family profiles and later-life memory decline with linear mixed-effects models adjusted for practice effects, baseline age, race/ethnicity, birth region, childhood socioeconomic status, and educational attainment.ResultsThere were 6,189 study participants (n = 488 working nonmothers, n = 4,326 working married mothers, n = 530 working single mothers, n = 319 nonworking single mothers, n = 526 nonworking married mothers). Mean baseline age was 57.2 years; average follow-up was 12.3 years. Between ages 55 and 60, memory scores were similar across work-family profiles. After age 60, average rate of memory decline was more than 50% greater among women whose work-family profiles did not include working for pay after childbearing, compared with those who were working mothers.ConclusionsWomen who worked for pay in early adulthood and midlife experienced slower rates of later-life memory decline, regardless of marital and parenthood status, suggesting participation in the paid labor force may protect against later-life memory decline.

RationaleLittle research has evaluated the life course drivers of cognitive aging in South Africa.ObjectivesWe investigated the relationships of self-rated childhood health and father's occupation during childhood with later-life cognitive function score and whether educational attainment mediated these relationships among older South Africans living in a former region of Apartheid-era racial segregation.MethodsData were from baseline assessments of "Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community" (HAALSI), a population-based study of 5059 men and women aged ≥40 years in 2015 in rural Agincourt sub-district, South Africa. Childhood health, father's occupation during childhood, and years of education were self-reported in study interviews. Cognitive measures assessed time orientation, numeracy, and word recall, which were included in a z-standardized latent cognitive function score variable. Linear regression models adjusted for age, sex, and country of birth were used to estimate the total and direct effects of each childhood risk factor, and the indirect effects mediated by years of education.ResultsPoor childhood health predicted lower cognitive scores (total effect = -0.28; 95% CI = -0.35, -0.21, versus good); this effect was not mediated by educational attainment. Having a father in a professional job during childhood, while rare (3% of sample), predicted better cognitive scores (total effect = 0.25; 95% CI = 0.10, 0.40, versus unskilled manual labor, 29% of sample). Half of this effect was mediated by educational attainment. Education was linearly associated with later-life cognitive function score (0.09; 95% CI = 0.09, 0.10 per year achieved).ConclusionIn this post-Apartheid, rural South African context, older adults with poor self-reported childhood health or whose father worked in unskilled manual labor had relatively poor cognitive outcomes. Educational attainment strongly predicted cognitive outcomes, and appeared to be, in part, a mechanism of social stratification in later-life cognitive health in this context.

Background: Dementia criteria require not only memory impairment, but additional impairment in at least one other cognitive domain, like visuospatial functioning. Cognitive measures assessing visuospatial function often involve drawing shapes. While these measures have proven reliable and valid in developed countries, their use in Low and Middle‐income Countries (LMICs) is challenging due to cultural differences and low literacy. Cultural and educational bias in visuospatial tests prevents comprehensive assessment of neuropsychological function, thus limiting dementia assessment in LMICs. Here, we compare the Stick Design Test (SDT) to Constructional Praxis (CP) for assessing visuospatial functioning among older South Africans adults. Method: We used data from Cognition and Dementia in the Health and Aging in Africa: A Longitudinal Study in South Africa (HAALSI‐HCAP), a population‐based nested cohort study in rural Agincourt, South Africa. In 2022, 675 participants, aged ≥ 50, were administered the immediate and delayed recall trials of the SDT and CP, as part of HAALSI‐HCAP cognitive battery. CP, completed on a tablet, involved copying four geometric shapes, while SDT required participants to reconstruct four configurations using matchsticks. Scoring for both CP (0‐11) and SDT (0‐12) was subsequently completed by trained researchers. We assessed acceptability and performance of both measures across participant demographics and investigated their correlation with performance on other visuospatial measures to ascertain criterion validity. Result: Participants were mostly women (63%), without education (58%) with mean age of 72.5±11. Refusals and missingness were more common for CP (40%) than SDT (13%). SDT had a more normal distribution compared to CP, overall and for individual figures. Worse performance was associated with higher age and lack of formal education for both measures. However, SDT demonstrated less extreme z‐standardized scores, particularly among those without education and over 70 years old. Participants were more likely to recall SDT configurations than CP figures after a delay. SDT showed weak but significant correlations (p<0.001) with CP(r = 0.14), Raven's Matrices(r = 0.27), and Symbol Cancellation (r = 0.38). Conclusion: SDT outperformed CP in acceptability and demonstrated lower sensitivity to education. Convergent validity findings suggest that SDT may be a robust and culturally adaptable measure for assessing visuospatial functioning in older populations, especially in low‐resource settings. [ABSTRACT FROM AUTHOR]

Background: People with Alzheimer's Disease (AD) often have neuropsychiatric symptoms. The Neuropsychiatric Inventory (NPI) is a validated tool for assessing the severity of these symptoms, but its applicability in a South African context remains unexamined. This study evaluated NPI‐Q, a brief version of the NPI, in relation to cognitive performance and markers of brain atrophy and emotional regulation among older South African adults. Method: Data were from Cognition and Dementia in the Health and Aging in Africa: A Longitudinal Study in South Africa (HAALSI‐HCAP), a population‐based nested cohort study in Agincourt, South Africa. The survey included a cognitive battery, clinical examination, and informant interview to assess perceived cognitive and functional changes in respondents. During the informant interview, the NPI‐Q was completed, and a severity score was derived from the cumulative sum of reported individual symptom scores (range: 0‐36). The final sample included 626 participants (71.9±11.3 years‐old, 35.6% men, 56.6% without formal education), of whom 185 underwent MRI scans. Pairwise correlations assessed the relationship between informant reported symptom severity with cognitive measures and MRI‐generated bilateral amygdala volume. Result: A total of 95 informants (15.2%) reported any neuropsychiatric symptoms, averaging 2.48 per participant among those who reported any symptom. Hallucinations were the most common symptom (5.4%), while disinhibition was the least (1%). Among those who reported symptoms, average symptom severity score was 4.28 (SD: 3.65). Severity was significantly correlated (p‐value<0.001) with most cognitive measures assessing general cognition (β: ‐0.27, ‐0.17), episodic memory (β: ‐0.26, ‐0.17), language (β: ‐0.28, ‐0.12), and executive function (β: ‐0.26, ‐0.12). However, no relationship was observed between neuropsychiatric symptoms and visuospatial functioning or amygdala volume, possibly attributable to high rate of missingness for visuospatial measures (30%), and the small MRI sample size reporting symptoms (n = 26). Conclusion: NPI‐Q symptoms were associated with lower cognitive performance, revealing a significant relationship between symptom severity and cognitive performance across all measures of the HAALSI‐HCAP cognitive battery, except for those evaluating visuospatial function. Associations between neuropsychiatric symptoms and bilateral amygdala volume were less evident. These results contribute to understanding the impact of neuropsychiatric symptoms on cognitive health in aging South African populations. [ABSTRACT FROM AUTHOR]

BackgroundSingle motherhood is associated with poorer health, but whether this association varies between countries is not known. We examine associations between single motherhood and poor later-life health in the USA, England and 13 European countries.MethodsData came from 25 125 women aged 50+ who participated in the US Health and Retirement Study, the English Longitudinal Study of Ageing and Survey of Health, Ageing and Retirement in Europe. We tested whether single motherhood at ages 16-49 was associated with increased risk of limitations with activities of daily living (ADL), instrumental ADL and fair/poor self-rated health in later life.Results33% of American mothers had experienced single motherhood before age 50, versus 22% in England, 38% in Scandinavia, 22% in Western Europe and 10% in Southern Europe. Single mothers had higher risk of poorer health and disability in later life than married mothers, but associations varied between countries. For example, risk ratios for ADL limitations were 1.51 (95% CI 1.29 to 1.98) in England, 1.50 (1.10 to 2.05) in Scandinavia and 1.27 (1.17 to 1.40) in the USA, versus 1.09 (0.80 to 1.47) in Western Europe, 1.13 (0.80 to 1.60) in Southern Europe and 0.93 (0.66 to 1.31) in Eastern Europe. Women who were single mothers before age 20, for 8+ years, or resulting from divorce or non-marital childbearing, were at particular risk.ConclusionsSingle motherhood during early-adulthood or mid-adulthood is associated with poorer health in later life. Risks were greatest in England, the USA and Scandinavia. Selection and causation mechanisms might both explain between-country variation.

ObjectivesWe examined relationships between US women's exposure to midlife work-family demands and subsequent mortality risk.MethodsWe used data from women born 1935 to 1956 in the Health and Retirement Study to calculate employment, marital, and parenthood statuses for each age between 16 and 50 years. We used sequence analysis to identify 7 prototypical work-family trajectories. We calculated age-standardized mortality rates and hazard ratios (HRs) for mortality associated with work-family sequences, with adjustment for covariates and potentially explanatory later-life factors.ResultsMarried women staying home with children briefly before reentering the workforce had the lowest mortality rates. In comparison, after adjustment for age, race/ethnicity, and education, HRs for mortality were 2.14 (95% confidence interval [CI] = 1.58, 2.90) among single nonworking mothers, 1.48 (95% CI = 1.06, 1.98) among single working mothers, and 1.36 (95% CI = 1.02, 1.80) among married nonworking mothers. Adjustment for later-life behavioral and economic factors partially attenuated risks.ConclusionsSequence analysis is a promising exposure assessment tool for life course research. This method permitted identification of certain lifetime work-family profiles associated with mortality risk before age 75 years.

ObjectivesTo assess the association of current and long-term spousal caregiving with risk of depression in a nationally (U.S.) representative sample of older adults.MethodsWe studied married and depression-free Health and Retirement Study respondents aged 50 years and older (n = 9,420) at baseline from 2000 to 2010. Current (≥14 hours per week of help with instrumental/activities of daily living for a spouse in the most recent biennial survey) and long-term caregiving (care at two consecutive surveys) were used to predict onset of elevated depressive symptoms (≥3 on a modified Centers for Epidemiologic Studies Depression scale) with discrete-time hazards models and time-updated exposure and covariate information.ResultsCurrent caregiving was associated with significant elevations in risk of depression onset (hazard ratio: 1.64; Wald χ(2), 1 df: 28.34; p

ObjectivesTo assess the correspondence between self-reported and measured indicators of mobility disability in older adults in six low- and middle-income countries (LMICs).DesignCross-sectional analysis of Study on Global AGEing and Adult Health (SAGE).SettingHousehold surveys in China, India, Russia, South Africa, Ghana, and Mexico.ParticipantsCommunity-dwelling SAGE respondents aged 65 and older (N = 12,215).MeasurementsObjective mobility was assessed according to a 4-m timed walk at normal pace conducted in the respondent's home; slow walking speed was defined according to the Fried frailty criteria (lowest quintile of walking speed, adjusted for age and height). Self-reported mobility difficulty was assessed according to a question about ability to walk 1 km; this response was dichotomized into any versus no self-reported difficulty walking 1 km (reference no difficulty). The age- (5-year groups) and sex-specific probability of self-reporting difficulty walking 1 km was estimated in those with a measured slow walk using logistic regression.ResultsBetween 42% and 76% of people aged 65 and older reported any difficulty walking 1 km. Average walking speed was slowest in Russia (0.61 m/s) and fastest in China (0.88 m/s). The probabilities of reporting any difficulty walking 1 km in women aged 65 to 69, for example, with a slow walk varied (China = 0.35, India = 0.90, Russia = 0.68, South Africa = 0.81, Ghana = 0.91, Mexico = 0.73; test of country differences P < .001). There was significant variation at older ages, albeit smaller in magnitude. Patterns were similar for men.ConclusionAlthough correspondence between an objective and self-reported measure of mobility was generally high, correspondence differed significantly between LMICs. International comparisons of self-reported disability measures for clinical, prevention, and policy guidelines in LMICs should consider that self-reported data may not correspond to objective measures uniformly between countries.

Aim To investigate mid-life employment trajectories in relation to later-life memory function and rate of decline in rural South Africa. Methods Data from the Agincourt Health and Socio-Demographic Surveillance System were linked to the 'Health and Ageing in Africa: A Longitudinal Study of an INDEPTH Community in South Africa' (HAALSI) in rural Agincourt, South Africa (N  =   3133). Employment was assessed every 4 years over 2000–12 as being employed (0, 1, 2 and ≥3 time points), being employed in a higher-skill occupation (0, 1, 2 and ≥3 time points) and dynamic employment trajectories identified using sequence analysis. Latent memory z-scores were assessed over 2014–22. Mixed-effects linear regression models were fitted to examine the associations of interest. Results Sustained mid-life employment from 2000–12 (β = 0.052, 95% CI: -0.028 to 0.132, 1 vs 0 time points; β = 0.163, 95% CI: 0.077 to 0.250, 2 vs 0 time points; β = 0.212, 95% CI: 0.128 to 0.296, ≥3 vs 0 time points) and greater time spent in a higher-skill occupation (β = 0.077, 95% CI: -0.020 to 0.175, 1 vs 0 time points; β = 0.241, 95% CI: 0.070 to 0.412, 2 vs 0 time points; β = 0.361, 95% CI: 0.201 to 0.520, ≥3 vs 0 time points) were associated with higher memory scores in 2014/15, but not subsequent rate of memory decline. Moving from a lower-skill to higher-skill occupation was associated with higher memory function, but a faster rate of decline over 2014–22. Conclusions Sustained mid-life employment, particularly in higher-skill occupations, may contribute to later-life memory function in this post-Apartheid South African setting. [ABSTRACT FROM AUTHOR]