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Background: Since older adults spend significant time in their neighborhood environment, environmental factors such as neighborhood socioeconomic disadvantage, high racial segregation, low healthy food availability, low access to recreation, and minimal social engagement may have adverse effects on cognitive function and increase susceptibility to dementia. DNA methylation, which is associated with neighborhood characteristics as well as cognitive function and white matter hyperintensity (WMH), may act as a mediator between neighborhood characteristics and neurocognitive outcomes. Methods: In this study, we examined whether DNA methylation in peripheral blood leukocytes mediates the relationship between neighborhood characteristics and cognitive function (N = 542) or WMH (N = 466) in older African American (AA) participants without preliminary evidence of dementia from the Genetic Epidemiology Network of Arteriopathy (GENOA). Results: For a 1-mile buffer around a participant's residence, each additional fast food destination or unfavorable food store with alcohol per square mile was nominally associated with a 0.05 (95%CI: 0.01, 0.09) and a 0.04 (0.00, 0.08) second improvement in visual conceptual tracking score, respectively. Also, each additional alcohol drinking place per square mile was nominally associated with a 0.62 (0.05, 1.19) word increase in delayed recall score, indicating better memory function (all p < 0.05). Neighborhood characteristics were not associated with WMH. We did not find evidence that DNA methylation mediates the observed associations between neighborhood characteristics and cognitive function. Conclusions: The presence of fast food destinations and unfavorable food stores with alcohol was associated cognitive measures, possibly due to greater social interaction provided in these venues. However, replication of these findings is necessary. Further examination of the potential pathways between the neighborhood environment and cognitive function/WMH may allow the development of potential behavioral, infrastructural, and pharmaceutical interventions to facilitate aging in place and healthy brain aging in older adults, especially in marginal populations that are most at risk. [ABSTRACT FROM AUTHOR] more...

Objectives The global prevalence of multimorbidity is increasing as the population ages. As individuals get older, they are likely to develop multiple chronic conditions, and nearly two-thirds of older adults in the United States are estimated to experience 2 or more chronic conditions. The present preregistered study examined whether multimorbidity was associated with longitudinal changes in health-related quality of life (i.e. anxiety, depression, and physical function) and whether these associations were moderated by sociodemographic factors (i.e. sex, race, marital status, income, insurance, and education). Methods Data come from the Health Literacy and Cognitive Function Among Older Adults Longitudinal Study (LitCog), a prospective cohort study of English-speaking older adults (N  = 900). At each measurement occasion, participants reported anxiety, depression, and physical function using the Patient Reported Outcomes Information System, chronic conditions, and sociodemographic characteristics. We employed multilevel growth models to estimate changes in health-related quality of life, with multimorbidities as a predictor and sociodemographics as covariates. Results Results indicated that individuals with multiple chronic conditions reported persistently high levels of anxiety and depression, and worse physical function. We found evidence for racial health disparities, such that individuals who identified as non-White experienced worse health-related quality of life as multimorbidities increased, relative to White participants. Discussion These results contribute to the current conversation about the long-term impacts of structural and systemic barriers experienced by minoritized groups. We further discuss the public health implications of multimorbidity in older adulthood. [ABSTRACT FROM AUTHOR] more...

Objectives: To assess whether older adults with a cognitive impairment were more likely to report challenges interacting with medical providers, or to avoid needed medical care. Methods: Data for this exploratory, cross-sectional analysis were from older adults (N = 493) ages 60–82 participating in the "LitCog" cohort study. Multivariable generalized linear models compared cognitive impairment (none, mild, moderate, severe) with validated measures of healthcare engagement. Results: A moderate cognitive impairment was associated with delays in medical care due to embarrassment (RR 5.34.95% CI 1.30–22.0) and discomfort asking the doctor questions (RR 4.07, 95% CI 1.00–16.5). Conclusions: Intermediate cognitive deficits, such as with mild cognitive impairment (MCI) or mild dementias, may impact meaningful engagement with healthcare systems, potentially affecting timely detection and appropriate management of cognitive concerns and other chronic medical conditions. More research is needed to understand mechanisms underlying this relationship. [ABSTRACT FROM AUTHOR] more...

Background: Most cognitive screening tests used in primary care to identify adults with cognitive impairment, including Alzheimer's disease and related dementias, have been limited in their diagnostic accuracy, especially in mild cases. Resultant false positives or false negatives (e.g., delayed diagnoses) have respective harms. While expressed concern of an individual's real‐world self‐care abilities from a caregiver can improve confidence in a screening result, as many as half of patients with cognitive complaints may lack this informant. We explored whether the addition of an objective, brief, health literacy assessment could improve the accuracy of a longstanding, common cognitive screening tool. Method: Data came from a longitudinal aging study of older adults from Chicago, IL. Cognitive function was assessed using Z‐scores generated from a comprehensive neurocognitive battery of 13 measured across 5 domains. Participants were determined to have an impairment if they scored ←1 on ≥2 tests within at least one domain. The Mini Mental Status Exam (MMSE) and the Newest Vital Sign (NVS), a common 3‐minute, 6‐item measure of health literacy, were administered. Receiver operating characteristic (ROC) curves assessed the specificity and sensitivity of adjusted MMSE models (cut‐off score ≤26) with and without the NVS to detect cognitive impairment. Areas under the curve (AUCs) were compared using the DeLong test. Result: Participants (N = 389) were on average 71 years old (SD 5.2); most participants were female (72%) and non‐Hispanic White (56%). Most (86%) had 2+ chronic conditions (M 3.4 (SD 1.8)), and 28% had at least a mild cognitive impairment based on our comprehensive neurocognitive battery. ROC analyses indicated that cognitive impairment detection by the MMSE alone (AUC = 0.79, 95% CI [0.73‐0.84]) was significantly improved (Z = ‐3.68, 95% CI [0.03,0.11], p‐value = <0.001) with inclusion of the NVS (AUC = 0.86, 95% CI [0.82‐0.90]). Conclusion: Our findings demonstrate the potential benefit of integrating a brief assessment of real‐world self‐care task performance and health literacy, such as the NVS, with routine cognitive screening tests to improve accurate identification of cognitive impairment in primary care. Improving the accuracy of common screening tools may help facilitate earlier detection, diagnosis, and subsequent care. [ABSTRACT FROM AUTHOR] more...

Background: Chronic depression impacts the ability to successfully manage one's health, yet mechanisms underlying this relationship are not fully understood. Cognitive dysfunction, or impairment, may result from persistent depression. We aimed to determine whether chronic depressive symptoms, leading to poor cognition, impacted self‐management capacity among older adults with chronic conditions. Method: Data from 369 older adults from Chicago, IL and participating in a longitudinal cohort study on aging was used for this analysis. The Patient‐Reported Outcomes Measurement Information System (PROMIS) Depression 8‐item survey was administered across 4 time points over 10 years; raw scores were transformed into T‐scores. Group‐based trajectory modeling was used to identify latent depressive symptom trajectory groups. The Comprehensive Health Activities Scale (CHAS) was used to measure chronic disease self‐management skills, including comprehension and recall of print, spoken, and multimedia information. A factor score representing fluid cognitive function was derived from 11 measures across 4 cognitive domains (processing speed, working memory, inductive reasoning, long‐term memory). Demographic‐adjusted multinomial linear regressions were used to assess associations between depressive symptom trajectory groups and self‐management skills, first without and then including fluid cognitive function. Result: Mean participant age was 71 years (SD 5.3); most participants were female (71%) and non‐Hispanic white (54%). 86% had 2+ chronic medical conditions (mean 3.3 (SD 1.8)). Three distinct depressive symptom trajectories emerged: participants displayed either consistently minimal (42%), normative (46%), or persistently elevated (12%) symptoms. In multivariable analyses, participants in the persistently elevated group had poorer self‐management performance (β = ‐6.4; 95% CI: ‐11.1, ‐1.7; p = 0.007). Adjusting for cognitive function attenuated this association to a level of non‐significance, while a strong association emerged between cognition and self‐management skills (β = 16.1; 95% CI: 14.4, 17.8; p<0.001). Conclusion: Persistent depression may reduce self‐care capacity, likely due to poorer cognitive function. Improved understanding of how depression may alter cognitive function or lead to its progressive decline, and ultimately impact self‐care capacity, may inform future health system interventions to support the management of comorbid conditions. [ABSTRACT FROM AUTHOR] more...

Objectives: Physical distancing precautions during the COVID-19 pandemic may challenge the provision of tangible support many middle age and older adults receive in managing their health. We examined the association between unmet tangible support needs and self-management behaviors and mental health status during the stay-at-home orders in Chicago and New York. Methods: We used data from the COVID-19 & Chronic Conditions study collected between May 1st and May 22nd, 2020. A total of 801 middle age and older adults with ≥1 chronic condition in Chicago and New York City completed the telephone interview. Adequacy of tangible social support was measured using a brief, validated scale that determined whether an individual needed assistance managing his or her health, and if yes, whether this need was met. Participants reported their level of difficulty engaging in self-management behaviors using 2 discrete items; they also self-reported medication adherence using the ASK-12 medication adherence scale. Mental health status was measured using the depression and anxiety PROMIS short-form instruments. Results: Participants' mean age was 63 years; 30% identified as Black, 26% identified as Latino, and 12% identified unmet support needs. Inadequacy of tangible support was associated with greater difficulty managing one's health and accessing medications due to COVID-19, as well as poorer medication adherence, increased anxiety and depressive symptoms, and poorer overall well-being (P 's <.05). Conclusions: Perceived unmet support needs during stay-at-home orders were associated with greater difficulty engaging in self-management behaviors and poorer overall well-being. Two brief items quickly identified individuals with unmet support needs. [ABSTRACT FROM AUTHOR] more...