Introduction to the Costs of Alzheimer's Disease and Related Dementias.

This special issue is the result of the Michigan Center for Contextual Factors in Alzheimer's Disease (MCCFAD) third Summer Data Immersion (SDI) program held on May 23-26, 2022. Thirty-seven researchers from 17 universities participated in the program, which emphasized racial/ethnic and other contextual factors in the study of Alzheimer's disease and related dementias (ADRD) costs using a team science approach. During the program, data from the Health and Retirement Study were used to investigate multiple topics related to both financial and non-financial costs of ADRD including: (1) life course socioeconomic factors, (2) costs of preclinical ADRD, (3) COVID-19, (4) family members' employment outcomes, (5) geographic contexts, (6) monetary value of unpaid ADRD care, and (7) spousal relations for couples living with ADRD.

COVID-19 Stress and Cognitive Disparities in Black, MENA, and White Older Adults.

BACKGROUND AND OBJECTIVES: Population aging has led to an increased interest in cognitive health and, in particular, the role that stress plays in cognitive disparities. This paper extends previous work by characterizing coronavirus disease 2019 (COVID-19) stress type prevalence and its association with cognitive health in metro-Detroit among Black, Middle Eastern/Arab (MENA), and White older adults. RESEARCH DESIGN AND METHODS: Data come from a regionally representative sample of adults aged 65+ in metro-Detroit (N = 600; MENA n = 199; Black n = 205; White n = 196). We used generalized linear models to compare groups on sociodemographic, objective stress, and social stress indicators. Multiple group structural equation models evaluated whether COVID-19 stress predicted cognitive health and whether that association varied across racial/ethnic groups. RESULTS: MENA and Black older adults reported higher levels of objective stress than Whites. There were no racial/ethnic group differences in social stress. More objective stress was associated with better cognitive health, and more social stress was associated with worse cognitive health. The positive effect of objective stress was especially apparent for White older adults. DISCUSSION AND IMPLICATIONS: Though it appears that minority stress was not exacerbated in the context of pandemic stress, links between greater objective stress and better cognitive health apparent among White older adults were not evident among MENA or Black older adults. Broadening health disparities research by including underrepresented populations allows us to elevate scientific knowledge by clarifying what is universal and what is unique about the stress process.

Friendship trajectories and health across the lifespan.

Friends are a vital source of social relations throughout the lifespan and across developmental stages. Our knowledge of how friendships develop over time, especially from childhood through adulthood, is limited. Furthermore, it is now recognized that this specific type of relationship influences health across the life course in unique ways. Using the Convoy Model of Social Relations as a guiding framework, this study charts the multiple and unique trajectories of friendship across adulthood and tests whether these trajectories influence health differentially by age. The sample for the study consisted of 553 adults from the longitudinal Social Relations Study. Respondents ranged in age from 13 to 77 at Wave 1 (1992), and included only those who reported a best friend in each wave, that is, Wave 2 (2005) and Wave 3 (2015). Approximately 65% of the respondents were women, and 24.5% were people of color. Latent growth curve analysis identified three trajectories of the presence of friends in one's network over time, two trajectories of positive friend quality, and three for negative quality. The most consistent findings are associated with positive friend relations over time. Gender was associated with friendship quality where women reported more positive friend relations over time, and increasing positive friend relations predicted better health 23 years later. These findings demonstrate that consistent and increasing positive friendships yield health benefits over time, whereas the presence of friends and negative quality does not have an effect. Overall, findings advance understanding of the long-term effects of social relations across the lifespan and life course. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Network Types and Functional Health in Old Age: It is Not Just the Size of the Network That Matters.

OBJECTIVES: Findings on the effect of network size and support on functional health are mixed. We examine whether network types, that simultaneously incorporate multiple network characteristics, are associated with functional health in late life. METHODS: Data are from the National Social Life, Health, and Aging Project (N = 3005). We estimated the longitudinal effect of membership in five multidimensional network types on disability in six activities of daily living using negative binomial regression, and on mobility (assessed using a timed walk test) using a generalized linear mixed model. RESULTS: Compared to those in the large without strain network, older adults in the small, restricted, high contact network had fewer disabilities but worse mobility, while those in the large network with strain also had worse mobility. DISCUSSION: Care plans focusing on function and mobility should consider multiple aspects of older adults' social networks including network size, diversity, and relationship strain.

Employment Dynamics Among Adult Children at the Onset of Parental Dementia: Variation by Sociodemographic Characteristics.

OBJECTIVES: To examine the influence of sociodemographic factors on employment changes among adult children following onset of parental Alzheimer's disease and related dementia (ADRD). METHODS: We used Health and Retirement Study (2010-2018; N = 20,110) data to examine adult child (ages 50-70) changes in employment and work hours at onset of parental ADRD and potential variation by gender, age, race, ethnicity, and education. RESULTS: Parental ADRD onset was not associated with changes in adult child employment overall, although associations differed substantially across subpopulations defined by education level. Sons with the lowest education were least likely to cease employment, while daughters with the lowest education were most likely to reduce work hours. Sons at older ages were increasingly likely to reduce work hours or end employment following parental ADRD onset. DISCUSSION: The potential impact of parental ADRD on adult child employment is complex and should be considered in the context of sociodemographic factors.

Measurement and structural invariance of a neuropsychological battery among Middle Eastern/North African, Black, and White older adults.

OBJECTIVE: There is a lack of guidance on common neuropsychological measures among Arabic speakers and individuals who identify as Middle Eastern/North African (MENA) in the United States. This study evaluated measurement and structural invariance of a neuropsychological battery across race/ethnicity (MENA, Black, White) and language (Arabic, English). METHOD: Six hundred six older adults (128 MENA-English, 74 MENA-Arabic, 207 Black, 197 White) from the Detroit Area Wellness Network were assessed via telephone. Multiple-group confirmatory factor analyses examined four indicators corresponding to distinct cognitive domains: episodic memory (Consortium to Establish a Registry for Alzheimer's Disease [CERAD] Word List), language (Animal Fluency), attention (Montreal Cognitive Assessment [MoCA] forward digit span), and working memory (MoCA backward digit span). RESULTS: Measurement invariance analyses revealed full scalar invariance across language groups and partial scalar invariance across racial/ethnic groups suggesting a White testing advantage on Animal Fluency; yet this noninvariance did not meet a priori criteria for salient impact. Accounting for measurement noninvariance, structural invariance analyses revealed that MENA participants tested in English demonstrated lower cognitive health than Whites and Blacks, and MENA participants tested in Arabic demonstrated lower cognitive health than all other groups. CONCLUSIONS: Measurement invariance results support the use of a rigorously translated neuropsychological battery to assess global cognitive health across MENA/Black/White and Arabic/English groups. Structural invariance results reveal underrecognized cognitive disparities. Disaggregating MENA older adults from other non-Latinx Whites will advance research on cognitive health equity. Future research should attend to heterogeneity within the MENA population, as the choice to be tested in Arabic versus English may reflect immigrant, educational, and socioeconomic experiences relevant to cognitive aging. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Longitudinal Associations Between Loneliness and Self-Rated Health Among Black and White Older Adults.

OBJECTIVES: This study examined the longitudinal association between loneliness and self-rated health (SRH), and whether there were race differences between non-Hispanic Black and White adults in these associations. METHOD: A total of 1,407 participants were drawn Social Relations Study, a regional study of social relations across the life span with 3 waves of data collection in 1992, 2005, and 2015 (Wave 1, W1: Mage = 50.28, 28% Black, 59% women). Cross-lagged structural equation models examined the association between loneliness and SRH over 3 waves. We adjusted for baseline age, gender, social network size, and depressive symptoms. RESULTS: There were no race differences in loneliness at any wave. Loneliness W1 was associated with Loneliness W2; Loneliness W2 was associated with Loneliness W3. We had similar findings for associations among SRH. However, only one of the cross-lagged paths was significant. Worse SRH W2 was associated with more Loneliness W3. The only path that varied across race was in the association between SRH W2 and Loneliness W3, and this path was significant only in Whites. DISCUSSION: Findings indicate that worse SRH at later midlife may increase risk for loneliness in later life, particularly for Whites. As a valid indicator of health, SRH can be used in the body of research on health correlates of loneliness as adults age. Use of the current sample of Black and White adults provides nuanced understanding in the ways in which racially diverse adults experience loneliness and should be useful in refining and developing culturally competent interventions for older adults.

Characteristics and Predictors of Sleep Among Spousal Care Dyads Living With Chronic Conditions.

OBJECTIVES: Poor sleep is common among older adults with chronic health conditions and their spousal caregivers. However, dyadic sleep patterns among spouses are underexplored within the literature. This study examines dyadic sleep characteristics and associated contextual factors among spousal care dyads. METHODS: Participants included 462 older adult spousal care dyads from the 2015 National Health and Aging Trends Study and National Study of Caregiving (mean ages of care recipients/caregivers = 79 and 76 years, respectively; 22% of dyads were living with dementia). Self-reported sleep included frequency of (a) trouble falling back asleep among dyads, (b) care-related sleep disturbances among caregivers, and (c) trouble initiating sleep among care recipients. Predictors included between-dyad characteristics such as whether respondents had dementia, care burden and support, relationship quality, neighborhood cohesion, and within-dyad characteristics such as demographics, depression, and positive affect. We conducted multilevel dyadic analysis and actor-partner interdependence modeling. RESULTS: Sleep was correlated more among dyads living with dementia than those with other chronic conditions. Care dyads had poorer sleep if caregivers reported higher care burden; however, better relationship quality marginally ameliorated the association. Depressive symptoms had a partner effect on poorer sleep among care dyads, whereas positive emotions and older age only had an actor effect on better sleep for care recipients and spousal caregivers. Neighborhood cohesion, care support, and other demographic characteristics were not associated with dyadic sleep outcomes. DISCUSSION: Addressing both care recipient- and caregiver-related factors may improve sleep health for both members of the care dyad living with chronic conditions.

Development of social convoys: Trajectories of convoy structure and composition from childhood through adulthood.

Personal networks undergo changes in structure and composition throughout the life span, adapting to developmental transitions and changing circumstances in a dynamic way. This study examines stability and change in social convoys from childhood to adulthood and variation in trajectories of convoy characteristics by gender and race. Multilevel models for convoy structure and composition characteristics were estimated using three waves of longitudinal data spanning 23 years. The regionally representative sample included 193 children aged 8 to 12 in Wave 1 (1992) who were surveyed again in their 20s (Wave 2) and 30s (Wave 3). The Wave 1 sample comprised 52% girls, 32% Black children, and 59% White children with average maternal educational attainment of 13 years. Overall, changes in composition, proximity, and contact frequency were observed at each wave. Between Waves 1 and 2, the changes reflect age-normative trends toward network diversification typical of the transition to adulthood, whereas between Waves 2 and 3, the changes were consistent with those expected as young adults settle into stable roles. We also identified convoy characteristics that differed between men and women and between Black and White individuals, emphasizing the importance of considering personal characteristics to fully understand form and function of social relations. Social convoy trajectories early in the life span provide direction for more in-depth examinations of the implications of social ties during these critical life periods. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Multidimensional Social Network Types and Their Correlates in Older Americans.

BACKGROUND AND OBJECTIVES: Social support networks of older adults have been linked to their health and well-being; however, findings regarding the effects of specific network characteristics have been mixed. Additionally, due to demographic shifts increasing numbers of older adults live outside of traditional family structures. Previous studies have not systematically examined the resulting complexity and heterogeneity of older adults' social networks. Our objectives were to examine this complexity and heterogeneity by developing a multidimensional typology of social networks that simultaneously considers multiple structural and functional network characteristics, and to examine differences in network type membership by sociodemographic characteristics, health characteristics, and birth cohort. RESEARCH DESIGN AND METHODS: Participants included 5,192 adults aged 57-85 years in the National Social Life, Health, and Aging Project at rounds 1 (2005-2006) and 3 (2015-2016). Data were collected on social relationships including network size, diversity, frequency of contact, and perceived support and strain in relationships. We used latent class analysis to derive the network typology and multinomial logistic regression to examine differences in network type membership by sociodemographic characteristics, health characteristics, and birth cohort. RESULTS: Older adults were classified into 5 distinct social network types: (i) large, with strain; (ii) large, without strain; (iii) small, diverse, low contact; (iv) small, restricted, high contact; and (v) medium size and support. Membership in these network types varied by age, gender, marital status, race/ethnicity, education, mental health, and birth cohort. DISCUSSION AND IMPLICATIONS: Network typologies can elucidate the varied interpersonal environments of older adults and identify individuals who lack social connectedness on multiple network dimensions and are therefore at a higher risk of social isolation.

Linked lives and convoys of social relations.

We consider linked lives through the Convoy Model of Social Relations to illustrate their complexity, consequences, and development across contexts. To illustrate how the Convoy Model lens provides a unique opportunity to examine the multidimensional and dynamic character of linked lives across time and space, we analyze twenty-three years of longitudinal data from the Social Relations Study (SRS). The SRS is a regionally representative Detroit-area sample (N=1,498) with three waves (1992; 2005; 2015) of data from community dwelling people age 13 to 93. We present three illustrative examples of linked lives: 1) the influence of earlier life social network characteristics (size and closeness) on later life health outcomes; 2) the influence of social position (race and education) on relationship quality with spouse/partner and child over time; and 3) the influence of transitioning from working to retirement on network structure (size and geographic proximity). Findings illustrate linked lives through multiple instances of social relationships and as influenced by various contexts. Further, the consequences of linked lives for mental health are consistent across the life course while influence on physical health is variable. The Convoy Model presents key concepts to situate the ways in which linked lives form and function at various levels and across multiple contexts to have far reaching effects on life outcomes.

Volunteering and health: The role of social network change.

OBJECTIVES: Levels of volunteering may differentially influence multiple dimensions of health among older adults. Further, increasing evidence indicates social networks represent critical bridging and bonding contexts for the volunteering-health link. This study examines two research questions: 1) does volunteering level (low, moderate, high) influence physical and mental health in the same ways? And 2) does social network change moderate this link? METHODS: Data come from Waves 1 and 2 of the longitudinal Social Relations Study (n = 556) collected in 1992 and 2005 and the sub-sample of adults age 50 and older at Wave 2. Regression analyses predicting self-rated health and depressive symptoms were conducted to examine main effects of volunteering and moderating effects of social network change. RESULTS: Volunteering at a moderate level (101-300 hours per year) was associated with fewer depressive symptoms compared to those not volunteering. Social network change moderated the association between volunteering and self-rated health. Among those reporting a decrease in the proportion of non-family in their network (decrease in bridging), a moderate level of volunteering was associated with better self-rated health. CONCLUSION: While moderate levels of volunteering are associated with better mental health, the link to physical health is only present in the context of decreasing network bridging. Identifying specific circumstances under which volunteering is beneficial is critical for developing interventions to promote health for all, including those in mid and later life.

Towards Positive Aging: Links between Forgiveness and Health.

Forgiveness may serve as an essential positive resource to help individuals cope emotionally with stressful events, ultimately influencing health. Examination of how individuals forgive within the context of close relationships can provide useful information about positive aging. In this study, we examine how the severity of a recent transgression committed by a spouse/partner or other close social relationship is associated with self-reported physical health among older adults. We also examine how state forgiveness (i.e., in context of a specific event) can offset the potentially negative impact of transgressions on health and further compare the impact when the transgressor is a spouse/partner versus another close social relationship. Data are from the Detroit Community Survey, a cross-sectional survey of social relations, forgiveness, humility, and health in the Detroit Metropolitan Area. Respondents age 50 and older were selected for analysis (N=380). Structural equation models indicated that greater transgression severity was associated with worse self-rated health. Further, state forgiveness was found to play a significant moderating role. Among older adults who were more likely to forgive their transgressor, experiencing a more severe transgression was associated with worse health. In contrast, among older adults less likely to forgive, there was no association between transgression severity and self-rated health. Additionally, among older adults less likely to forgive, the transgressor being a close other social relationship was associated with worse health compared to when it was a spouse/partner. In contrast, when more likely to forgive there was no association between who the transgressor was and self-rated health. This study contributes to a better understanding of how interpersonal stress, specifically a recent transgression experienced within the context of close social relationships, can be harmful to older adults' health. Findings highlight the importance of forgiveness as a resource that can help facilitate positive aging.

Partnering with Middle Eastern/Arab American and Latino Immigrant Communities to Increase Participation in Alzheimer's Disease Research.

Purpose: Recruitment and retention of US ethnic groups traditionally underrepresented in research continues to pose challenges. The Michigan Center for Contextual Factors in Alzheimer's Disease (MCCFAD) engages with two underserved immigrant communities in Michigan - Middle Eastern/Arab Americans in metro-Detroit and Latinos in the Grand Rapids area - to recruit and retain two Participant Resource Pools (PRP). Procedures: We adapt an existing community-based participatory research (CBPR) approach to recruit Middle Eastern/Arab American and Latino adults of all ages for Alzheimer's disease and related dementia (ADRD) research. Using American Community Survey (2014-2018) data, we compare socio-demographic characteristics of Middle Eastern/Arab Americans and Latinos living in Michigan to our PRPs. Assessment tools and community advisory board feedback identified missteps and culturally sensitive solutions. Main Findings: In the first year of MCCFAD activities, 100 Middle Eastern/Arab Americans and 117 Latinos joined the MCCFAD PRPs. Comparisons to state-level data showed that PRP participants were on average older and more likely to be female than the Middle Eastern/Arab American and Latino populations in Michigan. Further, Middle Eastern/Arab Americans in the PRP reported higher education levels while Latinos reported lower education levels than their respective statewide populations. Community partnerships/feedback identified the importance of connecting with community leaders, attending to matters of within-group diversity, as well as language and semantics. Conclusion: Partnership with communities to develop culturally targeted and sensitive community health events can fill a significant gap in addressing ADRD health disparities by establishing sustainable relationships to increase participation in ADRD research.

The Convoy Model and Later-Life Family Relationships.

The convoy model of social relations was developed to provide a heuristic framework for conceptualizing and understanding social relationships. In this Original Voices article, we begin with an overview of the theoretical tenets of the convoy model, including its value in addressing situational and contextual influences, especially variability in family forms and cultural diversity across the life span, but particularly in older adulthood. We also consider the contributions of the convoy model to the field of family gerontology by illustrating concepts, methods, and measures used to test the model, as well as its usefulness and limitations in addressing contemporary issues facing older adults. Finally, we discuss opportunities for innovation and application of the convoy model to the study of later-life family relationships. In summary, we emphasize the benefits and inclusiveness of the convoy model for guiding current and future research to address challenges facing family gerontology now and in the future.

The Strength of Weaker Ties: An Underexplored Resource for Maintaining Emotional Well-Being in Later Life.

OBJECTIVES: The purpose of this study was to examine dynamic links between changes in social ties and changes in emotional well-being. METHOD: Trivariate dual-change score models were used to test whether a large number of close ties would be more strongly associated with low levels of depressed affect than a large number of weaker ties, and a large number of weaker ties would be more strongly associated with high levels of positive affect compared to a large number of close ties, across three waves of a large, regionally representative sample of U.S. adults aged 40 and older (N = 802). RESULTS: We found that a greater number of weaker ties was associated with having more close ties over time, and that the number of weaker ties was more strongly predictive of positive age-related changes in both aspects of well-being (i.e., more positive affect and less depressed affect) than the number of close ties. DISCUSSION: Contrary to popular theoretical orientations in gerontology, weaker ties may offer older adults a more effective avenue for promoting emotional well-being over time than close ties, and may have the additional benefit of compensating for losses in the number of close ties.

Understanding the effects of Covid-19 through a life course lens.

The Covid-19 pandemic is shaking fundamental assumptions about the human life course in societies around the world. In this essay, we draw on our collective expertise to illustrate how a life course perspective can make critical contributions to understanding the pandemic's effects on individuals, families, and populations. We explore the pandemic's implications for the organization and experience of life transitions and trajectories within and across central domains: health, personal control and planning, social relationships and family, education, work and careers, and migration and mobility. We consider both the life course implications of being infected by the Covid-19 virus or attached to someone who has; and being affected by the pandemic's social, economic, cultural, and psychological consequences. It is our goal to offer some programmatic observations on which life course research and policies can build as the pandemic's short- and long-term consequences unfold.

So Close and Yet So Irritating: Negative Relations and Implications for Well-being by Age and Closeness.

OBJECTIVES: Negative social relationships are associated with poor health, chronic illness, and mortality. Yet, we know little about the dynamics of negative aspects of relationships within individual's closest relationships over time, how those experiences vary by age, and the implications of those relationships for well-being. METHOD: A total of 592 participants (ages 25-97; M = 57.5; 63.3% women) from the Social Relations Study completed monthly web surveys for up to 12 months. Each month they reported negative relationship quality with their three closest network members and multiple dimensions of well-being (positive affect, negative affect, self-rated health, and sleep quality). RESULTS: Multilevel models revealed older individuals reported less negativity in their relationships than younger people, but fewer age differences in the closest tie. Greater negative relationship quality predicted poor well-being (i.e., greater negative affect, sleep problems). Links between negative relations and well-being were less strong among older individuals; especially in the closest ties. DISCUSSION: Results were partially consistent with the strength and vulnerability integration (SAVI) model, which proposes fewer age-related improvements in emotion regulation when individuals are unable to avoid tensions. Despite feeling just as negative as younger individuals, older individuals may be more resilient to tensions in their closest relationships.

Beyond the Nuclear Family: Children's Social Networks and Depressive Symptomology.

This study identified social network profiles among children, determined whether profiles vary across sociodemographic characteristics, and investigated links between childhood profiles and depressive symptomology using three waves of data spanning 23 years (Wave 1, 1992 Metro-Detroit representative sample: n = 193, ages 8-12). Latent profile analysis revealed three profiles: Close Family (22%), Varied Family (57%), Friend and Family (21%). White children were more likely than Black children to be in the Friend and Family profile. Children in the Close Family profile reported the lowest levels of depressive symptomology in childhood, but exhibited the steepest increase over time. Findings suggest that close, family centric networks are protective in childhood, but less so as children develop into adulthood, highlighting the importance of considering developmental perspectives.