Activity Limitations and Depression Among Middle-Aged and Older Adults in China: The Moderating Impact of Assistance Adequacy.

This study aimed to examine the risk and protective factors associated with depression in middle-aged and older Chinese adults with activity limitations. Data were obtained from the 2018 Wave 4 Survey of the China Health and Retirement Longitudinal Study. In the logistic regression analysis, health and functioning, losing a child, and a perceived lack of future assistance with daily activities increased the odds of depression. Conversely, receiving adequate assistance with daily activities lessened the depressive impacts of activity limitations, as indicated by a significant interaction effect. Enhanced long-term support for individuals with disabilities is necessary to improve mental health.

Altruism Sustains the Village Model: How Motivations to Join a Village for Older Adults Predict Long-Term Membership.

A Village is a membership-driven organization based on neighbors helping neighbors age in place. Many Villages express difficulty maintaining membership and have concerns about sustainability. Drawing on socioemotional selectivity theory, we used qualitative and quantitative data from a representative survey of members of ShareCare (N = 91), the first known Village founded in 1994, to 1) identify members' motivations for joining ShareCare, and 2) examine the relationship between motivations for joining ShareCare and being a long-term member. Qualitative data revealed three motivations for joining ShareCare: instrumental, social, and altruistic. Long-term membership was operationalized as 8 years or more. Logistic regression models indicated that people with altruistic motivation were more likely to be long-term members compared to members without altruistic motivation. Instrumental and social motivations were not associated with long-term membership. Our findings inform recruitment and retention of members in Villages, and member-driven organizations for older adults more broadly.

Relocation Later in Life and Contact Frequency With Friends: Do Contact Modes Matter?

We examined changes in the frequencies of in-person, telephone, and written or email contact with friends in older adults who move short or longer distances. 3820 adults aged 50 years or older were included from a nationally representative sample from the Health and Retirement Study. Using ordinal logistic regression, we found differential effects of geographical distances on the in-person, telephone, and write or email contact with friends. Specifically, in-person contact frequency was most sensitive to distance. Telephone contact frequency was only impacted by long-distance moves; however, email contact frequency was not influenced by distance. Findings suggest that the impact of relocation on contact frequency exists even though communication technology gives older adults flexibility in maintaining frequent contact with their friends. We discuss our findings through the lens of socioemotional selective theory and social convoy model. Future studies could examine factors linked to changes in the amount and modes of contact.

The Relationship Between Volunteering and the Occurrence of Loneliness Among Older Adults: A Longitudinal Study with 12 Years of Follow-Up.

Informed by the social model of health promotion, this study examined the association between formal volunteering and the occurrence of loneliness among older adults over 12 years of follow-up and whether the association differs by gender. Data came from the Health and Retirement Study (2006-2018). The study sample included 5,000 individuals aged 60 and over who did not experience loneliness in 2006. Self-reported participation in formal volunteer work was classified into three levels: (0) no volunteering, (1) less than 100 hours of volunteering per year, and (2) more than 100 hours of volunteering per year. Cox regression was used to examine the relationship between volunteering level and the onset of loneliness during the 12 years of follow-up. Volunteering more than 100 hours per year was associated with a lower risk of loneliness compared to non-volunteers (HR = 0.55, p = .008). This protective effect was not observed for those who volunteered less than 100 hours per year (HR = 0.84, p = .246). The benefits of volunteering in mitigating loneliness did not differ by gender. Engagement in moderate to high levels of volunteering can protect against loneliness. More volunteering programs can be offered to older adults to reduce loneliness in later life.

Childhood adversity and cognitive impairment in later life.

Objectives: This study examined the association between childhood adversity and cognitive impairment in later life and explored the potential moderation effect of gender and race. Methods: The study sample included 15,133 participants of the Health and Retirement Study (1998-2016 surveys) who had complete data on key study measures and were more than 50. The outcome variable is a dichotomous indicator of cognitive impairment as assessed by the Telephone Interview for Cognitive Status for self-respondents and the 16-item Informant Questionnaire on Cognitive Decline in the Elderly for proxies. A total of six childhood adversity indicators included grade retention, parental substance abuse, physical abuse, trouble with the police, moving due to financial hardship, and receipt of help due to financial hardship in early life. The estimation of the association between childhood adversity and cognitive impairment involved Cox proportional hazards regression. Results: Grade retention had the largest effect on incident cognitive impairment (HR = 1.3, 95% CI = 1.23-1.38, p < 0.001), followed by physical abuse by a parent (HR = 1.10, 95% CI = 1.00-1.20, p = 0.001). The impact of grade retention was more detrimental to women than men (interaction term HR = 0.89, 95% CI = 0.80-1.00, p = 0.048, female as the reference). Parental substance abuse was associated with a lower risk of incident cognitive impairment for most racial groups (HR = 0.89, 95% CI = 0.83-0.95, p = 0.001), but this association was reversed in "non-Hispanic other" race, consisting mainly of Asians (HR = 1.54, 95% CI = 1.05-2.26, p = 0.025). Discussion: Some aspects of childhood adversity continue to harm cognitive functioning in later life, while some events may have the opposite effect, with evidence of heterogeneity across gender and race.

Exploring dementia care in acute care settings: Perspectives of nurses and social workers on caring for patients with behavioral and psychological symptoms.

This qualitative study compares perspectives of nurses (n = 5) and social workers (n = 12) about their role in caring for patients with dementia with behavioral and psychological problems in an acute care setting. A thematic qualitative analysis was conducted using the Rigorous and Accelerated Data Reduction Technique (RADaR). Three themes emerged: engagement of the patient and coordination with family and professionals, treatment and medical management of behavioral and psychological symptoms of dementia (BPSD) in the hospital, and barriers to care. Barriers to care are identified by both professions, with each having its own care niche. Social workers and nurses work as a team with the understanding that they face care challenges. Person centered care is a successful approach for the care team working with patients with BPSD.

Perceived Usefulness and Easiness of Information and Communication Technologies and Volunteering among Older Adults.

This study investigates the association between older adults' perception of usefulness and easiness (PUE) of Information Communication and Technologies (ICTs) and volunteering, and if this association differs across their income status. Data were obtained from the 2012 wave of the Health and Retirement Study (HRS), and the sample was restricted to respondents aged between 60 and 84 (N = 901) and who completed the 2012 HRS technology module. Multinomial logistic regression was employed to examine the independent and joint influence of PUE of ICTs and of low-income status on volunteering. The results show that only people with high PUE engaged in more than 100 hours of volunteering among older adults after controlling for covariates. The positive effect of high PUE was found to be more significant in the low-income group. This is the first known research to investigate the PUE of ICTs and volunteering among older adults. This study expands the knowledge of volunteering among older adults by exploring ICTs which can be considered as one of the most influential macrosocial changes in the current society. Moreover, our findings provide some insights and an empirical foundation in volunteering programs for older adults of different PUE levels.

Automated Gleason Scoring and Tumor Quantification in Prostate Core Needle Biopsy Images Using Deep Neural Networks and Its Comparison with Pathologist-Based Assessment.

The Gleason grading system, currently the most powerful prognostic predictor of prostate cancer, is based solely on the tumor's histological architecture and has high inter-observer variability. We propose an automated Gleason scoring system based on deep neural networks for diagnosis of prostate core needle biopsy samples. To verify its efficacy, the system was trained using 1133 cases of prostate core needle biopsy samples and validated on 700 cases. Further, system-based diagnosis results were compared with reference standards derived from three certified pathologists. In addition, the system's ability to quantify cancer in terms of tumor length was also evaluated via comparison with pathologist-based measurements. The results showed a substantial diagnostic concordance between the system-grade group classification and the reference standard (0.907 quadratic-weighted Cohen's kappa coefficient). The system tumor length measurements were also notably closer to the reference standard (correlation coefficient, R = 0.97) than the original hospital diagnoses (R = 0.90). We expect this system to assist pathologists to reduce the probability of over- or under-diagnosis by providing pathologist-level second opinions on the Gleason score when diagnosing prostate biopsy, and to support research on prostate cancer treatment and prognosis by providing reproducible diagnosis based on the consistent standards.

Artificial Intelligence in Pathology.

As in other domains, artificial intelligence is becoming increasingly important in medicine. In particular,deep learning-based pattern recognition methods can advance the field of pathology byincorporating clinical, radiologic, and genomic data to accurately diagnose diseases and predictpatient prognoses. In this review, we present an overview of artificial intelligence, the brief historyof artificial intelligence in the medical domain, recent advances in artificial intelligence applied topathology, and future prospects of pathology driven by artificial intelligence.

The Effect of California's Paid Family Leave Program on Employment Among Middle-Aged Female Caregivers.

BACKGROUND AND OBJECTIVES: This study examined the effect of a Paid Family Leave program in California (CA-PFL) on employment among middle-aged female caregivers. We also examined differences in the relationship between the availability of paid family leave (PFL) and employment in socioeconomic subgroups of midlife women. RESEARCH DESIGN AND METHODS: Data came from multiple years (2000‒2014) of the Current Population Survey (CPS) (N = 68,773 individuals). Applying a Difference in Differences (DiD) approach to removing potential selection biases related to program participation, we used a logistic regression to estimate the effects of PFL. RESULTS: There was a significant increase in the likelihood of working based on CA-PFL. This positive effect, however, was found only among the early middle-aged, the near-poor, and those had the highest level of education. DISCUSSION AND IMPLICATIONS: Among the late middle-aged, caregiving burden may not affect decisions on whether to exit the labor market, and PFL may not significantly mitigate the well-known negative effects of intense and multiple caregiving roles (parents, spouse, and/or children with disabilities). Future studies should examine PFL effects and their correlates such as age-cohorts, caregiving intensity, and retirement patterns. The unexpected null findings of CA-PFL's effect on employment outcomes for the poor and those with low education levels suggests these vulnerable groups might not be able to fully benefit from the originally intended goal of the policy, instead being left more vulnerable compared to the near poor. Such a possibility increases the importance of focused research and policymaking attention for this group.

Postretirement work and volunteering by poverty groups informed by role theory.

This study uses role theory to examine the association between postretirement work and volunteering among retirees and to determine whether this association varies across poverty status. Data came from the 2012 wave of the Health and Retirement Study (HRS). The sample was restricted to respondents of older retirees (N = 6,619). We found that postretirement work positively influenced volunteering. However, poverty can be a risk factor of volunteering among older retirees. The positive effect of post-retirement work was found to be more significant in the near-poverty group. We provide an empirical foundation to help inform volunteer programs for retirees.

Socioeconomic Disparity in Later-Year Group Trajectories of Depressive Symptoms: Role of Health and Social Engagement Change.

This study explored heterogeneous change patterns of South Korean older adults' depressive symptoms by poverty status, focusing on health status and social engagement changes. We used data from four waves (2006-2012) of the Korean Longitudinal Study of Aging (KLoSA). Our sample contained 2461 poor and 1668 non-poor individuals. All were 65 years old or older at baseline. We used latent class growth analysis to identify trajectory groups' depressive symptoms. Multinomial logistic regression was used to examine how a range of changes in health conditions and social engagement was associated with trajectories among poor and non-poor participants. Among the poor, five heterogeneous trajectories with clear patterns were identified: high-to-moderate, stable-high, slightly-increasing, steeply-increasing, and stable-low. Among non-poor, high-to-moderate, steeply-increasing, and stable-low groups were found. A decrease in health conditions was the most vulnerable subgroup's (steeply-increasing) primary risk factor. Poor older adults who reduced participation in, or decreased contact with, social networks were likely to belong to the steeply-increasing group. Our study provides impetus for organizational and/or environmental support systems to facilitate social engagement among poor older adults. Future research should examine whether the significance of social engagement among poor elders applies in less-developed and developed countries.