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.

Biomarkers of chronic inflammation and cognitive decline: A prospective observational study.

We sought to determine whether the biomarkers of chronic inflammation predict cognitive decline in a prospective observational study. We measured baseline serum soluble urokinase plasminogen activator receptor (suPAR) and high sensitivity C-reactive protein (hs-CRP) levels in 282 participants of the University of Michigan Memory and Aging Project. Cognitive function was measured using the Montreal Cognitive Assessment (MoCA) and the Clinical Dementia Rating (CDR) scale for up to five time points. SuPAR and hs-CRP levels were not significantly higher in participants with mild cognitive impairment (n = 97) or dementia (n = 59), compared to those with normal cognitive function (n = 126). Overall, 14% of participants experienced significant cognitive decline over the study period. The change in MoCA or CDR scores over time did not differ significantly according to baseline suPAR or hs-CRP levels. Chronic systemic inflammation, as measured by serum suPAR or hs-CRP levels, is unlikely to contribute significantly to cognitive decline.

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).

Use of Caregiving Support Services Among Diverse Dementia Caregivers by Geographic Context.

BACKGROUND AND OBJECTIVES: Little is known about how race/ethnicity and geographic context relate to support service use among dementia caregivers. Our objectives were to investigate (a) whether the use of at least one formal caregiving service-support groups, respite care, and training-differed by race/ethnicity and across metro and nonmetro areas; and (b) whether predisposing, enabling, and need characteristics influenced support service use by race/ethnicity. RESEARCH DESIGN AND METHODS: Data were analyzed from a sample of primary caregivers of care recipients aged 65 years or older with probable dementia (n = 482) in the 2017 National Health and Aging Trends Study and National Study of Caregiving. We calculated weighted prevalence estimates and then used the Hosmer-Lemeshow goodness of fit statistic to find the best-fitting logistic regression models. RESULTS: Among minority dementia caregivers, support service use was higher in metro than nonmetro areas (35% and 15%); the trend was reversed for non-Hispanic White caregivers (47% nonmetro and 29% metro). The best-fitting regression models included predisposing, enabling, and need factors for both minority and non-Hispanic White caregivers. Younger age and more disagreement within the family were consistently associated with more service use in both groups. Among minority caregivers, better caregiver and care recipient health were associated with using support services. Among non-Hispanic White caregivers, nonmetro geographic context and caregiving interfering with valued activities were associated with using support services. DISCUSSION AND IMPLICATIONS: Geographic context differently affected support service use and the influence of predisposing, enabling, and need factors varied by race/ethnicity.

Rural-Urban Health Care Cost Differences Among Latinx Adults With and Without Dementia in the United States.

OBJECTIVES: To compare rural-urban health care costs among Latinx adults ages 51+ and examine variations by dementia status. METHODS: Data are from the Health and Retirement Study (2006-2018 waves; n = 15,567). We inflation-adjusted all health care costs using the 2021 consumer price index. Geographic context and dementia status were the main exposure variables. We applied multivariate two-part generalized linear models and adjusted for sociodemographic and health characteristics. RESULTS: Rural residents had higher total health care costs, regardless of dementia status. Total health care costs were $850 higher in rural ($2,640) compared to urban ($1,789) areas (p < .001). Out-of-pocket costs were $870 higher in rural ($2,677) compared to urban ($1,806) areas (p < .001). Dementia status was not an effect modifier. DISCUSSION: Health care costs are disproportionately higher among Latinx rural, relative to urban, residents. Addressing health care costs among Latinx rural residents is a public health priority.

Dementia Caregiving Experiences and Health Across Geographic Contexts by Race and Ethnicity.

OBJECTIVES: Few studies have examined how the intersectionality of geographic context and race/ethnicity influences dementia caregiving. Our objectives were to determine whether caregiver experiences and health (a) differed across metro and nonmetro areas and (b) differed by caregiver race/ethnicity and geography. METHODS: We used data from the 2017 National Health and Aging Trends Study and National Study of Caregiving. The sample included caregivers (n = 808) of care recipients ages 65 and older with "probable" dementia (n = 482). The geographic context was defined as the care recipient's residence in metro or nonmetro counties. Outcomes included caregiving experiences (care situation, burden, and gains) and health (self-rated anxiety, depression symptoms, and chronic health conditions). RESULTS: Bivariate analyses indicated that nonmetro dementia caregivers were less racially/ethnically diverse (82.7% White, non-Hispanic) and more were spouses/partners (20.2%) than their metro counterparts (66.6% White, non-Hispanic; 13.3% spouses/partners). Among racial/ethnic minority dementia caregivers, nonmetro context was associated with more chronic conditions (p < .01), providing less care (p < .01), and not coresiding with care recipients (p < .001). Multivariate analyses demonstrated that nonmetro minority dementia caregivers had 3.11 times higher odds (95% confidence interval [CI] = 1.11-9.00) of reporting anxiety in comparison to metro minority dementia caregivers. DISCUSSION: Geographic context shapes dementia caregiving experiences and caregiver health differently across racial/ethnic groups. Findings are consistent with previous studies that have shown that feelings of uncertainty, helplessness, guilt, and distress are more prevalent among people providing caregiving from a distance. Despite higher rates of dementia and dementia-related mortality in nonmetro areas, findings suggest both positive and negative aspects of caregiving among White and racial/ethnic minority caregivers.

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.

Functional Limitations and Perceived Neighborhood Walkability Among Urban Dwelling Older Adults.

Older adults with functional limitations (FLs) often experience obstacles to walking. Although health promotion programs targeting physical activity are available in lower-income areas, few studies have compared the walking experiences of older adults who have FLs with those who do not in the community. The purpose of this cross-sectional survey was to compare perceptions of neighborhood walkability among older adults living in lower-income communities with and without FLs. Participants (N = 132) were recruited in 2018 at regional health clinics in Flint, Michigan. To be eligible, participants had to be 65 years of age or older, report no cognitive decline, and be Flint residents. Of the 132 participants, the mean age was 69.74 (SD = 4.97). The majority were female (66%); African American (77%); single, divorced, or widowed (72%); educated below the General Education Development level (57%), and had a FL (67%). Older adults with FLs were significantly (p < 0.05) less likely than those without to visit many places within walking distance, to have well-lit neighborhoods at night, and to reside in neighborhoods where sidewalks were separated from the road and traffic. Multiple regression analyses revealed that having a FL was associated with poorer neighborhood perceptions of mixed-land-use (b = -0.19, p < 0.05) and more walking hazards (b = -0.26, p < 0.05). Findings suggest that a FL is associated with perceptions of walkability. It is essential to develop disability-friendly support systems and accommodations to encourage walking in lower-income communities.

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 impact of region and urbanicity on the discrimination-cognitive health link among older Blacks.

Little research has examined how the link between discrimination and cognitive health varies by where people live. This study investigates how living in non-urban versus urban areas in different regions in the United States moderates the discrimination-cognitive health link among older non-Hispanic Blacks. Data are from the 2012 and 2014 waves of the Health and Retirement Study (HRS; N=2,347). Regression analyses indicate that experiencing more everyday discrimination is significantly associated with lower episodic memory when living in urban areas. Among non-Hispanic Blacks, the discrimination-episodic memory link does not significantly vary across U.S. regional contexts. Findings highlight variation in the association between everyday discrimination and cognitive health by where older non-Hispanic Blacks live. Results suggest the importance of socio-environmental factors in shaping how stressful experiences such as discrimination are linked to cognitive health in later life.

Towards bridging the grey digital divide: changes in internet access and its predictors from 2002 to 2014 in Germany.

The internet is an indispensable aspect of modern society. It facilitates long distance communication, access to information, health care interventions, as well as multiple opportunities for social participation. Despite increasing pervasiveness of this technology, persistent inequalities exist in who has access to the internet. In particular, older adults lag behind in having internet access, thus putting them at risk for social exclusion. In order to gain a better understanding about the determinants of this grey digital divide, the current study contrasts influencing factors of internet access, comparing samples from 2002 to 2014 across age groups (40 to 54 years, 55 to 69 years and 70 to 85 years) using data from the German Ageing Survey (DEAS). Logistic regression confirmed that the likelihood of having internet access was lower with higher age at both time points. However, the percentages of people with internet access grew primarily in the middle and older age groups between 2002 and 2014. Furthermore, being male and having a higher education were both associated with greater odds of internet access. However, gender and education differences in internet access were significantly less pronounced in 2014 in contrast to 2002. Finally, both greater income and cognitive ability were associated with greater odds of internet access, while providing care for a grandchild was significantly associated with internet access only among the oldest age group. In an attempt towards bridging the grey digital divide, the current study serves as a basis for identifying groups mostly affected by this increasingly important form of social inequality.

A Framework for Aging-Friendly Services and Supports in the Age of COVID-19.

COVID-19 has revealed gaps in services and supports for older adults, even as needs for health and social services have dramatically increased and may produce a cascade of disability after the pandemic subsides. In this essay, we discuss the perfect storm of individual and environmental risk factors, including deconditioning, reductions in formal and informal care support, and social isolation. We then evaluate opportunities that have arisen for strengthening person-centered services and supports for older adults, through in-home acute and primary medical care, aggressive use of video telehealth and social interaction, and implementation of volunteer or paid intergenerational service.

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.

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.

Multiple Chronic Conditions in Spousal Caregivers of Older Adults With Functional Disability: Associations With Caregiving Difficulties and Gains.

OBJECTIVES: Multiple chronic conditions (MCCs) are common and have harmful consequences in later life. Along with managing their own health, many aging adults care for an impaired partner. Spousal caregiving may be more stressful when caregivers have MCCs, particularly those involving complex management. Yet, little is known about combinations of conditions that are most consequential for caregiving outcomes. METHOD: Using a U.S. sample of 359 spousal caregivers and care recipients from the 2011 National Aging Trends Study and National Study of Caregiving, we examined three categories of MCCs based on similarity of management strategies (concordant only, discordant only, and both concordant and discordant) and their associations with caregiving difficulties and gains. We also considered gender differences. RESULTS: Relative to caregivers without MCCs, caregivers with discordant MCCs reported fewer gains, whereas caregivers with both concordant and discordant MCCs reported greater emotional and physical difficulties. Wives with discordant MCCs only reported a trend for greater physical difficulties. Caregivers with concordant MCCs did not report more difficulties or gains. DISCUSSION: Spousal caregivers with MCCs involving discordant management strategies appear to be at risk for adverse care-related outcomes and may benefit from support in maintaining their own health as well as their caregiving responsibilities.

Convoys of social relations: Cohort similarities and differences over 25 years.

Longer life expectancies and declining fertility rates suggest changes in connectedness among older adults. This study examines cohort patterns in the links between age and social relations by testing the Convoy Model of Social Relations among 2 adult cohorts in 1980 and 2005. We hypothesize that despite societal changes, connectedness remains fundamental in later life. The data are drawn from a regionally representative sample (N = 543) aged 50 to 100 collected in 2005 and a nationally representative sample (N = 718) aged 50 to 95 collected in 1980. We use multilevel-modeling to update the preliminary examination of how network characteristics vary by age and emotional closeness (Antonucci & Akiyama, 1987) with data collected 25 years later. Findings indicate that network size, gender composition, and years known were similar in both cohorts. Changes are also evident. In 2005, network members were older, had more frequent contact, and lived closer to their network members than in 1980. There was 1 cohort difference in network composition, the proportion of other family was smaller in 2005 compared with 1980. Finally, cohorts differed in the effects of age (e.g., on contact frequency), closeness (e.g., on network size), and Age × Closeness interactions (e.g., on sibling composition). In sum, overall patterns of network structure and composition are largely similar in the 2 cohorts. The effects of age and emotional closeness were largely consistent over 25 years. Although caution is warranted, these findings provide continued support for the importance of close relations in later life across historical periods. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Social Networks and Physical Activity in Senior Housing: A Pilot Feasibility Study.

Objective: Only 16% of people aged >65 years engage in recommended levels of physical activity, putting a vast majority at risk for multiple chronic conditions including heart disease. Physical activity is even lower among older adults with fewer economic resources. Research is needed to develop context-specific approaches to pair with physical activity interventions to increase effectiveness. In this pilot study, we examine social ties and physical activity levels of older adults living in a US Department of Housing and Urban Development subsidized senior housing community to test feasibility of a social network-based approach to physical activity interventions. This study is grounded in Social Contagion Theory and the Convoy Model of Social Relations, which argue health and health-related behaviors are facilitated through network ties. Methods: Data were collected through face-to-face interviews conducted over the course of three months (September-November 2018) with 46 residents living in a low-income senior housing community in southeast Michigan. Residents were asked about physical activity, people they know in the community, and their close social network composition. Results: Residents reported knowing, on average, six other residents and approximately 28% of those in their close networks were also residents. Sociocentric network analysis identified two socially engaged (known by seven or more other residents) physically active residents, whereas ego-centric analysis identified four (60% or more of their network comprised residents). Conclusions: This study demonstrates potential feasibility of a strategic partnership that involves pairing social resources with physical activity interventions in affordable senior housing. Multiple approaches, which need to be evaluated, exist to identify socially engaged residents.