@article {11904, title = {Depressive symptoms in older adults with and without a history of incarceration: A matched pairs comparison.}, journal = {Aging \& Mental Health}, year = {Forthcoming}, abstract = {

OBJECTIVES: Previous research has found that many incarcerated individuals have mental health conditions and that incarcerated women may be at elevated risk. These individuals have been shown to experience mental health concerns shortly after their release, but little is known about their mental health later in life. This study compared depressive symptoms in older adults with and without a history of incarceration and examined the impact of gender on this relationship.

METHOD: Data from 160 pairs of adults aged 65 or older (82.5\% male, mean age = 73.4 years) who participated in the 2012 wave of the Health and Retirement Study (HRS) was utilized. Older adults with a history of incarceration were matched to those without based on age, gender, race, and education level. Depressive symptoms (CES-D) of older adults with and without a history of incarceration were compared using a repeated-measures ANOVA.

RESULTS: The main effect of incarceration history (=.001, =.07) and the interaction between incarceration history and gender (=.01, =.04) were significant. Follow-up analyses revealed that the difference between depressive symptoms for older women with and without a history of incarceration was significant (=.02, = 0.69), whereas the difference for older men was not significant (=.19, = 0.16).

CONCLUSIONS: Findings suggest older adults with a history of incarceration report more depressive symptoms than those without and that the effect is seen among older women. Negative effects of incarceration on mental health may therefore persist into later life, highlighting the importance of pre- and post-release mental health services.

}, keywords = {depression, former inmates, incarceration}, issn = {1364-6915}, doi = {10.1080/13607863.2021.1984392}, author = {Steigerwald, Victoria L and Rozek, David C and Daniel Paulson} } @article {13028, title = {PERCEIVED FINANCIAL VULNERABILITY, WEALTH, AND WEALTH CHANGE: THE HEALTH AND RETIREMENT STUDY}, journal = {Innovation in Aging}, volume = {6}, year = {2022}, pages = {854}, abstract = {Financial vulnerability among older adults is an escalating social concern given all too frequent financial exploitation of this population. The 6-item Perceived Financial Vulnerability (PFV) was derived from the 56-item Lichtenberg Financial Decision Rating Scale to examine awareness and psychological vulnerability regarding finances. It was included as an experimental module in the Health and Retirement Study (HRS) in 2018. Prior findings have identified significant associations of PFV with wealth, demographics, and health status. The goals of the current study were to examine the relationship between wealth, changes in wealth, and perceived financial vulnerability. The sample included 1156 respondents to the HRS. Respondents were 57.5\% female and 77.2\% Caucasian. Average age was 68.28 (SD = 10.74) and average years of education was 13.11 (SD = 2.88). The PFV demonstrated adequate internal consistency (α = .60). Total assets at baseline (2016) and change in total assets over two waves (2016 to 2018) were independently stratified into deciles and used as primary predictors of perceived financial vulnerability in 2018. A multiple linear regression model was conducted to examine these relationships. Consistent with previous findings, demographics (R2=0.04, F(5,1150)=10.07, p < .001) and baseline wealth (B= -0.20, SE=0.02, p < .001) predicted PFV scores. Subsequent addition of wealth change (B=-0.06, SE=0.02, p=.002) significantly contributed to overall variance accounted for (p < .01). Negative wealth change over two years and low baseline wealth related to higher PFV. These findings support the construct and the PFV measure as valid and informative.}, keywords = {financial vulnerability, Wealth}, doi = {10.1093/geroni/igac059.3059}, author = {Madison Maynard and Emily Flores and Daniel Paulson and Peter Lichtenberg} } @article {WAN2022107064, title = {Subjective markers of successful aging and change in Internet use among older adults: The distinctive role of subjective health}, journal = {Computers in Human Behavior}, volume = {127}, year = {2022}, pages = {107064}, abstract = {Lower rates of Internet adoption among older adults pose significant challenges in delivering important online services to older adults. Addressing the age-related digital divide requires determining factors that can influence Internet use in aging and may be targeted for intervention. Candidate factors include self-perceptions associated with successful aging, but prior research has not determined whether changes in self-perceptions are related to changes in Internet use within individuals. The present study examined the relationship between self-perception measures (subjective age, subjective health, and life satisfaction) and Internet use among older adults, using longitudinal data from the Health and Retirement Study. Results indicated a selectively robust relationship between Internet use and better subjective health among older Americans. Further, these relationships were not altered by changes in technology adoption over time. Finally, longitudinal data over eight years revealed that change in Internet use was selectively associated with changes in subjective health. Together, these results indicate that among self-perception measures of successful aging, subjective health has a robust relationship with both current Internet use and changes in Internet use over time among older Americans. Such findings suggest that effective interventions to increase digital technology utilization likely require accommodations for older adults with poor subjective health.}, keywords = {Internet use, Life Satisfaction, Self-perceptions, Subjective age, Subjective health}, issn = {0747-5632}, doi = {https://doi.org/10.1016/j.chb.2021.107064}, author = {Xiaoqing Wan and Nichole R. Lighthall and Daniel Paulson} } @article {10563, title = {The Benefit of Moderate Alcohol Use on Mood and Functional Ability in Later Life: Due to Beers or Frequent Cheers?}, journal = {Gerontologist}, volume = {60}, year = {2020}, month = {2020 01 24}, pages = {80-88}, abstract = {

BACKGROUND AND OBJECTIVES: Evidence relates moderate alcohol consumption in later life to fewer depressive symptoms and greater functional ability. This study evaluated social interaction as a mediator of these outcomes.

RESEARCH DESIGN AND METHODS: Data included older adults in the Health and Retirement Study. In Study 1, cross-sectional mediation analyses evaluated social interaction as a mechanism through which moderate alcohol use was related to decreased depressive symptomatology (Model 1; N = 2,294) and less functional limitation (Model 2; N = 2,357). In Study 2, longitudinal cross-lagged path analyses further evaluated the impact of moderate alcohol use and social interaction on future depressive symptoms and functional limitation.

RESULTS: In Study 1, results from Model 1 indicated that moderate alcohol use was associated with decreased depressive symptomatology indirectly via greater social interaction. In Model 2, moderate alcohol use was associated with less functional limitation indirectly via greater social interaction. In Study 2, significant indirect effects corroborated findings from Study 1. In Model 3, moderate alcohol use in 2012 inversely predicted depressive symptomatology in 2014 via greater levels of social interaction in 2012. In Model 4, moderate alcohol use in 2012 predicted less functional limitation in 2014 via greater social interaction in 2012.

DISCUSSION AND IMPLICATIONS: Social interaction is essential to the seemingly beneficial effect of moderate alcohol use on depressive symptomatology and functional ability. Clinically, this suggests caution in attributing health benefits to consumption of alcohol itself and identifies social interaction as a treatment target for improved health outcomes in later life.

}, keywords = {Alcohol Consumption}, issn = {1758-5341}, doi = {10.1093/geront/gny129}, author = {Rosanna G Scott and Wiener, Chelsea H and Daniel Paulson} } @article {11187, title = {Examining Health and Wealth Correlates of Perceived Financial Vulnerability: A Normative Study.}, journal = {Innovation in Aging}, volume = {4}, year = {2020}, abstract = {

Background and Objectives: Age-associated financial vulnerability was introduced because it was increasingly recognized that cognitively intact older adults experienced changes that rendered them financially vulnerable. In this study, we attempt to apply the construct of Age-Associated Financial Vulnerability to a measure of Perceived Financial Vulnerability and whether this perceived vulnerability is predicted by risk factors from the 4 categorical domains used to define Age-Associated Financial Vulnerability{\textquoteright}s impact.

Research Design and Methods: This study was part of the Health and Retirement Study (HRS) survey in 2018. The survey contained 7 experimental module items of Perceived Financial Vulnerability. One thousand three hundred fourteen participants completed the Perceived Financial Vulnerability measure. The sample was drawn from Waves 13 and 14 of the HRS (2016 and 2018, respectively). The measurement of Perceived Financial Vulnerability was developed on the basis of 7 questions assessing financial awareness and psychological vulnerability items regarding personal finance that were included in the 2018 HRS data collection. Predictors included measures of cognition, function/health, depression, and wealth. Predictor measures from 2016 were regressed on 2018 Perceived Financial Vulnerability scores.

Results: Six items of Perceived Financial Vulnerability had psychometric properties acceptable for a new measure. Responses revealed variability in Perceived Financial Vulnerability. Overall, 18\% of variance was accounted for and measures from cognition, depression, assets, and functional abilities were all unique and significant predictors.

Discussion and Implications: This study represents both a conceptual and empirical contribution to our understanding of older adult{\textquoteright}s perceptions of financial vulnerability. The high levels of Perceived Financial Vulnerability found in this normative sample underscore the importance of context in understanding people{\textquoteright}s economic behaviors. For instance, more than one half of the sample indicated that they wished they had someone to talk to about their finances. This desire to talk with others is normative and yet often underappreciated.

}, keywords = {Financial strain, Mental Health, Wealth}, issn = {2399-5300}, doi = {10.1093/geroni/igaa039}, author = {Peter A Lichtenberg and Daniel Paulson and Han, S Duke} } @article {9350, title = {Alcohol use and frailty risk among older adults over 12 years: The Health and Retirement Study.}, journal = {Clinical Gerontologist}, volume = {41}, year = {2018}, pages = {315-325}, abstract = {

OBJECTIVES: The primary goal was to examine the relationship between alcohol use and frailty, a variable characterizing late-life decline, in a national, longitudinal survey of older adults living in the United States.

METHODS: The sample drawn from the Health and Retirement Study included 9,499 stroke-free participants over age 65 in 2000. The sample was 59.1\% female, and had a mean age of 74.25~years (SD~=~6.99). Follow-up data was from 2004, 2008, and 2012. Frailty was defined phenotypically using the Paulson-Lichtenberg Frailty Index (PLFI). Alcohol use was measured via self-report. Control variables included age, race, education, socio-economic status (SES), depressive symptomatology, medical burden score, body mass index (BMI), and partner status. With abstinent participants as the reference group, logistic regressions were conducted to determine prevalent frailty at 2000, and Cox{\textquoteright}s proportional hazard models were utilized to determine time to incident frailty over a 12-year period.

RESULTS: Results revealed that age, depressive symptomatology, and medical burden score were significant positive correlates of prevalent and incident frailty (p~<~.05) for both males and females. Logistic regressions revealed that consumption of 1-7 alcoholic drinks per week was associated with reduced prevalent frailty (OR~=~.49, p~<~.001) for females. Survival analysis results reveal that compared with nondrinkers, males and females who reportedly consumed 1-7 drinks per week had a decreased probability of incident frailty (HR~=~.78-081, p~<~.05).

CONCLUSIONS: Findings suggest that moderate alcohol use confers reduced frailty risk for both older men and women. Future research should examine the mechanism(s) relating alcohol consumption and frailty.

CLINICAL IMPLICATIONS: Findings support extant literature suggesting some healthcare benefits may be associated with moderate drinking.

}, keywords = {Alcohol Consumption, Frailty, Risk Factors}, issn = {1545-2301}, doi = {10.1080/07317115.2017.1364681}, author = {Mona Shah and Daniel Paulson and Nguyen, Vu} } @article {9254, title = {Moderate alcohol use and apolipoprotein E-4 (ApoE-4): Independent effects on cognitive outcomes in later life.}, journal = {Journal of Clinical and Experimental Neuropsychology}, volume = {40}, year = {2018}, pages = {326-337}, abstract = {

OBJECTIVES: Substantive past research suggests that moderate alcohol use confers beneficial health outcomes. The study of moderate alcohol use and cognition has produced variable findings. The primary goal was to examine the relationship between alcohol use and cognitive aging over time (Experiment 1), in a demographically representative, longitudinal survey of older adults. Experiment 2 examined the hypothesis that apolipoprotein E-4 (ApoE-4) would moderate the relationship between moderate drinking and performance on cognitive domains.

METHOD: The sample was drawn from the Aging, Demographics, and Memory Study (ADAMS) supplement of the Health and Retirement Study (HRS) and included 856 participants over age 65 in 2001. Follow-up data were from 2002, 2006, and 2008. Alcohol use was measured via self-report. Control variables included gender, age, race, number of years of education, medical burden (total number of medical diseases), and marital status.

RESULTS: Results of Experiment 1 indicated that moderate alcohol use was significantly associated with better baseline functioning across cognitive measures (p~<=~.05), but had no significant effect on rate of change over time across cognitive domains. Results of Experiment 2 indicated that while ApoE-4 carriage did not moderate the relationship between alcohol use and cognitive performance, generally, both ApoE-4 and moderate alcohol use were significant predictors of cognitive performance.

CONCLUSIONS: Overall, findings from this study support past findings that moderate alcohol use is associated with better cognitive functioning among community-dwelling older adults, and these relative benefits appear to persist throughout later life. However, the role of individual differences on manifestation of benefit remain very poorly understood. Future research should further examine the respective roles of demographic differences associated with cognitive aging, genetic moderators, and the influence of social interaction.

}, keywords = {Alcohol Consumption, APoE4, Cognitive Ability}, issn = {1744-411X}, doi = {10.1080/13803395.2017.1343803}, author = {Herring, Danielle and Daniel Paulson} } @article {9156, title = {The relationship between moderate alcohol consumption, depressive symptomatology, and C-reactive protein: the Health and Retirement Study.}, journal = {International Journal of Geriatric Psychiatry}, volume = {33}, year = {2018}, pages = {316-324}, abstract = {

OBJECTIVE: Moderate alcohol use has been broadly associated with health benefits among older adults, including improved mood. Aims of this study were to evaluate the relationship of moderate alcohol use and depressive symptomatology over a period of eight years, and to examine inflammation, indicated by C-reactive protein (CRP), as one mechanism by which this relationship functions.

METHODS: The study included 3177 community-dwelling participants over the age of 65 in 2008 drawn from the Health and Retirement Study. Data from the 2006, 2008, 2012, and 2014 waves were used. Alcohol use was measured via self-report and was dichotomized as abstinent (0 drinks per week) and moderate (1-14 drinks per week). Inflammation was measured using CRP, which was collected using an enzyme-linked immunosorbent assay and provided in units of μg/mL. Control variables included gender, age, body mass index (BMI), and medical burden.

RESULTS: A latent growth curve model with full information maximum likelihood was used, with results revealing that moderate drinkers endorsed fewer depressive symptoms at baseline and a steeper rate of change over time. Abstinent respondents{\textquoteright} depressive symptomatology was characterized by a more linear change rate. Further, moderate drinkers had lower CRP levels suggesting that inflammation partially mediates the relationship between moderate alcohol use and depressive symptomatology.

CONCLUSIONS: Moderate alcohol use predicts fewer depressive symptoms among older adults. This relationship is partially moderated by CRP and is eroded by the passage of time. Future research should identify additional mechanisms relating alcohol to positive health outcomes and less depressive symptomatology. Copyright {\textcopyright} 2017 John Wiley \& Sons, Ltd.

}, keywords = {Alcohol Consumption, C-reactive protein, Depressive symptoms}, issn = {1099-1166}, doi = {10.1002/gps.4746}, author = {Daniel Paulson and Mona Shah and Herring, Danielle and Rosanna G Scott and Herrera, Manuel and Brush, David and Bassett, Rachel} } @article {8588, title = {C-reactive protein level partially mediates the relationship between moderate alcohol use and frailty: the Health and Retirement Study.}, journal = {Age Ageing}, volume = {45}, year = {2016}, month = {2016 11}, pages = {874-878}, abstract = {

BACKGROUND: frailty is an indicator of late-life decline marked by higher rates of disability and healthcare utilisation. Research has linked health benefits with moderate alcohol use, including frailty risk reduction. Past work suggests inflammation, measured by C-reactive protein (CRP), as one candidate mechanism for this effect.

OBJECTIVE: this study aims to elucidate a possible mechanism - CRP modulation - by which moderate alcohol consumption may protect against frailty.

METHODS: a cross-sectional study using data from the 2008 wave of the Health and Retirement Study (HRS) conducted by the University of Michigan. The HRS is a cohort study on health, retirement and aging on adults aged 50 and older living in the USA. A final sample of 3,229 stroke-free participants, over the age of 65 years and with complete data, was identified from the 2008 wave. Alcohol use was measured via self-report. Frailty was measured using the Paulson-Lichtenberg Frailty Index. CRP was collected through the HRS protocol.

RESULTS: results from structural equation modelling support the hypothesised model that moderate alcohol use is associated with less frailty and lower CRP levels. Furthermore, the indirect relationship from moderate alcohol use to frailty through CRP was statistically significant.

CONCLUSIONS: overall findings suggest that inflammation measured by CRP is one mechanism by which moderate alcohol use may confer protective effects for frailty. These findings inform future research relating alcohol use and frailty, and suggest inflammation as a possible mechanism in the relationship between moderate alcohol use and other beneficial health outcomes.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Aging, Alcohol Drinking, Biomarkers, C-reactive protein, Cross-Sectional Studies, Female, Frail Elderly, Frailty, Geriatric Assessment, Humans, Inflammation Mediators, Male, Protective factors, Risk Factors, United States}, issn = {1468-2834}, doi = {10.1093/ageing/afw103}, url = {http://ageing.oxfordjournals.org/content/early/2016/06/30/ageing.afw103.long}, author = {Mona Shah and Daniel Paulson} } @article {8344, title = {Psychological and Functional Vulnerability Predicts Fraud Cases in Older Adults: Results of a Longitudinal Study}, journal = {CLINICAL GERONTOLOGIST}, volume = {39}, year = {2016}, pages = {48}, publisher = {39}, abstract = {Using cross sectional data Psychological vulnerability was identified as a correlate of older adults being defrauded. We extend that research by examining fraud prevalence using longitudinal data from the Health and Retirement Study, and to identify the best predictors of fraud longitudinally across a 4-year time frame. Whereas reported fraud prevalence was 5.0 in a 5-year look-back period in 2008, it increased to 6.1 in 2012. The rate of new-incident fraud across only a 4-year look-back was 4.3 . Being younger-old, having a higher level of education, and having more depression significantly predicted the new cases of fraud reported in 2012. Psychological vulnerability was a potent longitudinal predictor of fraud, with the most vulnerable individuals being more than twice as likely to be defrauded. Results indicate that fraud victimization among older adults is rising, and that vulnerability variables, along with some demographic variables, predict new cases of fraud.}, keywords = {Health Conditions and Status, Net Worth and Assets, Public Policy}, author = {Peter A Lichtenberg and Sugarman, Michael A. and Daniel Paulson and Ficker, Lisa J. and Rahman-Filipiak, Annalise} } @article {8257, title = {The Paulson-Lichtenberg Frailty Index: evidence for a self-report measure of frailty.}, journal = {Aging Ment Health}, volume = {19}, year = {2015}, note = {Export Date: 20 January 2015 Article in Press}, month = {2015}, pages = {892-901}, publisher = {19}, abstract = {

OBJECTIVES: This study evaluates the Paulson-Lichtenberg Frailty Index (PLFI), a self-report measure that is based on Fried{\textquoteright}s well-established frailty phenotype. The PLFI is examined using longitudinal data from the Health and Retirement Study (HRS) database, for which it was developed.

METHODS: The sample was drawn from the HRS and included 8844 community-dwelling older adults. Frailty was measured using the PLFI{\textquoteright}s five-item frailty index (wasting, weakness, slowness, falls, and fatigue).

RESULTS: In comparison to intermediate-frail or non-frail respondents, frail respondents were found to be older, more medically compromised, and less independent for activities of daily living (ADLs) and instrumental activities of daily living (IADLs). On average, frail respondents reported worse self-rated health and had fewer years of education. Women, ethnic minorities, and those who were not partnered were also more likely to be frail. Over subsequent years, frail respondents were more likely to be hospitalized, report more loss of independence, and experience higher mortality rates.

CONCLUSIONS: The PLFI is a valid tool for assessing frailty in the HRS data set.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Aging, Fatigue, Female, Frail Elderly, Geriatric Assessment, Health Status, Health Surveys, Humans, Longitudinal Studies, Male, Self Report, Socioeconomic factors, Walking}, issn = {1364-6915}, doi = {10.1080/13607863.2014.986645}, author = {Daniel Paulson and Peter A Lichtenberg} } @article {8055, title = {Does brain reserve protect older women from vascular depression?}, journal = {The journals of gerontology. Series B, Psychological sciences and social sciences}, volume = {69}, year = {2014}, note = {Times Cited: 0}, pages = {157-67}, publisher = {69}, abstract = {OBJECTIVES: Brain reserve theory, typically discussed in relation to dementia, was examined with regard to late-life depression symptomatology and cerebrovascular burden (CVB) in older-old women. METHOD: It was predicted that in a 6-year longitudinal sample (Health and Retirement Study) of 1,355 stroke-free women aged 80 years and older, higher levels of depressive symptomatology (8-item Center for Epidemiologic Studies-Depression score) would be predicted by high CVB, less educational attainment, and the education CVB interaction after controlling for age and cognitive functioning (Telephone Interview for Cognitive Status). A latent growth curve model was used to identify differences in depression symptomatology at baseline and over time. Logistic regression analyses were used to predict clinically significant depressive symptomatology at each wave based on CVB, education, and the education CVB interaction. RESULTS: Results indicate that among older women, greater educational attainment predicted fewer depression symptoms at baseline, but this advantage was partially eroded over time. The education CVB interaction predicted clinically significant depressive symptoms at baseline when the benefits of education were most robust. DISCUSSION: Brain reserve, characterized by educational attainment, may counterbalance the effect of high CVB with respect to depressive symptoms, thereby preserving mood in late life. These findings support the application of brain reserve theory to late-life depression.}, keywords = {Demographics, Health Conditions and Status}, doi = {10.1093/geronb/gbt007}, author = {Daniel Paulson and Mary E Bowen and Peter A Lichtenberg} } @article {7864, title = {Is Psychological Vulnerability Related to the Experience of Fraud in Older Adults?}, journal = {Clinical Gerontologist}, volume = {36}, year = {2013}, note = {Times Cited: 0}, pages = {132-146}, publisher = {36}, abstract = {Financial exploitation, and particularly thefts and scams, are increasing at an alarming rate. In this study we (a) determined the national prevalence of older adults who report having been a victim of fraud, (b) created a population-based model for the prediction of fraud, and (c) examined how fraud is experienced by the most psychologically vulnerable older adults. The older adults studied were 4,400 participants in a Health and Retirement Study substudy, the 2008 Leave Behind Questionnaire. The prevalence of fraud across the previous 5 years was 4.5 . Among measures collected in 2002, age, education, and depression were significant predictors of fraud. Financial satisfaction and social-needs fulfillment were measured in 2008 and were significantly related to fraud above and beyond the 2002 predictors. Using depression and social-needs fulfillment to determine the most psychologically vulnerable older adults, we found that fraud prevalence was three times higher (14 ) among those with the highest depression and the lowest social-needs fulfillment than among the rest of the sample (4.1 ; 2 = 20.49; p .001). Clinical gerontologists and other professionals in the field need to be aware of their psychologically vulnerable clients{\textquoteright} heightened exposure to financial fraud.}, keywords = {Health Conditions and Status, Net Worth and Assets, Other, Public Policy}, doi = {10.1080/07317115.2012.749323}, author = {Peter A Lichtenberg and Stickney, Laurie and Daniel Paulson} } @mastersthesis {6047, title = {Vascular depression: An early indicator of decline}, volume = {Ph.D.}, year = {2013}, school = {Wayne State University}, address = {Detroit, MI}, abstract = {Women over the age of 80 represent a rapidly growing demographic group. While older women live longer than men, they do so with more years of disability and frailty. The emergence of geriatric disorders such as vascular disease, depression, frailty and cognitive decline in the aging US population place additional strain and expense on the already over-burdened public health care system. Meanwhile, integrated models of care are associated with preserved functional independence, reduced medical costs, and greater satisfaction for both health care providers and patients. Implementation of integrated care demands process-models of disease that contextualize symptoms within broader patterns of decline. This dissertation proposes a model representing a hypothesized late-life clinical trajectory following from high cerebrovascular burden. The hypothesized trajectory includes higher rates of depression (of vascular origin), cognitive decline, frailty and shortened remaining lifespan. Different facets of this model are tested in the four studies that comprise this dissertation. The sample was drawn from the Health and Retirement Study; a longitudinal, demographically-representative data sample of older adults in the United States. The sub-sample used in this dissertation included 1,368 stroke-free women over the age of 80 at baseline (1998). This sub-sample was followed for 10 years. The first study tested the hypotheses that high CVB predicts greater depression symptoms, and that brain reserve (i.e.: education) protects elders from developing depression symptoms. A latent growth curve was used to identify differences in depression at baseline and over time based on CVB, cognitive functioning, education and age. Results indicate that at any level of CVB, older women with more education experienced fewer depression symptoms. Results support brain reserve theory and the vascular depression hypothesis. These results suggest that having greater education may postpone development of clinically-significant depressive symptoms resulting from high CVB, thereby preserving mood in late life. The second study tested the hypothesis that variables representing the three domains of Rowe and Kahn{\textquoteright}s Healthy Aging framework predict longevity in this sample of stroke-free women over the age of 80. The "avoidance of disease" domain was characterized in this paper as CVB - chronic comorbidites that slowly erode adaptive functioning over many years. The "sustained engagement" criteria was conceptualized as depression, and deficits in the "preservation of cognitive and physical functioning" domain were identified as rapid cognitive decline. We found that at most waves (2002, 2004, 2006) mortality was predicted by CVB, depressive symptoms and cognitive drop measured 2 years prior. CVB and depressive symptoms at the 2000 wave predicted mortality at 6 and 8-years. Older women with the greatest longevity had low CVB, robust cognitive functioning and few depression symptoms, supporting successful aging theory and terminal cognitive drop. The third study tested the hypothesis that vascular depression is a prodrome for frailty. At baseline, the prevalence of frailty was 31.5\%. Over a 4-years the incidence of frailty was 31.8\%. After controlling for age, education, ADL and IADL functioning, arthritis, pulmonary disorders, cancer, and self-rated health, vascular depression significantly predicted new cases of frailty. These findings suggest that vascular depression is a prodrome for frailty. The fourth study tested the proposed model using structural modeling. The model demonstrated good overall fit and a significant indirect pathway from vascular depression to mortality through frailty was identified. Results support the proposed theoretical framework and suggest that vascular depression symptoms are associated with a clinical trajectory including more frailty symptoms and shorted remaining lifespan. This finding supports integrated care for geriatric p tients and suggests specific targets for intervention with older patients experiencing vascular depressi n symptoms.}, keywords = {Health Conditions and Status, Healthcare, Women and Minorities}, url = {https://digitalcommons.wayne.edu/oa_dissertations/737/}, author = {Daniel Paulson} } @article {7741, title = {Vascular depression: an early warning sign of frailty.}, journal = {Aging Ment Health}, volume = {17}, year = {2013}, month = {2013}, pages = {85-93}, abstract = {

OBJECTIVES: Frailty is a common geriatric disorder associated with activities of daily living (ADL) impairment, hospitalization, and death. Phenomenological evidence suggests that late-life depression (Katz, 2004 ), particularly vascular depression, may be a risk factor for frailty. This study tests that hypothesis.

METHODS: We identified a sample of stroke-free women over the age of 80 from the Health and Retirement Survey. The sample included 984 respondents in 2000 (incidence sample). Of these, 459 were non-frail at baseline and still alive in 2004 (prevalence sample). Frail respondents experienced at least three of the following: wasting, exhaustion, weakness, slowness, and falls. Vascular depression was represented using two dummy variables. The first represented respondents with either high cerebrovascular burden (CVB; at least two cerebrovascular risk factors) or probable depression (score >=3 on the 8-item Center for Epidemiological Studies Depression Scale (CES-D)), and the second represented respondents with both high CVB and probable depression.

RESULTS: At baseline, the prevalence of frailty was 31.5\%. Over four years the incidence of frailty was 31.8\%. After controlling for age, education, ADL and IADL disability, arthritis, pulmonary disorders, cancer, and self-rated health, respondents with either high CVB or probable depression were more likely to be frail at baseline, and those with both were at even higher risk. Of those who were not frail at the 2000 wave, respondents who reported both high CVB and probable depression were more likely to become frail by 2004.

DISCUSSION: These findings suggest that vascular depression is a prodrome for frailty.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Aging, Cerebrovascular Disorders, depression, Disabled Persons, Female, Follow-Up Studies, Frail Elderly, Geriatric Assessment, Health Status, Humans, Incidence, Logistic Models, Male, Prevalence, Psychiatric Status Rating Scales, Risk Factors, Socioeconomic factors, United States}, issn = {1364-6915}, doi = {10.1080/13607863.2012.692767}, author = {Daniel Paulson and Peter A Lichtenberg} }