%0 Journal Article %J Ageing and Society %D 2023 %T Adult children's education and trajectories of episodic memory among older parents in the United States of America %A Pai, Manacy %A Lu, Wentian %A Xue, Baowen %K Adult children %K Cognition %K Education %K Marital Status %K socioeconomic status %X The purpose of this study is to assess the relationship between adult children's education and older parents’ cognitive health, and the extent to which this relationship is moderated by parents’ own socio-economic and marital statuses. Data using Waves 5 (2000) to 13 (2016) are drawn from the Health and Retirement Study (HRS), a nationally representative panel survey of individuals age 50 and above in the United States of America (USA). Older parents’ cognitive functioning is measured using episodic memory from Waves 5–13. Adult children's education is measured using years of schooling, on average, for all adult children of a respondent. Analyses based on multilevel linear growth curve modelling reveal that parents with well-educated adult children report higher memory score over time compared to their counterparts whose children are not as well-educated. We also find that the positive effect of children's education on parents’ cognitive health is moderated by parents’ own education, though not by their income, occupation or marital status. Our work contributes to the growing body of research on the ‘upward’ flow of resources model that assesses the ways in which personal and social assets of the younger generation shape the health and wellbeing of the older generation. Our findings are particularly relevant to the USA given the enduring linkage between socio-economic status and health, and the limited social and economic protection for those of lower social status. %B Ageing and Society %G eng %R 10.1017/S0144686X21000775 %0 Journal Article %J Arch Gerontol Geriatr %D 2023 %T The association between subjective cognitive decline and trajectories of objective cognitive decline: Do social relationships matter? %A Pai, Manacy %A Lu, Wentian %A Chen, Miaoqi %A Xue, Baowen %K Cognition %K Cognitive Dysfunction %K Humans %K Interpersonal Relations %K Memory, Episodic %K Neuropsychological tests %X

OBJECTIVES: We examine the association between subjective cognitive decline (SCD) and the trajectories of objective cognitive decline (OCD); and the extent to which this association is moderated by social relationships.

METHODS: Data come from waves 10 (2010) through 14 (2018) of the Health and Retirement Study, a nationally representative panel survey of individuals aged 50 and above in the United States. OCD is measured using episodic memory, and overall cognition. SCD is assessed using a baseline measure of self-rated memory. Social relationships are measured by social network size and perceived positive and negative social support. Growth curve models estimate the longitudinal link between SCD and subsequent OCD trajectories and the interactions between SCD and social relationship variables on OCD.

RESULTS: SCD is associated with subsequent OCD. A wider social network and lower perceived negative support are linked to slower decline in memory, and overall cognition. None of the social relationship variables, however, moderate the link between SCD and future OCD.

CONCLUSION: Knowing that SCD is linked to subsequent OCD is useful because at SCD stage, deficits are more manageable relative to those at subsequent stages of OCD. Future work on SCD and OCD should consider additional dimensions of social relationships.

%B Arch Gerontol Geriatr %V 111 %P 104992 %G eng %R 10.1016/j.archger.2023.104992 %0 Journal Article %J J Affect Disord %D 2023 %T Bidirectional association between depressive symptoms and mild cognitive impairment over 20 years: Evidence from the health and retirement study in the United States. %A Guo, Yunyun %A Pai, Manacy %A Xue, Baowen %A Lu, Wentian %X

BACKGROUND: Research examining the association between depressive symptoms and mild cognitive impairment (MCI) has yielded conflicting results. This study aimed to examine the bidirectional association between depressive symptoms and MCI, and the extent to which this bidirectional association is moderated by gender and education.

METHODS: Data come from the US Health and Retirement Study over a 20-year period (older adults aged ≥50 years). Competing-risks regression is employed to examine the association between baseline high-risk depressive symptoms and subsequent MCI (N = 9317), and baseline MCI and subsequent high-risk depressive symptoms (N = 9428). Interactions of baseline exposures with gender and education are tested.

RESULTS: After full adjustment, baseline high-risk depressive symptoms were significantly associated with subsequent MCI (SHR = 1.20, 95%CI 1.08-1.34). Participants with baseline MCI are more likely to develop subsequent high-risk depressive symptoms than those without baseline MCI (SHR = 1.16, 95%CI 1.01-1.33). Although gender and education are risk factors for subsequent depression and MCI, neither moderates the bidirectional association.

LIMITATIONS: Items used to construct the composite cognitive measure are limited; selection bias due to missing data; and residual confounding.

CONCLUSIONS: Our study found a bidirectional association between depressive symptoms and MCI. High-risk depressive symptoms are related to a higher risk of subsequent MCI; and MCI predicts subsequent high-risk depression. Though neither gender nor education moderated the bidirectional association, public health interventions crafted to reduce the risk of depression and MCI should pivot attention to older women and those with less formal education.

%B J Affect Disord %G eng %R 10.1016/j.jad.2023.06.046 %0 Journal Article %J Journal of Affective Disorders %D 2021 %T Do depressive symptoms link chronic diseases to cognition among older adults? Evidence from the Health and Retirement Study in the United States. %A Lu, Wentian %A Pai, Manacy %A Shaun Scholes %A Xue, Baowen %K Chronic condition %K cognitive aging %K depression %K Psychological condition %X

BACKGROUND: Few studies have assessed psychological pathways that connect the association between non-psychotropic chronic disease and cognition. We assessed the extent to which the association between the two was mediated by depressive symptoms in older adults.

METHODS: Data came from waves 10-13 (2010-2016) of the Health and Retirement Study in the United States (7,651 men and 10,248 women). Multilevel path analysis, allowing for random intercepts and slopes, was employed to estimate the extent to which depressive symptoms mediated the total effect of a chronic disease on cognition.

RESULTS: We found that the presence of stroke, high blood pressure, diabetes, heart problems, and comorbidity, in both men and women, and lung disease in women, was associated with lower levels of cognition. The total effects of chronic diseases on cognition were partially mediated through depressive symptoms. Depressive symptoms mediated approximately 19%-39% and 23%-54% of the total effects of chronic diseases on cognition in men and women, respectively.

LIMITATIONS: We relied on self-reported diagnoses of diseases and depressive symptoms. Our use of a multilevel path analysis with random slopes precluded the inclusion of binary/categorical dependent variables, and the estimation of standardized beta values.

CONCLUSIONS: To understand the cognitive challenges that chronically ill older adults face, practitioners and policymakers should consider not just the direct symptoms related to chronic diseases, but also the often overlooked psychological conditions faced by older adults.

%B Journal of Affective Disorders %V 294 %P 357-365 %G eng %R 10.1016/j.jad.2021.07.012 %0 Journal Article %J Occupational and Environmental Medicine %D 2018 %T Occupational and educational inequalities in exit from employment at older ages: evidence from seven prospective cohorts %A Carr, Ewan %A Fleischmann, Maria %A Goldberg, Marcel %A Kuh, Diana %A Murray, Emily T %A Stafford, Mai %A Stansfeld, Stephen %A Vahtera, Jussi %A Xue, Baowen %A Zaninotto, Paola %A Zins, Marie %A Head, Jenny %K Education %K Employment and Labor Force %K Europe %K Health Disparities %K Work %X Objectives Past studies have identified socioeconomic inequalities in the timing and route of labour market exit at older ages. However, few studies have compared these trends cross-nationally and existing evidence focuses on specific institutional outcomes (such as disability pension and sickness absence) in Nordic countries. We examined differences by education level and occupational grade in the risks of work exit and health-related work exit. Methods Prospective longitudinal data were drawn from seven studies (n=99 164). Participants were in paid work at least once around age 50. Labour market exit was derived based on reductions in working hours, changes in self-reported employment status or from administrative records. Health-related exit was ascertained by receipt of health-related benefit or pension or from the reported reason for stopping work. Cox regression models were estimated for each study, adjusted for baseline self-rated health and birth cohort. Results There were 50 003 work exits during follow-up, of which an average of 14% (range 2-32%) were health related. Low level education and low occupational grade were associated with increased risks of health-related exit in most studies. Low level education and occupational grade were also associated with an increased risk of any exit from work, although with less consistency across studies. Conclusions Workers with low socioeconomic position have an increased risk of health-related exit from employment. Policies that extend working life may disadvantage such workers disproportionally, especially where institutional support for those exiting due to poor health is minimal. %B Occupational and Environmental Medicine %V 75 %P 369 - 377 %8 Dec-05-2018 %G eng %U http://oem.bmj.com/content/75/5/369 %N 5 %! Occup Environ Med %R 10.1136/oemed-2017-10461910.1136/oemed-2017-104619.supp1