Working memory in older adults declines with age, but is modulated by sex and education

Working memory (WM), which underlies the temporary storage and manipulation of information, is critical for multiple aspects of cognition and everyday life. Nevertheless, research examining WM specifically in older adults remains limited, despite the global rapid increase in human life expectancy. We examined WM in a large sample (N=754) of healthy older adults (aged 58-89) in a non-Western population (Chinese speakers) in Taiwan, on a digit n-back task. We tested the influence not only of age itself and of load (1-back vs. 2-back), but also effects of both sex and education, which have been shown to modulate WM abilities. Mixed-effects regression revealed that, within older adulthood, age negatively impacted WM abilities (with linear, not nonlinear, effects), as did load (worse performance at 2-back). In contrast, education level was positively associated with WM. Moreover, both age and education interacted with sex. With increasing age, males showed a steeper WM decline than females; with increasing education, females showed greater WM gains than males. Together with other findings, the evidence suggests that age, sex, and education all impact WM in older adults, but interact in particular ways. The results have both basic research and translational implications, and are consistent with particular benefits from increased education for women

Socioeconomic Status and Biological Markers of Health: An Examination of Adults in the United States and Taiwan

Abstract Objective:The study documents whether socioeconomic status (SES) differentials in biological risk are more widely observed and larger in the United States than Taiwan. Method: Data come from the Social Environment and Biomarkers of Aging Study in Taiwan and the Midlife in the United States study. We use regression analyses to test whether four summary measures of biological risk are significantly related to categorical measures of education, income, and subjective social status among four country-sex-specific subgroups. Results: Physiological dysregulation is significantly, negatively related to SES in both the United States and Taiwan, especially for males. The prevalence and magnitude of the relationships are similar in the two countries: 12 of 24 possible SES-biological summary score relationships are significant in the United States and 11 of 24 are significant in Taiwan. Discussion: Overall, SES differentials in biological risk do no

Microbial−mammalian cometabolites dominate the age-associated urinary metabolic phenotype in Taiwanese and American populations

Understanding the metabolic processes associated with aging is key to developing effective management and treatment strategies for age-related diseases. We investigated the metabolic profiles associated with age in a Taiwanese and an American population. 1H NMR spectral profiles were generated for urine specimens collected from the Taiwanese Social Environment and Biomarkers of Aging Study (SEBAS; n = 857; age 54–91 years) and the Mid-Life in the USA study (MIDUS II; n = 1148; age 35–86 years). Multivariate and univariate linear projection methods revealed some common age-related characteristics in urinary metabolite profiles in the American and Taiwanese populations, as well as some distinctive features. In both cases, two metabolites—4-cresyl sulfate (4CS) and phenylacetylglutamine (PAG)—were positively associated with age. In addition, creatine and β-hydroxy-β-methylbutyrate (HMB) were negatively correlated with age in both populations (p < 4 × 10–6). These age-associated gradients in creatine and HMB reflect decreasing muscle mass with age. The systematic increase in PAG and 4CS was confirmed using ultraperformance liquid chromatography–mass spectrometry (UPLC–MS). Both are products of concerted microbial–mammalian host cometabolism and indicate an age-related association with the balance of host–microbiome metabolism

Quantifying the Value of Biomarkers for Predicting Mortality

Purpose—In light of widespread interest in the prognostic value of biomarkers, we apply three discrimination measures to evaluate the incremental value of biomarkers –beyond self-reported measures – for predicting all-cause mortality. We assess whether all three measures –AUC, NRI(>0), and IDI – lead to the same conclusions. Methods—We use longitudinal data from a nationally representative sample of older Taiwanese (n = 639, aged 54+ in 2000, examined in 2000 and 2006, with mortality follow-up through 2011). We estimate age-specific mortality using a Gompertz hazard model. Results—The broad conclusions are consistent across the three discrimination measures and support the inclusion of biomarkers, particularly inflammatory markers, in household surveys. Although the rank ordering of individual biomarkers varies across discrimination measures, the following is true for all three: interleukin-6 is the strongest predictor, the other three inflammatory markers make the top 10, and homocysteine ranks second or third. Conclusions—The consistency of most of our findings across metrics should provide comfort to researchers using discrimination measures to evaluate the prognostic value of biomarkers. However, because the degree of consistency varies with the level of detail inherent in the research question, we recommend that researchers confirm results with multiple discrimination measures

Is the Pain killing you? Could Pain interference be a warning signal for midlife mortality?

Although prior studies have documented an association between various measures of pain and mortality, none of those studies has evaluated whether the association between pain and mortality varies significantly by age. We suspect that pain—particularly pain that interferes with the ability to lead a normal life—could be an early warning sign that may portend increased risk of physical impairment and mortality later in life. In this paper, we investigated whether pain was associated with increased mortality risk, particularly in midlife. Data came from the Midlife in the US study, which sampled non-institutionalized, English-speaking adults aged 25–74 in the contiguous United States in 1995-96. Our analysis included 4041 respondents who completed a follow-up self-administered questionnaire in 2004-05, 2703 of whom completed another self-administered questionnaire in 2013-14. We modeled mortality through December 31, 2021. In demographic-adjusted models, pain interference was more strongly associated with mortality than other pain measures, and the association was stronger at younger ages. The hazard ratio for pain interference declined from 1.39 per SD (95% CI 1.26–1.54) at age 60 to 1.14 (95% CI 1.04–1.24) at age 90. Although potential confounders accounted for more than 60% of the association with premature mortality, pain interference remained significantly associated with increased mortality rates (HR = 1.13 at age 60, 95% CI 1.02–1.26). We found no evidence that the association between pain and mortality was driven by cancer. If anything, pain interference was more strongly associated with cardiovascular than cancer mortality. At the oldest ages, physical function is likely to be a better predictor of mortality than pain. Yet, pain interference may be a useful warning sign at younger ages, when there are fewer physical limitations and mortality rates are low. It may be particularly helpful in identifying risk of premature mortality in midlife, before the emergence of severe physical limitations

Evaluation of midwifery care: Results from a survey in rural Guatemala

Abstract In an effort to reduce infant and maternal morbidity and mortality in developing countries, the World Health Organization has promoted the training of traditional birth attendants (midwives) and their incorporation into the formal health care system. In this paper, we examine several aspects of the integration of traditional and biomedical maternity care that are likely to reflect the quality of care received by Guatemalan women. Specifically, we examine the extent to which women combine traditional and biomedical pregnancy care, the frequency with which midwives refer women to biomedical providers, the content and quality of care offered by midwives, and the effects of midwife training programs on referral practices and quality of care. The analysis is based on data from the 1995 Guatemalan Survey of Family Health. The results offer a mixed assessment of the efficacy of midwife training programs. For example, although trained midwives are much more likely than other midwives to refer their clients to biomedical providers, most pregnant women do not see a biomedical provider, and the quality of midwife care, as defined and measured in this study, is similar between trained and untrained midwives.

Evaluation of midwifery care: results from a survey in rural Guatemala

In an effort to reduce infant and maternal morbidity and mortality in developing countries, the World Health Organization has promoted the training of traditional birth attendants (midwives) and their incorporation into the formal health care system. In this paper, we examine several aspects of the integration of traditional and biomedical maternity care that are likely to reflect the quality of care received by Guatemalan women. Specifically, we examine the extent to which women combine traditional and biomedical pregnancy care, the frequency with which midwives refer women to biomedical providers, the content and quality of care offered by midwives, and the effects of midwife training programs on referral practices and quality of care. The analysis is based on data from the 1995 Guatemalan Survey of Family Health. The results offer a mixed assessment of the efficacy of midwife training programs. For example, although trained midwives are much more likely than other midwives to refer their clients to biomedical providers, most pregnant women do not see a biomedical provider, and the quality of midwife care, as defined and measured in this study, is similar between trained and untrained midwives.Pregnancy Prenatal care Birth Midwifery Traditional birth attendant Guatemala

Estimating the impact of drug use on US mortality, 1999-2016.

The impact of rising drug use on US mortality may extend beyond deaths coded as drug-related to include excess mortality from other causes affected by drug use. Here, we estimate the full extent of drug-associated mortality. We use annual death rates for 1999-2016 by state, sex, five-year age group, and cause of death to model the relationship between drug-coded mortality-which serves as an indicator of the population-level prevalence of drug use-and mortality from other causes. Among residents aged 15-64 living in the 50 US states, the estimated number of drug-associated deaths in 2016 (141,695) was 2.2 times the number of drug-coded deaths (63,000). Adverse trends since 2010 in midlife mortality are largely attributable to drug-associated mortality. In the absence of drug use, we estimate that the probability of dying between ages 15 and 65 would have continued to decline after 2010 among men (to 15% in 2016) and would have remained at a low level (10%) among women. Our results suggest that an additional 3.9% of men and 1.8% of women died between ages 15 and 65 in 2016 because of drug use. In terms of life expectancy beyond age 15, we estimate that drug use cost men 1.4 years and women 0.7 years, on average. In the hardest-hit state (West Virginia), drug use cost men 3.6 and women 1.9 life years. Recent declines in US life expectancy have been blamed largely on the drug epidemic. Consistent with that inference, our results imply that, in the absence of drug use, life expectancy at age 15 would have increased slightly between 2014 and 2016. Drug-associated mortality in the US is roughly double that implied by drug-coded deaths alone. The drug epidemic is exacting a heavy cost to American lives, not only from overdoses but from a variety of causes