Social Determinants of Cognitive Functioning and Its Development in Old Age: The Role of Education, Spousal Loss and Neighborhoods in a Longitudinal Perspective

Populations are aging in many countries all over the world. This trend is not only manifest in increased numbers and population shares of older adults; it is also associated with increases in old-age life expectancy. In conjunction with the quantitative gain in years, questions about the quality of life have been expressed. This is reflected in Rowe & Kahn’s concept of Successful Aging, which posits that cognitive functioning (CF) is one of the main resources for active engagement with life in old age. Besides medical, biological and behavioral factors, social factors can be expected to play an important role in CF because they are often enduring or intense in nature and shape cognitively relevant experiences in many areas of life. Against this background, this dissertation examines potential social determinants of older adults’ CF. At the theoretical level, I combine a sociological perspective emphasizing the importance of social factors in shaping individual experiences throughout the life course with psychological theories that link individual experiences (e.g., mental stimulation, stress, physical activity) to CF. At the empirical level, I apply growth curve modeling, fixed effect regression, and multilevel analysis to data from the Longitudinal Aging Study Amsterdam to address the following research questions: Are more (vs. less) educated persons more likely to maintain their CF as they grow older? Will the loss of the spouse accelerate cognitive decline? Does the CF of people in better-off or urban neighborhoods differ from that of their counterparts in less well-off or rural neighborhoods? The results indicate that the social factors examined in this dissertation are hardly associated with cognitive decline in old age. However, cross-sectional comparisons of the level of CF by education and neighborhood characteristics reveal that being more educated and living in a more urbanized neighborhood are associated with higher CF

Changes in employment and relationship satisfaction in times of the COVID-19 pandemic: Evidence from the German Family Panel

Families have been hit hard by the COVID-19 pandemic and its associated lockdown, but barely any research has been conducted yet, investigating how COVID-19-related stressors - and, specifically, disruptions in established employment arrangements - affected couples' relationship quality. To account more comprehensively for such non-monetary costs of the COVID-19 pandemic, the present study investigates whether changes in partners' employment situation during the COVID-19 crisis - particularly home-office and short-time work - had an immediate impact on the relationship satisfaction of cohabiting married and unmarried couples. To do so, we estimated fixed-effects regression models, exploiting unique data from the German Family Panel (pairfam; wave 11) and its supplementary COVID-19 web-survey. We observed a substantial proportion of respondents experiencing positive (20%) or negative (40%) changes in relationship satisfaction during the crisis. Relationship satisfaction has decreased, on average, for men and women alike, almost irrespective of whether they experienced COVID-19-related changes in their employment situation. While partners' employment situation hardly moderated the negative association between respondents' employment and relationship satisfaction, the presence of children seemed to buffer partly against a COVID-19-related decrease. Our results thus confirm previous findings suggesting that the COVID-19 pandemic constitutes a threat to couples' relationship quality and healthy family functioning more generally

The educational burden of disease: a cohort study

Background Students with health disorders might be at risk of disengaging from education, which can reinforce socioeconomic inequalities in health. We aimed to evaluate the associations between 176 diseases and injuries and later school performance in Norwegian adolescents and to estimate the importance of each disorder using a novel measure for the educational burden of disease (EBoD). Methods We used diagnostic information from government-funded health services for all Norwegian inhabitants who were born between Jan 1, 1995, and Dec 31, 2002, were registered as living in Norway at age 11–16 years, and were participating in compulsory education. School performance was assessed as grade point average at the end of compulsory education at age 16 years. We used a linear regression of school performance on disease in a fixed-effects sibling comparison model (113 411 families). The association (regression coefficients) between disease and school performance was multiplied by disease prevalence to estimate the proportional EBoD among 467 412 individuals participating in compulsory education. Findings Overall, although most diseases were not meaningfully associated with grade point average (regression coefficients close to 0), some were strongly associated (eg, intellectual disability regression coefficients –1·2 for boys and –1·3 for girls). The total educational disease burden was slightly higher for girls (53·5%) than for boys (46·5%). Mental health disorders were associated with the largest educational burden among adolescents in Norway (total burden 44·6%; boys 24·6% vs girls 20·0%), of which hyperkinetic disorder contributed to 22·1% of the total burden (boys 14·6% vs girls 7·5%). Among somatic diseases, those with unknown causes and possibly mental causes were associated with the largest educational burden. Interpretation The EBoD concept could provide a simple metric to guide researchers and policy makers. Because mental health disorders form a large component of the educational burden, investment in mental health might be particularly important for improving educational outcomes in adolescents.publishedVersio

Spousal Loss and Change in Cognitive Functioning: An Examination of Temporal Patterns and Gender Differences

Objectives: The study investigates whether the disadvantaged position of men in the adverse consequences of widowhood for health and mortality also exists for changes in cognitive health. Methods: We used data of up to 1,269 men and women aged 65 years and older who participated in the Longitudinal Aging Study Amsterdam in three-yearly assessments between 1992 and 2012 (5,123 person-observations). All were married and without cognitive impairment (MMSE ≥ 24) at baseline and up to 419 lost their spouse. In fixed-effects regression models, the effect of spousal loss on change in four domains of cognitive functioning was estimated independently of age-related cognitive change. Results: For women, a robust temporary decrease was found in the second year after spousal loss in the reasoning domain, but not in global cognitive functioning, processing speed, or memory. No robust effects were found for men. Discussion: Considering that only one cognitive domain was affected and effects were temporary, cognitive functioning seems rather robust to the experience of spousal loss. Despite men having often been reported to be in a disadvantaged position in other health domains, our analyses indicate no such pattern for cognitive functioning

Public Perceptions of Prescription Drug Use for Cognitive Enhancement in Healthy Children and Adolescents

Sattler S, Wörn J. Public Perceptions of Prescription Drug Use for Cognitive Enhancement in Healthy Children and Adolescents. In: Nagel SK, ed. Shaping Children. Ethical and Social Questions that Arise when Enhancing the Young. Advances in Neuroethics. Cham: Springer International Publishing; 2019: 85-103.Giving prescription drugs to healthy young people for so-called cognitive enhancement (CE) (e.g., of concentration or memory) is being discussed increasingly by scholars and the public. This includes debates about whether, given its potential side effects, CE should be restricted and whether peer pressure infringes upon autonomous decisionmaking. To date, however, virtually no empirical studies of the public’s perception regarding CE in healthy young people exist. We conducted a secondary analysis of data from a web-based survey of 1427 persons from 60 countries, conducted by the magazine Nature, in which the data had only been analyzed descriptively. To gain a better understanding of influences on attitudes about CE of young children, we explored factors (e.g., types of drug users, positive or negative experiences with prior CE-drugs) potentially associated with restrictions and peer pressure. The majority of respondents (85.3%) favored restricting CE-drug use for healthy young people under age 16. We found that respondents who had experienced side effects when using CE-drugs themselves were more likely to favor restrictions. One third of the respondents (33.8%) would feel pressure to give their children CE-drugs if their children’s classmates were taking such drugs. Respondents who were willing to use CE-drugs for themselves felt more pressure to give such drugs to their children if others did so. In addition to a more far-reaching use of the data, which can increase our knowledge of public perceptions of CE-drug use by young people, we also discuss multiple methodological caveats about the data and directions for future research

Employment changes during the COVID-19-pandemic and mental health: Evidence from a longitudinal study

This manuscript is currently under revision. Please do not cite

Cognitive functioning among Dutch older adults: Do neighborhood socioeconomic status and urbanity matter?

Positive associations of neighborhood socioeconomic characteristics and older adults' cognitive functioning have been demonstrated in previous studies, but overall results have been mixed and evidence from European countries and particularly the Netherlands is scarce. We investigated the effects of socioeconomic status (SES) and urbanity of neighborhoods on four domains of cognitive functioning in a sample of 985 Dutch older adults aged 65-88 years from the Longitudinal Aging Study Amsterdam. Besides cross-sectional level differences in general cognitive functioning, processing speed, problem solving and memory, we examined cognitive decline over a period of six years. Growth models in a multilevel framework were used to simultaneously assess levels and decline of cognitive functioning. In models not adjusting for individual SES, we found some evidence of higher levels of cognitive functioning in neighborhoods with a higher SES. In the same models, urbanity generally showed positive or inversely U-shaped associations with levels of cognitive functioning. Overall, effects of neighborhood urbanity remained significant when adjusting for individual SES. In contrast, level differences by neighborhood SES were largely explained by the respondents' individual SES. This suggests that neighborhood SES does not influence levels of cognitive functioning beyond the fact that individuals with a similar SES tend to self-select into neighborhoods with a corresponding SES. No evidence of systematically faster decline in neighborhoods with lower SES or lower degrees of urbanity was found. The findings suggest that neighborhood SES has no independent effect on older adults cognitive functioning in the Netherlands. Furthermore, the study reveals that neighborhood urbanity should be considered a determinant of cognitive functioning. This finding is in line with theoretical approaches that assume beneficial effects of exposure to complex environments on cognitive functioning. We encourage further investigations into the effect of urbanity in other contexts before drawing firm conclusions

The educational burden of disease: a cohort study

Background Students with health disorders might be at risk of disengaging from education, which can reinforce socioeconomic inequalities in health. We aimed to evaluate the associations between 176 diseases and injuries and later school performance in Norwegian adolescents and to estimate the importance of each disorder using a novel measure for the educational burden of disease (EBoD). Methods We used diagnostic information from government-funded health services for all Norwegian inhabitants who were born between Jan 1, 1995, and Dec 31, 2002, were registered as living in Norway at age 11–16 years, and were participating in compulsory education. School performance was assessed as grade point average at the end of compulsory education at age 16 years. We used a linear regression of school performance on disease in a fixed-effects sibling comparison model (113 411 families). The association (regression coefficients) between disease and school performance was multiplied by disease prevalence to estimate the proportional EBoD among 467 412 individuals participating in compulsory education. Findings Overall, although most diseases were not meaningfully associated with grade point average (regression coefficients close to 0), some were strongly associated (eg, intellectual disability regression coefficients –1·2 for boys and –1·3 for girls). The total educational disease burden was slightly higher for girls (53·5%) than for boys (46·5%). Mental health disorders were associated with the largest educational burden among adolescents in Norway (total burden 44·6%; boys 24·6% vs girls 20·0%), of which hyperkinetic disorder contributed to 22·1% of the total burden (boys 14·6% vs girls 7·5%). Among somatic diseases, those with unknown causes and possibly mental causes were associated with the largest educational burden. Interpretation The EBoD concept could provide a simple metric to guide researchers and policy makers. Because mental health disorders form a large component of the educational burden, investment in mental health might be particularly important for improving educational outcomes in adolescents