Determinants of Debt: An Econometric Analysis Based on the Cyprus Survey of Consumer Finances

This work is based on the Cyprus Survey of Consumer Finances (CySCF) and focuses on the investigation of home secured loans and consumer credit card outstanding balances among Cypriot families. The CySCF runs on a triennial basis with the first database created in 1999 (CySCF1999). According to CySCF1999 and CySCF2002, the overall participation in home secured debt among all families declined from 29.95% in 1999 and 29.77% in 2002 to 25.77% in 2005 (CySCF2005). Credit cards were introduced in the early 1980s and grew significantly during the 1990s. The overall percentage of Cypriot households holding credit cards is estimated at 41.7% for 1999, 50% for 2002, and 48% for 2005. This work deals with the econometric analysis of home secured loans and consumer credit card outstanding balances and it provides results based on logit models. The main variables selected for home secured loans are the age, family status, specific attitude toward credit, employment status, and income. The resulting model exhibits a polynomial behaviour of degree two with respect to age. The main variables for consumer credit card balances are the age, education, general attitude, income code, home secured loans and riskiness. Worth noting is the high probability of having credit card balances for those households where the economically dominant unit is of low age with a positive attitude towards credit.debt distribution, family finances, home secured loan, credit card use, logit model.

Prediction of dementia risk in low-income and middle-income countries (the 10/66 Study): an independent external validation of existing models

BackgroundTo date, dementia prediction models have been exclusively developed and tested in high-income countries (HICs). However, most people with dementia live in low-income and middle-income countries (LMICs), where dementia risk prediction research is almost non-existent and the ability of current models to predict dementia is unknown. This study investigated whether dementia prediction models developed in HICs are applicable to LMICs.MethodsData were from the 10/66 Study. Individuals aged 65 years or older and without dementia at baseline were selected from China, Cuba, the Dominican Republic, Mexico, Peru, Puerto Rico, and Venezuela. Dementia incidence was assessed over 3–5 years, with diagnosis according to the 10/66 Study diagnostic algorithm. Discrimination and calibration were tested for five models: the Cardiovascular Risk Factors, Aging and Dementia risk score (CAIDE); the Study on Aging, Cognition and Dementia (AgeCoDe) model; the Australian National University Alzheimer's Disease Risk Index (ANU-ADRI); the Brief Dementia Screening Indicator (BDSI); and the Rotterdam Study Basic Dementia Risk Model (BDRM). Models were tested with use of Cox regression. The discriminative accuracy of each model was assessed using Harrell's concordance (c)-statistic, with a value of 0·70 or higher considered to indicate acceptable discriminative ability. Calibration (model fit) was assessed statistically using the Grønnesby and Borgan test.Findings11 143 individuals without baseline dementia and with available follow-up data were included in the analysis. During follow-up (mean 3·8 years [SD 1·3]), 1069 people progressed to dementia across all sites (incidence rate 24·9 cases per 1000 person-years). Performance of the models varied. Across countries, the discriminative ability of the CAIDE (0·52≤c≤0·63) and AgeCoDe (0·57≤c≤0·74) models was poor. By contrast, the ANU-ADRI (0·66≤c≤0·78), BDSI (0·62≤c≤0·78), and BDRM (0·66≤c≤0·78) models showed similar levels of discriminative ability to those of the development cohorts. All models showed good calibration, especially at low and intermediate levels of predicted risk. The models validated best in Peru and poorest in the Dominican Republic and China.InterpretationNot all dementia prediction models developed in HICs can be simply extrapolated to LMICs. Further work defining what number and which combination of risk variables works best for predicting risk of dementia in LMICs is needed. However, models that transport well could be used immediately for dementia prevention research and targeted risk reduction in LMICs

The importance of engaging in physical activity in older adulthood for transitions between cognitive status categories and death: A coordinated analysis of 14 longitudinal studies

Background: Given increasing incidence of cognitive impairment and dementia, further understanding of modifiable factors contributing to increased healthspan is crucial. Extensive literature provides evidence that physical activity (PA) delays the onset of cognitive impairment; however, it is unclear whether engaging in PA in older adulthood is sufficient to influence progression through cognitive status categories. Method: Applying a coordinated analysis approach, this project independently analyzed 14 longitudinal studies (NTotal = 52 039; mean baseline age across studies = 69.9-81.73) from North America and Europe using multistate survival models to estimate the impact of engaging in PA on cognitive status transitions (nonimpaired, mildly impaired, severely impaired) and death. Multinomial regression models were fit to estimate life expectancy (LE) based on American PA recommendations. Meta-analyses provided the pooled effect sizes for the role of PA on each transition and estimated LEs. Results: Controlling for baseline age, sex, education, and chronic conditions, analyses revealed that more PA is significantly associated with decreased risk of transitioning from nonimpaired to mildly impaired cognitive functioning and death, as well as substantially longer LE. Results also provided evidence for a protective effect of PA after onset of cognitive impairment (eg, decreased risk of transitioning from mild-to-severe cognitive impairment; increased likelihood of transitioning backward from severe-to-mild cognitive impairment), though between-study heterogeneity suggests a less robust association. Conclusions: These results yield evidence for the importance of engaging in PA in older adulthood for cognitive health, and a rationale for motivating older adults to engage consistently in PA

Do self-reported hearing and visual impairments predict longitudinal dementia in older adults?

Background Sensory impairments have been associated with dementia in older adults. However, the contribution of different impairments and how they interact in the development of dementia is not clear. We examined the independent and interaction effects of hearing impairment (HI) and visual impairment (VI) on incident dementia. Design Multi-centric population-based prospective cohort study. Setting Data were taken from the AgeDifferent.de platform, pooling participants aged 75 and older from the German LEILA75+ and AgeCoDe/AgeQualiDe cohorts. Participants Older adults (N = 3497) with mean age 79.8 years, 67.2% female. Measurements Standardized interviews and questionnaires were used to assess self-reported HI and VI at baseline and all-cause dementia in 9 follow-ups, spanning over 20 years. Methods Competing risk regression models were conducted to test the main and interaction effects of HI and VI on dementia incidence, adjusting for established risk factors of dementia and accumulated mortality. Results HI and VI at baseline were reported by 30.3% and 16.6% of individuals, respectively. Adjusting for baseline information on sociodemographics, substance use, cognitive functioning and morbidity, and controlling for accumulated mortality risk, HI (sHR 1.16, 95% CI 1.04–1.30, p = 0.011) but not VI (sHR 1.07, 95% CI 0.90–1.28, p = 0.462) was significantly associated with incident dementia. There was no interaction between HI and VI (sHR 1.09, 95% CI 0.81–1.46, p = 0.567). Conclusions Hearing impairment is associated with an increased incidence of all-cause dementia in older adults. There is no excess risk or risk compensation through the additional presence or absence of visual impairment. Early prevention measures for hearing impairment might help to reduce the long-term risk of dementia

Prevalence of pain and its associated factors among the oldest-olds in different care settings – results of the AgeQualiDe study

Background; The prevalence of pain is very common in the oldest age group. Managing pain successfully is a key topic in primary care, especially within the ageing population. Different care settings might have an impact on the prevalence of pain and everyday life. Methods: Participants from the German longitudinal cohort study on Needs, Health Service Use, Costs and Health-related Quality of Life in a large Sample of Oldest-old Primary Care Patients (85+) (AgeQualiDe) were asked to rate their severity of pain as well as the impairment with daily activities. Besides gender, age, education, BMI and use of analgesics we focused on the current housing situation and on cognitive state. Associations of the dependent measures were tested using four ordinal logistic regression models. Model 1 and 4 consisted of the overall sample, model 2 and 3 were divided according to no cognitive impairment (NCI) and mild cognitive impairment (MCI). Results: Results show a decline in pain at very old age but nonetheless a high prevalence among the 85+ year olds. Sixty-three per cent of the participants report mild to severe pain and 69% of the participants mild to extreme impairment due to pain with daily activities. Use of analgesics, depression and living at home with care support are significantly associated with higher and male gender with lower pain ratings. Conclusions: Sufficient pain management among the oldest age group is inevitable. Outpatient care settings are at risk of overlooking pain. Therefore focus should be set on pain management in these settings

Dementia Risk Models in an Australian First Nations Population: Cross-Sectional Associations and Preparation for Follow-Up

Background: Reducing the burden of dementia in First Nations populations may be addressed through developing population specific methods to quantify future risk of dementia. Objective: To adapt existing dementia risk models to cross-sectional dementia prevalence data from a First Nations population in the Torres Strait region of Australia in preparation for follow-up of participants. To explore the diagnostic utility of these dementia risk models at detecting dementia. Methods: A literature review to identify existing externally validated dementia risk models. Adapting these models to cross-sectional data and assessing their diagnostic utility through area under the receiver operating characteristic curve (AUROC) analyses and calibration using Hosmer-Lemeshow Chi2. Results: Seven risk models could be adapted to the study data. The Aging, Cognition and Dementia (AgeCoDe) study, the Framingham Heart Study (FHS), and the Brief Dementia Screening Indicator (BDSI) had moderate diagnostic utility in identifying dementia (i.e., AUROC >0.70) before and after points for older age were removed. Conclusion: Seven existing dementia risk models could be adapted to this First Nations population, and three had some cross-sectional diagnostic utility. These models were designed to predict dementia incidence, so their applicability to identify prevalent cases would be limited. The risk scores derived in this study may have prognostic utility as participants are followed up over time. In the interim, this study highlights considerations when transporting and developing dementia risk models for First Nations populations

EMPIRICAL STUDY OF PSYCHOTIC DISORDER PATIENTS IN NIGERIA

A study on psychotic disorder ailment was carried out in this research paper where the target population consists of all patients that has any of the following five psychotic disorders: Menial Brain Dysfunction (MBD); Schizophrenia; Vascular Dementia; Bipolar; and Insomnia. The sample consist of five hundred (500) psychotic patients that were selected from the entire number of psychotic patients in the hospital records (files) from January, 2010 to December, 2014. They were selected based on their peculiar ailments with symptoms of psychotic disorders. The main aim of this paper is to examine the possible existence of association among these psychotic disorders. The specific objectives are to: determine the demographic factors that influence the levels of each of these psychotic disorders; propose appropriate model for each psychotic disorder; and determine the level of correct classification using each of these models. We observed that there exist strong association among these psychotic disorders except for MBD and Vascular Demetria. Nearly all the demographic factors under consideration are one way or the other influence the levels of any psychotic disorder except divorce, injury, and genetic. The percentages of correct classification using each of the models proposed ranges between 70.8% and 91.2%

Frequency and gender differences in the use of professional home care in late life: Findings from three German old-age cohorts

Aim: The aim of this study was to investigate the frequency of and the gender differences in the use of professional home care in Germany. Methods: We used harmonized data from three large cohort studies from Germany (“Healthy Aging: Gender-specific trajectories into the latest life”; AgeDifferent.de Platform). Data were available for 5,393 older individuals (75 years and older). Mean age was 80.2 years (SD: 4.1 years), 66.6% were female. Professional homecare outcome variables were use of outpatient nursing care, paid household assistance, and meals on wheels’ services. Logistic regression models were used, adjusting for important sociodemographic variables. Results: Altogether 5.2% of older individuals used outpatient nursing care (6.2% women and 3.2% men; p < 0.001), 24.2% used paid household assistance (26.1% women and 20.5% men; p < 0.001) and 4.4% used meals on wheels’ services (4.5% women and 4.0% men; p = 0.49). Regression analysis revealed that women had higher odds of using paid household assistance than men (OR = 1.48, 95% CI: [1.24–1.76]; p < 0.001), whereas they had lower odds of using meals on wheels’ services (OR = 0.64, 95% CI: [0.42–0.97]; p < 0.05). No statistically significant differences in using outpatient nursing care between women and men were found (OR = 1.26, 95% CI: [0.87–1.81]; p = 0.225). Further, the use of home care was mainly associated with health-related variables (e.g., stroke, Parkinson’s disease) and walking impairments. Conclusions: Our study showed that gender differences exist in using paid household assistance and in culinary dependency. For example, meals on wheels’ services are of great importance (e.g., for individuals living alone or for individuals with low social support). Gender differences were not identified regarding outpatient nursing care. Use of professional home care servicesmay contribute to maintaining autonomy and independence in old age

Depressionen bei hochaltrigen Menschen in Abhängigkeit von sozialer Isolation und Verlusterfahrungen – eine Frage des Geschlechts?

Depressionen bei hochaltrigen Menschen sind weit verbreitet und folgenschwer, dennoch bleiben diese häufig unentdeckt und unbehandelt. Daher ist die Identifizierung von Risikofaktoren besonders wichtig, um Depressionen im Alter zu erkennen oder präventiv zu begegnen. Die Bedeutung von psychosozialen Faktoren, wie Verlusterfahrungen und das soziale Netzwerk, werden dabei häufig vernachlässigt. Dabei wird der Tod von nahestehenden Personen mit zunehmendem Alter häufiger und erfordert ein hohes Maß an psychologischer Anpassungsleistung der Hinterbliebenen. Die damit einhergehende Veränderung des sozialen Netzwerks birgt ein Risiko für soziale Isolation und damit auch für Depressionen. Das Ziel der Dissertation war es, Depressionen bei hochaltrigen Menschen in Deutschland in Abhängigkeit von sozialer Isolation und Verlusterfahrungen zu analysieren und dabei auf mögliche Geschlechtsunterschiede einzugehen. Datengrundlage der ersten Untersuchung war die „Leipziger Langzeitstudie in der Altenbevölkerung“ (LEILA 75+), eine prospektive, epidemiologische und bevölkerungs-repräsentative Kohortenstudie. Mit einer Stichprobe von 783 Personen (durchschnittliches Alter 80,78 (SD 4,52) Jahre) wurde zunächst mittels einer deskriptiven Analyse die Veränderung des sozialen Netzwerks (PANT) im Alter unter Berücksichtigung von Verlusterfahrungen analysiert. 57% der älteren Menschen lebte kontinuierlich in einem restriktiven sozialen Netzwerk. Bei 30,9% der Hochaltrigen konnte eine Änderung im sozialen Netzwerk während des Untersuchungszeitraums festgestellt werden, diese konnten allerdings in keinen Zusammenhang mit Verlusterfahrungen gebracht werden. Verlusterfahrungen (OR 7,56 (1,60–35,72)) und ein restriktives soziales Netzwerk (OR 4,08 (1,52–10,95)) stellten sich in den Hybridregressionen als signifikante Prädiktoren zur Entwicklung einer Depression (ADS-L) heraus. Protektive wirkte hingegen ein integriertes soziales Netzwerk. In der zweiten Studie wurden die AgeDifferent.de Daten, die aus drei gepoolten Alterskohortenstudien (LEILA 75+, AgeCoDe / AgeQualiDe und AgeMooDe) bestehen, ausgewertet. Das durchschnittliche Alter der 2.470 Befragten lag bei 79,2 (SD 3,64) Jahren. Bei Frauen konnte ein signifikant höherer Schweregrad der Depression festgestellt werden als bei Männern (β=0.16; 95%-CI=0.09; 0.23). Analysen zum Vergleich der Depressivität vor und nach der Verwitwung verdeutlichten, dass der Schweregrad der Depression nach der Verwitwung signifikant höher ist. In dieser Studie konnte zudem gezeigt werden, dass verwitwete Männer signifikant mehr depressive Symptome haben als nicht verwitwete Männer. Bei der Betrachtung von Frauen konnten jedoch keine Unterschiede festgestellt werden. Bei intraindividueller Betrachtung zeigte sich, dass sowohl verwitwete Männer als auch verwitwete Frauen signifikant mehr depressive Symptome haben als vor ihrer Verwitwung. In der letzten Untersuchung wurde mit Daten der AgeCoDe / AgeQualiDe Studie analysiert ob Unterschiede zwischen Verwitweten und Verheirateten in Alter, Geschlecht und Bildung auch eine mögliche Erklärung für die Unterschiede in der Depressivität zwischen diesen Gruppen sein könnten. Mit Daten von 679 Personen (456 verwitwet, 223 verheiratet), mit einem durchschnittlichem Alter von 86,5 (SD 2,9) Jahren konnte gezeigt werden, dass Verwitwete häufig älter, häufiger weiblich und eher niedriger gebildet sind. Mittels „Entropy Balancing“ wurden diese Eigenschaften von Verwitweten und Verheirateten vereinheitlicht. Das Ausmaß der depressiven Symptome bei verwitweten hochaltrigen Frauen und Männern war in dieser Untersuchung ähnlich. Bei der Berücksichtigung der sozialen Isolation stellte sich in dieser Untersuchung heraus, dass soziale Isolation vor allem in der Gruppe der Verwitweten zu mehr depressiven Symptomen führt. Verwitwete Männer und Frauen, die zudem sozial isoliert leben, weisen signifikant mehr depressive Symptome auf, als Verwitwete ohne soziale Isolation (β=0.83; 95%-CI=0.44; 1.23). Soziale Isolation hatte in der Gruppe der Verheirateten im Gegensatz zu den Verwitweten keinen Einfluss auf die Häufigkeit depressiver Symptome. Zusammenfassend zeigt sich, dass Verlusterfahrungen als ein Risikofaktor zur Entwicklung depressiver Symptome identifiziert werden konnte. Nicht eindeutig ist der Einfluss des Geschlechts. Mögliche Unterschiede zwischen Frauen und Männern im Zuge der Verwitwung könnte beispielsweise die Unterrepräsentation von verwitweten Männern sein. Wird dieser Faktor berücksichtigt, können Frauen und Männer als ähnlich vulnerabel zur Entwicklung einer Depression nach dem Verlust des Ehepartners gelten. Für Menschen die zusätzlich neben dem Verlust des Ehepartners ein sozial isoliertes soziales Netzwerk haben, ist das Risiko zur Entwicklung einer Depression noch größer. Ein gestärktes soziales Netzwerk kann hingegen bei beiden Geschlechtern als ein protektiver Faktor zum Erhalt der psychischen Gesundheit gesehen werden.:Abbildungsverzeichnis Tabellenverzeichnis Abkürzungsverzeichnis 1 Einleitung 1.1 Depressionen im Alter 1.2 Trauer- und Verlusterfahrungen im Alter 1.3 Bedeutung des sozialen Netzwerks im Alter 1.4 Geschlechtsunterschiede im Alter 2 Datengrundlage und Publikationen der vorliegenden Dissertation 2.1 Datengrundlage 2.1.1 LEILA 75+ 2.1.2 AgeCoDe / AgeQualiDe 2.1.3 AgeMooDe 2.1.4 AgeDifferent.de 2.2 Überblick über die Publikationen der vorliegenden Dissertation 3 Loss experiences in old age and their impact on the social network and depression– results of the Leipzig Longitudinal Study of the Aged (LEILA 75+) 4 Are older men more vulnerable to depression than women after losing their spouse? Evidence from three German old-age cohorts (AgeDifferent.de platform) 5 The role of social isolation and the development of depression. A comparison of the widowed and married oldest old in Germany 6 Diskussion 6.1 Allgemeine Diskussion 6.2 Implikationen für die Praxis und die Versorgungsforschung 6.3 Fazit Zusammenfassung der Arbeit Literaturverzeichnis Anhang A: Darstellung des eigenen Beitrags Anhang B: Erklärung über die eigenständige Abfassung der Arbeit Anhang C: Lebenslauf Anhang D: Wissenschaftliche Beiträge Anhang E: Danksagun