Behavioral & Social Research

Higher occupational work complexity is associated with better cognition later in life, according to two recent NIA-funded studies published in Alzheimer’s & Dementia.

Previous research has indicated that people with complex jobs have better cognitive function as they age and a lower risk of dementia. Both of the two new studies built on these findings by exploring multiple forms of occupational complexity and cognitive outcomes. Occupational complexity with “data, people, and things” was classified using the Dictionary of Occupational Titles, which catalogs the type of work activities involved in different occupations. Examples of jobs with high complexity in each of these areas include a data analyst, a social worker, and a watch repairman, respectively. Education, self-reported as the highest level of education completed, was statistically accounted for as it could indicate prior cognitive abilities before entering the workforce.

In the first study, researchers from Indiana University and collaborating institutions analyzed data from 355 older adults enrolled in the Social Networks in Alzheimer’s Disease study. The scientists examined participants’ neuropsychological test results, neuroimaging data, employment history, and mild cognitive impairment (MCI) or dementia diagnoses. Most participants, age 70 on average, were retired and no longer working in their longest-held job. The researchers found complex work with people was associated with better memory, a decreased risk of MCI or dementia, and greater brain reserve — the gap between brain atrophy and poor cognitive function. After accounting for education, complexity with data or things was not associated with any cognitive outcome. These findings suggest that exposure to cognitive enrichment at work, especially via social interaction, may improve cognitive outcomes and increase cognitive resilience to neuropathology. However, a limitation of the study is that the participants were not a diverse sample.

In the other study, researchers from Kaiser Permanente Northern California; University of California, San Francisco; and collaborative institutions also looked at occupational complexity and cognition, specifically in a racially and ethnically diverse sample. Researchers interviewed 1,536 participants, average age of 76 years, in the Kaiser Healthy Aging and Diverse Life Experiences study, which consists of approximately equal numbers of Asian, Black, Latino, and White older adults. Three interview cycles were completed over an average of about two and a half years to measure initial cognition and change over time.

In line with the first study, higher occupational complexity with people was associated with better performance on cognitive measures. However, contrary to that study, higher occupational complexity with data was also found to be associated with better cognitive outcomes and a slower annual rate of cognitive decline. Differences in the methodologies between the two studies may contribute to this inconsistency, but further research is needed. Of note, a greater proportion of Black and Latino participants were categorized in jobs with lowest complexity for working with data and people.

These two studies add to an increasing body of research demonstrating that intellectually stimulating activities during midlife, such as complex work environments, may be associated with better cognitive outcomes among older adults. It’s important to note that the Dictionary of Occupational Titles assigns scores according to job titles and does not capture individual variability within the same title. Further research to better understand the pathways through which different types of occupational complexity affect cognition in later life could help to create work environments that promote cognitive health and health equity.

This research was supported in part by NIA grants.

Simple adjustments can go a long way toward building a healthier eating pattern. Follow these tips to get the most out of foods and beverages while meeting your nutrient needs and reducing the risk of disease:

Enjoy a variety of foods from each food group to help reduce the risk of developing diseases such as high blood pressure, diabetes, and heart disease. Choose foods with little to no added sugar, saturated fats, and sodium.

To get enough protein throughout the day and maintain muscle, try adding seafood, dairy, or fortified soy products along with beans, peas, and lentils to your meals. Learn more about protein and other important nutrients.

Add sliced or chopped fruits and vegetables to meals and snacks. Look for pre-cut varieties if slicing and chopping are a challenge for you.

Try foods fortified with vitamin B12, such as some cereals, or talk to your doctor about taking a B12 supplement. Learn more about key vitamins and minerals.

Reduce sodium intake by seasoning foods with herbs and citrus such as lemon juice.

Drink plenty of water throughout the day to help stay hydrated and aid in the digestion of food and absorption of nutrients. Avoid sugary drinks.

It can be hard for some people to follow through on smart food choices. Read about common roadblocks and how to overcome them and check out the USDA’s tips for older adults.

Eating habits can change as we grow older. The USDA has developed Food Patterns to help people understand different ways they can eat healthy. The food patterns include:

Healthy U.S.-Style Eating Pattern: This is based on the types of foods Americans typically consume. The main types of food in this eating pattern include a variety of vegetables, fruits, whole grains, fat-free or low-fat dairy, seafood, poultry, and meat, as well as eggs, nuts, seeds, and soy products. Check out this sample menu to get started.

Healthy Mediterranean-Style Eating Pattern: This one contains more fruits and seafood and less dairy than the Healthy U.S.-Style Eating Pattern.

Healthy Vegetarian Eating Pattern: This pattern contains no meat, poultry, or seafood, but does contain fat-free or low-fat dairy. Compared with the Healthy U.S.-Style Eating Pattern, it contains more soy products, eggs, beans and peas, nuts and seeds, and whole grains.

You can choose a person to make medical decisions for you if you are unable to communicate them yourself, whether it’s due to a serious illness, injury, or other reason. This person is called a health care proxy. Having a health care proxy can help you plan for unexpected situations that may not be covered in your living will.

Some important things to know:
Your proxy can only make decisions if you are too sick to make them yourself. In addition, you can specify how much say your proxy has over your care.
Your proxy will work with your health care team to ensure your care and treatment preferences are followed.
You can change your health care proxy at any time. Simply fill out a new proxy form and let your family and health care team know about the change.
You may name an alternate proxy if your proxy is unavailable.

It’s important to find someone who you trust to honor your wishes and who is comfortable speaking up on your behalf with loved ones and health care providers. You may want to talk to more than one person about your wishes before deciding who is the right proxy for you.

by National Institute on Aging

You can ask a doctor to help you think through health care choices that may be covered in your living will, like life-sustaining care and other treatment decisions, before you put them in writing. For example, you might ask about the decisions you or your family may face if your high blood pressure leads to a stroke.

You can also ask a doctor about other medical orders you may need in an emergency situation or at the end of life. Common orders include:

Do not resuscitate (DNR) order. A DNR becomes part of your medical chart to tell medical staff that you don’t want CPR or other life-support measures to restore your heartbeat and breathing.

Do not intubate (DNI) order. A similar document, a DNI tells medical staff that you don’t want to be put on a ventilator.

Out-of-hospital DNR order. An out-of-hospital DNR alerts emergency medical staff to your wishes to restore your heartbeat or breathing if you aren’t in a hospital.

Physician orders for life-sustaining treatment (POLST) and medical orders for life-sustaining treatment (MOLST) forms. These forms provide guidance about your medical care that medical staff can act on immediately in an emergency. Typically, you create a POLST or MOLST when you’re near the end of life or critically ill and know the specific decisions that might need to be made on your behalf.

Prepare for your appointment by:

Asking your health care proxy to come with you if that makes you more comfortable.

Writing down some of your current health issues and your questions about future health care and end-of-life care.

Completing the Tips for talking with your doctor about advance care plan worksheet.

You may find it difficult to ask your doctor directly about your current prognosis or about end-of-life care. Remember, the goal is simply to start the conversation. You do not have to make specific decisions about your medical care until you feel ready.

by the National Institute on Aging

Each year, millions of people suffer from seasonal influenza, which is often called the flu. Flu is a respiratory illness caused by viruses that infect the nose, throat, and sometimes the lungs.

Flu is a mild illness for some people. But for others, including older adults and those with chronic (long-lasting) health conditions, the flu can be very serious and even life-threatening. Getting a flu vaccine every year can help prevent the flu. The vaccine is safe, effective, and available for little to no cost to you.

Most people who get the flu feel better after a few days to two weeks. However, the flu can make you seriously ill. Some people develop other health issues, called complications, because of the flu. Complications can be mild, such as a sinus or ear infection, or more serious, like pneumonia.

Anyone can get sick from the flu, but some people are more likely to have complications. You are more at risk for flu and its complications if you:

Are age 65 or older

Have certain medical conditions such as asthma, diabetes, or chronic kidney disease

Have heart disease or have had a stroke

Live in a nursing home or other long-term care facility

Pregnant people and children younger than five years old are also more likely to get very sick from the flu. Flu vaccination is especially important for people in these higher-risk groups. Learn more about people at increased risk for flu and its complications.

Why is the flu more dangerous for older adults?

The flu is more dangerous for older adults for a few reasons. One reason is that the immune system — which helps your body fight infections — weakens as you age. For example, because your body is busy fighting off the flu, you might pick up a secondary infection such as pneumonia. A second reason is that older adults are also more likely to have other health conditions, like diabetes, that increase their risk for complications from the flu.

The good news is the flu vaccine reduces your risk of getting the flu and of getting seriously ill if you do get sick with the flu. Flu vaccination is especially helpful for people with chronic health conditions. For example, it has been linked to lower rates of heart problems (cardiac events) among people with heart disease and fewer hospitalizations among people who have chronic lung disease or diabetes. Learn more about the benefits of flu vaccination.

How does the flu spread?

The flu is contagious, which means it spreads from person to person. It mostly spreads through droplets in the air when people with flu cough, sneeze, or talk. It can spread from up to six feet away. Although it isn’t as common, the flu can also spread from surfaces — for example, if you touch something the virus is on and then touch your nose, mouth, or eyes.

It’s possible to spread the flu before you feel sick and when you have symptoms. Typically, people with the flu can spread it a day before, and up to a week after feeling sick. Young children and people with weakened immune systems may be able to spread the flu for even longer. If you or someone you know is sick with the flu, take steps to help prevent spreading the disease.

by National Institute on Aging

These small private facilities, also called residential care facilities or group homes, usually have 20 or fewer residents. Rooms may be private or shared. Residents receive personal care and meals, and staff are available around the clock. Nursing and medical care usually are not provided at the home.

In most cases, you must pay the costs of living at a board and care home. Medicare does not cover these costs. Medicaid may provide partial coverage, depending on the state and whether the person is eligible. If the older person has long-term care insurance, check their plan to see if it includes coverage for this type of facility.

Nursing homes, also called skilled nursing facilities, provide a wide range of health and personal care services. Their services focus more on medical care than most assisted living facilities or board and care homes. Services offered in a nursing home typically include nursing care, 24-hour supervision, three meals a day, and assistance with everyday activities. Rehabilitation services, such as physical, occupational, and speech therapy, are also available.

In many cases, people must pay for nursing home care themselves. Medicare generally doesn’t cover long-term stays in a nursing home, but it may pay for some related costs, such as doctor services and medical supplies. Medicaid may also cover some of the costs of nursing homes for people who are eligible based on income and personal resources. If the older person has long-term care insurance, the policy may include some coverage for nursing home care. Check with the insurance company for details.

Assisted living is for people who need help with daily care, but not as much help as a nursing home provides. Assisted living facilities range in size from as few as 25 residents to 100 or more. Typically, a few levels of care are offered, and residents pay more if they need extra services or special care.

Assisted living residents usually live in their own apartments or rooms and share common areas. They have access to many services, including up to three meals a day; assistance with personal care; help with medications, housekeeping, and laundry; 24-hour supervision, security, and on-site staff; and social and recreational activities. Some assisted living facilities are part of a larger organization that also offers other levels of care. For example, continuing care retirement communities may also offer independent living and skilled nursing care. Exact arrangements vary by facility and by state.

Most people pay the full costs of assisted living themselves. This option tends to be more expensive than living independently but less expensive than a nursing home. Medicare does not pay for assisted living. Medicaid may provide coverage for some aspects of assisted living, depending on the state and whether the person is eligible. This care option is partially covered by some long-term care insurance policies.

Low-dose daily aspirin does not provide significant protection against stroke resulting from blood clots and may increase risk of bleeding in the brain or skull after head trauma, according to an NIA-funded study. The findings, published in JAMA Network Open, provide new evidence countering past conventional wisdom recommending a daily low-dose or baby aspirin for healthy older adults.

In this study, an international team led by Australian researchers analyzed data from the ASPirin in Reducing Events in the Elderly (ASPREE) trial. ASPREE includes about 19,000 healthy older adult volunteers from Australia and the United States who were randomly assigned to take a daily 100 milligram aspirin or a placebo pill and were monitored for approximately five years.

The research team found no statistically significant difference in stroke incidence between those who took aspirin and those on the placebo. While a relatively small overall number of brain bleeds occurred in participants during the study period — 187 total, with 108 from the aspirin group and 79 from the placebo one — bleeding events were 38% higher among participants who were taking aspirin daily, regardless of their gender, age, or cardiovascular risk. Bleeding into the brain or onto its surface are common and serious results of fall-related head injuries in older adults. In this study, nearly half of these bleeding events were due to trauma.

In a related recent study, the ASPREE team also found that daily aspirin could increase anemia risk in older adults. In 2022, in part due to ASPREE findings, the U.S. Preventive Services Task Force updated its past recommendations to state that healthy adults age 60 or older should not start taking low-dose aspirin as a primary prevention strategy for cardiovascular disease. These recommendations do not apply to individuals taking aspirin for a known cardiovascular condition.

The ASPREE investigators view these recent results as further evidence that healthy older adults with no history of stroke or cardiovascular disease should talk with their doctors about the potential risks and benefits when considering taking aspirin daily. They further note that older adults who have had past strokes or are in higher risk groups for cardiovascular disease may still benefit from aspirin’s blood thinning effects, so these individuals should also ask about the benefits of aspirin versus other drugs such as statins.

This research was supported in part by NIA grants AG029824 and AG062682.

Scientists found both potentially new and previously discovered Alzheimer’s disease genetic risk factors by analyzing the genomes of a relatively small group of people who were identified as being of Ashkenazi Jewish ancestry. The results from the NIA-funded study, published in Alzheimer’s & Dementia, suggest that genomic studies of Ashkenazi Jewish people and other closely related “genetic founder” groups may help clarify the genetic basis for Alzheimer’s.

People of Ashkenazi ancestry descend from a population of Jewish people who founded communities in Central and Eastern Europe during the Middle Ages. For many centuries, Ashkenazi Jewish communities in Europe were culturally isolated from non-Jewish Europeans, and as a result, the population is genetically distinct from non-Jewish Europeans. Due to this reduction in genetic variation, or “founder effect,” several hereditary diseases and types of cancer are found predominantly or more frequently in people of Ashkenazi Jewish descent. In this study, the researchers hypothesized that Alzheimer’s disease genetic risk factors may appear more frequently — and thus be easier to identify — than in broader, more genomically diverse European populations.

Led by scientists at Boston University, the researchers used genomic information about the Ashkenazi Jewish population to analyze data of three different large genomic and genetic Alzheimer’s disease studies involving more than 80,000 participants of European descent. More than 6,500 individuals appeared to be of Ashkenazi Jewish descent. Approximately 2,800 of these people were diagnosed with Alzheimer’s and about 3,700 were not.

By comparing those who had Alzheimer’s with those who did not, the researchers found previously identified risk factors such as variants of genes called APOE and TREM2. The APOE associations were relatively strong given the small sample size. They also found several potential new risk factors that had borderline levels of association with Alzheimer’s. For example, one was found linked to a gene called RAB3B, which is involved in the release of dopamine, an important chemical signal in the brain.

Experiments on autopsied brain tissue provided further support for the idea that the variants identified by this analysis are Alzheimer’s disease genetic risk factors. The researchers note that studying a population with very similar genetics enabled them to uncover new genes that would have been hard to identify in a genetically heterogeneous population.

Further studies are needed to confirm these findings and potentially identify other genetic changes associated with Alzheimer’s in people of Ashkenazi Jewish descent or in other historically isolated populations.

This research was supported in part by NIA grants.