Based in successful aging theory and terminal cognitive drop research, this paper investigates cerebrovascular burden (CVB), depressive symptoms, and cognitive decline as threats to longevity. A subsample of stroke-free women over the age of 80 was identified in the Health and Retirement Survey (years 2000–2008). Mortality at 2, 6, and 8 year intervals was predicted using CVB (diabetes, heart disease, hypertension), depressive symptoms (Center for Epidemiological Studies Depression Scale), and cognitive decline (decline of 1 standard deviation or more on the 35-point Telephone Interview for Cognitive Status over 2 years). At most waves (2002, 2004, and 2006) mortality was predicted by CVB, depressive symptoms, and cognitive drop measured 2 years prior. CVB and depressive symptoms at the 2000 wave predicted mortality at 6 and 8 years. Older women with the greatest longevity had low CVB, robust cognitive functioning, and few depression symptoms, supporting successful aging theory and terminal cognitive drop. 1. Introduction Rowe and Kahn [1] proposed criteria for successful aging comprised of avoidance of disease, maintenance of high cognitive and physical function, and sustained engagement in social and productive activities. This model grew from highly prolific MacArthur Foundation Study of Successful Aging, a $10 million, 10-year research effort led by Rowe and Kahn. The objectives of this study, and the theoretical framework that grew from it, are to better understand risk factors for decline and to inform prevention efforts. For instance, work drawn from this initiative concluded that pulmonary health relates to both gross motor and cognitive functioning in late life, suggesting this as an area for primary intervention in preserving late-life independence [2]. Drawing on the MacArthur Study data, Others have investigated modifiable risk factors for dementia, concluding that late-life depression may be a precursor of cognitive decline [3]. Still other work based in this study found that older adults who frequently felt useful to others had lower rates of disability and mortality than less-engaged elders, emphasizing the importance of social engagement and productive activities [4]. While support for this theory of successful aging has been mixed [5, 6], it provides a useful framework for examining longevity. This paper will examine whether the Rowe and Kahn successful aging variables are each independently related to longevity. In the current paper we chose to examine this theory in older old women over 80 years. Women constitute a majority of all
References
[1]
J. W. Rowe and R. L. Kahn, “Successful aging,” The Gerontologist, vol. 37, no. 4, pp. 433–440, 1997.
[2]
N. R. Cook, M. S. Albert, L. F. Berkman, D. Blazer, J. O. Taylor, and C. H. Hennekens, “Interrelationships of peak expiratory flow rate with physical and cognitive function in the elderly: MacArthur Foundation Studies of Aging,” Journals of Gerontology—Series A, vol. 50, no. 6, pp. M317–M323, 1995.
[3]
J. Chodosh, D. M. Kado, T. E. Seeman, and A. S. Karlamangla, “Depressive symptoms as a predictor of cognitive decline: MacArthur Studies of Successful Aging,” The American Journal of Geriatric Psychiatry, vol. 15, no. 5, pp. 406–415, 2007.
[4]
T. L. Gruenewald, A. S. Karlamangla, G. A. Greendale, B. H. Singer, and T. E. Seeman, “Feelings of usefulness to others, disability and mortality in older adults: the MacArthur Study of Successful Aging,” Journals of Gerontology—Series B, vol. 62, no. 1, pp. P28–P37, 2007.
[5]
W. J. Strawbridge, M. I. Wallhagen, and R. D. Cohen, “Successful aging and well-being: self-rated compared with Rowe and Kahn,” The Gerontologist, vol. 42, no. 6, pp. 727–733, 2002.
[6]
M. B. Holstein and M. Minkler, “Self, society and the ‘New Gerontology’,” The Gerontologist, vol. 43, no. 6, pp. 787–796, 2003.
[7]
S. Arber and H. Cooper, “Gender differences in health in later life: the new paradox?” Social Science and Medicine, vol. 48, no. 1, pp. 61–76, 1999.
[8]
A. L. Rosso, C. B. Eaton, R. Wallace, et al., “Combined impact of geriatric syndromes and cardiometabolic diseases on measures of functional impairment,” Journals of Gerontology—Series A, vol. 66, no. 3, pp. 349–354, 2011.
[9]
M. L. Bruce, T. E. Seeman, S. S. Merrill, and D. G. Blazer, “The impact of depressive symptomatology on physical disability: MacArthur Studies of Successful Aging,” The American Journal of Public Health, vol. 84, no. 11, pp. 1796–1799, 1994.
[10]
M. Hirvensalo, T. Rantanen, and E. Heikkinen, “Mobility difficulties and physical activity as predictors of mortality and loss of independence in the community-living older population,” Journal of the American Geriatrics Society, vol. 48, no. 5, pp. 493–498, 2000.
[11]
L. Flicker, “Cardiovascular risk factors, cerebrovascular disease burden and healthy brain aging,” Clinics in Geriatric Medicine, vol. 26, no. 1, pp. 17–27, 2010.
[12]
N. Raz, K. M. Rodrigue, and J. D. Acker, “Hypertension and the brain: vulnerability of the prefrontal regions and executive functions,” Behavioral Neuroscience, vol. 117, no. 6, pp. 1169–1180, 2003.
[13]
J. R. Sneed, D. Rindskopf, D. C. Steffens, K. R. Krishnan, and S. P. Roose, “The vascular depression subtype: evidence of internal validity,” Biological Psychiatry, vol. 64, no. 6, pp. 491–497, 2008.
[14]
C. E. Coffey, G. S. Figiel, W. T. Djang, and R. D. Weiner, “Subcortical hyperintensity on magnetic resonance imaging: a comparison of normal and depressed elderly subjects,” The American Journal of Psychiatry, vol. 147, no. 2, pp. 187–189, 1990.
[15]
A. H. Glassman and P. A. Shapiro, “Depression and the course of coronary artery disease,” The American Journal of Psychiatry, vol. 155, no. 1, pp. 4–11, 1998.
[16]
M. J. Bos, T. Lindén, P. J. Koudstaal et al., “Depressive symptoms and risk of stroke: the Rotterdam Study,” Journal of Neurology, Neurosurgery and Psychiatry, vol. 79, no. 9, pp. 997–1001, 2008.
[17]
S. L. Larson, P. L. Owens, D. Ford, and W. Eaton, “Depressive disorder, dysthymia and risk of stroke: thirteen-year follow-up from the Baltimore Epidemiologic Catchment Area Study,” Stroke, vol. 32, no. 9, pp. 1979–1983, 2001.
[18]
B. W. Penninx, J. M. Guralnik, M. Pahor et al., “Chronically depressed mood and cancer risk in older persons,” Journal of the National Cancer Institute, vol. 90, no. 24, pp. 1888–1893, 1998.
[19]
C. L. Arfken, P. A. Lichtenberg, and M. E. Tancer, “Cognitive impairment and depression predict mortality in medically ill older adults,” Journals of Gerontology—Series A, vol. 54, no. 3, pp. M152–M156, 1999.
[20]
K. M. Mehta, K. Yaffe, K. M. Langa, L. Sands, M. A. Whooley, and K. E. Covinsky, “Additive effects of cognitive function and depressive symptoms on mortality in elderly community-living adults,” Journals of Gerontology—Series A, vol. 58, no. 5, pp. 461–467, 2003.
[21]
K. E. Covinsky, E. Kahana, M. H. Chin, R. M. Palmer, R. H. Fortinsky, and C. S. Landefeld, “Depressive symptoms and 3-year mortality in older hospitalized medical patients,” Annals of Internal Medicine, vol. 130, no. 7, pp. 563–569, 1999.
[22]
B. W. Penninx, S. W. Geerlings, D. J. Deeg, J. T. van Eijk, W. van Tilburg, and A. T. Beekman, “Minor and major depression and the risk of death in older persons,” Archives of General Psychiatry, vol. 56, no. 10, pp. 889–895, 1999.
[23]
P. Missotten, G. Squelard, M. Ylieff et al., “Quality of life in older Belgian people: comparison between people with dementia, mild cognitive impairment and controls,” International Journal of Geriatric Psychiatry, vol. 23, no. 11, pp. 1103–1109, 2008.
[24]
K. F. Riegel and R. M. Riegel, “Development, drop and death,” Developmental Psychology, vol. 6, no. 2, pp. 306–319, 1972.
[25]
E. Palmore and W. Cleveland, “Aging, terminal decline and terminal drop,” Journals of Gerontology, vol. 31, no. 1, pp. 76–81, 1976.
[26]
H. B. Bosworth and I. C. Siegler, “Terminal change in cognitive function: an updated review of longitudinal studies,” Experimental Aging Research, vol. 28, no. 3, pp. 299–315, 2002.
[27]
M. F. Folstein, S. E. Folstein, and P. R. McHugh, “‘Mini-mental state’: a practical method for grading the cognitive state of patients for the clinician,” Journal of Psychiatric Research, vol. 12, no. 3, pp. 189–198, 1975.
[28]
K. Yaffe, K. Lindquist, E. Vittinghoff et al., “The effect of maintaining cognition on risk of sisability and death,” Journal of the American Geriatrics Society, vol. 58, no. 5, pp. 889–894, 2010.
[29]
R. S. Wilson, T. L. Beck, J. L. Bienias, and D. A. Bennett, “Terminal cognitive decline: accelerated loss of cognition in the last years of life,” Psychosomatic Medicine, vol. 69, no. 2, pp. 131–137, 2007.
[30]
K. M. Langa, E. B. Larson, J. H. Karlawish et al., “Trends in the prevalence and mortality of cognitive impairment in the United States: is there evidence of a compression of cognitive morbidity?” Alzheimer's and Dementia, vol. 4, no. 2, pp. 134–144, 2008.
[31]
B. T. Mast, B. Yochim, S. E. MacNeill, and P. A. Lichtenberg, “Risk factors for geriatric depression: the importance of executive functioning within the vascular depression hypothesis,” Journals of Gerontology—Series A, vol. 59, no. 12, pp. 1290–1294, 2004.
[32]
A. Bielak, D. Gerstorf, K. M. Kiely, K. J. Anstey, and M. Luszcz, “Depressive symptoms predict decline in perceptual speed in older adulthood,” Psychology and Aging. In press.
[33]
S. G. Heeringa and J. Conner, “Technical description of the Health and Retirement Study sample design,” HRS/AHEAD Documentation Report DR-002, University of Michigan, Ann Arbor, Mich, USA, 1995.
[34]
L. Radloff, “The CES-D Scale: a self-report depression scale for research in the general population,” Applied Psychological Measurement, vol. 1, no. 3, pp. 385–401, 1977.
[35]
D. E. Steffick, “Documentation of affective functioning measures in the Health and Retirement Study,” HRS Documentation Report DR-005, Survey Research Center at the Institute for Social Research, Ann Arbor, Mich, USA, 2000.
[36]
R. Wallace, A. R. Herzog, M. B. Ofstedal, et al., “Documentation of affective functioning measures in the Health and Retirement Study,” Tech. Rep., Survey Research Center, University of Michigan, Ann Arbor, Mich, USA, 2000.
[37]
A. T. F. Beekman, D. J. H. Deeg, J. Van Limbeek, A. W. Braam, M. Z. De Vries, and W. Van Tilburg, “Criterion validity of the Center for Epidemiologic Studies Depression scale (CES-D): results from a community-based sample of older subjects in the Netherlands,” Psychological Medicine, vol. 27, no. 1, pp. 231–235, 1997.
[38]
J. Brandt, M. Spencer, and M. Folstein, “The telephone interview for cognitive status,” Neuropsychiatry, Neuropsychology and Behavioral Neurology, vol. 1, no. 2, pp. 111–117, 1988.
[39]
A. R. Herzog and R. B. Wallace, “Measures of cognitive functioning in the AHEAD study,” Journals of Gerontology—Series B, vol. 52, special issue, pp. 37–48, 1997.
[40]
K. A. Welsh, J. C. S. Breitner, and K. M. Magruder-Habib, “Detection of dementia in the elderly using telephone screening of cognitive status,” Neuropsychiatry, Neuropsychology and Behavioral Neurology, vol. 6, no. 2, pp. 103–110, 1993.
[41]
D. W. Desmond, T. K. Tatemichi, and L. Hanzawa, “The telephone interview for cognitive status (TICS): reliability and validity in a stroke sample,” International Journal of Geriatric Psychiatry, vol. 9, no. 10, pp. 803–807, 1994.
[42]
T. J？rvenp？？, J. O. Rinne, I. R？ih？ et al., “Characteristics of two telephone screens for cognitive impairment,” Dementia and Geriatric Cognitive Disorders, vol. 13, no. 3, pp. 149–155, 2002.
[43]
C. L. Dahle, B. S. Jacobs, and N. Raz, “Aging, vascular risk and cognition: blood glucose, pulse pressure and cognitive performance in healthy adults,” Psychology and Aging, vol. 24, no. 1, pp. 154–162, 2009.
[44]
T. L. Bush, S. R. Miller, A. L. Golden, and W. E. Hale, “Self-report and medical record report agreement of selected medical conditions in the elderly,” The American Journal of Public Health, vol. 79, no. 11, pp. 1554–1556, 1989.
[45]
B. M. Psaty, L. H. Kuller, D. Bild et al., “Methods of assessing prevalent cardiovascular disease in the cardiovascular health study,” Annals of Epidemiology, vol. 5, no. 4, pp. 255–335, 1995.
