Wallace Gail, Bell Tyler R, Thorpe Roland J, Rebok George W
Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Johns Hopkins Alzheimer's Disease Resource Center for Minority Aging Research, Baltimore, MD, USA.
J Aging Health. 2025 Mar;37(3-4_suppl):91S-103S. doi: 10.1177/08982643241310997. Epub 2025 Mar 23.
ObjectiveThis study examines the longitudinal relationship between subjective memory problems (SMPs) and timed instrumental activity of daily living (IADL) performance while considering the effects of depressive symptoms and the moderating role of the social determinants of health (SDHs).MethodsData from 2622 older adults in the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) randomized control trial were analyzed longitudinally, spanning up to 10 years. SMPs and timed IADL performance were assessed at each wave. The SDHs were captured using validated factors incorporating US Census data and person-level data from the ACTIVE Study. Multilevel mixed models examined associations, adjusting for demographics and the effects of depressive symptoms.ResultsMore SMPs at baseline were associated with slower timed IADL performance which rapidly became slower over time. Those older adults who experienced SMPs as they aged also experienced declines in timed IADL. These associations were influenced by socially determined health outcomes such as neighborhood and built environment, healthcare access and quality, and social and community context. Living in a better neighborhood and built environment and having access to quality healthcare weakened relationships over time between baseline SMPs and slower timed IADL performance. Better healthcare access and quality weakened the association of increases in SMPs with the slowing of timed IADL. Contrary to our prediction, living in a better social and community context, which fostered social engagement and decreased social isolation, strengthened relationships over time between baseline SMPs and slower timed IADL performance as well as the association of increases in SMPs with slower timed IADL performance over time.DiscussionMore SMPs at baseline were significantly related to slower rates of timed IADL performance over time, especially in older adults living in worse neighborhoods and built environments as well as areas with better social and community contexts. Increases in SMPs as one aged were also related to the slowing of timed IADL performance, especially in older adults living in areas with worse healthcare access and quality. Finally, our study found that higher scores on SMPs were related to slower timed IADL performance-independent of major confounds such as depressive symptoms.
目的
本研究探讨主观记忆问题（SMPs）与计时日常生活工具性活动（IADL）表现之间的纵向关系，同时考虑抑郁症状的影响以及健康的社会决定因素（SDHs）的调节作用。
方法
对“独立和活力老年人高级认知训练”（ACTIVE）随机对照试验中2622名老年人的数据进行了长达10年的纵向分析。在每一波次中评估SMPs和计时IADL表现。使用纳入美国人口普查数据和ACTIVE研究中个人层面数据的经过验证的因素来获取SDHs。多级混合模型检验了相关性，并对人口统计学因素和抑郁症状的影响进行了调整。
结果
基线时更多的SMPs与计时IADL表现较慢相关，且随着时间的推移这种情况迅速加剧。那些随着年龄增长出现SMPs的老年人在计时IADL方面也出现了下降。这些关联受到社会决定的健康结果的影响，如邻里和建成环境、医疗保健的可及性和质量以及社会和社区背景。随着时间的推移，生活在更好的邻里和建成环境中以及能够获得高质量医疗保健会削弱基线SMPs与计时IADL表现较慢之间的关系。更好的医疗保健可及性和质量削弱了SMPs增加与计时IADL变慢之间的关联。与我们的预测相反，生活在更好的社会和社区背景中，这促进了社会参与并减少了社会孤立，随着时间的推移，加强了基线SMPs与计时IADL表现较慢之间的关系，以及SMPs增加与计时IADL表现随着时间变慢之间的关联。
讨论
基线时更多的SMPs与计时IADL表现随着时间推移的较慢速率显著相关，特别是在生活在较差邻里和建成环境以及具有较好社会和社区背景地区的老年人中。随着年龄增长SMPs的增加也与计时IADL表现变慢相关，特别是在生活在医疗保健可及性和质量较差地区的老年人中。最后，我们的研究发现，SMPs得分较高与计时IADL表现较慢相关——独立于诸如抑郁症状等主要混杂因素。
