The contribution of adult child socio-economic status to parents' risk and outcomes of Alzheimer's disease and related dementias (ADRDs) in cross-national settings

跨国环境中成年子女社会经济地位对父母罹患阿尔茨海默病和相关痴呆 (ADRD) 的风险和结果的影响

• 批准号: 10361136
• 负责人: Jacqueline Marie Torres
• 金额: $ 74.31万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-02-01 至 2027-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10361136
• 关键词: Adult; Adult Children; Aging; Alzheimer' s disease related dementia; Alzheimer' s disease risk; Asia; Behavioral; Central America; Characteristics; Child; Cognitive; Cognitive aging; Cohort Studies; Complement; Country; Data; Dementia; Diagnosis; Disadvantaged; Economics; Education; Educational Status; Elderly; Epidemiology; Europe; Family; Family Sizes; Future; Gender; Goals; Health; Health behavior; Heterogeneity; Impaired cognition; Individual; Intervention; Investments; Laws; Light; Literature; Longevity; Measures; Mediation; Mediator of activation protein; Mental Health; Methodology; Methods; National Institute on Aging; Natural experiment; North America; Outcome; Parents; Pathway interactions; Personal Satisfaction; Pharmacological Treatment; Physical Function; Play; Population; Population Research; Prevention; Quasi-experiment; Research; Resources; Respondent; Risk; Schools; Social Policies; Socioeconomic Status; Subgroup; Testing; Variant; base; cognitive impairment no dementia; cohort; data harmonization; dementia care; dementia risk; econometrics; family structure; health care availability; improved; improved outcome; modifiable risk; mortality; mortality risk; parental influence; physical conditioning; psychologic; psychosocial; residence; rural residence; socioeconomics; theories; welfare

Globally, nearly 10 million older adults are diagnosed with Alzheimer’s disease and related dementias (ADRDs) each year. Given the current absence of effective pharmacological treatments, along with global disparities in dementia care, there is an urgent need to identify population-level targets of ADRDs prevention and intervention, including at the family and societal level. Much of the population-level ADRDs research focuses on the contributions of one’s own socio-economic status (SES) to later life ADRDs risk. However, in many global settings, the SES of adult children may be a critical driver of parents’ economic, informational, and behavioral resources in late life. Nevertheless, very little research has evaluated the impact of adult child SES on parents’ ADRDs risk or outcomes of ADRDs. This is a surprisingly overlooked opportunity given prior literature suggesting that adult child educational attainment may influence parents’ physical and mental health and mortality outcomes, independent of parents’ own education. The objective of this proposed study is to rigorously evaluate the potential for adult child SES to reduce parental ADRDs risk and improve outcomes among older parents with ADRDs in global settings. We will additionally evaluate a comprehensive set of economic and non-economic pathways that may underlie observed associations and identify subgroups of older adults who may benefit most from improvements to their children’s education. We propose to use population-level cohort data on over 156,000 adults representing 20 countries in North and Central America, Asia, and Europe, and with similar measures of adult child education and rich data on candidate mediators and multi-level modifiers. These global data will allow us to achieve excellent external validity not possible with single- country studies, and we will use rigorous observational approaches for analyses of main effects and mediation. To maximize internal validity, we will validate observational estimates with a quasi-experimental approach that leverages changes to compulsory schooling laws as “natural experiments” to identify the causal effect of increases to adult child education on parents’ longitudinal cognitive outcomes. We have gathered an interdisciplinary team with deep expertise in these global aging cohort data and the application of rigorous epidemiologic and econometric methods to population-level research on cognitive aging to carry out the following Specific Aims: 1) Quantify the influence of adult child SES on older parents’ cognitive decline, risk of probable dementia or cognitive impairment, and outcomes for older parents after dementia onset, 2) Evaluate economic and non-economic mediators of observed associations between adult child SES and parents’ ADRDs risk and outcomes, and 3) Identify within and cross-country heterogeneity in the association between adult child SES and parents’ ADRD risk and outcomes. Our study makes use of the over 20 years of investment of the National Institute on Aging in global aging cohort studies to evaluate largely unanswered questions regarding the influence of adult child SES on parents’ ADRDs risk and outcomes.

全球有近 1000 万老年人被诊断患有阿尔茨海默病和相关痴呆症 (ADRD) 鉴于目前缺乏有效的药物治疗，以及全球的差异。 痴呆症护理，迫切需要确定 ADRD 预防和干预的人口层面目标， 包括家庭和社会层面的大部分人口层面的ADRDs研究都集中在ADRDs上。 然而，在全球许多地区，一个人自己的社会经济地位（SES）对晚年 ADRD 风险的影响。 在不同的环境中，成年子女的社会经济地位可能是父母经济、信息和行为的关键驱动因素 然而，很少有研究评估成年子女社会经济地位对父母的影响。 鉴于先前的文献表明，ADRD 的风险或 ADRD 的结果令人惊讶地被忽视了。 成年子女受教育程度可能影响父母的身心健康和死亡率 结果，独立于父母自己的教育。这项研究的目的是严格地 评估成年子女 SES 降低父母 ADRD 风险并改善儿童结局的潜力 我们还将评估全球范围内患有 ADRD 的老年父母。 可能构成观察到的关联并确定亚组的经济和非经济路径 我们建议，可能从改善子女教育中受益最多的老年人。 使用代表北美和中美洲 20 个国家的超过 156,000 名成年人的人口水平队列数据， 亚洲和欧洲，在成年子女教育方面有类似的衡量标准，并且有关于候选调解员的丰富数据 这些全局数据将使我们能够实现单级修饰无法实现的出色外部有效性。 国家研究，我们将使用严格的观察方法来分析主要效应和中介作用。 为了最大限度地提高内部有效性，我们将使用准实验方法验证观察估计， 利用义务教育法的变化作为“自然实验”来确定以下因素的因果影响 增加成年子女教育对父母纵向认知结果的影响。 跨学科团队在这些全球老龄化队列数据方面拥有深厚的专业知识，并应用严格的方法 流行病学和计量经济学方法以人群水平的认知老化研究开展以下工作 具体目标： 1) 量化成年子女 SES 对年长父母认知能力下降、可能的风险的影响 痴呆或认知障碍，以及老年父母在痴呆发作后的结果，2) 评估经济学 成年子女 SES 与父母 ADRD 风险和观察到的关联的非经济中介因素 3) 确定成年儿童社会经济地位与国家之间关系的国内和跨国异质性 我们的研究利用了国家 20 多年的投资。 老龄化研究所在全球老龄化队列研究中评估有关影响的大部分尚未解答的问题 成年子女 SES 对父母 ADRD 风险和结果的影响。