Xiang Qi

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This study examines whether age-related cognitive decline varies by race/ethnicity and how edentulism moderates these effects. Data from the Health and Retirement Study (2006–2020), including 23,669 respondents aged 51 and above across 189,352 person-wave observations were analyzed. Of all respondents, 13.4% were edentulous at baseline, with 65.4% identified as non-Hispanic White, 20.5% non-Hispanic Black, and 14.18% Hispanic. Results from linear mixed-effect models indicated that compared to non-Hispanic Whites, Hispanic and non-Hispanic Black participants exhibited lower baseline cognition scores but slower cognitive decline with age. For edentulous Hispanic participants, this slower rate of decline was attenuated by 0.03 units per year (95% CI: −0.06, −0.01, p =.049). The findings highlighted the need for targeted interventions and policies to improve oral health, particularly for Hispanic populations. Addressing oral health disparities could help mitigate cognitive decline in this group and reduce cognitive health disparities across racial/ethnic groups.

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Introduction: This study examined oral health trends of older immigrants in the US from 1999 to 2018 and disparities between immigrants and non-immigrants across different races/ethnicities. Methods: Data were from the 1999–2018 National Health and Nutrition Survey (NHANES). Outcome variables were self-reported poor oral health and significant tooth loss (i.e., < 20 permanent teeth). Participants were categorized into three groups as US natives, naturalized citizens, or noncitizen residents. The analytical sample comprised 13,424 older adults (ages 60+), including 10,087 US natives, 2280 naturalized citizens, and 1057 noncitizen residents. We assessed the trends in poor oral health and significant tooth loss across the three groups and conducted analyses stratified by race/ethnicity to examine within-group disparities. Results: From 1999 to 2018, noncitizen residents consistently showed higher rates of poor oral health and significant tooth loss compared to US natives and naturalized citizens. Multiple logistic regression model results showed that naturalized citizens were less likely (AOR = 0.79, p = 0.03) to report poor oral health. Stratified analyses by racial/ethnic groups showed that among Blacks, naturalized citizens were less likely to report poor oral health (AOR = 0.59, p = 0.02) than Blacks who were born in the US. Conclusion: While overall oral health improved among older immigrants from 1999 to 2018, oral health disparities persisted, especially between noncitizen residents and US natives. There were significant differences in oral health between Black immigrants and their US-born counterparts. Future research is needed to corroborate these findings and monitor the trend of oral health disparities.

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The COVID-19 pandemic profoundly impacted population mental health worldwide. Few studies examined how the neighborhood environment and online social connections might influence the social gradient in mental health during the pandemic lockdown. We aim to examine the moderating and mediating role of neighborhood environment and online social connections in the association between socioeconomic status (SES) and mental health outcomes. We conducted a cross-sectional online survey of 3763 Shanghai residents during the COVID-19 lockdown between April 29 and June 1, 2022. Employing OLS linear regression analyses, our findings reveal that SES was negatively associated with depressive symptoms (B = 0.173, p < 0.001) and anxiety (B = 0.147, p < 0.001). The findings supported our hypotheses that this disparity in mental health was partially mediated by neighborhood social capital, community management, and the extent of online social connections measured by the frequency of social connection through the social media WeChat (all p < 0.05). Additionally, neighborhood social capital, community management, and online social connections also mitigated SES-driven mental health inequalities (all p < 0.05). The study underscores the significance of the neighborhood environment and online social interactions in amplifying SES-related mental health effects, offering valuable insights for urban planning and health equity strategies.

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Loneliness and social isolation affect more than 1 in 4 community-dwelling older adults in the United States, who may also require long-term care support. Despite being seen as a solution to the long-term care crisis, most older adults prefer to age in place rather than using skilled nursing facilities. However, in-home care is unsustainable due to a shortage of direct care workers and may exacerbate social isolation by confining older adults to their homes. Adult Day Services (ADS) addresses both issues. ADS provides care to adults with physical, functional, and or cognitive limitations in non-residential, congregate, community-based settings. ADS also provides daily cognitive and physical stimulation, often with medical support, in a social and supported environment, centered around the needs and preferences of participants. Before the COVID-19 pandemic, nearly 5,000 ADS centers were widely available. However, with limited public support, the ADS industry has struggled as demand by the growing number of older adults and families need health and social support. The ADS industry must be recognized for its unique ability to buffer social isolation and loneliness in chronically ill older adults while serving as an effective platform for chronic disease management. This perspective piece highlights the critical role of ADS centers in reducing loneliness and social isolation and promoting healthy equity. We also explore the benefits of ADS, the financial, policy, and societal barriers to utilizing ADS, and the potential solutions to ensure its sustainability and growth.

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Background While Type 2 Diabetes Mellitus (T2DM) prevalence is increasing among younger individuals, few studies have examined how age at T2DM diagnosis relates to dementia risk in diabetic populations. We aimed to investigate the association between age at T2DM diagnosis and subsequent dementia risk, and to determine whether obesity moderates this relationship. Methods We conducted a prospective cohort study using data from the Health and Retirement Study (2002–2016) matched with its 2003 Diabetes Mail-Out Survey. The study included 1,213 dementia-free adults aged ≥50 with diagnosed T2DM. Primary exposures were age at T2DM diagnosis (categorized as

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Aim: To evaluate the association between oral hygiene behaviour and cognitive decline in adults. The outcomes include changes in global cognitive function, visual attention, task switching and the risk of dementia. Design: We conducted a systematic review following the preferred reporting items for systematic reviews and meta-analyses guidelines. Data Sources: A systematic search of 11 databases and grey literature sources was conducted from inception to January 2024. We included interventional trials or cohort studies that investigated the effect of oral hygiene behaviours (e.g., toothbrushing, mouth washing, flossing, using toothpicks and cleaning dentures) on cognitive decline in adults. Methods: Data extraction and risk of bias assessment were performed by two independent reviewers with expertise in conducting systematic reviews. Meta-analyses were conducted using random-effects models, and heterogeneity was assessed with the I2 statistic and χ2 test. Results: A total of eight studies (six intervention studies and two cohort studies) met inclusion criteria, including 261,772 participants. Follow-up periods ranged from 30 days to 48 months for interventions and 9 to 18 years for cohorts. Toothbrushing was associated with a significantly slower decline in global cognitive overtime. Toothbrushing in older adults with moderate/severe dementia could achieve significant changes in cognitive decline. There was no significant difference between the effectiveness of toothbrushing performed by professionals and caregivers. Other oral hygiene behaviours, including dental flossing, using mouthwash, using toothpicks and cleaning dentures, were not associated with the risk of dementia. Conclusions: Toothbrushing is linked to a decreased risk of dementia and improved global cognitive function. Promoting toothbrushing at least twice daily may significantly reduce the risk of cognitive decline and dementia. Impact: These findings highlight the urgent need for programmes that encourage daily toothbrushing, particularly in nursing home settings and among older adults with moderate-to-severe dementia.

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Objective: Denture use has been shown to improve nutritional intake and diet quality in people with tooth loss. Despite evidence linking tooth loss and dementia, few studies have examined the association between denture use and cognitive decline. We investigated the relationship between denture use and cognitive decline among Chinese older adults with tooth loss. Methods: We analyzed data from the Chinese Longitudinal Healthy Longevity Survey 2008–2018, including 27,708 community-dwelling dentate and edentulous (i.e., who have lost all natural teeth) older adults aged 65 and older. Cognitive function was assessed using the Mini-Mental State Examination from 2008 to 2018. Linear mixed-effect models were employed to assess the association of denture use with baseline cognitive function and rate of cognitive decline, adjusting for sociodemographic characteristics, health-related behavior, and health status. Subgroup analyses evaluated differences in associations among dentate participants with varying degrees of tooth loss (1–9, 10–19, 20–31). Results: Compared to non-denture users, dentate participants who used dentures had better baseline cognitive function (β, 1.032; 95% CI, 0.813–1.251; p < 0.001) and a slower annual decline in cognitive function (β, 0.127; 95% CI, 0.047–0.206; p < 0.01). For edentulous participants, denture use was associated with higher baseline cognitive function (β, 3.063; 95% CI, 2.703–3.423; p < 0.001) but not with the rate of cognitive decline (β, 0.011; 95% CI, –0.082 to 0.105; p = 0.818). Results remained consistent across subgroups of dentate participants with various degrees of missing teeth. Conclusions: Denture use may help protect against cognitive decline in older adults with partial tooth loss. This study highlights the potential importance of prosthodontic rehabilitation in preserving cognitive health. Further research is needed to establish a causal relationship between denture use and cognitive function.

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Family members of Asian Americans (AAs) hold enormous potential as health changemakers to help combat the growing non-communicable disease burden in the community. To inform the development of impactful family-based interventions, there is a need to disentangle the mechanisms behind family influences on health. This study aims to deconstruct how interactivity and closeness mediate the association of age and acculturation with how much AA young adults perceive themselves to influence the health behaviors of family members. 502 AA young adults (48.0% East Asian, 20.9% South Asian, 23.1% Southeast Asian) were recruited in March 2021 to participate in an online survey on family interaction patterns, providing data on 944 unique dyadic family relationships. Associations between age, acculturation, interactivity (shared family activities, living proximity, and interaction frequency), closeness (family connectedness and interaction quality), and family health influence (reflecting influence on diet, exercise, sleep, stress, substance use, and relationship building) were evaluated through structural equation modeling. The final model displayed strong fit (CFI:0.956, RMSEA:0.081, SRMR:0.041), and revealed that an increase in closeness compared to interactivity corresponded with a greater increase in family health influence, with both completely mediating the association between age and family health influence. Acculturation was not associated with closeness, and its effect on family health influence was only partially mediated through interactivity. In subgroup analyses, neither interactivity nor closeness mediated the relationship between age and family health influence among South Asians (unlike East and Southeast Asians). Findings suggest the importance of targeting interactivity and closeness separately when developing AA family-based health interventions, and considering how the age and acculturation profile of AA young adults may shape these dynamics.