How Does Surviving War Age the Body and Mind? An Analysis of - - PowerPoint PPT Presentation

VHAS

How Does Surviving War Age the Body and Mind? An Analysis of Subjective Age in Vietnam

Kim Korinek, University of Utah Jefferson Schmidt, University of Utah Eleanor Brindle, University of Washington Tran Khanh Toan, Hanoi Medical University Yvette Young, University of Utah Zachary Zimmer, Mount Saint Vincent University

This research was supported by the National Institutes of Health/National Institute on Aging (R01AG052537)

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Background: Biological, Social and Contextual Underpinnings of Subjective Age

• Recent research advances biomedical perspective on SA

– Older S SA correlates with lower grip strength, lower PEF, higher waist circumference, higher Albumin, Cystatin C1,2,3,4 – Younger S SA correlates with faster gait speed, higher ADL/IADL functioning; and lower levels of C-reactive protein, Cystatin C5,6

• Few studies of SA in non-western or LMICs, where often uniquely adverse contexts

affect aging

– China studies7,8,9; Israeli veteran studies10,11,12

• Interpreting SA: intersection of life course, social context, & biology

– Past research: stress exposure in SA-inflammation association6; ageism & SA2 – Famine, war stress, military service à psychosocial & biological correlates of SA

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Dependent Variable

“I know that you are currently__ years old. People sometimes feel younger or older than their age. Do you feel younger, older

• r about your age?”

13 42 45 5 10 15 20 25 30 35 40 45 50

Younger than Chron Age Same as Chron Age Older than Chron Age

%

Subjective Age in VHAS Sample

(N=306) (N=986) (N=1057)

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Dependent Variable

“I know that you are currently__ years old. People sometimes feel younger or older than their age. Do you feel younger, older

• r about your age?”

(N=306) (N=986) (N=1057)

13 42 45 74.9 14.3 10.8 10 20 30 40 50 60 70 80

Younger than Chron Age Same as Chron Age Older than Chron Age %

Subjective Age in VHAS & HRS Samples

VHAS, 2018 HRS, 2016

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Hypotheses

1.Subjective age will be INCREASED among individuals with greater exposure to wartime stressors during their early adulthood. 2.Individuals with biomarkers and self-assessed outcomes indicative of poor functional and physical health will perceive their subjective age as OLDER than their chronological age; 3.Indicators of nutritional deficiency, as indicated by periods of severe hunger in childhood, low hematocrit & underweight BMI, will correlate will OLDER SA

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Vietnam H Health & & A Aging Study, 2 2018

• N=2,447 adults age 60+
• Omnibus survey; dimensions of

war stressors, health, aging11

• ‘American War’ cohort
• Multi-stage probability sampling

in 4 purposively selected districts;

• Biomarker data

– Collected by HMU staff in 12 CHCs – Anthropometrics – Hair sample – cortisol – Finger prick capillary blood sample; CBC & A1c by POCTs, stored samples for ELISA & multiplex assays

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Key Covariates

Biomarkers & & S Self-re reported H Health

Mean Std Dev ADL Limitations (0-5) 0.92 1.68 Chronic Conditions (0-8) 1.72 1.23 Peak Expiratory Flow (L/min; max of 3) 288.3 98.9 Grip Strength – avg of 2 tests on each (kg) 20.54 8.17 Calf Circumference (cm) 30.04 3.35 BMI 21.68 3.09 Waist-height ratio 0.51 0.06 Hematocrit %tile (assessed by QBC Star centrifugal hematology system) 41.87 4.26

Earl rly L Life & & W War S r Stre ress E Exposure res

Mean/% Std Dev

Severe Childhood Hunger – once or multiple episodes of 1+ months (%) 46.0

• Served in formal military

26.1

• Served in militia

40.3

• Wartime Combat/Death Index (0-11)

2.6 3.2 Wartime Malevolent Environment Index (0-5) 1.4 1.5

Recent P Psychological D Distre ress

Mean/% Std Dev

• Psych. Distress Score (SRQ) (0-7)

2.02 1.79 Distressing Life Events within past 2-3 years (0-5) 0.89 1.01

Crosstabs: Severe childhood hunger, by sex, and health/biomarker covariates

ADLS PEF Grip Strength Calf Circ. BMI

Crosstabs: Wartime malevolent environment exposures, by sex, and health/biomarker covariates

ADLS PEF Grip Strength Calf Circ.

• Chron. Conds.

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Analytical approach

Survey-adjusted multinomial logistic regression; adjusted for commune- level clustering Outcome variable: Subjective Age (SA) Feeling Older vs. Feeling about the same as chronological age Feeling younger vs. Feeling about the same as chronological age Independent variable groups: Early life stress exposures Biomarkers & self-assessed health outcomes Psychological distress Control variables: chronological age, sex, educational attainment, main occupation, marital status, district of residence

Analytical N = 2,126 (proxies & missing data; missing coded as ‘9’ in categorical variable where feasible)

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Multinomial Logit – Feeling older than CA

(RRRs, ref: Feeling One’s CA)

0.4 0.6 0.8 1 1.2 1.4 1.6

Relative Risk Ratio (RRR) Severe Childhood Hunger - Mult times (vs None) # Malevolent Environ Stressors Served in Formal Military (vs No Mil Service) t * *** n.s. n.s. n.s. n.s. n.s. n.s. * ** *

Life Course Stress Covariates (w/ Sociodemog. Controls) Life Course Stress + HEALTH/BIO Covariates (w/ Sociodemog. Controls) Life Course Stress + PSYCH DISTRESS Covariates (w/

• Sociodemog. Controls)

Full Model

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0.4 0.6 0.8 1 1.2 1.4 1.6

# ADLS # Chron Conds Calf Circ - Below Threshold BMI - Underweight WHR-Ab Adiposity

* n.s. n.s.

Multinomial Logit – Feeling older than CA

(RRRs, ref: Feeling One’s CA)

** ** ** ** ** *** *** * * * * * *

Life Course Stress + HEALTH/BIO Covariates (w/ Sociodemog. Controls) Life Course Stress + PSYCH DISTRESS Covariates (w/ Sociodemog. Controls) Full Model

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Multinomial Logit – Feeling younger than CA

(RRRs, ref: Feeling One’s CA)

0.4 0.5 0.6 0.7 0.8 0.9 1 1.1 1.2 1.3 1.4

Relative Risk Ratio (RRR) Severe Childhood Hunger - One (vs None) # Combat/Death Stress Exposures

n.s. n.s.

* * * * * *

Life Course Stress Covariates (w/ Sociodemog. Controls) Life Course Stress + HEALTH/BIO Covariates (w/ Sociodemog. Controls) Life Course Stress + PSYCH DISTRESS Covariates (w/

• Sociodemog. Controls)

Full Model

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0.4 0.6 0.8 1 1.2 1.4 1.6 Relative Risk Ratio (RRR)

Grip Strength - weakest quartile Underweight BMI Hematocrit %tile

*

Multinomial Logit – Feeling younger than CA

(RRRs, ref: Feeling One’s CA)

n.s. * * * * * * * *

Life Course Stress + HEALTH/BIO Covariates (w/ Sociodemog. Controls) Life Course Stress + PSYCH DISTRESS Covariates (w/ Sociodemog. Controls) Full Model

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Discussion

• Undernutrition (childhood

hunger, low Hct, underweight) à feeling older

• Malevolent war environment

stressors ‘age’ survivors

• Military veterans & combat-

stressed: more youthful SA – survivor ‘resilience’ &/or benefits of military service?

• Biomarkers of aging/frailty

correlate with older SA – Life course stressors partially expressed through biomarkers

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Limitations

– Selective survival influences observed associations between war stress exposure & aging, including subjective age – Limited ability to assess inflammation & other biological processes linking stress exposure & SA; additional biomarkers in stored blood will paint a fuller picture – Categorical measure of subjective age along a singular dimension

Looking a ahead

– One of many cross-sectional studies; modeling techniques & Wave II data to assess bi-directionality, longitudinal associations

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References

1. Demakakos, P., Gjonca, E., & Nazroo, J. (2007). Age identity, age perceptions, and health: Evidence from the English Longitudinal Study of

• Ageing. Annals of the New York Academy of Sciences, 1114(1), 279-287.

2. Stephan, Y., Sutin, A. R., & Terracciano, A. (2015). How Old Do You Feel? The Role of Age Discrimination and Biological Aging in Subjective Age. PLOS ONE, 10(3), e0119293. 3. Stephan, Y., Sutin, A. R., & Terracciano, A. (2019). Subjective Age and Cystatin C Among Older Adults. The Journals of Gerontology: Series B, 74(3), 382–388. 4. Thyagarajan, B., Shippee, N., Parsons, H., Vivek, S., Crimmins, E., Faul, J., & Shippee, T. (2019). How Does Subjective Age Get “Under the Skin”? The Association Between Biomarkers and Feeling Older or Younger Than One’s Age: The Health and Retirement Study. Innovation in Aging, 3(4), igz035. 5. Liang, K. (2014). The cross-domain correlates of subjective age in Chinese oldest-old. Aging & Mental Health, 18(2), 217–224. 6. Stephan, Y., Sutin, A. R., & Terracciano, A. (2015). Younger subjective age is associated with lower C-reactive protein among older adults. Brain, Behavior, and Immunity, 43, 33-36. 7. Du, P., & Wu, X. L. (2008). Du, P., and X. L. Wu. "Zhong guo lao nian ren shen fen ren tong de shi zheng yan jiu [An Empirical Study of Age Identity Among Chinese Older People]. Population Research, 32(2), 67–72. 8. Ying, B., & Yao, R. (2010). Self-perceived Age and Attitudes Toward Marketing of Older Consumers in China. Journal of Family and Economic Issues, 31(3), 318–327. 9. Solomon, Z., Helvitz, H., & Zerach, G. (2009). Subjective age, PTSD and physical health among war veterans. Aging & Mental Health, 13(3), 405– 413. 10. Avidor, S., Palgi, Y., & Solomon, Z. (2017). Lower subjective life expectancy in later life is a risk factor for posttraumatic stress symptoms among trauma survivors. Psychological Trauma: Theory, Research, Practice, and Policy, 9(2), 198–206. https://doi.org/10.1037/tra0000182 11. Avidor, S., Levin, Y., & Solomon, Z. (2018). Guilt as a mediator between depressive symptoms and subjective age: A 17-year longitudinal study of Israeli ex-prisoners of war. American Journal of Orthopsychiatry, 88(2), 199. 12. Korinek, K., Teerawichitchainan, B., Zimmer, Z., Brindle, E., Nguyen, T. K. C., Nguyen, H. M., & Tran, K. T. (2019). Design and measurement in a study of war exposure, health, and aging: protocol for the Vietnam health and aging study. BMC public health, 19(1), 1-11.

Questions?

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