Regular Internet Use May Lower Dementia Risk in Older Adults

Older adults who use the internet regularly have nearly half the risk of dementia as adults with limited internet use, according to a report in the Journal of the American Geriatrics Society. The study also suggested that the more years of regular internet use, the more pronounced the dementia benefits become.

“Our findings show evidence of a digital divide in the cognitive health of older-age adults,” wrote Gawon Cho, B.A., B.B.A., Rebecca Betensky, Ph.D., and Virginia Chang, M.D., Ph.D., of New York University. The benefits of regular internet use did not vary based on race/ethnicity, sex, educational attainment, or generation. “Therefore, we did not find evidence that the internet has exacerbated socioeconomic disparities in the burden of dementia.”

Cho and colleagues used data from the Health and Retirement Study (HRS), an ongoing biennial survey of community-dwelling adults aged 50 years and older. Since 2002, HRS participants have been asked the following yes/no survey question: “Do you regularly use the World Wide Web, or the Internet, for sending and receiving e-mail or for any other purpose, such as making purchases, searching for information, or making travel reservations?” Based on participants’ baseline response to this question, they were divided into two groups: regular internet users or nonregular internet users.

The analysis by Cho and colleagues included 18,154 adults aged 50 to 64 who did not have dementia at baseline and who responded to at least one survey between 2002 and 2016. Participants were then followed until they stopped completing the HRS survey or they completed the 2018 HRS survey (the median follow-up period was about 8 years).

Overall, about 65% of participants considered themselves regular internet users at baseline, and most of these adults continued to report regular use of the internet during subsequent surveys. The researchers found that adults who used the internet regularly at baseline had a 43% reduced risk of dementia during the follow-up period. The benefits seemed to be cumulative; that is, for every survey period in which a participant reported regular internet use, dementia risk dropped by about 20%.

“Since a person’s online engagement may include a wide range of activities, future research may identify different patterns of internet usage associated with the cognitively healthy lifespan while being mindful of the potential side effects of excessive usage,” Cho and colleagues concluded.

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Past Incarceration Linked to Increased Mental Health Risk, Heavy Drinking in Older People

Past incarceration may raise the risk of cognitive impairment, mental health conditions, and heavy drinking in older people, a study published today in JAMA Network Open suggests.

Ilana R. Garcia-Grossman, M.D., of the University of California, San Francisco, and colleagues analyzed data from 13,462 community-dwelling adults aged 50 years or older who participated in the Health and Retirement Study (HRS) in 2012 or 2014. The HRS is a longitudinal survey of adults in which participants are asked about their economic, health, and psychosocial well-being. The participants were considered to have mental health conditions if they had been told by a physician that they have any emotional, nervous, or psychiatric problem. The participants were considered to have cognitive impairment if they had been told by a physician that they have Alzheimer disease, dementia, senility, or serious memory impairment. Garcia-Grossman and colleagues defined self-reported heavy alcohol use as drinking more than four alcoholic drinks daily.

Among the 13,462 participants, 946 (7.6%) reported having been incarcerated at some point in their lives. Those who had been incarcerated had a mean age of 62.4 years versus 66.7 years for those who had not been incarcerated and were more likely to be male, Black, or Latinx or in the lowest quartile of wealth (total assets and debts).

After adjusting for the participants’ age, sex, race and ethnicity, wealth, educational attainment, and uninsured status, the researchers found that those who had been incarcerated had an 80% higher risk of having cognitive impairment or a mental health condition and a 113% higher risk of heavy alcohol use than participants who had not been incarcerated. Participants who had been incarcerated also had a higher risk of having hearing impairment, chronic lung impairment, mobility impairment (for example, using a cane or walker), and impairment in activities of daily living (for example, difficulties taking medications and shopping for groceries).

“It is possible that people who experience incarceration have worse baseline health before they enter jail or prison that persists into older age following incarceration,” Garcia-Grossman and colleagues wrote. “Additionally, exposure to incarceration may exacerbate poor health outcomes through exposure to trauma and violence, acute and chronic stress from living in dehumanizing conditions, and/or variable access to healthy food, physical activity, and high-quality health care.”

The researchers added that it is also possible that incarceration has a negative impact on social determinants of health such as employment or housing.

“These findings suggest that attention to incarceration history may be valuable for understanding and mitigating health risks in older age,” the researchers concluded.

For related information, see the Psychiatric Services article “Mental Health in the Era of Mass Incarceration.”

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Volunteering May Boost Longevity, Mental Health in Adults Over 50

Volunteering at least two hours a week may increase longevity and improve mental health in adults over age 50, suggests a study in the American Journal of Preventive Medicine.

“The growing older adult population possesses a vast array of skills and experiences that can be leveraged for the greater good of society via volunteering,” wrote Eric S. Kim, Ph.D., of the Harvard T.H. Chan School of Public Health and colleagues. “[P]olicies and interventions aimed at encouraging more volunteering might be an innovative way of simultaneously enhancing society and fostering a trajectory of healthy aging.”

To arrive at their conclusion, the researchers studied data from approximately 13,000 participants in the Health and Retirement Study, a large, ongoing study of adults aged 50 years and older in the United States that began in 2006. Study researchers interview participants upon their enrollment, after which the participants complete a questionnaire about various aspects of their health. One question asks the participants whether they had spent any time in the previous 12 months doing volunteer work for religious, educational, health-related, or other charitable organizations, and if so, how much time the participants devote to their volunteer activities.

During the four-year follow-up, participants who volunteered 100 hours a year or more had a 44% lower risk of dying and a 17% lower risk of limitations in their physical functioning than those who did not volunteer. They also had higher positive affect, optimism, and sense of purpose in life and lower depressive symptoms, hopelessness, and loneliness than those who did not volunteer. There was no evidence that volunteering was associated with other outcomes such as the number of chronic conditions participants had or whether volunteering was associated with life satisfaction.

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Time for Action: APA to Hold Town Hall on Structural Racism

APA President Jeffrey Geller, M.D., M.P.H., will lead a webinar town hall on Monday, June 15, at 8 p.m. EDT with distinguished panelists on the topic of structural racism. Panelists include Danielle Hairston, M.D.; Thea James, M.D.; Ayana Jordan, M.D., Ph.D.; and Walter E. Wilson Jr., M.D., M.H.A. The discussion will be followed by a Q&A session with APA members about the way forward for our organization.

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Insomnia Symptoms, Sleep Medications Increase Risk of Falls in Seniors

The more insomnia symptoms an older adult reports, the greater their risk of future falls, according to a study published in the journal Sleep. This risk appears to be even greater in older adults who took physician-recommended sleep medications.

“Multiple insomnia complaints are common among older adults, and our findings suggest that investigating a single insomnia symptom may underestimate the impact of multiple co-existing insomnia symptoms on fall risk,” wrote Orfeu Buxton, Ph.D., and colleagues at the Pennsylvania State University Center for Healthy Aging.


Buxton and colleagues analyzed data from the 2006 through 2014 versions of the Health and Retirement Study (HRS), an ongoing national study that interviews older adults every two years on a variety of health and lifestyle topics. The HRS includes sleep-related questions such as whether the participants have trouble “falling asleep,” “waking up during the night,” “waking up too early and not being able to fall asleep again,” and “not feeling rested during the day.” The researchers compiled answers from participants aged 65 and older to create a composite insomnia score of 0-4 for each respondent. As part of the HRS interview, participants were also asked whether they had fallen since the previous assessment (last two years).

They found that a higher insomnia score correlated with a future risk of falling. Specifically, older adults were 5% more likely to report a fall for each insomnia symptom they had. In addition, adults who used physician-recommended sleep medications were approximately 34% more likely to report a fall at the survey two years later compared with adults who did not use sleep medications. Interestingly, nonphysician-recommended sleep medications showed no association with falls at follow up.

“It is … important for clinicians to screen older adults for the presence of insomnia and make a referral to a specialist in sleep disorders if needed,” Buxton and colleagues wrote. “CBT-I [cognitive-behavioral therapy for insomnia] has been found to be effective in treating insomnia among older adults and in sustaining the effects longer compared with sleep medications or other treatments … with potentially fewer side effects for falls.”

For related information, see the Psychiatric News article “Online CBT for Insomnia Offers Long-Term Benefit.”

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Chronic Pain May Accelerate Memory Decline, Study Reports

Older adults troubled by persistent pain may be at a greater risk of rapid memory decline, according to a study published today in JAMA Internal Medicine.

“Whereas it is known that chronic pain is associated with poorer cognitive performance in cross-sectional studies, this study newly demonstrates accelerated memory decline and increased probability of developing dementia year-on-year at a population level,” wrote Elizabeth Whitlock, M.D., of the University of California, San Francisco, and colleagues. 

Whitlock and colleagues analyzed data collected as part of the Health and Retirement Study (HRS)—a nationally representative cohort of community-dwelling older adults who undergo detailed in-person or telephone interviews every two years. The researchers focused on adults who were 62 years or older in 2000 and answered pain and cognition questions in 1998 and 2000; those reporting being “often troubled by moderate or severe pain” both years were classified as having “persistent pain.” Participants were followed until death, dropout, or evaluation in 2012.

Of the 10,065 adults included in the sample, 1,120 (10.9% of the weighted sample) reported persistent pain at baseline. Participants reporting persistent pain had more depressive symptoms, a greater prevalence of limitations in activities of daily living, and more comorbid medical conditions than those not experiencing pain. 

“Over time, participants with persistent pain experienced a 9.2% more rapid decline in memory score. This translated to a relative 11.8% to 15.9% increased risk of inability to manage medications or finances independently at the end of 10 years, compared with age-adjusted HRS peers,” Whitlock and colleagues wrote. Additionally, “population-level dementia probability increased 7.7% faster in those with persistent pain compared with those without.”

The authors concluded, “For the elderly, maintenance of cognition is crucial for quality of life and functional independence. … Elucidating the nature of the relationship between pain and cognitive decline is the first step toward developing strategies to mitigate it.”

For related information, see the Psychiatric News article “New Dementia Measures Address Disclosure of Diagnosis to Patients.”

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Dementia Prevalence in United States Falls From 2000 to 2012, Report Finds

Between 2000 and 2012, the proportion of U.S. adults 65 and older with dementia decreased significantly, from 11.6% to 8.8%, reported a study published today in JAMA Internal Medicine. Dementia rates fell even as obesity, diabetes, and hypertension—cardiovascular risk factors believed to increase dementia risk—went up.

In addition to helping experts to better estimate the future societal impact of dementia, continuing to monitor dementia trends could one day lead to a better understanding of potential protective and risk factors for cognitive decline.

While recent studies have suggested that the age-specific risk of dementia may be declining in several high-income countries, this is the first study to provide this evidence in a nationally representative population. 

Kenneth M. Langa, M.D., Ph.D., and colleagues at the University of Michigan Medical School, analyzed data from the Health and Retirement Study—a nationally representative longitudinal survey of U.S. adults (65 years or older) that collects data on health, cognition, family, employment, and wealth. The sample included about 10,500 people from the 2000 and 2012 waves of the survey, and about 4,000 participants were featured in both the 2000 and 2012 datasets.

The study revealed that as dementia rates fell from 11.6% in 2000 to 8.8% in 2012, educational attainment increased significantly, with those 65 years or older in 2012 having nearly one additional year of education compared with the 2000 cohort. More years of formal education were associated with a lower risk for dementia. 

“Our study, along with prior studies, supports the notion that ‘cognitive reserve’ resulting from early-life and lifelong education and cognitive stimulation may be a potent strategy for the primary prevention of dementia in both high- and low-income countries around the world,” wrote the study authors. “However, it should be noted that the relationships among education, brain biology, and cognitive function are complex and likely multidirectional.”

The authors also noted that while rates of cardiovascular risk factors have gone up since 2000, treatments for cardiovascular disease have improved, which may contribute to the reduced dementia incidence.

For more information, see the Psychiatric News article “Framingham Study Suggests Dementia Rates May Be Falling” and the AJP article “Computerized Cognitive Training in Older Adults With Mild Cognitive Impairment or Dementia: A Systematic Review and Meta-Analysis.”

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