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

在全球，近1000万老年人被诊断为阿尔茨海默病和相关痴呆(ADRD) 每年。鉴于目前缺乏有效的药物治疗，以及全球在 在痴呆症护理方面，迫切需要确定人口层面的ADRDS预防和干预目标， 包括在家庭和社会层面。许多人群水平的ADRDS研究都集中在 个人的社会经济地位(SES)对晚年ADRDS风险的贡献。然而，在许多全球 背景下，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 晚年的资源。然而，很少有研究评估成年子女SES对父母的影响 ADRDS风险或ADRDS的结果。考虑到之前的文献表明，这是一个令人惊讶的被忽视的机会 成年子女的教育程度可能会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。这项拟议的研究的目标是严格地 评估成年儿童SES降低父母ADRDS风险并改善以下方面结果的潜力 全球设置中患有ADRDS的年长父母。我们还将评估一套全面的 经济和非经济途径，可能是观察到的关联的基础，并确定亚组 老年人可能从子女教育的改善中受益最大。我们建议 使用来自北美和中美洲20个国家的156,000多名成年人的人口水平队列数据， 亚洲和欧洲，以及类似的成人子女教育措施和关于候选调解人和 多级别修改器。这些全球数据将使我们获得优秀的外部有效性，这是单一的- 国家研究，我们将使用严格的观察方法分析主要影响和调解。 为了使内部有效性最大化，我们将使用准实验方法来验证观测估计 利用义务教育法律的变化作为“自然实验”来确定 增加成人子女教育对父母纵向认知结果的影响。我们聚集了一个 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 运用流行病学和计量经济学方法对人群层面的认知老化进行研究，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的影响， 痴呆症或认知障碍，以及老年父母在痴呆症发作后的结果，2)经济评估 以及观察到的成年子女SES与父母ADRDS风险之间的关联的非经济中介因素 结果，以及3)确定成年子女SES和SES之间关联的国内和跨国异质性 父母的ADRD风险和结果。我们的研究利用了国家投资公司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悬而未决的问题 成年子女SES对父母ADRDS风险和结局的影响。

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.