Anxiety, Stressful Life Events, and Physical Health in Older Adults

描述（由申请人提供）：拟议项目的总体目标是了解晚年焦虑，压力性生活事件（SLE）和身体健康之间的关系。尽管焦虑障碍在老年人中比情感性障碍更为普遍，但对老年人焦虑的研究却很少。在成年人中，焦虑与高患病率、残疾、过度使用医疗保健和生活质量差有关。人们对焦虑对老年人身体健康的影响知之甚少。本研究旨在(1)了解晚年焦虑、SLE和躯体疾病的时间关联；(2)测试焦虑和SLE是否会增加老年人的死亡风险；(3)了解这些过程背后的遗传和环境影响。这项研究将从一个大规模的人口双胞胎登记处抽取分开抚养和一起抚养的双胞胎样本。在20年的时间里，通过8次问卷调查收集了焦虑、SLE和身体健康的自我报告数据；与国家登记处的联系将进一步提供关于住院记录和死亡率的数据。时间关联将检验与潜在差异评分（LDS）结构方程模型。与常用的交叉滞后模型或生长曲线模型相比，LDS模型允许我们评估焦虑和SLE的增加（相对于平均水平）是否预示着身体疾病的晚发，反之亦然。在调整潜在协变量后，计算焦虑和压力生活事件导致的死亡风险将与生存分析一起进行。分析将在表型和基因型水平上进行，以估计焦虑和SLE对疾病和死亡率的影响

DESCRIPTION (provided by applicant): The broad objective of the proposed project is to understand the association of anxiety, stressful life events (SLE), and physical health in late life. Little research has been conducted on anxiety in older adults, although anxiety disorders are more prevalent than affective disorders in this age group. Among adults, anxiety is associated with high prevalence of illness, disability, excessive health care usage and poor quality of life. Less is known about the impact of anxiety on the physical health of older adults. The proposed research aims at (1) understanding the temporal association of anxiety, SLE, and physical illness in late life; (2) testing whether anxiety and SLE increase the risk of death in older adults; and (3) understanding genetic and environmental influences underlying these processes. The study will draw from a sample of reared-apart and reared-together twins from a large scale population twin registry. Self-report data on anxiety, SLE and physical health were collected through questionnaires at 8 occasions over a 20-year period; linkage to national registries will further provide data on hospitalization records and mortality. Temporal association will be examined with latent difference score (LDS) structural equation models. Compared to the commonly used cross-lagged or growth curve models, LDS models allow us to evaluate whether increases in (versus mean levels of) anxiety and SLE are predictive of later onset of physical illness, and vice versa. Calculation of mortality risk due to anxiety and stressful life events after adjusting for potential covariates will be performed with survival analysis. Analyses will be performed at both phenotypic and genotypic levels to estimate the effects of anxiety and SLE on illness and mortality after partialling genetic influences. This project directly addresses the research priorities stated by the National Institute on Aging and the Healthy People 2010 initiative: understanding late-life anxiety and its impact on morbidity and mortality are necessarily to improve prevention, diagnosis and intervention of these comorbid conditions. Prevention, diagnosis and intervention efforts can in turn prolong active life and health expectancies in older adults, and reduce unnecessarily costs due to excessive service utilization, medications and impairment in the later half of life.