Project 1: Influence of Midlife on Functioning and Psychological Well-being in Early Old Age

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Women live longer with disability than men and constitute a disproportionate share of the population receiving assistance with daily activities. Cognitive decline (including age-related mild cognitive impairment, Alzheimer’s disease and Alzheimer’s disease related dementia), disrupted sleep, genitourinary symptoms and activity limitations increasingly affect women’s health and well-being as they age. Studies on aging highlight the midlife (age 40-65 years) as a critical life stage for prevention of cognitive impairment, dementia, Alzheimer’s disease, physical disability and multi-morbidity in old age. In women, the midlife encompasses the menopause transition (MT), characterized by significant changes in women’s endocrine environment, alterations in health indicators (e.g., bone mineral density, lipids, inflammatory markers), changes in family structure and social roles, and new stressors, all of which can affect cognition, functioning and well-being in later life. The 22-year multi-site Study of Women’s Health Across the Nation (SWAN) is the most comprehensive prospective study describing characteristics of the MT and elucidating relationships between the MT and change in numerous domains of health and cognitive, physical and psychosocial function in a diverse racial/ethnic cohort (Black, Chinese, Hispanic, Japanese and White women). This U19 application is designed to assess the extent to which midlife health and the MT affect risk for cognitive decline/mild cognitive impairment and physical disability, or promote psychosocial well-being and successful aging. Building on SWAN’s comprehensive midlife assessments, Project 1 will evaluate the impact of MT characteristics and MT/midlife-aging-related changes in health indicators on multiple domains of functioning in early old age (ages 66-75 years). Specific Aims of this Project are to: 1) Evaluate the impact of MT characteristics and trajectories of midlife health indicators on preservation of cognitive function (avoiding cognitive decline and onset of mild cognitive impairment), sleep health, genitourinary and sexual function, and ability for independent living in early old age; 2) Evaluate the impact of MT characteristics and trajectories of health indicators on the preservation of psychological well-being and HRQL in early old age; 3) Determine the extent to which racial/ethnic health disparities in functioning and well-being in early old age are attributable to racial/ethnic differences in MT characteristics and midlife health trajectories; and 4) Translate for women and their health care providers findings regarding the relation of the MT/midlife health to cognition, functioning and well-being in early-old age. Integrating across Projects, we will examine associations of cognitive, physical and psychosocial functioning with cardiovascular health and mortality (Project 2) and with musculoskeletal health and falls (Project 3). Resources of the three Cores are essential to the data collection, data processing and analyses proposed. Knowledge gained from Project 1 will facilitate identification of midlife prevention targets to delay or avoid mild cognitive impairment, preserve functioning, maintain independence, and optimize quality of life in early old age.