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

残疾妇女的寿命比男子长，在接受日常活动援助的人口中所占比例过高。随着年龄的增长，认知能力下降（包括与年龄有关的轻度认知障碍、阿尔茨海默病和与阿尔茨海默病有关的痴呆症）、睡眠中断、泌尿生殖系统症状和活动受限越来越多地影响妇女的健康和福祉。关于老龄化的研究强调中年（40-65岁）是预防老年认知障碍、痴呆、阿尔茨海默病、身体残疾和多种疾病的关键生命阶段。在妇女中，中年包括更年期过渡（MT），其特征是妇女的内分泌环境发生重大变化，健康指标（例如，骨矿物质密度、血脂、炎症标志物）、家庭结构和社会角色的变化以及新的压力源，所有这些都会影响晚年的认知、功能和福祉。22年的全国妇女健康多中心研究（SWAN）是最全面的前瞻性研究，描述了MT的特征，并阐明了MT与不同种族/民族队列（黑人、中国人、西班牙裔、日本人和白色妇女）健康和认知、身体和心理社会功能众多领域变化之间的关系。此U19应用程序旨在评估中年健康和MT影响认知下降/轻度认知障碍和身体残疾风险的程度，或促进心理社会健康和成功老龄化。在SWAN综合中年评估的基础上，项目1将评估MT特征和MT/中年衰老相关健康指标变化对老年早期（66-75岁）多个功能领域的影响。本项目的具体目标是：1）评估中年健康指标的MT特征和轨迹对认知功能保护的影响（避免认知能力下降和轻度认知障碍的发生）、睡眠健康、泌尿生殖和性功能以及老年早期独立生活的能力; 2）评估MT特征和健康指标轨迹对老年早期心理健康和HRQL的影响; 3）确定在多大程度上，种族/民族健康差异的功能和福祉在老年早期归因于种族/民族差异的MT特征和中年健康轨迹;以及4）为妇女及其医疗保健提供者提供关于MT/中年健康与老年早期认知、功能和福祉关系的研究结果。整合项目，我们将研究认知，身体和心理社会功能与心血管健康和死亡率（项目2）和肌肉骨骼健康和福尔斯（项目3）的关联。这三个核心的资源对于拟议的数据收集、数据处理和分析至关重要。从项目1中获得的知识将有助于确定中年预防目标，以延迟或避免轻度认知障碍，保持功能，保持独立性，并优化老年早期的生活质量。

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.