National Social Life, Health, and Aging Project: Rounds 4.2 and 4.4

国家社会生活，健康和老龄化项目（NSHAP）旨在研究老年人的社会，认知，心理和身体健康轨迹之间的联系，其中许多人将获得阿尔茨海默病和阿尔茨海默病相关痴呆症（AD/ADRD）。从2005-06年开始，NSHAP每隔5年收集一组丰富而独特的数据，包括关于社交网络、认知功能、心理健康、身体健康和AD/ADRD的临床诊断、药物、生物样本、感觉功能以及加速度计测量的日常活动和睡眠的详细信息。第四轮调查（R4）目前正在进行中，2023年完成后，将提供约3,500名60-100岁受访者的最新数据。 虽然NSHAP的5年周期在年轻人中可能是足够的，但在老年人中就不那么正确了，特别是在那些经历健康下降（包括AD/ADRD发作）的人中，因此快速变化和死亡的风险更高。我们建议增加NSHAP的研究设计，以便研究人员可以更详细地研究生命过程的这一部分。具体而言，我们将把使用R4数据确定的NSHAP受访者子集转换为每两年随访一次的死亡风险更大的人群。一个较小的，年龄匹配的低死亡风险对照组也将包括在内，所有黑人和西班牙裔受访者将包括在内，无论年龄或健康状况如何。为了最大限度地提高完整性和信息的分析价值，从受访者越来越差的身体和认知健康，包括阿尔茨海默氏病和阿尔茨海默氏病相关的痴呆症，我们将管理访谈有针对性的措施，以捕捉他们的社会，认知和身体健康和福祉的最新变化，并获得配偶，代理，和线人访谈时，需要加强受访者的数据。此外，我们建议增加新的措施，在文化上适应黑人和西班牙裔人口的独特经历。 该NSHAP子集和两年周期将允许研究健康关键方面变化的前因和后果，因为它们在人们的最后几年发生得更快，包括AD/ADRD、日常活动、睡眠、虚弱、多种药物和社会福祉，对于（1）与低风险相比，死亡风险高的人，以及（2）在此期间死亡的高风险人群与未死亡的高风险人群的比较。这种策略与生命终结研究中经常采用的策略不同，在生命终结研究中，对一组已故个体进行回顾性研究，从而得出以死亡为条件的结论。12相反，我们的方法将允许研究人员对目前活着的人的未来做出结论，包括AD/ADRD的发病和病程，并允许我们改进死亡率预测模型。 我们测试的总体假设，社会福利将调节死亡风险。在整个过程中，我们测试了相互竞争的假设，其中社会福祉的变化先于其他健康指标的变化，如阿尔茨海默病和阿尔茨海默病相关的痴呆症，这些疾病易导致早期死亡。

The National Social Life, Health, and Aging Project (NSHAP) is designed to study the links between social, cognitive, mental, and physical health trajectories among older adults, many of whom will acquire Alzheimer’s disease and Alzheimer’s disease-related dementias (AD/ADRD). Started in 2005–06, NSHAP collects a rich and unique set of data at 5-year intervals, including detailed information on social networks, cognitive function, mental health, clinical diagnoses of physical health and AD/ADRD, medications, biological samples, sensory function, and accelerometer-measured daily activity and sleep. Round 4 (R4) is currently underway and when completed in 2023, will provide updated data on ~3,500 respondents aged 60–100. While NSHAP’s 5-year cadence may be adequate at younger ages, this is less true at older ages, especially among those who are experiencing health declines including onset of AD/ADRD and are thus at higher risk of rapid changes and mortality. We propose to augment NSHAP’s study design so researchers can study this part of the lifecourse in more detail. Specifically, we shall transition a subset of NSHAP respondents identified using data through R4 as being at greater risk of mortality to being followed-up every two years. A smaller, age-matched control group at low risk of mortality will also be included and all Black and Hispanic respondents will be included regardless of age or health status. To maximize the completeness and analytic value of information from respondents in increasingly poor physical and cognitive health, including Alzheimer's disease and Alzheimer’s disease-related dementias, we shall administer interviews with targeted measures to capture recent changes in their social, cognitive, and physical health and well-being, and to obtain spousal, proxy, and informant interviews when needed to enhance respondent data. Further, we propose to add new measures that are culturally attuned to the unique experiences of Black and Hispanic populations. This NSHAP subset and a two-year periodicity will allow the study of the antecedents and consequences of changes in key dimensions of health as they occur more rapidly in people’s final years, including AD/ADRD, daily activity, sleep, frailty, polypharmacy, and social well-being, for (1) those at high risk of mortality as compared to those at lower risk, and for (2) those at high risk who die during the period compared to those at high risk who do not die. This strategy differs from that often taken by studies of end of life in which a group of deceased individuals is studied retrospectively, thereby yielding conclusions conditional on having died.12 In contrast, our approach will allow researchers to make conclusions about the future for those currently alive, including onset and course of AD/ADRD, as well as permit us to refine our mortality prediction models. We test the overarching hypothesis that social well-being will modulate mortality risk. Throughout, we test competing hypotheses in which changes in social well-being precede changes in other health indicators such as Alzheimer’s disease and Alzheimer’s disease-related dementias that predispose toward early mortality.