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

妇女残疾的寿命比男子长，在接受日常活动援助的人口中占不成比例的比例。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限制日益影响妇女的健康和福祉。老龄化研究强调，中年（40-65岁）是预防老年认知功能障碍、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），其特点是妇女内分泌环境发生重大变化，健康指标发生变化（例如，骨密度、脂质、炎症标志物），家庭结构和社会角色发生变化，以及新的压力源，所有这些都可能影响晚年的认知、功能和福祉。为期22年的全国妇女健康多站点研究（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，西班牙裔，日本和白人妇女）中健康和认知，身体和心理社会功能的许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影响认知能力下降/轻度认知障碍和身体残疾风险的程度，或促进社会心理健康和成功老龄化。基于SWAN的全面中年评估，项目1将评估早期老年（66-75岁）MT特征和MT/中年老龄化相关健康指标变化对多个功能领域的影响。本项目的具体目的是：1)评估中年健康指标的MT特征和轨迹对老年早期认知功能（避免认知衰退和轻度认知障碍的发生）、睡眠健康、泌尿生殖功能和性功能、独立生活能力的影响；2)评估MT特征和健康指标轨迹对老年早期心理健康和HRQL保持的影响；3)确定早期老年功能和幸福感的种族/民族健康差异在多大程度上归因于MT特征和中年健康轨迹的种族/民族差异；4)为妇女及其医疗保健提供者翻译关于MT/中年健康与早期老年认知、功能和幸福感之间关系的研究结果。综合各个项目，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）以及与肌肉骨骼健康和跌倒（项目3）的关系。三个核心的资源对于所提出的数据收集、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，以延缓或避免轻度认知障碍，保持功能，保持独立性，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.