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Published in: Journal of General Internal Medicine 8/2016

01-08-2016 | Original Research

Social Function and Cognitive Status: Results from a US Nationally Representative Survey of Older Adults

Authors: Ashwin A. Kotwal, M.D., M.S., Juyeon Kim, Ph.D., Linda Waite, Ph.D., William Dale, M.D., Ph.D.

Published in: Journal of General Internal Medicine | Issue 8/2016

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ABSTRACT

BACKGROUND

An early sign of cognitive decline in older adults is often a disruption in social function, but our understanding of this association is limited.

OBJECTIVE

We aimed to determine whether those screening positive for early stages of cognitive impairment have differences across multiple dimensions of social function and whether associations differ by gender.

DESIGN

United States nationally representative cohort (2010), the National Social life, Health, and Aging Project (NSHAP).

PARTICIPANTS

Community-dwelling adults aged 62–90 years (N = 3,310) with a response rate of 76.9 %.

MAIN MEASURES

Cognition was measured using a survey adaptation of the Montreal Cognitive Assessment categorized into three groups: normal, mild cognitive impairment (MCI), and dementia. We measured three domains of social relationships, each comprised of two scales: network structure (size and density), social resources (social support and social strain), and social engagement (community involvement and socializing). We used multiple linear regression to characterize the relationship of each social relationship measure to cognition.

KEY RESULTS

Individuals screened as at risk for MCI and early dementia had smaller network sizes by 0.3 and 0.6 individuals (p < 0.001), and a 10 % and 25 % increase in network density (p < 0.001), respectively. For social resources, individuals at risk for MCI and dementia had 4 % and 14 % less social strain (p = 0.01), but only women had 3 % and 6 % less perceived social support (p = 0.013), respectively. For social engagement, individuals screened positive for MCI and dementia had 8 % and 19 % less community involvement (p = 0.01), but only men had 8 % and 13 % increased social involvement with neighbors and family members (p < 0.001), respectively.

CONCLUSION

Changes in social functioning provide an early indication to screen for cognitive loss. Recognition that early cognitive loss is associated with differences in social function can guide counseling efforts and help identify social vulnerabilities to ease the transition to overt dementia for both patients and caregivers.
Literature
1.
go back to reference Secker J, Hill R, Villeneau L, Parkman S. Concept forum promoting independence: but promoting what and how. Ageing Soc. 2003;23(3):375–391.CrossRef Secker J, Hill R, Villeneau L, Parkman S. Concept forum promoting independence: but promoting what and how. Ageing Soc. 2003;23(3):375–391.CrossRef
2.
go back to reference Hillcoat-Nallétamby S. The meaning of “independence” for older people in different residential settings. J Gerontol Ser B Psychol Sci Soc Sci. 2014;69(3):419.CrossRef Hillcoat-Nallétamby S. The meaning of “independence” for older people in different residential settings. J Gerontol Ser B Psychol Sci Soc Sci. 2014;69(3):419.CrossRef
3.
go back to reference Mack R, Salmoni A, Viverais-Dressler G, Porter E, Garg R. Perceived risks to independent living: the views of older, community-dwelling adults. The Gerontologist. 1997;37(6):729–736.CrossRefPubMed Mack R, Salmoni A, Viverais-Dressler G, Porter E, Garg R. Perceived risks to independent living: the views of older, community-dwelling adults. The Gerontologist. 1997;37(6):729–736.CrossRefPubMed
4.
go back to reference Berkman LF, Glass T, Brissette I, Seeman TE. From social integration to health: Durkheim in the new millennium. Soc Sci Med. 2000;51(6):843–857.CrossRefPubMed Berkman LF, Glass T, Brissette I, Seeman TE. From social integration to health: Durkheim in the new millennium. Soc Sci Med. 2000;51(6):843–857.CrossRefPubMed
5.
go back to reference Sampson EL, Bulpitt CJ, Fletcher AE. Survival of community‐dwelling older people: the effect of cognitive impairment and social engagement. J Am Geriatr Soc. 2009;57(6):985–991.CrossRefPubMed Sampson EL, Bulpitt CJ, Fletcher AE. Survival of community‐dwelling older people: the effect of cognitive impairment and social engagement. J Am Geriatr Soc. 2009;57(6):985–991.CrossRefPubMed
6.
go back to reference Fratiglioni L, Paillard-Borg S, Winblad B. An active and socially integrated lifestyle in late life might protect against dementia. Lancet Neurol. 2004;3(6):343–353.CrossRefPubMed Fratiglioni L, Paillard-Borg S, Winblad B. An active and socially integrated lifestyle in late life might protect against dementia. Lancet Neurol. 2004;3(6):343–353.CrossRefPubMed
7.
go back to reference Fratiglioni L, Wang HX, Ericsson K, Maytan M, Winblad B. Influence of social network on occurrence of dementia: a community-based longitudinal study. Lancet. 2000;355(9212):1315.CrossRefPubMed Fratiglioni L, Wang HX, Ericsson K, Maytan M, Winblad B. Influence of social network on occurrence of dementia: a community-based longitudinal study. Lancet. 2000;355(9212):1315.CrossRefPubMed
8.
go back to reference Crooks VC, Lubben J, Petitti DB, Little D, Chiu V. Social network, cognitive function, and dementia incidence among elderly women. Am J Public Health. 2008;98(7):1221.CrossRefPubMedPubMedCentral Crooks VC, Lubben J, Petitti DB, Little D, Chiu V. Social network, cognitive function, and dementia incidence among elderly women. Am J Public Health. 2008;98(7):1221.CrossRefPubMedPubMedCentral
9.
go back to reference Andrew MK, Rockwood K. Social vulnerability predicts cognitive decline in a prospective cohort of older Canadians. Alzheimer’s Dementia. 2010;6(4):319.CrossRefPubMed Andrew MK, Rockwood K. Social vulnerability predicts cognitive decline in a prospective cohort of older Canadians. Alzheimer’s Dementia. 2010;6(4):319.CrossRefPubMed
10.
go back to reference Barnes LL, De Leon CFM, Wilson RS, Bienias JL, Evans DA. Social resources and cognitive decline in a population of older African Americans and whites. Neurology. 2004;63(12):2322–2326.CrossRefPubMed Barnes LL, De Leon CFM, Wilson RS, Bienias JL, Evans DA. Social resources and cognitive decline in a population of older African Americans and whites. Neurology. 2004;63(12):2322–2326.CrossRefPubMed
11.
go back to reference Wang HX, Karp A, Winblad B, Fratiglioni L. Late-life engagement in social and leisure activities is associated with a decreased risk of dementia: a longitudinal study from the Kungsholmen project. Am J Epidemiol. 2002;155(12):1081–1087.CrossRefPubMed Wang HX, Karp A, Winblad B, Fratiglioni L. Late-life engagement in social and leisure activities is associated with a decreased risk of dementia: a longitudinal study from the Kungsholmen project. Am J Epidemiol. 2002;155(12):1081–1087.CrossRefPubMed
12.
go back to reference Zunzunegui MV, Alvarado BE, Del Ser T, Otero A. Social networks, social integration, and social engagement determine cognitive decline in community-dwelling Spanish older adults. J Gerontol Ser B Psychol Sci Soc Sci. 2003;58(2):S93–S100.CrossRef Zunzunegui MV, Alvarado BE, Del Ser T, Otero A. Social networks, social integration, and social engagement determine cognitive decline in community-dwelling Spanish older adults. J Gerontol Ser B Psychol Sci Soc Sci. 2003;58(2):S93–S100.CrossRef
13.
go back to reference Béland F, Zunzunegui M-V, Alvarado B, Otero A, del Ser T. Trajectories of cognitive decline and social relations. J Gerontol Ser B Psychol Sci Soc Sci. 2005;60(6):320–P330.CrossRef Béland F, Zunzunegui M-V, Alvarado B, Otero A, del Ser T. Trajectories of cognitive decline and social relations. J Gerontol Ser B Psychol Sci Soc Sci. 2005;60(6):320–P330.CrossRef
14.
go back to reference Seeman TE, Lusignolo TM, Albert M, Berkman L. Social relationships, social support, and patterns of cognitive aging in healthy, high-functioning older adults: MacArthur studies of successful aging. Health Psychol; Health Psychol. 2001;20(4):243.CrossRefPubMed Seeman TE, Lusignolo TM, Albert M, Berkman L. Social relationships, social support, and patterns of cognitive aging in healthy, high-functioning older adults: MacArthur studies of successful aging. Health Psychol; Health Psychol. 2001;20(4):243.CrossRefPubMed
15.
go back to reference Ertel KA, Glymour MM, Berkman LF. Effects of social integration on preserving memory function in a nationally representative US elderly population. Am J Public Health. 2008;98(7):1215–1220.CrossRefPubMedPubMedCentral Ertel KA, Glymour MM, Berkman LF. Effects of social integration on preserving memory function in a nationally representative US elderly population. Am J Public Health. 2008;98(7):1215–1220.CrossRefPubMedPubMedCentral
16.
go back to reference Saczynski JS, Pfeifer LA, Masaki K, et al. The effect of social engagement on incident dementia the Honolulu-Asia aging study. Am J Epidemiol. 2006;163(5):433–440.CrossRefPubMed Saczynski JS, Pfeifer LA, Masaki K, et al. The effect of social engagement on incident dementia the Honolulu-Asia aging study. Am J Epidemiol. 2006;163(5):433–440.CrossRefPubMed
17.
go back to reference Seeman TE, Miller-Martinez DM, Merkin SS, Lachman ME, Tun PA, Karlamangla AS. Histories of social engagement and adult cognition: midlife in the US study. J Gerontol Ser B Psychol Sci Soc Sci. 2011;66(S1):i141–i152.CrossRef Seeman TE, Miller-Martinez DM, Merkin SS, Lachman ME, Tun PA, Karlamangla AS. Histories of social engagement and adult cognition: midlife in the US study. J Gerontol Ser B Psychol Sci Soc Sci. 2011;66(S1):i141–i152.CrossRef
18.
go back to reference Hultsch DF, Hertzog C, Small BJ, Dixon RA. Use it or lose it: engaged lifestyle as a buffer of cognitive decline in aging? Psychol Aging. 1999;14(2):245.CrossRefPubMed Hultsch DF, Hertzog C, Small BJ, Dixon RA. Use it or lose it: engaged lifestyle as a buffer of cognitive decline in aging? Psychol Aging. 1999;14(2):245.CrossRefPubMed
19.
go back to reference Bennett DA, Schneider JA, Tang Y, Arnold SE, Wilson RS. The effect of social networks on the relation between Alzheimer’s disease pathology and level of cognitive function in old people: a longitudinal cohort study. Lancet Neurol. 2006;5(5):406–412.CrossRefPubMed Bennett DA, Schneider JA, Tang Y, Arnold SE, Wilson RS. The effect of social networks on the relation between Alzheimer’s disease pathology and level of cognitive function in old people: a longitudinal cohort study. Lancet Neurol. 2006;5(5):406–412.CrossRefPubMed
20.
go back to reference Bosma H, van Boxtel MP, Ponds R, et al. Engaged lifestyle and cognitive function in middle and old-aged, non-demented persons: a reciprocal association? Z Gerontol Geriatr. 2002;35(6):575–581.CrossRefPubMed Bosma H, van Boxtel MP, Ponds R, et al. Engaged lifestyle and cognitive function in middle and old-aged, non-demented persons: a reciprocal association? Z Gerontol Geriatr. 2002;35(6):575–581.CrossRefPubMed
21.
go back to reference Thomas PA. Gender, social engagement, and limitations in late life. Soc Sci Med. 2011;73(9):1428–1435.CrossRefPubMed Thomas PA. Gender, social engagement, and limitations in late life. Soc Sci Med. 2011;73(9):1428–1435.CrossRefPubMed
22.
go back to reference Green AF, Rebok G, Lyketsos CG. Influence of social network characteristics on cognition and functional status with aging. Int J Geriatric Psychiatry. 2008;23(9):972–978.CrossRef Green AF, Rebok G, Lyketsos CG. Influence of social network characteristics on cognition and functional status with aging. Int J Geriatric Psychiatry. 2008;23(9):972–978.CrossRef
23.
go back to reference Bassuk SS, Glass TA, Berkman LF. Social disengagement and incident cognitive decline in community-dwelling elderly persons. Ann Intern Med. 1999;131(3):165.CrossRefPubMed Bassuk SS, Glass TA, Berkman LF. Social disengagement and incident cognitive decline in community-dwelling elderly persons. Ann Intern Med. 1999;131(3):165.CrossRefPubMed
24.
go back to reference Glei DA, Landau DA, Goldman N, Chuang Y-L, Rodríguez G, Weinstein M. Participating in social activities helps preserve cognitive function: an analysis of a longitudinal, population-based study of the elderly. Int J Epidemiol. 2005;34(4):864–871.CrossRefPubMed Glei DA, Landau DA, Goldman N, Chuang Y-L, Rodríguez G, Weinstein M. Participating in social activities helps preserve cognitive function: an analysis of a longitudinal, population-based study of the elderly. Int J Epidemiol. 2005;34(4):864–871.CrossRefPubMed
25.
go back to reference Holtzman RE, Rebok GW, Saczynski JS, Kouzis AC, Doyle KW, Eaton WW. Social network characteristics and cognition in middle-aged and older adults. J Gerontol Ser B Psychol Sci Soc Sci. 2004;59(6):278–284.CrossRef Holtzman RE, Rebok GW, Saczynski JS, Kouzis AC, Doyle KW, Eaton WW. Social network characteristics and cognition in middle-aged and older adults. J Gerontol Ser B Psychol Sci Soc Sci. 2004;59(6):278–284.CrossRef
26.
go back to reference Friedman TW, Yelland GW, Robinson SR. Subtle cognitive impairment in elders with mini‐mental state examination scores within the ‘normal’range. Int J Geriatric Psychiatry. 2011;27(5):463–471.CrossRef Friedman TW, Yelland GW, Robinson SR. Subtle cognitive impairment in elders with mini‐mental state examination scores within the ‘normal’range. Int J Geriatric Psychiatry. 2011;27(5):463–471.CrossRef
27.
go back to reference Pendlebury ST, Cuthbertson FC, Welch SJ, Mehta Z, Rothwell PM. Underestimation of cognitive impairment by mini-mental state examination versus the Montreal cognitive assessment in patients with transient ischemic attack and stroke a population-based study. Stroke. 2010;41(6):1290–1293.CrossRefPubMed Pendlebury ST, Cuthbertson FC, Welch SJ, Mehta Z, Rothwell PM. Underestimation of cognitive impairment by mini-mental state examination versus the Montreal cognitive assessment in patients with transient ischemic attack and stroke a population-based study. Stroke. 2010;41(6):1290–1293.CrossRefPubMed
28.
go back to reference Shega JW, Sunkara PD, Kotwal A, et al. Measuring Cognition: The Chicago Cognitive Function Measure in the National Social Life, Health and Aging Project, Wave 2. J Gerontol Ser B Psychol Sci Soc Sci. 2014;69(S2):S166–S176.CrossRef Shega JW, Sunkara PD, Kotwal A, et al. Measuring Cognition: The Chicago Cognitive Function Measure in the National Social Life, Health and Aging Project, Wave 2. J Gerontol Ser B Psychol Sci Soc Sci. 2014;69(S2):S166–S176.CrossRef
30.
go back to reference Fuhrer R, Stansfeld SA. How gender affects patterns of social relations and their impact on health: a comparison of one or multiple sources of support from “close persons”. Soc Sci Med. 2002;54(5):811–825.CrossRefPubMed Fuhrer R, Stansfeld SA. How gender affects patterns of social relations and their impact on health: a comparison of one or multiple sources of support from “close persons”. Soc Sci Med. 2002;54(5):811–825.CrossRefPubMed
31.
go back to reference Cornwell B. Independence through social networks: bridging potential among older women and men. J Gerontol Ser B Psychol Sci Soc Sci. 2011;66(6):782–794.CrossRef Cornwell B. Independence through social networks: bridging potential among older women and men. J Gerontol Ser B Psychol Sci Soc Sci. 2011;66(6):782–794.CrossRef
32.
go back to reference Umberson D. Gender, marital status and the social control of health behavior. Soc Sci Med. 1992;34(8):907–917.CrossRefPubMed Umberson D. Gender, marital status and the social control of health behavior. Soc Sci Med. 1992;34(8):907–917.CrossRefPubMed
33.
go back to reference Waite L, Gallagher M. The case for marriage: Why married people are happier, healthier and better off financially: Broadway Books; 2002. Waite L, Gallagher M. The case for marriage: Why married people are happier, healthier and better off financially: Broadway Books; 2002.
34.
go back to reference Zhang Z. Gender differentials in cognitive impairment and decline of the oldest old in China. J Gerontol Ser B Psychol Sci Soc Sci. 2006;61(2):S107–S115.CrossRef Zhang Z. Gender differentials in cognitive impairment and decline of the oldest old in China. J Gerontol Ser B Psychol Sci Soc Sci. 2006;61(2):S107–S115.CrossRef
35.
go back to reference Cornwell EY, Waite LJ. Measuring social isolation among older adults using multiple indicators from the NSHAP study. J Gerontol Ser B Psychol Sci Soc Sci. 2009;64(suppl 1):i38.CrossRef Cornwell EY, Waite LJ. Measuring social isolation among older adults using multiple indicators from the NSHAP study. J Gerontol Ser B Psychol Sci Soc Sci. 2009;64(suppl 1):i38.CrossRef
36.
go back to reference Cornwell B, Schumm LP, Laumann EO, Graber J. Social networks in the NSHAP study: rationale, measurement, and preliminary findings. J Gerontol Ser B Psychol Sci Soc Sci. 2009;64(suppl 1):i47.CrossRef Cornwell B, Schumm LP, Laumann EO, Graber J. Social networks in the NSHAP study: rationale, measurement, and preliminary findings. J Gerontol Ser B Psychol Sci Soc Sci. 2009;64(suppl 1):i47.CrossRef
37.
go back to reference Cronbach LJ. Coefficient alpha and the internal structure of tests. Psychometrika. 1951;16(3):297–334.CrossRef Cronbach LJ. Coefficient alpha and the internal structure of tests. Psychometrika. 1951;16(3):297–334.CrossRef
38.
go back to reference Nasreddine ZS, Phillips NA, Bédirian V, et al. The Montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53(4):695–699.CrossRefPubMed Nasreddine ZS, Phillips NA, Bédirian V, et al. The Montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53(4):695–699.CrossRefPubMed
39.
go back to reference Kotwal AA, Schumm LP, Kern D, et al. Evaluation of a brief survey instrument for assessing subtle differences in cognitive function among older adults. Alzheimer Dis Assoc Disord. 2015;29(4):317–324.CrossRefPubMed Kotwal AA, Schumm LP, Kern D, et al. Evaluation of a brief survey instrument for assessing subtle differences in cognitive function among older adults. Alzheimer Dis Assoc Disord. 2015;29(4):317–324.CrossRefPubMed
40.
go back to reference McLennan SN, Mathias JL, Brennan LC, Stewart S. Validity of the Montreal cognitive assessment (MoCA) as a screening test for mild cognitive impairment (MCI) in a cardiovascular population. J Geriatr Psychiatry Neurol. 2011;24(1):33–38.CrossRefPubMed McLennan SN, Mathias JL, Brennan LC, Stewart S. Validity of the Montreal cognitive assessment (MoCA) as a screening test for mild cognitive impairment (MCI) in a cardiovascular population. J Geriatr Psychiatry Neurol. 2011;24(1):33–38.CrossRefPubMed
41.
go back to reference Damian AM, Jacobson SA, Hentz JG, et al. The Montreal cognitive assessment and the mini-mental state examination as screening instruments for cognitive impairment: item analyses and threshold scores. Dement Geriatr Cogn Disord. 2011;31(2):126–131.CrossRefPubMed Damian AM, Jacobson SA, Hentz JG, et al. The Montreal cognitive assessment and the mini-mental state examination as screening instruments for cognitive impairment: item analyses and threshold scores. Dement Geriatr Cogn Disord. 2011;31(2):126–131.CrossRefPubMed
42.
go back to reference Waldron‐Perrine B, Axelrod BN. Determining an appropriate cutting score for indication of impairment on the Montreal cognitive assessment. Int j Geriatric Psychiatry. 2012;27(11):1189–1194.CrossRef Waldron‐Perrine B, Axelrod BN. Determining an appropriate cutting score for indication of impairment on the Montreal cognitive assessment. Int j Geriatric Psychiatry. 2012;27(11):1189–1194.CrossRef
43.
go back to reference Freitas S, Simões MR, Alves L, Santana I. Montreal cognitive assessment: validation study for mild cognitive impairment and Alzheimer disease. Alzheimer Dis Assoc Disord. 2013;27(1):37–43.CrossRefPubMed Freitas S, Simões MR, Alves L, Santana I. Montreal cognitive assessment: validation study for mild cognitive impairment and Alzheimer disease. Alzheimer Dis Assoc Disord. 2013;27(1):37–43.CrossRefPubMed
44.
go back to reference Luis CA, Keegan AP, Mullan M. Cross validation of the Montreal cognitive assessment in community dwelling older adults residing in the southeastern US. Int J Geriatric Psychiatry. 2009;24(2):197–201.CrossRef Luis CA, Keegan AP, Mullan M. Cross validation of the Montreal cognitive assessment in community dwelling older adults residing in the southeastern US. Int J Geriatric Psychiatry. 2009;24(2):197–201.CrossRef
45.
go back to reference Barnes DE, Cauley JA, Lui LY, et al. Women who maintain optimal cognitive function into old age. J Am Geriatr Soc. 2007;55(2):259–264.CrossRefPubMed Barnes DE, Cauley JA, Lui LY, et al. Women who maintain optimal cognitive function into old age. J Am Geriatr Soc. 2007;55(2):259–264.CrossRefPubMed
46.
go back to reference Vasilopoulos T, Kotwal A, Huisingh-Scheetz MJ, Waite LJ, McClintock MK, Dale W. Comorbidity and chronic conditions in the national social life, health and aging project (NSHAP), wave 2. J Gerontol Ser B Psychol Sci Soc Sci. 2014;69(Suppl 2):S154–S165.CrossRef Vasilopoulos T, Kotwal A, Huisingh-Scheetz MJ, Waite LJ, McClintock MK, Dale W. Comorbidity and chronic conditions in the national social life, health and aging project (NSHAP), wave 2. J Gerontol Ser B Psychol Sci Soc Sci. 2014;69(Suppl 2):S154–S165.CrossRef
47.
go back to reference Payne C, Hedberg E, Kozloski M, Dale W, McClintock MK. Using and interpreting mental health measures in the national social life, health, and aging project. J Gerontol Ser B Psychol Sci Soc Sci. 2014;69(Suppl 2):S99–S116.CrossRef Payne C, Hedberg E, Kozloski M, Dale W, McClintock MK. Using and interpreting mental health measures in the national social life, health, and aging project. J Gerontol Ser B Psychol Sci Soc Sci. 2014;69(Suppl 2):S99–S116.CrossRef
48.
go back to reference Coups EJ, Gaba A, Orleans CT. Physician screening for multiple behavioral health risk factors. Am J Prev Med. 2004;27(2 Suppl):34.CrossRefPubMed Coups EJ, Gaba A, Orleans CT. Physician screening for multiple behavioral health risk factors. Am J Prev Med. 2004;27(2 Suppl):34.CrossRefPubMed
49.
go back to reference Weisberg S. Applied linear regression. Vol 528: Wiley; 2005. Weisberg S. Applied linear regression. Vol 528: Wiley; 2005.
50.
go back to reference O’Muircheartaigh C, Eckman S, Smith S. Statistical design and estimation for the national social life, health, and aging project. J Gerontol: Series B. 2009;64(Supplement 1):i12.CrossRef O’Muircheartaigh C, Eckman S, Smith S. Statistical design and estimation for the national social life, health, and aging project. J Gerontol: Series B. 2009;64(Supplement 1):i12.CrossRef
51.
go back to reference Stata Statistical Software: Release 12 [computer program]. College Station: StataCorp LP; 2011. Stata Statistical Software: Release 12 [computer program]. College Station: StataCorp LP; 2011.
52.
go back to reference Coleman JS. Social capital in the creation of human capital. Am J Sociol. 1988;94:S95–S120.CrossRef Coleman JS. Social capital in the creation of human capital. Am J Sociol. 1988;94:S95–S120.CrossRef
54.
go back to reference Covinsky KE, Newcomer R, Fox P, et al. Patient and caregiver characteristics associated with depression in caregivers of patients with dementia. J Gen Intern Med. 2003;18(12):1006–1014.CrossRefPubMedPubMedCentral Covinsky KE, Newcomer R, Fox P, et al. Patient and caregiver characteristics associated with depression in caregivers of patients with dementia. J Gen Intern Med. 2003;18(12):1006–1014.CrossRefPubMedPubMedCentral
55.
go back to reference Schulz R, Beach SR. Caregiving as a risk factor for mortality: the caregiver health effects study. JAMA. 1999;282(23):2215–2219.CrossRefPubMed Schulz R, Beach SR. Caregiving as a risk factor for mortality: the caregiver health effects study. JAMA. 1999;282(23):2215–2219.CrossRefPubMed
56.
go back to reference Schulz R, Martire LM. Family caregiving of persons with dementia: prevalence, health effects, and support strategies. Am J Geriatr Psychiatry. 2004;12(3):240–249.CrossRefPubMed Schulz R, Martire LM. Family caregiving of persons with dementia: prevalence, health effects, and support strategies. Am J Geriatr Psychiatry. 2004;12(3):240–249.CrossRefPubMed
57.
go back to reference Salthouse T. All data collection and analysis methods have limitations: reply to rabbitt (2011) and Raz and lindenberger (2011). Psychol Bull. 2011;137(5):796–799.CrossRefPubMedPubMedCentral Salthouse T. All data collection and analysis methods have limitations: reply to rabbitt (2011) and Raz and lindenberger (2011). Psychol Bull. 2011;137(5):796–799.CrossRefPubMedPubMedCentral
Metadata
Title
Social Function and Cognitive Status: Results from a US Nationally Representative Survey of Older Adults
Authors
Ashwin A. Kotwal, M.D., M.S.
Juyeon Kim, Ph.D.
Linda Waite, Ph.D.
William Dale, M.D., Ph.D.
Publication date
01-08-2016
Publisher
Springer US
Published in
Journal of General Internal Medicine / Issue 8/2016
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-016-3696-0

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