Hui Liu’s research while affiliated with Purdue University West Lafayette and other places

Education is one of the strongest social factors influencing cognitive outcomes. Previous studies have predominantly focused on the impact of one’s own education, with less attention given to the education of one’s spouse. Guided by the “linked lives” perspective, this study examines the association between spousal education and cognitive function among older couples in England. We analyzed data from the English Longitudinal Study of Ageing (ELSA) Waves 7-9, 2014-2019. The sample comprised 7,131 married and cohabiting couples. Cognitive function was assessed using the modified version of the Telephone Interview for Cognitive Status (TICS). Results from the Actor-Partner Interdependence Model (APIM) showed a significant correlation in cognitive trajectories between spouses within dyads. Cross-sectional APIM analysis revealed that higher educational attainment of both spouses was associated with better cognitive function in both themselves and their partners. Longitudinal APIM growth curve analysis suggested that the association between spousal education and cognitive function was mainly driven by correlations at the initial levels, with no significant association observed with the slope of cognitive trajectories over time. We discuss these findings in the context of England and compare them to recent studies conducted in the U.S. and Mexico. Potential explanations for both similarities and differences in findings across studies are explored, shedding light on the nuanced interplay between spousal education and cognitive function.

This study aims to investigate various forms of online engagement in relation to feelings of loneliness among older men and women during the COVID-19 pandemic. We explored which types of online engagement were associated with loneliness among older adults, with special attention to potential gender differences. We analyzed data from the 2020 Health and Retirement Study (HRS), including 4,421 respondents aged 50 or older (1,732 men and 2,689 women). Loneliness was measured using the 11-item UCLA Loneliness Scale. Ordinary Least Squares Regression models were estimated to assess the relationship between different types of online engagement and loneliness. More frequent use of all examined online engagement types, including instant messaging, social network sites, other social media, chat apps, and video chat, was associated with lower loneliness levels. Video chat had the strongest association with reduced loneliness, while social network sites had the weakest. Older men tended to report higher levels of loneliness compared to older women during the pandemic. Older women generally reported higher levels of online engagement than older men, although this pattern varied across different online platforms. No gender differences were found in the associations between online engagement and loneliness. This study highlights the potential positive role of online engagement in mitigating loneliness among older adults during the COVID-19 pandemic. Our findings emphasize the importance of developing policies that encourage and support internet access and online engagement initiatives for older adults to combat loneliness.

Not all U.S. populations have equal access to a primary care provider (PCP). This study presents one of the first population-based evidence of inequities in access to PCPs at the intersection of race/ethnicity, sexual orientation, and gender. We analyzed pooled data from the Behavioral Risk Factor Surveillance System from 2016 to 2021 across 42 states and 1 territory in the United States. The final sample encompassed 1,142,344 respondents aged 18 and older. Logistic regression models, stratified by gender spectrum, were estimated to compare predicted probabilities of having a PCP across 20 sexual and racial/ethnic identity groups. Among those on the feminine spectrum, most sexual minorities of color exhibited lower rates of having a PCP compared to heterosexual White individuals. Even when sociodemographic and health factors were accounted for, PCP access disadvantages remained significant in some groups of Native and Hispanic sexual minorities. Among sexual minorities of color on the masculine spectrum, inequities were less prominent, and sociodemographic and health factors nearly explained all their disadvantages. Sexual orientation, gender, and race/ethnicity intersect to shape the access to PCPs. Future research, policy designs, and clinical practices should adopt an intersectional approach to achieve a better understanding of healthcare inequities and to reduce inequities.

Objectives Recent studies have found that perceived discrimination as a chronic stressor predicts poorer cognitive health. However, little research has investigated how social relationships as potential intervening mechanisms may mitigate or exacerbate this association. Using a nationally representative sample of U.S. older adults, this study examined how the existence and quality of four types of relationships—with a partner, children, other family members, and friends—may modify the impact of perceived discrimination on incident dementia. Methods We analyzed data from the 2006–2016 Health and Retirement Study (N=12,236) using discrete-time event history models with competing risks. We used perceived discrimination, social relationships, and their interactions at the baseline to predict the risk of incident dementia in the follow-ups. Results Perceived discrimination predicted a higher risk of incident dementia in the follow-ups. Although having a partner or not did not modify this association, partnership support attenuated the negative effects of discrimination on incident dementia. Neither the existence nor quality of relationships with children, other family members, or friends modified the association. Discussion Our findings imply that intimate partnership plays a critical role in coping with discrimination and, consequently, influencing the cognitive health of older adults. While perceived discrimination is a significant risk factor for the incidence of dementia, better partnership quality may attenuate this association. Policies that eliminate discrimination and interventions that strengthen intimate partnership may facilitate better cognitive health in late life.

Objectives This study provides one of the first national longitudinal studies of the association between caring for grandchildren (i.e., grandparenting) and the risk of dementia in the U.S., with a focus on gender-specific variations. Method We estimated discrete-time event history models, drawing upon data from the Health and Retirement Study (2000-2016). The analytic sample included 10,217 community-dwelling White and Black grandparents aged 52 years and older at baseline. Results Noncoresident grandparenting was associated with a lower risk of dementia for both women and men compared to grandparents who did not take care of grandchildren. However, the cognitive advantage showed different patterns based on gender and the combination of care intensity and family structure. Grandmothers had a lower risk of dementia than noncaregiving grandmothers when providing a light level of noncoresident grandparenting, while grandfathers who provided intensive noncoresident grandparenting had a reduced risk of dementia compared to their noncaregiving counterparts. Grandparenting experiences within multigenerational households and skipped-generation households were not associated with dementia risk. Discussion Intergenerational caregiving plays a pivotal role in shaping cognitive health during later life; however, the impact is nuanced, depending on factors such as gender, care intensity and family structure.

Objective This study examines the long‐observed marital advantage in happiness during the COVID‐19 pandemic. Background The COVID‐19 pandemic may have altered the marital advantage in happiness due to changes in social integration processes. However, this has not been explored in previous studies. Method Data were from the COVID‐19 substudy of the National Social Life, Health, and Aging Project ( N = 2622). A series of regressions were estimated to understand marital status differences in pandemic happiness and changes in relationships with nonresident family and friends. Karlson–Holm–Breen mediation analysis was conducted to examine whether relationships with nonresident family and friends explained the marital association with pandemic happiness. Results From pre‐pandemic to pandemic, married respondents experienced a greater increase in unhappiness than unmarried counterparts, narrowing happiness gaps. However, unmarried individuals, including cohabiting, divorced, widowed, and never married individuals, continued to report higher levels of unhappiness during the pandemic than married peers. These differences primarily stemmed from pre‐pandemic happiness. After controlling for pre‐pandemic happiness, cohabiting, widowed, and never married older adults did not significantly differ from their married counterparts in reporting unhappiness during the pandemic. In contrast, divorced individuals remained consistently more unhappy than married individuals during the pandemic, mainly due to deteriorated relationship quality with nonresident family. Conclusion During a global crisis, it is crucial for policymakers, healthcare providers, and researchers to develop innovative interventions to promote happiness and healthy aging among all older adults, paying special attention to those who are divorced.

Guided by the social integration perspective, we conducted one of the first population-based studies on marital status differences in loneliness during the COVID-19 pandemic among older Americans. Analysis of data from the 2020 National Health and Aging Trends Study COVID-19 supplement (n = 2861) suggested that, compared to their married counterparts, divorced and widowed older adults reported higher levels of loneliness during the pandemic, and divorced older adults also felt lonely more often when compared to before the pandemic. These marital status differences in pandemic loneliness cannot be explained by changes in social participation (e.g., working for pay, volunteering, attending religious services, or attending clubs, classes, or other organized activities) or changes in contact frequency with family and friends (via phone calls, emails/texts/social media messages, video calls, or in-person visits). No gender difference was found in the association between marital status and loneliness during the pandemic. These results, coupled with the growth of the unmarried older population, highlight that policymakers, health care providers, and researchers should think creatively about ways to reduce the loneliness gap between married and unmarried groups to promote healthy aging for all older adults, particularly in the face of emerging pandemics that may complicate strategies to improve population health in the future.

Background and objectives: Although disparities in disability and the unequal distribution of care resources are widely discussed in the literature, there has been less research on disparities in experiencing unmet care needs among older adults. This study aims to investigate how unmet care needs are unevenly distributed across social groups with various intersecting identities, such as race/ethnicity, nativity, and gender, while considering their care needs and care networks, drawing on the conceptual framework of the pathway to unmet needs. Research design and methods: The data for this study came from the National Health and Aging Trends Study (NHATS, 2011-2018), and the study sample consisted of 7,061 Medicare beneficiaries who needed assistance with daily activities. Questions about unmet care needs were in the form of consequences related to difficulty or lack of help with daily activities. Mixed-effects negative binomial regression models were used to predict rates of unmet needs. Results: Older adults of color, especially women, experienced higher rates of unmet care needs compared to their White and male counterparts. Although Black-White and gender differences in unmet needs were mostly explained by unequal exposures to care needs and differential care networks, Hispanic women and foreign-born Hispanic men were still at a disadvantage even after adjusting for these covariates. Discussion and implications: These results emphasize the importance of adopting an intersectional approach to enhance the quality of long-term services and support for older adults facing social disadvantages.