Aging & mental health · 2026
Identifying older adults with heightened stress responsivity before public health crises: a retrospective cohort study of the US and England.
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Yang Yi, Liu Chuanhui, Xiao Jiaqi, Lian Weishan, Xu Zhongzhi
Аннотация
OBJECTIVE: Using COVID-19 as a natural experiment, this study aimed to develop a pre-crisis approach to identify older adults with relatively elevated stress responses and evaluate the robustness of the identified vulnerability profile across the HRS and ELSA cohorts.
METHODS: Harmonized pre-pandemic (2018) longitudinal data of 11,533 seniors from U.S. HRS and English ELSA cohorts were analyzed. The primary outcome was the Pandemic Stress Response Index (PSRI), constructed separately within each cohort as a conceptually harmonized measure of relative multidimensional stress response. Weighted LASSO with stability selection screened stable predictors, followed by a pooled weighted multivariable logistic regression adjusted for cohort/country fixed effect. Weighted AUC, Brier score, and diagnostic indices assessed overall model performance, with descriptive cohort-specific performance evaluated using predictions from the same final model.
RESULTS: The final sample included 11,533 participants (6,185 HRS; 5,348 ELSA), of whom 2,931 (25.4%) were classified into the relative high-stress group. Fourteen predictors were retained by stability selection. Poor self-rated health, perceived loneliness, functional impairment, chronic disease burden, visual impairment, higher BMI, and female sex/gender were associated with higher odds of high stress response, whereas older age, higher life satisfaction, greater household wealth, better cognitive function, and greater physical activity were associated with lower odds. The pooled AUC was 0.729 (0.703 in HRS and 0.764 in ELSA).
CONCLUSIONS: Accessible pre-emergency indicators may help identify older adults with relatively elevated stress responses. The broadly similar vulnerability pattern observed across HRS and ELSA supports further evaluation of multidimensional pre-crisis vulnerability profiling for public health preparedness.
METHODS: Harmonized pre-pandemic (2018) longitudinal data of 11,533 seniors from U.S. HRS and English ELSA cohorts were analyzed. The primary outcome was the Pandemic Stress Response Index (PSRI), constructed separately within each cohort as a conceptually harmonized measure of relative multidimensional stress response. Weighted LASSO with stability selection screened stable predictors, followed by a pooled weighted multivariable logistic regression adjusted for cohort/country fixed effect. Weighted AUC, Brier score, and diagnostic indices assessed overall model performance, with descriptive cohort-specific performance evaluated using predictions from the same final model.
RESULTS: The final sample included 11,533 participants (6,185 HRS; 5,348 ELSA), of whom 2,931 (25.4%) were classified into the relative high-stress group. Fourteen predictors were retained by stability selection. Poor self-rated health, perceived loneliness, functional impairment, chronic disease burden, visual impairment, higher BMI, and female sex/gender were associated with higher odds of high stress response, whereas older age, higher life satisfaction, greater household wealth, better cognitive function, and greater physical activity were associated with lower odds. The pooled AUC was 0.729 (0.703 in HRS and 0.764 in ELSA).
CONCLUSIONS: Accessible pre-emergency indicators may help identify older adults with relatively elevated stress responses. The broadly similar vulnerability pattern observed across HRS and ELSA supports further evaluation of multidimensional pre-crisis vulnerability profiling for public health preparedness.