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• 21. [Article] Escobedo thesis.pdf

  Citation × Citation Citation Abstract Copy Title: Escobedo thesis.pdf Author: Escobedo, Emily R. Title: Escobedo thesis.pdf Author: Escobedo, Emily R. Close

• 22. [Article] OddenMichellePubicHealthHumanSciYearsAbleLife.pdf

  Citation × Citation Citation Abstract Copy Title: OddenMichellePubicHealthHumanSciYearsAbleLife.pdf Author: Gardin, Julius M., Yee, Laura M., Alshawabkeh, Laith I., et al., Odden, Michelle C. Title: OddenMichellePubicHealthHumanSciYearsAbleLife.pdf Author: Gardin, Julius M., Yee, Laura M., Alshawabkeh, Laith I., et al., Odden, Michelle C. Close

• 23. [Article] OddenMichellePubicHealthHumanSciYearsAbleLifeSupplementalMaterial.pdf

  Citation × Citation Citation Abstract Copy Title: OddenMichellePubicHealthHumanSciYearsAbleLifeSupplementalMaterial.pdf Author: Gardin, Julius M., Yee, Laura M., Alshawabkeh, Laith I., et al., Odden, Michelle C. Title: OddenMichellePubicHealthHumanSciYearsAbleLifeSupplementalMaterial.pdf Author: Gardin, Julius M., Yee, Laura M., Alshawabkeh, Laith I., et al., Odden, Michelle C. Close

• 24. [Article] Kidney Function and Cognitive Health in Older Adults: The Cardiovascular Health Study

  This is an author's peer-reviewed final manuscript, as accepted by the publisher. The published article is copyrighted by the Author(s) and published by Oxford University Press on behalf of the Johns Hopkins ...

  Citation × Citation Citation Abstract Copy Title: Kidney Function and Cognitive Health in Older Adults: The Cardiovascular Health Study Author: Shlipak, Michael G., Katz, Ronit, Darsie, Brendan, Fitzpatrick, Annette L., Odden, Michelle C., Sarnak, Mark J. This is an author's peer-reviewed final manuscript, as accepted by the publisher. The published article is copyrighted by the Author(s) and published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. It can be found at: http://aje.oxfordjournals.org/ Title: Kidney Function and Cognitive Health in Older Adults: The Cardiovascular Health Study Author: Shlipak, Michael G., Katz, Ronit, Darsie, Brendan, Fitzpatrick, Annette L., Odden, Michelle C., Sarnak, Mark J. This is an author's peer-reviewed final manuscript, as accepted by the publisher. The published article is copyrighted by the Author(s) and published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. It can be found at: http://aje.oxfordjournals.org/ Close

• 25. [Article] Years of Able Life in Older Persons-The Role of Cardiovascular Imaging and Biomarkers: The Cardiovascular Health Study

  This is the publisher’s final pdf. The published article is copyrighted by the author(s) on behalf of the American Heart Association, Inc., and published by John Wiley & Sons, Ltd. The published article ...

  Citation × Citation Citation Abstract Copy Title: Years of Able Life in Older Persons-The Role of Cardiovascular Imaging and Biomarkers: The Cardiovascular Health Study Author: Gardin, Julius M., Yee, Laura M., Alshawabkeh, Laith I., et al., Odden, Michelle C. This is the publisher’s final pdf. The published article is copyrighted by the author(s) on behalf of the American Heart Association, Inc., and published by John Wiley & Sons, Ltd. The published article can be found at: http://jaha.ahajournals.org/ Title: Years of Able Life in Older Persons-The Role of Cardiovascular Imaging and Biomarkers: The Cardiovascular Health Study Author: Gardin, Julius M., Yee, Laura M., Alshawabkeh, Laith I., et al., Odden, Michelle C. This is the publisher’s final pdf. The published article is copyrighted by the author(s) on behalf of the American Heart Association, Inc., and published by John Wiley & Sons, Ltd. The published article can be found at: http://jaha.ahajournals.org/ Close

• 26. [Article] Surface composition age analysis of photo-oxidized polystyrene thin films by X-ray photoelectron spectroscopy

  Polystyrene thin film surfaces are commonly used to study the interactions of macromolecules, such as proteins, with surfaces. Polystyrene films oxidized in UV light become more hydrophilic, however these ...

  Citation × Citation Citation Abstract Copy Title: Surface composition age analysis of photo-oxidized polystyrene thin films by X-ray photoelectron spectroscopy Author: Silva, Nicholas A. Polystyrene thin film surfaces are commonly used to study the interactions of macromolecules, such as proteins, with surfaces. Polystyrene films oxidized in UV light become more hydrophilic, however these surfaces have a limited shelf life because they are reduced over time. Experiments were performed to determine the effect of radiation duration and exposure time on the surface composition of photo-oxidized polystyrene thin films. Polystyrene (2 wt%) in toluene was spin-coated onto 1-cm² monocrystalline silicon squares, and annealed at 70 °C for 18 hours. Three sets of triplicate samples were irradiated in a UV-ozone cleaner for 0, 3, and 9 minutes. Film surface compositions were analyzed via X-ray Photoelectron Spectroscopy 6 hours after irradiation and after one week of air exposure. Overall oxidation level decreased after one week, and the oxidation structure varied with irradiation time. It is speculated that decreases in oxidation level were due to surface contamination and reduction over time. Experimental results were inconclusive due to high levels of oxidative degradation and significant variation within sample sets. Future studies should shorten annealing and radiation exposure times to allow for improved contact angle measurement and lower degradation levels. More replicates or sample sets may further improve experimental outcomes. Title: Surface composition age analysis of photo-oxidized polystyrene thin films by X-ray photoelectron spectroscopy Author: Silva, Nicholas A. Polystyrene thin film surfaces are commonly used to study the interactions of macromolecules, such as proteins, with surfaces. Polystyrene films oxidized in UV light become more hydrophilic, however these surfaces have a limited shelf life because they are reduced over time. Experiments were performed to determine the effect of radiation duration and exposure time on the surface composition of photo-oxidized polystyrene thin films. Polystyrene (2 wt%) in toluene was spin-coated onto 1-cm² monocrystalline silicon squares, and annealed at 70 °C for 18 hours. Three sets of triplicate samples were irradiated in a UV-ozone cleaner for 0, 3, and 9 minutes. Film surface compositions were analyzed via X-ray Photoelectron Spectroscopy 6 hours after irradiation and after one week of air exposure. Overall oxidation level decreased after one week, and the oxidation structure varied with irradiation time. It is speculated that decreases in oxidation level were due to surface contamination and reduction over time. Experimental results were inconclusive due to high levels of oxidative degradation and significant variation within sample sets. Future studies should shorten annealing and radiation exposure times to allow for improved contact angle measurement and lower degradation levels. More replicates or sample sets may further improve experimental outcomes. Close

• 27. [Article] Shaping social worlds : exploring relationship regulation processes in older adults' daily lives

  The social aspects of older adults lives are strongly linked to well-being outcomes. Social relationships in older adulthood are rewarding, but also complex, and to maintain a positive social environment, ...

  Citation × Citation Citation Abstract Copy Title: Shaping social worlds : exploring relationship regulation processes in older adults' daily lives Author: Mejia, Shannon T. The social aspects of older adults lives are strongly linked to well-being outcomes. Social relationships in older adulthood are rewarding, but also complex, and to maintain a positive social environment, older adults must reconcile long relationships histories, negotiate changing roles, and deal with increasing dependencies. Older adults are known to be particularly effective at regulating their social environments under these circumstances to maximize satisfaction, but some are more successful than others. Older adults manage their social environments through processes of relationship regulation, where individuals actively work towards social goals to customize their social environments and close relationships to meet developmental and emotional needs. Importantly, relationship regulation is embedded in older adults’ social environments, which are not only an outcome, but also the context that inspires, motivates, and hinders efforts to change the social environment. Within the proximal social environment older adults may experience support, hindrance, and satisfying contact with close social partners. Although supportive social environments are related to health and well-being in old age, and evidence suggests that older adults regulate their relationships, little is known about how these goals are worked towards and achieved on a daily basis and within the context of older adults' daily lives. The current study had two distinct aims: (a) to understand the intraindividual processes of regulating social goals within daily context of the social environment; and (b) to examine how interindividual differences predict between-person differences in social regulatory processes. Specifically, this study investigated the degree to which older adults depend on daily support and contact with a close social partner to make progress towards a meaningful social goal, and also the extent to which perceptions of social hindrance impede goal progress. On an interindividual level, this study examined how differences in the proximal social environment and goal orientation are linked to differences in social regulatory processes. Data from the Personal Understanding of Life and Social Experiences (PULSE) project, a 100-day, internet-based microlongitudinal study of 100 Oregon residents age 52 to 88 (M = 63.13, SD = 7.8), were used to explore processes of relationship regulation. At the beginning of the study, participants created a meaningful social goal, and mapped their social convoy. Participants then tracked their daily goal progress and feelings of social support, hindrance and satisfaction over a 100-day time period. Analysis was conducted using multilevel random coefficient models, and was structured to examine within person processes. Daily experiences of goal progress were positively related to social support and contact satisfaction, and negatively related with social hindrance. Importantly, these associations varied greatly between participants, in part as a function of convoy composition and goal orientations. The results from this study suggest that relationship regulation is (a) embedded in the social context of daily life; (b) differs based on the structure of the proximal social environment; (c) contingent on regulatory strategies selected by older adults to work towards their goals; and (d) differentiated by mean tendencies. The linkages between support, hindrance and contact satisfaction with daily goal progress found in this study suggest that the process of working towards a social goal is dependent on older adults' daily social contexts. This has implications for populations with varying access to social support and exposure to social hindrance. Further, individual differences in social regulatory processes were only partially explained by convoy structure and goal orientation. Future research is needed to search for the mechanisms that drive these between person differences in social regulatory processes. Title: Shaping social worlds : exploring relationship regulation processes in older adults' daily lives Author: Mejia, Shannon T. The social aspects of older adults lives are strongly linked to well-being outcomes. Social relationships in older adulthood are rewarding, but also complex, and to maintain a positive social environment, older adults must reconcile long relationships histories, negotiate changing roles, and deal with increasing dependencies. Older adults are known to be particularly effective at regulating their social environments under these circumstances to maximize satisfaction, but some are more successful than others. Older adults manage their social environments through processes of relationship regulation, where individuals actively work towards social goals to customize their social environments and close relationships to meet developmental and emotional needs. Importantly, relationship regulation is embedded in older adults’ social environments, which are not only an outcome, but also the context that inspires, motivates, and hinders efforts to change the social environment. Within the proximal social environment older adults may experience support, hindrance, and satisfying contact with close social partners. Although supportive social environments are related to health and well-being in old age, and evidence suggests that older adults regulate their relationships, little is known about how these goals are worked towards and achieved on a daily basis and within the context of older adults' daily lives. The current study had two distinct aims: (a) to understand the intraindividual processes of regulating social goals within daily context of the social environment; and (b) to examine how interindividual differences predict between-person differences in social regulatory processes. Specifically, this study investigated the degree to which older adults depend on daily support and contact with a close social partner to make progress towards a meaningful social goal, and also the extent to which perceptions of social hindrance impede goal progress. On an interindividual level, this study examined how differences in the proximal social environment and goal orientation are linked to differences in social regulatory processes. Data from the Personal Understanding of Life and Social Experiences (PULSE) project, a 100-day, internet-based microlongitudinal study of 100 Oregon residents age 52 to 88 (M = 63.13, SD = 7.8), were used to explore processes of relationship regulation. At the beginning of the study, participants created a meaningful social goal, and mapped their social convoy. Participants then tracked their daily goal progress and feelings of social support, hindrance and satisfaction over a 100-day time period. Analysis was conducted using multilevel random coefficient models, and was structured to examine within person processes. Daily experiences of goal progress were positively related to social support and contact satisfaction, and negatively related with social hindrance. Importantly, these associations varied greatly between participants, in part as a function of convoy composition and goal orientations. The results from this study suggest that relationship regulation is (a) embedded in the social context of daily life; (b) differs based on the structure of the proximal social environment; (c) contingent on regulatory strategies selected by older adults to work towards their goals; and (d) differentiated by mean tendencies. The linkages between support, hindrance and contact satisfaction with daily goal progress found in this study suggest that the process of working towards a social goal is dependent on older adults' daily social contexts. This has implications for populations with varying access to social support and exposure to social hindrance. Further, individual differences in social regulatory processes were only partially explained by convoy structure and goal orientation. Future research is needed to search for the mechanisms that drive these between person differences in social regulatory processes. Close

• 28. [Article] Social regulatory processes in adulthood : responding to change and variability in proximal and distal social forces

  Adult development and social experiences are intertwined, which has implications for social policy, health, and well-being across the lifespan. This dissertation explores the benefit and risk that close ...

  Citation × Citation Citation Abstract Copy Title: Social regulatory processes in adulthood : responding to change and variability in proximal and distal social forces Author: Mejía, Shannon T. Adult development and social experiences are intertwined, which has implications for social policy, health, and well-being across the lifespan. This dissertation explores the benefit and risk that close social partners bring to adults' lives, and the efficacy and consequences of engaging social resources to maintain well-being in the face of variability and change in their proximal and distal social environments. The first study, using a life course perspective and a macro analytic lens, traced experiences of financial loss in middle adulthood during the 2008 recession. Using the 2006 and 2010 waves of the Health and Retirement Study (n = 1,881; age range = 51 - 60 years), this study used conditional change models and path analysis to examine the extent to which increasing household complexity, giving help, receiving help, and relationship quality promoted or hindered the capacity to maintain a sense of control in the face of financial loss. Experiencing financial loss was directly associated with decreased control and giving help, and increased household complexity and receiving help. Experiences of financial loss indirectly decreased control through increased household complexity and decreased giving help. Although the experience of financial loss was distributed across differences in income and education, social resources patterned the engagement of interpersonal resources, which translated to engagement patterns that could compromise the sense of control. However, change in relationship quality, which did not systematically differ across experiences of financial loss, created pathways to support or hinder maintaining a sense of control while engaging interpersonal resources. The second study, informed by lifespan developmental theory and developmental systems theory, applied a micro analytic lens to closely examine the within-person processes that connect daily interactions within the social convoy to emotional well-being in older adulthood. Using data from the Personal Understanding of Life and Social Experiences Project, this study linked older adults' (N = 99; age mean = 63.29, SD = 7.93) satisfaction with their five closest social partners to daily experiences of positive and negative affect across 100 days. Multivariate multilevel models suggest that older adults’ daily affect is more sensitive to the quality of daily interactions with closest compared to other social partners. The relative strength of positive and negative affect sensitivity also varied within levels of closeness. Negative affect was relatively more sensitive to interactions with the closest social partner, and positive affect was relatively more sensitive to interactions with other close social partners. This study also found emotional sensitivity to vary within individuals. Satisfying contact with other social partners dampened emotional sensitivity to the closest social partner on that day. These patterns differed across overall levels of contact satisfaction. Those with lower overall satisfaction had higher emotional sensitivity, and were less able to regulate the sensitivity of positive affect. Together, the findings from these studies suggest that: (a) how individuals engage their interpersonal resources in response to loss can facilitate or hinder the maintenance of control and well-being; (b) the strategies that individuals engage vary by the presence or absence of socioeconomic and socioemotional resources; and (c) social partners contribute to both emotional reaction and recovery, but this sensitivity can be up and down regulated by reaching out to other close social partners. Relationships with others therefore contribute to well-being by supporting (or hindering) the regulation of self, actions, and emotions. Regulation through close interpersonal ties illustrates a process that links developmental and life course trajectories. Title: Social regulatory processes in adulthood : responding to change and variability in proximal and distal social forces Author: Mejía, Shannon T. Adult development and social experiences are intertwined, which has implications for social policy, health, and well-being across the lifespan. This dissertation explores the benefit and risk that close social partners bring to adults' lives, and the efficacy and consequences of engaging social resources to maintain well-being in the face of variability and change in their proximal and distal social environments. The first study, using a life course perspective and a macro analytic lens, traced experiences of financial loss in middle adulthood during the 2008 recession. Using the 2006 and 2010 waves of the Health and Retirement Study (n = 1,881; age range = 51 - 60 years), this study used conditional change models and path analysis to examine the extent to which increasing household complexity, giving help, receiving help, and relationship quality promoted or hindered the capacity to maintain a sense of control in the face of financial loss. Experiencing financial loss was directly associated with decreased control and giving help, and increased household complexity and receiving help. Experiences of financial loss indirectly decreased control through increased household complexity and decreased giving help. Although the experience of financial loss was distributed across differences in income and education, social resources patterned the engagement of interpersonal resources, which translated to engagement patterns that could compromise the sense of control. However, change in relationship quality, which did not systematically differ across experiences of financial loss, created pathways to support or hinder maintaining a sense of control while engaging interpersonal resources. The second study, informed by lifespan developmental theory and developmental systems theory, applied a micro analytic lens to closely examine the within-person processes that connect daily interactions within the social convoy to emotional well-being in older adulthood. Using data from the Personal Understanding of Life and Social Experiences Project, this study linked older adults' (N = 99; age mean = 63.29, SD = 7.93) satisfaction with their five closest social partners to daily experiences of positive and negative affect across 100 days. Multivariate multilevel models suggest that older adults’ daily affect is more sensitive to the quality of daily interactions with closest compared to other social partners. The relative strength of positive and negative affect sensitivity also varied within levels of closeness. Negative affect was relatively more sensitive to interactions with the closest social partner, and positive affect was relatively more sensitive to interactions with other close social partners. This study also found emotional sensitivity to vary within individuals. Satisfying contact with other social partners dampened emotional sensitivity to the closest social partner on that day. These patterns differed across overall levels of contact satisfaction. Those with lower overall satisfaction had higher emotional sensitivity, and were less able to regulate the sensitivity of positive affect. Together, the findings from these studies suggest that: (a) how individuals engage their interpersonal resources in response to loss can facilitate or hinder the maintenance of control and well-being; (b) the strategies that individuals engage vary by the presence or absence of socioeconomic and socioemotional resources; and (c) social partners contribute to both emotional reaction and recovery, but this sensitivity can be up and down regulated by reaching out to other close social partners. Relationships with others therefore contribute to well-being by supporting (or hindering) the regulation of self, actions, and emotions. Regulation through close interpersonal ties illustrates a process that links developmental and life course trajectories. Close

• 29. [Article] Big game from hunt to home

  Published January 2010. Reviewed April 2015. Please check for up-to-date information in the OSU Extension Catalog: http://extension.oregonstate.edu/catalog

  Citation × Citation Citation Abstract Copy Title: Big game from hunt to home Author: Raab, Carolyn A., Pacific Northwest Cooperative Extension, Sanchez, Dana Michelle, Busboom, Jan Roger, Oregon State University. Extension Service Published January 2010. Reviewed April 2015. Please check for up-to-date information in the OSU Extension Catalog: http://extension.oregonstate.edu/catalog Title: Big game from hunt to home Author: Raab, Carolyn A., Pacific Northwest Cooperative Extension, Sanchez, Dana Michelle, Busboom, Jan Roger, Oregon State University. Extension Service Published January 2010. Reviewed April 2015. Please check for up-to-date information in the OSU Extension Catalog: http://extension.oregonstate.edu/catalog Close

• 30. [Article] Exploring the Validity and Genetic Basis of Frailty

  Frailty is a clinical syndrome characterized by decreased resilience to stressors, resulting from dysregulation across multiple physiological systems. Frailty is prevalent in elders and is associated with ...

  Citation × Citation Citation Abstract Copy Title: Exploring the Validity and Genetic Basis of Frailty Author: Wu, Chenkai Frailty is a clinical syndrome characterized by decreased resilience to stressors, resulting from dysregulation across multiple physiological systems. Frailty is prevalent in elders and is associated with a wide range of adverse outcomes including death, disability, hip fracture, and falls. In the absence of a gold standard, there is a lack of consensus on the operational definition of frailty. Fried and colleagues developed the physical frailty phenotype (PFP) scale using gait speed, grip strength, exhaustion, physical activity, and weight loss. Since its emergence, the PFP scale has been repeatedly validated and widely used in assessing frailty. The PFP scale, however, like all other frailty assessments, has limitations. First, precision is lost in the process of dichotomizing continuous indicators (e.g., gait speed). In addition, all five frailty indicators in the PFP scale are assumed to be of equal importance in measuring frailty. Moreover, the PFP scale is very effective in identifying the frailest elders but has limited ability to differentiate persons with low levels of frailty. This dissertation had two overarching goals. The first was to create a new continuous scale for assessing frailty and to comprehensively evaluate its construct and predictive validity as well as measurement properties. The second was to explore the genetic basis of frailty. First, I demonstrated the feasibility to construct a continuous frailty scale that had high construct validity and desirable measurement properties. Second, I showed that the new continuous frailty scale had high predictive validity for adverse health outcomes including mortality, disability, hip fracture, and falls among older adults. Third, the new scale could provide additional risk stratification for adverse outcomes above and beyond the categorical PFP scale, especially at the lower to middle end of the frailty continuum. Fourth, the new frailty scale was strongly associated with recovery of and improvement in activities of daily living function among elders who were newly disabled. Fifth, older persons with higher scores on the new frailty scale were more likely to have prolonged length of hospital stay after undergoing myocardial infarction and coronary artery bypass grafting. Additionally, frailer elders had higher mortality after experiencing myocardial infarction, heart failure, pneumonia, and coronary artery bypass grafting. Lastly, several genetic variants that have biological plausibility were suggestively associated with frailty. From a methodological perspective, the new continuous frailty scale frailty is a valid continuous construct with a unidimensional factor structure robust to nuanced differences in measurements and invariant across cohorts and demographics including age and sex. In addition, the new frailty scale has high predictive validity for multiple health outcomes including death, disability, hip fracture, and falls among community-dwelling older adults. Moreover, the new frailty scale could capture elders’ ability to recover from stressors (disability, medical events, and surgeries), which is considered one of the defining features of frailty. Findings from this dissertation could also have important public health and clinical implications. First, the new continuous frailty scale could further stratify risk of outcomes among robust and prefrail persons, suggesting these two subgroups were not homogeneous. Second, the new frailty scale was able to pinpoint frailty level in the early stage, which may be valuable for identifying at-risk persons who are not frail yet and offers opportunities for interventions that prevent or slow down the progression of frailty and maintain health and function. Third, assessment of frailty may help clinicians, public health professionals, and researchers better identify at-risk elders after experiencing disability and acute diseases and provide useful information in making informed decisions about surgical procedures. Fourth, the new continuous frailty scale, due to its continuous and sensitive nature, may be suitable to evaluate the effectiveness of interventions for frailty and track trajectories of frailty over time. Title: Exploring the Validity and Genetic Basis of Frailty Author: Wu, Chenkai Frailty is a clinical syndrome characterized by decreased resilience to stressors, resulting from dysregulation across multiple physiological systems. Frailty is prevalent in elders and is associated with a wide range of adverse outcomes including death, disability, hip fracture, and falls. In the absence of a gold standard, there is a lack of consensus on the operational definition of frailty. Fried and colleagues developed the physical frailty phenotype (PFP) scale using gait speed, grip strength, exhaustion, physical activity, and weight loss. Since its emergence, the PFP scale has been repeatedly validated and widely used in assessing frailty. The PFP scale, however, like all other frailty assessments, has limitations. First, precision is lost in the process of dichotomizing continuous indicators (e.g., gait speed). In addition, all five frailty indicators in the PFP scale are assumed to be of equal importance in measuring frailty. Moreover, the PFP scale is very effective in identifying the frailest elders but has limited ability to differentiate persons with low levels of frailty. This dissertation had two overarching goals. The first was to create a new continuous scale for assessing frailty and to comprehensively evaluate its construct and predictive validity as well as measurement properties. The second was to explore the genetic basis of frailty. First, I demonstrated the feasibility to construct a continuous frailty scale that had high construct validity and desirable measurement properties. Second, I showed that the new continuous frailty scale had high predictive validity for adverse health outcomes including mortality, disability, hip fracture, and falls among older adults. Third, the new scale could provide additional risk stratification for adverse outcomes above and beyond the categorical PFP scale, especially at the lower to middle end of the frailty continuum. Fourth, the new frailty scale was strongly associated with recovery of and improvement in activities of daily living function among elders who were newly disabled. Fifth, older persons with higher scores on the new frailty scale were more likely to have prolonged length of hospital stay after undergoing myocardial infarction and coronary artery bypass grafting. Additionally, frailer elders had higher mortality after experiencing myocardial infarction, heart failure, pneumonia, and coronary artery bypass grafting. Lastly, several genetic variants that have biological plausibility were suggestively associated with frailty. From a methodological perspective, the new continuous frailty scale frailty is a valid continuous construct with a unidimensional factor structure robust to nuanced differences in measurements and invariant across cohorts and demographics including age and sex. In addition, the new frailty scale has high predictive validity for multiple health outcomes including death, disability, hip fracture, and falls among community-dwelling older adults. Moreover, the new frailty scale could capture elders’ ability to recover from stressors (disability, medical events, and surgeries), which is considered one of the defining features of frailty. Findings from this dissertation could also have important public health and clinical implications. First, the new continuous frailty scale could further stratify risk of outcomes among robust and prefrail persons, suggesting these two subgroups were not homogeneous. Second, the new frailty scale was able to pinpoint frailty level in the early stage, which may be valuable for identifying at-risk persons who are not frail yet and offers opportunities for interventions that prevent or slow down the progression of frailty and maintain health and function. Third, assessment of frailty may help clinicians, public health professionals, and researchers better identify at-risk elders after experiencing disability and acute diseases and provide useful information in making informed decisions about surgical procedures. Fourth, the new continuous frailty scale, due to its continuous and sensitive nature, may be suitable to evaluate the effectiveness of interventions for frailty and track trajectories of frailty over time. Close