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Erythocyte sedimentation rate (ESR) is one of the oldest measures of inflammation. It is used extensively in clinical medicine and has shown some utility in biomedical research. It is a nonspecific inflammation assay, and although it is less sensitive than more modern measures such as C-reactive protein, it is a useful measure in chronic illnesses. In general, ESR increases with age and appears to be a biomarker of aging in general. It predicts both cardiovascular disease (CVD) and cancer and is elevated in autoimmune disorders such as rheumatoid arthritis. Further, it predicts mortality both in the general population and in those with chronic illnesses such as CVD and cancer, independent of other indicators of illness severity. Interestingly, ESR is not associated with anxiety or general measures of distress but is consistently associated with measures of depression and suicidal ideation. Further, the effect of depressive symptoms on mortality appears to be mediated through increases in ESR. Studies of the relationship between stress and ESR have been less consistent, primarily because early studies were largely cross-sectional and in small samples. Studies using more modern, longitudinal analyses in larger samples may show more consistent results, especially if multilevel modeling was used that examined within-person changes in ESR in response to stress. Given that other large, longitudinal studies, such as the Baltimore Longitudinal Study on Aging, the Rotterdam Study, The Reykjavik Cohort Study, and Women’s Healthy Ageing Study have included ESR in their biomedical assays, it should be possible to analyze existing data to examine how psychosocial factors influence inflamm-aging in humans.


Joseph E. Gaugler, Colleen M. Peterson, Lauren L. Mitchell, Jessica Finlay, and Eric Jutkowitz

Mixed methods research consists of collecting and analyzing qualitative and quantitative data within a singular study. The “methods” of mixed methods research vary, but the ultimate goal is to provide greater understanding and explanation via the integration of qualitative and quantitative data. Mixed methods studies have the potential to advance our understanding of complex phenomena over time in adult development and aging (e.g., depression following the death of a spouse), but the utility of this approach depends on its application. The authors systematically searched the literature (CINHAL, Embase, Ovid/Medline, PubMed, PsychInfo, and ProQuest) to identify longitudinal mixed methods studies focused on aging. They identified 6,351 articles published between 1994 and 2017, of which 174 met the inclusion criteria. The majority of mixed methods studies reported on the evaluation of interventions or educational programs. Non-interventional studies tended to report on experiences related to the progression of various health conditions, the needs and experiences of caregivers, and the lived experiences of older adults. About half (n = 81) of the mixed methods studies followed a sequential explanatory design where a qualitative component followed quantitative evaluation, and most of these studies achieved “integration” by comparing qualitative and quantitative data in Results sections. There was considerable heterogeneity across studies in terms of overall design (randomized trials, program evaluations, cohort studies, and case studies). As a whole, the literature suffered from key limitations, including a lack of reporting on sample selection methodology and mixed methods design characteristics. To maximize the value of mixed methods in adult development in aging research, investigators should conform to recommended guidelines (e.g., depict participant study flow and use recommended notation) and consider more sophisticated mixed methods applications to advance the state of the art.