Cumulative advantage/disadvantage and the life course: cross-fertilizing age and social science theory

From patterns to pathways: Latent class trajectories of self-perceptions of aging and their causal effects on multi-state functional transitions

OBJECTIVES

This study examines the heterogeneous developmental trajectories of self-perceptions of aging (SPA) and their causal effects on functional health transitions in older adults. Specifically, we aim to identify latent classes of SPA development, assess their impact on multi-state functional transitions, and quantify the loss in healthy life expectancy attributable to negative SPA.

METHODS

Drawing from the Chinese Longitudinal Healthy Longevity Survey (2008-2018; n = 14,020), we implemented latent class trajectory modeling to identify SPA developmental patterns. We then applied multi-state Markov models to examine the effects of SPA on transitions among functional states (fully independent, assistance needed, and deceased), and established a counterfactual framework to estimate the loss in multi-state life expectancy attributable to SPA.

RESULTS

Analysis revealed two distinct SPA trajectories: a high-level group (57.75 %) and a low-level group (42.25 %), both exhibiting declining trends while maintaining consistent level differences. After adjusting for demographic characteristics, negative SPA significantly increased the risk of functional impairment (HR=1.31, 95 % CI: 1.20-1.44) and diminished the probability of functional recovery (HR=0.61, 95 % CI: 0.53-0.71). At age 65, negative SPA was associated with a 2.18-year reduction in total life expectancy, with substantial disparities in healthy life expectancy (10.93 vs. 7.96 years).

DISCUSSION

This study reveals two distinct trajectories of SPA in later life and demonstrates its causal effects on health state transitions. Early interventions targeting negative aging perceptions, particularly before age 65, may effectively extend healthy life expectancy.

Research on the impact and pathways of childhood trauma on the health status of middle-aged and elderly people

BACKGROUND

Childhood trauma can shape one's life trajectories, with implications in later years. While some studies have investigated the effects of childhood trauma on the health of older adults, these researches remain limited on the pathways through which childhood trauma affects their health status.

OBJECTIVE

To explore the impact and pathways of childhood trauma on the health status of middle-aged and elderly people, providing empirical evidence for enhancing health levels.

METHODS

The data from the 2014 life course survey and 2018 cross-sectional survey of the China Health and Retirement Longitudinal Study were analyzed, focusing on individuals aged 45 and above. Using 15,812 observed samples and employing multiple mediation models, this study analyzed the impacts and pathways of childhood trauma on the health status of middle-aged and elderly people.

RESULTS

Controlling for age, marital status, household registration, and activities of daily living (ADL), the total effect of childhood physical trauma on self-rated health was -0.059 (P < 0.001), with a direct effect of -0.057 (P < 0.001) and an indirect effect of 0.002. Physical trauma had indirect impacts through education level, behavioral lifestyle, and utilization of medical health services. The total effect of childhood emotional trauma on self-rated health was -0.048 (P < 0.001), with a direct effect of -0.050 (P < 0.001) and an indirect effect of 0.002. Emotional trauma had an indirect impact on educational level and social participation.

CONCLUSIONS

Childhood physical and emotional traumas have a sustained negative effect on self-rated health of middle-aged and elderly people, but the degree of influence and pathways are different. Therefore, it is necessary to provide effective support measures for children who have experienced childhood trauma throughout their entire lifecycle.

Associations between social vulnerability and functioning in older age, and the moderating role of optimism and self-efficacy

BACKGROUND

Although links between social factors, psychological characteristics and functioning have been established, interactions between social vulnerability and psychological characteristics impacting later-life functioning remain unclear. We investigated whether social vulnerability is associated with physical and emotional functioning and with the change in functioning over 5 years. Further, we studied whether optimism and self-efficacy moderate these associations.

METHODS

Physical and emotional functioning were measured in 2015 and 2020 using the SF-36 Health Survey in participants from the Helsinki Birth Cohort Study data (n = 1153, mean age 74y). Social vulnerability comprised several self-reported and register-based social indicators. We used linear mixed models to analyse the associations between social vulnerability and physical and emotional functioning, the change in functioning, and the moderating effects of optimism and self-efficacy.

RESULTS

Social vulnerability was inversely associated with the level of physical (β =-2.71, p < 0.001) and emotional functioning (β =-2.55, p < 0.001), as well as with the changes in physical functioning over the 5-year follow-up (β =-1.09, p = 0.003), but not with the decline in emotional functioning. Optimism and self-efficacy served as moderators by buffering the negative association of social vulnerability on emotional functioning, but not physical functioning. Optimism or self-efficacy did not moderate the change in physical or emotional functioning.

CONCLUSION

By impacting social vulnerability we may be able to promote functioning in older age. Social and psychological characteristics need to be acknowledged when planning effective health interventions and services for older adults.

Household-income trajectories and mental health inequalities in Germany before, during, and after the COVID-19 pandemic: a quasi-experimental panel study

BACKGROUND

The COVID-19 pandemic disrupted progress toward achieving the Sustainable Development Goals (SDGs), particularly SDG 10 (Reduced Inequalities) and SDG 3 (Good Health and Well-Being). In Germany, labor market volatility, compounded by record inflation, widened social inequalities and contributed to a gradient in mental health. This study examines the relationship between household income and mental health before, during, and after the pandemic in the German working population, addressing whether mental health burdens persisted post-pandemic.

METHODS

Using the German Socioeconomic Panel (v39.0), we applied a quasi-experimental design employing a 'placebo control' approach to obtain difference-in-difference (DiD) estimates. For this purpose, we created an 'intervention' sample consisting of respondents exposed to the COVID-19 pandemic (N = 8,340, 2018-2022) and a 'placebo control' sample, consisting of respondents not exposed to the COVID-19 pandemic (N = 11,869, 2014-2018), designed to mimic the intervention sample. Sequence analysis identified six typical household income trajectories (S1-S6): high, regular, fluctuating-I-II, low and unemployed. We used estimation methods to assess the mental health impacts of these trajectories during and post-pandemic, stratified by gender.

RESULTS

The results confirmed a strong social gradient in mental health tied to household income. For males, the COVID-19 pandemic caused a mental health decline of ~ ¼ standard deviation for trajectories reflecting regular (S2), fluctuating (S3), and low household income (S5) (e.g., S3-DiD = -2.043**), while those in high household income or unemployed trajectories were unaffected. Females experienced a more generalized mental health decline across all trajectories. Post-pandemic, mental health showed signs of recovery but did not fully return to pre-pandemic levels.

CONCLUSIONS

These findings revealed that regular and fluctuating household income trajectories (S2-S5) are particularly vulnerable to mental health impacts during crises. Females are disproportionately affected, highlighting the need for targeted public health interventions. Strengthening institutional supports, such as childcare, and addressing gender disparities can help build resilience and advance progress toward the SDGs.

Agentic Recombination of Health Behaviors into Adult Health Lifestyles

We advance health lifestyle research by developing the concept of agentic recombination to capture how individuals uniquely combine health behaviors to form adult health lifestyles. Using data from the 2005 to 2019 Transition to Adulthood Supplement of the Panel Study of Income Dynamics, we examine intergenerational transmission of health behaviors, directionality of health behaviors, and health lifestyles. We find significant parent/adult child correspondence in individual health behaviors and directionality of health-beneficial behaviors. However, associations between parent and adult child health lifestyles are comparatively more complex and uncertain. Our findings support theoretical consideration of what we term "agentic recombination": the structurally informed way that individuals uniquely combine health behaviors to form their overall health lifestyle. Findings extend knowledge on how changing social structural positions shape eventual adulthood health behaviors and provide novel evidence of the intergenerational link between not only health behaviors but also combinations of such behaviors into health lifestyles.

Stable Marital Histories Predict Happiness and Health Across Educational Groups

Couple relations are a key determinant of mental and physical well-being in old age. However, we do not know how the advantages and disadvantages associated with partnership histories vary between socioeconomic groups. We create relationship history typologies for the cohorts 1945-1957 using the Survey of Health, Ageing, and Retirement in Europe and examine, for the first time, how relationship histories relate to multiple indicators of well-being by educational attainment. The results show that stable marriages predict greater well-being, compared to single and less stable partnership histories. The positive outcomes are similar across all educational groups. Those with lower education who have divorced experience even lower well-being in old age. The interaction analyses suggest that individuals with fewer resources could suffer more from losing a partner. The findings underscore that current and past romantic relationships are linked to well-being in old age and help policymakers identify vulnerable subgroups among the ageing population.

Adverse Childhood Experiences and Intergenerational Relationships in Young Adulthood: Variation Across Gender, Race and Ethnicity

Young adults' quality relationships with parents are essential for their meaningful achievements and transition into adulthood. We aimed to examine the long-term effects of adverse childhood experiences (ACEs) on young adults' relationships with parents and the moderating roles of gender and race/ethnicity. We used data from Waves I, III, and IV of Add Health and focused on respondents' reports of closeness, satisfaction with communication, and the receipt and provision of financial support with mothers and fathers at 28.9 years of age on average. The key predictor was a cumulative score of 10 different types of adversity experienced in the family. We employed a series of multiple regression analyses. The key results showed that young adults' greater cumulative ACEs were significantly associated with decreased closeness and communication satisfaction with both parents and less frequent financial support received from fathers. ACEs were significantly associated with more frequent financial support provided to mothers but not fathers. The negative associations of ACEs with closeness and communication satisfaction with mothers were exacerbated for women. We also found significant moderating effects of race/ethnicity; for example, the positive association between ACEs and the provision of financial support to mothers was strengthened for Asian young adults relative to white young adults. ACEs' long-term effects may corroborate a pattern of cumulative disadvantage, suggesting that young adults with ACEs histories may continue to struggle in their essential family relationships. Extended support will help in the absence of strong parental support.

Aging With Emerging Social Welfare and Disappearing Filial Piety: Chinese Migrant Workers' Pathways Toward Financial Retirement Planning

This study examines the pathways and mechanisms linking Chinese migrant workers' migration experiences and their financial retirement planning. Using a mixed-methods approach with 1083 surveys and 32 interviews, this study finds that having a good financial status and social support system and maintaining a hopeful attitude toward retirement are direct pathways toward good financial retirement planning. Good health and hope for retirement are further enhanced by a good financial status and social support. Conversely, poor health and negative employment experiences are linked to poor financial retirement planning. The qualitative findings provide a contextual understanding of the pathways identified in the quantitative analyses. Migrant workers often face a dilemma between self-reliance for retirement and relying on filial piety. These findings apply not only to Chinese migrant workers but also to all migrant workers with limited access to healthcare and public pensions for retirement.

Age-related trajectories of health and cognition in mothers of children with developmental disabilities: Longitudinal findings from two independent studies

Developmental disabilities are a heterogenous group of disorders characterized by impairments in physical functioning, learning, language, behavior, and self-care (Zablotsky et al., 2019). Parenting a child with a developmental disability can be a profound source of stress, particularly for mothers. This atypical parenting experience can begin with the birth of the child, or soon thereafter, and continues over the life course, often extending six decades or more. However, there is limited research on the impact of this parenting role across the full adult life course - from mothers' early years of parenting through older age. Here we draw on data from two separate studies, one a national study of mothers of children with a range of developmental conditions (n = 96) and the other a community study of mothers of children with autism (n = 391). We used an accelerated longitudinal design to estimate mothers' trajectories of health, mental health, and cognitive functioning beginning in their 20s and extending until their 80s or beyond, and conducted a series of cohort and sensitivity analyses. Together, the results of analyses of these two studies revealed very similar patterns across a number of important outcomes. The inclusion in one of the studies of a nationally representative comparison group of mothers whose children did not have disabilities (n = 1,181) indicated that after around age 65, aging in mothers of children with developmental disabilities differed from the norm, suggesting the 'wear-and-tear' effects of this common form of stressful parenting.

Psychiatric disorders following the clustering of family disadvantages in previous generations: a multigenerational cohort study

PURPOSE

There is a lack of multigenerational research on the extent to which mental health is informed by transmission of multiple disadvantages across previous generations. This study aims to investigate how family socioeconomic and psychosocial disadvantages cluster and transition over grandparental and parental generations, and how this might be associated with grandchild psychiatric disorders.

METHODS

We utilized a cohort study with data following three generations from the Stockholm Birth Cohort Multigenerational Study, including 11,299 individuals born in 1953 (parental generation), their 22,598 parents (grandparental generation), and 24,707 adult children (grandchild generation). Family disadvantages as exposures were measured across two periods- grandparental adulthood (parental childhood) and parental adulthood (grandchild childhood), and included socioeconomic (i.e., low income, non-employment, overcrowding, and single parenthood) and psychosocial aspects (i.e., single parenthood, teenage motherhood, psychiatric disorders, and criminality of father). Psychiatric disorders in the adult grandchildren as outcome were defined by hospitalizations with a main or contributing diagnosis reflecting mental and behavioral disorders from age 18 until 2019.

RESULTS

Multiple disadvantages within the grandparental and parental generations, respectively, predicted higher probabilities of grandchild psychiatric disorders. Multigenerational transmission is evident in that grandchildren with combinations of grandparental socioeconomic disadvantages and parental psychosocial disadvantages had comparably high probabilities of psychiatric disorders. Importantly, improved socioeconomic and psychosocial circumstances across previous generations predicted comparably low probabilities of grandchild psychiatric disorders.

CONCLUSION

Mental health of future generations is informed by the transmission of multiple disadvantages across previous generations, and the transition from grandparental socioeconomic disadvantages into parental psychosocial disadvantages is particularly important.

Health inequalities for China's low-income population: trends, subgroup differences, and influencing factors, 2010-2022

Objective

Health inequality is a global challenge, with low-income populations often facing higher health risks. This study aims to systematically analyze the current status, trends, and influencing factors of health inequalities for China's low-income population.

Methods

Utilizing panel data from the China Family Panel Studies (CFPS) from 2010 to 2022, the low-income population was identified using a threshold of 67% of median income. Health inequalities were measured across four dimensions: self-rated health, mental health, two-week health, and chronic diseases status, using the Erreygers Index (EI) and Wagstaff Index (WI). Recentered Influence Function (RIF) regression and RIF-Oaxaca decomposition were employed to examine influencing factors of health inequalities and sources of disparities across urban-rural, gender, and age dimensions.

Results

From 2010 to 2022, the degree of health inequality was significantly higher for the low-income group compared to the middle and high-income groups in China. Inequalities in self-rated health and chronic diseases status showed an increasing trend for the low-income population. Per capita household income (PCHI) was a key factor, exhibiting a significant negative impact on inequalities in self-rated health and mental health (p < 0.01). Age had an inverted U-shaped effect on health inequalities, while household size significantly and negatively influenced disparities in self-rated health and two-week health (p < 0.01). Differences in the level of medical expertise of the visited institutions significantly affected chronic disease status inequalities (p < 0.01). The PCHI was the primary source of health inequality disparities across urban-rural, gender, and age groups, with the older adult low-income group experiencing significantly higher levels of health inequality compared to the non-older adult group.

Conclusion

Health inequalities for the low-income population in China are becoming increasingly severe, particularly pronounced among older adult and rural groups. The study recommends implementing interventions across multiple dimensions, including income support, healthcare accessibility, and family care support, while adopting differentiated policies tailored to the characteristics of various groups. Particular attention should be given to intersectionally disadvantaged groups such as low-income older adult individuals in rural areas.

Longitudinal impact of different categories of adverse childhood experiences on social participation and informal social support among middle-aged and older adults in China

BACKGROUND

Adverse childhood experiences (ACEs) can have a significant impact on informal social support (ISS) and social participation (SP) among middle-aged and older adults. Existing studies highlight the critical role of SP and ISS in promoting healthy aging. Social participation is associated with reduced cognitive decline, lower mortality risk, and improved mental health in older adults. ISS is linked to better physical and psychological outcomes. However, despite evidence on the protective effects of SP and ISS, the impact of ACEs on these factors in middle and older adulthood remains unclear. To analyze and understand the characteristics of different subgroups of ACEs and to comprehend the influence of ACEs on SP and ISS in middle-aged and older adults.

METHODS

Data from the China Health and Retirement Longitudinal Study (CHARLS, 2011-2018) and the 2014 Life History Survey (N = 11070). Diverse aspects of SP frequency, ISS, and ACEs were identified based on the CHARLS questionnaire items and ACEs were categorized using latent profile models. The fixed effects model was used to understand the impact of ACEs on SP and ISS and to explore differences in ACE subgroup.

RESULTS

Three distinct subgroups of ACEs were determined. It was found that the central role of parental mental health in the intergenerational transmission of ACEs, that better parental mental health and childhood SES in ACEs had a positive impact on SP and ISS (p < 0.01), and that those who experienced physical abuse were less likely to contact their children (β = -0.009, p < 0.001). But no significant differences were found in poor parental mental group.

CONCLUSIONS

This study reveals that better parental mental health and childhood SES in ACEs have a positive impact on SP and ISS. It is recommended that screening and intervention for ACEs be integrated into the Chinese community health service system to increase the prevalence of SP and reduce the intergenerational transmission of trauma for healthy aging.

The long-term health effects of welfare reform

Childhood poverty is associated with poor health in adulthood, but social policies may buffer poverty's long-term harmful effects by providing cash and in-kind resources. This study assessed the long-term health effects of welfare reform, which added work requirements, sanctions for noncompliance, lifetime limits, and family caps to welfare programming in the US in the mid-1990s. Research has found mixed evidence on the short-term health effects of welfare reform, but fewer studies have documented its impacts on health across the life course. This study exploited temporal and state variation in the implementation of welfare reform to examine the association between exposure to welfare reform as a child on self-rated health, psychological distress, and chronic conditions in adulthood using data from the Panel Study of Income Dynamics. We found that welfare reform exposure in early childhood, from conception to age five, was associated with more psychological distress (b = 0.41, 95%CI 0.08, 0.74) and more chronic conditions (b = 0.21, 95%CI 0.10, 0.33) in adulthood. We also found that welfare reform exposure in later childhood, from ages six to 18, was associated with lower likelihood of reporting poor health (b = -0.03, 95%CI -0.05, -0.01), less psychological distress (b = -0.33, 95%CI -0.54, -0.11), and fewer chronic conditions (b = -0.18, 95%CI -0.25, -0.10), which was especially true for non-Hispanic Black and Hispanic individuals compared to non-Hispanic White individuals. Our findings suggest that the difference in outcomes based on age of exposure is related to the ease with which parents fulfill welfare requirements, though more research is needed on possible mechanisms.

Socio-economic position and sudden cardiac death: a Danish nationwide study

AIMS

The aim of this study was to examine differences in incidence rates of all-cause mortality (ACM) and sudden cardiac death (SCD) in persons of differing socio-economic position (SEP).

METHODS AND RESULTS

All deaths in Denmark from 1 January to 31 December 2010 (1 year) were included. Autopsy reports, death certificates, discharge summaries, and nationwide health registries were reviewed to identify cases of SCD. Socio-economic position was measured as either household income or highest achieved educational level and analysed separately. Hazard rates were calculated using univariate and multivariable Cox regression models adjusting for age, sex, and selected comorbidities. A total of 53 452 deaths were included, of which 6820 were classified as SCDs. Incidence rates of ACM and SCD increased with age and were higher in the lower SEP groups. The greatest difference in SCD incidence was found between the low and high education level groups, with an incidence rate ratio of 5.1 (95% confidence interval 3.8-6.8). The hazard ratios for ACM and SCD were significantly higher for low SEP groups, independent of comorbidities. Compared with the highest income group, the low-income group had adjusted hazard ratios of ACM and SCD that were 2.17 (2.01-2.34) and 1.72 (1.67-1.76), respectively.

CONCLUSION

We observed an inverse association between both income and education level and the risk of ACM and SCD in the general population, which persisted independently of baseline comorbidities. Our results indicate a need for further research into the mechanisms behind socio-economic disparities in healthcare and targeted preventative strategies.

Health vulnerabilities of undocumented central and eastern European migrants in Switzerland

Destitute Central and Eastern European migrants, including homeless people, beggars, and sex workers, are in a highly vulnerable position in Switzerland. In the absence of residence permits, their access to health services and insurance is severely limited, and they suffer from institutional discrimination in Swiss medical facilities. The aim of this study is to examine the forms of health vulnerabilities of destitute mobile Eastern European citizens in Geneva and Zürich. To do this, we carried out narrative-biographical interviews with destitute migrants (n = 38) on their level of access to medical facilities and insurance. The results confirm that our respondents face severe vulnerabilities in accessing medical services and insurance mechanisms in Switzerland. This tendency is exemplified in the paper through the respondents' experiences of psychiatric disorders and substance abuse. Destitute migrants often transfer health vulnerabilities from their home countries. They mostly receive therapies and medicines in their countries of origin but remain untreated in Switzerland after arrival. Without Swiss health insurance, they turn to medical services only in cases of emergency, and even then, they are either rejected or discharged after very brief treatments. This dangerous combination of individual and systemic health vulnerabilities greatly exacerbates the disadvantages of destitute Eastern Europeans and hampers their integration into Swiss society.

Gendered life-course trajectories of childcare and informal care in the Netherlands

Unpaid caregiving remains highly gendered both in the context of childcare for young children and informal care provided to ill or ageing family members, friends, or neighbors. Using a life-course framework, this study expands previous research which generally treated these care types as separate life domains, by exploring the variety in caregiving trajectories including both childcare and informal care as integral parts of life courses. In addition to identifying and describing clusters of caregiving trajectories, we examine to what extent these are stratified by gender and education. We use unique retrospective survey data on informal caregiving combined with longitudinal data on childrearing, collected by the LISS Panel in the Netherlands (N = 1631). Using sequence and cluster analysis, we created caregiving trajectories covering up to 50 years of individual life courses and identified six clusters of caregiving trajectories that differed in care-heaviness, based on different combinations of the timing, duration, order, and intensity of care episodes. Our findings indicate path-dependency in care patterns, whereby most individuals who have engaged in unpaid care, provided both childcare and informal care at various points throughout their lives. In addition, while patterns of caregiving over the life course did not differ by gender, women were overrepresented in care-heavier clusters while men were more likely to follow the least care-heavy clusters. Theoretical expectations predicting educational differences based on opportunity costs and normative pressure were not supported. Given the anticipated rise in informal care due to population ageing and welfare state retrenchment, our findings suggest that while both women and men will be increasingly confronted with balancing unpaid care with other commitments, the gender gap in care-heaviness might persist and even widen.

Failed reciprocity in core social roles and cardiovascular disease mortality: prospective results from the U.S. health and retirement study

BACKGROUND

Several epidemiologic cohort studies documented increased risks of cardiovascular disease (CVD) resulting from exposure to psychosocial stress at work, as measured by theoretical models, such as the demand-control model and effort-reward imbalance (ERI) model. Few studies extended these concepts beyond paid work. With this study, we explore associations of ERI in family and household work, voluntary work and/or partnership with prospective CVD mortality risk, in addition to ERI at work.

METHODS

In the frame of the U.S. Health and Retirement Study (HRS), 4,642 individuals with mean age 61.5 who were employed at baseline (2006-2008) provided full data on ERI at work and beyond work, sociodemographic factors, lifestyle behaviors, and health conditions. Mortality data through the end of 2018 were available through linkage to the National Death Index. Participants were dichotomized into 'low' and 'high' group for each ERI dimension. Prospective associations of the two types of ERI at baseline with CVD mortality during follow-up were estimated, using competing-risk Cox proportional hazards regression.

RESULTS

Independ effects of work ERI and social ERI on CVD mortality risk were observed (HR: 1.66 [1.08; 2.53] and HR: 1.56 [1.02; 2.38], respectively). The hazard ratio of CVD mortality among participants with joint exposure was 2.58 [1.49; 4.45], compared to unexposed participants. This risk was further augmented (HR: 3.38 [1.45; 7.85]) in participants with cardiometabolic disease at baseline.

CONCLUSION

Failed reciprocity in core social roles of adult life is associated with increased CVD mortality risk in this study of older employed persons in the U.S.

Occupational Success Across the Lifespan: On the Differential Importance of Childhood Intelligence, Social Background, and Education Across Occupational Development

What shapes (occupational) success in later life? This study examines the differential importance of intelligence in late childhood, socioeconomic background, and education across later occupations. The quantity and quality of educational success are thought to mediate the other dimensions. We analyzed data from N = 4387 participants in a German longitudinal large-scale study in multiple regression and mediation models to examine how childhood intelligence and socioeconomic background predict income and occupational status at different career stages. Both childhood intelligence and socioeconomic background predict status and income in adulthood, with childhood intelligence being the stronger predictor. However, education is an even stronger predictor and-once included in the model-mediates virtually all effects of childhood intelligence and socioeconomic background. This pattern remains stable across career stages, and education has unique effects on income and occupational status in later work life, even when controlling for work experience. Our results emphasize the pivotal role of education in transitioning to the labor market and further development at work, even at later career stages. Given the stronger link between childhood intelligence and educational success in Germany than in other countries, we find that Germany is one of the more intelligence-driven systems.

The long-term impact of childhood peer relationships on disability in later life: Causal mediation evidence from older Chinese adults

Despite the recognized importance of social connections in Chinese culture, research on how childhood peer relationship deficits impact health later in life has been limited. This study aimed to investigate the association between childhood peer relationship deficits and the odds of disability among older Chinese adults and to explore the potential mediating roles of social isolation, loneliness, and cognitive function. Using the longitudinal sample of respondents aged 60 years and older in the China Health and Retirement Longitudinal Study 2013-2018 (N = 7133), the link between peer relationship deficits in childhood and disability in late life was assessed using marginal structural models, and the potential mediating effects of social isolation, loneliness, and cognitive function were examined by the inverse odds ratio weighting technique. Participants who experienced greater childhood peer relationship deficits were more prone to disability (odds ratio: 1.19, 95% CI: 1.09, 1.29) than those with more positive childhood peer interactions. The inverse odds ratio weighting analysis indicated that social isolation, loneliness, and cognitive function individually played partial mediating roles in the association between childhood peer relationships and disability by 11.36% (95% CI: 4.04%-18.99%), 11.95 % (95% CI: 4.65%-19.23%), and 24.58% (95% CI: 17.01%-32.43%), respectively. The combined mediation effect of the three mediators was 30.57% (95% CI: 23.52%-39.91%). These findings suggest that interventions to enhance social connections and cognitive health in older adults may help mitigate the long-term impacts of childhood peer relationship deficits on disability among older Chinese adults.

Both Partnership History and Current Relationship Quality are Associated With Life Satisfaction in Old Age

Romantic relationships significantly impact physical and mental wellbeing. While both partnership history and current relationship quality influence wellbeing in later life, they are seldom investigated together. This study examines the long-term effects of partnership history on wellbeing, exploring whether current relationship quality can mitigate the impact of past experiences. Using data from the Survey of Health, Ageing, and Retirement in Europe (SHARE) Finland, we categorize partnership histories and examine if relationship quality mediates their effect on life satisfaction. The analysis identifies five partnership history clusters, revealing that continuous relationships lead to the highest life satisfaction, while unstable histories are linked to lower wellbeing. High relationship satisfaction and fewer conflicts are associated with greater wellbeing for both sexes. Relationship quality mediates the negative associations between unstable partnership histories and subjective wellbeing for both men and women but does not alter the wellbeing associations for those with a continuous partnership history.

Association between school bullying and late-life depression: Evidence from the China health and retirement longitudinal study

BACKGROUND

Existing literature suggests that school bullying can have long-lasting effects on mental health, but its specific impact on late-life depression remain underexplored. This study aims to investigate the association between early-life school bullying experiences and depression symptoms in old age and the variations by sex, place of residence and educational level.

METHOD

Data were derived from the Life History Survey of the China Health and Retirement Longitudinal Study in 2014, including 4333 older adults aged ≥60 years. School bullying was assessed on the basis of self-reported experiences during childhood. Depression symptoms were measured using the Center for Epidemiologic Studies Depression Scale-10. Poisson regression analyses were performed to examine the relationship between early-life school bullying experience and late-life depression.

RESULTS

Of the 4333 respondents, 607 (14%) reported being bullied during childhood, and 1274 (29.4%) exhibited symptoms of depression. Older adults who experienced school bullying were 1.17 times more likely to exhibit depression symptoms compared with those without such experiences (prevalence ratio [PR], 1.173; 95% confidence interval [CI], 1.027-1.3390). This association was more prominent among women (PR, 1.284; 95% CI, 1.093-1.475), rural residents (PR, 1.477; 95% CI, 1.210-1.803) and those with education at primary school level (PR, 1.172; 95% CI, 1.017-1.352). The results remained robust using an alternative school bullying cutoff and after imputing all missing data.

CONCLUSION

Early-life school bullying is a significant risk factor for depression in later life, with its impact being particularly pronounced among women, rural residents and those with lower educational levels. These findings highlight the need for targeted mental health interventions for individuals with a history of early-life school bullying to mitigate long-term psychological effects. Geriatr Gerontol Int 2025; 25: 454-462.

Religiosity, Religious Beliefs, and Cognitive Impairment Among Black and White Men With Modest Incomes

ObjectiveThe objective of this study was to examine the association between religious practices, beliefs, and cognitive impairment among Black and White men with modest incomes in the 2016 Health and Retirement Study.MethodsData were drawn from Black and White men who reported annual incomes at or below $50,000 (n = 926). The primary outcome was any cognitive impairment, a dichotomous variable derived from a modified version of the Telephone Interview for Cognitive Status. The religious variables were religious service attendance, private prayer frequency, and religious beliefs.ResultsResults from regression models indicated that religious service attendance was inversely related with cognitive impairment among White men (PR = 0.64, CI: 0.48-0.87). Private prayer (PR = 0.67, CI: 0.47-0.97) and religious beliefs (PR = 0.91, CI: 0.84-1.00) were inversely related to cognitive impairment among Black men.DiscussionOur results suggest that religious practices and beliefs may contribute to cognitive preservation among Black and White men, but longitudinal studies are needed to examine these associations further.

How are location and type of caring associated with the carer's mental health? Cross-sectional and longitudinal findings from SHARE

Research findings on the relationship between caring and health are mixed and call for a more nuanced analysis of the care situation. This study investigates cross-sectional and longitudinal associations between caring and depressive symptoms, considering location and type of care. Data come from the Survey of Health Ageing and Retirement in Europe (SHARE), collected in wave 6 (from 2015 to 2016) and wave 8 (from 2019 to 2020). Cross-sectional data were available for 52.186 respondents in 18 countries. Of these, 18.659 were free of elevated depressive symptoms in wave 6 and were used to investigate incident depression in the longitudinal analyses. We distinguished between personal care, practical help, and paperwork, and were able to compare in-home and outside-home personal care. For both men and women, findings indicate that in-home personal care is associated with an increased risk of reporting and developing depressive symptoms (after controlling for age, country affiliation, education, wealth, employment situation, and functional limitations). Cross-sectional, but not longitudinal, associations were also found for outside-home care in terms of personal care or paperwork, but not for practical help. Additionally, women and disadvantaged population groups were more likely to provide in-home care, but less likely to provide outside care (regardless of the type). Overall, the results highlight that different locations and types of care are associated differently with mental health. Findings also underscore the need for interventions specifically tailored to support disadvantaged populations who provide in-home care, addressing the unique challenges they face.

Nomogram for predicting changes in cognitive function in community dwelling older adults with mild cognitive impairment based on Korea Longitudinal Study of Ageing Panel Data: a retrospective study

Purpose

This study aimed to identify factors associated with normal cognitive reversion and progression to dementia in older adults with mild cognitive impairment (MCI) residing in the community and to develop a nomogram.

Methods

This longitudinal study used secondary data from the Korea Longitudinal Study of Ageing Panel Data (2006-2018). The study included 1,262 participants aged 60 or older, with initial Mini-Mental State Examination scores ranging from 18 to 23. Data were analyzed using the Rao-Scott chi-square test, panel binary logistic regression, and receiver operating characteristic (ROC) curve in Stata ver. 17.0 (Stata Corp.).

Results

The rate of reversion from MCI to normal cognition was 37.0% after 2 years and 32.9% after 12 years. The rate of progression to dementia was 18.0% after 2 years and 30.2% after 12 years. In the nomogram for reversion to normal cognition, the most significant influences were grip strength, depression, number of meetings, age, and regular exercise, with an area under the ROC curve (AUC) of .66. In contrast, in the nomogram for progression to dementia, the most significant influences were age, grip strength, instrumental activities of daily living, number of social meetings attended, depression, and regular exercise, with an AUC of .69.

Conclusion

These nomograms can serve as an effective intervention tool for preventing dementia in the field of community health care since they can serve as a visual technique for presenting information on risk to individuals with MCI.

The long-term effects of housing insecurity in young adulthood on subsequent material hardship, physiological and mental health

Economic and material hardship, including housing insecurity - limited or uncertain availability or access to safe, quality, and affordable housing - is strongly linked to negative physical and mental health outcomes among adolescents and adults. However, data limitations and the inherent selectivity of housing insecurity have hindered comprehensive analysis of its long-term effects on physiological and mental health. This study uses data from The National Longitudinal Study of Adolescent to Adult Health (Add Health) to construct a sample of participants who experienced housing insecurity between the ages of 18-26 (Wave III) to a suitable control group using propensity score matching. We assess the effects of housing insecurity on (1) material hardship at Wave IV (ages 24-32), (2) allostatic load (AL) and depression symptoms at Waves IV and V (ages 33-43), and (3) the change in allostatic load and depression symptoms from Wave IV to V. Further, we evaluate whether effects differ by sex. Experiencing housing insecurity is associated with a significantly higher likelihood of experiencing material hardship at Wave IV and significantly worse depressive symptoms at both Waves IV and V. The treatment effects are more pronounced among women, with housing insecurity being linked to a significant increase in allostatic load from Wave IV to Wave V exclusively for women. Our results provide crucial support that housing insecurity is not just an outcome of economic hardship but a cause of it in the future, with downstream effects on health and well-being, particularly for women.

Risk of Hospitalization Among Assisted Living Residents Dually Enrolled in Medicare and Medicaid

OBJECTIVES

To examine how risk of hospitalization among assisted living (AL) residents differs by dual enrollment in Medicare and Medicaid and by the percent of dually enrolled individuals in an AL community.

DESIGN

Retrospective cohort study.

SETTING AND PARTICIPANTS

We used Medicare data from 2008 to 2018 and a national directory of licensed AL communities to identify Medicare beneficiaries with a change in their ZIP+4 code suggesting a new residence in an AL.

METHODS

We estimated linear regression models of hospitalization onto interactions of residents' dual enrollment status and categories of the AL community's percentage of dually enrolled residents. In the models, we adjusted for person-level clinical and demographic characteristics, year-fixed effects, and fixed effects for the AL residents' prior ZIP code.

RESULTS

Among 620,542 Medicare beneficiaries who moved to an AL community, the 1-year risk of hospitalization was higher for dually enrolled residents compared with Medicare-only residents. In adjusted models, dually enrolled residents in high-dual AL communities (>50% dually enrolled) had an 7.4% higher risk of hospital admission compared with dually enrolled residents in low-dual AL communities. Medicare-only beneficiaries in high-dual AL communities had a 9.4% higher risk of hospitalization than Medicare-only beneficiaries in low-dual ALs.

CONCLUSIONS AND IMPLICATIONS

The proportion of residents in an AL community who were dually enrolled was associated with residents' risk of hospitalization, regardless of their dual enrollment status. Additional research is needed to understand whether differences observed in residents' risk of hospitalization are due to differences in the types of services provided, unmeasured resident acuity, or the quality of care delivered in these settings.

The development of attitudes toward science and technology: a longitudinal analysis of Generation X

Research on public attitudes toward science and technology policy has relied on surveys taken at single points in time. These surveys fail to indicate how these attitudes develop or change. In this study, we use data from the Longitudinal Study of American Life that has followed a national sample of Generation X for 33 years-from middle school to midlife. We demonstrate that the critical period for the formation of attitudes toward science and technology is the 15-18 years after high school-college, work, family, and career. The attitudes formed in this period remain stable for most individuals during midlife. This work provides an important perspective for scientists, engineers, and the leadership of the scientific community in their efforts to foster positive attitudes toward science and technology and to understand the roots of concerns and reservations about science.

Geographic Patterns of Human Immunodeficiency Virus (HIV) Risk Behaviors Among Older Adults: A Strategy for Identifying Space as a Risk Exposure

OBJECTIVES

This study examined geographical patterns of HIV risk among adults aged 60 and older.

METHODS

The 2019 Behavioral Risk Factor Surveillance System (BRFSS) weighted data was used to analyze self-reported participation in HIV risk behaviors among older adults (n = 62,852). Logistic regression models were used on a dichotomous HIV risk variable to map the distribution of HIV risk behaviors across both census regions and divisions.

RESULTS

The weighted model revealed significance across regions. Across all regions, identifying as female, identifying as Hispanic, and reporting not having depression were protective from participating in HIV risk behaviors.

DISCUSSION

The geographic heterogeneity in patterns of high-risk behaviors among older adults are discussed, along with the implications of partner access (marital status) and emotional health (depression) that need further examination. Recommendations for additional geographic analysis are made.

Urban-rural disparities in the prevalence and trends of loneliness among Chinese older adults and their associated factors: Evidence from machine learning analysis

In the context of rapid aging development, exploring the predictive factors of older adults' loneliness and its urban-rural differences is of great significance for promoting the psychological health of older adults. This study selected 30 variables from the three waves of China Family Panel Studies (CFPS) data in 2016, 2018, and 2020, using a random forest classifier to explore the predictive factors of loneliness. The sense of loneliness among rural older adults is significantly higher than that of urban older adults. Among the top 10 predictors of loneliness, there are seven common factors in urban and rural, including sleep quality, marital status, confidence in the future, weekly family dinners, life satisfaction, physical discomfort in the past 2 weeks, and relationship with children. The other three different predictive factors for urban older adults are weekly movie and TV duration, family size, and family net worth, while self-rated health, health change, and per capita family income set the rural older adults apart. In addition, the urban-rural differences in the predictive factors of older adults' loneliness show different development trends in the time dimension. Paying attention to the predictive factors that contribute to the high ranking of older adults' loneliness and the widening trend of urban-rural differences is highly required.

Safer dementia care spaces: Perspectives from LGBTQ+ people with cognitive impairment and caregivers

The number of caregivers and people living with dementia and other related forms of cognitive impairment is increasing worldwide. Compared to heterosexual and cisgender individuals, studies suggest that lesbian, gay, bisexual, queer, or other sexual and/or gender minority people (LGBTQ+) are at a higher risk for known risk factors for cognitive impairment and dementia, stemming from minority stress experiences. Limited research has explored the distinct obstacles that LGBTQ+ people with cognitive impairment and caregivers encounter, especially within dementia care. The purpose of this study was to deepen our understanding regarding LGBTQ+ people with cognitive impairment and caregivers' experiences with dementia care spaces, and to identify the strategies that they perceive as effective in creating safer and more inclusive spaces. Fourteen LGBTQ+ participants aged 27-78 (M = 58.07), consisting of two individuals with cognitive impairment and 12 caregivers, were interviewed about the care needs of LGBTQ+ people with cognitive impairment and caregivers, and their experiences with dementia care spaces. Using reflexive thematic analysis, we identified three overarching themes from the data, indicating that LGBTQ+ people with cognitive impairment and caregivers feel left "on the margins" of dementia care and express a desire for their identities to be celebrated and recognized. Additionally, they proposed recommendations for policy change to foster safer and more inclusive spaces for dementia care. The findings call attention to the negative experiences of LGBTQ+ people with cognitive impairment and caregivers with dementia care, but also highlight the ways in which care practices can be transformed to effectively address their care needs.

Life course social mobility and cognitive function among middle-aged and older adults in India: Exploring heterogeneity by gender

This study investigates the link between life course social mobility and cognitive function among middle-aged and older adults in India, specifically emphasizing whether upward and downward mobility exerts symmetric associations and potential gender heterogeneity within these associations. Leveraging data from the Longitudinal Aging Study in India 2017-2018, encompassing 64,710 individuals aged 45 years or above, we classified social mobility as 'consistently high,' 'upward mobility,' 'downward mobility,' and 'consistently low,' based on socioeconomic position during childhood and late adulthood. Multivariable regression and gender-interaction analyses were employed to assess associations. Overall, 35.69% maintained a consistently high socioeconomic position, whereas 22.87% remained consistently low; 20.05% experienced upward mobility, and 21.39% faced downward mobility. Compared to consistently high socioeconomic position, consistently low socioeconomic position was associated with lower cognitive function (b = -1.47; 95% CI = -1.59, -1.34), followed by downward mobility (b = -0.84; 95% CI = -0.95, -0.72) and upward mobility (b = -0.72; 95% CI = -0.84, -0.61). Notably, the interaction model revealed significant differences by gender, especially between opposite social mobility groups. Among men, upward and downward mobility displayed asymmetric associations, with upward mobility being associated with a higher cognitive function than downward mobility (b = 0.31; 95% CI = 0.13, 0.50), whereas such differences were not observed for women (b = -0.01; 95% CI = -0.20, 0.17). These findings highlight the critical influence of life course social mobility on cognitive health, with implications for interventions tailored to the unique trajectories of social mobility by gender in India.

Living with(out) Citizenship: The Impact of Naturalization on Mortality Risk among U.S. Immigrants

In recent decades, naturalization rates among U.S. immigrants have surged as many seek citizenship to regain lost rights and protections. However, the impact of naturalization on immigrants' life outcomes, such as health, remains underexplored in academic research. Challenges arising from selection processes complicate the interpretation of any observed health disparities between naturalized citizens and noncitizens. To address this gap, we link restricted-use data from the 2000 U.S. census to individual Social Security records on citizenship change and death, enabling a 20-year observation of naturalization and mortality. Results from discrete-time hazard analysis of mortality risk reveals a significant protective health effect from naturalization, which increases in magnitude among long-term naturalized citizens. The effect is particularly strong across older ages and among groups with lower education, refugee entry status, Hispanic origin, and health limitations. These findings suggest that naturalization represents an important but stratifying source of institutional support for socially vulnerable immigrants.

Unequal ageing: the quality of life of senior citizens in the EU before and after COVID-19. A multidimensional approach

Introduction

The ageing population presents a significant demographic and socio-economic challenge for the European Union (EU). Declining fertility rates, coupled with increasing life expectancy, have led to a growing proportion of older individuals within the population, raising concerns about their quality of life. This study aims to assess the quality of life for seniors across EU countries in the years 2015, 2019, and 2022, with a particular focus on the impact of the COVID-19 pandemic. The research seeks to answer the following question: How has the quality of life among seniors in the EU evolved over time, and how has the COVID-19 pandemic affected this trajectory? We hypothesize that the pandemic has exacerbated existing socio-economic inequalities, particularly affecting the most vulnerable older populations.

Methods

This study utilises the Synthetic Measure of Senior Quality of Life (SMSQoL) to evaluate the living conditions of seniors across four critical domains: health, finances, social relations, and environment. Data for the analysis were drawn from Eurostat and national statistical reports, complemented by pilot studies conducted in selected EU countries. The pilot studies focused on gathering qualitative data to supplement the quantitative measures, especially in areas where standardised data were incomplete or unavailable. The assessment spans three years: 2015 (pre-pandemic baseline), 2019 (immediate pre-pandemic), and 2022 (post-pandemic). The analysis includes 27 EU member states and uses both descriptive and inferential statistical methods to evaluate trends and disparities. Cross-sectional analysis was applied to examine the impact of differing social policies, levels of social security, access to healthcare, and economic strength across these countries.

Results

The analysis reveals significant disparities in the quality of life among seniors across EU countries, with pronounced differences between regions. In particular:Northern and Western Europe: seniors in these regions generally experienced improved overall life quality over the observed period. Countries such as Sweden and Germany reported gains in health, financial stability, and social relations, largely due to strong social policies and robust healthcare systems.Eastern Europe: Seniors in Eastern European countries, including Romania and Bulgaria, continued to face substantial challenges, with minimal improvements in quality of life. Economic instability, limited access to healthcare, and weaker social security systems were identified as key contributors to this stagnation.Impact of COVID-19: the pandemic exacerbated existing inequalities, particularly in the domains of social relations and finances. Seniors in economically vulnerable regions were disproportionately affected by social isolation and reduced income, intensifying the pre-existing challenges in their living conditions.Quantitative analysis confirmed that while some regions showed resilience, the most vulnerable populations experienced a sharp decline in their overall quality of life, particularly between 2019 and 2022.

Discussion

The findings from this study highlight the persistence of economic and social inequalities in the life conditions among seniors across the EU. While countries in Northern and Western Europe have made strides in improving senior living conditions, Eastern Europe continues to face significant challenges. The COVID-19 pandemic acted as a catalyst, exacerbating these inequalities, particularly in terms of social isolation and financial insecurity. These results align with previous studies that have highlighted the uneven impact of social policies and economic strength on senior well-being across Europe. The disparities underscore the need for more balanced and equitable policy interventions that can address the vulnerabilities of older populations, particularly in regions struggling with economic instability. Future research should focus on longitudinal studies that track the recovery trajectories of seniors post-pandemic and assess the effectiveness of policy measures aimed at mitigating these disparities.

Housing insecurity pathways to physiological and epigenetic manifestations of health among aging adults: a conceptual model

Introduction

Housing insecurity is a social determinant of health, as evidenced by its associations with mental, physical, and biological outcomes. The scientific understanding of the mechanisms by which housing insecurity is associated with health is still limited. This review adapts existing stress process models to propose a conceptual model illustrating potential pathways linking the specific stressor of housing insecurity to physiological and epigenetic manifestations of stress among aging adults.

Methods

This narrative review examines literature across multiple fields, including public health, psychology, and sociology. The literature selected for this review was identified through scientific databases including Web of Science, PubMed, JSTOR, and Google Scholar; primarily peer-reviewed empirical studies, literature reviews, and research reports published in English between 1981 and 2024; and principally based in the United States context. A synthesis of this literature is presented in a proposed conceptual model.

Results

The literature supports the existence of two main predictors of housing insecurity: sociodemographic characteristics and the historical/current context. The main mediating pathways between housing insecurity and manifestations of stress include health behaviors, psychosocial resources, and structural resources. Moderating factors affecting the associations between housing insecurity and manifestations of stress include government assistance, chronic discrimination/unfair treatment, and individual differences. These interdependent mediating and moderating mechanisms affect stressor reactivity, a proximal manifestation of stress, which contributes to the physiological and epigenetic distal manifestations of stress in aging adults.

Discussion and implications

The prevalence of housing insecurity among aging adults is growing in the United States, with significant implications for public health and health disparities, given the growing percentage of aging adults in the population. Further empirical testing of the mediating and moderating mechanisms proposed in the conceptual model will elucidate how housing insecurity is connected to health and provide insight into preventive strategies to ameliorate the adverse effects of housing insecurity on biological health among aging adults.

Cumulative Social Disadvantage and Medicinal Cannabis Use Among Younger Adults in Rural Communities: A Mixed Methods Approach

This mixed-methods study investigated the role of medicinal cannabis use among younger adults who live in rural communities and experience high levels of cumulative social disadvantage (CSD). Results are based on cross-sectional surveys and online interviews with 153 younger adults (18-35-years old) in rural California. We assessed participants' levels of CSD (high, medium, and low) and examined associations with perceived general physical and mental health and with medicinal use of cannabis (MUC). Qualitative analyses were then conducted to better understand the roles of cannabis use in the lives of study participants with high versus low CSD. High CSD was associated with perceived poorer physical and mental health and with MUC, but not past month general cannabis use. Qualitative findings emphasized the significant role of MUC for rural young people with high CSD to reduce stress and manage physical and mental health. Findings suggest the need to address CSD inequities in rural communities, such as increasing access to health care, to reduce health inequities and the reliance on cannabis use for managing mental and physical health.

Spillover effect of children's education on parental physical functioning over the life course

Parental well-being is linked to the life chances of adult children in later life. Despite accumulated knowledge on the role of children's education on parental longevity in developed contexts, it remains unknown how children's education may influence the trajectories of parental physical well-being over the aging process, particularly in developing contexts. Using a growth curve model and four-wave data from the China Health and Retirement Longitudinal Study, this study examines the association between children's education and parental physical functioning trajectories as parents age. This study yields several findings. First, adult children's schooling is negatively associated with the limited physical functioning of older parents. Second, consistent with the cumulative disadvantage perspective, this study confirms the diverging parental health trajectories across different children's education groups as parents age. The linear rate of decline in parental physical functioning is slower among older adults with better-educated children. Third, the education returns of sons and daughters with regard to their parents' physical functioning are similar to each other, implying the rationale for gender-blind attitudes in parenthood. Fourth, children's education has a compensatory effect among parents lacking institutional old-age support. The association between children's education and parental physical functioning is significant among rural older adults only.

Beyond the Nest: The Role of Financial Independence in Young Adult Health

BACKGROUND

This study aimed to examine the impact of neighborhood conditions and household material hardship experiences on young adult health outcomes, while also considering financial autonomy as a critical determinant of health.

METHOD

We employed a cross-sectional observational design with a diverse sample of young adults from a large urban university. Structural equation modeling was used to analyze the relationships between neighborhood conditions and material hardship with health outcomes by financial autonomy.

RESULTS

Material hardship and neighborhood conditions were significantly related to various health outcomes among young adults. Food insecurity emerged as a significant mediator linking neighborhood conditions to health including global physical health, cognitive functioning, and depression. Financially independent young adults showed stronger direct and indirect effects of neighborhood conditions on health compared to financially dependent counterparts.

CONCLUSION

This study underscores the complex interplay of neighborhood conditions, household material hardship, and financial autonomy in shaping young adult health. Our findings also suggest how the impact of SDOH on young adult health may have long-term effects later in life. Future research should consider these factors comprehensively to address disparities in emerging adult health.

Social determinants of recovery from ongoing symptoms following COVID-19 in two UK longitudinal studies: a prospective cohort study

Introduction

Social gradients in COVID-19 exposure and severity have been observed internationally. Whether combinations of pre-existing social factors, particularly those that confer cumulative advantage and disadvantage, affect recovery from ongoing symptoms following COVID-19 and long COVID is less well understood.

Methods

We analysed data on self-perceived recovery following self-reported COVID-19 illness in two UK community-based cohorts, COVID Symptom Study Biobank (CSSB) (N=2548) and TwinsUK (N=1334). Causal effects of sociodemographic variables reflecting status prior to the COVID-19 pandemic on recovery were estimated with multivariable Poisson regression models, weighted for inverse probability of questionnaire participation and COVID-19 infection and adjusted for potential confounders. Associations between recovery and social strata comprising combinations of sex, education level and local area deprivation were estimated using the intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) approach. Further analyses estimated associations with variables reflecting experiences during the pandemic.

Results

Gradients in recovery from COVID-19 along the lines of social advantage were observed in intersectional MAIHDA models, with predicted probability of recovery lowest in female strata with lowest education and highest deprivation levels (CSSB: 55.1% (95% CI 44.0% to 65.1%); TwinsUK: 73.9% (95% CI 61.1% to 83.0%)) and highest in male strata with highest education and lowest deprivation levels (CSSB: 79.1% (95% CI 71.8% to 85.1%); TwinsUK: 89.7% (95% CI 82.5% to 94.1%)). Associations were not explained by differences in prepandemic health. Adverse employment, financial, healthcare access and personal experiences during the pandemic were also negatively associated with recovery.

Conclusions

Inequalities in likelihood of recovery from COVID-19 were observed, with ongoing symptoms several months after coronavirus infection more likely for individuals with greater social disadvantage prior to the pandemic.

Financial strain measures and associations with adult health: A systematic literature review

Despite growing attention to other social needs like food and housing insecurity, financial strain, defined as having difficulty making ends meet or lacking money for basic needs, is under-recognized. Inconsistent labels and measures have made the literature difficult to unify. We used many synonyms for financial strain to systematically identify 199 U.S. studies (316 papers) that used financial strain measures that were operationally consistent with our definition as predictors of health among adults. We thematically coded financial strain measures for content and synthesized evidence based on measure and methods. Financial strain was measured by self-reported lacking money for basic needs (119 studies) and/or difficulty making ends meet (n = 132), and less commonly additionally based on coping strategies (n = 23), satisfaction with finances (n = 14), worry about finances (n = 22), the anticipation of strain (n = 14), and/or lacking money for leisure (n = 29). Regardless of measure, financial strain was associated with poorer mental, physical, biological, and functional health, worse health behaviors and more social needs. Associations were found across diverse and population-based samples and when accounting for other socioeconomic factors and even intermediating health factors. Results demonstrate predictive validity for two different one-item screening tools. Furthermore, the vast evidence linking financial strain to health highlights an urgent need for policy action addressing financial strain to advance health equity.

The mortality implications of a unionized career

An emerging literature has documented a wide range of protections and benefits that union membership provides for health and wellbeing. However, this literature primarily focuses on point-in-time associations between unionization and health, whereas the theoretical benefits of union membership should accrue over a long period of time through such mechanisms as predictable upward attainment and greater employment security. Moreover, studies have not examined union membership's association with mortality, a core health outcome in medical research. We build on recent research that examines the contributions of a unionized career to middle- and older-adulthood mortality using data from the Panel Study of Income Dynamics between 1969 and 2019. We track respondents born between 1935 and 1965 and predict mortality using discrete time hazard regression models. We find that more time spent in a union predicts lower rates of mortality, with an additional year as a union member decreasing the odds of mortality by about 1.5%. This magnitude is about half that of consistent attachment to paid employment. Moreover, we find that male, White, and less educated respondents were most protected by unionized careers, while union protection was found between ages 41 and 67. Our findings extend knowledge of the noneconomic consequences of union benefits and point to a source of emerging health disparities among older adults.

Non-Stop Parenting and Generational Reciprocity Gap: Exploring Elderly Poverty in South Korea Through an Intergenerational Sustainability Lens

Later-life poverty is a complex issue, particularly in South Korea. This study investigates this puzzling phenomenon, focusing on continuing parental investment and its impact on economic hardship facing older people in the contemporary Korean context. Data were derived from critical document analysis and interviews with 26 participants, including older people experiencing poverty and professional experts. Thematic analysis revealed the impact of older adults' ongoing parenting on their financial security and well-being. The "generational reciprocity gap" is proposed as a framework for understanding the dynamic and temporal nature of intergenerational exchanges and their influence on economic strain in later life.

"Successfully" Aging "Alone?": Unequal Global Opportunities and Rising Risks in Family-Based Models of Care Cross-Nationally

BACKGROUND AND OBJECTIVES

For the first time in human history, older adults will outnumber children and a substantial and growing proportion will live alone and lack one or more nuclear family ties. Such unprecedented shifts require a reevaluation of existing models of "successful aging," particularly in terms of long-term care policies.

RESEARCH DESIGN AND METHODS

This paper draws on country-level data from multiple publicly available sources (e.g., World Bank, Organization for Economic Cooperation and Development, Our World in Data, and the World Values Survey) to examine cross-national patterns of development, health, demography, resources and policies, and cultural values in low-, middle-, and high-income countries.

RESULTS

Although there exists substantial heterogeneity across countries, country-level patterns illustrate the economic privilege of living alone and the dominance of "successful aging" opportunities in high-income countries. Cultural values about family reflect standard patterns of economic development, yet friendship emerges as a particularly consistent global value. At the country-level, living alone and health are associated with higher-income countries with lower within-country inequality.

DISCUSSION AND IMPLICATIONS

Aging "alone" is a risk factor in some contexts, yet a marker of privilege in others. Models of "successful aging" are largely unobtainable in lower-income countries or high-inequality countries, and therefore require a thorough incorporation of global realities or final abandonment in favor of more nuanced structural perspectives. Long-term care policies that assume the presence of family will yield increasing risk over time across all global contexts and represent a key vulnerability in the future of healthy aging policy.

Surgery for colorectal cancer in people aged 80 years or older - complications, risks, and outcomes

The number of older adult patients with colorectal cancer (CRC) is steadily increasing with the increasing aging population. However, healthcare professionals continue to approach treatment in older adult patients while considering the potential coexistence of complications relative to their age. There is a tendency to define and limit treatment options for managing "older adult patients" at relatively younger ages. Given the progression of aging societies and aging of patients with CRC, the impact of age on post-surgical outcomes should be analyzed to guide treatment decisions and ensure the highest quality of care for this population. This study aimed to compare outcomes in patients aged approximately 80 years who have undergone surgery after being diagnosed with CRC at the National Pusan University Hospital. This retrospective observational study included 502 patients who underwent surgery after being diagnosed with CRC at Pusan National University Hospital from January 2018 to December 2022. All surgeries were performed by a single surgeon. Older adult patients underwent open surgery more frequently. No significant differences in surgical outcomes or hospital stay were found between the two groups. Moreover, no notable differences were observed in overall complications, including major surgery-related complications such as anastomotic leakage, bleeding, and infection, between the two groups. However, pneumonia was significantly more common in the older patient group (P = .016). Among patients requiring emergency surgery, the older adult group demonstrated a significantly higher proportion of emergency surgeries and complications associated with regular surgeries compared with the younger group. In older adult patients, the risk of postoperative complications should not be determined solely based on age; a comprehensive assessment is necessary. However, in the case of emergency surgery, older adult patients may be relatively vulnerable compared with younger patients.

Study on the age-period-cohort effects of cognitive abilities among older Chinese adults based on the cognitive reserve hypothesis

BACKGROUND

Cognitive abilities serves as a critical indicator of healthy aging. As China progresses into a stage of advanced population aging, there has been a significant increase in the number of elderly individuals experiencing age-related cognitive decline. Despite this demographic shift, there is a paucity of longitudinal research examining cognitive abilities among older Chinese adults over extended time periods. This study aims to investigate changes in cognitive abilities and explore group differences among older Chinese adults aged 65 to 110 years, employing a multidimensional temporal approach that encompasses age, period, and birth cohort effects.

METHODS

This study utilizes data from eight waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), spanning from 1998 to 2018. The dataset comprises 94,116 observations from 36,157 unique participants. Cognitive abilities are assessed using Mini-Mental State Examination (MMSE) scores as a proxy measure. To address the issue of perfect collinearity in the temporal dimension, the study employs the Hierarchical Age-Period-Cohort Cross-Classified Random Effects Model (HAPC-CCREM). This model allows for the examination of age effects, period effects, and cohort effects on cognitive abilities among older Chinese adults. In the model specification, age is treated as a fixed effect, while period and birth cohort are incorporated as random effects. Drawing upon the cognitive reserve hypothesis, the study investigates significant factors influencing cognitive abilities in this population.

RESULTS

At the fixed-effect level, demographic factors, health behaviors, self-rated health, subjective well-being, and childhood adversity significantly influence cognitive abilities among older Chinese adults. The age effects are significant, with cognitive abilities exhibiting an inverted U-shaped curve across the lifespan. At the random-effect level, period effects are significant, revealing a gradual annual increase in overall cognitive levels among older Chinese adults since 2008. Cohort effects are also significant, demonstrating an increasing trend in overall cognitive levels for the earlier-born cohorts in the first six groups. Conversely, later-born cohorts in the latter five groups show a declining trend in overall cognitive levels. Notably, period effects significantly enhance cohort effects.

CONCLUSIONS

The cognitive reserve hypothesis supports the significance of the majority of identified influencing factors. Cognitive abilities demonstrate an accelerating decline with increasing age, following an evolutionary trajectory consistent with physiological principles among older Chinese adults. Since 2008, cognitive abilities have shown a monotonic increasing trend annually, further validating the Flynn effect in this population. The cognitive abilities of the six earlier-born cohorts exhibit an increasing trend, supporting the compression of morbidity hypothesis. Conversely, the cognitive abilities of the five later-born cohorts show a declining trend, supporting the expansion of morbidity hypothesis. These findings collectively contribute to our understanding of cognitive aging patterns and their underlying mechanisms among older Chinese adults.

Bereavement due to child loss, divorce, and depressive mood in older age across European welfare regimes

While bereavement, particularly the loss of a child, is a well-known risk factor for mental health in the short term, its long-term consequences on depressive mood in old age and across different welfare regimes have been investigated less. This study focused on the combined role of child loss and divorce on depressive symptoms, measured using the EURO-D scale in Central, Nordic, Southern, and Eastern European countries. We used data from the European SHARE project, covering 22,959 participants aged 50+ over a 16-year period. Using OLS regressions, we found that, compared to no child loss and no divorce, the association between depressive symptoms and child loss was significant ( β  = 0.22, 95% C.I. = [0.13, 0.30]), among both women and men. The absolute increase was even stronger when the mutual effect of child loss and divorce was considered ( β  = 0.34, 95% C.I. = [0.18, 0.48]). Employing Generalized Estimating Equations, we found that depressive symptoms related to divorce did not increase over time, regardless of past bereavement. Compared with people in the Nordic countries, those living in Southern Europe experienced more depressive symptoms related to child loss and no divorce, but fewer depressive symptoms related to the combined effect of child loss and divorce. In sum, our findings indicate that bereavement due to child loss may lead to more depressive symptoms among both women and men in old age, especially in combination with divorce. In the latter case, we posit that participants living in Southern European countries may be protected by higher levels of social support through family ties or informal social networks.

The double disadvantage faced by adolescents from low socioeconomic backgrounds with mental health problems affects earnings up to mid-life

Early childhood socioeconomic disadvantage and mental health problems are both important determinants of adult social and economic experiences, but little is known about how they interact in this respect. We aimed to assess whether poor mental health in adolescence exacerbates labour market inequalities originating from low socioeconomic status (SES) in childhood. We use a birth cohort of individuals born in 1958 in England and follow their employment experiences and cumulative earnings up to age 55. We proxy low SES in childhood with father's occupational class at the time the respondent was aged 11, and use caregiver (usually, parent) ratings of the Rutter inventory at age 16 to identify mental health problems in adolescence. We fit ordinary least squares (OLS) models to estimate the effect of growing up in a low-SES family and experiencing mental health problems (conduct or emotional problems) in adolescence on cumulative earnings (log-transformed). We use an interaction term to test whether the association between mental health problems (conduct and emotional separately) and earnings differed by socioeconomic group. Individuals who experienced conduct problems in adolescence had lower cumulative earnings and employment levels up to age of 55. Moreover, the association between mental health problems and cumulative earnings was higher among individuals who also experienced low SES in childhood. Families from a higher socioeconomic group may have more effective means to counteract the adverse impacts of adolescent mental health problems, likely due to broader access to resources, support systems and opportunities. This underscores the role of structural supports in addressing socioeconomic inequalities in mental health outcomes and their long-terms implications.

A Lack of Food for Thought: Midlife Food Insecurity and Its Association With Subsequent Cognitive Ability of Older Americans

OBJECTIVES

The 50-59 age group in the United States experience higher levels of food insecurity (FI) compared to older adults. While previous research has identified an association between FI and cognition outcomes in older populations, limited research has examined midlife as a specific FI exposure window and the association of this hardship with long-run cognition outcomes.

METHODS

Utilizing 14 waves of Health and Retirement Study (HRS) data (1995-2020), I applied mixed-effects models to assess the relationship between midlife FI exposure and later-life cognitive function, controlling for childhood disadvantages and other health-related and sociodemographic characteristics.

RESULTS

Findings indicate that both cumulative FI duration and ever experiencing FI during ages 50-59 are significantly associated with subsequent cognitive decline. Specifically, ever experiencing FI during midlife was linked to a decrease in cognitive function by 0.07 standard units (95% confidence interval [CI], -0.13 to -0.003; p < .05). In addition, each additional year of FI exposure during midlife was associated with a reduction in cognitive function by 0.01 standard units (95% CI: -0.03 to -0.003; p < .05). These associations remained robust even after accounting for a range of potential confounders and covariates.

DISCUSSION

The findings support the cumulative inequality model, suggesting that midlife FI is a significant predictor of lower cognitive function in later life. Both the timing and extent of FI during midlife are crucial factors in shaping cognitive health outcomes. Policy interventions targeting FI in the 50-59 age group could play a pivotal role in promoting healthy aging and mitigating cognitive decline in older adulthood.

The life course effects of socioeconomic status on later life loneliness: The role of gender and ethnicity

Precursors of loneliness include individual risk factors and experiences of social exclusion. Using the New Zealand Health Work and Retirement Life Course History Study, we investigated the impact of unequal access to material resources across the life course (from age 10 to present) on late life emotional and social loneliness and the moderating effects of gender and Māori ethnicity (indigenous population of Aotearoa/New Zealand) in 613 adults aged 65 to 81 years. Childhood and adult life socioeconomic status (SES) negatively predicted late life emotional and social loneliness, but their effects disappeared after controlling for late life SES, suggesting a mediation effect. Education was also a significant predictor; however, it exerted different effects on social (positive) and emotional (negative) loneliness. Education's effect was moderated by gender, indicating a protective effect for emotional and an exacerbating effect for social loneliness in men. These findings suggest that lifelong exclusion from material resources is a risk factor for late life loneliness.

Nonparticipation in Work and Education in Emerging Adulthood and Depressive Symptoms through Early Midlife

More than one-in-eight young adults in the US between the ages of 16 to 24 were not in employment, education, or training (NEET) in 2020 - a level not seen since the Great Recession. This study examines the long-term association between NEET status in emerging adulthood and later depressive symptoms using the National Longitudinal Study of Adolescent to Adult Health (1995-2018). Growth curve models chart the association between NEET status and depressive symptoms over time in the US. The analytic sample includes 9,349 individuals and 28,047 person-wave observations for respondents between ages 18 to 43. In a fully specified model, respondents who reported NEET status in emerging adulthood (ages 18-26), exhibited greater depressive symptoms across emerging adulthood through early midlife (ages 33-43) (b=0.44, 95% CI 0.33, 0.54) compared to those participating in employment, education, or training. Associations persisted even after accounting for early life disadvantage and using propensity score matching to further diminish possible sources of bias. Results indicate that disconnection from school and work during emerging adulthood may constitute a risk factor for depressive symptoms through early midlife.