Population aging and the future of the welfare state: the example of Sweden

Which clinical factors and biochemical parameters are associated with late-life major depression?

INTRODUCTION

Late-life major depression (MD) is a frequent and high-cost psychiatric disorder. Our purpose was to detect clinical and biological factors possibly associated with this condition to better prevent and treat it.

METHODS

We recruited 343 patients, consecutively admitted for a Major Depressive Episode to the inpatient clinic of Policlinico of Milan and ASST Monza, Italy. A large set of clinical and biochemical variables was collected from clinical charts. Univariate analyses were performed both dividing the sample into two groups (age < or ≥65) and considering age as a continuous quantitative variable. Regression analyses were then performed considering as independent variables only those statistically significant at univariate analyses.

RESULTS

Patients aged ≥ 65 resulted in having longer duration of illness, shorter duration of last antidepressant therapy, higher number of antidepressants assumed in the past, higher frequency of treatment-resistant depression, higher frequency of overweight/obesity and diabetes. As for biochemical parameters, patients ≥ 65 showed lower total plasmatic proteins and albumin, higher uric acid and creatinine.

CONCLUSIONS

These preliminary results suggest less effectiveness of antidepressants, more susceptibility to metabolic disorders and poor nutritional status in patients with late-life depression; such aspects may consequently be taken into consideration for a proper therapeutic approach. KEY POINTSDepression in late life seems to be associated with poorer response to antidepressants;Clinicians should prefer compounds with minimal pharmacokinetic interactions and less risk of side effects including metabolic ones;The poor nutritional status and the higher risk of metabolic disorders in older patients points out the importance of proper diet and healthy lifestyle in this group of subjects;Further studies are needed to confirm the results of this research.

Lateral interbody fusion without intraoperative neuromonitoring in addition to posterior instrumented fusion in geriatric patients: A single center consecutive series of 108 surgeries

Introduction

Lateral lumbar interbody fusion (LLIF) and lateral thoracic interbody fusion (LTIF), supported by intraoperative neuromonitoring (IONM), gained popularity as a mini-invasive alternatives for standard interbody fusion. The objective of this study was to investigate the clinical outcome in a large elderly patient cohort who underwent LTIF/LLIF without IONM.

Methods

This retrospective, single-center study enrolled elderly patients (≥70 years old) operated during the period from 2010 to 2016. Anterior lumbar interbody fusion (ALIF) in the L5/S1 segment was excluded from the analysis.

Results

The study enrolled 108 patients (63 males, 58.3%) with a mean age of 76.5 ​y/o. The mean follow-up was 14.4 ​± ​11.3 months. The mean time of the surgery was 92 ​± ​34.2 ​min. The mean blood loss was 62.2 ​ml. There were no vascular or visceral surgical complications. 39 medical complications were encountered in 24 (22%) patients. Less than 5% of patients presented with a new onset of motor weakness and less than 2% of the patients developed a new sensory deficit at the discharge. 46% of patients were lost in follow-up at 12 months.

Conclusions

IONM is not mandatory for LLIF/LTIF surgery in geriatric patients and has a low frequency of approach-related complications as well as neurological deterioration. Our results are comparable to the available literature. Regardless of the utilization of these mini-invasive, anterior approaches, in patients of advanced aged, the risk for major medical complications is high and is responsible for contributing to prolonged hospitalization.

Managing a positive impression: Self-presentation among octogenarians

This paper addresses self-presentation among home-dwelling octogenarians living in the Faroe Islands. The purpose was to examine how older adults make meaning of ageing in interaction and examine the possible impact of social and cultural norms on this meaning making practice. The study is based on social constructionism. Interviews were conducted with both married couples and individual men and women during the spring of 2019. The interviewees projected a positive impression of life as older adults. They used humour to cover up health problems, and downward social comparison with others to enhance their own active lifestyle. They included third-party compliments to enhance the impression of appearing 'younger' than their chronological age, thus reconciling the misalignment between age norms and lived experience.

Projections of Primary and Revision Shoulder Arthroplasty until 2040: Facing a Massive Rise in Fracture-Related Procedures

Although the demand for shoulder arthroplasties has reached its highest number worldwide, there remains a lack of epidemiologic data regarding recent and future trends. In this study, data for all shoulder arthroplasties (hemiarthroplasty, reverse/anatomic shoulder arthroplasty) from the nationwide inpatient statistics of Germany (2010–2019) and population forecasts until 2040 were gathered. A Poisson and a negative binomial approach using monotone B-splines were modeled for all types of prostheses to project the annual number and incidence of primary and revision arthroplasty. Additionally, trends in main indicators were also gathered and expected changes were calculated. Overall, the number of primary shoulder replacements is set to increase significantly by 2040, reaching at least 37,000 (95% CI 32,000–44,000) procedures per year. This trend is mainly attributable to an about 10-fold increased use of fracture-related reverse shoulder arthroplasty in patients over 80 years of age, although the number of procedures in younger patients will also rise substantially. In contrast, hemiarthroplasties will significantly decrease. The number of revision procedures is projected to increase subsequently, although the revision burden is forecast to decline. Using these country-specific projection approaches, a massive increase of primary and revision shoulder arthroplasties is expected by 2040, mainly due to a rising number of fracture-related procedures. These growth rates are substantially higher than those from hip or knee arthroplasty. As these trends are similar in most Western countries, this draws attention to the international issue, of: if healthcare systems will be able to allocate human and financial resources adequately, and if future research and fracture-prevention programs may help to temper this rising burden in the upcoming decades.

Economic Aspects of Shrinking Cities in Poland in the Context of Regional Sustainable Development

Two trends are observed in contemporary cities around the world: whereas some urban areas develop rapidly and experience population growth, a steady population decline is noted in other cities. Demographic changes in urban areas are also accompanied by economic changes. These changes constitute a very serious challenge for sustainable regional growth. However, these problems have not been sufficiently investigated to date, including in Poland. The aim of this study was to identify shrinking cities in Poland and the phenomena that are related to the economic aspects of urban shrinkage in Poland. Empirical research relied on analysis of the population growth rate in Polish urban municipalities, and the phenomena related to the economic aspects of urban shrinkage were identified by multiple linear regression analysis. The period of research was 2003–2019. Thirty-three Polish cities experienced a steady population decline. The economic phenomena related to urban shrinkage included changes in own-source revenues, proportions of government transfers in municipal budgets, unemployment, migration, municipal spending on education, transport, communications, and social welfare. Population decline was not related to changes in the age-dependency ratio, public spending on housing, the number of companies, or the number of vacant homes in cities. The research results can be a source of important information for regional sustainable growth policies used not only in cities and regions in Poland, but also in other Central and Eastern European countries where this phenomenon occurs.

Use of Counterfactual Population Projections for Assessing the Demographic Determinants of Population Ageing

Counterfactual population projections have been used to estimate the contributions of fertility and mortality to population ageing, a method recently designated as the gold standard for this purpose. We analyse projections with base years between 1850 and 1950 for 11 European countries with long-run demographic data series to estimate the robustness of this approach. We link this approach with stable population theory to derive quantitative indicators of the role of fertility and mortality; consider ways of incorporating net migration; and examine the effect of using alternative indicators of population ageing. A number of substantive and technical weaknesses in the counterfactual projection approach are identified: (1) the conclusions are very sensitive to the choice of base year. Specifically, the level of base year fertility has a major influence on whether fertility or mortality is considered the main driver of population ageing. (2) The method is not transitive: results for two adjacent intervals are unrelated to results for the combined period. Therefore, overall results cannot be usefully allocated between different sub-intervals. (3) Different ageing indices tend to produce similar qualitative conclusions, but quantitative results may differ markedly. (4) Comparisons of alternative models should be with a fixed fertility and mortality projection model rather than with the baseline values as usually done. (5) The standard counterfactual projections approach concatenates the effects of initial age structure and subsequent fertility and mortality rates: methods to separate these components are derived.

Older age does not influence the success of weight loss through the implementation of lifestyle modification

OBJECTIVE

Age is sometimes a barrier for acceptance of patients into a hospital-based obesity service. Our aim was to explore the effect of age on the ability to lose weight through lifestyle interventions, implemented within a hospital-based obesity service.

DESIGN

Retrospective study.

PATIENTS

We included a cohort of randomly selected patients with morbid obesity (n = 242), who attended our hospital-based obesity service during 2005-2016 and received only lifestyle weight loss interventions.

MEASUREMENTS

Primary outcome measures were percentage weight loss (%WL) and percentage reduction in body mass index (%rBMI) following implemented lifestyle interventions. Data were stratified according to patient age at referral: group 1 (age < 60 years, n = 167) and group 2 (age ≥ 60 years, n = 75). Weight loss was compared between groups, and correlations with age at referral were explored.

RESULTS

The duration of hospital-based weight loss interventions ranged between 1 and 143 months (mean: 38.9 months; SD: 32.3). Baseline BMI at referral differed significantly between groups 1 and 2 (49.7 kgm^-2 [SD: 8.7] vs 46.9 kgm^-2 [SD: 6.1], respectively; P < .05). Following implemented lifestyle interventions, between groups 1 and 2 there were no differences in %WL (6.9% [SD: 16.7] vs 7.3% [SD: 11.60], respectively; P = NS) or %rBMI (8.1% [SD: 14.9] vs 7.8% [SD: 11.7], respectively; p = NS). Overall, there was no significant correlation between patient age at referral and %WL (r = -.13, p = NS).

CONCLUSIONS

Older age does not influence the success of weight loss through the implementation of lifestyle modification within a hospital-based obesity service. Therefore, age per se should not influence clinical decisions regarding acceptance of patients to hospital-based obesity services.

Work despite poor health? A 14-year follow-up of how individual work accommodations are extending the time to retirement for workers with poor health conditions

Given many OECD countries' efforts to extend their citizens' working years, research underscores the importance of work accommodations to maintain older workers and enable them to work despite poor health or declines in physical functions. Nevertheless, few studies have investigated the associations between poor health conditions and opportunities to accommodate work in accordance with individual needs and preferences. In this study, we differentiate between three types of poor health conditions (disease, illness, or sickness). We examine the separate effects of these health conditions as well as of possibilities for work accommodations (working hours, pace, planning), on time to retirement. Additionally, we examine the potentially joint effect of poor health and low opportunities for work accommodations. The analyses are based on a representative sample of 1143 Swedish workers from Panel Survey of Ageing and the Elderly (PSAE) with a baseline (2002/2003) age of 55–64 years. Using complementary register data on income, we followed the labor market activity of these individuals until the end of 2015. We employed Cox proportional hazard regression to estimate the time to retirement and adjusted for demographical, socio-economic, and work-related covariates. In comparison to those with good health, having disease, illness, and sickness is associated with a higher risk of earlier exit from the labor market, and the joint effect of poor health and low opportunities for work accommodations increases this risk. High influence to accommodate work while having a disease or sickness supports work participation, while these patterns of associations were not equally consistent for individuals with illness. This study highlights the importance of increasing older individuals’ opportunities to make their own work accommodations, particularly in the presence of disease and sickness, and thereby combat the negative effects of poor health on time to retirement.

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Government efforts to extend working life face challenges concerning older workers health conditions and physical function.

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Poor health is known as an important predictor for early retirement.

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Work accommodations are advocated as critical to maintaining older workers ability to work despite poor health conditions.

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Longitudinal studies capturing individual's health and working conditions with retirement are needed.

Allocation of Eldercare Responsibilities between Children and the Government in China: Does the Sense of Injustice Matter?

China's large aging population poses grim challenges to eldercare provision. Against the background of withering traditional kinship-based eldercare and the increasing significance of government-sponsored support programs, this study draws on data from the 2013 Chinese General Social Survey to investigate not only the correlation between the sense of social injustice and the preference to allocate eldercare responsibilities between public and private agents but also how this correlation varies between urban-versus-rural regions. We find that perceived social injustice is significantly correlated with the odds of designating the government, instead of family members, to shoulder eldercare responsibilities. Further mediation analysis suggests that this correlation is mediated through concerns about eldercare. On average, the link between perceived social injustice and the preference for eldercare duty allocation is weaker in rural China than in urban China. Theoretical and policy implications are discussed.

A scoping review of the incentives for a prolonged work life after pensionable age and the importance of "bridge employment"

BACKGROUND

With a growing share of older people in almost every population, discussions are being held worldwide about how to guarantee welfare in the immediate future. Different solutions are suggested, but in this article the focus is on the need to keep older employees active in the labor market for a prolonged time.

OBJECTIVE

The aim was to find out and describe the incentives at three system levels for older people 1) wanting, 2) being able, and 3) being allowed to work.

MATERIAL

The literature search embraced articles from the databases Scopus, PsycInfo, Cinahl, AgeLine and Business Source Premier, from May 2004 until May 2016. After the removal of 506 duplicates, the selection and analysis started with the 1331 articles that met the search criteria. Of these, 58 articles corresponded with the research questions.

METHOD

The design was a 'scoping review' of the research area bridge employment and prolonged work life.

RESULTS

The results show that most investigations are conducted on individual-level predictors, research on organizational-level predictors is more scattered, and societal-level predictor information is scarce.

CONCLUSIONS

Attitudes and behavior according to a prolonged work life could be summarized as dependent on good health, a financial gain in combination with flexible alternative working conditions.

Normal Bone Microstructure and Density But Worse Physical Function in Older Women Treated with Selective Serotonin Reuptake Inhibitors, a Cross-Sectional Population-Based Study

Depression in the elderly is today often treated with selective serotonin reuptake inhibitors (SSRIs) because of their favorable adverse effect profile. However, treatment with SSRIs is associated with increased risk of fractures. Whether this increased risk depends on reduced bone strength or increased fall risk due to reduced physical function is not certain. The aim was therefore to investigate if treatment with SSRIs is associated with impaired bone microstructure, bone density, or physical function in older women. From an ongoing population-based study, 1057 women (77.7 ± 1.5 years) were included. Validated questionnaires were used to assess information regarding medical history, medications, smoking, mental and physical health, and physical activity. Physical function was measured using clinically used tests: timed up and go, walking speed, grip strength, chair stand test, and one leg standing. Bone mineral density (BMD) was measured at the hip and spine with dual-energy X-ray absorptiometry (Hologic Discovery A). Bone geometry and microstructure were measured at the ultradistal and distal (14%) site of radius and tibia using high-resolution peripheral quantitative computed tomography (HR-pQCT; XtremeCT). Treatment with SSRIs was associated with higher BMD at the femoral neck, total hip, and lumbar spine, whereas no associations were found for any HR-pQCT-derived measurements. The use of SSRIs was associated with lower grip strength, walking speed, and fewer chair stand rises. These associations were valid also after adjustments for known risk factors for falls. Treatment with SSRIs was, independently of covariates, associated with worse physical function without any signs of inferior bone geometry and microstructure.

Genomic Approach to Understand the Association of DNA Repair with Longevity and Healthy Aging Using Genomic Databases of Oldest-Old Population

Aged population is increasing worldwide due to the aging process that is inevitable. Accordingly, longevity and healthy aging have been spotlighted to promote social contribution of aged population. Many studies in the past few decades have reported the process of aging and longevity, emphasizing the importance of maintaining genomic stability in exceptionally long-lived population. Underlying reason of longevity remains unclear due to its complexity involving multiple factors. With advances in sequencing technology and human genome-associated approaches, studies based on population-based genomic studies are increasing. In this review, we summarize recent longevity and healthy aging studies of human population focusing on DNA repair as a major factor in maintaining genome integrity. To keep pace with recent growth in genomic research, aging- and longevity-associated genomic databases are also briefly introduced. To suggest novel approaches to investigate longevity-associated genetic variants related to DNA repair using genomic databases, gene set analysis was conducted, focusing on DNA repair- and longevity-associated genes. Their biological networks were additionally analyzed to grasp major factors containing genetic variants of human longevity and healthy aging in DNA repair mechanisms. In summary, this review emphasizes DNA repair activity in human longevity and suggests approach to conduct DNA repair-associated genomic study on human healthy aging.