Biopsychosocial predictors of perceived life expectancy in a national sample of older men and women

Sociodemographic, lifestyle and psychological factors associated with healthy ageing in a national longitudinal study of middle-aged and older adults in Thailand

The aim of this study was to estimate the longitudinal associations with healthy ageing as well as its association with mortality in a national sample in Thailand. The analytic sample consisted of 2585 participants (≥45 years) in four study assessments in 2015, 2017, 2020, and 2022. The distribution of the healthy ageing components at baseline was 93.7% no major disease, 97.2% no activities of daily living (ADL) disability, 86.3% no depression, 91.8% social engagement and 88.1% high quality of life (QoL); healthy ageing increased from 64.7% in 2015 to 67.1% in 2022. Standardised self-reported measures were used to assess healthy ageing components and covariates. In the adjusted GEE logistic regression analysis, working, high subjective economic status, high physical activity or exercise, and high subjective life expectancy were positively associated, and aged 70 years and older, widowed, past smoking, having underweight, obesity, and low self-rated physical health were negatively associated with healthy ageing. In addition, in adjusted Cox regression, healthy ageing was negatively associated with mortality. Sociodemographic factors, lifestyle indicators, self-rated physical health and subjective life expectancy were associated with healthy ageing. Addressing modifiable factors (e.g. lifestyle factors such as physical activity, smoking or underweight and/or obesity) may contribute to healthy ageing.

Does subjective life expectancy matter in purchasing life insurance among middle-aged and older adult? Evidence from China

Population-wide increase in life expectancy is a source of aggregate longevity risk. Life insurance is a natural instrument to manage the risk. Previous studies used chronological age to examine the relationship between aging and life insurance purchase, which ignored the impact of subjective life expectancy-the real perception of remaining time. Therefore, this study aims to fill the lack in this area and to explore in depth the relationship between subjective life expectancy and purchasing life insurance among middle-aged and older adult at micro perspective. This paper utilizes data from the China Health and Retirement Longitudinal Study (CHARLS) over a period of 4 years to construct both Probit and Tobit models. The findings reveal that subjective life expectancy positively affects the likelihood of participation and the extent of life insurance among the middle-aged and older adult population in China. IV model estimation results show good robustness of the results. Meanwhile, there is also heterogeneity in the effect with respect to gender, hukou, education and wealth. The findings provide new perspective to explain the subjective motivation of purchasing life insurance in China.

Predictive Clinical Factors of In-Hospital Mortality in Women Aged 85 Years or More with Acute Ischemic Stroke

INTRODUCTION

There are limited data on the outcome of acute ischemic stroke in oldest old women. We assessed clinical risk factors for in-hospital mortality in women aged 85 years or more with acute ischemic stroke.

METHODS

This single-center retrospective cohort study included 506 women aged ≥85 years collected from a total of 4,600 patients with acute cerebral infarction registered in an ongoing 24-year hospital stroke database. The identification of clinical risk factors for in-hospital mortality was the primary endpoint of the study.

RESULTS

The mean (± standard deviation) age of the patients was 88.6 ± 3.2 years. Stroke subtypes were cardioembolic infarcts in 37.7% of patients, atherothrombotic infarcts in 30.8%, infarcts of unknown cause and lacunar infarcts in 26.1% each, and infarcts of unusual cause in 11.5%. The in-hospital mortality rate was 20.4% (n = 103). Cardioembolic infarct accounted for 67% of all deaths (n = 69). Sudden stroke onset (OR 1.87, 95% CI 1.14-3.06), altered consciousness (OR 7.05, 95% CI 4.36-11.38), and neurological, cardiac, respiratory, and hemorrhagic events during hospitalization were independent risk factors for death, whereas lacunar infarction was a protective factor (OR 0.10, 95% CI 0.01-0.82).

CONCLUSION

The oldest old age segment of women with acute ischemic infarction is a subgroup of stroke patients with unfavorable prognosis and high in-hospital mortality associated with sudden stroke onset, altered consciousness, and medical complications developed during hospitalization. Lacunar infarction as stroke subtype showed a favorable prognosis.

Gender Predicts Differences in Acute Ischemic Cardioembolic Stroke Profile: Emphasis on Woman-Specific Clinical Data and Early Outcome-The Experience of Sagrat Cor Hospital of Barcelona Stroke Registry

Background and Objectives: Acute ischemic cardioembolic stroke (CS) is a clinical condition with a high risk of death, and can lead to dependence, recurrence, and dementia. Materials and Methods: In this study, we evaluated gender differences and female-specific clinical data and early outcomes in 602 women diagnosed with CS from a total of 4600 consecutive acute stroke patients in a single-center hospital stroke registry over 24 years. A comparative analysis was performed in women and men in terms of demographics, cerebrovascular risk factors, clinical data, and early outcomes. Results: In a multivariate analysis, age, hypertension, valvular heart disease, obesity, and internal capsule location were independent variables associated with CS in women. The overall in-hospital mortality rate was similar, but the group of women had a greater presence of neurological deficits and a higher percentage of severe limitation at hospital discharge. After the multivariate analysis, age, altered consciousness, limb weakness, and neurological, respiratory, gastrointestinal, renal, cardiac and peripheral vascular complications were independent predictors related to early mortality in women. Conclusions: Women with CS showed a differential demographic and clinical profile and worse early outcomes than men. Advanced age, impaired consciousness, and medical complications were predictors of stroke severity in women with CS.

Do sexual minorities believe that they die earlier? Results from a large, representative survey

BACKGROUND

While various consequences of belonging to sexual minorities have been examined - it remains completely unclear whether sexual minorities believe that they die earlier. Thus, our aim was to investigate the association between sexual orientation and expected longevity.

METHODS

Data from the German Ageing Survey, a nationally representative sample, were used (year 2014, n = 6,424 individuals; mean age: 63.6 years). It included individuals residing in private households aged 40 years and over in Germany. Sexual orientation (heterosexual; sexual minorities including homosexual, bisexual, or other) served as key independent variable. As outcome, we used the expected life expectancy. In multiple linear regressions it was adjusted for gender, age, education, marital status, labour force participation, BMI, smoking status, alcohol intake, sports activities, physical functioning, self-rated health and the number of chronic conditions.

RESULTS

Adjusting for sociodemographic, lifestyle-related and health-related factors, our study showed that sexual minorities reported a lower expected longevity (β=-0.69, p = .02) compared to heterosexuals. This association remained nearly the same in robustness checks.

CONCLUSION

After adjusting for various other factors, our findings showed a lower life expectancy among sexual minorities compared to heterosexuals. Efforts are required to make sexual minorities believe in a high life expectancy (e.g., increased optimism or reduced perceived discrimination) - which in turn can help to increase their actual longevity and successful ageing. Future research is required to explore underlying mechanisms (such as expected stigma in later life).

Perceived Life Expectancy Among Dialysis Recipients: A Scoping Review

Rationale & Objective

Greater prognostic understanding is associated with higher quality care at the end of life. We undertook a scoping review to explore how long dialysis recipients expect to live.

Study Design

Scoping Review.

Setting & Study Populations

People with kidney failure over 18 years old.

Search Strategy & Sources

Studies were identified by searching Medline, Embase, APA PsycINFO, HMIC, and ProQuest database for terms related to "life expectancy", "self-estimated", and "end stage kidney disease".

Data Extraction

Search strategies reported 349 unique, potentially eligible studies, with 8 studies meeting the inclusion criteria after screening.

Results

Significant mismatches between dialysis recipients and their health care provider's estimations of prognosis were reported, with patients predicting significantly higher life expectancies than health care professionals and almost no agreement between patient and nephrologist's estimates of 1-year survival. Documented cognitive impairment did not affect 1-year or 5-year prognosis estimates, nor did gender, age, time on dialysis, or discussing perceived life expectancy. Dialysis recipients who thought they were on the transplant list or who self-identified as African American reported higher perceived life expectancy, whereas people who were 75 years or older, or with fair or poor self-reported health status reported a lower perceived life expectancy. Those with a lower perceived life expectancy preferred care focusing on relieving pain and discomfort, whereas people who thought they had a higher chance of survival were significantly more likely to prefer life-extending care.

Limitations

There is a marked paucity of research in this area, with most studies conducted in North American cohorts.

Conclusions

Optimistic patient prognostic expectations persist in dialysis recipients. Given the effects of perceived life expectancy on treatment choices and subsequent quality of life, it is important that transparent discussions regarding prognosis are conducted with people receiving dialysis and their families.

Plain-Language Summary

Understanding illness severity and prognosis allows people to make decisions and prioritize areas of their lives that are important to them. We undertook a scoping review to explore how long dialysis recipients expect to live. We found significant mismatches between the perceived life expectancy of people treated with dialysis and their health care providers. Perceived life expectancy influenced treatment choices; thus, those who thought they would die sooner prioritized care focusing on relieving pain and discomfort. Those who thought they had a higher chance of survival were more likely to prefer life-extending care (with potential effects on quality of life). It is important to have frank discussions about prognosis with people receiving dialysis, to empower individuals and help them make informed decisions about their care.

Subjective expectation of reaching age 85: agreement with population statistics and association with behavioral and psychological factors

BACKGROUND

It is not clearly known how well Danes estimate their chances of reaching the average life expectancy and whether identifiable population subgroups misestimate their life expectancy, and potentially also investments and savings in health and pensions. Therefore, in this study, we examined on the individual level whether subjective life expectancy is in line with the statistically calculated chance of reaching age 85, and further explored the psychological and behavioral factors associated with under or overestimation.

METHODS

We opted for a cross-sectional survey design based on a sample of 5,379 Danish citizens aged 50-70 years, returning a web-based questionnaire with socio-demographic data supplemented from a national registry. Average participant estimates of their chance of reaching age 85 for each age range and sex group were compared with actuarial data. We then performed multiple linear regression analyses to examine factors associated with the subjective expectancy of reaching age 85 years.

RESULTS

We found that 32% of females and 23% of males reported 100% certainty of reaching age 85, and average expected survival chance exceeded the statistically predicted survival chance for 23% of males and 16% for females in age-ranges 50-60 and 61-70. Our multivariable analysis found that health literacy, internal health locus of control, willingness to take health risks, self-rated health, and health and life satisfaction all showed a significant positive association with expectation of reaching age 85. Moreover, those on daily medications, ex- or current smokers, and heavy drinkers were significantly less optimistic about reaching age 85.

CONCLUSIONS

Particularly for the population groups with inaccurate life expectancies, the significant associations with psychological and behavioral factors open a way for initiatives based on behavior change theories to reach a better agreement between subjective and statistical life expectancy.

Acute Spontaneous Lobar Cerebral Hemorrhages Present a Different Clinical Profile and a More Severe Early Prognosis than Deep Subcortical Intracerebral Hemorrhages-A Hospital-Based Stroke Registry Study

Acute spontaneous intracerebral hemorrhage (ICH) is the most severe stroke subtype, with a high risk of death, dependence, and dementia. Knowledge about the clinical profile and early outcomes of ICH patients with lobar versus deep subcortical brain topography remains limited. In this study, we investigated the effects of ICH topography on demographics, cerebrovascular risk factors, clinical characteristics, and early outcomes in a sample of 298 consecutive acute ICH patients (165 with lobar and 133 with subcortical hemorrhagic stroke) available in a single-center-based stroke registry over 24 years. The multiple logistic regression analysis shows that variables independently associated with lobar ICH were early seizures (OR 6.81, CI 95% 1.27−5.15), chronic liver disease (OR 4.55, 95% CI 1.03−20.15), hemianopia (OR 2.55, 95% CI 1.26−5.15), headaches (OR 1.90, 95% CI 1.90, 95% IC 1.06−3.41), alcohol abuse (>80 gr/day) (OR 0−10, 95% CI 0.02−0,53), hypertension (OR 0,41, 95% CI 0.23−0−70), sensory deficit (OR 0.43, 95% CI 0.25−0.75), and limb weakness (OR: 0.47, 95% CI 0.24−0.93). The in-hospital mortality was 26.7% for lobar and 16.5% for subcortical ICH. The study confirmed that the clinical spectrum, prognosis, and early mortality of patients with ICH depend on the site of bleeding, with a more severe early prognosis in lobar intracerebral hemorrhage.

Vertigo in Acute Stroke Is a Predictor of Brain Location but Is Not Related to Early Outcome: The Experience of Sagrat Cor Hospital of Barcelona Stroke Registry

BACKGROUND

Vertigo is an uncommon symptom among acute stroke victims. Knowledge about the clinical profile, the brain location, and the early outcome in stroke patients with cerebrovascular diseases and vertigo remains limited.

OBJECTIVES

In this study, the effects of vertigo on cerebral topography and early prognosis in cerebrovascular diseases were investigated.

METHODS

A comparative analysis in terms of demographics, risk factors, clinical characteristics, stroke subtypes, cerebral and vascular topography, and early outcome was performed between patients with presence or absence of vertigo on a sample of 3743 consecutive acute stroke patients available from a 24-year ongoing single-center hospital-based stroke registry.

RESULTS

Vertigo was present in 147 patients (3.9%). Multiple logistic regression analysis showed that variables independently associated with vertigo were: location in the cerebellum (OR 5.59, CI 95% 3.24-9.64), nausea or vomiting (OR 4.48, CI 95% 2.95-6.82), medulla (OR 2.87, CI 95% 1.31-6.30), pons (OR 2.39, CI 95% 1.26-4.51), basilar artery (OR 2.36, CI 95% 1.33-4.17), ataxia (OR 2.33, CI 95% 1.41-3.85), and headache (OR 2.31, CI 95% 1.53-3.49).

CONCLUSION

The study confirmed that the presence of vertigo was not related with increased in-hospital mortality or poor prognosis at hospital discharge. Vertigo is mainly related to non-lacunar vertebrobasilar stroke with topographic localization in the cerebellum and/or brainstem.

A Scoping Review on Biopsychosocial Predictors of Mental Health among Older Adults

This review aims to map the available evidence on biopsychosocial predictors of elderly mental health. The articles were independently screened in three selected databases, namely Pubmed, Proquest and Google Scholar. The stages consist of identifying the research questions, seeking and selecting relevant evidence, mapping data, and concluding and reporting results. The PRISMA flowchart was used to show the PEOS evidence search flow. A total of 23,722 articles were obtained from all databases during the initial search, where 458 titles fulfilled the eligibility criteria at the title screening stage. Furthermore, 383 articles passed through abstract screening, where 75 met the inclusion criteria and were included for full-text screening. Based on the full-text screening stage, 28 articles were excluded and the remaining 47 articles that matched the search process were included for data extraction. This review creates biopsychosocial variables related to the mental health of the elderly. The biological factors consist of age, biomarkers, female, health conditions, chronic diseases, and physical function. Variables related to psychological factors are affect, personality traits, and subjective well-being. Meanwhile, social factors include smoking, sleep quality, physical activity, daily living, social support, marital status, loneliness, religiosity, spirituality, and early life conditions.

Does Religious Participation Predict Future Expectations About Health? Using a Life Course Framework to Test Multiple Mechanisms

Though an impressive array of health outcomes has been studied, research within the field of religion and health has not yet considered how religious involvement may affect future expectations about health. This is a significant shortcoming because the teachings of many religions direct adherent's focus to the distant future, and future self-ratings of health are a known predictor of subjective life expectancy and eventual mortality risk. Recognizing the need for a life course approach to conceptualizing patterns of religious involvement, we assess how stability or change in religious attendance from childhood to adulthood structures individual expectations of future health. Drawing on data from the 2017 Values and Beliefs of the American Public Study (Baylor Religion Survey Wave 5), we find that stable high (weekly) attendance between childhood and adulthood is associated with higher future health expectations. Parametric mediation analyses conducted in the counterfactual framework suggest that this association is explained by the tendency of frequent stable attenders to have (a) higher levels of beliefs in the sense of divine control and (b) a lower likelihood of engaging in harmful health behaviors (smoking).

Capturing Subjective Age, Subjective Life Expectancy, and Their Links With Older Adults' Health: The Dutch Longitudinal Aging Study Amsterdam

Objectives: This study compares the associations of two subjective lifetime perspectives, subjective age (SA) and subjective life expectancy (SLE), with physical performance, self-rated health, and depressive symptoms. Methods: 64 91-year-old participants were selected from three waves of the Longitudinal Aging Study Amsterdam (2008/09, 2011/12, 2015/16; n = 1822 participants, n = 3500 observations) that included graphical and numerical measures of SA and SLE. We used generalized estimating equations to examine their associations with health. Results: Associations of SA/SLE with health were weaker for physical performance than for self-rated health and depressive symptoms. The associations of SA and SLE with physical performance were of similar magnitude but with self-rated health depended on the type of measure. Depressive symptoms, instead, showed a stronger association with SA than with SLE. Graphical measures showed weaker associations than numerical measures. Discussion: The way in which subjective lifetime perspectives and health are conceptualized and measured influences the strength of their associations.

Perceptions of Illness Severity, Treatment Goals, and Life Expectancy: The ePISTLE Study

Introduction

A better understanding of factors influencing perceived life expectancy (PLE), interactions between patient prognostic beliefs, experiences of illness, and treatment behavior is urgently needed.

Methods

Case-notes at 3 hemodialysis units were screened: patients with ≥20% 1-year mortality risk were included. Patients and their health care professionals (HCPs) were invited to complete a structured interview or mixed-methods questionnaire. Four hundred eleven patient notes were screened. Seventy-seven eligible patients were approached and 51 were included.

Results

Patients predicted significantly higher life expectancies than HCPs (P < 0.0001). Documented cognitive impairment, gender, or increasing age did not affect 1- or 5-year PLE. PLE influenced priorities of care: one-fifth of patients who estimated themselves to have >95% 1-year survival preferred “care focusing on relieving pain and discomfort,” compared with nearly three-quarters of those reporting a ≤50% chance of 1-year survival. Twenty of 51 (39%) patients believed transplantation was an option for them, despite only 4 being waitlisted at the time of the interview. Patients who thought they were transplant candidates were significantly more confident they would be alive at 1 and 5 years and to want resuscitation attempted. Cognitive impairment had no effect on perceived transplant candidacy. A high symptom burden was present and underrecognized by HCPs. High symptom burden was associated with significantly lower PLE at both 1 and 5 years, increased anxiety/depression scores, and treatment choices more likely to prioritize relief of suffering.

Conclusion

There is a disparity between patient PLE and those of their HCPs. Severity of symptom burden and beliefs regarding PLE or transplant candidacy affect patient treatment preferences.

Age-Related Risk Factors at the First Stroke Event

(1) Background: Stroke is a multifactorial disease, which can affect individuals at any age. Risk factors (RFs) associated with the first stroke event have been well identified; however, the influence of these RFs on the patient’s age needs to be studied. (2) Objective: This study aimed to examine the effect of modifiable RFs on the age at which a stroke occurs. (3) Methods: A cross-sectional study was conducted on patients admitted consecutively with a first-ever acute stroke at the Burgos University Hospital (Spain). Data on sociodemographic and clinical parameters were collected (high blood pressure (HBP), smoking habit, diabetes mellitus (DM), dyslipemia, abdominal obesity, sedentary lifestyle, alcohol consumption, and cardiovascular diseases). The possible associations between RFs and age were studied using univariate and multivariate regression analyses and a decision tree. (4) Results: A total of 436 patients with a mean age of 75.39 years (standard deviation (SD) ± 12.67) were included. HBP and overweight/obesity were the most prevalent stroke RFs. Being an active smoker (OR 21.48; 95% confidence interval (CI) 8.80–52.41), having a sedentary lifestyle (OR 3.24; 95% CI 1.97–5.31), being an excessive alcohol drinker (OR 2.36; 95% CI 1.45–3.84), or being overweight or obese (OR 1.95; 95% CI 1.14–3.34) increased the risk of having an acute cerebrovascular event in individuals aged 75 years or below. However, a personal history of HBP (OR 0.40; 95% CI 0.24–0.67) was significantly associated with a greater likelihood of having an acute stroke in individuals aged more than 75 years. (5) Conclusions: This study showed that the modifiable RFs strongly influence the first stroke event in patients aged below 75 years, which will be useful in guiding different prevention strategies.

Predictive clinical features of cardioembolic infarction in patients aged 85 years and older

OBJECTIVE

To assess predictive clinical factors of cardioembolic infarction in very old patients (85 years of age and older).

METHODS

Prospective hospital-based stroke registry ("The Sagrat Cor Hospital of Barcelona Stroke Registry") is an acute-care teaching hospital in Barcelona, Catalonia, Spain. From 956 first-ever cardioembolic stroke patients included in the stroke registry over a 24-year period, 639 were younger than 85 years of age and 317 were 85 years or older (mean age: 88.9 years). Demographics, clinical characteristics, risk factors and early outcome were compared. Predictors of cardioembolic infarction in the oldest age group were assessed by multivariate analyses.

RESULTS

In a logistic regression model based on demographics, risk factors, clinical features and complications, female gender (odds ratio [OR] = 1.74, 95% confidence interval [CI]: 1.27-2.39), heart failure (OR = 2.27, 95% CI: 1.46-3.56), altered consciousness (OR = 1.76, 95% CI: 1.28-2.42), and infectious complications (OR = 2.01, 95% CI: 1.39-2.91) were predictors of cardioembolic stroke in the oldest age group. By contrast, heavy smoking, heart valve disease, hypertension, headache, early seizures, sensory deficit, and involvement of the posterior cerebral artery were independently associated with cardioembolic stroke in the younger group.

CONCLUSIONS

Identification of a differential clinical profile of cardioembolic stroke between patients aged 85 years or more and those younger than 85 years helps clinicians to the optimal management of ischemic infarction in the oldest segment of the population.

Chronic conditions as predictors of later life disability employment exit: a gendered analysis

OBJECTIVES

Increasing life expectancy has led governments to implement reforms aimed at delaying retirement. Chronic conditions are an important barrier to this given their association with pain, functional limitations, depression and ultimately lower life expectancy. Chronic diseases are gendered in terms of these characteristics, as well as their population prevalence. I examined the extent to which gender moderates the extent to which different chronic conditions lead to disability employment exit, the proportion of exits they account for and key mediators in this process.

METHODS

Data from waves 1 to 8 of the English Longitudinal Study of Ageing were analysed. I followed employees aged 50-70 years until they experienced disability employment exit, or were censored. I analysed the influence of chronic conditions, functional limitations, pain, depressive symptoms and subjective life expectancy using discrete time survival analysis. All analyses were carried out separately by gender if a significant interaction was found. The mediation analysis was carried out using the Karlson/Holm/Breen method.

RESULTS

No significant gender interactions were found for the risk of chronic conditions on disability employment exit. Lung disease (OR 4.1; 95% CI 2.8 to 5.9), cancer (OR 2.9; 95% CI 2.1 to 4.0) and arthritis (OR 2.6; 95% CI 2.1 to 3.3) were the strongest determinants. Depressive symptoms (OR 3.2; 95% CI 2.5 to 4.1) were also a strong determinant, and along with arthritis, explained a greater proportion of women than men's exits given differences in prevalence. Pain and various types of functional limitations were important mediators of exit as well as determinants in their own right.

CONCLUSION

The results suggest that gender differences in the prevalence of different chronic conditions result in differences in the proportion of disability employment exits they account for in the population. Targeted and tailored interventions, for example, in the workplace might take this into account.