Midlife Cardiovascular Status and Old Age Physical Functioning Trajectories in Older Businessmen

Social Mobility and Health-Related Quality of Life Trajectory Classes Among Older Women and Men

OBJECTIVES

Changes in socioeconomic status (SES) during life may impact health in old age. We investigated whether social mobility and childhood and adulthood SES are associated with trajectories of health-related quality of life (HrQoL) over a 17-year period.

METHODS

We used data from the Helsinki Birth Cohort Study (n = 2003, 46% men, mean age 61.5 years). Social mobility was derived from childhood SES, obtained from healthcare records, and register-based adulthood SES.

RESULTS

Logistic regression models showed that lower adulthood SES was associated with lower physical HrQoL trajectories. Among men low (OR 3.95, p < .001), middle (OR 2.20, p = .006), and declining lifetime SES (OR 2.41, p = .001) were associated with lower physical HrQoL trajectories compared to men with high SES. Socioeconomic status was not associated with mental HrQoL trajectories.

DISCUSSION

Declining SES during life course may have negative health consequences, while improving SES is potentially as beneficial as high SES to later-life health among men.

Retirement as a predictor of physical functioning trajectories among older businessmen

BACKGROUND

Associations between retirement characteristics and consequent physical functioning (PF) are poorly understood, particularly in higher socioeconomic groups, where postponing retirement has had both positive and negative implications for PF.

METHODS

Multiple assessments of PF, the first of which at the mean age of 73.3 years, were performed on 1709 men who were retired business executives and managers, using the RAND-36/SF-36 instrument, between 2000 and 2010. Questionnaire data on retirement age and type of pension was gathered in 2000. Five distinct PF trajectories were created using latent growth mixture modelling. Mortality- and covariate-adjusted multinomial regression models were used to estimate multinomial Odds Ratios (mOR) on the association between retirement characteristics and PF trajectories.

RESULTS

A one-year increase in retirement age was associated with decreased likelihood of being classified in the 'consistently low' (fully adjusted mOR = 0.82; 95%CI = 0.70, 0.97; P = 0.007), 'intermediate and declining' (mOR = 0.89; 95%CI = 0.83, 0.96; P = 0.002), and 'high and declining' (mOR = 0.92; 95%CI = 0.87, 0.98; P = 0.006) trajectories, relative to the 'intact' PF trajectory. Compared to old age pensioners, disability pensioners were more likely to be classified in the 'consistently low' (mOR = 23.77; 95% CI 2.13, 265.04; P = 0.010), 'intermediate and declining' (mOR = 8.24; 95%CI = 2.58, 26.35; P < 0.001), and 'high and declining' (mOR = 2.71; 95%CI = 1.17, 6.28; P = 0.020) PF trajectories, relative to the 'intact' PF trajectory.

CONCLUSIONS

Among executives and managers, older age at retirement was associated with better trajectories of PF in old age. Compared to old age pensioners, those transitioning into disability and early old age pensions were at risk of having consistently lower PF in old age.

Adverse Childhood Experiences and Trajectories of ADL Disability among Middle-Aged and Older Adults in China: Findings from the CHARLS Cohort Study

OBJECTIVES

There is little evidence on the association between adverse childhood experiences (ACEs) and disability trajectories among middle-aged and older adults. This study aimed to investigate the association between ACEs and activities of daily living (ADL) trajectories over eight years of follow-up and the mediation role of different chronic diseases on this relationship.

DESIGN

Prospective cohort study, eight-year follow-up.

SETTING

China Health and Retirement Longitudinal Study(CHARLS).

PARTICIPANTS

A total of 10651 participants age 45 and over from CHARLS 2011 to 2018 were included in this study.

MEASUREMENTS

Five ACEs exposure groups were formed based on the cumulative ACE scores. A 6-item ADL score was used, including bathing, dressing, eating, getting in/out of bed, using the toilet, and controlling urination, to measure the ADL disability, and the group-based trajectory model (GBTM) was used to identify the ADL disability trajectories. Multinomial logistic regression was performed to investigate the association between ACEs and ADL disability trajectory memberships, and KHB-method was used to estimate the contribution of different chronic diseases on this relationship.

RESULTS

Of the 10651 participants, 9.64% showed a mild-increasing trajectory in terms of change in ADL score during follow-up, followed by the low-mild trajectory (32.00%) and low-low trajectory (58.36%). Compared with those without ACEs exposure, participants who had ≥4 ACEs were associated with an increased risk of being on low-mild trajectory (OR 1.32, 95%CI:1.11-1.57) and mild-increasing trajectory (OR 1.41, 95%CI: 1.06-1.89), respectively. Besides, mediation analysis revealed chronic diseases had a mediation effect in this association, with the largest effect from arthritis or rheumatism (over 60%), followed by digestive system disease (around 14%), respiratory disease (around 12%), and cardio-metabolic disease (around 5%).

CONCLUSION

This study suggested that exposure to ACEs was associated with a higher risk of being worse ADL disability trajectories. Moreover, chronic disease accounts for a meaningful proportion of this association. Further studies are needed to clarify how chronic diseases mediate the association between ACEs and ADL disability trajectories.

Retirement age and type as predictors of frailty: a retrospective cohort study of older businessmen

OBJECTIVES

To study the association between retirement characteristics and frailty in a homogenous population of former business executives.

DESIGN

Cross-sectional cohort study using data from the Helsinki Businessmen Study.

SETTING

Helsinki, Finland.

PARTICIPANTS

1324 Caucasian men, born in 1919-1934, who had worked as business executives and managers and of whom 95.9% had retired by the year 2000. Questions on age at and type of retirement, lifestyle and chronic conditions were embedded in questionnaires.

PRIMARY AND SECONDARY OUTCOME MEASURES

Frailty assessed according to a modified phenotype definition at mean age 73.3 years.

RESULTS

Mean age at retirement was 61.3 years (SD 4.3) and 37.1% had retired due to old age. The prevalence of frailty was lowest among men retiring at ages 66-67 years but increased among those who worked up to age 70 years or older. Compared with men who retired before age 55 years, those retiring at ages 58-69 years were at decreased risk of frailty in old age relative to non-frailty (adjusted ORs 0.07-0.29, p<0.05). Compared with men who transitioned into old age retirement, those who retired due to disability were at increased risk of prefrailty (adjusted OR 1.53, 95% CI 1.01 to 2.32) and frailty (adjusted OR 3.52, 95% CI 1.97 to 6.29), relative to non-frailty.

CONCLUSION

Exiting working life early and continuing to be occupationally active until age 70 years and older were both associated with increased risk of frailty among the men. Promotion of longer work careers could, however, promote healthier ageing, as the lowest prevalence of frailty was observed in former business executives who retired at ages 66-67 years.