Active Aging in Senior Housing Residents and Community-Dwelling Older Adults: A Comparative Study in Finland

OBJECTIVES

Leading an active life in old age underpins positive life experience. This study aimed to compare the levels of active aging in senior housing residents and community-dwelling older people.

METHODS

We combined data from the BoAktiv senior house survey (N = 336, 69% women, mean age 83 years) and AGNES cohort study among community-dwelling older adults (N = 1021, 57% women, mean age 79 years). Active aging was assessed with the University of Jyvaskyla Active Aging scale. Data were analyzed with general linear models, and the analyses were stratified by sex.

RESULTS

Men in senior houses demonstrated lower active aging scores in general than community-dwelling men. Women in senior houses showed greater will to be active, but poorer ability and possibilities for activity than community-dwelling women.

DISCUSSION

Despite the social and supporting environment, senior housing residents' possibilities for leading an active life seem to be compromised, potentially leading to an unmet activity need.

Biologically Informed Polygenic Scores for Brain Insulin Receptor Network Are Associated with Cardiometabolic Risk Markers and Diabetes in Women

Background

To investigate associations between variations in the co-expression-based brain insulin receptor polygenic score and cardiometabolic risk factors and diabetes mellitus.

Methods

This cross-sectional study included 1,573 participants from the Helsinki Birth Cohort Study. Biologically informed expression-based polygenic risk scores for the insulin receptor gene network were calculated for the hippocampal (hePRS-IR) and the mesocorticolimbic (mePRS-IR) regions. Cardiometabolic markers included body composition, waist circumference, circulating lipids, insulin-like growth factor 1 (IGF-1), and insulin-like growth factor-binding protein 1 and 3 (IGFBP-1 and -3). Glucose and insulin levels were measured during a standardized 2-hour 75 g oral glucose tolerance test and impaired glucose regulation status was defined by the World Health Organization 2019 criteria. Analyzes were adjusted for population stratification, age, smoking, alcohol consumption, socioeconomic status, chronic diseases, birth weight, and leisure-time physical activity.

Results

Multinomial logistic regression indicated that one standard deviation increase in hePRS-IR was associated with increased risk of diabetes mellitus in all participants (adjusted relative risk ratio, 1.17; 95% confidence interval, 1.01 to 1.35). In women, higher hePRS-IR was associated with greater waist circumference and higher body fat percentage, levels of glucose, insulin, total cholesterol, low-density lipoprotein cholesterol, triglycerides, apolipoprotein B, insulin, and IGFBP-1 (all P≤0.02). The mePRS-IR was associated with decreased IGF-1 level in women (P=0.02). No associations were detected in men and studied outcomes.

Conclusion

hePRS-IR is associated with sex-specific differences in cardiometabolic risk factor profiles including impaired glucose regulation, abnormal metabolic markers, and unfavorable body composition in women.

Body composition in male lifelong trained strength, sprint and endurance athletes and healthy age-matched controls

Introduction

Aging involves many physiological processes that lead to decreases in muscle mass and increases in fat mass. While regular exercise can counteract such negative body composition outcomes, masters athletes maintain high levels of exercise throughout their lives. This provides a unique model to assess the impact of inherent aging. The present study compared lean mass and fat mass in young and masters athletes from different sports to age-matched non-athletic individuals.

Methods

Participants included young (20-39 years, n = 109) and older (70-89 years, n = 147) competitive male athletes, and 147 healthy age-matched controls (young = 53, older = 94 males). Athletes were separated into strength (e.g., weightlifters, powerlifters), sprint (e.g., sprint runners, jumpers) and endurance (e.g., long-distance runners, cross-country skiers) athletic disciplines. Body composition was assessed by dual-energy x-ray absorptiometry (DXA). Upper and lower limb lean mass was combined for appendicular lean mass as well as appendicular lean mass index (ALMI; kg/m2). Individuals' scores were assessed against established cut-offs for low muscle mass, obesity, and sarcopenic obesity to determine prevalence in each group.

Results

ALMI was greater in young strength (0.81-2.36 kg/m2, ∼15% and 1.24-2.74 kg/m2, ∼19%) and sprint (95% CI = 0.51-1.61 kg/m2, ∼11% and 0.96-1.97 kg/m2, ∼15%) athletes than in endurance and controls, respectively (all P < 0.001). In masters athletes, only strength athletes had greater ALMI than endurance athletes, but both older strength and sprint athletes had greater ALMI than older controls (0.42-1.27 kg/m2, ∼9% and 0.73-1.67 kg/m2, ∼13%, respectively, both P < 0.001). Fat mass was significantly lower in sprint and endurance athletes compared to strength athletes and controls in both age-groups. Sarcopenic obesity was identified in one young (2%) and eighteen (19%) older controls, while only two older endurance athletes (3%) and one older strength athlete (2%) were identified.

Discussion

Lifelong competitive sport participation leads to lower prevalence of sarcopenic obesity than a recreationally active lifestyle. This is achieved in strength athletes by emphasizing muscle mass, while sprint and endurance athletes demonstrate low fat mass levels. However, all older athlete groups showed higher fat mass than the young groups, suggesting that exercise alone may not be sufficient to manage fat mass.

Depressive symptoms and mortality-findings from Helsinki birth cohort study

BACKGROUND

Individuals with depression and depressive symptoms have a higher mortality rate than non-depressed individuals. The increased comorbidity and mortality associated with depression has remained largely unexplained. The underlying pathophysiological differences between depressive subtypes, melancholic and non-melancholic, may provide some explanation to this phenomenon.

METHODS

One thousand nine hundred and ninety five participants (mean age 61 years) from the Helsinki Birth Cohort Study were recruited for this prospective study and followed up for a mean of 14.1 years. Information regarding medical history, lifestyle, and biochemical parameters were obtained. Depressive symptoms were assessed using the Beck Depression Inventory. Standardized mortality ratios were calculated.

RESULTS

Participants were followed up for a total of 28,044 person-years. The melancholic depressive group had an increased adjusted risk of mortality [HR 1.49 (95% CI: 1.02-2.20)] when compared to the non-depressive group. Comparing mortality to the whole population of Finland using standardized mortality ratios (SMR) both the non-melancholic [1.11 (95% CI: 0.85-1.44)] and melancholic depressive [1.26 (95% CI: 0.87-1.81)] groups had higher mortality than the non-depressive group [0.82 (95% CI: 0.73-0.93)].

CONCLUSIONS

Melancholic depressive symptoms are most strongly related to a higher mortality risk.

Motives for competitive sports participation in masters track and field athletes: Impact of sociodemographic factors and competitive background

OBJECTIVES

Masters athletes due to their lifelong engagement in sport represent a unique group to study motivation for regular physical activity, but there is less scientific data on the sport motives in masters athletes. Therefore, the aim of this study was to evaluate the association of age, sex, education, nationality, competitive background and training amount with sport motives of masters track and field athletes.

METHODS

811 (254 women) athletes aged 35-89 years participated in European Veterans Athletics Championships in the year of 2000. Sport motives were assessed with a questionnaire and categorized into1) well-being, 2) competitive and performance 3) health and fitness motives.

RESULTS

Men considered health and fitness motives more important than women (p = 0.022). Over 65-year-old athletes considered health and fitness motives more important than the youngest, 35-49-year age group (p<0.001). Education was not associated with sport motives, while motives varied significantly among different nationalities. Athletes from Nordic Countries considered well-being motives more important than Southern Europeans (p<0.001) or Western Europeans (p<0.05). Athletes from Nordic Countries (p = 0.003), Eastern Europe (p<0.001) and Central Europe (p<0.001) found health and fitness motives more meaningful than athletes from the British Isles. Furthermore, athletes with competitive background before the age of 35 and training amount more than 7.5 h a week found competitive and performance motives more important than athletes without a competitive history (p = 0.002).

CONCLUSIONS

These results suggest that age, sex, nationality and former athleticism are associated with sports motives among international level masters track and field athletes. It seems that while for masters athletes with competitive background performance motives dominate, for older adults, particularly for males, health and fitness motives are more important. In addition, when designing the exercise interventions for older adults, different sport motives across countries should be considered.

Non-melancholic depressive symptoms are associated with above average fat mass index in the Helsinki birth cohort study

There is an existing link between two of the most common diseases, obesity and depression. These are both of great public health concern, but little is known about the relationships between the subtypes of these conditions. We hypothesized that non-melancholic depressive symptoms have a stronger relationship with both body composition (lean mass and fat mass) and dysfunctional glucose metabolism than melancholic depression. For this cross-sectional study 1510 participants from the Helsinki Birth Cohort Study had their body composition evaluated as lean mass and fat mass (Lean Mass Index [LMI, kg/m²] + Fat Mass Index [FMI kg/m²] = Body Mass Index). Participants were evaluated for depressive symptoms utilizing the Beck depression inventory, and had laboratory assessments including an oral glucose tolerance test. Higher than average FMI was associated with a higher percentage (mean [%], 95% CI) of participants scoring in the depressive range of the Beck depression inventory (20.2, 17.2–23.2) compared to those with low FMI (16.3, 13.8–18.9; p = 0.048) when adjusted for age, sex, education, and fasting plasma glucose concentration. Higher FMI was associated with a higher likelihood of having depressive symptoms (OR per 1-SD FMI = 1.37, 95% CI 1.13–1.65), whereas higher LMI was associated with a lower likelihood of having depressive symptoms (OR per 1-SD LMI = 0.76, 95% CI 0.64–0.91). Participants with an above average FMI more frequently (mean [%], 95% CI) had non-melancholic depressive symptoms (14.7, 11.8–17.7) as compared to those with low FMI (9.7, 7.6–11.9; p = 0.008) regardless of LMI levels. There was no difference between the body composition groups in the likelihood of having melancholic depressive symptoms. The non-melancholic group had higher (mean [kg/m²], SD) FMI (9.6, 4.1) than either of the other groups (BDI < 10: 7.7, 3.1; melancholic: 7.9, 3.6; p < 0.001), and a higher (mean [mmol/l], SD) 2-h glucose concentration (7.21, 1.65) than the non-depressed group (6.71, 1.70; p = 0.005). As hypothesized, non-melancholic depressive symptoms are most closely related to high fat mass index and dysfunctional glucose metabolism.

Higher carotid-radial pulse wave velocity is associated with non-melancholic depressive symptoms in men - findings from Helsinki Birth Cohort Study

BACKGROUND

Depression and cardiovascular disease (CVD) are major causes of global disease burden that are interrelated through mostly unknown mechanisms. We studied the relationship of melancholic and non-melancholic depressive symptoms with arterial stiffness, an important underlying mechanism of CVD.

METHODS

The Helsinki Birth Cohort Study recruited 683 previously extensively phenotyped subjects for this sub-study. Cross-sectional data along with responses regarding depressive symptoms were obtained for each participant. For evaluation of depressive symptoms, the Beck Depression Inventory (BDI)and subscales were used to measure melancholic and non-melancholic depressive symptoms. Arterial stiffness was assessed as pulse wave velocity (PWV) that was measured between the carotid and radial artery, and carotid and femoral artery.

RESULTS

Of the participants, 532 scored <10 on the BDI and were classified as not having depressive symptoms. Of the 151 participants that scored ≥10 on the BDI, 122 were classified as having non-melancholic depressive symptoms and 29 as having melancholic depressive symptoms. Men had higher carotid-radial PWV (crPWV) values than women (p < .001). A positive relationship between BDI scores and crPWV (p < .001) was found in men. We also found higher crPWV in men with non-melancholic depressive symptoms compared to all others. No such differences were found in women.

DISCUSSION

Arterial stiffness has a relationship with depressive symptoms and subtypes of depressive symptoms, at least in men. There is a significant relationship between higher PWV and non-melancholic depressive symptoms in men. Due to the intricate nature of the disease causality or directionality is impossible to infer solely based on this study. Further studies into the subtypes of depressive symptoms may be of benefit to understanding depression.KEY MESSAGESIt is known that arterial stiffness contributes to cardiovascular disease, and is associated with depression.Higher Beck Depression Inventory scores are associated with higher carotid-radial pulse wave velocity in men.Non-melancholic depressive symptoms are associated with higher carotid-radial pulse wave velocity in men.

The relationship between health-related quality of life and melancholic depressive symptoms is modified by brain insulin receptor gene network

To investigate whether expression-based polygenic risk scores for the insulin receptor gene network (ePRS-IRs) modifiy the association between type of depressive symptoms and health-related quality of life (HRQoL). This cross-sectional study includes 1558 individuals from the Helsinki Birth Cohort Study. Between 2001 and 2004, the Short Form-36 questionnaire was employed to assess mental and physical components of HRQoL and Beck Depression Inventory (BDI) to assess depressive symptoms. Depressive symptoms were categorized into minimal (BDI < 10), non-melancholic and melancholic types of depression. The ePRS-IRs were calculated for the hippocampal (hePRS-IR) and the mesocorticolimbic (mePRS-IR) regions of the brain. General linear regression models adjusted for age, sex, population stratification, lifestyle factors and body mass index were applied to analyze the data. Both types of depressive symptoms were associated with lower HRQoL (p < 0.0001). HePRS-IR modified the association between the types of depression and mental HRQoL (p for interaction = 0.005). Melancholic type of depressive symptoms was associated with higher mental HRQoL compared to the non-melancholic symptoms among individuals with low hePRS-IR (adjusted mean 4.1, 95% CI 0.7–7.4, p = 0.018). However, no such difference was evident in moderate or high hePRS-IR groups as higher hePRS-IR was associated with lower mental HRQoL (B = − 3.4, 95% CI − 5.6 to − 1.2) in individuals with melancholic type of depressive symptoms. No direct associations were detected between the ePRS-IRs and type of depressive symptoms or HRQoL. Variations in the glucose-insulin metabolism can lower HRQoL in individuals with melancholic depressive symptoms.

Advanced glycation end products measured by skin autofluorescence are associated with melancholic depressive symptoms - Findings from Helsinki Birth Cohort Study

BACKGROUND

Millions of people live with depression and its burden of disease. Depression has an increased comorbidity and mortality that has remained unexplained. Studies have reported connections between advanced glycation end products (AGEs) and various disease processes, including mental health. The present study evaluated associations between AGEs, depressive symptoms, and types of depressive symptoms.

METHODS

From the Helsinki Birth Cohort Study, 815 participants with a mean age of 76 years were recruited for this cross-sectional study. Characteristics regarding self-reported lifestyle and medical history, as well as blood tests were obtained along with responses regarding depressive symptoms according to the Beck Depression Inventory (BDI) and Mental Health Inventory-5. Each participant had their AGE level measured non-invasively with skin autofluorescence (SAF). Statistical analyses looked at relationships between types of depressive symptoms and AGE levels by sex.

RESULTS

Of women, 27% scored ≥10 on the BDI and 18% of men, respectively. Men had higher crude AGE levels (mean [standard deviation], arbitrary units) (2.49 [0.51]) compared to women (2.33 [0.46]) (p < 0.001). The highest crude AGE levels were found in those with melancholic depressive symptoms (2.61 [0.57]), followed by those with non-melancholic depressive symptoms (2.45 [0.45]) and those with no depressive symptoms (2.38 [0.49]) (p = 0.013). These findings remained significant in the fully adjusted model.

CONCLUSIONS

The current study shows an association between depressive symptoms and higher AGE levels. The association is likely part of a multi-factorial effect, and hence no directionality, causality, or effect can be inferred solely based on the results of this study.

Birth cohort differences in cognitive performance in 75- and 80-year-olds: a comparison of two cohorts over 28 years

Objective

To evaluate cohort differences in cognitive performance in older men and women born and assessed 28 years apart.

Methods

Data in this study were drawn from two age-homogeneous cohorts measured in the same laboratory using the same standardized cognitive performance tests. Participants in the first cohort were born in 1910 and 1914 and assessed in 1989–1990 (Evergreen project, n = 500). Participants in the second cohort were born in 1938 or 1939 and 1942 or 1943 and assessed in 2017–2018 (Evergreen II, n = 726). Participants in both cohorts were assessed at age 75 and 80 years and were recruited from the population register. Cognitive performance was measured using the Digit Span test from the Wechsler Memory Scale (WMS), Digit Symbol test from the Wechsler Adult Intelligence Scale (WAIS) and phonemic Verbal Fluency test from the Schaie-Thurstone Adult Mental Abilities Test. Reaction time assessing motor and mental responses was measured with a simple finger movement task, followed by a complex finger movement task. T-tests were used to study cohort differences and linear regression models to study possible factors underlying differences.

Results

We found statistically significant cohort differences in all the cognitive performance tests, except for the digit span test and simple movement task in men, the later-born cohort performing better in all the measured outcomes.

Conclusions

The results of this study provide strong evidence that cognitive performance is better in more recent cohorts of older people compared to their counterparts measured 28 years earlier.

Impaired glucose regulation, depressive symptoms, and health-related quality of life

INTRODUCTION

This study aims to investigate whether the associations between impaired glucose regulation and health-related quality of life are modified by severity or type of depressive symptoms.

RESEARCH DESIGN AND METHODS

For this cross-sectional study, we included 1939 individuals (mean age 61.5 years) from the Helsinki Birth Cohort Study. Between 2001 and 2004, a standard 2-hour 75 g oral glucose tolerance test was applied to define normoglycemia, pre-diabetes, and newly diagnosed diabetes. Information on previously diagnosed diabetes was collected from national registers and questionnaires. Pre-diabetes was defined as having either impaired fasting glucose or impaired glucose tolerance. The Mental and Physical Component Scores of health-related quality of life were assessed with Short Form-36. Beck's Depression Inventory was employed to investigate the severity of depressive symptoms and to define minimal (depression score <10), non-melancholic, and melancholic types of depression. We analyzed data with general linear models adjusted for sex, age, lifestyle factors, comorbidities, and body mass index.

RESULTS

Glucose regulation subgroups, especially previously known diabetes, were associated with lower Physical Component Score (p=0.001) and higher depression score (p=0.015), but not with the Mental Component Score (p=0.189). Non-melancholic depression was associated with lower Physical and Mental Component Scores compared with those with depression score <10 and melancholic depression (p<0.001), independently of glucose regulation status (p for glucose regulation status by depression type interaction >0.54).

CONCLUSIONS

Non-melancholic type of depression and previously known diabetes are independently associated with lower health-related quality of life. This should be appraised in long-term treatment of diabetes and when treating non-melancholic depressive symptoms to maintain a higher health-related quality of life.

Mortality Risk Among Older People Who Did Versus Did Not Sustain a Fracture: Baseline Prefracture Strength and Gait Speed as Predictors in a 15-Year Follow-Up

BACKGROUND

Physiological reserve, as indicated by muscle strength and gait speed, may be especially determinant of survival in people who are exposed to a health stressor. We studied whether the association between strength/speed and mortality risk would be stronger in the time period after a fracture compared to other time periods.

METHODS

Participants were population-based sample of 157 men and 325 women aged 75 and 80 years at baseline. Maximal 10-m gait speed and maximal isometric grip and knee extension strength were tested at the baseline before the fracture. Subsequent fracture incidence and mortality were followed up for 15 years. Cox regression analysis was used to estimate fracture time-stratified effects of gait speed and muscle strength on mortality risk in three states: (i) nonfracture state, (ii) the first postfracture year, and (iii) after the first postfracture year until death/end of follow-up.

RESULTS

During the follow-up, 20% of the men and 44% of the women sustained a fracture. In both sexes, lower gait speed and in women lower knee extension strength was associated with increased mortality risk in the nonfracture state. During the first postfracture year, the mortality risk associated with slower gait and lower strength was increased and higher than in the nonfracture state. After the first postfracture year, mortality risk associated with lower gait speed and muscle strength attenuated.

CONCLUSIONS

Lower gait speed and muscle strength were more strongly associated with mortality risk after fracture than during nonfracture time, which may indicate decreased likelihood of recovery.

Living alone vs. living with someone as a predictor of mortality after a bone fracture in older age

Background

Living alone is a risk factor for health decline in old age, especially when facing adverse events increasing vulnerability.

Aim

We examined whether living alone is associated with higher post-fracture mortality risk.

Methods

Participants were 190 men and 409 women aged 75 or 80 years at baseline. Subsequent fracture incidence and mortality were followed up for 15 years. Extended Cox regression analysis was used to compare the associations between living arrangements and mortality risk during the first post-fracture year and during the non-fracture time. All participants contributed to the non-fracture state until a fracture occurred or until death/end of follow-up if they did not sustain a fracture. Participants who sustained a fracture during the follow-up returned to the non-fracture state 1 year after the fracture unless they died or were censored due to end of follow-up.

Results

Altogether, 22% of men and 40% of women sustained a fracture. During the first post-fracture year, mortality risk was over threefold compared to non-fracture time but did not differ by living arrangement. In women, living alone was associated with lower mortality risk during non-fracture time, but the association attenuated after adjustment for self-rated health. In men, living alone was associated with increased mortality risk during non-fracture time, although not significantly.

Conclusion

The results suggest that living alone is not associated with pronounced mortality risk after a fracture compared to living with someone.

Electronic supplementary material

The online version of this article (10.1007/s40520-020-01511-5) contains supplementary material, which is available to authorized users.

The impact of maternal weight in pregnancy on glucose metabolism in non-diabetic offspring in late adulthood

AIMS

We aimed to examine the association between maternal adiposity and glucose metabolism in adult offspring without diabetes, simultaneous taking offspring own adiposity into account.

METHODS

This longitudinal birth cohort study (Helsinki Birth Cohort Study) included 1,440 non-diabetic subjects examined at a mean age of 62 years. Subjects were divided into quartiles according to maternal body mass index (BMI). The impact of maternal BMI on offspring body composition was also studied.

RESULTS

There were no differences in fasting glucose between the groups. In men, maternal BMI was inversely associated with mean 2-hour glucose concentration after a 75 g oral glucose tolerance test (p < 0.001) and mean homeostatic model assessment of insulin resistance (HOMA-IR) (p = 0.049). According to the subjects' own BMI, high maternal BMI was associated with lower 2-hour glucose concentrations only in non-obese men and with lower HOMA-IR only in obese men. Maternal BMI was not associated with glucose concentrations nor with HOMA-IR in women. In addition, maternal BMI was positively associated with a higher offspring lean body mass in men.

CONCLUSIONS

High maternal BMI was associated with lower 2-hour plasma glucose concentration, especially in non-obese men. Offspring lean body mass may be a mediating factor for the association.

Associations of overweight and metabolic health with successful aging: 32-year follow-up of the Helsinki Businessmen Study

BACKGROUND & AIMS

Prognostic significance of metabolically healthy overweight and obesity (MHO) is under debate. However the relationship between MHO and health-related quality of life (HRQoL) is less studied. We compared successful aging (longevity plus HRQoL) in men with MHO, metabolically healthy normal weight (MHN) and metabolically unhealthy overweight and obesity (MUO).

METHODS

In the Helsinki Businessmen Study longitudinal cohort, consisting of men born 1919 to 1934. In 1985/86, overweight (BMI≥25 kg/m²) and metabolic health were determined in 1309 men (median age 60 years). HRQoL was assessed using RAND-36/SF-36 in 2000 and 2007, and all-cause mortality retrieved from registers up to 2018. The proportion of men reaching 90 years was also calculated.

RESULTS

Of the men, 469 (35.8%), 538 (41.1%), 276 (21.1%), and 26 (2.0%) were MHN, MHO, MUO and MUN, respectively. During the 32-year follow-up, 72.3% men died. With MHN as reference, adjusted hazard ratio with all-cause mortality was 1.08 (95% confidence interval [CI] 0.93 to 1.27) for MHO, and 1.18 (95% CI 0.95 to 1.47) for MUO. During follow-up, 273 men reached 90 years. With MHN as reference, adjusted odds ratio for MHO was 0.82 (95% CI 0.59 to 1.14) and 0.62 (95% CI 0.41 to 0.95) for MUO. Men in MHN group scored generally highest in RAND-36 HRQoL subscales in 2000 and 2007, of those significantly better in Physical functioning, Role physical, Role emotional, Bodily Pain, and General health sub-scales compared to MHO group in 2000.

CONCLUSIONS

As compared to MHN, MHO in late midlife does not increase mortality, but impairs odds for successful aging.

Investigating the links between resilience, perceived HRM practices, and retirement intentions

Purpose

Human resource management (HRM) scholars’ interest in older employees’ resilience has only recently started to emerge. Little is known about how resilience and perceived HRM are linked to different retirement intentions. Drawing on the conservation of resources and social exchange theories, the purpose of this paper is to investigate the links between perceived HRM practices, resilience and retirement intentions. Additionally, the paper examines the possible mediating role of resilience in the relationship between perceived HRM practices and retirement intentions.

Design/methodology/approach

In 2016, a cross-sectional study was conducted among older (50+) nursing professionals working in a Finnish university hospital. Statistical methods, including mean comparisons and linear and logistic regression analyses, were used to analyze the data.

Findings

The results indicated that resilience partly mediated the relationship between perceived HRM practices and early retirement intentions, and fully mediated the association between perceived HRM practices and intentions to continue working after retirement age.

Originality/value

This study produces new knowledge regarding the links between resilience, perceived High involvement work practices and retirement intentions.

Maternal body mass index in pregnancy and offspring physical and psychosocial functioning in older age: findings from the Helsinki Birth Cohort Study (HBCS)

INTRODUCTION

Maternal obesity is associated with several adverse long-term health outcomes in the offspring. In this study, we examined the association between maternal body mass index (BMI) and offspring physical and psychosocial functioning in late adulthood.

METHODS

The study included 1759 men and women born during 1934-1944 and belonging to the Helsinki Birth Cohort Study. Data on maternal weight and height in late pregnancy and on offspring birth weight were retrieved from hospital birth records. Physical and psychosocial functioning was assessed using the Short Form 36 scale.

RESULTS

Maternal BMI was positively associated with poorer physical and psychosocial functioning among men, but not among women. This association was not mediated by birth weight.

DISCUSSION

The present study emphasizes the importance of preventing overweight and obesity among women of childbearing age. Key messages Maternal BMI is known to be associated with adverse health outcomes among adult offspring. We found that higher maternal BMI was associated with poorer physical and psychosocial functioning among male offspring in late adulthood. The association between maternal BMI and offspring physical and psychosocial functioning was not mediated by birth weight.

Mobility limitation as a predictor of inpatient care in the last year of life among community-living older people

BACKGROUND AND AIMS

Need for inpatient care increases toward the end of life. We studied whether mobility limitation assessed approximately 5.8 years prior to death predicts the number of days in care during the last year of life.

METHODS

A population-based, prospective study with interviews conducted, on average, 5.8 years prior to death. Data on vital status and health care use were register-based. Participants consisted of 846 persons who had died between 1989 and 2004 at the age of 66-98 years. Participants were categorized as having mobility limitation if, at baseline, they reported difficulties in walking 2 km or climbing one flight of stairs.

RESULTS

Mean ± standard deviation of age at death for men was 81.6 ± 6.2 years and the median number of days in inpatient care in the last year of life was 38.5 days. For women, the corresponding figures were 84.1 ± 6.1 years and 66.0 days. Only 11% of men and 7% of women had no inpatient care in the last year of life. The adjusted incidence rate ratio for all-cause inpatient care in the last year of life was 1.53 (95% CI 1.09-2.16) among men with mobility limitation compared to those with intact mobility. Among women, mobility limitation did not increase the risk for all-cause inpatient care.

CONCLUSION

Mobility limitation (vs. intact mobility) at 5.8 years prior to death markedly increases the need of inpatient care in the last year of life among men.

Accumulation of disparity in physical activity in old age

BACKGROUND AND AIMS

The level of physical activity often declines in old age, although many older people would like to be more active than what they are capable of. This leads to unmet physical activity need, the feeling that one's level of physical activity is inadequate, which is a manifestation of disparity in physical activity in old age. The accumulation of risk factors, including mobility limitations, low socioeconomic status (SES) and lack of social support may increase disparity in physical activity. The aim of this study was to investigate how the accumulation of risk factors is associated with unmet physical activity need in older community-living people.

METHODS

The study was based on cross-sectional analyses of an observational study with 632 participants. Unmet physical activity need, SES, mobility limitations and availability of social support were self-reported by standardized questionnaires.

RESULTS

Having mobility limitations increased the risk of unmet physical activity need almost four-fold compared to those with no mobility limitations; having mobility limitations and either low SES or not having social support increased the risk over four-fold and having mobility limitations, low SES and no social support further increased the risk over seven-fold.

CONCLUSIONS

We found that accumulation of risk factors increases disparity in physical activity.

Long-term 1,25-dihydroxycholecalciferol treatment in renal failure

1,25-Dihydroxycholecalciferol (1,25-DHCC) was administered to four patients on maintenance hemodialysis and to four patients with renal failure not requiring hemodialysis. Secondary hyperparathyroidism was found in both groups of patients. Before initiation of 1,25-DHCC treatment both groups had serum 1,25-DHCC levels below the normal range (33.1 +/- 15.3 pg/ml). During the treatment period, serum 1,25-DHCC concentrations were normalized. Parathormone concentration in serum decreased in both groups during the observation period. Serum calcium concentration was normalized in patients with renal failure and within the upper normal range in patients on maintenance hemodialysis. Bone biopsy and densitometry, of the radius showed a trend towards normalization of bone during the treatment period, while X-ray studies showed no clear effect of 1,25-DHCC treatment. This study shows that changes in bone mineralization can be reversed by normalization of 1,25-DHCC.

Mobility limitations and cognitive deficits as predictors of institutionalization among community-dwelling older people

PURPOSE

Mobility limitations and cognitive disorders have often been observed as risks for institutionalization. However, their combined effects on risk of institutionalization among initially community-dwelling older people have been less well reported.

DESIGN

A prospective cohort study with 10-year surveillance on institutionalization.

SUBJECTS

Study population (n = 476) consisted of 75- and 80-year-old people who were community-dwelling, had not been diagnosed with dementia, and participated in tests on walking speed and cognitive capacity at a research centre.

MEASURES

Cognitive capacity was measured with three validated psychometric tests that were from the Wechsler Adult Intelligence Scale, Wechsler Memory Scale and Schaie-Thurstone Adult Mental Abilities Test. Mobility was measured with walking speed over a 10-m distance. Exclusive distribution based study groups were formed with cut-offs at the lowest third as follows: no limitation, solely mobility limitation, solely cognitive deficits, and combined mobility limitation and cognitive deficits. Cox proportional hazards model was used to determine the relative risks of institutionalization for the study groups.

RESULTS

Eleven percent of the participants were institutionalized during the 10-year surveillance. The risk for institutionalization was 4.9 times greater (95% confidence interval: 2.1-11.2) for those who had co-existing mobility limitations and cognitive deficits than for those with no limitations.

CONCLUSIONS

The findings show that the accumulation of limitations in physical and cognitive performance substantially decreases the possibility for a person remaining at home. This might be due to a decreased reserve capacity and ineffective compensatory strategies. Therefore, interventions targeted to improve even one limitation, or prevent accumulation of these risk factors, could significantly reduce the risk of institutionalization.

Clinical environment as a learning environment: student nurses' perceptions concerning clinical learning experiences

The aim of this study is to describe student nurses' perceptions of clinical learning experiences in the context of the clinical learning environment. We use the phenomenological approach by Colaizzi. The data was collected by unstructured interviews. Altogether 16 student nurses were asked to describe the significance of clinical learning experiences and good and bad learning experiences. Four elements sum up these clinical learning experiences: the appreciation and support the students received, the quality of mentoring and patient care, and students' self-directedness. Student nurses valued clinical practice and the possibilities it offered in the process of growing to become a nurse and a professional. A good clinical learning environment was established through good co-operation between the school and the clinical staff. It was concluded that the school should be able to provide a suitable clinical learning environment at the right time, so that theory and practice would complement each other. The teacher was the expert on nursing education, the aims set for each practice, as well as student nurses and their skills, but then again the nurse mentor knew the ward on which students were practicing. This was why collaboration between nurse mentors and nurse teachers was considered very necessary.