Lifetime prevalence of homelessness in housed people aged 55-79 years in England: its childhood correlates and association with mortality over 10 years of follow-up

OBJECTIVES

Since 2010, the number of homeless people in the UK has increased, and homelessness in its different types has become a major public health problem. Housed older people with past experience of homelessness are an understudied population that can provide valuable insight into this problem. For this reason, we examined the lifetime prevalence of homelessness and its associations with childhood adversity and mortality in a national sample of older people.

STUDY DESIGN

This is a longitudinal cohort study.

METHODS

We studied 6649 housed individuals aged 55-79 years in 2007 from the English Longitudinal Study of Ageing (ELSA). We used logistic regression to model the association between adverse childhood experiences (ACE) and lifetime experience of homelessness (ever been homeless for ≥1 months) and Cox proportional hazards regression to model the prospective association between lifetime experience of homelessness and mortality.

RESULTS

We identified 107 participants with lifetime experience of homelessness. We found a strong graded association between the number of ACE and lifetime experience of homelessness; participants with two ACE had 5.35 (95% confidence interval [CI]: 3.17-9.05) times greater odds of having experienced homelessness than those reporting none. Most ACE were individually associated with lifetime homelessness, but fewer remained so in the mutually adjusted model. Participants with lifetime experience of homelessness had 1.55 (95% CI: 1.01-2.37) times greater risk of mortality over a 10-year follow-up and after adjustment for covariates.

CONCLUSIONS

Exposure to childhood adversity is associated with increased risk of experiencing homelessness. Older housed people with past experience of homelessness are at increased risk of mortality.

Severity of depressive symptoms as a predictor of mortality: the English longitudinal study of ageing

BACKGROUND

Major depressive disorder and subthreshold depression have been associated with premature mortality. We investigated the association between depressive symptoms and mortality across the full continuum of severity.

METHOD

We used Cox proportional hazards models to examine the association between depressive symptom severity, assessed using the eight-item Center for Epidemiological Studies Depression Scale (CES-D; range 0-8), and the risk of all-cause mortality over a 9-year follow-up, in 11 104 members of the English Longitudinal Study of Ageing.

RESULTS

During follow-up, one fifth of study members died (N = 2267). Depressive symptoms were associated with increased mortality across the full range of severity (p trend < 0.001). Relative to study members with no symptoms, an increased risk of mortality was found in people with depressive symptoms of a low [hazard ratio (HR) for a score of 2 was 1.59, 95% confidence interval (CI) 1.40-1.82], moderate (score of 4: HR 1.80, 95% CI 1.52-2.13) and high (score of 8: HR 2.27, 95% CI 1.69-3.04) severity, suggesting risk emerges at low levels but plateaus thereafter. A third of participants (36.4%, 95% CI 35.5-37.3) reported depressive symptoms associated with an increased mortality risk. Adjustment for physical activity, physical illnesses, and impairments in physical and cognitive functioning attenuated this association (p trend = 0.25).

CONCLUSIONS

Depressive symptoms are associated with an increased mortality risk even at low levels of symptom severity. This association is explained by physical activity, physical illnesses, and impairments in physical and cognitive functioning.

Higher effort-reward imbalance and lower job control predict exit from the labour market at the age of 61 years or younger: evidence from the English Longitudinal Study of Ageing

BACKGROUND

We examined whether higher effort-reward imbalance (ERI) and lower job control are associated with exit from the labour market.

METHODS

There were 1263 participants aged 50-74 years from the English Longitudinal Study on Ageing with data on working status and work-related psychosocial factors at baseline (wave 2; 2004-2005), and working status at follow-up (wave 5; 2010-2011). Psychosocial factors at work were assessed using a short validated version of ERI and job control. An allostatic load index was formed using 13 biological parameters. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale. Exit from the labour market was defined as not working in the labour market when 61 years old or younger in 2010-2011.

RESULTS

Higher ERI OR=1.62 (95% CI 1.01 to 2.61, p=0.048) predicted exit from the labour market independent of age, sex, education, occupational class, allostatic load and depression. Job control OR=0.60 (95% CI 0.42 to 0.85, p=0.004) was associated with exit from the labour market independent of age, sex, education, occupation and depression. The association of higher effort OR=1.32 (95% CI 1.01 to 1.73, p=0.045) with exit from the labour market was independent of age, sex and depression but attenuated to non-significance when additionally controlling for socioeconomic measures. Reward was not related to exit from the labour market.

CONCLUSIONS

Stressful work conditions can be a risk for exiting the labour market before the age of 61 years. Neither socioeconomic position nor allostatic load and depressive symptoms seem to explain this association.

Low-intensity physical activity is associated with reduced risk of incident type 2 diabetes in older adults: evidence from the English Longitudinal Study of Ageing

AIMS/HYPOTHESIS

We examined whether small amounts of low-intensity physical activity were associated with reduced risk of developing type 2 diabetes in a national sample of people aged 50 years and over.

METHODS

The sample comprised 7,466 individuals (55.9% women) free from self-reported doctor-diagnosed diabetes and was prospectively followed for a mean of 45.3 months. Baseline self-reported physical activity was categorised as physical inactivity, low- and vigorous/moderate-intensity physical activity at least once a week. Cox proportional hazard regression was used to model the association between baseline physical activity and incident type 2 diabetes.

RESULTS

Vigorous/moderate-intensity physical activity at least once a week was associated with reduced risk of type 2 diabetes (HR 0.64, 95% CI 0.43-0.95, p = 0.026) but low-intensity physical activity at least once a week was not (HR 0.87, 95% CI 0.58-1.30, p = 0.497) after adjustment for all covariates. However, age-stratified analysis showed that low-intensity physical activity at least once a week was associated with reduced risk of type 2 diabetes for those aged 70 years and over (HR 0.53, 95% CI 0.28-1.02, p = 0.059), but not for those aged 50 to 59 years (HR 1.09, 95% CI 0.52-2.29, p = 0.828) or those aged 60 to 69 years (HR 1.15, 95% CI 0.55-2.41, p = 0.715) after adjustment for all covariates.

CONCLUSIONS/INTERPRETATION

Compared with physical inactivity, any type of physical activity was associated with reduced risk of type 2 diabetes in adults aged 70 years and over, while in adults aged 50 to 69 years, physical activity needed to be vigorous/moderate in intensity to be associated with reduced risk of type 2 diabetes.

Physical activity, emotional and behavioural problems, maternal education and self-reported educational performance of adolescents

This study examined whether physical activity, mental health and socio-economic position were associated with the overall academic performance and future educational plans of adolescents aged 15-16 years. We used a sample of 7002 boys and girls from the Northern Finland Birth Cohort 1986. Data were collected by a postal enquiry in 2001-02. Multivariable logistic regression models were estimated and adjusted for family structure and all variables in the models. In the fully adjusted models, higher levels of physical activity and high parental socio-economic position were associated with higher overall academic performance and future plans for higher education. High scoring on behavioural problems was related to lower overall academic performance and poorer future academic plans. In summary, a higher level of physical activity, fewer behavioural problems and higher socio-economic position were independently associated with high self-perceived overall academic performance and plans for higher education among adolescents. The interrelations of these factors and the positive relationship between physical activity, mental health and school outcomes provide a context of critical importance for future research, intervention programming and policy directed at improving the educational attainment of adolescents.

Spectroscopic characterisation of carotid atherosclerotic plaque by laser induced fluorescence

BACKGROUND AND OBJECTIVE

An effort has been made to distinguish the composition of carotid atherosclerotic plaques (CAP) from patients undergoing carotid endarterectomy, by laser induced fluorescence spectroscopy.

STUDY DESIGN/MATERIALS AND METHODS

Different excitation wavelengths were used: 476, 488, and 458 nm of a continuous wave krypton/argon ion laser, and 337 nm of a pulsed nitrogen laser. Twenty-three CAP samples from different patients were investigated and several spectra from each plaque were obtained.

RESULTS

Results were crossed-examined with conventional histologic techniques, which showed three areas of different composition on the pathologic samples: fibrous tissue, lipid constituents, and calcified plaque. Gaussian fittings were performed to reproduce the fluorescence spectra as a correlation of multiple Gaussian curves.

CONCLUSION

The accuracy for discrimination of the heterogeneous composition of the atherosclerotic plaque is still limited, due to superposition of the fluorescence emission of various plaque components.