What Explains the Link Between Hearing and Vision Impairment and Cognitive Function? Analysis of Mediating Effects in the USA, England and Ireland.

OBJECTIVES: Hearing and vision impairments are associated with cognitive decline and dementia risk. Explanations for this include age-related processes impacting on sensory and cognitive function (common cause), or sensory impairments having a direct or indirect impact on cognition via social engagement, depression and physical activity (cascade). We tested whether associations between hearing, vision and episodic memory were mediated by allostatic load, social engagement, depression and physical activity. METHODS: We used structural equation modelling with cross-sectional data from the USA (n = 4746, aged 50-101), England (n = 4907, aged 50-89) and Ireland (4292, aged 50-80) to model factors related to the common cause (indexed by allostatic load) and the cascade hypothesis with respect to cognitive ability (episodic memory). RESULTS: Poorer hearing/vision was associated with lower social engagement, depression and sedentary lifestyle. Poor vision was not related to allostatic load, and poor hearing was associated with allostatic load in only one data set, contributing to a common-cause hypothesis. Lower social engagement, depression and a sedentary lifestyle were associated with poorer episodic memory, contributing to the cascade hypothesis. Using effect estimates to calculate the proportion of the total effects mediated by the combined mediator variables, up to two fifths of the relationship between hearing and vision with episodic memory can be explained by the mediators. CONCLUSIONS: The association between hearing, vision and episodic memory is mediated by allostatic load, social engagement, depression, and physical activity. The finding that social engagement, depression, and physical activity mediate the association between sensory abilities and cognitive function supported the cascade hypotheses. Interventions to improve healthy lifestyle, reduce depression and foster social engagement of older people with sensory impairments are likely to be beneficial in preventing cognitive decline and dementia.

Trajectories of self-reported hearing and their associations with cognition: evidence from the United Kingdom and United States of America.

OBJECTIVE: This study aimed to investigate the relationships between trajectories of change in self-reported hearing over eight years with subsequent effects on cognition, measured using episodic memory. METHODS: Data were drawn from 5 waves (2008-2016) of the English Longitudinal Study of England (ELSA) and the Health and Retirement Study (HRS), involving 4,875 individuals aged 50+ at the baseline in ELSA and 6,365 in HRS. The latent growth curve modelling was used to identify trajectories of hearing over eight years, and linear regression models were performed to investigate the relationship between hearing trajectory memberships and episodic memory scores, controlling for confounding factors. RESULTS: Five trajectories of hearing (stable very good, stable fair, poor to fair/good, good to fair, and very good to good) were retained in each study. Individuals whose hearing remains suboptimal and those whose hearing deteriorates within suboptimal levels throughout eight years have significantly poorer episodic memory scores at follow-up than those with stable very good hearing. Conversely, individuals whose hearing declines but is within an optimal category at baseline do not see significantly poorer episodic memory scores than those with consistently optimal hearing. There was no significant relationship between individuals whose hearing improved from suboptimal baseline levels to optimal by follow-up and memory in ELSA. However, analysis using HRS data shows a significant improvement for this trajectory group (-1.260, P < 0.001). CONCLUSIONS: Either stable fair or deterioration in hearing is associated with worse cognitive function, both stable good or improving hearing is associated with better cognitive function specifically episodic memory.

Allostatic load and risk of hearing impairment.

Background: Prevention of hearing loss via addressing potentially modifiable risk factors may offer means of reducing the global burden of hearing loss. Prior studies reported associations between individual markers of inflammation and risk of hearing impairment. Allostatic load is an index of cumulative physiological stressors, including inflammation, to multiple biological systems. Our aims were to investigate associations between allostatic load and both audiometric and self-reported hearing impairment and examine whether associations are stronger over time due to prolonged high allostatic load. Methods: Data were taken from the English Longitudinal Study of Ageing (ELSA), a nationally representative study of people aged 50+ living in England over 3 time points between 2008 and 2014. Allostatic load score was comprised of thirteen different measures available at baseline and 4 years post-baseline (high-density lipoprotein/total cholesterol, triglyceride, fibrinogen, haemoglobin A1c, C-reactive protein, insulin-like growth factor 1 (IGF-1), systolic and diastolic blood pressure, mean arterial pressure, resting pulse rate, peak expiratory flow, BMI and waist circumference), measured using clinical cut-off points for normal biomarker parameters. Hearing acuity was measured with a simple handheld tone-producing device at follow-up 7 years post-baseline, while self-reported hearing impairment was measured at time point. Results: We included samples of 4373 and 4430 for the cross-sectional and longitudinal analysis, respectively. In the cross-sectional model high allostatic load was associated both self-reported (OR = 1.08, 95% CI 1.0,1.1; p < 0.01) and objective hearing loss (OR = 1.10, 95% CI 1.1,1.2; p < 0.001) adjusting for age and sex. Cross-sectional associations between allostatic load and hearing were not significant after further adjustment for covariates (qualification, physical activity and smoking).In longitudinal modelling, high allostatic load was associated with both audiometric (Z score OR = 1.11, 95% CI 1.1,1.2; p < 0.001) and self-reported hearing impairment (OR = 1.08, 95% CI 1.0,1.1; p < 0.001) adjusting for age and sex. Allostatic load was no longer associated with self-reported hearing loss but the association with audiometric hearing impairment (OR = 1.08, 95% CI 1.03,1.13; p < 0.001) remained following additional adjustment for baseline self-reported hearing, education, physical activity, and smoking. Conclusions: Prolonged high allostatic load was associated with risk of hearing impairment. Reducing allostatic load via healthy lifestyle changes including non-smoking, healthy diet and exercise may offer an opportunity to reduce the risk of hearing impairment in later life.

The Impact of Volunteering and Its Characteristics on Well-being After State Pension Age: Longitudinal Evidence From the English Longitudinal Study of Ageing.

OBJECTIVES: Volunteering after retirement age is beneficial to well-being. This study furthers previous research by presenting a longitudinal analysis of the well-being of volunteers, compared to non-volunteers, based on characteristics of the voluntary work in which they participate. METHOD: Participants were 3,740 people aged State Pension Age and over from the English Longitudinal Study of Ageing. Longitudinal regression models were used to determine whether frequent volunteers saw beneficial changes in well-being (depression, satisfaction with life, CASP-19, and social isolation) compared to non-volunteers. The initial model used a hierarchical approach so that we could also examine the impact of social and health factors. Models were then run to determine whether well-being in relation to volunteering was influenced by its continuity, the number of activities engaged in, whether the volunteering was formal or informal in nature, and whether or not the respondent reported feeling appreciated for their efforts. RESULTS: Although sociodemographic and health circumstances reduce the magnitude of the effects of volunteering on well-being, the effect of volunteering remained significant in almost all analyses. The beneficial effect of volunteering appeared to stop among respondents who stopped volunteering between waves. The best outcomes were observed among those participating in higher numbers of activities, regardless of whether or not these were classed as formal or informal, and who felt appreciated for their work. DISCUSSION: Certain aspects of volunteering might be especially beneficial to the well-being of older people. That these effects stop when volunteering stops suggest a causal element to this relationship.

Who in Europe Works beyond the State Pension Age and under which Conditions? Results from SHARE.

There is much research about those who exit the labour market prematurely, however, comparatively little is known about people working longer and about their employment and working conditions. In this paper, we describe the employment and working conditions of men and women working between 65 and 80 years, and compare them with previous conditions of those retired in the same age group. Analyses are based on wave 4 data from the Survey of Health, Ageing and Retirement in Europe (SHARE) with information collected between 2009 and 2011 from 17,625 older men and women across 16 European countries. Besides socio-demographic and health-related factors (physical and mental health), the focus lies on employment conditions (e.g. employment status, occupational position and working hours) and on stressful working conditions, measured in terms of low control at work and effort-reward imbalance. In case of retired people, information on working conditions refer to the last job before retirement. Following descriptive analyses, we then conduct multivariable analyses and investigate how working conditions and poor health are related to labour market participation (i.e. random intercept models accounting for country affiliation and adjusted for potential confounders). Results illustrate that people working between the ages of 65 and 80 are more likely to be self-employed (either with or without employees) and work in advantaged occupational positions. Furthermore, findings reveal that psychosocial working conditions are generally better than the conditions retired respondents had in their last job. Finally, in contrast to those who work, health tends to be worse among retired people. In conclusion, findings deliver empirical evidence that paid employment beyond age 65 is more common among self-employed workers throughout Europe, in advantaged occupations and under-favourable psychosocial circumstances, and that this group of workers are in considerably good mental and physical health. This highlights that policies aimed at increasing the state pension age beyond the age of 65 years put pressure on specific disadvantaged groups of men and women.

Trajectories of vision in older people: the role of age and social position.

Visual impairment becomes more prevalent with age. Rather than a uniform decline in vision with age, the strength and direction of change varies between people. This study applies an analytical method that posits multiple trajectories in eyesight, allowing for a more specific description of developmental course of this health outcome and its relationship with social position. The analysis uses the responses of 2956 respondents, aged 60 years and over, followed over 8 years (five observations) as part of the English longitudinal study of ageing. At each observation respondents self-reported their general vision. Optimal matching (sequence analysis), hierarchical clustering, and multinomial logistic regression were used to describe the sequential data, produce a typology of vision trajectories, and examine the socio-demographic characteristics associated with different trajectories. Eight distinctive clusters of trajectories were identified. The probability of reporting different types of vision trajectory varies with a change in age; however, the magnitude of the age effect is associated with social position. Visual impairment in older people is an increasingly relevant area for policy focus, with the rapid growth and diversity of the older population. Identifying factors underpinning the patterning of changes in visual function is essential for developing evidence-based policy, which both meets the needs of those most at risk and increases cost-effectiveness of public health interventions.

Linking Quality of Work in Midlife to Volunteering During Retirement: a European Study.

There is increasing recognition that disadvantaged work and employment conditions over the life course, including psychosocial stress at work, have negative long-term effects on health at older ages. Yet, the question whether stress at work additionally influences the likelihood of participating in voluntary work during retirement still needs to be explored. This paper studies long-term influences of stressful work during adulthood (as defined by low control and low reward at work) on participation in voluntary work in older ages. Analyses are based on the Survey of Health Ageing and Retirement in Europe (SHARE), with detailed retrospective information on individual life courses collected among 11,751 retired men and women in 13 European countries. Results of multivariable analyses demonstrate that people who experienced stressful work are also less likely to participate in voluntary work during retirement. Importantly, these associations remain significant after controlling for important factors, including disability in older ages and disadvantaged socioeconomic circumstances. In conclusion, findings suggest that promoting good working conditions may not only increase health and well-being, but also encourage participation in productive activities after labour market exit.