Do work and family care histories predict health in older women?

Background: Social and policy changes in the last several decades have increased women's options for combining paid work with family care. We explored whether specific combinations of work and family care over the lifecourse are associated with variations in women's later life health. Methods: We used sequence analysis to group women in the English Longitudinal Study of Ageing according to their work histories and fertility. Using logistic regression, we tested for group differences in later life disability, depressive symptomology and mortality, while controlling for childhood health and socioeconomic position and a range of adult socio-economic circumstances and health behaviours. Results: Women who transitioned from family care to either part-time work after a short break from the labour force, or to full-time work, reported lower odds of having a disability compared with the reference group of women with children who were mostly employed full-time throughout. Women who shifted from family care to part-time work after a long career break had lower odds of mortality than the reference group. Depressive symptoms were not associated with women's work and family care histories. Conclusion: Women's work histories are predictive of their later life disability and mortality. This relationship may be useful in targeting interventions aimed at improving later life health. Further research is necessary to explore the mechanisms linking certain work histories to poorer later life health and to design interventions for those affected.

Mental health care use in later life: results from a national survey of Canadians.

OBJECTIVE: To estimate the proportion of older adults who have used mental health services in the past 12 months among those who meet the criteria for one or more Diagnostic and Statistical Manual of Mental Disorders (DSM), Fourth Edition, 12-month psychiatric disorders. We also examine the factors associated with mental health care use in this population. METHOD: We used secondary data from the Canadian Community Health Survey: Mental Health and Well-Being (CCHS 1.2). We first estimated the proportion of adults aged 55 years and older who used a range of mental health services. Next, using logistic regression, we examined the relative contribution of predisposing, enabling, and need characteristics in predicting any service use in this population. RESULTS: Among the 12 792 adults aged 55 years and older in the CCHS 1.2, 513 (4.23%, 95% CI 3.89% to 4.95%) met the criteria for at least one 12-month DSM-IV disorder. Among these respondents, 37% (95% CI 31% to 43%) saw at least one type of mental health care provider in the past 12 months. Visits to a general health care provider for mental health reasons were most common, followed by specialist care. Only psychological distress was significantly and positively associated with using mental health care services. CONCLUSIONS: Over 60% of the older adults who met the criteria for a DSM-IV disorder were not using mental health care services. Social and demographic factors did not predict service use in this population.

Corrected and uncorrected hearing impairment in older Canadians.

BACKGROUND: Hearing impairment (HI) is a common chronic condition in later life, but one that can often be improved with the use of a hearing aid. However, a distinction is not often made between corrected and uncorrected HI in the literature. OBJECTIVE: To estimate the prevalence of corrected and uncorrected HI, and assess whether there are differences in sociodemographic factors among older adults (age 50+) with corrected HI, uncorrected HI and no HI. METHOD: Secondary data came from two national data sources: the 1994 National Population Health Survey (n = 6,202) and the Canadian Community Health Survey 1.1 (n = 50,113). We use multinomial logistic regression to assess sociodemographic risk markers for both corrected and uncorrected HI. RESULTS: Both corrected and uncorrected HI was common in this age group: 6.5 and 4.0%, respectively, in the National Population Health Survey and 5.7 and 2.5% in the Canadian Community Health Survey. In both samples, the prevalence of corrected and uncorrected HI increased with age and was more common among men. Respondents with either corrected or uncorrected HI were less likely to be married and more likely to report other physical health problems compared to respondents with no HI. In the Canadian Community Health Survey, income was associated with lower odds of reporting uncorrected HI, while education was associated with reduced likelihood of reporting corrected HI. CONCLUSION: Our findings suggest that HI is prevalent in later life, and sociodemographic factors such as marital status, education, and income do not differ significantly between those with corrected and uncorrected HI compared with respondents with no HI. Further investigation into the factors associated with hearing aid use is necessary to better target older adults who might benefit from wearing a hearing aid.

Transitions in hearing impairment and psychological distress in older adults.

OBJECTIVE: Although previous research has demonstrated an association between hearing impairment (HI) and psychological distress, less work has explored the effect of transitions in hearing status on distress over time, or the explanatory pathways that may explain this association. METHOD: We use 2 waves of data from the Canadian National Population Health Survey to examine the effect of HI transitions on changes in distress during 6 years, and to test the potential mediating effects of psychosocial factors and chronic stressors. RESULTS: Experiencing a decline in hearing was associated with increased distress at Wave 4, net of Wave 1 distress, although the significance of the relation was reduced to trend level following adjustment for sociodemographic variables (P < 0.06). The introduction of mastery and self-esteem further reduced the size of the effect of reporting a decline in hearing in the full model. CONCLUSIONS: The association between declines in HI and psychological distress during a 6-year period did not reach a traditional level of statistical significance, and we discuss potential explanations for this finding. Mastery and self-esteem may be important explanatory variables in the HI-distress association and should be considered in future research.

Does greater frequency of contact with general physicians reduce feelings of mastery in older adults?

In this study, we test one aspect of Rodin's hypothesis concerning age-related decline in mastery: The effect of frequent contact with the health care sector on mastery. We conducted cross-sectional and longitudinal multiple regression analyses to examine the effect of general physician (GP) visits on mastery. In the cross-sectional analyses, a higher number of GP visits is associated with lower mastery, but this relationship is substantially weakened when physical health is entered into the analysis. These results are confirmed in the longitudinal analysis. The effect of GP visits on mastery thus appears to be significantly confounded by physical health problems. These findings direct attention away from the role of contact with the health care sector in influencing perceived mastery and toward the importance of physical health status as both a cause and potential consequence of changes in perceived control with age.

Is being in paid work beyond state pension age beneficial for health? Evidence from England using a life-course approach.

BACKGROUND: Given the current policy emphasis in many Western societies on extending working lives, we investigated the health effects of being in paid work beyond state pension age (SPA). Until now, work has largely focused on the health of those who exit the labour force early. METHODS: Our data come from waves 2-4 of the English Longitudinal Study of Ageing, including the life history interview at wave 3. Using logistic and linear regression models, we assessed the longitudinal associations between being in paid work beyond SPA and 3 measures of health (depression, a latent measure of somatic health and sleep disturbance) among men aged 65-74 and women aged 60-69. Our analyses controlled for baseline health and socioeconomic characteristics, as well as for work histories and health in adulthood and childhood. RESULTS: Approximately a quarter of women and 15% of men were in paid work beyond SPA. Descriptive bivariate analyses suggested that men and women in paid work were more likely to report better health at follow-up. However, once baseline socioeconomic characteristics as well as adulthood and baseline health and labour market histories were accounted for, the health benefits of working beyond SPA were no longer significant. CONCLUSIONS: Potential health benefits of working beyond SPA need to be considered in the light of the fact that those who report good health and are more socioeconomically advantaged are more likely to be working beyond SPA to begin with.

Relationship between employment histories and frailty trajectories in later life: evidence from the English Longitudinal Study of Ageing.

BACKGROUND: Given the acceleration of population ageing and policy changes to extend working lives, evidence is needed on the ability of older adults to work for longer. To understand more about the health impacts of work, this study examined the relationship between employment histories before retirement and trajectories of frailty thereafter. METHODS: The sample comprised 2765 women and 1621 men from the English Longitudinal Study of Ageing. We used gendered typologies of life-time employment and a frailty index (FI). Multilevel growth curve models were used to predict frailty trajectories by employment histories. RESULTS: Women who had a short break for family care, then did part-time work till 59 years had a lower FI after 60 years than those who undertook full-time work until 59 years. Women who were largely family carers or non-employed throughout adulthood, had higher levels of frailty at 60 years but experienced a slower decline with age. Men who worked full-time but early exited at either 49 or 60 years had a higher FI at 65 years than those who worked full-time up to 65 years. Interaction between employment histories and age indicated that men in full-time work who experienced an early exit at 49 tended to report slower declines. CONCLUSIONS: For women, experiencing distinct periods throughout the lifecourse of either work or family care may be advantageous for lessening frailty risk in later life. For men, leaving paid employment before 65 years seems to be beneficial for decelerating increases in frailty thereafter. Continuous full-time work until retirement age conferred no long-term health benefits.

The role of social support in the relationship between urinary incontinence and psychological distress in older adults.

While an association between UI and psychological distress among older adults has been established in the literature, the mechanisms underlying this relationship remain less clear. Using a sample of 4,689 older adults from the Canadian Community Health Survey (1.1), we test the potential mediating and moderating effects of four dimensions of social support on the UI-distress relationship. Incontinent older adults are significantly more likely to report higher levels of distress than continent adults. Although we do not find support for a mediating effect of any of the dimensions of social support, we do report a significant interaction between one dimension of social support (tangible support) and UI. A buffering effect of tangible support is evident for continent - but not incontinent - respondents. These findings emphasize the need to assess the types of social support and the context in which they operate.

A life course perspective on socioeconomic inequalities in health: a critical review of conceptual frameworks.

Social scientists and public health researchers have long known that social position is related to health and that socioeconomic inequalities in health persist in later life. Increasingly, a life course perspective is adopted to understand the socioeconomic position (SEP)-health dynamic. This paper critically reviews the conceptual perspectives underlying empirical research seeking to better understand socioeconomic inequalities in health in the context of the life course. I comment on the contributions of this work, but also its limitations. In particular, I note the emphasis on understanding the mechanisms linking SEP to health, to the exclusion of research on the institutional and structural factors associated with socioeconomic inequalities over the life course. I also critique the relative absence of gender in this work, and how, by not linking individual experiences to the social policy contexts that shape resources and opportunities, the proximal, rather than the structural or institutional determinants of health are emphasized. I suggest that moving forward, a return to some of the key tenets of life course theory, including contributions from the comparative welfare states literature, may better inform life course analyses of socioeconomic inequalities in health. Specific suggestions for life scholarship are discussed.

Suicide ideation in older adults: relationship to mental health problems and service use.

PURPOSE: to assess the prevalence of suicide ideation among community-dwelling older adults and the relationship between suicide ideation, major psychiatric disorder, and mental health service use. DESIGN AND METHODS: we use data from the Canadian Community Health Survey 1.2: Mental Health and Well-being (CCHS 1.2). We estimate the prevalence of suicide ideation and the prevalence of major psychiatric disorder and service use among ideators versus nonideators. In multivariate models, we consider the sociodemographic, social, and mental health correlates of suicide ideation and mental health care use. RESULTS: in our sample, more than 2% of older adults reported suicide ideation in the past year and more than two thirds of these respondents did not meet the criteria for any of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition disorders assessed in the CCHS 1.2. In multivariate models, being male, younger, or widowed, reporting lower social support and higher psychological distress increased the likelihood of suicide ideation. More than 50% of the respondents who reported suicidal thoughts did not access any type of mental health care use. IMPLICATIONS: although suicide ideation is associated with depression and anxiety disorders, many older adults with suicidal thoughts do not meet the criteria for these clinical disorders. The low prevalence of service use among older adults with suicide ideation suggests the need for further inquiry into the factors associated with discussing mental health concerns with health care providers, particularly among older adults who do not meet the criteria for clinical disorder.

Comorbid depression and anxiety in later life: patterns of association, subjective well-being, and impairment.

OBJECTIVE: Very little epidemiological work has examined comorbidity between depression and anxiety disorders in community-dwelling older adults, despite the fact these disorders are known to co-occur in younger adults and that this co-occurrence is associated with greater clinical severity. In this study, the authors examine psychiatric comorbidity and associated impairment of four disorders (major depression, panic disorder, social phobia, and agoraphobia) in a community-based sample of adults aged 55 and older. SETTING: Population-based sample of older adults (N=12,792) from the Canadian Community Health Survey-Mental Health and Well-Being (CCHS 1.2). METHOD: The World Mental Health Composite International Diagnostic Interview was used to identify cases of 12-month disorder. Descriptive analysis and regression analysis is used to examine patterns of association between disorders and related impairment. RESULTS: Among adults aged 55 years and older, 4.4% met the criteria for at least one disorder and 0.8% had two or more. Social phobia was the most common comorbid disorder among respondents with depression, and depression was the most common comorbid disorder among respondents with any of the anxiety disorders. Respondents who report comorbid disorders reported significantly lower well-being and greater impairment. CONCLUSION: Although comorbidity between physical health conditions and depression, and between dementias and depression, are well documented among older adults, these results suggest that comorbid depression and anxiety are also prevalent in later life. The significant impact of comorbidity on function and well-being underlines the need to screen for comorbid disorders in this population.

The social epidemiology of affective and anxiety disorders in later life in Canada.

OBJECTIVE: To examine the association between markers of social position and psychiatric disorder among older adults, and test whether social support mediates the association between social position and psychiatric disorder in this population. METHODS: We used data from the Canadian Community Health Survey: Mental Health and Well-Being to examine the social patterning of disorder. Using a series of logistic regression analyses, we regressed indicators of mood, anxiety, and any disorder on markers of social position and social support. RESULTS: A negative association between age and disorder was evident across all models, and the likelihood of reporting disorder was elevated among separated-divorced and widowed respondents relative to their married counterparts. Social support was statistically significant in all models, and mediated a considerable amount of the effect of marital status on disorder. CONCLUSIONS: Many of the markers of social position associated with disorder among younger adults continue to be important predictors among older adults, and these variables are mediated to varying degrees by social support. The results support the general notion that social circumstances are important to psychological well-being. We discuss potential explanations for findings related to sex, age, marital status, and education as predictors of disorder in later life.

Panic disorder in later life: results from a national survey of Canadians.

BACKGROUND: At present, our understanding of the risk markers associated with panic disorder among older, community dwelling older adults is limited. To address this gap, we examined the prevalence, risk markers, and comorbidity of panic disorder defined using DSM-IV criteria among older adults. METHOD: Using data drawn from a large, nationally representative sample of Canadians, we estimated lifetime and 12-month prevalence of panic disorder, and examined demographic predictors and patterns of comorbidity of current panic disorder in adults aged 55 years and older (n = 12,792). RESULTS: The 12-month and lifetime prevalence estimates of panic disorder in this sample were 0.82% and 2.45% respectively, and one-fifth of these cases reported a first onset after the age of 55 years. In multivariate models, the risk of panic disorder decreased with older age and was significantly lower among widowed respondents. Physical limitations in daily activities as well as the presence of other psychiatric disorders (major depression, and social phobia) were also significantly associated with panic disorder in this sample. CONCLUSIONS: Consistent with previous research on panic disorder, the prevalence of the disorder decreased with age among older adults. Potential explanations for the age effect and the clinical implications of the mental health comorbidities with panic disorder are discussed.

Epidemiology of social phobia in later life.

OBJECTIVE: Although anxiety disorders, including social phobia (SP), are common among older adults, very little is known about the epidemiology of SP in later life. METHOD: Using data drawn from a large, nationally representative sample of older adults from Canada (N=12,792), the authors estimate lifetime and 12-month prevalence of social phobia and examine demographic predictors and patterns of comorbidity of current SP in this population. RESULTS: The results reveal that SP is a prevalent disorder in later life with lifetime and 12-month prevalence estimates of 4.94% and 1.32%, respectively. Current SP (12-month) declines with age and is more common in individuals with other psychiatric disorders. Interestingly, there is no correlation between current SP and gender, marital status, or socioeconomic status. CONCLUSIONS: SP remains a highly prevalent disorder even in late life with the pattern of feared/avoided situations being strikingly similar to that of younger populations.