The cost of monitoring in time-based prospective memory.

Time-based prospective memory (TBPM) involves remembering to perform actions at specific times in the future. Several studies suggest that monetary consequences improve prospective remembering; however, the effect of monetary consequences on strategic time monitoring (i.e., clock-checking behaviour) in TBPM is still unknown. The present study investigated how the monetary costs on clock-checking affected TBPM accuracy and strategic time monitoring. Participants performed an ongoing lexical decision task while carrying out a TBPM task every two minutes. Motivational incentives were manipulated across three experimental conditions: a single-cost condition in which missed TBPM responses led to monetary deductions, a double-cost condition in which both missed responses and time monitoring led to monetary deductions, and a control condition with no monetary deductions. Overall, the findings indicated that monetary costs on clock-checking prompted more parsimonious strategic time monitoring behaviour, which negatively impacted TBPM accuracy. These results emphasize the importance of weighing the motivational aspects involved in strategic monitoring, shedding light on the complex relationship between clock-checking behaviour, its consequences, and TBPM performance.

Assessment of goal-directed behavior and prospective memory in adult ADHD with an online 3D videogame simulating everyday tasks.

The diagnosis of ADHD is based on real-life attentional-executive deficits, but they are harder to detect in adults than in children and objective quantitative measures reflecting these everyday problems are lacking. We developed an online version of EPELI 3D videogame for naturalistic and scalable assessment of goal-directed action and prospective memory in adult ADHD. In EPELI, participants perform instructed everyday chores in a virtual apartment from memory. Our pre-registered hypothesis predicted weaker EPELI performances in adult ADHD compared to controls. The sample comprised 112 adults with ADHD and 255 neurotypical controls comparable in age (mean 31, SD = 8 years), gender distribution (71% females) and educational level. Using web-browser, the participants performed EPELI and other cognitive tasks, including Conner's Continuous Performance Test (CPT). They also filled out questionnaires probing everyday executive performance and kept a 5-day diary of everyday prospective memory errors. Self-reported strategy use in the EPELI game was also examined. The ADHD participants' self-ratings indicated clearly more everyday executive problems than in the controls. Differences in the EPELI game were mostly seen in the ADHD participants' higher rates of task-irrelevant actions. Gender differences and a group × gender interaction was found in the number of correctly performed tasks, indicating poorer performance particularly in ADHD males. Discriminant validity of EPELI was similar to CPT. Strategy use strongly predicted EPELI performance in both groups. The results demonstrate the feasibility of EPELI for online assessment and highlight the role of impulsivity as a distinctive everyday life problem in adult ADHD.

Assessment of goal-directed behavior with the 3D videogame EPELI: Psychometric features in a web-based adult sample.

EPELI (Executive Performance in Everyday LIving) is a recently developed gaming tool for objective assessment of goal-directed behavior and prospective memory (PM) in everyday contexts. This pre-registered study examined psychometric features of a new EPELI adult online version, modified from the original child version and further developed for self-administered web-based testing at home. A sample of 255 healthy adults completed EPELI where their task was to perform household chores instructed by a virtual character. The participants also filled out PM-related questionnaires and a diary and performed two conventional PM tasks and an intelligence test. We expected that the more "life-like" EPELI task would show stronger associations with conventional PM questionnaires and diary-based everyday PM reports than traditional PM tasks would do. This hypothesis did not receive support. Although EPELI was rated as more similar to everyday tasks, performance in it was not associated with the questionnaires and the diary. However, there were associations between time-monitoring behavior in EPELI and the traditional PM tasks. Taken together, online adult-EPELI was found to be a reliable method with high ecological face validity, but its convergent validity requires further research.

EPELI: a novel virtual reality task for the assessment of goal-directed behavior in real-life contexts.

A recently developed virtual reality task, EPELI (Executive Performance in Everyday LIving), quantifies goal-directed behavior in naturalistic conditions. Participants navigate a virtual apartment, performing household chores given by a virtual character. EPELI aims to tap attention, executive function, and prospective memory. To ensure its applicability to further research and clinical work and to study its relationship to relevant background factors, we examined several key properties of EPELI in 77 typically developing 9-13-year-old children. These included EPELI's internal consistency, age and gender differences, sensitivity to gaming experience, head-mounted display (HMD) type, and verbal recall ability, as well as its relationships with parent-rated everyday executive problems. Of the eight EPELI measures, the following six showed acceptable internal consistency: task and navigation efficacy, number of correctly performed tasks and overall actions, time monitoring, and controller movement. Some measures were associated with age, gender, or verbal encoding ability. Moreover, EPELI performance was associated with parent-rated everyday executive problems. There were no significant associations of gaming background, task familiarity, or HMD type with the EPELI measures. These results attest to the reliability and ecological validity of this new virtual reality tool for the assessment of attention, executive functions, and prospective memory in children.

Cognitive Reserve Mediates the Relation between Neighborhood Socio-Economic Position and Cognitive Decline.

Introduction: We investigated the mediating role of leisure activity engagement as marker of cognitive reserve in the relation between neighborhood socio-economic position (SEP) and cognitive decline over 6 years. Methods: The study analyzed longitudinal data from 897 older adults who participated in the two waves (2011 and 2017) of the Vivre-Leben-Vivere (VLV) survey in Switzerland (M = 74.33 years in the first wave). Trail Making Test parts A and B were administered in both waves. Leisure activity engagement was assessed during interviews. Neighborhood SEP was derived from the Swiss Neighborhood Index of Socio-Economic Position (Swiss-SEP), provided by the Swiss National Cohort (SNC). Results: Latent change score modeling revealed that 42.5% of the relationship between higher neighborhood SEP and smaller cognitive decline was mediated via a higher frequency of leisure activities in the first wave. Conclusion: Neighborhood SEP constitutes an important contextual factor potentially influencing the pathways of cognitive reserve accumulation and, therefore, should be taken into account to better understand their effects on cognitive decline in old age.

Signatures of life course socioeconomic conditions in brain anatomy.

Socioeconomic status (SES) plays a significant role in health and disease. At the same time, early-life conditions affect neural function and structure, suggesting the brain may be a conduit for the biological embedding of SES. Here, we investigate the brain anatomy signatures of SES in a large-scale population cohort aged 45-85 years. We assess both gray matter morphometry and tissue properties indicative of myelin content. Higher life course SES is associated with increased volume in several brain regions, including postcentral and temporal gyri, cuneus, and cerebellum. We observe more widespread volume differences and higher myelin content in the sensorimotor network but lower myelin content in the temporal lobe associated with childhood SES. Crucially, childhood SES differences persisted in adult brains even after controlling for adult SES, highlighting the unique contribution of early-life conditions to brain anatomy, independent of later changes in SES. These findings inform on the biological underpinnings of social inequality, particularly as they pertain to early-life conditions.

How Welfare Regimes Moderate the Associations Between Cognitive Aging, Education, and Occupation.

OBJECTIVES: Previous studies have shown the importance of individual markers of cognitive reserve, such as education and occupation, for cognitive health in old age. However, there has been only little investigation so far on how this relationship varies across contexts. METHODS: We analyzed data from the Survey of Health, Ageing, and Retirement in Europe, using second-order latent growth models, to assess the moderating role of welfare regimes on the relationship between education and occupation skill level in explaining overall cognitive functioning and decline in old age. Our sample includes 13 European countries using data from 5 regular waves of the survey (2004-2007 and 2011-2015) and 2 retrospective ones (2008-2009 and 2017). Cognitive functioning was modeled as a latent variable measured by immediate and delayed recall, verbal fluency, and numeracy. RESULTS: 74,193 participants were included from the survey. Our analysis showed that the association of education with cognition was weaker overall in Scandinavian countries, but stronger in Southern European countries, relative to Bismarckian ones. However, educational differences in the decline of cognition were more pronounced only in Scandinavian compared to Bismarckian countries. Additionally, higher-skilled occupations in Scandinavian countries had better overall functioning compared to the same occupations in Bismarckian countries, but there was no difference in the decline in cognitive functioning. DISCUSSION: Our findings indicate that the associations of cognitive functioning and its decline with individuals' cognitive reserve markers (education and occupational skill level) vary according to welfare regimes, showing the importance of contextual factors in cognitive aging processes.

Associations Between Life-Course Socioeconomic Conditions and the Pace of Aging.

BACKGROUND: Socioeconomic disadvantage is a well-established predictor of morbidity and mortality, and is thought to accelerate the aging process. This study examined associations between life-course socioeconomic conditions and the Pace of Aging, a longitudinal measure of age-related physiological decline. METHODS: Data were drawn from a Swiss population-based cohort of individuals originally recruited between 2003 and 2006, and followed up for 11 years (2 834 women, 2 475 men aged 35-75 years [mean 52]). Pace of Aging was measured using 3 repeated assessments of 12 biomarkers reflecting multiple body systems. Analysis tested associations of socioeconomic conditions with physiological status at baseline and with the Pace of Aging. RESULTS: Participants with more life-course socioeconomic disadvantage were physiologically older at baseline and experienced faster Pace of Aging. Effect sizes (ß) for associations of childhood socioeconomic disadvantage with baseline physiological status ranged from 0.1 to 0.2; for adulthood socioeconomic disadvantage, effect sizes ranged from 0.2 to 0.3. Effect sizes were smaller for associations with the Pace of Aging (<0.05 for childhood disadvantage, 0.05-0.1 for adulthood disadvantage). Those who experienced disadvantaged socioeconomic conditions from childhood to adulthood aged 10% faster over the 11 years of follow-up as compared with those who experienced consistently advantaged socioeconomic conditions. Covariate adjustment for health behaviors attenuated associations, but most remained statistically significant. CONCLUSIONS: Socioeconomic inequalities contribute to a faster Pace of Aging, partly through differences in health behaviors. Intervention to slow aging in at-risk individuals is needed by midlife, before etiology of aging-related diseases become established.

The longitudinal relation between social reserve and smaller subsequent decline in executive functioning in old age is mediated via cognitive reserve.

OBJECTIVES: Social reserve such as having close friends helps promoting activity engagement in old age. Activity engagement in turn contributes to the accumulation of cognitive reserve and is a key predictor for maintaining executive functioning in aging. We investigated the mediating role of leisure activity engagement in the longitudinal relation between close friends and subsequent change in executive functioning as measured through performance changes in the Trail Making Test (TMT). DESIGN, SETTING, AND PARTICIPANTS: Longitudinal study with 897 older adults tested in two waves 6 years apart, analyzed using latent change score modeling. MEASUREMENTS: TMT parts A and B, leisure activity engagement, and close friends. RESULTS: A larger number of close friends in the first wave of data collection was related to a higher frequency of leisure activities in the first wave. A higher frequency of leisure activities in the first wave significantly predicted a smaller subsequent increase in TMT completion time from the first to the second wave (i.e. a smaller decline in executive functioning). Importantly, 41.3% of the longitudinal relation between a larger number of close friends in the first wave and a smaller subsequent increase in TMT completion time (i.e. a smaller decline in executive functioning) was mediated via a higher frequency of leisure activities in the first wave. CONCLUSIONS: Social reserve such as having close friends may help promoting activity engagement in old age. By enhancing individuals' cognitive reserve, this activity engagement may finally result in smaller subsequent decline in executive functioning in aging.

Face-to-face Assessment of COGTEL in Adolescents: Test-Retest Reliability and Association with School Grades / Aplicação Presencial do COGTEL em Adolescentes: a Fiabilidade Teste-Reteste e a Associação com as Notas Escolares

Abstract The Cognitive Telephone Screening Instrument (COGTEL) has shown to be a brief, reliable, and valid instrument to assess cognitive functioning in adults in face-to-face procedures as well as over the phone. So far, no psychometric evaluation exists on its use in adolescents. The present study set out to evaluate the psychometric properties of the face-to-face application of the COGTEL in adolescents in the school context and to analyse the association with school grades. We assessed cognitive performance using COGTEL in face-to-face assessments of 170 adolescents, with retests after 6 months for test-retest reliability. Predictive validity was assessed using school grades. Test-retest reliability for the COGTEL was good (ICC = .77; p < .001). The partial correlation controlling for age between COGTEL and school grades was medium and positive (r = .40; p < .001). School grades alone explained 42% and 36% of the variance in the COGTEL total score in elementary and secondary students, respectively. The present study suggests that COGTEL is a reliable and valid instrument to assess cognitive functioning in adolescents, with the advantage of feasibility in multiple contexts.

Resumo O Instrumento de Rastreio Cognitivo por Telefone (COGTEL) tem demostrado ser um instrumento fiável, válido e breve para avaliar o funcionamento cognitivo em adultos, quer por telefone, quer de forma presencial. Até à data, não foram estudadas as suas características psicométricas para uso em adolescentes. O presente estudo teve por objetivo avaliar as propriedades psicométricas do COGTEL em adolescentes no contexto escolar, através da aplicação presencial, e analisar a associação dos scores com as notas escolares. O desempenho cognitivo foi avaliado em 170 adolescentes, usando o COGTEL em entrevistas presenciais, com um reteste após 6 meses para avaliar a fiabilidade teste-reteste. A validade preditiva foi avaliada com base nas notas escolares. A fiabilidade teste-reteste para o COGTEL foi boa (ICC = 0.77; p < .001). As correlações parciais, controlando pelo efeito da idade, entre o score total do COGTEL e as notas escolares foram moderadas e positivas (r = .40; p < .001). As notas escolares, individualmente, explicaram 42% e 36% da variância total no score total do COGTEL, em alunos do ensino básico e secundário, respetivamente. O presente estudo sugere que o COGTEL é um instrumento fiável e válido para avaliar o funcionamento cognitivo em adolescentes, com a vantagem de ser aplicável em múltiplos contextos.

Do Welfare Regimes Moderate Cumulative Dis/advantages Over the Life Course? Cross-National Evidence from Longitudinal SHARE Data.

OBJECTIVES: This study aimed to examine the cumulative disadvantage of different forms of childhood misfortune and adult-life socioeconomic conditions (SEC) with regard to trajectories and levels of self-rated health in old age and whether these associations differed between welfare regimes (Scandinavian, Bismarckian, Southern European, and Eastern European). METHOD: The study included 24,004 respondents aged 50-96 from the longitudinal SHARE survey. Childhood misfortune included childhood SEC, adverse childhood experiences, and adverse childhood health experiences. Adult-life SEC consisted of education, main occupational position, and financial strain. We analyzed associations with poor self-rated health using confounder-adjusted mixed-effects logistic regression models for the complete sample and stratified by welfare regime. RESULTS: Disadvantaged respondents in terms of childhood misfortune and adult-life SEC had a higher risk of poor self-rated health at age 50. However, differences narrowed with aging between adverse-childhood-health-experiences categories (driven by Southern and Eastern European welfare regimes), categories of education (driven by Bismarckian welfare regime), and main occupational position (driven by Scandinavian welfare regime). DISCUSSION: Our research did not find evidence of cumulative disadvantage with aging in the studied life-course characteristics and age range. Instead, trajectories showed narrowing differences with differing patterns across welfare regimes.

Life Course Socioeconomic Conditions and Frailty at Older Ages.

OBJECTIVES: This article aimed to assess associations of childhood socioeconomic conditions (CSC) with the risk of frailty in old age and whether adulthood socioeconomic conditions (ASC) influence this association. METHODS: Data from 21,185 individuals aged 50 years and older included in the longitudinal Survey of Health, Ageing, and Retirement in Europe were used. Frailty was operationalized as a sum of presenting weakness, shrinking, exhaustion, slowness, or low activity. Confounder-adjusted multilevel logistic regression models were used to analyze associations of CSC and ASC with frailty. RESULTS: While disadvantaged CSC was associated with higher odds of (pre-)frailty in women and men (odds ratio [OR] = 1.73, 95% confidence interval [CI] 1.34, 2.24; OR = 1.84, 95% CI 1.27, 2.66, respectively), this association was mediated by ASC. Personal factors and demographics, such as birth cohort, chronic conditions, and difficulties with activities of daily living, increased the odds of being (pre-)frail. DISCUSSION: Findings suggest that CSC are associated with frailty at old age. However, when taking into account ASC, this association no longer persists. The results show the importance of improving socioeconomic conditions over the whole life course in order to reduce health inequalities in old age.

Early predictors of impaired sleep: a study on life course socioeconomic conditions and sleeping problems in older adults.

Objectives: This study aimed to assess how childhood socioeconomic conditions are associated with sleeping problems in older adults and how this association may be mediated by socioeconomic conditions across the lives of individuals using a life course perspective. Since the life course opportunities differ systematically between men and women, attention was given to gender differences in the association.Methods: Data from 23,766 individuals aged over 50 years of the longitudinal Survey of Health, Ageing and Retirement in Europe (SHARE) were used. Logistic mixed-effect models were estimated to examine the associations between childhood socioeconomic conditions and the presence of sleeping problems.Results: For women, the analyses showed an association between childhood socioeconomic conditions and sleeping problems. For men, only current socioeconomic conditions were found to be relevant for sleep. The importance of childhood socioeconomic conditions for sleeping problems did not affect the evolution of sleeping problems over ageing.Conclusion: In this study no empirical support was found for processes of cumulative advantage/disadvantage or age-as-leveler. However, childhood does seem to be a critical period for the sleep of women, because the association with childhood socioeconomic conditions remains even when the circumstances later in life are considered. These findings, in particular the gender differences in the association, underline the importance of tracking life course patterns in the study of sleeping problems in older adults.

Life-Course Circumstances and Frailty in Old Age Within Different European Welfare Regimes: A Longitudinal Study With SHARE.

OBJECTIVES: This study aimed to assess whether cumulative disadvantage in childhood misfortune and adult-life socioeconomic conditions influence the risk of frailty in old age and whether welfare regimes influence these associations. METHOD: Data from 23,358 participants aged 50 years and older included in the longitudinal SHARE survey were used. Frailty was operationalized according to Fried's phenotype as presenting either weakness, shrinking, exhaustion, slowness, or low activity. Confounder-adjusted mixed-effects logistic regression models were used to analyze associations of childhood misfortune and life-course socioeconomic conditions with frailty. RESULTS: Childhood misfortune and poor adult-life socioeconomic conditions increased the odds of (pre-)frailty at older age. With aging, differences narrowed between categories of adverse childhood experiences (driven by Scandinavian welfare regime) and adverse childhood health experiences (driven by Eastern European welfare regime), but increased between categories of occupational position (driven by Bismarckian welfare regime). DISCUSSION: These findings suggest that childhood misfortune is linked to frailty in old age. Such a disadvantaged start in life does not seem to be compensated by a person's life-course socioeconomic trajectory, though certain types of welfare regimes affected this relationship. Apart from main occupational position, our findings do not support the cumulative dis/advantage theory, but rather show narrowing differences.

A longitudinal study of neighbourhood conditions and depression in ageing European adults: Do the associations vary by exposure to childhood stressors?

Emerging literature emphasises the association between neighbourhood conditions and late life depression. Childhood experiences, crucial for life course development of mental health, may modify how neighbourhood affects subsequent depression. This study assessed the longitudinal associations of access to services and neighbourhood nuisance with depression among older adults, and tested whether these associations varied by exposure to childhood stressors. Data were drawn from the cross-national Survey of Health, Ageing and Retirement in Europe, a prospective cohort study between 2004/2005 and 2015, representative for European adults over the age of 50. Individual perceptions of neighbourhood were measured at baseline; childhood stressors, defined as socioeconomic conditions, adverse experiences and health problems, were collected retrospectively. Multilevel logistic regression estimated the risk of depression (n = 10,328). Access to services were negatively (OR = 0.78, 95% CI 0.68-0.90) and neighbourhood nuisance positively (OR = 1.36, 95% CI 1.18-1.56) associated with the probability of depression during follow-up. We found interactions between neighbourhood and childhood socioeconomic conditions, but not with adverse experiences and health problems. While older adults who grew up in better childhood socioeconomic conditions benefited more from living in a residential area with good access to services, they were at higher risk of developing depression when residing in areas with more neighbourhood nuisances. Older adults' mental health can benefit from better access to public transportation and neighbourhood amenities, while physical and social problems in the local area increase the risk of depression. Importantly, socioeconomic circumstances in early life may influence vulnerability to neighbourhood effects in older age.

Disadvantaged Early-Life Socioeconomic Circumstances Are Associated With Low Respiratory Function in Older Age.

BACKGROUND: Poor lung function in late life may stem from early-life risk factors, but the epidemiological evidence is inconsistent. We investigated whether individuals who experienced disadvantageous socioeconomic circumstances (SEC) in early life showed lower levels of respiratory function in older age, a steeper decline over time, and whether these relationships were explained by adult-life SEC, body mass index, and physical inactivity in older age. METHODS: We used data from the Survey of Health Ageing and Retirement in Europe (2004-2015). Participants' peak expiratory flow (PEF) was assessed with a mini-Wright peak flow meter at second, fourth, and sixth waves. Confounder-adjusted linear mixed-effect models were used to examine the associations between early-life SEC and PEF in older age. A total of 21,734 adults aged 50-96 years (46,264 observations) were included in the analyses. RESULTS: Older adults with disadvantaged early-life SEC showed lower levels of PEF compared with those with advantaged early-life SEC. The association between early-life SEC and late-life PEF persisted after adjusting for adult-life SEC, smoking, physical inactivity, and body mass index. PEF declined with age, but the effect of early-life SEC on this decline was not consistent across robustness and sensitivity analyses. CONCLUSIONS: Early life is a sensitive period for respiratory health. Further considering the effect of SEC arising during this period may improve the prevention of chronic respiratory diseases.

Early-life socioeconomic circumstances explain health differences in old age, but not their evolution over time.

BACKGROUND: Early-life socioeconomic circumstances (SEC) are associated with health in old age. However, epidemiological evidences on the influence of these early-life risk factors on trajectories of healthy ageing are inconsistent, preventing drawing solid conclusion about their potential influence. Here, to fill this knowledge gap, we used a statistical approach adapted to estimating change over time and an outcome-wide epidemiology approach to investigate whether early-life SEC were associated with the level of and rate of decline of physical, cognitive and emotional functioning over time. METHODS: We used data on more than 23 000 adults in older age from the Survey of Health, Ageing and Retirement in Europe, a 12-year large-scale longitudinal study with repeated measurements of multiple health indicators of the same participants over time (2004 -2015, assessments every 2 years). Confounder-adjusted linear growth curve models were used to examine the associations of early-life SEC with the evolution of muscle strength, lung function, cognitive function, depressive symptoms and well-being over time. RESULTS: We consistently found an association between early-life SEC and the mean levels of all health indicators at age 63.5, with a critical role played by the cultural aspect of disadvantage. These associations were only partly explained by adult-life SEC factors. By contrast, evidences supporting an association between early-life SEC and the rate of change in health indicators were weak and inconsistent. CONCLUSIONS: Early-life SEC are associated with health in old age, but not with trajectories of healthy ageing. Conceptual models in life course research should consider the possibility of a limited influence of early-life SEC on healthy ageing trajectories.

Advantaged socioeconomic conditions in childhood are associated with higher cognitive functioning but stronger cognitive decline in older age.

Cognitive aging is characterized by large heterogeneity, which may be due to variations in childhood socioeconomic conditions (CSC). Although there is substantial evidence for an effect of CSC on levels of cognitive functioning at older age, results on associations with cognitive decline are mixed. We examined by means of an accelerated longitudinal design the association between CSC and cognitive trajectories from 50 to 96 years. Cognition included two functions generally found to decline with aging: delayed recall and verbal fluency. Data are from six waves of the Survey of Health, Aging, and Retirement in Europe (SHARE), conducted between 2004 and 2015 (n = 24,066 at baseline; 56% female, age 50+). We found a consistent CSC pattern in levels of cognitive functioning in later life. Older people with disadvantaged CSC had lower levels of cognitive functioning than those with more advantaged CSC. We also find that decline is almost 1.6 times faster in the most advantaged group compared with the most disadvantaged group. The faster decline for people with more advantaged CSC becomes less pronounced when we additionally control for adulthood socioeconomic conditions and current levels of physical activity, depressive symptoms, and partner status. Our findings are in line with the latency, pathway, and cumulative model and lend support to theories of cognitive reserve, stating that neuronal loss can no longer be repaired in people with more cognitive reserve once the underlying pathology is substantial and speed of decline is accelerated.

Welfare regimes modify the association of disadvantaged adult-life socioeconomic circumstances with self-rated health in old age.

BACKGROUND: Welfare regimes in Europe modify individuals' socioeconomic trajectories over their life-course, and, ultimately, the link between socioeconomic circumstances (SECs) and health. This paper aimed to assess whether the associations between life-course SECs (early-life, young adult-life, middle-age and old-age) and risk of poor self-rated health (SRH) trajectories in old age are modified by welfare regimes (Scandinavian [SC], Bismarckian [BM], Southern European [SE], Eastern European [EE]). METHODS: We used data from the longitudinal SHARE survey. Early-life SECs consisted of four indicators of living conditions at age 10. Young adult-life, middle-age, and old-age SECs indicators were education, main occupation and satisfaction with household income, respectively. The association of life-course SECs with poor SRH trajectories was analysed by confounder-adjusted multilevel logistic regression models stratified by welfare regime. We included 24 011 participants (3626 in SC, 10 256 in BM, 6891 in SE, 3238 in EE) aged 50 to 96 years from 13 European countries. RESULTS: The risk of poor SRH increased gradually with early-life SECs from most advantaged to most disadvantaged. The addition of adult-life SECs differentially attenuated the association of early-life SECs and SRH at older age across regimes: education attenuated the association only in SC and SE regimes and occupation only in SC and BM regimes; satisfaction with household income attenuated the association across regimes. CONCLUSIONS: Early-life SECs have a long-lasting effect on SRH in all welfare regimes. Adult-life SECs attenuated this influence differently across welfare regimes.

Childhood socioeconomic circumstances and disability trajectories in older men and women: a European cohort study.

Background: We observed a lack of population-based longitudinal research examining the association of disadvantaged childhood socioeconomic circumstances (CSC) and disability [activities of daily living (ADL) and instrumental activities of daily living (IADL)] in older age, and whether socioeconomic attainments in adulthood can compensate for a poor socioeconomic start in life. Methods: Data on 24 440 persons aged 50-96 in 14 European countries (Survey of Health, Ageing and Retirement in Europe) were used to measure the associations between CSC and limitations with ADL and with IADL, using mixed-effects logistic regression models. Models stratified by gender were adjusted for education during young adulthood, main occupation during middle age, ability to make ends meet during old age and potential confounding and control variables. Results: Risks of ADL and IADL limitations increased with age and were different between women and men. For women, a gradient across CSC strata was observed, showing that the more disadvantaged the CSC, the higher the risk of ADL and IADL limitations in old age, even after adjustment for adult socioeconomic indicators. For men, the association between CSC and disability was mediated by the main occupation in middle age and the ability to make ends meet at older age. Conclusion: Women who grew up in socioeconomically disadvantaged households were at higher risk of disability in older age and this disadvantage was not attenuated by favourable adult socioeconomic conditions. Men were more likely to make up for a disadvantaged start in adulthood.