What Matters and What Matters Most for Survival After age 80? A Multidisciplinary Exploration Based on Twin Data.

Given research and public interest for conditions related to an extended lifespan, we addressed the questions of what matters and what matters most for subsequent survival past age 80. The data was drawn from the population-based and multidisciplinary Swedish OCTO Twin Study, in which a sample (N = 699) consisting of identical and same-sex fraternal twin pairs, followed from age 80 until death, provided detailed data on health, physical functioning, life style, personality, and sociodemographic conditions. Information concerning date of birth and death were obtained from population census register. We estimated heritability using an ACE model and evaluated the role of multiple predictors for the mortality-related hazard rate using Cox regression. Our findings confirmed a low heritability of 12%. As expected, longer survival was associated with being a female, an apolipoprotein E (APOE) e4 allele non-carrier, and a non-smoker. Several diseases were found to be associated with shorter survival (cerebrovascular, dementia, Parkinson's, and diabetes) as well as certain health conditions (high diastolic blood pressure, low body mass index, and hip fracture). Stronger grip and better lung function, as well as better vision (but not hearing), and better cognitive function (self-evaluated and measured) was related to longer survival. Social embeddedness, better self-evaluated health, and life-satisfaction were also significantly associated with longer survival. After controlling for the impact of comorbidity, functional markers, and personality-related predictors, we found that sex, cerebrovascular diseases, compromised cognitive functioning, self-related health, and life-satisfaction remained as strong predictors. Cancer was only associated with the mortality hazard when accounting for other co-morbidities. The survival estimates were mostly in anticipated directions and contained effect sizes within the expected range. Noteworthy, we found that some of the so-called "soft-markers" remained strong predictors, despite a control for other factors. For example, self-evaluation of health and ratings of life-satisfaction provide additional and valuable information.

Cognitive Dispersion Predicts Grip Strength Trajectories in Men but not Women in a Sample of the Oldest Old Without Dementia.

BACKGROUND AND OBJECTIVES: Grip strength is a reliable marker of biological vitality and it typically demonstrates an expected decline in older adults. According to the common-cause hypothesis, there is also a significant association between cognitive and physical function in older adults. Some specific cognitive functions have been shown to be associated with grip strength trajectories with most research solely focused on cutoff points or mean cognitive performance. In the present study, we examine whether a measure of cognitive dispersion might be more informative. We therefore used an index that quantifies dispersion in cognitive scores across multiple cognitive tests, shown to be associated with detrimental outcomes in older adults. RESEARCH DESIGN AND METHODS: Using repeated grip strength measures from men and women aged 80 and older, free of dementia in the OCTO-Twin study, we estimated aging-related grip strength trajectories. We examined the association of cognitive dispersion and mean cognitive function with grip strength level and aging-related rate of change, accounting for known risk factors. RESULTS: Cognitive dispersion was associated with grip strength trajectories in men and the association varied by mean cognitive performance, whereas we found no association in women. DISCUSSION AND IMPLICATIONS: Our results provide evidence of a sex-specific vitality association between cognitive dispersion and aging-related trajectories of grip strength. Our results support the call for integration of sex and gender in health promotion and intervention research.

Frailty trajectories in three longitudinal studies of aging: Is the level or the rate of change more predictive of mortality?

BACKGROUND: frailty shows an upward trajectory with age, and higher levels increase the risk of mortality. However, it is less known whether the shape of frailty trajectories differs by age at death or whether the rate of change in frailty is associated with mortality. OBJECTIVES: to assess population frailty trajectories by age at death and to analyse whether the current level of the frailty index (FI) i.e. the most recent measurement or the person-specific rate of change is more predictive of mortality. METHODS: 3,689 individuals from three population-based cohorts with up to 15 repeated measurements of the Rockwood frailty index were analysed. The FI trajectories were assessed by stratifying the sample into four age-at-death groups: <70, 70-80, 80-90 and >90 years. Generalised survival models were used in the survival analysis. RESULTS: the FI trajectories by age at death showed that those who died at <70 years had a steadily increasing trajectory throughout the 40 years before death, whereas those who died at the oldest ages only accrued deficits from age ~75 onwards. Higher level of FI was independently associated with increased risk of mortality (hazard ratio 1.68, 95% confidence interval 1.47-1.91), whereas the rate of change was no longer significant after accounting for the current FI level. The effect of the FI level did not weaken with time elapsed since the last measurement. CONCLUSIONS: Frailty trajectories differ as a function of age-at-death category. The current level of FI is a stronger marker for risk stratification than the rate of change.

A Coordinated Multi-study Analysis of the Longitudinal Association Between Handgrip Strength and Cognitive Function in Older Adults.

OBJECTIVE: Handgrip strength, an indicator of overall muscle strength, has been found to be associated with slower rate of cognitive decline and decreased risk for cognitive impairment and dementia. However, evaluating the replicability of associations between aging-related changes in physical and cognitive functioning is challenging due to differences in study designs and analytical models. A multiple-study coordinated analysis approach was used to generate new longitudinal results based on comparable construct-level measurements and identical statistical models and to facilitate replication and research synthesis. METHODS: We performed coordinated analysis on 9 cohort studies affiliated with the Integrative Analysis of Longitudinal Studies of Aging and Dementia (IALSA) research network. Bivariate linear mixed models were used to examine associations among individual differences in baseline level, rate of change, and occasion-specific variation across grip strength and indicators of cognitive function, including mental status, processing speed, attention and working memory, perceptual reasoning, verbal ability, and learning and memory. Results were summarized using meta-analysis. RESULTS: After adjustment for covariates, we found an overall moderate association between change in grip strength and change in each cognitive domain for both males and females: Average correlation coefficient was 0.55 (95% CI = 0.44-0.56). We also found a high level of heterogeneity in this association across studies. DISCUSSION: Meta-analytic results from nine longitudinal studies showed consistently positive associations between linear rates of change in grip strength and changes in cognitive functioning. Future work will benefit from the examination of individual patterns of change to understand the heterogeneity in rates of aging and health-related changes across physical and cognitive biomarkers.

Towards an active and happy retirement? Changes in leisure activity and depressive symptoms during the retirement transition.

Objectives: Retirement is a major life transition in the second half of life, and it can be associated with changes in leisure activity engagement. Although theories of retirement adjustment have emphasized the need to find meaningful activities in retirement, little is known about the nature of changes in leisure activity during the retirement transition and their association with mental health.Methods: Based on four annual waves of the 'Health, Aging and Retirement Transitions in Sweden' study, we investigated the longitudinal association of leisure activity engagement and depressive symptoms using bivariate dual change score models. We distinguished intellectual, social, and physical activity engagement.Results: We found increases in all three domains of activity engagement after retirement. Although level and change of activity and depressive symptoms were negatively associated, the coupling parameters were not significant, thus the direction of effects remains unclear.Conclusion: The results highlight the need to consider the role of lifestyle changes for retirement adjustment and mental health.

Helping out or helping yourself? Volunteering and life satisfaction across the retirement transition.

It has been suggested that volunteering leads to increases in well-being, particularly in older and retiring adults, and that volunteering could be used as a public health intervention to increase well-being. However, the causal relationship has been questioned. We investigated the association between voluntary work and life satisfaction in a bivariate dual-change score model, using 4 years of longitudinal data from 1,123 participants from the Health, Aging and Retirement Transitions in Sweden (HEARTS) study. Both the frequency of volunteering and the level of life satisfaction increased across the retirement transition. However, baseline life satisfaction and volunteering were only marginally associated. Further, the coupling parameters suggest that higher levels of volunteering were followed by decreases in life satisfaction and that higher levels of life satisfaction were followed by increases in volunteering. These findings suggest that increasing levels of volunteering might not be a fruitful strategy for improving life satisfaction for all older adults-if people engage too much in voluntary work, it might even be detrimental for their life satisfaction. More research is needed to better understand when and for whom increased levels of volunteering might have positive effects on life satisfaction. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Cognitive dispersion and ApoEe4 genotype predict dementia diagnosis in 8-year follow-up of the oldest-old.

BACKGROUND: Cognitive dispersion, or inconsistencies in performance across cognitive domains, has been posited as a cost-effective tool to predict conversion to dementia in older adults. However, there is a dearth of studies exploring cognitive dispersion in the oldest-old (>80 years) and its relationship to dementia incidence. OBJECTIVE: The main aim of this study was to examine whether higher cognitive dispersion at baseline was associated with dementia incidence within an 8-year follow-up of very old adults, while controlling for established risk factors and suggested protective factors for dementia. METHODS: Participants (n = 468) were from the Origins of Variance in the Old-Old: Octogenarian Twins study, based on the Swedish Twin Registry. Cox regression analyses were performed to assess the association between baseline cognitive dispersion scores and dementia incidence, while controlling for sociodemographic variables, ApoEe4 carrier status, co-morbidities, zygosity and lifestyle engagement scores. An additional model included a composite of average cognitive performance. RESULTS: Cognitive dispersion and ApoEe4 were significantly associated with dementia diagnosis. These variables remained statistically significant when global cognitive performance was entered into the model. Likelihood ratio tests revealed that cognitive dispersion and cognitive composite scores entered together in the same model was superior to either predictor alone in the full model. CONCLUSIONS: The study underscores the usefulness of cognitive dispersion metrics for dementia prediction in the oldest-old and highlights the influence of ApoEe4 on cognition in very late age. Our findings concur with others suggesting that health and lifestyle factors pose little impact upon cognition in very advanced age.

Do I lose cognitive function as fast as my twin partner? Analyses based on classes of MMSE trajectories of twins aged 80 and older.

BACKGROUND: Aging is associated with an increasing risk of decline in cognitive abilities. The decline is, however, not a homogeneous process. There are substantial differences across individuals although previous investigations have identified individuals with distinct cognitive trajectories. Evidence is accumulating that lifestyle contributes significantly to the classification of individuals into various clusters. How and whether genetically related individuals, like twins, change in a more similar manner is yet not fully understood. METHODS: In this study, we fitted growth mixture models to Mini Mental State Exam (MMSE) scores from participants of the Swedish OCTO twin study of oldest-old monozygotic and same-sex dizygotic twins with the purpose of investigating whether twin pairs can be assigned to the same class of cognitive change. RESULTS: We identified four distinct groups (latent classes) whose MMSE trajectories followed different patterns of change over time: two classes of high performing individuals who remained stable and declined slowly, respectively, a group of mildly impaired individuals with a fast decline and a small group of impaired individuals who declined more rapidly. Notably, our analyses show no association between zygosity and class assignment. CONCLUSIONS: Our study provides evidence for a more substantial impact of environmental, rather than genetic, influences on cognitive change trajectories in later life.

Going web or staying paper? The use of web-surveys among older people.

BACKGROUND: Web-surveys are increasingly used in population studies. Yet, web-surveys targeting older individuals are still uncommon for various reasons. However, with younger cohorts approaching older age, the potentials for web-surveys among older people might be improved. In this study, we investigated response patterns in a web-survey targeting older adults and the potential importance of offering a paper-questionnaire as an alternative to the web-questionnaire. METHODS: We analyzed data from three waves of a retirement study, in which a web-push methodology was used and a paper questionnaire was offered as an alternative to the web questionnaire in the last reminder. We mapped the response patterns, compared web- and paper respondents and compared different key outcomes resulting from the sample with and without the paper respondents, both at baseline and after two follow-ups. RESULTS: Paper-respondents, that is, those that did not answer until they got a paper questionnaire with the last reminder, were more likely to be female, retired, single, and to report a lower level of education, higher levels of depression and lower self-reported health, compared to web-respondents. The association between retirement status and depression was only present among web-respondents. The differences between web and paper respondents were stronger in the longitudinal sample (after two follow-ups) than at baseline. CONCLUSIONS: We conclude that a web-survey might be a feasible and good alternative in surveys targeting people in the retirement age range. However, without offering a paper-questionnaire, a small but important group will likely be missing with potential biased estimates as the result.

Cholesterol and cognitive aging: Between-person and within-person associations in a population-based representative sample not on lipid-lowering medication.

Previous studies suggest that cholesterol metabolic dysregulation, characterized by abnormally low or high serum total cholesterol (TC) values, constitutes a risk for pronounced cognitive decline in old age. We tested this prediction using a population-based representative Swedish sample (N = 382), born in 1901-1902, and subsequently assessed on TC and 3 cognitive outcomes (verbal ability, spatial ability, and perceptual-motor-speed) at ages 70, 75, 79, 85, 88, and 90. None of the participants were on lipid-lowering medication, as prescription availability for these medications were not initiated in Sweden until the mid-1990s. We used a 3-level hierarchical model, with cognitive tests nested within time, nested within individuals. Estimates from this model revealed a nonlinear between-person association between TC and cognition, indicating that low, and to some degree high, TC values were associated with poorer cognition. This association was stronger among nondementia-cases (n = 255). Among subsequent dementia cases (n = 127), the data suggested a linear trend, indicating that lower TC values were associated with poorer cognition. TC levels declined over time in the vast majority (96%), and the steepness of this decline was associated with the rate of cognitive decline. This within-person association was particularly strong among incident dementia cases with low TC values. Our findings indicate an optimal range of TC values associated with better cognition in old age and that the within-person association between TC and cognition is related to dementia pathologies. Further, our findings demonstrate the need to separate between-person from within-person associations when evaluating the relation between TC and cognition in old age. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Trajectories of Big Five Personality Traits: A Coordinated Analysis of 16 Longitudinal Samples.

This study assessed change in self-reported Big Five personality traits. We conducted a coordinated integrative data analysis using data from 16 longitudinal samples, comprising a total sample of over 60 000 participants. We coordinated models across multiple datasets and fit identical multi-level growth models to assess and compare the extent of trait change over time. Quadratic change was assessed in a subset of samples with four or more measurement occasions. Across studies, the linear trajectory models revealed declines in conscientiousness, extraversion, and openness. Non-linear models suggested late-life increases in neuroticism. Meta-analytic summaries indicated that the fixed effects of personality change are somewhat heterogeneous and that the variability in trait change is partially explained by sample age, country of origin, and personality measurement method. We also found mixed evidence for predictors of change, specifically for sex and baseline age. This study demonstrates the importance of coordinated conceptual replications for accelerating the accumulation of robust and reliable findings in the lifespan developmental psychological sciences.

The role of personality in retirement adjustment: Longitudinal evidence for the effects on life satisfaction.

OBJECTIVE: Research on retirement suggests that personality can influence the adjustment process, but the mechanisms involved remain still largely unknown. In the present study, we investigate direct and indirect associations between the Big Five personality traits and life satisfaction over the retirement transition. Indirect effects were evaluated through the role of personality for levels and changes in self-esteem, autonomy, social support, self-rated physical health, self-rated cognitive ability, and financial satisfaction. METHOD: Our sample consisted of 796 older adults (age 60-66) and four annual measurement waves from the longitudinal population-based HEalth, Ageing, and Retirement Transitions in Sweden (HEARTS) study, including individuals retiring during the study period. RESULTS: Results from multivariate latent growth curve analysis revealed multiple indirect associations between personality and life satisfaction. Extraversion, Agreeableness, and Conscientiousness were positively related to life satisfaction through higher levels of self-esteem, autonomy, and social support. Neuroticism was negatively associated with life satisfaction through lower levels of self-esteem and lower levels and negative changes in autonomy and social support. CONCLUSIONS: Our findings suggest that retirees with higher levels of Neuroticism are more vulnerable in the transition process and they are also more likely to experience adjustment problems resulting from negative changes in key resources.

Increases in Neuroticism May Be an Early Indicator of Dementia: A Coordinated Analysis.

OBJECTIVES: Although personality change is typically considered a symptom of dementia, some studies suggest that personality change may be an early indication of dementia. One prospective study found increases in neuroticism preceding dementia diagnosis (Yoneda, T., Rush, J., Berg, A. I., Johansson, B., & Piccinin, A. M. (2017). Trajectories of personality traits preceding dementia diagnosis. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 72, 922-931. doi:10.1093/geronb/gbw006). This study extends this research by examining trajectories of personality traits in additional longitudinal studies of aging. METHODS: Three independent series of latent growth curve models were fitted to data from the Longitudinal Aging Study Amsterdam and Einstein Aging Study to estimate trajectories of personality traits in individuals with incident dementia diagnosis (total N = 210), in individuals with incident Mild Cognitive Impairment (N = 135), and in individuals who did not receive a diagnosis during follow-up periods (total N = 1740). RESULTS: Controlling for sex, age, education, depressive symptoms, and the interaction between age and education, growth curve analyses consistently revealed significant linear increases in neuroticism preceding dementia diagnosis in both datasets and in individuals with mild cognitive impairment. Analyses examining individuals without a diagnosis revealed nonsignificant change in neuroticism overtime. DISCUSSION: Replication of our previous work in 2 additional datasets provides compelling evidence that increases in neuroticism may be early indication of dementia, which can facilitate development of screening assessments.

Longitudinal correspondence between subjective and objective memory in the oldest old: A parallel process model by gender.

Subjective memory and objective memory performance have predictive utility for clinically relevant outcomes in older adults. Previous research supports certain overlap between objective performance and subjective ratings of memory. These studies are typically cross-sectional or use baseline data only to predict subsequent change. The current study uses a parallel process model to examine concurrent changes in objective memory and subjective memory. We combined data from two population-based Swedish studies of individuals aged 80 + years, assessed every 2 years (OCTO-3 measurement occasions, OCTO-Twin-5 measurement occasions) yielding 607 participants (66% female). The results confirmed that both objective and subjective memory declined over time. The association between the slope of objective memory and subjective memory was statistically significant for women but not for men. This pattern remained after accounting for age and depressive symptoms. Our findings suggest that, in population-based samples of the oldest old, women seem to show better metacognitive abilities in detecting and reporting changes in memory. Memory changes for men may be better identified by objective performance as their self-assessment of memory changes is not associated with actual change in memory performance.

A Multi-study Coordinated Meta-analysis of Pulmonary Function and Cognition in Aging.

BACKGROUND: Substantial research is dedicated to understanding the aging-related dynamics among individual differences in level, change, and variation across physical and cognitive abilities. Evaluating replicability and synthesizing these findings has been limited by differences in measurements and samples, and by study design and statistical analyses confounding between-person differences with within-person changes. In this article, we conducted a coordinated analysis and summary meta-analysis of new results on the aging-related dynamics linking pulmonary function and cognitive performance. METHODS: We performed coordinated analysis of bivariate growth models in data from 20,586 participants across eight longitudinal studies to examine individual differences in baseline level, rate of change, and occasion-specific variability in pulmonary and cognitive functioning. Results were summarized using meta-analysis. RESULTS: We found consistent but weak baseline and longitudinal associations in levels of pulmonary and cognitive functioning, but no associations in occasion-specific variability. CONCLUSIONS: Results provide limited evidence for a consistent link between simultaneous changes in pulmonary and cognitive function in a normal aging population. Further research is required to understand patterns of onset of decline and differences in rates of change within and across physical and cognitive functioning domains, both within-individuals and across countries and birth cohorts. Coordinated analysis provides an efficient and rigorous approach for replicating and comparing results across independent longitudinal studies.

Visuospatial Reasoning Trajectories and Death in a Study of the Oldest Old: A Formal Evaluation of Their Association.

OBJECTIVES: To model trajectories of visuospatial reasoning measured using Kohs Block Design test under realistic missing data assumptions and evaluate their association with hazard of death. METHODS: A joint longitudinal-survival model was used to estimate trajectories of visuospatial reasoning under a missing not at random assumption of participants from the Origins of Variance in the Old-Old: Octogenarian Twins study. Sensitivity analyses to missing data assumptions were conducted. RESULTS: Visuospatial reasoning declined at constant rate. Baseline age, dementia status, education, and history of stroke were associated with visuospatial reasoning performance, but only dementia was associated with its rate of decline. Importantly, our results demonstrated an association between poorer visuospatial reasoning and increased hazard of death. Baseline age and sex were associated with risk of death. DISCUSSION: We confirmed an association between visuospatial reasoning and death under plausible missing data assumptions.

Beyond health and economy: resource interactions in retirement adjustment.

Objectives: The retirement transition is a multidimensional and dynamic process of adjustment to new life circumstances. Research has shown that individual differences in resource capability accounts for a substantial amount of the previously observed heterogeneity in retirement adjustment. The aim of the present study was to investigate interaction effects of self-esteem, autonomy, social support, self-rated physical health, self-rated cognitive ability, and basic financial resources on levels and changes in life satisfaction in the retirement transition. Method: Our sample included 1924 older adults from the longitudinal population-based HEalth, Ageing, and Retirement Transitions in Sweden (HEARTS) study. The participants were assessed annually over a three-year period, covering the transition from work to retirement (n = 614). Participants continuously working (n = 1310) were included as a reference group. Results: Results from latent growth curve models showed that the relationship between a particular resource and levels and changes in life satisfaction varied depending on other available resources, but also that these effects varied between retirees and workers. Autonomy moderated the effect of physical resources, and social support and perceived cognitive ability moderated the effect of financial resources. Discussion: Our findings add to the current knowledge on retirement adjustment and suggest that negative effects of poor health and lack of basic financial resources on retirees life satisfaction may be compensated for by higher levels of autonomy, social support, and perceived cognitive ability.

The Gothenburg H70 Birth cohort study 2014-16: design, methods and study population.

To improve health care for older persons, we need to learn more about ageing, e.g. identify protective factors and early markers for diseases. The Gothenburg H70 Birth Cohort Studies (the H70 studies) are multidisciplinary epidemiological studies examining representative birth cohorts of older populations in Gothenburg, Sweden. So far, six birth cohorts of 70-year-olds have been examined over time, and examinations have been virtually identical between studies. This paper describes the study procedures for the baseline examination of the Birth cohort 1944, conducted in 2014-16. In this study, all men and women born 1944 on specific dates, and registered as residents in Gothenburg, were eligible for participation (n = 1839). A total of 1203 (response rate 72.2%; 559 men and 644 women; mean age 70.5 years) agreed to participate in the study. The study comprised sampling of blood and cerebrospinal fluid, psychiatric, cognitive, and physical health examinations, examinations of genetics and family history, use of medications, social factors, functional ability and disability, physical fitness and activity, body composition, lung function, audiological and ophthalmological examinations, diet, brain imaging, as well as a close informant interview, and qualitative studies. As in previous examinations, data collection serves as a basis for future longitudinal follow-up examinations. The research gained from the H70 studies has clinical relevance in relation to prevention, early diagnosis, clinical course, experience of illness, understanding pathogenesis and prognosis. Results will increase our understanding of ageing and inform service development, which may lead to enhanced quality of care for older persons.

Do later-born birth cohorts of septuagenarians sleep better? A prospective population-based study of two birth cohorts of 70-year-olds.

Study Objectives: To investigate birth cohort differences in the prevalence of insomnia from ages 70 to 79. Methods: Data were drawn from population-based samples of two cohorts of septuagenarians; the early-born 1901-07-cohort, who took part in psychiatric examinations between 1971 and 1986 (n = 681), and the later-born 1930-cohort examined between 2000 and 2010 (n = 943). Examinations were conducted at ages 70, 75, and 79. Criteria for insomnia were identical across cohorts and included sleep dissatisfaction accompanied with complaints of difficulty initiating or maintaining sleep. Associations were analyzed with logistic growth curve models. Results: The later-born cohort had lower odds for insomnia at age 70 (OR = 0.52, 95% CI: 0.32-0.87) compared with the earlier born cohort. Age was not related to insomnia as a main effect but we found an interaction between age and birth cohort (OR = 1.14, 95% CI: 1.08-1.21); insomnia increased with age in the later but not in the early-born cohort. Women had higher odds for insomnia compared with men (OR = 3.10, 95% CI: 2.02-4.74), and there was an interaction between sex and birth cohort (OR = 0.51, 95% CI: 0.30-0.88; there were larger cohort differences among women than among men and less sex differences in the later than in the earlier born cohort. Also, there were no significant differences between the cohorts in taking sleep medications. Conclusions: Our findings provide evidence of improved self-reported sleep in later-born cohorts of septuagenarians, but the difference diminished with age. The prevalence of self-reported insomnia was greater in women than in men, but sex differences were less pronounced in the later-born cohort.

Invisible Scars or Open Wounds? The Role of Mid-career Income for the Gender Pension Gap in Sweden.

This study investigates the importance of mid-career income for the gender pension gap and psychological scarring effects of low income earlier in life. More specifically we analyse whether women's typically less stable mid-life careers also affect outcomes in late careers and in retirement. Swedish income register data from 1990, 2009, and 2015 was linked to the "HEalth, Ageing, and Retirement Transitions in Sweden" survey. The gender pension gap of 966 retirees and worries about pension income of 2,723 older workers between the age of 60 and 66 years were investigated. Blinder-Oaxaca decompositions were applied to analyse the gender pension gap and linear regressions were used for the analysis of financial worries. Results show that gender differences in mid-career income play a stronger role for the gender pension gap than late career income. Mid-career income is furthermore related to higher worries about pension income and accounts for observed gender differences. Our findings demonstrate that gender gaps in mid-career income can be regarded as an open wound with visible negative effects in older ages. The reformed pension system in Sweden may potentially contribute to an even greater gender gap in pensions.