Links between life-course SES and frailty trajectory moderated by community environment resources: Person-environment Fit perspective.

INTRODUCTION: Drawing from the life course and person-environment fit perspectives, this study examined whether life-course SES disadvantages during childhood, adulthood and old- age influence frailty development in late- life and how community environment resources moderated the association between life-course SES disadvantages and frailty trajectories over a seven-year follow-up period. METHODS: Data from 11,675 participants aged ≥ 50 years at baseline who participated in the four waves (2011-2018) of the China Health and Retirement Longitudinal Survey (CHARLS) were used. Life-course SES disadvantages were self-reported, and community environment resources (basic infrastructure and voluntary organizations) were ascertained from informed officials in the community. Frailty development was measured at each wave by the Frailty Index (FI) based on 39 potential deficits. Multilevel growth modeling was used to examine the interactive effect of life-course SES disadvantages and community environment resources on frailty development. RESULTS: Life-course SES disadvantage exerted cumulatively negative effects on frailty trajectory, and individuals with SES disadvantages in two or three life stages reported higher initial levels of and faster increases in frailty scores. Community environmental resources (basic infrastructure and voluntary organizations) had a protective effect on frailty development and buffered the negative effects of SES vulnerability experiences accumulated over the life course. Community basic infrastructure resources played an important role in slowing the progression of frailty for individuals with cumulative SES disadvantage and downward mobility. DISCUSSION: Our findings provided new evidence of person-environmental docility among older adults, documenting the role of community resources in buffering SES disparities in health during later-life.

Barker's Hypothesis Among the Global Poor: Positive Long-Term Cardiovascular Effects of in Utero Famine Exposure.

An influential literature on the Developmental Origins of Health and Disease (DOHaD) has documented that poor conditions in utero lead to higher risk of cardiovascular disease at older ages. Evidence from low-income countries (LICs) has hitherto been missing, despite the fact that adverse in utero conditions are far more common in LICs. We find that Malawians exposed in utero to the 1949 Nyasaland famine have better cardiovascular health 70 years later. These findings highlight the potential context specificity of the DOHaD hypothesis, with in utero adversity having different health implications among aging LIC individuals who were exposed to persistent poverty.

Socially stratified associations between self-employment and health among Chilean older people.

Non-standard forms of employment, such as self-employment, are among the most prevalent routes for older people to access the workforce. While the financial benefits of any form of self-employment in later life have been widely acknowledged, less is known about their impact on health. This study explores the association between self-employment and 16 health outcomes among older people with different social stratification characteristics in Chile, a developing country experiencing rapid population ageing. We rely on a rich representative life history survey of Chilean men and women between the ages 65 and 75 years (N = 802) living in the capital Santiago, weighted sequence analysis to reconstruct employment histories and weighted regression analysis to measure the association between self-employment and health in later life. All our analyses are adjusted by both individual lifetime health indicators and employment trajectories. Our results show that being self-employed relative to not working is positively associated with health in seven out of 16 outcomes. More surprisingly, those in a self-employment position seem to enjoy better health outcomes, particularly among the less educated and lower-income levels. These stratified associations raise questions about how these individuals enjoy better health despite facing adverse social conditions.

Intersecting Early-Life Selection Mechanisms: Socio-Historical Changes in Racially Stratified Effects of Education on Functional Limitations in the United States.

OBJECTIVE: Scant research has focused on the role of sociohistorical changes in shaping intersecting early-life selection mechanisms and their impacts on racially stratified effects of education on health across cohorts. METHOD: Drawing from the Health and Retirement Survey, this study fitted negative binomial regression models to assess the impacts of childhood socioeconomic status (SES) on the relationship between education and functional limitations for Black and White adults across birth cohorts (n = 16,269, born 1931-1959). RESULTS: The disparities between Black adults and White adults in impacts of childhood SES on both education and functional limitations were more pronounced in recent cohorts. The racial stratification in the impacts of education on functional limitations was documented across cohorts. However, after adjusting for childhood SES, this stratification narrowed considerably in recent cohorts. DISCUSSION: This study underscores the role of a sociohistorical context in shaping the effects of education on health at the intersection of race and cohort.

Adult Children's Intergenerational Mobility and Older Adults' Self-Rated Health: A U.S.-China Comparison.

OBJECTIVES: This study examines whether and how adult children's educational mobility is associated with the self-rated health of older adults aged 50 and above in China and the United States. METHODS: The analytic sample included 12,445 Chinese respondents from the 2011 to 2013 China Health and Retirement Longitudinal Study, and 17,121 US respondents from the 2010 to 2012 Health and Retirement Study. Multinomial logistic regression was employed to examine the relationship between children's educational mobility and parents' self-rated health, and the Karlson-Holm-Breen-method was used for mediation analysis. RESULTS: Adult children's upward mobility was associated with their parents' better health in both countries. This association was mediated by child-to-parent economic support, as well as parents' social engagement and depressive symptoms in China; in the United States, parents' depression was the only significant mediator. DISCUSSION: This study is among the first to empirically show the benefit of adult children's upward mobility for their parents' health. The cross-national differences in the mediating paths suggest that the cross-over effect of children's intergenerational mobility on their parents' health is embedded within specific sociocultural contexts.

Midlife financial strain and later-life health and wellbeing of husbands and wives: Linking and moderating roles of couple intimacy trajectories.

This study investigates (a) heterogeneous trajectories of couple intimacy over the mid-later years (average ages of 40-65) and (b) how these intimacy classes are differentially associated with spouses' midlife financial strain as well as their later-life health and wellbeing outcomes. The sample was comprised of white couples in long-term marriages from the rural Mid-west who experienced the economic downturn of the farm crisis in late 1980s. Couple-level measures of emotional intimacy and sexual intimacy were created by summing husbands' and wives' reports. Using growth mixture modeling with a sample of 304 couples, conjoint intimacy classes were identified from trajectories of couple emotional intimacy and sexual intimacy. Three qualitatively different latent intimacy classes of couples were identified: Consistently High, Moderate and Increasing, and Chronically Low. Intimacy classes were differentially associated with midlife financial strain and later-life health and wellbeing. Spouses with consistently high and moderate and increasing intimacy in their mid-later years averaged lower financial strain in early midlife and better health and wellbeing outcomes in later years (>67 years) compared to those with consistently low intimacy after controlling for lagged health measures. The identification of couple intimacy trajectory groups provides a potentially useful prognostic tool for counseling efforts that can promote and develop resiliency factors to aid in the redirection of adverse couple intimacy trajectories.

En el presente estudio se investigan las a) trayectorias heterogéneas de la intimidad de la pareja durante los años de la mediana edad y la vejez (edades promedio de 40 a 65 años) y b) cómo estas clases de intimidad se asocian diferencialmente con la presión económica de la mediana edad de los cónyuges, así como con los resultados en la salud y el bienestar en la vejez. La muestra estuvo compuesta de parejas blancas en matrimonios duraderos de zonas rurales del centro de los Estados Unidos que sufrieron la recesión económica de la crisis agrícola a fines de la década de los ochenta. Las medidas a nivel de la pareja de la intimidad emocional y la intimidad sexual se crearon sumando los informes de los esposos y las esposas. Utilizando un modelo de combinación de crecimiento con una muestra de 304 parejas, se identificaron clases de intimidad conjunta a partir de las trayectorias de la intimidad emocional y la intimidad sexual de la pareja. Se identificaron tres clases de parejas cualitativamente diferentes según su intimidad latente: constantemente alta, moderada y en aumento, y crónicamente baja. Las clases de intimidad estuvieron asociadas diferencialmente con la presión económica en la mediana edad y la salud y el bienestar en la vejez. Los cónyuges con intimidad constantemente alta, y moderada y en aumento entre la mediana edad y la vejez promediaron una menor presión económica a principios de la mediana edad y mejores resultados en la salud y el bienestar durante la vejez (más de 67 años) en comparación con aquellos que tenían una intimidad constantemente baja después de tener en cuenta las medidas de salud retardadas. La identificación de los grupos de trayectorias de la intimidad de la pareja ofrece una herramienta de pronóstico que puede ser útil para el trabajo de terapia orientado a personas y a parejas, ya que puede promover y desarrollar factores de resiliencia que ayuden a redirigir las trayectorias desfavorables de la intimidad de la pareja.

Adult correlates of adverse childhood experiences in Ukraine.

BACKGROUND: The impact of adverse childhood experiences (ACEs) on adult life outcomes is well-documented by a considerable body of research. This study investigates the relationship between ACEs and both physical and mental health outcomes in a nationally representative sample of Ukrainian adults. OBJECTIVE: The aim of this study was to analyze whether ACEs are associated with lifetime physical and mental health outcomes in a nationally representative sample of Ukrainian adults. Participants and Setting In 2002, the World Mental Health Composite International Diagnostic Interview (WMH-CIDI) was administered to a national probability sample of Ukrainian adults (n = 4725). METHODS: Associations between ACEs and later life physical and mental health outcomes are examined using logistic regression models. RESULTS: ACEs were significantly correlated with poor later life mental and physical health. Participants with three or more ACEs were most likely to have chronic pain, cardiovascular disease, other disease, depressive disorders, anxiety disorders, substance abuse disorders, and all disability metrics analyzed. Adjusted odds ratios for these models ranged from 1.80 to 3.81. Additionally, we found a large association between the number of ACES and later negative health outcomes. CONCLUSIONS: Our results indicate that in Ukraine, ACEs have a strong negative effect on later life mental and physical health. Further research is needed to explore specific ACEs and examine potential mediators such as social support in the relationship between ACEs and health outcomes.

Placenta-targeted treatment strategies: An opportunity to impact fetal development and improve offspring health later in life.

The Developmental Origins of Health and Disease (DOHaD) theory states that a sub-optimal prenatal and early postnatal environment during development leads to an increased risk of long-term development of adult chronic diseases. Developmental programming of disease has the potential to greatly impact the health of our population. Therefore, research has focused on the development of primary treatment strategies and/or therapeutic interventions for individuals who are at increased risk, with the objective to reverse or prevent later life onset of chronic disease in the offspring born from complicated pregnancies. Many studies have focused on systemic treatments and/or interventions in complicated pregnancies to improve offspring outcomes. However, there are limitations to systemic maternal/prenatal treatments, as most of the treatments are able to cross the placenta and have potential adverse off-target effects on the developing fetus. The placenta serves as the primary interface between mother and fetus, and placental dysfunction in complicated pregnancies has been associated with impaired fetal development and negative impact on offspring health. Therefore, recent research has focused on treatment strategies that specifically target the placenta to improve placental function and prevent passage of prenatal therapeutics and/or treatments into the fetal circulation, thus avoiding any potential adverse off-target effects on the fetus. This article reviews the currently available knowledge on treatment strategies and/or therapeutics that specifically target the placenta with the goal of improving pregnancy outcomes with a focus on long-term health of the offspring born of complicated pregnancies.

Gendered "Long Arm" of Parental Education? Life Course Influences on Later Life Functional Limitations in India.

Objective: We adopt a novel approach to mediation analysis to account for interrelated life course social processes that constitute later life health disparities. We examine gender-specific direct effect of parental education on functional limitations in later life. Method: Based on the first wave (2007-2010; n = 7,150) of the Study on Global Ageing and Adult Health (SAGE), we estimate both (natural) direct and indirect effects of parental education on functional limitations in later life. Results: We observed a significant indirect and positive effect of parental education on functional health. Contrary to prior literature, we documented adverse direct effect of parental education on later life functional health. The direct effect is statistically significant only for father's education, and is greater, though not statistically significantly so, for women than men. Discussion: The intersection of gender status and interrelated social stratification documented by this study highlights the need for gender-sensitive life course research. Such research can enhance our understanding of the ways patriarchal social systems produce heterogeneous effects of interrelated structural factors on later life health for men and women.

Study of Migration and Later Life Health in Nepal.

PURPOSE: This study investigates long-term consequences of individual migration experience on later life health, specifically self-rated health and functional difficulty. DESIGN/METHODOLOGY/APPROACH: The study uses multiple community-, household-, and individual-level data sets from the Chitwan Valley Family Study (CVFS) in Nepal. The CVFS selected a systematic probability sample of 151 neighborhoods in Western Chitwan and collected information on all households and individuals residing in the selected sample neighborhoods. This study uses data from multiple surveys featuring detailed migration histories of 1,373 older adults, and information on their health outcomes, households, and communities. FINDINGS: Results of the multi-level multivariate analysis show a negative association between number of years of migration experience and self-rated health, and a positive association between migration and functional difficulty. These findings suggest a negative relationship between migration experience and later life health. RESEARCH LIMITATIONS/IMPLICATIONS: Although we collected health outcome measures after the measurement of explanatory and control measures-a unique strength of this study-we were unable to control for baseline health outcomes. Also, due to the lack of time-varying measures of household socioeconomic status in the survey, this investigation was unable to control for measures associated with the economic prosperity hypothesis. Future research is necessary to develop panel data with appropriately timed measures. PRACTICAL IMPLICATIONS: The findings provide important insights that may help shape individual's and their family's migration decisions. ORIGINALITY/VALUE: This research provides important insight to individuals lured by potential short-term economic prospects in destination places, as well as to scholars and policy makers from migrant-sending settings that are grappling with skyrocketing medical expenses, rapid population aging, and old age security services.

Life course influences on later life health in China: Childhood health exposure and socioeconomic mediators during adulthood.

China's unprecedented population aging and social and economic change raise important issues concerning life course determinants of advantage or disadvantage into later life. Data from the China Health and Retirement Longitudinal Study (CHARLS) 2013 were analysed to identify the influence of childhood health on later life health as indicated by self-rated health and how this influence could be mediated by social and economic positions (SEP) and resources later in the life span. CHARLS provides nationally representative data on 18, 000 individuals aged 45 years and above in approximately 150 districts and 450 villages. Both multivariate logit regression model and KHB method (Karlson/Holm/Breen method) were applied to examine and decompose the life span influences on later life health. The results show that the childhood health, accounts for approximately half of the effect directly and another half of the effect indirectly through social and economic variations during adulthood. Relative living standard, marital status and urban residence are the most significant and important social and economic mediators for men; For women, living standard and secondary schooling are most influential while marital status is not significant. Implications for social and economic policies to improve later life health are discussed.

Childhood adversity, midlife generativity, and later life well-being.

OBJECTIVES: Prior studies confirm that after experiencing childhood adversity, resilient adults can recover and engage in generative growth. This study explored the long-term effects of childhood adversity (assessed as harsh parenting and/or childhood poverty) on successful aging for individuals who either achieved or failed to achieve Erikson's psychosocial developmental stage of generativity in midlife. METHOD: The study utilized a sample of 636 men from the Harvard Sample and Inner City Cohort of the 73-year longitudinal Study of Adult Development. Nested ordinary least squares regression models were used to test the mediating and moderating effects of midlife generativity on later life health and adjustment to aging. RESULTS: Men who experienced childhood adversity were less likely than men with no childhood adversity to achieve generativity in midlife. Although achievement of generativity was associated with better later life health and adjustment to aging, it neither mediated nor moderated the negative relation between childhood poverty and later life health outcomes. However, for men who experienced an adversarial childhood, achievement of generativity mediated and moderated adjustment to aging. DISCUSSION: Results suggest that psychosocial growth in adulthood can compensate for the long-term negative effects of an adversarial childhood on adjustment to aging, but not for later life health.