Overweight as a Causal Factor Contributing to Better Survival at the Oldest Old Ages: A Mendelian Randomization Study.

Overweight, defined by a body mass index (BMI) between 25 and 30, has been associated with enhanced survival among older adults in some studies. However, whether being overweight is causally linked to longevity remains unclear. To investigate this, we conducted a Mendelian randomization (MR) study of lifespan 85+ years, using overweight as an exposure variable and data from the Health and Retirement Study and the Long Life Family Study. An essential aspect of MR involves selecting appropriate single-nucleotide polymorphisms (SNPs) as instrumental variables (IVs). This is challenging due to the limited number of SNP candidates within biologically relevant genes that can satisfy all necessary assumptions and criteria. To address this challenge, we employed a novel strategy of creating additional IVs by pairing SNPs between candidate genes. This strategy allowed us to expand the pool of IV candidates with new 'composite' SNPs derived from eight candidate obesity genes. Our study found that being overweight between ages 75 and 85, compared to having a normal weight (BMI 18.5-24.9), significantly contributes to improved survival beyond age 85. Results of this MR study thus support a causal relationship between overweight and longevity in older adults.

The effect of heavy smoking on retirement risk: A mendelian randomisation analysis.

BACKGROUND AND AIMS: The extent to which heavy smoking and retirement risk are causally related remains to be determined. To overcome the endogeneity of heavy smoking behaviour, we employed a novel approach by exploiting the genetic predisposition to heavy smoking, as measured with a polygenic risk score (PGS), in a Mendelian Randomisation approach. METHODS: 8164 participants (mean age 68.86 years) from the English Longitudinal Study of Ageing had complete data on smoking behaviour, employment and a heavy smoking PGS. Heavy smoking was indexed as smoking at least 20 cigarettes a day. A time-to-event Mendelian Randomization (MR) analysis, using a complementary log-log (cloglog) link function, was employed to model the retirement risk. RESULTS: Our results show that being a heavy smoker significantly increases the risk of retirement (ß = 1.324, standard error = 0.622, p < 0.05). Results were robust to a battery of checks and a placebo analysis considering the never-smokers. CONCLUSIONS: Overall, our findings support a causal pathway from heavy smoking to earlier retirement.

Associations between modifiable risk factors and frailty progression among individuals with pre-frailty.

BACKGROUND: In the context of the present global aging phenomenon, the senior population and pace of aging in China have emerged as prominent issues on the worldwide stage. Frailty, a complicated condition that is closely linked to the clinical syndrome of advancing age, poses a considerable health risk to older individuals. Frailty status was assessed by the frailty index (FI) ranging from 0 to 1, pre-frailty was defined as >0.10 to <0.25, and frailty was defined as ≥0.25. To look at the connection between modifiable risk factors and frailty progression among individuals in the pre-frailty population. METHODS: Using pre-frailty patients as characterized by the 32-frailty index, the study focused on middle-aged and elderly persons from China and ultimately recruited 5,411 participants for analysis. The relationship between modifiable factors and changes in pre-frailty status throughout follow-up was investigated. Modifiable factors were body mass index (BMI), abdominal obesity, smoking status, alcohol use, and sleep status. We employed logistic regression to examine the relationships between modifiable risk factors and changes in pre-frailty status, as well as the associations between modifiable factors scores and the corresponding pre-frailty progression. Additionally, we generated the modifiable factors scores and examined how these related to modifications in the pre-frailty stage. RESULTS: In this study, after a mean follow-up of 6 years, (OR = 0.59, 95%CI: 0.48-0.71) for BMI ≥ 25 kg/m2 and (OR = 0.74, 95%CI: 0.63-0.89) for concomitant abdominal obesity were significantly associated with lower reversal to a healthy state; (OR = 1.24, 95%CI:1.07-1.44) and (OR = 1.25, 95%CI: 1.10-1.42) for the group that negatively progressed further to frailty were significantly associated with increased frailty progression profile. Subsequently, investigation of modifiable factor scores and changes of pre-frailty status found that as scores increased further, frailty developed (OR = 1.12, 95%CI:1.05-1.18), with scores of 3 and 4 of (OR = 1.38, 95%CI: 1.08-1.77) and (OR = 1.52, 95%CI:1.09-2.14). Finally, we also performed a series of stratified analyses and found that rural unmarried men aged 45 to 60 years with less than a high school degree were more likely to develop a frailty state once they developed abdominal obesity. CONCLUSION: In pre-frailty individuals, maintaining more favorable controllable variables considerably enhances the chance of return to normal and, conversely, increase the risk of progressing to the frailty.

[The ethical obligation to continue research during retirement]. / La obligación ética de seguir investigando durante la jubilación.

We advocate in this little assay for the concept of active retirement. We feel the need to broadcast our experience to younger professionals. Mentor, Telemachus' advisor in the Odyssey, has evolved greatly into the 21st century. From an ideal point of view, we consider that clinical practice is inextricably linked to research. Within the public health system there is an ethical space for volunteering. Perhaps it is what Anglo-Saxon primary care calls "vocational training".

Bridge Employment or Encore Career? Examining Predictors that Distinguish Later-Life Career Transitions.

OBJECTIVES: Bridge employment and encore careers are two prevalent retirement pathways that have different goals and outcomes. Yet, 'changing jobs in later life' is the shared prequel that blurs the distinction between them in empirical studies. This study proposes a set of criteria - voluntariness of career transition and the duration of work in the post-transition job - to distinguish various retirement pathways and investigates the predictors that distinguish the workers' choice of these pathways. METHODS: I conducted multinomial logistic regression to examine the predictors that distinguish between bridge employment, encore career, and direct workforce exit using the longitudinal sample of respondents with full-time career jobs in the Health and Retirement Study 1992-2020 (HRS, N = 2,038). To examine the predictors that distinguish between bridge employment and encore careers, I conducted logistic regression on the subsample of respondents who chose either bridge employment or encore careers (n = 927). RESULTS: The results show that the accumulated human capital from career jobs, physical and mental health conditions before leaving career jobs, and self-identified retirement status when transitioning to new jobs distinguish the workers' choices of taking on different retirement pathways. DISCUSSION: Maintaining the labor force participation of older workers is an important human resource agenda for policymakers. This study suggests that increasing the number of quality jobs for older workers would promote bridge employment and encore careers by raising the benefits of making career transitions as well as improving older workers' health.

Meaning of working for older nurses and nursing assistants in Sweden: A qualitative study.

Meaningful work is related to the motivation to continue to work in older ages and later retirement. This qualitative study addresses calls for further research on the meaning of working for older workers using the Interpretative Phenomenological Analysis approach to explore in-depth the dimensions underlying the subjective experience of meaningful work among 27 nurses and nursing assistants aged 55-75 years. The findings show that work was perceived as a primary source of: (1) personal identity (2) purpose and contribution, (3) competence and accomplishment, (4) social contacts and belongingness, (5) activity, routines and purposeful use of time, and (6) economic security and freedom. These qualitative findings may be applied in interventions aiming to encourage extended working lives in key welfare occupations, which are facing significant staff shortages.

The impact of retirement on blood pressure: evidence from a nationwide survey in China.

INTRODUCTION: The health impact of retirement is controversial. Most previous studies have been based on self-reported health indicators or the endpoints of some chronic diseases (e.g., morbidity or mortality), but objective physiological indicators (e.g., blood pressure) have rarely been used. The objective of this study is to elucidate the health effects of retirement on blood pressure, thereby offering empirical evidence to facilitate the health of retirees and to optimize retirement policies. METHODS: From 2012 to 2015, 84,696 participants of the Chinese Hypertension Survey (CHS) were included in this study. We applied the fuzzy regression discontinuity design (FRDD) to identify retirement's causal effect on systolic blood pressure (SBP), diastolic blood pressure (DBP) and pulse pressure. We also explored the heterogeneity in the effects of retirement across different sex and education level groups. RESULTS: Based on the fully adjusted model, we estimated that retirement increased SBP by 5.047 mm Hg (95% CI: -2.628-12.723, P value: 0.197), DBP by 0.614 mm Hg (95% CI: -3.879-5.108, P value: 0.789) and pulse pressure by 4.433 mm Hg (95% CI: -0.985-9.851, P value: 0.109). We found that retirement led to a significant increase in male participants' SBP and pulse pressure as well as a possible decrease in female participants' blood pressure. Additionally, the blood pressure levels of low-educated participants were more vulnerable to the shock of retirement. CONCLUSION: Retirement is associated with an increase in blood pressure level. There is a causal relationship between the increase in blood pressure levels of men and retirement. Policy-makers should pay extra attention to the health status of men and less educated people when adjusting retirement policies in the future.

On the road to retirement: Predicting nighttime driving difficulty and cessation using self-reported health factors.

Introduction: Older drivers now expect to drive longer than previous cohorts and will make up about 25% of licensed U.S. drivers by 2050. Identifying early predictors of nighttime driving difficulty, a precursor to driving retirement, can inform screening procedures and timely linkage to interventions supporting driving or transitioning to driving cessation. Methods: We examined self-reported physical and mental health baseline predictors of greater nighttime driving difficulty in five and ten years using weighted multivariate logistic analyses of 2261 drivers, aged 57 to 85, from the National Social Life, Health, and Aging Project (NSHAP). Transition matrix models describe probabilities of having greater, lesser, or the same nighttime driving difficulty after five years based on baseline driving conditions and the significant logistic model factors. We built a transition matrix tool that offers users the ability to calculate expected probabilities of change in nighttime driving difficulty based on the identified salient factors. Results: Five-year predictors of greater nighttime driving difficulty included perceived poor physical health (OR = 3.75), limitations to activities of daily living (ADLs; OR = 1.97), and clinical levels of depressive and anxiety symptoms (OR = 1.63; OR = 1.71). Excellent physical health (OR = 0.52), mental health (OR = 0.60), and any frequency of physical activity compared to 'never' were protective (OR = 0.37-0.51). Physical health, walking pain, and limitations to ADLs were predictive at ten-years. Transition models showed physical health and anxiety were most indicative of greater nighttime driving difficulty at 5-years for those reporting no difficulty at baseline, but limitations to ADLs were more predictive otherwise. Conclusions: Lay practitioners could capitalize on the use of self-report screening measures to identify older adults who may experience near-term nighttime driving difficulty. Earlier identification may better guide long-term driving retirement planning or engagement in appropriate health interventions. The transition matrix modeling tool is freely available to facilitate development and validation of related measures.

Sensory Loss and its Association with Different Types of Departures from the Labor Force Among Older Adults in the US.

To investigate the association between sensory loss and the timing and type of self-reported departures from the labor force, via retirement or disability, we used data from the Health and Retirement Study, cycles 2004-2018. Based on self-reported sensory loss, we classified individuals into four groups: no sensory loss, hearing loss only, vision loss only, and dual sensory loss (vision and hearing loss). We assumed that older adults could leave the labor force either by retirement or due to disability. Because once one type of exit is observed the other type cannot be observed, we implemented a competing risk approach to estimate the instantaneous rate of departure (sub-distribution hazard rate) for leaving the labor force due to disability, treating retirement as a competing risk, and for departures via retirement, with disability as the competing risk. We found that compared to older adults with no sensory loss, adults with vision loss are at a higher risk for leaving the labor force via disability (when treating retirement as a competing risk). Compared to no sensory loss, hearing loss was associated with a higher risk for retirement in models treating disability as a competing risk. Given the differences between disability and retirement benefits (before and after retirement age), policies intended to keep people with sensory loss from early labor force departures, such as accommodations in the workplace and/or hearing and vision care coverage, might contribute to better retiring conditions and healthy aging among older adults with sensory loss.

Long-run consequences of informal elderly care and implications of public long-term care insurance.

We estimate a dynamic structural model of labor supply, retirement, and informal caregiving to study short and long-term costs of informal caregiving in Germany. Incorporating labor market frictions and the German tax and benefit system, we find that in the absence of Germany's public long-term insurance scheme, informal elderly care has adverse and persistent effects on labor market outcomes and, thus, negatively affects lifetime earnings and future pension benefits. These consequences of caregiving are heterogeneous and depend on age, previous earnings, and institutional regulations. Policy simulations suggest that while public long-term care insurance policies are fiscally costly and induce negative labor market effects, they can largely offset the personal costs of caregiving and increase welfare, especially for low-income individuals.

Does work after retirement affect health-related quality of life: Evidence from a propensity score matching study in China.

AIM: Extending working life is considered as an important initiative to respond to the population aging and pension payment dilemma. This study aimed to investigate whether work after retirement is related to improved health-related quality of life. METHODS: We used two waves of data from the China Health and Retirement Longitudinal Study in 2011 and 2018. Work after retirement was ascertained based on self-reported retirement and work status, and health-related quality of life (HRQOL) was measured with the three-level EuroQol five-dimensions. The impact of work after retirement on HRQOL was analyzed using the propensity score matching with difference-in-difference approach. RESULTS: A total of 1043 retirees were included. The results showed that work after retirement was associated with significant improvement in HRQOL among retirees (ß = 0.072, P < 0.001). Heterogeneity analyses did not show specificity on sex (P for sex interaction >0.05), but older-aged retirees seemed more sensitive to the benefits of work after retirement on HRQOL than their younger-aged counterparts (≥65 years: ß = 0.167, P < 0.001 vs <65 years: ß = -0.047, P > 0.05; P for age interaction = 0.010). CONCLUSIONS: Work after retirement shows a positive impact on HRQOL among community-dwelling adults in China. Policy-makers should take the health of retirees into account when implementing policies related to delayed retirement, and reduce health inequity. Geriatr Gerontol Int 2024; ••: ••-••.

Remaining as a Clinical Doctor in a Smaller Institute after Retirement: A Personal View.

Clinical doctors with overwhelming workloads at university or center hospitals may not have sufficient time to allocate for each patient or to consider each patient's personal condition. Retirement may be a good chance to make a new start by becoming a clinical doctor in a smaller institute. Becoming a clinical doctor in a smaller institute may give you satisfaction and happiness different from being a university clinical doctor. I believe that after retirement from a university or big hospital, older clinical doctors should continue to participate in clinical practice for as long as they wish. This may be one of the solutions for providing clinical doctors in the current and coming super-aged Japan.

The effect of retirement eligibility on mental health in the United Kingdom: Heterogeneous effects by occupation.

I investigate heterogeneity across occupational characteristics in the effect of retirement eligibility on mental health in the United Kingdom. I use K-means clustering to define three occupational clusters, differing across multiple dimensions. I estimate the effect of retirement eligibility using a Regression Discontinuity Design, allowing the effect to differ by cluster. The effects of retirement eligibility are beneficial, and greater in two clusters: one comprised of white-collar jobs in an office setting and another of blue-collar jobs with high physical demands and hazards. The cluster with smaller benefits mixes blue- and white-collar uncompetitive jobs with high levels of customer interaction. The results have implications for the distributional effect of raising the retirement age.

Association between combination COVID-19-influenza vaccination and long COVID in middle-aged and older Europeans: A cross-sectional study.

The potential impact of combined COVID-19 and influenza vaccination on long COVID remains uncertain. In the present cross-sectional study, we aimed to investigate the plausible association between them in middle-aged and older Europeans based on the Survey of Health, Ageing, and Retirement in Europe (SHARE). A total of 1910 participants were recruited in the analyses. The study outcome was long COVID. Participants were divided into 4 groups through the self-reported status of COVID-19 and influenza vaccination. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated. 1397 participants experienced long COVID. After multivariable adjustment, those vaccinated with neither COVID-19 nor influenza vaccine had higher risk of long COVID (OR, 1.72; 95% CI, 1.26-2.35) compared to those vaccinated with both vaccines. Furthermore, adding the 4 statuses of COVID-19 vaccination/influenza vaccination to conventional risk model improved risk reclassification for long COVID (continuous net reclassification improvement was 16.26% [p = .003], and integrated discrimination improvement was 0.51% [p = .005]). No heterogeneity was found in the subgroup analyses (all p-interaction ≥0.05). Our study might provide a strategy for people aged 50 and over to reduce the occurrence of long COVID, that is, to combine the use of the COVID-19 vaccine and influenza vaccines.

Is Transition to Retirement Associated With Volunteering? Longitudinal Evidence from Europe.

Studies have shown that retired older adults are more likely to volunteer than their working counterparts. However, whether the transition to retirement is associated with increased volunteering frequency and whether this varies according to material and time resources of participants is unclear. We used four waves of data from the longitudinal Survey of Health, Ageing and Retirement in Europe, collected between 2011-2018 across 19 countries (n = 12,400 person-observations from 6200 individuals over 50). Within-person (or panel fixed-effect) regression analyses revealed that transition to retirement was associated with an increased volunteering frequency over time. This association was stronger among individuals with better health, higher education, improved financial situation and in countries with higher gross domestic product per capita. Overall, transition to retirement tends to open new ways of organizing everyday life and is associated with increased frequency of volunteering.

Procrastination, depressive symptomatology, and loneliness in later life.

OBJECTIVES: Procrastination is an almost universal behaviour and yet little research to date has focused on procrastination among older adults. The purpose of this study was to explore the potential association between age and procrastination, and the potential mediating roles of depressive symptomatology and loneliness. METHOD: Structural equation modelling was applied to data from 1309 participants (aged 29-92) from two waves United States Health and Retirement Study (2016-2020). Within the model, sex, education, marital status, and job status were added as covariates. RESULTS: There was no statistically significant direct effect between age and procrastination (ß = 0.06, p = 0.106). However, an indirect effect was present via depressive symptomatology (ß = -0.40, p < 0.001). No mediating effect of loneliness was observed (ß = - 0.01, p = 0.371). Subsequent analysis revealed that the symptoms, fatigue, loneliness, and lack of motivation significantly predicted procrastination. CONCLUSION: While age was not directly associated with procrastination, increasing age was associated with a decreased likelihood of depressive symptomatology, which was in turn associated with an increased likelihood of procrastination. Such findings indicates that age demonstrates no association with procrastination because of the suppressing effect of depressive symptomatology.

Lifestyle Planning in the Transition to Retirement.

Background: There is a further need to examine the types of planning people do for their lives in retirement and to examine goals and challenges in relation to planning efforts. Objectives: This report summarizes highlights from a study that examined retirement planning and explored personal retirement experiences. Design: An online survey included quantitative and qualitative questions about retirement preparedness and satisfaction and open-ended questions about retirement goals, fears, challenges, and advice. Participants: Canadians (n = 748) fully or partly retired responded to questions. Results: Quantitative results determined that while both financial and lifestyle planning were significant predictors of higher perceived preparedness, only lifestyle planning was a significant predictor for perceived satisfaction. Qualitative comments highlighted the importance of goal-setting, including planning for meaningful time use and strategies to address anticipated or existing challenges. Conclusions: Lifestyle planning is an essential component of planning for the transition to retirement.

Decoding emotional resilience in aging: unveiling the interplay between daily functioning and emotional health.

Background: EPs pose significant challenges to individual health and quality of life, attracting attention in public health as a risk factor for diminished quality of life and healthy life expectancy in middle-aged and older adult populations. Therefore, in the context of global aging, meticulous exploration of the factors behind emotional issues becomes paramount. Whether ADL can serve as a potential marker for EPs remains unclear. This study aims to provide new evidence for ADL as an early predictor of EPs through statistical analysis and validation using machine learning algorithms. Methods: Data from the 2018 China Health and Retirement Longitudinal Study (CHARLS) national baseline survey, comprising 9,766 samples aged 45 and above, were utilized. ADL was assessed using the BI, while the presence of EPs was evaluated based on the record of "Diagnosed with Emotional Problems by a Doctor" in CHARLS data. Statistical analyses including independent samples t-test, chi-square test, Pearson correlation analysis, and multiple linear regression were conducted using SPSS 25.0. Machine learning algorithms, including Support Vector Machine (SVM), Decision Tree (DT), and Logistic Regression (LR), were implemented using Python 3.10.2. Results: Population demographic analysis revealed a significantly lower average BI score of 65.044 in the "Diagnosed with Emotional Problems by a Doctor" group compared to 85.128 in the "Not diagnosed with Emotional Problems by a Doctor" group. Pearson correlation analysis indicated a significant negative correlation between ADL and EPs (r = -0.165, p < 0.001). Iterative analysis using stratified multiple linear regression across three different models demonstrated the persistent statistical significance of the negative correlation between ADL and EPs (B = -0.002, ß = -0.186, t = -16.476, 95% CI = -0.002, -0.001, p = 0.000), confirming its stability. Machine learning algorithms validated our findings from statistical analysis, confirming the predictive accuracy of ADL for EPs. The area under the curve (AUC) for the three models were SVM-AUC = 0.700, DT-AUC = 0.742, and LR-AUC = 0.711. In experiments using other covariates and other covariates + BI, the overall prediction level of machine learning algorithms improved after adding BI, emphasizing the positive effect of ADL on EPs prediction. Conclusion: This study, employing various statistical methods, identified a negative correlation between ADL and EPs, with machine learning algorithms confirming this finding. Impaired ADL increases susceptibility to EPs.

Association of the Type of Public Pension With Mental Health Among South Korean Older Adults: Longitudinal Observational Study.

BACKGROUND: As income and health are closely related, retirement is considered undesirable for health. Many studies have shown the association between pension and health, but no research has considered the association between contribution-based public pensions or their types and health. OBJECTIVE: This study investigates the association between the type of contributory public pension and depressive symptoms among older adults. METHODS: We analyzed the data of 4541 older adults who participated in the South Korea Welfare Panel Study (2014-2020). Depressive symptoms were measured using the 11-item Center for Epidemiologic Studies Depression scale. Public pensions in South Korea are classified into specific corporate pensions and national pensions. For subgroup analyses, pensioners were categorized according to the amount of pension received and the proportion of public pension over gross income. Analyses using generalized estimating equations were conducted for longitudinal data. RESULTS: Individuals receiving public pension, regardless of the pension type, demonstrated significantly decreased depressive symptoms (national pension: ß=-.734; P<.001; specific corporate pension: ß=-.775; P=.02). For both pension types, the higher the amount of benefits, the lower were the depression scores. However, this association was absent for those who received the smaller amount among the specific corporate pensioners. In low-income households, the decrease in the depressive symptoms based on the amount of public pension benefits was greater (fourth quartile of national pension: ß=-1.472; P<.001; second and third quartiles of specific corporate pension: ß=-3.646; P<.001). CONCLUSIONS: Our study shows that contributory public pension is significantly associated with lower depressive symptoms, and this association is prominent in low-income households. Thus, contributory public pensions may be good income sources for improving the mental health of older adults after retirement.

Reproductive factors and cardiometabolic disease among middle-aged and older women: a nationwide study from CHARLS.

Background: Cardiometabolic disease is skyrocketing to epidemic proportions due to the high prevalence of its components and the aging of the worldwide population. More efforts are needed to improve cardiometabolic health. The aim of this nationally representative study based on the China Health and Retirement Longitudinal Study (CHARLS, 2014-2018) was to examine the association between reproductive factors and cardiometabolic disease among Chinese women aged ≥45 years. Methods: The CHARLS is an ongoing longitudinal study initiated in 2011, and the latest follow-up was completed in 2018. In total, 6,407 participants were analyzed. Effect-sizes are expressed as odds ratios (OR) and 95% confidence intervals (CI). Confounding was considered from statistical adjustment, subsidiary exploration, and unmeasured confounding assessment aspects. Results: Of 6,407 accessible participants, 60.9% were recorded as having one or more of five predefined cardiovascular or metabolic disorders. Compared to those with two children, participants who had 0-1 child were found to have a lower risk of cardiometabolic disease (OR = 0.844, 95% CI: 0.714-0.998), and those who had ≥3 children had a greater risk (OR = 1.181, 95% CI: 1.027-1.357). Age at menarche of 16-18 years was a protective factor compared with ≤16 years of age (OR = 0.858, 95% CI: 0.749-0.982). In contrast, participants with a history of abortion were 1.212 times more likely to have cardiometabolic disorders (OR = 1.212, 95% CI: 1.006-1.465). The likelihood for the presence of unmeasured confounding was low, as reflected by E-values. Conclusions: Our findings demonstrate that number of children, age at menarche, and history of abortion were associated with a significant risk of cardiometabolic disease among Chinese women aged ≥45 years.