Designing mosaic landscapes for sustainable outcome: Evaluating land-use options on ecosystem service provisioning in southwestern Ghana.

The landscape in southwestern Ghana faces rampant modification due to socio-economic activities, posing threats to ecosystem service provision and environmental sustainability. Addressing these threats involves empowering land-use actors to design landscapes that offer multiple benefits concurrently. This study employs a geodesign framework, integrating participatory ecosystem service assessment and spatial simulations. This geodesign framework aims to design the landscape in a collaborative manner in a way that supports multiple benefits concurrently, mitigating the threats posed by landscape modification. Reflecting on local land-use perceptions during a workshop, we developed land-use options and land management strategies based on selected land-cover types. We identified urban greens, open space restoration, rubber mixed-stands, mangrove restoration, selective-cutting land preparation, soil conservation, and relay cropping as land-use options to target selected land-cover types of shrubland, cropland, smallholder rubber, smallholder palm, wetland, and settlement. The land management strategies translated into landscape scenarios based on local need conditions. We generated the local need conditions which translated into the landscape scenarios by reflecting on the location of land-cover types, 'change-effect' conditions within rubber, settlement, and cropland, and 'no-change'conditions within cropland. Results indicate synergies between the created landscape scenarios and ecosystem service provisioning, with 'no-change' within cropland providing the highest synergy and 'change-effect' within rubber providing the least synergy. Spatial modeling of local perceptions forms the novelty of this study, as the fusion of participatory assessments and spatial modeling allows for a more holistic understanding of the landscape, its services, and the potential implications of different management strategies. The geodesign framework facilitated the design of the complex heterogeneous landscape to visualize possibilities of maximizing multiple benefits and can be used for future planning on the landscape.

Impact of forest landscape restoration in combating soil erosion in the Lake Abaya catchment, Southern Ethiopia.

As an effect of forest degradation, soil erosion is among Ethiopia's most pressing environmental challenges and a major threat to food security where it could potentially compromise the ecosystem functions and services. As the effects of soil erosion intensify, the landscape's capacity to support ecosystem functions and services is compromised. Exploring the ecological implications of soil erosion is crucial. This study investigated the soil loss and land degradation in the Lake Abaya catchment to explore forest landscape restoration (FLR) implementation as a possible countermeasure to the effects. The study used a geographic information system (GIS)-based approach of the Revised Universal Soil Loss Equation (RUSLE) to determine the potential annual soil loss and develop an erosion risk map. Results show that 13% of the catchment, which accounts for approximately 110,000 ha, is under high erosion risk of exceeding the average annual tolerable soil loss of 10 t/ha/year. Allocation of land on steep slopes to crop production is the major reason for the calculated high erosion risk in the catchment. A scenario-based analysis was implemented following the slope-based land-use allocation proposal indicated in the Rural Land Use Proclamation 456/2005 of Ethiopia. The scenario analysis resulted in a reversal erosion effect whereby an estimated 3000 t/ha/year of soil loss in the catchment. Thus, FLR activities hold great potential for minimizing soil loss and contributing to supporting functioning and providing ecosystem services. Tree-based agroforestry systems are among the key FLR measures championed in highly degraded landscapes in Ethiopia. This study helps policymakers and FLR implementors identify erosion risk areas for future FLR activities. Thereby, it contributes to achieving the country's restoration commitment.

Participatory and Spatially Explicit Assessment to Envision the Future of Land-Use/Land-Cover Change Scenarios on Selected Ecosystem Services in Southwestern Ghana.

Settlement expansion and commercial agriculture affect landscape sustainability and ecosystem service provision. Integrated landscape approaches are promoted to negotiate trade-offs between competing land uses and their reconciliation. Incorporating local perceptions of landscape dynamics as basis for such negotiations is particularly relevant for sub-Saharan Africa, where most people depend on natural ecosystems for livelihoods and well-being. This study applied participatory scenario building and spatially explicit simulation to unravel perceptions of the potential impact of rubber and settlement expansion on the provision of selected ecosystem services in southwestern Ghana under a business-as-usual scenario. We collected data in workshops and expert surveys on locally relevant ecosystem services, their indicator values, and the probable land-use transitions. The data was translated into an assessment matrix and integrated into a spatially explicit modeling platform, allowing visualization and comparison of the impact on ecosystem service provision of land-use scenarios under rubber plantation and settlement expansion. The results show the capacity of current (2020) and future land-use patterns to provide locally relevant ecosystem services, indicating a decline in capacity of ecosystem service provisioning in the future compared to the 2020 land-use patterns, a threat to the benefits humans derive from ecosystems. This highlights urgent need for policies and measures to control the drivers of land-use/land-cover change. Furthermore, the results emphasize the importance of diversifying land-use/land-cover types for sustainable landscape development. The paper contributes new insights into how spatially explicit and semi-quantitative methods can make stakeholder perceptions of landscape dynamics explicit as a basis for implementing integrated landscape approaches.

Multimorbidity and Quality of Life: The Mediating Role of ADL, IADL, Loneliness, and Depressive Symptoms.

Background and Objectives: The ubiquity of multimorbidity makes it crucial to examine the intermediary factors linking it with quality of life (QoL). The objective was to examine to what extent the association between multimorbidity and QoL was mediated by functional and emotional/mental health and how these mediation pathways differed by sociodemographic factors (age, gender, education, and financial strain). Research Design and Methods: Data from Waves 4 to 8 of 36,908 individuals from the Survey of Health, Aging, and Retirement in Europe (SHARE) were included. Multimorbidity (exposure) was defined as having 2 or more chronic conditions. Mediators included limitations with (instrumental) activities of daily living (ADL and IADL), loneliness, and depressive symptoms. QoL (outcome) was assessed with the CASP-12 scale. Longitudinal model-based causal mediation analyses were performed to decompose the total association between multimorbidity and QoL into direct and indirect effects. Moderated mediation analyses tested for differences in mediation pathways by sociodemographic factors. Results: Multimorbidity was significantly associated with lower QoL (direct effect: b = -0.66). This association was mediated by ADL limitations (percentage mediated 0.97%), IADL limitations (3.24%), and depressive symptoms (16.70%), but not by loneliness. The mediation pathways were moderated by age, education, financial strain, and gender. Discussion and Implications: ADL, IADL, and depressive symptoms are crucial intermediary factors between multimorbidity and QoL in older European adults, with changing importance according to age, education, financial strain, and gender. The findings may help to increase the QoL of individuals with multimorbidity and redirect care efforts to these factors.

Physical activity matters for everyone's health, but individuals with multimorbidity benefit more.

Multimorbidity, defined as the presence of two or more chronic conditions, is increasingly prevalent and is a major contributor to ill health in old age. Physical activity (PA) is a key protective factor for health and individuals with multimorbidity could particularly benefit from engaging in PA. However, direct evidence that PA has greater health benefits in people with multimorbidity is lacking. The objective of the present study was to investigate whether the associations between PA and health were more pronounced in individuals with (vs. without) multimorbidity. We used data from 121,875 adults aged 50 to 96 years (mean age = 67 ± 10 years, 55% women) enrolled in the Survey of Health, Ageing and Retirement in Europe (SHARE). Multimorbidity and PA were self-reported. Health indicators were assessed using tests and validated scales. Variables were measured up to seven times over a 15-year period. Confounder-adjusted linear mixed-effects models were used to investigate the moderating role of multimorbidity on the associations of PA with the levels and trajectories of health indicators across aging. Results showed that multimorbidity was associated with declines in physical, cognitive, and mental health, as well as poorer general health. Conversely, PA was positively associated with these health indicators. We found a significant interaction between multimorbidity and PA, revealing that positive associations between PA and health indicators were strengthened in people with multimorbidity - although this stronger association became less pronounced in advanced age. These findings suggest that the protective role of PA for multiple health indicators is enhanced in individuals with multimorbidity.

Initial status and change in cognitive function mediate the association between academic education and physical activity in adults over 50 years of age.

Higher levels of academic education are associated with higher levels of physical activity throughout the lifespan. However, the mechanisms underlying this association are unclear. Cognitive functioning is a potential mediator of this association because higher levels of education are associated with better cognitive function, which is related to greater engagement in physical activity. Here, we used large-scale longitudinal data from 105,939 adults 50 years of age or older (55% women) from the Survey of Health, Ageing, and Retirement in Europe to investigate whether initial status and change in cognitive function mediate the relationship between education and change in physical activity. Education and physical activity were self-reported. Cognitive function was assessed based on delayed recall and verbal fluency. Academic education was assessed at the first measurement occasion. The other measures were collected seven times between 2004 and 2019. The mediating role of cognitive function was tested using longitudinal mediation analyses combined with growth curve models. We found that higher levels of education were associated with higher levels and slower decreases in cognitive function, which in turn predicted a lower decrease in physical activity across time. These results support the presence of an indirect effect of education on physical activity trajectories by affecting the intercept and slope of cognitive function. Specifically, these findings suggest that both the initial status and change in cognitive function mediate the association between academic education and change in physical activity. In addition, results revealed that, across the aging process, differences in cognitive function and physical activity widen between the low and high educated. In other words, this study demonstrates the long-lasting effect of education on cognitive function and physical activity. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Physical activity mediates the effect of education on mental health trajectories in older age.

OBJECTIVE: Why people with lower levels of educational attainment have poorer mental health than people with higher levels can partly be explained by financial circumstances. However, whether behavioral factors can further explain this association remains unclear. Here, we examined the extent to which physical activity mediates the effect of education on mental health trajectories in later life. METHODS: Data from 54,818 adults 50 years of age or older (55 % women) included in the Survey of Health, Aging and Retirement in Europe (SHARE) were analyzed using longitudinal mediation and growth curve models to estimate the mediating role of physical activity (baseline and change) in the association between education and mental health trajectories. Education and physical activity were self-reported. Mental health was derived from depressive symptoms and well-being, which were measured by validated scales. RESULTS: Lower education was associated with lower levels and steeper declines in physical activity over time, which predicted greater increases in depressive symptoms and greater decreases in well-being. In other words, education affected mental health through both levels and trajectories of physical activity. Physical activity explained 26.8 % of the variance in depressive symptoms and 24.4 % in well-being, controlling for the socioeconomic path (i.e., wealth and occupation). CONCLUSIONS: These results suggest that physical activity is an important factor in explaining the association between low educational attainment and poor mental health trajectories in adults aged 50 years and older.

Shaping farmers' beliefs, risk perception and adaptation response through Construct Level Theory in the southwest Iran.

Due to the severe effects of climate change on the agricultural sector, urgent action is required on the part of farmers and is, indeed, critical to reducing climate change impacts. However, reports globally revealed farmers' engagement in climate change adaptation is still insufficient, ambivalent, and inconsistent and farmers do not consider adaptation to be urgent. Researchers have argued that this issue is rooted in psychological biases beside other factors. Therefore, the aim of this study is to evaluate how psychological distance determines climate change beliefs, risk perception and adaptation strategies among Iranian farmers. A cross-sectional paper-based survey was conducted in the Dasht-e Azadegan county of Khuzestan province in southwest Iran. The study sample consisted of 250 farmers selected through a multi-stage random sampling process. An expert panel review and a pilot study were conducted to confirm convergent validity and reliability of the scales. The results confirm that all four dimensions of psychological distance influence water management adaptation strategies and non-farm activities. Moreover, all psychological dimensions, except the temporal dimension, affect adaptation in farming management. Thus, making climate change more proximal to decision makers could be a strategic way of encouraging individuals to take adaptive actions. This study emphasizes that concepts of psychological distance can be applied to help organizations (e.g., agriculture extension services) to understand farmers' risk perceptions and responses to climate change impacts and improve risk communication to better engage farmers in climate action.

Future-proofing ecosystem restoration through enhancing adaptive capacity.

Social-ecological ecosystem restoration involves interacting challenges, including climate change, resource overexploitation and political instability. To prepare for these and other emerging threats, we synthesized key restoration and social-ecological systems literature and derived three guiding themes that can help to enhance the adaptive capacity of restoration sites: (i) work with the existing system, (ii) create self-sustaining, adaptive systems, and (iii) foster diversity and participation. We propose a two-step approach and provide an example from Rwanda detailing the application of these principles. While site-specific activities have to be designed and implemented by local practitioners, our synthesis can guide forward-thinking restoration practice.

Personal and Professional Mitigation Behavioral Intentions of Agricultural Experts to Address Climate Change.

Mitigation activities, whether at the personal level relating to lifestyle or on the professional level, especially in the agriculture sector, are widely encouraged by scientists and policymakers. This research empirically analyses the association between agricultural experts' perceptions about climate change and their intention to implement climate change mitigation. Based on survey data, individuals' reported intention to implement personal and professional mitigation behavior is explained using a conceptual model. The structural equation modeling results suggest that the new ecological paradigm (NEP), institutional trust, and risk salience indirectly influence climate change mitigation intentions. The findings indicate that risk perception, personal efficacy, responsibility, belief in climate change occurring, and low psychological distance trigger a significantly greater intention to support personal and professional mitigation behaviors. However, the research framework is much stronger at predicting the intention to mitigate climate change in professional affairs compared to personal activities. The findings suggest that hypothetical distance factors only have a moderating effect on the relationship between higher climate change environmental values, institutional trust, risk salience, and mitigation intention. This paper analytically explores the regulating role of risk perception, hypothetical distance, personal efficacy, and responsibility between institutional trust, risk salience, and the NEP as independent concepts and intention to personal and professional mitigation behaviors as dependent variables. The findings of the study have important implications for encouraging personal and professional mitigation behaviors.

Intergenerational educational trajectories and inequalities in longevity: A population-based study of adults born before 1965 in 14 European countries.

Background: While educational gradients in longevity have been observed consistently in adult Europeans, these inequalities have been understudied within the context of family- and country-level influences. We utilized population-based multi-generational multi-country data to assess the role (1) of parental and individual education in shaping intergenerational inequalities in longevity, and (2) of country-level social net expenditure in mitigating these inequalities. Methods: We analyzed data from 52,271 adults born before 1965 who participated in the Survey of Health, Ageing and Retirement in Europe, comprising 14 countries. Mortality from all causes (outcome) was ascertained between 2013 and 2020. Educational trajectories (exposure) were High-High (reference), Low-High, High-Low, and Low-Low, corresponding to the sequence of parental-individual educational attainment. We quantified inequalities as years of life lost (YLL) between the ages of 50 and 90 estimated via differences in the area under standardized survival curves. We assessed the association between country-level social net expenditure and YLL via meta-regression. Results: Inequalities in longevity due to educational trajectories were associated with low individual education regardless of parental education. Compared to High-High, having High-Low and Low-Low led to 2.2 (95% confidence intervals: 1.0 to 3.5) and 2.9 (2.2 to 3.6) YLL, while YLL for Low-High were 0.4 (-0.2 to 0.9). A 1% increase in social net expenditure led to an increase of 0.01 (-0.3 to 0.3) YLL for Low-High, 0.007 (-0.1 to 0.2) YLL for High-Low, and a decrease of 0.02 (-0.1 to 0.2) YLL for Low-Low. Conclusion: In European countries, individual education could be the main driver of inequalities in longevity for adults older than 50 years of age and born before 1965. Further, higher social expenditure is not associated with smaller educational inequalities in longevity.

Women carry the weight of deprivation on physical inactivity: Moderated mediation analyses in a European sample of adults over 50 Years of age.

Deprived people are less physically active than privileged individuals. However, pathways underlying the association between deprivation and physical activity remain overlooked. We examined whether the association between deprivation and physical activity was mediated by body mass index (BMI). Consistent with an intersectional perspective (how the combination of belongingness to vulnerable social categories widens inequalities), we tested whether gender moderated this mediating pathway and hypothesized that the mediating effect of BMI would be stronger among women (vs men). Large-scale longitudinal data from 20,961 adults 50 years of age or older (57% women) from the Survey of Health, Ageing and Retirement in Europe were used. Social and material deprivation were measured by questionnaire, BMI and physical activity were reported from two to six years later. Simple mediation models showed that BMI partly mediated the association of material (total effect c = -0.14, proportion of mediated effect = 8%) and of social deprivation (c = -0.24, proportion of mediated effect = 4%) with physical activity. Moderated mediation models revealed that this mediating pathway was moderated by gender. The effect of deprivation on BMI was stronger among women (vs men), with BMI mediating 18% and 7% of the association of material and social deprivation with physical activity among women (vs 4% and 2% among men). Lower levels of physical activity observed among deprived older adults could be partly attributed to a higher BMI. Critically, this mechanism was exacerbated among women, reinforcing the need to understand how deprivation and gender interact to predict health behaviors.

Assessing Farmers' Diverse Preferences and Expectations for Tailoring Food and Nutrition Security Interventions in Southeastern Madagascar.

Background: Severe food and nutrition insecurity persists in Madagascar. The Atsimo Atsinanana region is among the most affected areas due to elevated poverty rates and low levels of resilience to frequent shocks. Implementing food and nutrition security (FNS) interventions could help to improve this situation, but to be effective and sustainable, intervention packages must fit the local context. Objectives: To identify locally suitable options, this study assessed the perceptions of local communities in rural Atsimo Atsinanana toward a range of FNS intervention options. Methods: We held 12 gender-disaggregated workshops with 80 prospective beneficiaries of an FNS project, from inland and coastal parts of the region. Preferences were elicited for 14 potential FNS interventions. Next, through participatory ex ante impact assessment, participants ranked 8 impact criteria and individually estimated expected impacts of all intervention options on these criteria. Results: Overall, participants preferred interventions targeting on-farm crop, vegetable, and livestock production. Income and food self-sufficiency were ranked as the highest intervention priorities. However, intervention preferences differed by gender and geographic location. Whereas preferences for interventions targeting dietary habits were weak across genders, women had relatively stronger preferences for these interventions than men. This shows that collecting gender-disaggregated preferences can enable more gender-sensitive choice of interventions. Preferences also reflected local livelihoods, as more market-oriented coastal sites showed stronger interest in income generation than more subsistence-oriented inland sites. The ex ante impact assessments highlight positive and negative expectations for most interventions, with increased labor burden being the most prominent negative impact overall. Conclusions: The findings suggest that participatory, multidimensional impact assessments before project implementation can support development stakeholders in tailoring intervention packages, considering 1) local and gendered preferences and 2) trade-offs among development objectives.

Effect of passive solar drying on food security in rural Mozambique.

Achieving food security in Mozambique is critical, since 80% of the population cannot afford an adequate diet. While increasing agricultural production is a necessary effort to address this challenge, inadequate post-harvest treatment leads to storage losses and quality degradation, with repercussions for food security. The use of solar drying is promoted as a solution to provide efficient and reliable access to food preservation that improves the food security situation in rural communities. However, there is a lack of clear evidence on how the use or access to solar drying affects food security. This study identifies the determinants of farmers' choice to use solar drying and evaluates the effect of a passive solar dryer on food security using survey data from 634 households. We allocated solar dryers to selected communities and all interested individuals belonging to these communities were eligible to use it. Propensity score matching and endogenous switching poisson regression are used to estimate the average effect. The use of solar drying with associated training significantly increases the food security status of participants by increasing household food availability, women's dietary diversity, and months of adequate household food provision and by decreasing the household food insecurity access scale.

Governing COVID-19: analyzing the effects of policy responses on food systems in Tanzania.

Background: The outbreak of the COVID-19 pandemic increased debates on global public health concerns. From early 2020 to 2022, globally, life was upended in the wake of the pandemic. Industries of all kinds were forced to rapidly changed how they work, including agriculture. Particularly for smallholder farmers in developing countries, the COVID-19 pandemic, coupled with climate change effects, negatively affected their livelihoods. Achieving the UN Sustainable Development Goals by 2030 is unrealistic if immediate efforts are not made to address the existential threats facing smallholder farmers. This study analyzes COVID-19 governance and policy responses, examining its effects on smallholder farmers in the south and east of Tanzania using both qualitative and quantitative techniques. Results: Findings show that mobility restrictions imposed by other countries and fears of the Tanzanian people leading to voluntary isolation resulted in an amended structure of farmers' markets: Reductions in exports, imports and in the purchasing power of the local people followed. Food security was diminished as food availability on the market level was reduced due to mobility restrictions. The impact of COVID-19 resulted in more than 85% of smallholder farmers experiencing an income reduction, thus also increasing the pre-existing vulnerability of these communities. Findings show that farms producing non-exported crops had less severe income reductions and could cope better. The results indicate that only 20% of smallholder farmers started using digital information technology to gather information since physical movements were restricted. Access to technology remained limited in rural areas. Even during the COVID-19 crises, farmers' concerns about the vulnerability of their food systems include non-COVID-19 causes, such as climate change. Conclusions: Although Tanzania did not impose a total lockdown, the country was affected by COVID-19, partly via policies of other countries. Impacts included: (i) a decline in local markets as smallholder farmers had fewer trading partners from neighboring states; (ii) a loss of employment opportunities due to the absence of both local and external trade; (iii) reductions of farm output and income; (iv) a lack of agricultural inputs (fertilizer etc.) that are usually imported; (v) fear to continue farming activities due to news about COVID-19 spreading; and (vi) reduction of work efficiency because of a lack of social gathering due to voluntary isolation.While COVID-19 compelled policymakers to make urgent decisions to ensure stable food supply chains, the fundamental task is to address these immediate disruptions while also investing in the long-term goal of a resilient, sustainable, and productive global food system. This can be achieved by adopting a policy package that includes investments in technological development, access to small long-term loans, and regulatory reforms, with which governments can create conditions supporting productive, sustainable, and resilient food systems that can withstand future shocks.

Physical inactivity amplifies the negative association between sleep quality and depressive symptoms.

Poor sleep quality and physical inactivity are known risk factors for depressive symptoms. Yet, whether these factors differently contribute to depressive symptoms and whether they interact with one another remains unclear. Here, we examined how sleep quality and physical activity influence depressive symptoms in 79,274 adults 50 years of age or older (52.4% women) from the Survey of Health, Aging and Retirement in Europe (SHARE) study. Sleep quality (poor vs. good), physical activity (inactive vs. active), and depressive symptoms (0 to 12 score) were repeatedly collected (7 waves of data collection) between 2004 and 2017. Results showed that sleep quality and physical activity were associated with depressive symptoms. Specifically, participants with poorer sleep quality reported more depressive symptoms than participants with better sleep quality (b = 1.85, 95% CI = 1.83-1.86, p < .001). Likewise, compared to physically active participants, physically inactive participants reported more depressive symptoms (b = 0.44, 95% CI = 0.42-0.45, p < .001). Moreover, sleep quality and physical activity showed an interactive association with depressive symptoms (b = 0.17, 95% CI = 0.13-0.20, p < .001). The negative association between poor sleep quality and higher depressive symptoms was stronger in physically inactive than active participants. These findings suggest that, in adults 50 years of age or older, both poor sleep quality and physical inactivity are related to an increase in depressive symptoms. Moreover, the detrimental association between poor sleep quality and depressive symptoms is amplified in physically inactive individuals.

Cognitive functions and physical activity in aging when energy is lacking.

Declines in subjective energy availability and cognitive functions could explain the decrease in physical activity observed across aging. However, how these factors interact remains unknown. Based on the theory of effort minimization in physical activity (TEMPA), we hypothesized that cognitive functions may help older adults to maintain physical activity even when energy availability is perceived as insufficient. This study used data of 104,590 adults from 21 European countries, from the Survey of Health, Ageing and Retirement in Europe (SHARE), including 7 measurement occasions between 2004 and 2017. Cognitive functions were assessed with verbal fluency and delayed recall, using the verbal fluency test and the 10-word delayed recall test. Physical activity and subjective energy availability were self-reported. Results of linear mixed-effects models revealed that cognitive functions moderated the associations between subjective energy availability and physical activity. Moreover, as adults get older, cognitive functions became critical to engage in physical activity regardless the availability of perceived energy. Sensitivity and robustness analyses were consistent with the main results. These results suggest that cognitive functions may help older adults to maintain regular physical activity even when energy for goal pursuit becomes insufficient, but that the protective role of cognitive functions becomes critical at older age, irrespective of the state of perceived energy. Supplementary Information: The online version contains supplementary material available at 10.1007/s10433-021-00654-2.

Physical activity partly mediates the association between cognitive function and depressive symptoms.

Cognitive function, physical activity, and depressive symptoms are intertwined in later life. Yet, the nature of the relationship between these three variables is unclear. Here, we aimed to determine which of physical activity or cognitive function mediated this relationship. We used large-scale longitudinal data from 51,191 adults 50 years of age or older (mean: 64.8 years, 54.7% women) from the Survey of Health, Ageing and Retirement in Europe (SHARE). Results of the longitudinal mediation analyses combined with autoregressive cross-lagged panel models showed that the model with physical activity as a mediator better fitted the data than the model with cognitive function as a mediator. Moreover, the mediating effect of physical activity was 8-9% of the total effect of cognitive function on depressive symptoms. Our findings suggest that higher cognitive resources favor the engagement in physical activity, which contributes to reduced depressive symptoms.

Life-course socioeconomic conditions, multimorbidity and polypharmacy in older adults: A retrospective cohort study.

Socioeconomic conditions across the life course may contribute to differences in multimorbidity and polypharmacy in old age. However, whether the risk of multimorbidity changes during ageing and whether life-course socioeconomic conditions are associated with polypharmacy remain unclear. We investigated whether disadvantaged childhood socioeconomic conditions (CSCs) predict increased odds of multimorbidity and polypharmacy in older adults, whether CSCs remain associated when adjusting for adulthood socioeconomic conditions (ACSs), and whether CSCs and ACSs are associated cumulatively over the life course. We used data for 31,432 participants (multimorbidity cohort, mean [SD] age 66·2[9] years), and 21,794 participants (polypharmacy cohort, mean age 69·0[8.9] years) from the Survey of Health, Ageing, and Retirement in Europe (age range 50-96 years). We used mixed-effects logistic regression to assess the associations of CSCs, ASCs, and a life-course socioeconomic conditions score (0-8; 8, most advantaged) with multimorbidity (≥2 chronic conditions) and polypharmacy (≥5 drugs taken daily). We found an association between CSCs and multimorbidity (reference: most disadvantaged; disadvantaged: odds ratio (OR) = 0·79, 95% confidence interval (CI) 0·70-0·90; middle: OR = 0·60; 95%CI 0·53-0·68; advantaged: OR = 0·52, 95%CI 0·45-0·60, most advantaged: OR = 0·40, 95%CI 0·34-0·48) but not polypharmacy. This multimorbidity association was attenuated but remained significant after adjusting for ASCs. The life-course socioeconomic conditions score was associated with multimorbidity and polypharmacy. We did not find an association between CSCs, life-course socioeconomic conditions, and change in odds of multimorbidity and polypharmacy with ageing. Exposure to disadvantaged socioeconomic conditions in childhood or over the entire life-course could predict multimorbidity in older age.