Change in quality of life among community-dwelling older adults: population-based longitudinal study.

PURPOSE: This population-based study aimed to determine 5-year change in multidimensional QoL among community-dwelling older people, and to identify predictors of QoL change among demographic, socioeconomic, and health characteristics. METHODS: Data of the 2011 and 2016 annual assessments of 1845 older men and women (age range 68-77 years) from the Lc65 + cohort study were used. QoL was assessed using a 28-item instrument yielding a QoL overall score and seven domain-specific QoL subscores. Additional ratings of QoL included a single item (excellent; very good; good; fair; poor), expected QoL in 1 year (better; worse; same as today), and retrospective assessment of QoL 5-year change (better; worse; same as 5 years ago). The predictors of 5-year change in the QoL score were assessed using linear regression, controlling for baseline QoL score. RESULTS: All prospective and retrospective indicators of QoL converged towards a slight deterioration over 5 years. QoL subscores significantly decreased in domains "Close entourage" (P = 0.004), "Social and cultural life" (P < 0.001), "Esteem and recognition" (P = 0.001), "Health and mobility" (P < 0.001), and "Autonomy" (P < 0.001), whereas "Material resources" (P = 0.345) and "Feeling of safety" (P = 0.380) remained stable. A stronger decrease in QoL was observed in the most vulnerable profiles at baseline in terms of demographic, socioeconomic, and health characteristics. Changes in depressive symptoms and in disability-either worsening or improving-predicted QoL change in the expected direction. CONCLUSIONS: Age-related decline in QoL may be limited through the prevention of disability and depressive symptoms, and more generally by devoting special attention to vulnerable profiles.

Trajectories of phenotypical frailty over a decade in young-old community-dwelling adults: results from the Lc65+ study.

BACKGROUND: Few studies have examined the frailty trajectories of young-old adults using Fried frailty phenotype. Dropouts due to death were rarely taken into account. This longitudinal study aimed to identify trajectories with and without adjustment for non-random attrition and to analyse related factors. METHODS: We used the first two samples of community-dwelling people in the Lausanne cohort 65+. Frailty phenotype was assessed at age 66-71 years and every third year over 10 years. A group-based trajectory modelling-first without and then with adjustment for non-random attrition-identified trajectories among all individuals with at least two observations (n=2286), excluding dropouts for reasons other than death. Multinomial logistic regressions estimated independent effects of participants' baseline characteristics. RESULTS: We identified three frailty trajectories (low, medium and high). Participants in the highest trajectory had a higher mortality over 10 years. (Pre)frailty at baseline was the main factor associated with adverse trajectories. Smoking, obesity, comorbidity and negative self-perceived health were associated with unfavourable trajectories independently of baseline frailty, while social engagement was related to the lowest frailty trajectory. Ignoring transitions to death attenuated the estimated effects of age on trajectories. CONCLUSIONS: Fried frailty phenotype should be assessed in individuals aged late 60s as it is strongly associated with frailty trajectories in the following decade of their life. Lifetime prevention of behavioural risk factors such as smoking and obesity is the strategy most likely to influence the development of frailty in older populations. Furthermore, our results underline social engagement as an important area of interest for future research.

Bi-directional associations between religious attendance and mental health: findings from a British birth cohort study.

BACKGROUND: There is evidence that religious attendance is associated with positive outcomes for mental health; however, there are few longitudinal studies, and even fewer, which take into account the possibility of bi-directional associations. This study aimed to investigate bi-directional associations between religious attendance and mental health. METHODS: Participants were 2125 study members who provided data at age 68-69 from the Medical Research Council National Survey of Health and Development (1946 British birth cohort study). Mental health was assessed using the 28-item General Health Questionnaire at ages 53, 60-64 and 68-69. Religious attendance was measured using a 4-point scale (weekly=3, monthly=2, less than monthly=1 or never=0) at ages 43, 60-64 and 68-69. Cross-lagged path analysis was used to assess reciprocal associations between mental health and religious attendance, adjusting for gender and education. RESULTS: Previous religious attendance was strongly related to later attendance (r=0.62-0.74). Similarly, mental health at baseline was strongly associated with subsequent mental health scores (r=0.46-0.54). Poor mental health at age 53 and 60-64 was associated with more frequent religious attendance at age 60-64 (b=0.04; 95% CI: 0.02 to 0.06; p<0.05), and 68-69 (b=0.03; 95% CI: 0.02 to 0.06; p<0.05), respectively. There was no evidence that religious attendance at age 43, 60-64 or 68-69 was associated with later or concurrent mental health. CONCLUSION: Using birth cohort data from the UK, it was found that poor mental health was associated with later religious attendance but not vice versa. Future research should confirm these novel findings and explore the underlying mechanisms between religious attendance and mental health.

Association between community-level social capital and frailty onset among older adults: a multilevel longitudinal study from the Japan Gerontological Evaluation Study (JAGES).

BACKGROUND: Little is known about the prospective association between community-level social capital and individual-level frailty onset. Therefore, this study aimed to examine the impact of community-level social capital on frailty onset among older adults using 3-year longitudinal data. METHODS: This prospective cohort study recruited non-institutionalised older adults from the Japan Gerontological Evaluation Study, established in 2013 and robust older adults were followed up for 3 years. We assessed three aspects of community-level social capital (civic participation, social cohesion and reciprocity), and employed a multilevel logistic regression analysis; frailty was evaluated using the Kihon Checklist questionnaire, which has been widely used as a screening tool for frailty in Japan. RESULTS: In total, 21 940 older adults (from 384 communities) who were robust at baseline (2013) completed the follow-up survey (2016). Participants' mean age (SD) was 71.8 (4.9) years, and 51.2% were female. In the follow-up period, frailty onset occurred in 622 participants (2.8%). Regarding community-level social capital variables, civic participation was inversely associated with frailty onset (OR=0.94, 95% CI 0.90 to 0.97, p=0.001), after adjusting for individual-level and community-level covariates. The potential intermediate factors of individual social relationships and health behaviours did not largely change the results. This association was found regardless of individual socioeconomic status. CONCLUSIONS: Living in a community with rich civic participation, such as engagement in social activities, was associated with lower frailty onset among older adults. Community development that fosters social participation is essential for frailty prevention.

Trajectories of work ability from mid-life to pensionable age and their association with retirement timing.

BACKGROUND: This study aimed to identify the trajectories of work ability over 16 years preceding the individual pensionable age and to examine the association with retirement timing. METHODS: The study population consisted of 2612 public sector employees from the Finnish Retirement and Aging study and the Finnish Public Sector study. Participants were grouped into 'no-extension' (retired at the individual pensionable date or worked no longer than 6 months after that date) and 'extension' (worked more than 6 months after individual pensionable age). Trajectories of self-reported work ability score (0-10) in maximum of eight measurement points over 16 years preceding retirement were examined using the group-based latent trajectory analysis. Log-binomial regression was used to analyse the association between trajectory groups and extended employment. RESULTS: Four stable ('Stable excellent', 7%; 'Stable high', 62%; 'Stable medium', 24%; 'Low', 4%) and one decreasing ('Declining', 3%) work ability trajectories were identified. After taking into account gender, age, occupational status, marital status and self-rated health, 'Stable excellent' trajectory was associated with a higher likelihood of extended employment compared with the 'Low' (risk ratio (RR) 2.38, 95% CI 1.21 to 4.68) and to the 'Declining' (RR 2.82, 95% CI 1.32 to 6.01) trajectories. There was no difference in retirement timing between 'Declining', 'Low' and 'Stable medium' trajectories. CONCLUSION: Work ability remained relatively stable among majority of the participants over 16 years of follow-up. Stable excellent work ability from mid-life to late career was associated with higher likelihood of extending employment beyond individual pensionable age than those with low or declining work ability.

Social and physical neighbourhood characteristics and loneliness among older adults: results from the MINDMAP project.

BACKGROUND: Loneliness is associated with several adverse mental and physical health outcomes in older adults. Previous studies have shown that a variety of individual-level and perceived area-level characteristics are associated with loneliness. This study examined the associations of objectively measured social and physical neighbourhood characteristics with loneliness. METHODS: We used cross-sectional data from 1959 older adults (63-98 years) who participated in the Longitudinal Ageing Study Amsterdam (LASA; wave 2011/12) and the Health and Living Conditions of the Population of Eindhoven and Surroundings study (GLOBE; wave 2014) in the Netherlands. Study-specific loneliness scores were harmonised across both cohort studies and divided into tertiles denoting low, medium and high levels of loneliness. Objectively measured neighbourhood characteristics, including area-level percentages of low educated residents, social security beneficiaries and unoccupied dwellings, average income, crime levels and land use mix, were linked to individual-level data. Multinomial logistic regression analyses were conducted to examine the associations of interest. RESULTS: There was no statistical evidence for an association of the included neighbourhood characteristics with loneliness. Although not statistically significant, the observed associations suggested that participants living in neighbourhoods with more heterogeneous land use mix were less likely to have a medium and high level of loneliness than those living in more homogeneous neighbourhoods in terms of land use mix (ORmedium=0.54, 95% CI=0.18-1.67; ORhigh=0.67, 95% CI=0.21-2.11). CONCLUSION: The results indicate that the included objectively measured social and physical neighbourhood characteristics are not associated with loneliness in old age.

Attitudes to ageing, biomarkers of ageing and mortality: the Lothian Birth Cohort 1936.

OBJECTIVE: To investigate whether people with more positive attitudes to ageing are biologically younger as defined by leucocyte telomere length, accelerated DNA methylation GrimAge (AgeAccelGrim) and brain-predicted age difference, and whether these biomarkers explain relationships between attitudes to ageing and mortality. METHODS: We used linear regression to examine cross-sectionally attitudes to ageing (measured using the Attitudes to Ageing Questionnaire) and the three biomarkers in 758 adults, mean age 72.5 years, from the Lothian Birth Cohort 1936. We used Cox proportional hazards models to examine longitudinally attitudes to ageing and mortality and the role of the biomarkers. RESULTS: More positive attitude to physical change was associated with younger biological age, as measured by AgeAccelGrim and brain-predicted age difference in age-adjusted and sex-adjusted models: for an SD higher score, AgeAccelGrim was lower by -0.73 (95% CI -1.03 to -0.42) of a year, and brain-predicted age difference was lower by -0.87 (1.51 to 0.23) of a year. Both associations were attenuated by adjustment for covariates and not significant after simultaneous adjustment for all covariates and correction for multiple testing. More positive attitudes to physical change were associated with lower mortality: for an SD higher score the age-adjusted and sex-adjusted HR (95% CI) was 0.66 (0.56 to 0.78). Adjustment for AgeAccelGrim or brain-predicted age difference attenuated this association slightly. It remained significant after adjustment for all covariates. CONCLUSION: We found partial evidence that attitudes to ageing are linked with ageing biomarkers but they accounted for only a little of the association between attitudes and mortality.

Leveraging naturally occurring variation in financial stress to examine associations with inflammatory burden among older adults.

BACKGROUND: Financial strain is associated with earlier disability and mortality, but causal links are underexplored, partly because it is unethical to randomise people to financial stress. This study leverages naturally occurring random variation in days since monthly Social Security payment arrival among older adults to test associations with inflammatory biomarkers. METHODS: Biomarker data, including tumour necrosis factor (TNF)-α, interleukin (IL)-6 and C reactive protein (CRP), was collected from 2155 non-working healthy adults aged 70-79 years, participating in the Health, Aging and Body Composition Study. Days since payment arrival was independent of all demographic, socioeconomic or health characteristics measured in this study. Restricted cubic spline models estimated associations separately for each week of the month, stratified by financial strain status (interaction term p value for TNF-α model <0.05). RESULTS: Among financially strained older adults, more days since payment arrival was associated with higher TNF-α levels during the first week of the month (coefficient=0.102). Associations with IL-6 and CRP differed depending on the degree of financial strain (interaction term p values <0.05). Those with low, but not high, strain had lower levels of IL-6 (coefficient=-0.152) and CRP (coefficient=-0.179) during the first week. CONCLUSIONS: Days since monthly payments were associated with inflammatory cytokines among older adults who have difficulty making ends meet financially and associations depended on financial strain severity, suggesting that results are attributable to monthly variation in financial stress. Future research should examine whether more frequent Social Security disbursement would modify financial strain and inflammatory biomarkers.

Ageing trajectories of health-longitudinal opportunities and synergies (ATHLOS) Healthy Ageing Scale in adults from 16 international cohorts representing 38 countries worldwide.

BACKGROUND: Uniform international measurement tools for assessing healthy ageing are currently lacking. OBJECTIVES: The study assessed the novel comprehensive global Ageing Trajectories of Health: Longitudinal Opportunities and Synergies (ATHLOS) Healthy Ageing Scale, using an Item Response Theory approach, for evaluating healthy ageing across populations. DESIGN: Pooled analysis of 16 international longitudinal studies. SETTING: 38 countries in five continents. SUBJECTS: International cohort (n=355 314), including 44.4% (n=153 597) males, aged (mean±SD) 61.7±11.5 years old. METHODS: The ATHLOS Healthy Ageing Scale (including 41 items related to intrinsic capacity and functional ability) was evaluated in a pooled international cohort (n=355 314 from 16 studies) according to gender, country of residence and age group. It was also assessed in a subset of eight cohorts with ≥3 waves of follow-up assessment. The independent samples t-test and Mann-Whitney test were applied for comparing normally and skewed continuous variables between groups, respectively. RESULTS: The ATHLOS Scale (range: 12.49-68.84) had a mean (±SD) value of 50.2±10.0, with males and individuals >65 years old exhibiting higher and lower mean scores, respectively. Highest mean scores were detected in Switzerland, Japan and Denmark, while lowest in Ghana, India and Russia. When the ATHLOS Scale was evaluated in a subset of cohorts with ≥3 study waves, mean scores were significantly higher than those of the baseline cohort (mean scores in ≥3 study waves vs baseline: 51.6±9.4 vs 50.2±10.0; p<0.01). CONCLUSIONS: The ATHLOS Healthy Ageing Scale may be adequately applied for assessing healthy ageing across populations.

Is perceived neighbourhood physical disorder associated with muscle strength in middle aged and older men and women? Findings from the US health and retirement study.

BACKGROUND: Research documenting the relevance of neighbourhoods for the health of older adults has focused on global physical functioning outcomes, such as disability, rather than physiologic impairments that lead to disability. Muscle weakness is an age-related impairment and a central mechanism of disability. Evaluating neighbourhood effects on muscle weakness may offer insight into physiologic mechanisms of disability. We examined the association between perceived neighbourhood disorder and muscle strength in a nationally representative sample of US adults aged 51+. METHODS: Among 11 277 participants (57% women; mean age: 66.6 years) in the Health and Retirement Study (2012-2014), we investigated whether self-reported neighbourhood physical disorder (1-7 scale, mean=2.61, SD=1.45); presence of vandalism/graffiti, litter, deserted houses, feeling safe walking alone) was associated with mean hand grip strength using linear regression models with sampling weights. We tested whether the association between neighbourhood disorder and grip strength differed by age and gender. RESULTS: After adjusting for demographic characteristics, marital status, education and household wealth, residence in neighbourhoods with high perceived physical neighbourhood disorder was associated with lower muscle strength for men (ß=-1.95 kg; 95% CI, 2.68 to -1.22) and to a lesser extent, for women (ß=-0.64 kg, 95% CI, -1.11 to -0.19), (p for interaction <0.0001). For both men and women, associations between neighbourhood physical disorder and grip strength were more adverse among the middle aged (51-64 years) than for older (ages 65+) adults. DISCUSSION: Perceived neighbourhood disorder was associated with lower muscle strength. Future studies should more rigorously evaluate causality and evaluate potential interventions.

Public transit and depression among older adults: using agent-based models to examine plausible impacts of a free bus policy.

BACKGROUND: Daily transport is associated with mental health. A free bus policy (FBP) may be effective in promoting the use of public transit in older adults and be associated with reductions in depressive symptoms. METHODS: We developed an agent-based model and grounded it using empirical data from England to examine the impact of an FBP on public transit use and depression among older adults. We also used the model to explore whether the impact of the FBP bus use and depression is modified by the type of income segregation or by simultaneous efforts to improve attitudes towards the bus, to reduce waiting times or to increase the cost of driving via parking fees or fuel price. RESULTS: Our model suggests that improving attitudes towards the bus (eg, campaigns that promote bus use) could enhance the effect of the FBP, especially for those in proximity to public transit. Reducing wait times could also significantly magnify FPB impacts, especially in those who live in proximity to public transit. Contrary to expectation, neither fuel costs nor parking fees significantly enhanced the impact of the FBP. The impact of improving attitudes towards the bus and increasing bus frequency was more pronounced in the lower-income groups in an income segregation scenario in which destination and public transit are denser in the city centre. CONCLUSION: Our results suggest that the beneficial mental health effects of an FBP for older adults can be magnified when combined with initiatives that reduce bus waiting times and increased spatial access to transit.

Effects of social network diversity on mortality, cognition and physical function in the elderly: a longitudinal analysis of the Chicago Health and Aging Project (CHAP).

BACKGROUND: Having a larger social network has been shown to have beneficial effects on health and survival in adults, but few studies have evaluated the role of network diversity, in addition to network size. We explore whether social network diversity is associated with mortality, cognition and physical function among older black and white adults. METHODS: Data are obtained from the Chicago Health and Aging Project, a longitudinal, population-based study of adults aged 65 years and older at baseline. Using Cox proportional hazards regression, we estimate the hazard of mortality by network diversity (n=6497). The association between network diversity and cognition (n=6560) and physical function (n=6561) is determined using generalised estimating equations. Models were adjusted for age, gender, race, socioeconomic status, marital status and health-related variables. RESULTS: In fully adjusted models, elderly with more diverse social networks had a lower risk of mortality (HR=0.93, p<0.01) compared with elderly with less diverse networks. Increased diversity in social networks was also associated with higher global cognitive function (coefficient=0.11, p<0.001) and higher physical function (coefficient=0.53, p<0.001). CONCLUSIONS: Social networks are particularly important for older adults as they face the greatest threats to health and depend on network relationships, more than younger individuals, to meet their needs. Increasing diversity, and not just increasing size, of social networks may be essential for improving health and survival among older adults.

Combined healthy lifestyle behaviours and incident disability in an elderly population: the Ohsaki Cohort 2006 Study.

BACKGROUND: The joint impact of healthy lifestyle behaviours (HLBs) on incident disability among elderly populations is still uncertain. This cohort study was conducted to estimate the population-attributable fraction (PAF) of combined HLBs for disability reduction in elderly Japanese. METHODS: We analysed 10-year follow-up data for 9910 community-dwelling elderly people (≥65 years) in a prospective cohort study. Information on lifestyle behaviours and food consumption was collected via a questionnaire in 2006. The exposure variable was defined as a healthy lifestyle index (HLI), which represented the summed number of HLBs ('never or former smoker', 'time spent walking ≥0.5 hour/day' and 'vegetable and fruit consumption volume ≥median'). Data on incident disability were retrieved from the public Long term Care Insurance database. HRs and 95% CIs were estimated by Cox proportional regression and the PAFs and their 95% CIs were estimated with the multivariate-adjusted model. RESULTS: The 10-year incidence of disability was 35.7%. An inverse dose-response relationship was observed (HR (95% CI): 0.85(0.81 to 0.90) for each one-point increase of the HLI score, p-trend <0.001). Based on multivariate-adjustment, adherence to each one additional HLB gives PAF of 10.5%(95% CI 9.0% to 12.0%) for disability reduction. The PAF would have been 25.9%(14.2% to 36.0%) if all subjects had adhered to all three HLBs. CONCLUSION: Combined HLBs may have a substantial impact on reducing the risk of incident disability among elderly people. Even having one more healthy lifestyle habit may bring considerable benefit.

Alcohol consumption, smoking and development of visible age-related signs: a prospective cohort study.

BACKGROUND: Visible age-related signs indicate biological age, as individuals that appear old for their age are more likely to be at poor health, compared with people that appear their actual age. The aim of this study was to investigate whether alcohol and smoking are associated with four visible age-related signs (arcus corneae, xanthelasmata, earlobe crease and male pattern baldness). METHODS: We used information from 11 613 individuals in the Copenhagen City Heart Study (1976-2003). Alcohol intake, smoking habits and other lifestyle factors were assessed prospectively and visible age-related signs were inspected during subsequent examinations. RESULTS: The risk of developing arcus corneae, earlobe crease and xanthelasmata increased stepwise with increased smoking as measured by pack-years. For alcohol consumption, a high intake was associated with the risk of developing arcus corneae and earlobe crease, but not xanthelasmata. CONCLUSIONS: High alcohol consumption and smoking predict development of visible age-related signs. This is the first prospective study to show that heavy alcohol use and smoking are associated with generally looking older than one's actual age.

Assessing the measurement properties of a Frailty Index across the age spectrum in the Canadian Longitudinal Study on Aging.

BACKGROUND: Frailty is a way to appreciate the variable vulnerability to declining health status of people as they age. No consensus for measuring frailty has been established. This study aimed to adapt a Frailty Index (FI) to the Canadian Longitudinal Study on Aging (CLSA) and evaluate its applicability in both younger and older adults. METHODS: An FI was created based on 90 potential health deficits collected from adults aged 45-85 years at recruitment (N=21 241, 49.0% male). The construct validity of this instrument and the factor structure of the health deficits were evaluated. RESULTS: The direction of associations between the FI and other variables were consistent with a priori hypotheses for construct validity. FI values were significantly associated with age (r=0.17; p<0.001), falls (r=0.12; p<0.001), injuries (r=0.12; p<0.001), formal home care (r =0.30; p<0.001), informal home care (r=0.32; p<0.001) and use of assistive devices (r=0.40; p<0.001). Values were negatively associated with male sex (r=-0.12; p<0.001), income (r=-0.34; p<0.001) and education (r=-0.17; p<0.001). Key factors among the health indicators were physical functioning, satisfaction with life and depressive symptoms. Results did not change when the sample was stratified by age and sex. CONCLUSION: The FI is a feasible method to evaluate frailty and capture frailty-related heterogeneity in populations aged 45-85 years. In this study, the FI had good construct validity in middle-aged and older adults, showing expected correlations with sociodemographic factors consistently across age groups. This method can be easily reproduced in similar datasets, making the FI a generalisable instrument.

Does the risk of hospitalisation for ischaemic heart disease rise already before widowhood?

BACKGROUND: The death of a spouse has been shown to increase mortality from various causes, including ischaemic heart disease. It is unclear, however, whether cardiac problems are already on the rise before widowhood. METHODS: Using longitudinal register data of Finnish widows-to-be aged 65 and over at baseline (N=19 185), we assessed the risk of hospitalisation for ischaemic heart disease 18 months before and after widowhood. Hospital admissions were derived from national hospital discharge registers between 1996 and 2002. Analyses used population-averaged and fixed-effects logistic models, the latter of which controlled for unobserved time-invariant characteristics, such as genetic susceptibility, personality and behavioural and medical history. RESULTS: For men, fixed-effects model revealed that hospitalisation for ischaemic heart disease increased twofold already 0-3 months prior to the death of a spouse (OR=2.09, 95% CI 1.22 to 3.60), relative to the period of 15-18 months before widowhood. It stayed at a heightened level up to 6 months following bereavement (OR=2.15, 95% CI 1.07 to 4.30). Among women, the fixed-effects analysis detected no statistically significant increase in hospitalisation for ischaemic heart disease before or after widowhood. CONCLUSIONS: These findings indicate that men are already vulnerable to cardiac problems before the death of a wife. Medical interventions and health counselling could be targeted to the husbands of terminally ill patients, in order to improve their cardiovascular health over the transition to widowhood.

Impact of socioeconomic position on frailty trajectories in 10 European countries: evidence from the Survey of Health, Ageing and Retirement in Europe (2004-2013).

BACKGROUND: Whether or not, and how, health inequalities change throughout older age is currently under debate. The goal of this study was to assess the net impact of education, occupational class, income and wealth on frailty trajectories among older adults in Continental Europe. METHODS: We modelled frailty index trajectories within a repeated cohort design among the community-dwelling population (50+) in 10 countries, using growth curve models based on 54 036 observations from 20 965 respondents in 4 waves (2004-2013) of the Survey of Health, Ageing and Retirement in Europe. RESULTS: Gaps in frailty due to education, occupational class and wealth continued throughout old age, while the gap due to income, smaller in comparison, converged. Frailty levels were higher and trajectories steeper in later birth cohorts, and the impact of education increased over time. Frailty levels and growth curves were higher in Southern European countries, and results were consistent across countries regarding the continuous effect of education and occupation and more mixed regarding wealth and income. CONCLUSIONS: Health inequalities due to education, occupational class and wealth tend to persist throughout old age, whereas the negligible effect of income declines with age, which, substantially, highlights the importance of social conditions on the pace of physiological decline in older Europeans and, methodologically, highlights the need to assess multiple measures of socioeconomic position.

Association of retirement age with mortality: a population-based longitudinal study among older adults in the USA.

BACKGROUND: Retirement is an important transitional process in later life. Despite a large body of research examining the impacts of health on retirement, questions still remain regarding the association of retirement age with survival. We aimed to examine the association between retirement age and mortality among healthy and unhealthy retirees and to investigate whether sociodemographic factors modified this association. METHODS: On the basis of the Health and Retirement Study, 2956 participants who were working at baseline (1992) and completely retired during the follow-up period from 1992 to 2010 were included. Healthy retirees (n=1934) were defined as individuals who self-reported health was not an important reason to retire. The association of retirement age with all-cause mortality was analysed using the Cox model. Sociodemographic effect modifiers of the relation were examined. RESULTS: Over the study period, 234 healthy and 262 unhealthy retirees died. Among healthy retirees, a 1-year older age at retirement was associated with an 11% lower risk of all-cause mortality (95% CI 8% to 15%), independent of a wide range of sociodemographic, lifestyle and health confounders. Similarly, unhealthy retirees (n=1022) had a lower all-cause mortality risk when retiring later (HR 0.91, 95% CI 0.88 to 0.94). None of the sociodemographic factors were found to modify the association of retirement age with all-cause mortality. CONCLUSIONS: Early retirement may be a risk factor for mortality and prolonged working life may provide survival benefits among US adults.

The association of grip strength from midlife onwards with all-cause and cause-specific mortality over 17†years of follow-up in the Tromsø Study.

BACKGROUND: Grip strength has consistently been found to predict all-cause mortality rates. However, few studies have examined cause-specific mortality or tested age differences in these associations. METHODS: In 1994, grip strength was measured in the population-based Tromsø Study, covering the ages 50-80 years (N=6850). Grip strength was categorised into fifths, and as z-scores. In this cohort study, models with all-cause mortality and deaths from specific causes as the outcome were performed, stratified by sex and age using Cox regression, adjusting for lifestyle-related and health-related factors. RESULTS: During 17 years of follow-up, 2338 participants died. A 1 SD reduction in grip strength was associated with HR=1.17 (95% CI 1.12 to 1.22) for all-cause mortality in a model adjusted for age, gender and body size. This association was similar across all age groups, in men and women, and robust to adjustment for a range of lifestyle-related and health-related factors. Results for deaths due to cardiovascular disease (CVD), respiratory diseases and external causes resembled those for all-cause mortality, while for cancer, the association was much weaker and not significant after adjustment for lifestyle-related and health-related factors. CONCLUSIONS: Weaker grip strength was associated with increased all-cause mortality rates, with similar effects on deaths due to CVD, respiratory disease and external causes, while a much weaker association was observed for cancer-related deaths. These associations were similar in both genders and across age groups, which supports the hypothesis that grip strength might be a biomarker of ageing over the lifespan.

Understanding poor health behaviours as predictors of different types of hospital admission in older people: findings from the Hertfordshire Cohort Study.

BACKGROUND: Rates of hospital admission are increasing, particularly among older people. Poor health behaviours cluster but their combined impact on risk of hospital admission among older people in the UK is unknown. METHODS: 2997 community-dwelling men and women (aged 59-73) participated in the Hertfordshire Cohort Study (HCS). We scored (from 0 to 4) number of poor health behaviours engaged in at baseline (1998-2004) out of: current smoking, high weekly alcohol, low customary physical activity and poor diet. We linked HCS with Hospital Episode Statistics and mortality data to 31/03/2010 and analysed associations between the score and risk of different types of hospital admission: any; elective; emergency; long stay (>7 days); 30-day readmission (any, or emergency). RESULTS: 32%, 40%, 20% and 7% of men engaged in 0, 1, 2 and 3/4 poor health behaviours; corresponding percentages for women 51%, 38%, 9%, 2%. 75% of men (69% women) experienced at least one hospital admission. Among men and women, increased number of poor health behaviours was strongly associated (p<0.01) with greater risk of long stay and emergency admissions, and 30-day emergency readmissions. Hazard ratios (HRs) for emergency admission for 3/4 poor health behaviours in comparison with none were: men, 1.37 (95% CI 1.11 to 1.69); women, 1.84 (95% CI 1.22 to 2.77). Associations were unaltered by adjustment for age, body mass index and comorbidity. CONCLUSIONS: Clustered poor health behaviours are associated with increased risk of hospital admission among older people in the UK. Lifecourse interventions to reduce number of poor health behaviours could have substantial beneficial impact on health and use of healthcare in later life.