Chronic Conditions In Later Life Research Articles

Menopause as a window of opportunity: the benefits of designing more effective theory-driven behaviour change interventions to promote healthier lifestyle choices at midlife.

Menopause is a natural developmental phase that all women go through from their early forties to mid-fifties, marking the transition from the reproductive to the non-reproductive years. This is characterised as the permanent cessation of menses due to progressive ovarian failure. Each woman's experience of the menopause is unique. Biopsychosocial changes occur during this time with some symptoms affecting up to 80 % of women and lasting for 4-5 years from the peri- to post-menopause. Reduced oestrogen may predispose some women to health issues following menopause, such as heart disease, diabetes, stroke and cognitive decline. It is vital to understand how to promote health and well-being to reduce the risk of developing chronic conditions in later life. Increased symptoms and concerns about health during the menopausal transition can be cues to action for some women to actively maintain their health. Menopause represents a window of opportunity to promote health, and to support women to make healthier lifestyle choices, part of the National Institute for Clinical Excellence guidelines for menopause management. Identifying appropriate strategies to change behaviour is less clear. Theories of behaviour change can provide frameworks to gain more insight into the facilitators and barriers to behaviour and can inform the researcher on what needs to change. This information can be used to inform the design, content, implementation and evaluation of a lifestyle intervention. This review paper will explore the impact of menopause on health and well-being generally, and the benefits of designing more effective theory-driven behaviour change interventions for menopause.

Marital Status, Marital Transitions, and Sleep Quality in Mid to Late Life

Sleep is an important behavior in the prevention and management of chronic conditions in later life. Marital status may account for variability in sleep quality, but little is known about this association in the later part of life or how transitions into and out of marriage are related to changes in sleep quality. This study used the resource model and crisis model as frameworks to understand how marital status and marital transitions were related to sleep quality in mid to late life and whether these findings differed by gender. Interview data from 2,872 participants 50-74 years old (M=59.77 years; 63.7% women) from the ORANJ BOWL, a longitudinal panel study in New Jersey, were used. Marital status and sleep quality were examined in two waves approximately 10 years apart. All analyses controlled for health and sociodemographic characteristics. Weighted regressions revealed that individuals in committed romantic relationships and women had worse sleep quality than those in other marital status groups and men (p<.005). Weighted fixed effects regressions revealed that compared to individuals who remained married, individuals who remained divorced or widowed or who became widowed had better sleep quality, whereas those who became divorced had worse sleep quality (ps<.05); individuals who transitioned into marriage had better sleep quality than those who remained divorced or widowed (ps<.03). Findings differed depending on the index of sleep quality examined. Efforts to understand which middle-aged and older adults are most vulnerable to sleep disturbances can inform the design of interventions to promote better sleep quality.

Childhood Disadvantage and Later-Life Multimorbidity: Demonstrating Robustness Under Imperfect Identification

This study assesses the relationship between indicators of early childhood disadvantage and later-life multimorbidity within a nationally representative sample of Brazilians aged 50 and over (n = 9,412). Data come from the baseline assessment (2015/2016) of the Brazilian Longitudinal Study of Aging (ELSI). We employed survey-weighted Ordinary Least Squares regression to estimate the effects of individual and combined measures of childhood disadvantage on the total number of chronic conditions in later life. Mediation analysis assessed whether adult socioeconomic status (SES) mediated the relationship between childhood disadvantage and chronic conditions. We found that individual and combined measures of childhood disadvantage were associated with the total number of chronic conditions, even after controlling for potential confounders. Mediation analysis suggested that part of the effect of childhood adversity is mediated by higher SES in adulthood (~10%). A formal strategy of sensitivity analysis showed that omitted variable bias is extremely unlikely. To rule out the observed effect, an unobserved hypothetical confounder would need the explanatory power of the residual variance of both the independent and the dependent variables that is at least 30 times larger than that of BMI or 5 times larger than the explanatory power of age. Results should inform efforts to strengthen interventions targeting early childhood development and to improve other key inputs (such as education) to enhance adult SES and lessen the impact of early life stressors on health in older adulthood.

Adverse childhood experiences in relation to comorbid cardiovascular diseases and diabetes among middle-aged and old adults in China.

To examine whether various aspects of adverse childhood experiences (ACEs) are associated with comorbid cardiovascular diseases (CVDs) and diabetes among middle-aged and old adults in China. Using the 2018 China Health and Retirement Longitudinal Study survey and the 2014 Life History survey, in total, 17 115 respondents aged ≥45 years were included. Logistic regressions were applied to estimate the relationship between aspects of ACEs and diagnosis of both CVDs and diabetes while adjusting for adulthood demographics, health and health behaviors. Childhood hunger (OR=1.75, P < 0.01), childhood socioeconomic status (OR=1.45, P <0.05) and abuse from father (OR=1.50, P <0.05) were significantly associated with greater odds of comorbid CVDs and diabetes above and beyond adulthood characteristics. In addition, the effects of these ACEs on comorbidity were stronger than their effects on the single chronic condition. Our findings suggest that, for middle-aged and old Chinese adults, ACEs could have long-lasting impacts on multiple chronic conditions in later life. Public health interventions should focus on the early life stage as the protective childhood conditions might help in warning of later clustering chronic diseases. Geriatr Gerontol Int 2022; 22: 12-18.

Living with multimorbidity? The lived experience of multiple chronic conditions in later life.

Multimorbidity is defined biomedically as the co-existence of two or more long-term conditions in an individual. Globally, the number of people living with multiple conditions is increasing, posing stark challenges both to the clinical management of patients and the organisation of health systems. Qualitative literature has begun to address how concurrency affects the self-management of chronic conditions, and the concept of illness prioritisation predominates. In this article, we adopt a phenomenological lens to show how older people with multiple conditions experience illness. This UK study was qualitative and longitudinal in design. Sampling was purposive and drew upon an existing cohort study. In total, 15 older people living with multiple conditions took part in 27 in-depth interviews. The practical stages of analysis were guided by Constructivist Grounded Theory. We argue that the concept of multimorbidity as biomedically imagined has limited relevance to lived experience, while concurrency may also be erroneous. In response, we outline a lived experience of multiple chronic conditions in later life, which highlights differences between clinical and lay assumptions and makes the latter visible.

Childhood adversities and chronic conditions: examination of mediators, recall bias and age at diagnosis.

The aim of this study was to (1) identify the influence of childhood socioeconomic status (CSES) on five chronic conditions: asthma, bronchitis, hypothyroid, migraine, and psychiatric disorders in later life; (2) determine the mediating role of childhood abuse (CA) in these associations, and (3) quantify recall bias due to respondent's mental health in these associations. 10,325 men and women from the Tromsø Study were followed for 13years, and Poisson regression models were used. Low CSES was associated with a 16-23% higher risk of chronic conditions, and CA was associated with a 16-58% higher risk of chronic conditions (p<0.05). A minor proportion of the association between CSES and CA (3.98%, p<0.05); CSES and chronic conditions (5.54-8.71%, p<0.05); and CA and chronic conditions (9.51-19.52%, p<0.05), were driven by recall bias due to the respondent's mental health. CA mediated the association between CSES and chronic conditions (9.58-25.06%, p<0.05). Low CSES and CA are associated with higher risk of chronic conditions in later life. A minor proportion of these associations are driven by recall bias.

Early menarche, nulliparity and the risk for premature and early natural menopause.

STUDY QUESTIONAre parity and the timing of menarche associated with premature and early natural menopause?SUMMARY ANSWEREarly menarche (≤11 years) is a risk factor for both premature menopause (final menstrual period, FMP <40 years) and early menopause (FMP 40–44 years), a risk that is amplified for nulliparous women.WHAT IS KNOWN ALREADYWomen with either premature or early menopause face an increased risk of chronic conditions in later life and of early death. Findings from some studies suggest that early menarche and nulliparity are associated with early menopause, however overall the evidence is mixed. Much of the evidence for a direct relationship is hampered by a lack of comparability across studies, failure to adjust for confounding factors and inadequate statistical power.STUDY DESIGN, SIZE, DURATIONThis pooled study comprises 51 450 postmenopausal women from nine observational studies in the UK, Scandinavia, Australia and Japan that contribute to the International collaboration for a Life course Approach to reproductive health and Chronic disease Events (InterLACE).PARTICIPANTS/MATERIALS, SETTING, METHODSAge at menarche (categorized as ≤11, 12, 13, 14 and 15 or more years) and parity (categorized as no children, one child and two or more children) were exposures of interest. Age at FMP was confirmed by at least 12 months of cessation of menses where this was not the result of an intervention (such as surgical menopause due to bilateral oophorectomy or hysterectomy) and categorized as premature menopause (FMP before age 40), early menopause (FMP 40–44 years), 45–49 years, 50–51 years, 52–53 years and 54 or more years. We used multivariate multinomial logistic regression models to estimate relative risk ratio (RRR) and 95% CI for associations between menarche, parity and age at FMP adjusting for within-study correlation.MAIN RESULTS AND THE ROLE OF CHANCEThe median age at FMP was 50 years (interquartile range 48–53 years), with 2% of the women experiencing premature menopause and 7.6% early menopause. Women with early menarche (≤11 years, compared with 12–13 years) were at higher risk of premature menopause (RRR 1.80, 95% CI 1.53–2.12) and early menopause (1.31, 1.19–1.44). Nulliparity was associated with increased risk of premature menopause (2.26, 1.84–2.77) and early menopause (1.32, 1.09–1.59). Women having early menarche and nulliparity were at over 5-fold increased risk of premature menopause (5.64, 4.04–7.87) and 2-fold increased risk of early menopause (2.16, 1.48–3.15) compared with women who had menarche at ≥12 years and two or more children.LIMITATIONS, REASONS FOR CAUTIONMost of the studies (except the birth cohorts) relied on retrospectively reported age at menarche, which may have led to some degree of recall bias.WIDER IMPLICATIONS OF THE FINDINGSOur findings support early monitoring of women with early menarche, especially those who have no children, for preventive health interventions aimed at mitigating the risk of adverse health outcomes associated with early menopause.STUDY FUNDING/COMPETING INTEREST(S)InterLACE project is funded by the Australian National Health and Medical Research Council project grant (APP1027196). G.D.M. is supported by Australian Research Council Future Fellowship (FT120100812). There are no competing interests.

Learning about the experience of living with chronic conditions: A framework analysis of nursing students’ reflections on their conversations with older adults

ABSTRACTPreparing nursing students to work effectively with older adults is an important element of undergraduate nursing education. Reflective journals written as course assignments represent a source of data about students’ learning. The aim of this study was to analyze nursing students’ reflective journals based on conversations with older adults who are community dwelling, to identify learning in relation to experiences of living with a chronic condition. This was one element of a wider study to evaluate learning partnerships between older adults who are community dwelling and nursing students as an alternative to traditional clinical placements in long-term care settings. Nursing students worked with faculty to complete a qualitative secondary analysis of 47 journals utilizing framework analysis. Students learned about three main aspects of living with chronic conditions: beliefs about chronic conditions, managing chronic conditions, and experiencing chronic conditions, with some evidence that these themes may be interconnected. Findings suggest that learning partnerships with older adults combined with reflective journaling enable nursing students to understand the experience of chronic conditions in later life as reflected within current literature and to identify interventions for gerontological nursing practice. Enabling nursing students to recognize the highly skilled nature of working with older adults with chronic illness has the potential to influence their future career choices.

Midlife Fitness Predicts Less Burden of Chronic Disease in Later Life

To investigate the relationship between midlife fitness in healthy adults and the development of nonfatal chronic conditions (CCs) in older age. Cohort study. Data on participants were drawn from the Cooper Center Longitudinal Study and linked with US Medicare claims made in the years 1999 through 2009. The cohort included 18 670 participants (median age, 49 years; 21% women) who had received a comprehensive clinical examination between 1970 and 2009 at the Cooper Center, were ≥65 years of age and covered by Medicare between 1999 and 2009, and who reported no baseline history of CCs such as cardiovascular disease, diabetes, and cancer. The participants tended to be from upper educational and socioeconomic strata. Fitness was assessed by maximal treadmill effort using the modified Balke protocol. The participants' treadmill times were classified into age- and sex-specific quintiles (Q) of fitness (Q1, least fit) and converted into metabolic equivalents (MET). Clinical and anthropometric variables and physical activity were measured. The main outcome measure was the association between level of fitness in midlife (ie, at study entry) and the development of chronic conditions (specifically, congestive heart failure, ischemic heart disease, stroke, diabetes mellitus, chronic obstructive pulmonary disease, chronic kidney disease, Alzheimer's disease, and colon or lung cancer), recorded by Medicare. The conditions were each assigned a value of 1, and those present were summed for survivors at ages 70, 75, 80, and 85 years. Death was an additional outcome. Total follow-up was 120 780 person-years. At study entry the participants had, overall, low levels of traditional risk factors for CCs, with the less fit having somewhat less healthy risk factor profiles. The highest level of midlife fitness (Q5) was associated with developing fewer CCs compared with low midlife fitness (Q1) in men (15.6; 95% confidence interval [CI], 15.0-16.2 vs 28.2; 95% CI, 27.4-29.0 per 100 person-years) and women (11.4; 95% CI, 10.5-12.3 vs 20.1; 95% CI, 18.7-21.6 per 100 person-years). After multivariate adjustment, higher fitness remained associated with a lower risk of developing CCs (men: hazard ratio [HR], 0.95; 95% CI, 0.94-0.96 per MET; and women: HR, 0.94; 95% CI, 0.91-0.96 per MET). Level of fitness was similarly associated with the development of CCs in younger and older participants. Among the 2406 participants who died during the study period, the number of CCs among the more fit persons was significantly lower than that among the less fit; thus, in their final 5 years of life, 58.3% of fitness Q4 and Q5 versus 43.5% of Q1 had ≤1 CC and 9.5% of Q4 and Q5 versus 18.3% of Q1 had ≥4 CCs. Healthy, fit, middle-aged adults developed fewer chronic conditions in later life than unfit persons and had a lesser burden of chronic disease before death.

Midlife Fitness and the Development of Chronic Conditions in Later Life

BACKGROUND The association between cardiorespiratory fitness (fitness) and mortality is well described. However, the association between midlife fitness and the development of nonfatal chronic conditions in older age has not been studied. METHODS To examine the association between midlife fitness and chronic disease outcomes in later life, participant data from the Cooper Center Longitudinal Study were linked with Medicare claims. We studied 18670 healthy participants (21.1% women; median age, 49 years) who survived to receive Medicare coverage from January 1, 1999, to December 31, 2009. Fitness estimated by Balke treadmill time was analyzed as a continuous variable (in metabolic equivalents [METs]) and according to age- and sex-specific quintiles. Eight common chronic conditions were defined using validated algorithms, and associations between midlife fitness and the number of conditions were assessed using a modified Cox proportional hazards model that stratified the at-risk population by the number of conditions while adjusting for age, body mass index, blood pressure, cholesterol and glucose levels, alcohol use, and smoking. RESULTS After 120780 person-years of Medicare exposure with a median follow-up of 26 years, the highest quintile of fitness (quintile 5) was associated with a lower incidence of chronic conditions compared with the lowest quintile (quintile 1) in men (15.6 [95% CI, 15.0-16.2] vs 28.2 [27.4-29.0] per 100 person-years) and women (11.4 [10.5-12.3] vs 20.1 [18.7 vs 21.6] per 100 person-years). After multivariate adjustment, higher fitness (in METs) was associated with a lower risk of developing chronic conditions in men (hazard ratio, 0.95 [95% CI, 0.94-0.96] per MET) and women (0.94 [0.91-0.96] per MET). Among decedents (2406 [12.9%]), higher fitness was associated with lower risk of developing chronic conditions relative to survival (compression hazard ratio, 0.90 [95% CI, 0.88-0.92] per MET), suggesting morbidity compression. CONCLUSIONS In this cohort of healthy middle-aged adults, fitness was significantly associated with a lower risk of developing chronic disease outcomes during 26 years of follow-up. These findings suggest that higher midlife fitness may be associated with the compression of morbidity in older age.

'You learn to live with all the things that are wrong with you': gender and the experience of multiple chronic conditions in later life.

This article examines how older adults experience the physical and social realities of having multiple chronic conditions in later life. Drawing on data from in-depth interviews with 16 men and 19 women aged 73+ who had between three and 14 chronic conditions, we address the following research questions: (a) What is it like to have multiple chronic conditions in later life? (b) How do older men and women 'learn to live' with the physical and social realities of multiple morbidities? (c) How are older adults' experiences of illness influenced by age and gender norms? Our participants experienced their physical symptoms and the concomitant limitations to their activities to be a source of personal disruption. However, they normalised their illnesses and made social comparisons in order to achieve a sense of biographical flow in distinctly gendered ways. Forthright in their frustration over their loss of autonomy and physicality but resigned and stoic, the men's stories reflected masculine norms of control, invulnerability, physical prowess, self-reliance and toughness. The women were dismayed by their bodies' altered appearances and concerned about how their illnesses might affect their significant others, thereby responding to feminine norms of selflessness, sensitivity to others and nurturance. We discuss the findings in relation to the competing concepts of biographical disruption and biographical flow, as well as successful ageing discourses.

High-Protein Diet in Lactation Leads to a Sudden Infant Death-Like Syndrome in Mice

BackgroundIt is well accepted that reduced foetal growth and development resulting from maternal malnutrition are associated with a number of chronic conditions in later life. On the other hand such generation-transcending effects of over-nutrition and of high-protein consumption in pregnancy and lactation, a proven fact in all developed societies, are widely unknown. Thus, we intended to describe the generation-transcending effects of a high-protein diet, covering most relevant topics of human life like embryonic mortality, infant death, and physical health in later life.MethodsFemale mice received control food (21% protein) or were fed a high protein diet (42% protein) during mating. After fertilisation, females stayed on their respective diet until weaning. At birth, pups were put to foster mothers who were fed with standard food or with HP diet. After weaning, control diet was fed to all mice. All offspring were monitored up to 360 days after birth. We determined glucose-tolerance and measured cardiovascular parameters using a tip-catheter. Finally, abdominal fat amount was measured.Results and ConclusionsWe identified a worried impact of high-protein diet during pregnancy on dams' body weight gain, body weight of newborns, number of offspring, and also survival in later life. Even more important is the discovery that high-protein diet during lactation caused a more than eight-fold increase in offspring mortality. The observed higher newborn mortality during lactation is a hitherto non-described, unique link to the still incompletely understood human sudden infant death syndrome (SIDS). Thus, although offspring of lactating mothers on high-protein diet might have the advantage of lower abdominal fat within the second half of life, this benefit seems not to compensate the immense risk of an early sudden death during lactation. Our data may implicate that both pregnant women and lactating mothers should not follow classical high-protein diets.

Childhood psychosocial stressors and adult onset arthritis: Broad spectrum risk factors and allostatic load

Neural, endocrine, and immune stress mediators are hypothesized to increase risks of diverse chronic diseases, including arthritis. Retrospective data from the World Mental Health Surveys ( N = 18,309) were employed to assess whether adult onset of arthritis was associated with childhood adversities and early onset psychological disorder. Cox proportional hazard models assessed the association of number of childhood adversities and the presence of early onset psychological disorder with arthritis age of onset. Controlling for age, sex, and early onset mental disorder, relative to persons with no childhood adversities, persons with two adversities had an increased risk of adult onset arthritis (hazard ratio = 1.27, 95% CI = 1.08, 1.50), while persons with three or more adversities had a higher risk (HR = 1.44, CI = 1.24, 1.67). Early onset depressive and/or anxiety disorder was associated with an increased risk of adult onset arthritis after controlling for childhood adversities (HR = 1.43, CI = 1.28, 1.61). Since psychosocial stressors may be broad spectrum risk factors that increase risks of diverse chronic conditions in later life (e.g. arthritis, heart disease, diabetes, asthma, and chronic pain), prospective studies of childhood psychosocial stressors may be most productive if multiple disease outcomes are assessed in the same study. Results from this study provide methodological guidance for future prospective studies of the relationship between childhood psychosocial stressors and subsequent risk of adult onset arthritis.

Failing Bodies: Body Image and Multiple Chronic Conditions in Later Life

There is a rich qualitative tradition of examining the lived experience of singular chronic conditions as well as the relationship between illness and identity in chronic disease. There has been little exploration of the experience of multiple chronic conditions or how these health issues may influence body image in later life. Building on the extant research and providing an alternative lens for understanding the experience of health issues, this article examines the body images of older adults with five or more chronic conditions. We use data from in-depth interviews with 10 men and 10 women aged 68 to 88 to analyze how older adults perceive their bodies to be failing in terms of their appearances, functional abilities, and impending mortality. We discuss how the participants view their bodies as both aesthetic and instrumental entities and how gender norms and discourses of successful aging and healthism shape their body evaluations.