Health In Later Life Research Articles

Neighborhood disadvantage and the risk of dementia and mortality among refugees to Denmark: A quasi-experimental study

ObjectivesNeighborhood disadvantage may increase the risk of adverse health outcomes among older refugees. Yet few studies rigorously estimate the effects of place-based factors on later-life health, particularly dementia and mortality. Evidence about refugees is especially sparse. MethodsThis study leveraged a natural experiment in the form of a Danish policy (1986–1998) that dispersed refugees quasi-randomly across neighborhoods upon arrival. We used longitudinal registers allowing 30 years of follow-up among refugees aged 40+ years upon arrival in Denmark (N = 9,854). Cox models assessed the association between neighborhood disadvantage and risk of dementia and mortality. We examined heterogeneous effects by sex, age, and family size. We also examined associations among non-refugee immigrants and native-born Danes. ResultsNeighborhood disadvantage was not associated with dementia in any group. One unit increase in neighborhood disadvantage index (ranges −8 to 5.7) was associated with greater mortality risk among non-refugee immigrants (HR 1.06, 95%CI: 1.02, 1.10) and native-born Danes (HR 1.11, 95%CI: 1.06, 1.17). In contrast, neighborhood disadvantage was associated with lower mortality risk among refugees (HR 0.96, 95%CI: 0.93, 0.99). Neighborhood disadvantage remained negatively associated with mortality risk in subgroups: refugees who are female (on moderate-disadvantage compared to low-disadvantage), aged 60+, and who arrived with families. DiscussionWhile neighborhood disadvantage was associated with lower mortality risk among refugees, it was associated with greater mortality risk among non-refugee immigrants and native-born Danes, perhaps due to confounding in the latter groups or different place-based experiences by immigration status. Future research is warranted to explain the reasons for contrasting findings.

The charm of country life? Impact of rural childhood residence on physical and mental health in later life.

Most studies of geographic health disparities are focused on adult rural residence. However, previous studies have shown that the residential area in which one grows up during childhood has lasting impacts on adult health. In one of the only studies to date to examine the impact of rural childhood residence on mental health in middle-aged and older adults, Murchland and colleagues (2019) evaluated inequalities by childhood residence and noted elevated depressive symptoms were more common among those living in rural areas compared to those living in non-rural areas. The current study expands the model proposed by Murchland and colleagues to include further antecedents related to rural childhood residence, and to include multiple outcomes of physical and mental health among middle-aged and older adults. Participants included 4614 individuals aged 40 or older recruited as part of the Midlife in the United States (MIDUS) study. Consistent with Murchland's model, childhood rurality played an important part in middle-aged and older adult's health, despite not having a direct influence. Rurality status was impacted by parental education level and SES during childhood, and was associated with the level of education obtained by the participants (and thus their occupation), which played a direct role in their current health status. Mental and physical health had differential predictors. The study was limited by its non-diverse sample and self-reported measures. Further research into the impact of childhood rurality on health is needed, utilizing comprehensive self-reported and observed outcome measures.

Dietary Impacts on Gestational Diabetes: Connection between Gut Microbiome and Epigenetic Mechanisms.

Gestational diabetes mellitus (GDM) is one of the most common obstetric complications due to an increased level of glucose intolerance during pregnancy. The prevalence of GDM increases due to the obesity epidemic. GDM is also associated with an increased risk of gestational hypertension and preeclampsia resulting in elevated maternal and perinatal morbidity and mortality. Diet is one of the most important environmental factors associated with etiology of GDM. Studies have shown that the consumption of certain bioactive diets and nutrients before and during pregnancy might have preventive effects against GDM leading to a healthy pregnancy outcome as well as beneficial metabolic outcomes later in the offspring's life. Gut microbiome as a biological ecosystem bridges the gap between human health and diseases through diets. Maternal diets affect maternal and fetal gut microbiome and metabolomics profiles, which consequently regulate the host epigenome, thus contributing to later-life metabolic health in both mother and offspring. This review discusses the current knowledge regarding how epigenetic mechanisms mediate the interaction between maternal bioactive diets, the gut microbiome and the metabolome leading to improved metabolic health in both mother and offspring.

Understanding the effects of adverse childhood experiences on older people.

There is increasing recognition that adverse childhood experiences are linked to suboptimal mental and physical health in later life. Despite this, there has been little research into the effects of adverse childhood experiences on older people. This article gives an overview of the long-term mental and physical effects of adverse childhood experiences and discusses how childhood trauma may manifest in older people. The author also discusses how nurses and unpaid family carers may themselves have been exposed to adverse childhood experiences and how this may affect their caring role. It is crucial that nurses adopt a trauma-informed approach to the care of older people to take account of possible adverse childhood experiences and prevent re-traumatisation.

Influence of cohousing communities on social determinants of health in later life: a scoping review protocol.

The objective of this scoping review is to chart the extent and type of literature available worldwide on the effects of cohousing communities on older adults' social determinants of health, to identify and categorize key evidence on this topic, and to highlight gaps to guide further research. The rapid aging population in many industrialized countries has precipitated the development of housing alternatives, such as cohousing communities, to better address older adults' housing and social needs. There is mounting evidence that living in a cohousing community has many positive outcomes for this population; however, the scope and size of this body of research are unknown. This review will assess studies conducted in all countries and territories focusing on people aged 60 and older living in cohousing communities. It will include quantitative, qualitative, and mixed method studies published from 1960 to 2022. The databases to be searched are APA PsycArticles (EBSCO), Cairn.info, Campbell Collaboration, CINAHL (EBSCO), Érudit, Google Scholar, JBI, PubMed, SAGE Journals Online, Scopus, Science Direct (Elsevier), Sociological Abstracts (ProQuest), and ProQuest Dissertations and Theses Global (ProQuest). Two independent reviewers will review the titles and abstracts of potential studies against the inclusion criteria for the review followed by an assessment of the full text of selected citations. Data will then be extracted using a data extraction tool developed by the reviewers. The findings will be presented graphically and include tables with a narrative summary organized by relevant geographic areas.

Examining the Complex (Curvilinear and Contingent) Associations between Social Distancing Compliance and Subjective Health during a Global Health Crisis

This study investigated a potential curvilinear link between social distancing behavior and subjective health in later life. It also evaluated whether food insecurity and community social capital moderated the focal relationship. Data were drawn from three waves of the COVID Impact Survey (N = 19,234). Mixed-effects models were fitted. Social distancing has a non-monotonic (U-shaped) relationship with subjective health, i.e., individuals with low and high levels of social distancing show relatively better health. Moreover, the negative linear relationship between social distancing and health is weaker among people suffering from food insecurity as well as those living in communities with lower stocks of social capital. This study sheds new light on the health implications of social distancing during the pandemic. Our findings dovetail with the steeling hypothesis, i.e., that social distancing is less harmful for U.S. older adults exposed to prior stressful or vulnerable conditions.

Work and Family Pathways and Their Associations with Health for Young Women in Korea.

The aim of this study is two-fold: to discern patterns in pathways of work and family transitions among young women (aged 24-39 years) whose decisions and behaviors toward labor force participation, marriage, and parenthood are considerably shaped by social constraints and gender norms; and to examine whether and to what extent work and family pathways are associated with later health. Using data from a longitudinal survey based on a large sample of adult women in Korea (N = 2418), we identified eight dominant pathways of employment, marriage, and parenthood among young women and found that educational attainment and family values are strong predictors of these work-family pathways. We also found that the timing and sequencing of work-family pathways appears to be associated with later health outcomes. In particular, unemployed women who are not married and do not have children seem to be vulnerable to health problems, compared to those with other pathways. We discuss the implications of our findings regarding the occurrence of work and/or family transitions, as well as their timing and sequencing for women's health in later life.

Burden of disease among older adults in Europe-trends in mortality and disability, 1990-2019.

It is important to understand the effects of population ageing on disease burden and explore conditions that drive poor health in later life to prevent or manage these. We examined the development of disease burden and its components for major disease groups among older adults in Europe over the last 30 years. Using data from the Global Burden of Disease 2019 Study, we analyzed burden of disease trends between 1990 and 2019 measured by years of life lost (YLL), years lived with disability (YLD) and disability-adjusted life years (DALYs) among older adults (65+ years) in Western, Central and Eastern Europe using cause groups for diseases and injuries. Between 1990 and 2019, the crude numbers of DALYs for all causes increased substantially among older Western Europeans. In Eastern Europe, the absolute DALYs also increased from 1990 to 2005 but then decreased between 2006 and 2013. However, DALY rates declined for all European regions over time, with large differences in the magnitude by region and gender. Changes in the YLL rate were mainly driven by the contribution of cardiovascular diseases. This study found an increased overall absolute disease burden among older Europeans between 1990 and 2019. The demographic change that has taken place in Eastern European countries implies a potential problem of directed resource allocation to the health care sector. Furthermore, the findings highlight the potential health gains through directing resources to health promotion and treatment to reduce YLDs and to prevent YLLs, primarily from cardiovascular diseases.

Longitudinal health behaviour patterns among adults aged ≥50 years in China and their associations with trajectories of depressive symptoms

Objectives Against the background of the growing recognition of the need for a holistic perspective on health behaviour, we aim to identify longitudinal patterns of multiple health behaviours, and to assess associations of such patterns with depressive symptoms among older people in China. Methods Using three waves of China Health and Retirement Longitudinal Study data (n = 8439), we performed latent class growth analyses (LCGAs) to identify longitudinal patterns of multiple health behaviours. Random-effects models were estimated to assess associations between health behaviour patterns and depressive symptoms. Results The best fitting LCGA model had seven classes: (1) connected active non-smokers (average posterior probability: 21.8%), (2) isolated active non-smokers (24.7%), (3) isolated inactive non-smokers (17.0%), (4) isolated active smokers (14.5%), (5) connected active smokers (12.2%), (6) increasingly connected and active non-smokers (5.4%), and (7) moderately connected inactive smokers (4.4%). Depressive symptoms were highest in the four classes with lower probabilities of social participation across waves. No evidence was found of change over time in depressive symptomatology gaps between people with different health behaviour trajectories. Conclusion Health behaviour patterns characterized by consistently low social participation were associated with raised depressive symptomatology, suggesting that focusing on social participation may benefit later-life mental health promotion strategies.

Adverse childhood experiences and somatic symptoms in adulthood: A moderated mediation effects of disturbed self-organization and resilient coping.

Early life adversity is associated with somatic symptoms (SS) in adulthood, but the psychological mechanisms involved need to be further investigated. The aim of this study was to investigate whether disturbances in self-organization (DSO), consisting of affective dysregulation, negative self-concept, and disturbances in relationships, mediate the relationship between exposure to adverse childhood experiences (ACEs) and SS in adulthood. In addition, we investigated whether resilient coping buffers the direct and indirect effect of ACEs on SS. The study sample comprised 4,847 Slovenian adults aged 18 to 75 years and was broadly representative of the general population. Results of the mediation analysis showed that DSO had a notable, significant mediating effect on the relationship between ACEs and SS, with the indirect effect (a × b = .386, p < .001) accounting for 53.3% of the total effect. A moderated mediation analysis revealed a significant interaction between ACEs and resilient coping in predicting DSO (B = -.074, p = .020), suggesting that resilient coping moderated the indirect effect of ACEs on SS. The flexible use of coping strategies to solve problems in stressful circumstances reduced the negative effect of ACEs on DSO, and hence the frequency of SS in adults with a history of ACEs. Health care professionals should be aware of the role that DSO may have in maintaining or exacerbating SS in victims of early trauma. Strengthening the individual's capacities for resilient coping can alleviate the negative effects of early trauma on psychological functioning and health in later life. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Short-term physical exercise controls age-related hyperinsulinemia and improves hepatic metabolism in aged rodents.

Aging is associated with changes in glucose homeostasis related to both decreased insulin secretion and/or impaired insulin action, contributing to the high prevalence of type 2 diabetes (T2D) in the elderly population. Additionally, studies are showing that chronically high levels of circulating insulin can also lead to insulin resistance. In contrast, physical exercise has been a strategy used to improve insulin sensitivity and metabolic health. However, the molecular alterations resulting from the effects of physical exercise in the liver on age-related hyperinsulinemia conditions are not yet fully established. This study aimed to investigate the effects of 7days of aerobic exercise on hepatic metabolism in aged hyperinsulinemic rats (i.e., Wistar and F344) and in Slc2a4+/- mice (hyperglycemic and hyperinsulinemic mice). Both aged models showed alterations in insulin and glucose tolerance, which were associated with essential changes in hepatic fat metabolism (lipogenesis, gluconeogenesis, and inflammation). In contrast, 7days of physical exercise was efficient in improving whole-body glucose and insulin sensitivity, and hepatic metabolism. The Slc2a4+/- mice presented significant metabolic impairments (insulin resistance and hepatic fat accumulation) that were improved by short-term exercise training. In this scenario, high circulating insulin may be an important contributor to age-related insulin resistance and hepatic disarrangements in some specific conditions. In conclusion, our data demonstrated that short-term aerobic exercise was able to control mechanisms related to hepatic fat accumulation and insulin sensitivity in aged rodents. These effects could contribute to late-life metabolic health and prevent the development/progression of age-related T2D.

Book Review: Mental health in later life: Taking a life course approach by Alisoun Milne

Book Review: <i>Mental health in later life: Taking a life course approach</i> by Alisoun Milne

Late-life bone health in hens: A challenge for nutritionists

Late-life bone health in hens: A challenge for nutritionists

Preparedness for healthy ageing and polysubstance use in long-term cannabis users: a population-representative longitudinal study

SummaryBackgroundCannabis is often characterised as a young person’s drug. However, people who began consuming cannabis in the 1970s and 1980s are no longer young and some have consumed it for many years. This study tested the preregistered hypothesis that long-term cannabis users show accelerated biological ageing in midlife and poorer health preparedness, financial preparedness, and social preparedness for old age.MethodsIn this longitudinal study, participants comprised a population-representative cohort of 1037 individuals born in Dunedin, New Zealand, between April, 1972, and March, 1973, and followed to age 45 years. Cannabis, tobacco, and alcohol use and dependence were assessed at ages 18 years, 21 years, 26 years, 32 years, 38 years, and 45 years. Biological ageing and health, financial, and social preparedness for old age were assessed at age 45 years. Long-term cannabis users were compared using independent samples t tests with five groups: lifelong cannabis non-users, long-term tobacco users, long-term alcohol users, midlife recreational cannabis users, and cannabis quitters. In addition, regression analyses tested dose–response associations for continuously measured persistence of cannabis dependence from age 18 years to 45 years, with associations adjusted for sex, childhood socioeconomic status, childhood IQ, low childhood self-control, family substance dependence history, and persistence of alcohol, tobacco, and other illicit drug dependence.FindingsOf 997 cohort members still alive at age 45 years, 938 (94%) were assessed at age 45 years. Long-term cannabis users showed statistically significant accelerated biological ageing and were less equipped to manage a range of later-life health, financial, and social demands than non-users. Standardised mean differences between long-term cannabis users and non-users were large: 0·70 (95% CI 0·46 to 0·94; p<0·0001) for biological ageing, −0·72 (−0·96 to −0·49, p<0·0001) for health preparedness, −1·08 (−1·31 to −0·85; p<0·0001) for financial preparedness, and −0·59 (−0·84 to −0·34, p<0·0001) for social preparedness. Long-term cannabis users did not fare better than long-term tobacco or alcohol users. Tests of dose–response associations suggested that cannabis associations could not be explained by the socioeconomic origins, childhood IQ, childhood self-control, and family substance-dependence history of long-term cannabis users. Statistical adjustment for long-term tobacco, alcohol, and other illicit drug dependence suggested that long-term cannabis users’ tendency toward polysubstance dependence accounted for their accelerated biological ageing and poor financial and health preparedness, although not for their poor social preparedness (β −0·10, 95% CI −0·18 to −0·02; p=0·017).InterpretationLong-term cannabis users are underprepared for the demands of old age. Although long-term cannabis use appears detrimental, the greatest challenge to healthy ageing is not use of any specific substance, but rather the long-term polysubstance use that characterises many long-term cannabis users. Substance-use interventions should include practical strategies for improving health and building financial and social capital for healthy longevity.

Umbilical Cord Maternal Microchimerism in Normal and Preeclampsia Pregnancies.

Bidirectional exchange of cells between mother and fetus establishes microchimerism (Mc). Mc can persist for decades and is associated with later-life health and disease. Greater fetal Mc is detected in the maternal compartment in preeclampsia (PE), but whether maternal Mc (MMC) in umbilical cord blood (CB) is altered in PE is unknown. We evaluated MMc in CB from normal and PE pregnancies. DNA from CB mononuclear cells following placental delivery (n = 36 PE, n = 37 controls) and maternal blood was extracted and genotyped. MMc, quantified by qPCR assays targeting maternal-specific nonshared polymorphisms in CB, was compared using logistic and negative binomial regression models. Clinically and statistically relevant confounders were included, and included the total number of cell equivalents tested, gravidity, mode of delivery, birthweight, and fetal sex. PE participants delivered at earlier gestational ages, with higher Cesarean rates, and lower infant birthweights. CB MMc detection was similar between PE and controls (52.8% vs. 51.3%, respectively, p = 0.90) and unchanged after adjustment for confounders. MMc concentration was not different between groups (mean 73.7 gEq/105gEq in PE vs. mean 22.8 gEq/105 in controls, p = 0.56), including after controlling for confounders (p = 0.64). There was no difference in CB MMc detection or concentration between PE and normal pregnancies, despite previously noted greater fetal Mc in the maternal compartment. This suggests possible differential transfer of cells at the maternal fetal interface in PE. Phenotypic evaluation of Mc cells may uncover underlying mechanisms for differential cellular exchange between mother and fetus in PE.

Creativity and art therapies to promote healthy aging: A scoping review.

The purpose of this scoping review is to investigate the value of creative arts therapies in healthy older adults. This article aims to shed light on current knowledge concerning the effectiveness of art therapies (ATs) for the prevention of common age-related conditions using the definition of art therapy provided by the American Art Therapy Association (AATA), as well as Cohen’s conceptual framework for the psychological conceptualization of the relationship between the arts and health in later life. The objective is to carefully capture subthreshold situations of distress, which are often not taken into account and primarily involve psychological aspects that are crucial in the multidimensional perspective of healthy aging. Twelve articles were selected and examined following an initial electronic search on 3 databases. A thematic analysis of the results identified four major themes: improving cognitive performance and proprioception; enhancing self-identity and meaningful life; reducing feelings of loneliness and depressive symptoms; and the importance of socialization. All these aspects constitute the basis for preventing psychological distress and enhancing mental well-being for healthy aging.

Implications of disparities in social and built environment antecedents to adult nature engagement.

Antecedent factors which influence adult engagement with nature are underexplored given the human health benefits strongly associated with nature exposure. Formative pathways and impediments to nature contact merit understanding as they may contribute to later-life health disparities. We probed experiential pathways and attitudes toward nature engagement among adults purposefully sampled across U.S. regions, age, race/ethnicity, and urbanicity through semi-structured focus group discussions. The research aims were to explore entryways and barriers to experiencing nature and learn how natured and built environments compete in influencing human-nature relationships. Sessions were recorded, transcribed, and analyzed following Braun and Clarke’s phases of thematic analysis. Qualitative content analysis of discussions identified three principal themes: 1) formative influences promoting adult nature engagement (i.e., persons/organizations and places of origin), 2) detractors from nature engagement (i.e., perceptual, material, and physical barriers), and 3) role of current setting (i.e., natural and built environments) shaping nature-seeking relationships. We found experiential factors that included early life exposures outdoors, personal mentorship, and organizational affiliation to be highly influential in socializing individuals to nature and in soldering attachment to nature which manifests into adulthood. In contrast, changing demographics and childhood, inequity, social dynamics, metropolitan growth, urban renewal explained alienation from nature. These findings emphasize the importance of efforts to expand opportunities for nature contact, especially for youth living in economically challenged urban areas, which go beyond increasing greenspace to encompass mentoring partnerships for gaining skills and comfort outdoors and redesign of safe natured spaces within cities for hands-on learning and discovery.

Associations of source-specific PM2.5 and incident disability in older U.S. adults: the Health Retirement Study

Keywords: Air Pollution, emission sources, Activities of Daily Living, PM2.5 Background and Aims: Late-life disability is a common endpoint of the chronic health conditions that affect people as they age. Although fine particulate matter (PM2.5) is associated with chronic conditions that contribute to disability, associations with disability itself are understudied, and the most toxic emission sources have yet to be identified. We evaluated the association between long-term exposure to PM2.5 from specific emission sources and disability. Methods: We used biennial survey data between 2006 and 2016 on Activities of Daily Living (ADL) from participants &amp;#x3e;65 years of the Health and Retirement Study. Using a spatiotemporal prediction model, we estimated 10-year PM2.5 concentrations at participants&amp;#x27; residences and multiplied these values by spatially-resolved fractions of PM2.5 from sources including agriculture, energy production, industry, transportation, fires, and windblown dust, derived from a chemical transport model. We used Cox models to estimate the risk of incident ADL disability per 1-µg/m³ source-specific PM2.5, adjusting for individual- and area-level confounders, time, geography, and sampling weights. Results: Among 11,782 adults (72&amp;#xb1;6.8 years), 37% reported a new disability during follow-up. Overall, both total PM2.5 and source-specific PM2.5 were associated with increased incident of ADL disability. A 1-µg/m³ increment in total PM2.5 corresponded to a 2% (95% CI: 1.00, 1.04) greater hazard of ADL. In single-sector models, PM2.5 from each source was also positively associated with incident ADL. After adjusting for PM2.5 from other sources, associations with agriculture, non-road and road transportation, non-coal energy production, and windblown dust PM2.5 remained, whereas no associations were observed for the other sources. Conclusions: We found evidence that higher levels of PM2.5 from some but not all sources were associated with increased risk of disability, suggesting that selective interventions could be effective at improving health and function in late-life.

Specific Associations Between Type of Childhood Abuse and Elevated C-Reactive Protein in Young Adult Psychiatric Rehabilitation Participants.

Early-life adversity such as childhood emotional, physical, and sexual trauma is associated with later-life psychiatric and chronic medical conditions, including elevated inflammatory markers. Although previous research suggests a role for chronic inflammatory dysfunctions in several disease etiologies, specific associations between childhood trauma types and later-life inflammation and health status are poorly understood. We studied patients (n = 280) admitted to a psychiatric rehabilitation center. Self-reported histories of childhood emotional, physical, and sexual trauma were collected with a standard instrument. At the time of admission, we also assessed individuals' body mass index and collected blood samples used to examine inflammatory marker C-reactive protein (CRP) levels. The prevalence of all 3 types of abuse was relatively high at 21% or more. Fifty percent of the sample had elevations in CRP, with clinically significant elevations in 26%. We found that compared with a history of emotional or physical abuse, a history of childhood sexual trauma was more specifically associated with elevated CRP. This result held up when using linear regressions to examine the contribution of body mass index. Our sample was relatively young, with an average age of 27.2 years and minimal representation of ethnic and racial minority participants. Relative to childhood emotional and physical trauma, childhood sexual trauma may lead to elevated inflammatory responses, as confirmed in our finding of an association between CRP and sexual abuse. Future studies need to assess the causal link between childhood sexual trauma and poorer health outcomes later in life.

Windows of Vulnerability: Consequences of Exposure Timing during the Dutch Hunger Winter.

Prior research on early-life exposures to famine has established in utero development as a critical period of vulnerability to malnutrition. Yet, previous research tends to focus narrowly on this stage, at the expense of a more comprehensive examination of childhood. As a result, the literature has yet to compare the severity of the consequences of exposure to malnutrition across developmentally salient periods. Such comparison is crucial not only in the magnitude of effects but also in the nature of outcomes. Using a restricted population registry-linked health survey, this study examines the Dutch Hunger Winter to provide a comprehensive examination of the long-term consequences of in utero, infant, childhood, and adolescent exposure to famine. The results show malnutrition leads to heterogeneous effects depending on when the exposure occurs. In utero exposure to malnutrition leads to deleterious conditions in physical health and lower socioeconomic attainment. For older cohorts, results suggest a resilience to the effects of malnutrition on physical health in late life, but a higher vulnerability to socioeconomic stunting. Furthermore, the results suggest important gender differences in the long-term impact of malnutrition. Males consistently show stronger negative consequences across a wider array of conditions.