Health In Later Life Research Articles

Gestational Perfluoroalkyl Substance Exposure and DNA Methylation at Birth and 12 Years of Age: A Longitudinal Epigenome-Wide Association Study.

Background:DNA methylation alterations may underlie associations between gestational perfluoroalkyl substances (PFAS) exposure and later-life health outcomes. To the best of our knowledge, no longitudinal studies have examined the associations between gestational PFAS and DNA methylation.Objectives:We examined associations of gestational PFAS exposure with longitudinal DNA methylation measures at birth and in adolescence using the Health Outcomes and Measures of the Environment (HOME) Study (2003–2006; Cincinnati, Ohio).Methods:We quantified serum concentrations of perfluorooctanoate (PFOA), perfluorooctane sulfonate (PFOS), perfluorononanoate (PFNA), and perfluorohexane sulfonate (PFHxS) in mothers during pregnancy. We measured DNA methylation in cord blood () and peripheral leukocytes at 12 years of age () using the Illumina HumanMethylation EPIC BeadChip. We analyzed associations between PFAS concentrations and repeated DNA methylation measures using linear regression with generalized estimating equations. We included interaction terms between children’s age and gestational PFAS. We performed Gene Ontology enrichment analysis to identify molecular pathways. We used Project Viva (1999–2002; Boston, Massachusetts) to replicate significant associations.Results:After adjusting for covariates, 435 cytosine–guanine dinucleotide (CpG) sites were associated with PFAS (false discovery rate, ). Specifically, we identified 2 CpGs for PFOS, 12 for PFOA, 8 for PFHxS, and 413 for PFNA; none overlapped. Among these, 2 CpGs for PFOA and 4 for PFNA were replicated in Project Viva. Some of the PFAS-associated CpG sites annotated to gene regions related to cancers, cognitive health, cardiovascular disease, and kidney function. We found little evidence that the associations between PFAS and DNA methylation differed by children’s age.Discussion:In these longitudinal data, PFAS biomarkers were associated with differences in several CpGs at birth and at 12 years of age in or near genes linked to some PFAS-associated health outcomes. Future studies should examine whether DNA methylation mediates associations between gestational PFAS exposure and health. https://doi.org/10.1289/EHP10118

Patient journey during and after a pre-eclampsia-complicated pregnancy: a cross-sectional patient registry study

ObjectivesTo gain insight into the patient journey through a pre-eclampsia-complicated pregnancy.DesignCross-sectional patient registry study.SettingOnline patient registry initiated by the Preeclampsia Foundation.ParticipantsWomen with a history of pre-eclampsia enrolled in The Preeclampsia...

Association of Weight at Different Ages and All-Cause Mortality Among Older Adults in the US.

Objective: Assess the association of BMI and BMI change with mortality. Methods: Using data from the Wisconsin Longitudinal Study (WLS) on participants born mainly in 1939 (n=4922), we investigated the associations between various measures of BMI across the life course (age 54 BMI; age 65 BMI; age 72 BMI; lifetime maximum BMI; BMI change between ages 54 and 65; BMI change between ages 65 and 72) and mortality. We also assessed whether these associations are mediated by late life health. Results: BMI at age 54 was more strongly associated with late life mortality than BMI at older ages. The association between BMI change and mortality varied based on the timing of weight change. Health at age 72, particularly self-rated health, diabetes, and physical functioning, mediated the observed associations. Conclusion: Knowing older people's weight at midlife and how their weight has changed may be more important in assessing late life mortality risk than their current weight.

Active Time Use and Well-Being in Older Adulthood: Results From a Day Reconstruction Method Study

AbstractActive time use is considered to be one of the keys to successful aging. Previous studies have investigated the influence of various activities on subjective well-being (SWB) and health in later life. As different activities have often been investigated in isolation, showing only minor influences of each activity on well-being, a more global measure of active time use might show a stronger relation to well-being. Moreover, empirical evidence is still insufficient regarding the relationship between active time use and SWB in very old age and regarding the impact of socioeconomic factors that can hinder or promote active time use. Therefore, we examined (1) the association between active time use and SWB using information from the day reconstruction method (DRM) as a more global approach to active time use; (2) the association between active time use and SWB until very old age, and (3) income and education as relevant correlates for active time use. The results indicated that a global measure of active time use was associated with higher levels of SWB. This pattern was present until very old age for several dimensions of negative affect (NA). Finally, higher levels of income and education were associated with a higher level of active time use, potentially pointing at contextual constraints of active time use. In sum, the results show that a global index for measuring active time use provides a comprehensive insight into the relationship between time use and SWB, and we suggest that it should be considered in further studies.

Relationship between adolescent friendship networks and contraceptive use and unintended pregnancies in early adulthood in the United States

ObjectiveTo examine the relationship between reproductive attitude of friends during adolescence, and unintended pregnancy outcomes and contraceptive non-use during early adulthood. Study DesignWe used longitudinal data from the National Longitudinal Study of Adolescent to Adult Health (n = 1866). Adolescent friendship network structures were constructed from the first wave of data to assess reproductive attitudes of friends, measured via 3 subscales: attitude toward contraceptive use, attitude toward sex in adolescence, and attitude toward pregnancy in adolescence. We then used multilevel logistic regression to examine the relationship of friends’ reproductive attitudes in adolescence with unintended pregnancy and contraceptive non-use in adulthood. ResultsAround one-third of the sample experienced at least one unintended pregnancy, and 12% reported contraceptive non-use. Being friends with individuals who are not accepting of adolescent pregnancy reduced the likelihood of an unintended pregnancy in young adulthood (adjusted odds ratios [aOR]: 0.79; 95% CI: 0.67–0.94); this association varied by sex, being significant only for females (aOR:0.75; 95% CI: 0.58–0.96). Additionally, friends’ acceptability of adolescent sex increased the odds of contraceptive use in later life. Individuals with friends who held negative attitude toward contraceptive use during adolescence were more likely to be non-users in later life (aOR:1.37; 95% CI: 1.03–1.81). ConclusionsOur results suggest a relationship between adolescent social networks and reproductive health outcomes in young adulthood, highlighting the importance of friendship networks for young individuals’ reproductive well-being. ImplicationsAttitudes held by adolescent friends regarding contraceptive use, adolescent sex, and adolescent pregnancy have significant, and distinct associations with an individuals’ later-life reproductive health outcomes. Future research should consider evaluation of social network-based sexual and reproductive health interventions aimed at adolescents.

Association of Treatable Health Conditions During Adolescence With Accelerated Aging at Midlife

Biological aging is a distinct construct from health; however, people who age quickly are more likely to experience poor health. Identifying pediatric health conditions associated with accelerated aging could help develop treatment approaches to slow midlife aging and prevent poor health in later life. To examine the association between 4 treatable health conditions in adolescence and accelerated aging at midlife. This cohort study analyzed data from participants in the Dunedin Study, a longitudinal investigation of health and behavior among a birth cohort born between April 1, 1972, and March 31, 1973, in Dunedin, New Zealand, and followed up until age 45 years. Participants underwent an assessment at age 45 years and had data for at least 1 adolescent health condition (asthma, smoking, obesity, and psychological disorders) and outcome measure (pace of aging, gait speed, brain age, and facial age). Data analysis was performed from February 11 to September 27, 2021. Asthma, cigarette smoking, obesity, and psychological disorders were assessed at age 11, 13, and 15 years. The outcome was a midlife aging factor composite score comprising 4 measures of biological aging: pace of aging, gait speed, brain age (specifically, BrainAGE score), and facial age. A total of 910 participants (459 men [50.4%]) met the inclusion criteria, including an assessment at age 45 years. Participants who had smoked daily (0.61 [95% CI, 0.43-0.79] SD units), had obesity (0.82 [95% CI, 0.59-1.06] SD units), or had a psychological disorder diagnosis (0.43 [95% CI, 0.29-0.56] SD units) during adolescence were biologically older at midlife compared with participants without these conditions. Participants with asthma were not biologically older at midlife (0.02 [95% CI, -0.14 to 0.19] SD units) compared with those without asthma. These results remained unchanged after adjusting for childhood risk factors such as poor health, socioeconomic disadvantage, and adverse experiences. This study found that adolescent smoking, obesity, and psychological disorder diagnoses were associated with older biological age at midlife. These health conditions could be treated during adolescence to reduce the risk of accelerated biological aging later in life.

Intergenerational effects of early-life health shocks during the Chinese 1959–1961 famine

AbstractA large literature has examined early-life insult and later-life health outcomes. However, whether early-life exposure might persist into the outcomes of future generations remains unclear. Using data from the China Family Panel Studies, this study examines the intergenerational effects of early-life health shocks during the great famine in China, distinguishes the intergenerational effects of in utero and early-life famine exposure, and estimates whether there is a sex-specific transgenerational response. Difference-in-difference results show that first-generation male in utero famine exposure (1959–1961) is associated with a series of health and economic disadvantages in the second generation, compared with the unexposed post-famine-born cohort (1964–1965) in China. The effect persists in the third generation but attenuates, and there is no same-sex transgenerational response. These findings may suggest a novel source of multigenerational persistence in health and economic poverty and may point to a need to consider evidence of transgenerational mechanisms.

Associations Between Satisfaction With Aging and Health and Well-being Outcomes Among Older US Adults

Researchers and policy makers are expanding the focus from risk factors of disease to seek potentially modifiable health factors that enhance people's health and well-being. Understanding if and to what degree aging satisfaction (one's beliefs about their own aging) is associated with a range of health and well-being outcomes aligns with the interests of older adults, researchers, health systems, and politicians. To evaluate associations between changes in aging satisfaction and 35 subsequent health and well-being outcomes. This cohort study used data from the Health and Retirement Study, a national, diverse, and longitudinal sample of 13 752 US adults older than 50 years, to evaluate if changes in aging satisfaction (between combined cohorts from 2008 and 2010 and 4 years later, in 2012 and 2014) were subsequently associated with 35 indicators of physical, behavioral, and psychosocial health and well-being in 2016 and 2018. Statistical analysis was conducted from July 24, 2020, to November 6, 2021. Aging satisfaction. A total of 35 physical (eg, stroke), behavioral (eg, sleep problems), and psychosocial (eg, depression) outcomes were evaluated using multiple linear and generalized linear regression models. Data from all participants, irrespective of how their levels of aging satisfaction changed from the prebaseline to baseline waves, were incorporated into the overall estimate, which was conditional on prior satisfaction. During the 4-year follow-up period, participants (N = 13 752; 8120 women [59%]; mean [SD] age, 65 [10] years; median age, 64 years [IQR, 56-72 years]; 7507 of 11 824 married [64%]) in the highest (vs lowest) quartile of aging satisfaction had improved physical health (eg, 43% reduced risk of mortality [risk ratio, 0.57; 95% CI, 0.46-0.71]), better health behaviors (eg, 23% increased likelihood of frequent physical activity [risk ratio, 1.23; 95% CI, 1.12-1.34]), and improved psychosocial well-being (eg, higher positive affect [β = 0.51; 95% CI, 0.44-0.58] and lower loneliness [β = -0.41; 95% CI, -0.48 to -0.33]), conditional on prebaseline aging satisfaction. This study suggests that higher aging satisfaction is associated with improved subsequent health and well-being. These findings highlight potential outcomes if scalable aging satisfaction interventions were developed and deployed at scale; they also inform the efforts of policy makers and interventionists who aim to enhance specific health and well-being outcomes. Aging satisfaction may be an important target for future interventions aiming to improve later-life health and well-being.

Life course socioeconomic position and general and oral health in later life: Assessing the role of social causation and health selection pathways

ObjectiveTo examine the pathways between life course socioeconomic position (SEP) and general and oral health, assessing the role of two competing theories, social causation and health selection, on a representative sample of individuals aged 50 years and over in England. MethodsSecondary analysis from the English Longitudinal Study of Ageing Wave 3 data (n = 8659). Structural equation models estimated the social causation pathways from childhood SEP to adult self-rated general health and total tooth loss, and the health selection pathways from childhood health to adult SEP. ResultsThere were direct and indirect (primarily via education, but also adult SEP, and behavior) pathways from childhood SEP to both health outcomes in older adulthood. There was a direct pathway from childhood health to adult SEP, but no indirect pathway via education. The social causation path total effect estimate was three times larger for self-rated general health and four times larger for total tooth loss than the health selection path respective estimates. ConclusionsThe relationship between SEP and health is bidirectional, but with a clearly stronger role for the social causation pathway.

"Went Along With": Acquiescence During First Sexual Experience and Late-Life Health.

Working from a life course perspective, we examined how acquiescence (i.e., "lack of resistance") to an unwanted (i.e., "without experiencing a concomitant desire") first sexual experience was related to health and well-being in late life. Data were drawn from the second wave of the National Social Life, Health, and Aging Project (2010/11). The sample included 2558 older adults ages 62-99 (1182 men and 1376 women). Results from regression models suggested those respondents whose first sex was acquiesced reported higher levels of psychological distress and poorer physical health during late life than respondents whose first sex was wanted. Results from generalized structural equation modeling analysis further suggested that the association between acquiesced first sex and late-life health operated through adulthood socioeconomic status but not through marital relationships. We did not find gender differences in these processes.

Effects of Adverse Childhood Experiences on Late-life Mental Health: Potential Mechanisms Based on a Nationally Representative Survey in China

Adverse childhood experiences (ACEs) are risk factors in the mental health of older adults; however, little is known about its underlying mechanisms. This study investigates the mediating role of physical and cognitive functions and the moderating role of number of children in the association between ACEs and mental health. A sample of 8,494 Chinese older adults are drawn from the 2018 China Longitudinal Aging Social Survey. Findings show that ACEs have negative effects on mental health of older adults. Physical and cognitive functions partially mediate the above relationship. Furthermore, the effect of ACEs on mental health is stronger for older adults with fewer rather than more children. This study advances extant knowledge by illuminating the possible mechanisms of how ACEs influence later-life mental health. Important policy and practical implications are provided.

Effect of childhood proximity to lead mining on late life cognition

IntroductionLead exposure negatively affects cognitive functioning among children. However, there is limited evidence about whether exposure to lead in early life impairs later life cognitive functioning. MethodsParticipants in the prospective Wisconsin Longitudinal Study cohort (N = 8583) were linked to the 1940 Census, which was taken when they were young children. We estimated the effect of living near a lead mine in childhood on late life memory/attention and language/executive function in 2004 (mean age 64) and 2011 (mean age 71). ResultsLead-exposed children had significantly steeper memory/attention decline between 2004 and 2011 and worse language/executive function at baseline in late life. These long-term effects of lead were not mediated through adolescent IQ or late life SES and health factors. DiscussionProximity to lead mining in childhood had long-term effects on late life memory/attention decline and language/executive function, reflecting a possible latent influence of lead exposure. More research is needed to understand behavioral and biological pathways underlying this relationship.

Childhood Stressors, Relationship Quality, and Cognitive Health in Later Life.

The rising prevalence of cognitive impairment, Alzheimer's disease, and related disorders signals the need for a better understanding of how social factors may affect cognitive health for millions of Americans. Drawing from cumulative inequality theory, we aim to understand the implications of a stressful childhood on social relationships and cognitive health in later life. This study utilizes longitudinal data (2006-2016) from the Health and Retirement Study to examine pathways, both direct and indirect through social relationships in adulthood, from childhood stressors to cognitive health trajectories over time. Respondents reporting a greater number of stressors in childhood had worse cognitive health over time, but those negative effects were not as steep as time progressed. Early-life stressors are also associated with less social support and more social strain in adulthood which, in turn, are associated with initial cognitive health. Finally, pathway analyses confirm that childhood stressors are indirectly associated with initial cognitive health through social strain and social support. Findings reveal that a stressful childhood creates chains of risks that have lifelong implications for cognitive health, both directly and indirectly by creating obstacles for developing healthy and supportive social relationships.

Intergenerational support and depressive symptoms among older adults in rural China: the moderating roles of age, living alone, and chronic diseases

BackgroundWhile depressive symptoms are recognized as major mental health problems in later life, there is a lack of study in examining potential moderators in the association between intergenerational support and depressive symptoms, especially in social contexts with low socioeconomic status and inadequate formal public support. This study set out to examine the association between intergenerational support and depressive symptoms among older adults in rural Northeast China, and the potential moderating roles of age, living alone, and number of chronic diseases on this link.MethodsA quota sampling approach was used to recruit 448 respondents aged 60 and above from rural Chinese communities. Depressive symptoms were the dependent variable. Intergenerational emotional, instrumental, and financial support were the main independent variables. Age, living alone, and number of chronic diseases were the moderators. Multiple linear regression models with interaction terms were conducted to test the proposed model.ResultsThe results showed that intergenerational emotional support was significantly associated with depressive symptoms in older adults when instrumental and financial support and covariates were controlled (β = -0.196, p < .001). Age was found to have a significant moderating effect on the relationship between intergenerational instrumental support and depressive symptoms (β = -0.118, p < .05). Among older respondents aged 74.51 years and older, instrumental support was positively associated with depressive symptoms, but this association was not significant for younger respondents. Furthermore, living alone and number of chronic diseases suffered moderated the association between intergenerational financial support and depressive symptoms, which was statistically significant only for those living alone and with more chronic diseases (interaction term between living alone and intergenerational financial support: β = -0.082, p < .05; interaction term between number of chronic diseases and intergenerational financial support: β = -0.088, p < .05.ConclusionsThe findings not only highlight the important role of intergenerational support in promoting mental health in later life in rural Chinese contexts, but also identify within-population heterogeneity in the identified associations. Policy and intervention implications are discussed.

Trends in Health in Midlife and Late Life.

Gains in life expectancy have recently slowed and mortality inequalities have increased. This paper examines whether trends in health observed at ages 55 to 89 mirror those trends in mortality, which may serve as an early indicator for the future evolution of mortality. We found that many health outcomes have worsened from 1992 to 2016, especially at ages below 70, and that differentials in health between low and high education groups have increased among the more recent cohorts. Overall the findings cast a pessimistic light on the future evolution of mortality rates and mortality inequalities.

Conjoint trajectories of couples’ marital and parental conflictual behaviors and later-life mental, physical, and relational health

Conflictual marital and parental relationships mutually reinforce each other generating family-level stress. The cumulative experiences of stressful family conflictual circumstances (a family-level construct of family conflictual circumstances (FCC), based on marital and parental conflictual behaviors) affect a couple’s well-being. The present study, utilizing longitudinal data of 370 couples in enduring marriages and a person-centered approach, examined: a) the existence of heterogeneous groups of couples with FCC trajectory patterns, b) whether individual and contextual factors are associated with FCC trajectory patterns, and c) differential later-life health and relational consequences of these groups. We identified four heterogeneous groups of couples with distinct FCC trajectory patterns in the early middle years (from 1990 to 1994; approximately age 40 for both husbands and wives). Personal (neurotic vulnerability) and contextual factors (family financial hardship) influenced the development of the FCC trajectories, and FCC trajectory patterns were consequential for spouses’ later mental, physical, and relational health (2001). Two features of the longitudinal synchrony in FCC trajectory patterns (severity and synchrony) were utilized to explain the differential impacts of the trajectory patterns on spouses’ later health and relational outcomes.

The presence of neighbours in informal supportive interactions is important for mental health in later life

BackgroundPrevious studies have shown the social support-mental health associations varied in different bonding social networks. However, a further study is needed to determine these network-specific associations for mutually supportive interaction in a wider social network include bridging relationship members. MethodWe conducted a self-reported questionnaire in Osaka, Japan. The study included 659 pre-old age participants (age 65–74 years) and 888 old age participants (age 75–89 years). SF-36v2 was used to measure mental health. We measured three types of social network members (kin, friends, or neighbours) and divided them into recipients or sources of emotional or instrumental social support. We performed multiple regressions to investigate which network member is beneficial in terms of the impact of social support on mental health. ResultsOnly the neighbour social support was positively related with mental health in all subtypes. Associations were inconsistent amongst kin or friend social support subtypes. Positive associations were only found within the pre-old group. ConclusionFor pre-old people, only the presence of neighbours, not kin members, or friends, in social supportive interactions has consistently beneficial associations with mental health, regardless of the roles or functions. Accessibility of neighbour social support should be considered into community-based mental health promotion interventions along with the social network transformation in later life.

Mental Health in Later Life: Taking a Life Course Approach, Alisoun Milne

Mental Health in Later Life: Taking a Life Course Approach, Alisoun Milne

Links between obesity, weight stigma and learning in adolescence: a qualitative study

BackgroundEducational attainment is a key social determinant of health. Health and education are linked by multiple pathways, many of which are not well understood. One such pathway is the association between being above a healthy weight and lower academic achievement. While various explanations have been put forward to explain this relationship, evidence for causal pathways is sparse and unclear. This study addresses that evidence gap.MethodsWe interviewed 19 adults (late 20s; 14 female, 5 male) and one young person (14 years, male) from the UK in 2019/2020. Participants were recruited from the ALSPAC 1990s birth cohort, sampled to ensure diversity in socio-economic status and educational attainment, and a community-based weight management group for young people. Interviews focused on experiences of being above a healthy weight during secondary school and how this may have affected their learning and achievement. Interviews were face-to-face, digitally recorded, and transcribed verbatim. We analysed the data thematically.ResultsWe identified key pathways through which higher body weight may negatively impact educational performance and showed how these are linked within a novel theoretical model. Because larger body size is highly stigmatised, participants engaged in different strategies to minimise their exposure to negative attention. Participants sought to increase their social acceptance or become less socially visible (or a combination of both). A minority navigated this successfully; they often had many friends (or the ‘right’ friends), experienced little or no bullying at school and weight appeared to have little effect on their achievement at school. For most however, the behaviours resulting from these strategies (e.g. disruptive behaviour, truanting, not working hard) or the physical, social or mental impacts of their school experiences (e.g. hungry, tired, self-conscious, depressed) made it difficult to concentrate and/or participate in class, which in turn affected how teachers viewed them.ConclusionsAction to combat weight stigma, both within schools and in wider society, is urgently required to help address these educational disparities that in turn can impact health in later life.

Midlife financial strain and later-life health and wellbeing of husbands and wives: Linking and moderating roles of couple intimacy trajectories.

This study investigates (a) heterogeneous trajectories of couple intimacy over the mid-later years (average ages of 40-65) and (b) how these intimacy classes are differentially associated with spouses' midlife financial strain as well as their later-life health and wellbeing outcomes. The sample was comprised of white couples in long-term marriages from the rural Mid-west who experienced the economic downturn of the farm crisis in late 1980s. Couple-level measures of emotional intimacy and sexual intimacy were created by summing husbands' and wives' reports. Using growth mixture modeling with a sample of 304 couples, conjoint intimacy classes were identified from trajectories of couple emotional intimacy and sexual intimacy. Three qualitatively different latent intimacy classes of couples were identified: Consistently High, Moderate and Increasing, and Chronically Low. Intimacy classes were differentially associated with midlife financial strain and later-life health and wellbeing. Spouses with consistently high and moderate and increasing intimacy in their mid-later years averaged lower financial strain in early midlife and better health and wellbeing outcomes in later years (>67years) compared to those with consistently low intimacy after controlling for lagged health measures. The identification of couple intimacy trajectory groups provides a potentially useful prognostic tool for counseling efforts that can promote and develop resiliency factors to aid in the redirection of adverse couple intimacy trajectories.