Physical Health In Later Life Research Articles

A024: Adverse Childhood Experiences on Social Participation and Informal Social Support in Adulthood in China

Background/Purpose: Adverse childhood experiences (ACEs) have a significant impact on the developmental trajectory of healthy aging. The profound impact of ACEs on individuals may spill over to influence the informal social support and social participation (SP) of middle-aged and older adults. However, the precise influence of ACEs on SP and informal social support is not yet clear. Therefore, to fill the research gap, we examined the characteristics of different subgroups of ACEs and analyzed the effects of ACEs on SP and informal social support among middle-aged and older adults. Method: Data were obtained from the China Health and Retirement Longitudinal Study (CHARLS, 2011 - 2018) and the 2014 Life History Survey (N=11070). Diverse aspects of SP frequency, informal social support, and ACEs were identified based on the CHARLS questionnaire items and ACEs were categorized using latent profile models. The fixed effects model was used to understand the impact of ACEs on SP and informal social support and to explore differences in ACE subgroups. Results: Three distinct subgroups of ACE were determined. It was found that in the group with excellent and good parental mental group, older adults with poorer parental mental health, lower quality family relationships, and better socioeconomic conditions were more likely to engage in SP with higher frequency (p < 0.05). There was a clear correlation between ACEs and informal support (p < 0.05), but no significant differences were found in the poor parental mental group. Conclusion/Discussion: In conclusion, the present study demonstrated that ACEs have an impact on SP and informal social support. To mitigate the adverse effects of ACEs, middle-aged and elderly individuals engage in SP and seek social support. As parents, it is crucial to take preventive measures during the child's formative years and particularly focus on mental health. Moreover, it is essential to pay attention to childhood SES and provide equal opportunities and resources to promote SP and development. This will ultimately improve mental and physical health in later life and foster healthy aging.

Exposure to Adversity and its Impact on Later Life Cognitive, Mental, and Physical Health.

We aimed to assess later-life health responses to childhood and lifetime adversity in a cohort of rural, Black South African adults. We performed ordinary least squares regression using two waves of data from Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI) to estimate a decline in cognitive, mental, and physical health over approximately 3years. Our analytic sample consisted of 1,993 women and 1,496 men. Associations between several types of adversity and health outcomes point to declines in health. At the same time, many adverse experiences are associated with improvements in cognitive, mental, and physical health in later life. The direction of the association varied by type of exposure, health outcome, and gender. In populations exposed to many adversities during life, specific adverse experiences may sometimes be associated with greater improvements (and not just greater decline) in health in later life. Further research is needed to unpack the mechanisms at play in these populations.

Physical activity across midlife and health-related quality of life in Australian women: A target trial emulation using a longitudinal cohort.

There is little long-term causal evidence on the effect of physical activity on health-related quality of life. This study aimed to examine the associations between longitudinal patterns of physical activity over 15 years and health-related quality of life in both the physical and mental health domains, in a cohort of middle-aged Australian women. We used data collected at 3-year intervals (1998 to 2019) from 11,336 participants in the Australian Longitudinal Study on Women's Health (ALSWH) (1946 to 1951 birth cohort). Primary outcomes were the physical (PCS) and mental health component summary (MCS) scores (range from 0 to 100; higher scores indicate higher perceived physical/mental health) from the SF-36 in 2019 (when women aged 68 to 73 years). Using target trial emulation to imitate a randomized controlled trial (RCT), we tested 2 interventions: (1) meeting the World Health Organization (WHO) physical activity guidelines consistently throughout the 15-year "exposure period" (2001 to 2016; when women aged 50-55 to 65-70 years; physical activity assessed every 3 years); and (2) not meeting the guidelines at the beginning of the exposure period but starting to first meet the guidelines at age 55, 60, or 65; against the control of not meeting the guidelines throughout the exposure period. Analysis controlled for confounding using marginal structural models which were adjusted for sociodemographic and health variables and conditions. Consistent adherence to guidelines during the exposure period (PCS: 46.93 [99.5% confidence interval [CI]: 46.32, 47.54]) and first starting to meet the guidelines at age 55 (PCS: 46.96 [99.5% CI: 45.53, 48.40]) were associated with three-point higher PCS (mean score difference: 3.0 [99.5% CI: 1.8, 4.1] and 3.0 [99.5% CI:1.2, 4.8]) than consistent non-adherence (PCS: 43.90 [99.5% CI: 42.79, 45.01]). We found a similar pattern for most SF-36 subscales but no significant effects of the interventions on MCS. The main limitations of the study were that it may not account for all underlying health conditions and/or other unmeasured or insufficiently measured confounders, the use of self-reported physical activity and that findings may not be generalizable to all mid-age women. Results from the emulated RCT suggest women should be active throughout mid-age, ideally increasing activity levels to meet the guidelines by age 55, to gain the most benefits for physical health in later life.

Artful Ageing, Not Just Successful Ageing

In this article, we develop a tentative philosophy to orchestrate and support possibilities for artful ageing. This effort argues that older adults need a broader range of opportunities to explore the manifold ephemeral, non-rational, and in-between elements of an ageing life. The philosophy is rooted in the notion that older adults need space (literally and metaphorically) to explore and process their existence and that engaging in such processes can entail emancipatory effects in everyday life. The perspective unfolded throughout the article is a philosophical venture, or, rather, a preliminary work, developing the concept of artful ageing as a tool applicable in rethinking and broadening the range of activities occurring in institutional settings dedicated to older adults. Furthermore, the perspective also presents a critical stance towards normative footings and biopolitical agendas embedded in current regimes of active ageing. Artful ageing represents the ambition to enable and support artful lives, events, and activities among residents and participants in care homes and other contexts. We argue that physical and existential spaces are closely intertwined entities and that initiatives aimed at maintaining adequate measures of openness, ambiguity, and sensory intimacy, i.e., events that allow for the experience of metaphorical cracks, can afford artful pockets in which to reside for a while, seek refuge, recharge, stray from the beaten track, and obtain an always partial feeling of emancipation. In qualifying the concept of artful ageing, we hope to open new avenues to contemplate and subsequently initiate activities for older adults that are not just orientated towards physical health in later life. At the same time, our ambition is to develop a critical perspective aimed at challenging existing notions of successful ageing in (re)invigorating the importance of artful processes and experiences as an element inherent to successful ageing, as well.

Childhood Residential Mobility and Mental and Physical Health in Later Life: Findings From the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study.

The study objective was to investigate the effects of childhood residential mobility on older adult physical and mental health. In REasons for Geographic and Racial Differences in Stroke (REGARDS) Study, we used linear regression models to investigate if number of moves during childhood predicted mental and physical health (SF-12 MCS, PCS), adjusting for demographic covariates, childhood socioeconomic status (SES), childhood social support, and adverse childhood experiences (ACEs). We investigated interaction by age, race, childhood SES, and ACEs. People who moved more during childhood had poorer MCS scores, β = -0.10, SE = 0.05, p = 0.03, and poorer PCS scores, β = -0.25, SE = 0.06, p < 0.0001. Effects of moves on PCS were worse for Black people compared to White people (p = 0.06), those with low childhood SES compared to high childhood SES (p = 0.02), and high ACEs compared to low ACEs (p = 0.01). As family instability accompanying residential mobility, family poverty, and adversity disproportionately affect health, Black people may be especially disadvantaged.

Peers’ parental education and cardiovascular disease risk in adulthood: The mediating role of health-related behaviors

RationaleAlthough there is a growing body of empirical evidence on the relationship between peers' parental education and adolescents' educational outcomes, little is known about whether exposure to highly educated peers’ parents is associated with improved physical health in adulthood. ObjectiveThis study investigated the relationship between the education level of peers' parents (Wave I) and the risk of developing cardiovascular disease (CVD) in adulthood (Wave IV). Moreover, we considered a set of health-related behaviors (Wave II) as the underlying mechanisms linking peers’ parental education to later-life physical health such as substance use (smoking, binge drinking, and marijuana use) and other lifestyle behaviors (physical activity, sedentary behavior, and unhealthy dietary habits). MethodsData from the National Longitudinal Study of Adolescent to Adult Health (Add Health), spanning respondents’ adolescence to adulthood, were used. To address the endogenous school selection problem and account for the unobserved school-level confounders, this study exploited quasi-experimental within-school/across-cohort variation in peer composition. To formally test for mediation, Sobel tests were conducted. ResultsThe results of this study revealed that independent of own parents' education levels, exposure to higher levels of peers' parental education is associated with a lower CVD risk score in adulthood. For a one-standard-deviation increase in peers' parental education—that is, about a 0.98-year increase in grademates’ parental educational attainment, a CVD risk in adulthood increased by about 6.2%. Our mediation analyses showed that part of this association is explained by a decrease in substance use (27% for smoking, 10% for binge drinking, and 11% for marijuana use). In contrast, none of the other lifestyle behaviors evaluated significantly mediated the association. ConclusionThe study's findings suggest that the role of peers' parents should not be overlooked when developing health-promoting interventions for adolescents. Policymakers and practitioners may wish to increase opportunities for students to benefit from health-related social learning from their peers’ highly educated parents.

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.

Through Him and With Him? A Longitudinal Study of How God-Mediated Control Beliefs Shape the Relationship between Divine Forgiveness and Physical Health in Later Life.

Objectives: While there has been a recent surge in research on forgiveness and health, much less is known about the relationship between divine forgiveness and health. Methods: Using longitudinal data from the 2001-2004 Religion, Aging, and Health Survey from the United States, the current study assesses how changes in beliefs in God-mediated control, a perceived collaborative relationship with a divine power, affect the association between divine forgiveness and physical health among Christian older adults. Results: Older adults with consistently high beliefs in God-mediated control over the study period received stronger health benefits of divine forgiveness. Forgiveness by God also had a stronger relationship with health compared to forgiveness of self and others. Discussion: The findings underscore the importance of subjective beliefs about God. Future research directions are proposed to advance the study of religion and health in later life by conceiving of a more salient role for divine forgiveness.

Economic and Social Influences on Later-Life Well-Being: New Evidence From the NLSY79

The National Longitudinal Survey of Youth 1979 (NLSY79) provides unprecedented opportunities for understanding how work, family, and socioeconomic characteristics over a 40-year period shape the well-being of older adults. The large sample enables explorations of race, gender, and socioeconomic differences in these processes. The five papers in this symposium exploit the rich life course data of NLSY79 to understand two key outcomes: health, and work/economic arrangements as adults approach their retirement years. Harrati and Heburn document the impacts of unemployment trajectories on physical and mental health, highlighting gender differences in these processes. Wolfe investigates the long-term health consequences of significant economic setbacks over the life course (shocks), taking into account those risk factors (selection) that render one vulnerable to such shocks. Jang and Tang document the negative impacts of informal caregiving on later-life physical health, yet their subgroup analyses detect positive impacts for African-Americans. Aughinbaugh delineates women’s time spent in caregiving over the life course, and discusses the implications for later-life economic well-being of both early life childcare and later-life coresidential caregiving. Walsemann, Fisk and Ailshire examine the role that parents and grandparents play in paying for their offspring’s college education, with careful attention to gender and socioeconomic differences in these patterns. Taken together, these papers underscore the importance of adopting an intersectional approach to understanding later-life well-being, and reveal the complex ways that paid work, unpaid work (caregiving), and inter-transfers (via tuition payment) bear on the health and financial stability of adults transitioning into their retirement years.

Long-Term Physical Health Consequences of Financial and Marital Stress in Middle-Aged Couples.

To examine psychological health as a mechanism linking economic pressure and marital instability in the early middle years to poor physical health in later life. Although previous research suggests that sustained stressful marital experience may lead to mental and physical health problems, little is known about how contextual factors, such as economic pressure, impact marital outcomes, and how changes in marital attributes influence health outcomes in a longitudinal and dyadic context. Utilizing an actor-partner interdependence model within a latent growth curve approach and prospective data from couples in enduring marriages, we examined the associations between family economic pressure, marital instability, and mental health over their early middle years (1989-1994) and subsequent physical health in later adulthood (2015). Analyses assessed a couple-level pathway and an individual pathway involving within-spouse and between-spouse effects. During the middle years, family financial difficulties were linked to reduced marital stability, which was associated with increased mental health challenges. The findings also reinforced the salient role of psychological distress for subsequent physical health outcomes as husbands' and wives' anxiety symptoms over their early middle years contributed to declines in their physical health outcomes in later adulthood. A partner effect was noted between husbands' anxiety and wives' physical health. For couples, experiences of financial and marital stress in their early middle years can have long-lasting detrimental impacts on their physical health in later adulthood.

Religious Attendance and Physical Health in Later Life: A Life Course Approach.

Existing research on the life course origins of adult health has extensively examined the influence of childhood socioeconomic conditions, family structure, and exposure to trauma. Left unexplored are the potential long-term health effects of sociocultural exposures, such as religiosity at earlier phases of the life course. Integrating life course models of health with literature on the health-protective effects of adult religiosity, we consider how adolescent and midlife religiosity combine to structure the physical health profiles of adults past age 50. Using more than 35 years of representative data from the National Longitudinal Survey of Youth 79 (NLSY79), we found that the stability of frequent religious practice over time was associated with better health composite scores and lower disease burden. Causal mediation analyses revealed that part of this association is driven by a lower risk of smoking for consistent, frequent attenders. Adulthood religiosity also mediated the relationship between frequent early-life religious attendance and health.

Couple BMI trajectory patterns during mid-later years: Socioeconomic stratification and later-life physical health outcomes.

Although previous studies have documented spousal resemblance in health attributes, questions remain regarding the longitudinal resemblance of spouses' body mass index (BMI) and the possible formation of couple-level BMI trajectory patterns. Consequentially, we know little about how the longitudinal resemblance of spouses' BMI may link couples' varying socioeconomic experiences to their physical health outcomes in later years. Thus, the present study using prospective data from a sample of 255 couples in enduring marriages over a period of 26 years (from 1991 to 2017) examined (a) the existence of couple-level BMI trajectory patterns in mid-later years, (b) their social stratification into heterogeneous groups of couples associated with family economic hardship (FEH), and (c) differential later-life health outcomes of these groups. The results provided evidence for groups of couples with distinct BMI trajectory patterns. These groups were associated with latent groups of FEH trajectories, suggesting a persistent association between couple BMI and FEH. Couple BMI trajectory patterns were consequential for physical health consequences in later years. Two features of couple BMI trajectory patterns, severity and synchrony, were utilized to explain these associations. Taken together, the results provided evidence for a couple-level FEH-BMI-health process over the life course and emphasize the impact of severity and synchrony in couples' BMI for their health problems in later adulthood. Findings are discussed as they relate to health policies and interventions focusing on the well-being of married couples in later life, particularly the need for couple-focused obesity-related interventions and policies that mitigate economic hardship given its long-lasting health impacts. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Husbands' and wives' stressful work, couple BMI dynamics, and later-life physical health.

Previous research has not adequately investigated the persistent influence of stressful work experiences, particularly person-work mismatch (PWM), on later-life physical health outcomes of working husbands and wives. Using prospective data collected from 235 working husbands and wives over a period of 27 years (1991-2017), this study examined PWM in early middle years (40-50 years of age) and body mass index (BMI) trajectories in mid-later years (50-65 years of age) in a dyadic actor-partner interdependence modelling framework. Results showed PWM in early middle years was related to BMI trajectories in mid-later years, which contributed to multiple physical health outcomes in later life. Spouses' PWM influenced not only their BMI trajectories but also their partners' BMI trajectories, providing evidence for partner effects. This couple-level BMI process over the mid-later years was related to spouses' physical health in later years. Husbands' elevated BMI level resulted in adverse physical health outcomes. In contrast, for wives, it was the change in BMI over time that resulted in adverse physical health outcomes in their later years. These findings are particularly important for couple-focused family interventions as they highlight the need to consider couple-level lifestyle and behavioural factors that can safeguard spouses from the negative health consequences of PWM.

Supplemental Material for Couple BMI Trajectory Patterns During Mid-Later Years: Socioeconomic Stratification and Later-Life Physical Health Outcomes

Supplemental Material for Couple BMI Trajectory Patterns During Mid-Later Years: Socioeconomic Stratification and Later-Life Physical Health Outcomes

COHORT DIFFERENCES AND 4-YEAR CHANGE IN EVERYDAY DISCRIMINATION AMONG OLDER AMERICANS

Experiences of everyday discrimination, such as being treated with less courtesy or respect, are associated with poorer mental and physical health in later life. Yet not much is known about cohort differences in experiences of everyday discrimination, nor how subjective reports of discrimination change over time among older adults. This study assessed cohort differences and 4-year change in everyday discrimination using data from the 2006 and 2010 waves of the Health and Retirement Study (HRS), a nationally-representative study of Americans 50+. In both waves, participants were asked about 5 possible experiences of everyday discrimination: for example, “In your day-to-day life, how often have any of the following things happened to you? You receive poorer service than other people at restaurants and stores” and could respond from 0=never to 5=almost every day. Average everyday discrimination was lower for older cohorts compared with younger cohorts in both 2006 and 2010. Paired-samples t-tests showed that average everyday discrimination declined significantly over the 4-year period. However, it is unclear if changes are due to period or age effects. Implications of these findings will be discussed.

Midlife general psychopathology trajectories and later-life physical health in husbands and wives.

General psychopathology (GPP), as reflected by dimensional symptoms of depression, anxiety, and hostility, has been shown to have a persistent influence on physical health problems. Yet, little is known about longitudinal changes in GPP and the long-term GPP- physical health process within married couples over their midlater years. This study examined the multilevel influence of GPP trajectories on husbands' and wives' physical health problems at the couple- and individual-levels over a period of 25 years. A sample of 257 husbands and wives in enduring marriages (Mean age = 40.85 and 38.81 years in 1990 for husbands and wives, respectively) in Iowa self-reported their GPP and physical health from 1990 to 2015. Latent growth curve modeling was used to investigate the influence of GPP trajectories (as higher-order latent constructs of depressive symptoms, anxiety, and hostility) during midlife (from 1990 to 2001) on physical health problems in later adulthood (2015) at both the individual- and couple-level. Couple-level trajectories of GPP (husbands' and wives' shared trajectories of GPP) in midlife had long-term influences on couple-level health problems in later adulthood. After adjusting for this couple-level association, husbands' and wives' individual-specific GPP trajectories uniquely influenced their own health problems (actor effects), but no effects were found for their partners' health problems (partner effects). This study demonstrates the multilevel, long-term associations between GPP and health problems for older adults in a couple context, emphasizing the value of considering both couple- and individual-level psychopathology when developing interventions targeting health outcomes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Supplemental Material for Midlife General Psychopathology Trajectories and Later-Life Physical Health in Husbands and Wives

Supplemental Material for Midlife General Psychopathology Trajectories and Later-Life Physical Health in Husbands and Wives

Violence from childhood to adulthood: The influence of child victimization and domestic violence on physical health in later life

ObjectivePrevious research has shown a detrimental effect of child victimization (CV) on physical disease and mortality. Additionally, individuals with adverse experiences in childhood frequently face domestic violence (DV) in later life. As DV has also been observed to harm physical health, a potential cumulative effect has been proposed. Currently, however, only limited data on such a cumulative effect and its impact on patients' physical health are available. MethodsA cross-sectional observational study at the University Hospital of Innsbruck was conducted. Data on CV, DV and physical health were collected using self-report questionnaires. To evaluate the impact of CV and DV on patients' health, odds ratios (OR) were calculated using binary logistic regression. ResultsA total of 1480 patients from various departments participated in the study. CV was found for 38% and DV for 16% of participants. A significantly higher occurrence of physical disease was observed in patients with poly-victimization (4+ CVs). When accounting for the cumulative effect of CV and DV, the occurrence was further increased for musculoskeletal disorders (OR:5.1), chronic pain (OR:5.0), gastrointestinal diseases (OR:3.0), metabolic diseases (OR:2.8) and respiratory diseases (OR:2.4). ConclusionCV and DV were found to be prevalent and highly correlated in patients treated in a primary care hospital. CV and DV – individually, combined and cumulatively – may thus present risks for physical health. Screening patients for the risk of DV as well as assessing CV may aid in early identification and initiation of psychosocial interventions to avoid further aggravation of physical and psychological problems.

Longitudinal associations of hopelessness and loneliness in older adults: results from the US health and retirement study.

Hopelessness and loneliness are potent risk factors for poor mental and physical health in later life, although the nature of their relationships with each other over time is not clear. The aim of the current study was to examine relationships between hopelessness and loneliness over an eight-year study period. Three waves of data from the US Health and Retirement Study (2006, 2010, 2014) were used to test a cross-lagged model of hopelessness and loneliness (N = 7,831), which allows for the simultaneous evaluation of the reciprocal associations of loneliness and hopelessness. Age in 2006, gender, years of education, number of medical conditions, and depressive symptoms were included as covariates. The autoregressive effects of loneliness (B (SE) = 0.63 (0.02), p < 0.001) and hopelessness (B (SE) = 0.63 (0.02), p < 0.001) were substantive and significant across the three waves, pointing to the stability of both constructs over the eight-year study period. The lagged effect of loneliness on hopelessness was non-significant (B (SE) = 0.05 (0.03), p = 0.16), whereas the lagged effect of hopelessness on loneliness was significant (B (SE) = 0.01 (0.01), p = 0.03). These lagged effects were not significantly different from each other, however, χ2 (1) = 2.016, p = 0.156. Participants who were more hopeless tended to become lonelier four years later, but lonelier participants did not become more hopeless four years later. Findings are tentative given the small magnitude and lack of difference between the cross-lagged effects. Future directions include replicating these findings in different samples and time frames, examining potential mechanisms of relationships between hopelessness and loneliness, and potential intervention strategies that might improve both conditions.

How does difficulty communicating affect the social relationships of older adults? An exploration using data from a national survey

Healthy social relationships are important for maintaining mental and physical health in later life. Less social support, smaller social networks, and more negative social interactions have been linked to depression, poorer immune functioning, lower self-rated health, increased incidence of disease, and higher mortality. Overwhelming evidence suggests that communication disorders adversely affect social relationships. Much less is known about whether some or all aspects of social relationships are negatively affected by a communication disorder. The relative impact of a communication disorder on social relationships, as compared to other kinds of disability, is also poorly understood. Data were analyzed from a representative national sample of community-dwelling adults aged 65 and older living in the continental United States (n=742). Results from multiple regressions indicated that difficulty communicating was significantly associated with several parameters of social relationships even after controlling for age, gender, partnership status, health, functional limitations, and visual impairment. Communication difficulty was a significant predictor of smaller social network size, fewer positive social exchanges, less frequent participation in social activities, and higher levels of loneliness, but was not a significant predictor of negative social exchanges. These findings suggest that communication disorders may place older adults at increased risk for mental and physical health problems because of social isolation, reduced social participation, and higher rates of loneliness. In addition, it appears that communication disorders may have a greater impact on positive, rather than negative, aspects of social relationships.Learning outcomes: As a result of this activity, the following learning outcomes will be realized: Readers will be able to (1) describe changes in the social relationships of older adults that occur as part of normal aging, (2) identify the aspects of social relationships that were significantly impacted by a communication difficulty, and (3) discuss possible reasons for these findings including potential clinical implications.