Socioeconomic position and healthy ageing: A systematic review of cross-sectional and longitudinal studies

Socioeconomic inequalities linked to the transitioning to neurocognitive disorders and mortality

Research on socioeconomic position (SEP) and mild neurocognitive impairment, considered a transient state between normal cognitive function and dementia is limited. The purpose of this study was to determine the role of SEP in transitioning between different cognitive states and mortality risk. Using nationally representative English data and utilising a multistate model association between SEP and the risk of transitioning from no cognitive impairment (NOCI) to Cognitive impairment no dementia (CIND), dementia and death were investigated. The potential reverse transition from CIND to NOCI was also explored. The probabilities of transitioning between cognitive states and time spent in each state differed significantly between those with lower and higher levels of SEP. Higher wealth was associated with a reverse transition from CIND to NOCI [HR = 1.56, CI (1.42,1.72)]. Socioeconomic advantage might protect against the progression to the early stages of neurocognitive disorders (CIND) and facilitate the potential reversion from mild cognitive impairment to a healthy cognitive state in later life. Lower levels of education affect the risk of mortality after the onset of dementia.

Operationalisation of Successful Ageing in the Oral Health Context: A Citation Analysis

OBJECTIVES

The rapidly ageing world has placed considerable demands on health and social care. To address this, the World Health Organization (WHO) and United Nations (UN) have declared action for this decade (2021-2030) to promote healthy ageing. Operationalisation of successful ageing in the oral health context in terms of its dimensions and their interconnectedness was determined.

METHODS

A citation analysis was conducted following a scoping review to determine oral health's relationship with 5 key dimensions of successful ageing. This included examining the occurrence and co-occurrence amongst dimensions and over time. Specific consideration of citations by country, journal type, and authors through overlay visualisation was performed to map their interconnectedness.

RESULTS

The scoping review identified 263 publications covering 1730 specific terms. There was a growing interest in successful ageing in the oral health context, mostly in the past decade (2010 onwards; 65.8%, 173 publications). The dimension of key consideration was "health and ADLs" (activities of daily living); this dimension appeared in 97.3% of publications (n = 256) and was found earliest to emerge, with the greatest link strengths compared to other dimensions. Country-level variations in citation data were observed, and there was good citation interconnectedness between them. Key oracles for dissemination have been medical rather than dental-specific journals. Amongst authors, there was considerable interconnectedness in the field.

CONCLUSIONS

Findings highlight how successful ageing in the oral health context has been studied, with implications for addressing the significance of oral health to older peoples' lives in line with the WHO and UN's agenda. Citation analyses identified the "known unknowns" area for further consideration, and these findings have the potential to inform how dental research may best move forward with the successful ageing agenda to bring about translational impact.

Healthy Aging in Colombia 2018 and Its Variation in Relation to Social Conditions

The population aging in the region is occurring under scenarios of inequality, raising concerns about how the increase in life expectancy is experienced and what factors affect the quality of life of older adults. This research quantified the differentials of healthy aging in Colombia in 2018 and its association with social indicators through a cross-sectional, descriptive, and correlational observational study. Healthy aging was quantified using the Disability-Free Life Expectancy (DFLE) indicator and later correlated with social indicators and subjected to a Multiple Factor Analysis (MFA). The results showed a healthy life expectancy of 71.5 years for women and 66.9 years for men, with a disability expectancy of 8.3 and 6.4 years, respectively. Negative associations emerged with health problems, disability, lack of medical care, illiteracy, school absenteeism, and poverty, while higher education levels and retirement showed positive associations. The factor analysis by area of residence highlighted urban areas as conducive to healthy aging. In conclusion, the accelerated aging of the Colombian population faces health disparities that policies must address by improving education, economic security, and health services, especially for women and rural areas.

Frailty and socioeconomic position: A systematic review of observational studies

BACKGROUND

Frailty, an age-related state of reduced physiological reserve, is often associated with lower socio-economic position (SEP). This systematic review synthesised observational studies assessing (i) the association between SEP and frailty prevalence; (ii) how changes in frailty status over time vary by SEP; and (iii) whether the association between frailty and clinical outcomes is modified by SEP.

METHODS

We searched three electronic databases from 2001 to 2023. We included observational studies measuring early-, mid-, and late-life indicators of SEP (education, income, wealth, housing, occupation, and area-based measures of multiple deprivation) and frailty (assessed using any validated measure). Screening and extraction were performed in duplicate. Findings were synthesised using narrative synthesis.

RESULTS

We included 383 studies reporting findings from 265 independent samples/cohorts across 64 countries. Lower SEP was associated with higher frailty prevalence across all indicators (childhood deprivation 7/8 studies, education 227/248, occupation 28/32, housing 8/9, income 98/108, wealth 39/44 and area-based deprivation 32/34). Lower SEP was also associated with higher frailty incidence (27/30), with greater odds of transitioning towards a more severe frailty state (35/43), lower odds of frailty reversion (7/11), and (in some studies) with more rapid accumulation of deficits (7/15). The relationship between frailty and mortality was not modified by SEP.

INTERPRETATION

Preventative measures across multiple levels of individual and structural inequality are likely to be required to reduce the rising levels of frailty. Resourcing of interventions and services to support people living with frailty should be proportionate to needs in the population to avoid widening existing health inequalities.

Prevalence and Factors Associated With Healthy Aging in a Large Representative Community Sample of Older Ethiopians

Objectives: To examine the prevalence and predictors of healthy aging among community-dwelling older adults living in Bahir Dar, Ethiopia. Methods: A community-based cross-sectional study included older adults aged 60 and above (n = 845; Mage = 71 years; 56.4% females). Poisson regression estimated the Relative Risk (RR) of factors associated with healthy aging status. Results: 36.7% of respondents were classified as healthy agers. Factors associated with an increased likelihood of healthy aging included reporting not being lonely, adequate nutrition, no multimorbidity, good self-rated health, financial independence, and engaging in at least 1 hour of moderate physical activity per week. Discussion: The proportion of healthy agers in this study was substantially lower compared to developed countries but comparable to the prevalence reported in similar developing nations. Enhancing physical activity, ensuring proper nutrition, interventions to foster social participation engagement, and networking, and managing chronic diseases were identified as promising strategies to promote healthy aging.

A scoping review shows that no single existing risk of bias assessment tool considers all sources of bias for cross-sectional studies

OBJECTIVES

Different tools to assess the potential risk of bias (RoB) for cross-sectional studies have been developed, but it is unclear whether all pertinent bias concepts are addressed. We aimed to identify RoB concepts applicable to cross-sectional research validity and to explore coverage for each in existing appraisal tools.

STUDY DESIGN AND SETTING

This scoping review followed the Joanna Briggs Institute methodology. We included records of any study design describing or reporting methods, concepts or tools used to consider RoB in health research reported to be descriptive/prevalence survey or analytic/association (cross-sectional) study designs. Synthesis included quantitative and qualitative analysis.

RESULTS

Of the 4556 records screened, 90 were selected for inclusion; 67 (74%) described the development of, or validation process for, appraisal tools, 15 (17%) described methodological content or theory relevant to RoB for cross-sectional studies and 8 (9%) records of methodological systematic reviews. Review of methodological reports identified important RoB concepts for both descriptive/prevalence and analytic/association studies. Tools identified (n = 64 unique tools) were either intended to appraise quality or assess RoB in multiple study designs including cross-sectional studies (n = 21; 33%) or cross-sectional designs alone (n = 43; 67%). Several existing tools were modified (n = 17; 27%) for application to cross-sectional studies. The RoB items most frequently addressed in the RoB tools were validity and reliability of the exposure (53%) or outcome (65%) measurement and representativeness of the study population (59%). Most tools did not consider nonresponse or missingness appropriately or at all.

CONCLUSION

Assessing cross-sectional studies involve unique RoB considerations. We identified RoB tools designed for broad applicability across various study designs as well as those specifically tailored for cross-sectional studies. However, none of the identified tools comprehensively address all potential biases pertinent to cross-sectional studies. Our findings indicate a need for continued improvement of RoB tools and suggest that the development of context-specific or more precise tools for this study design may be necessary.

Understanding healthy ageing in India: insights from multivariate regression trees

BACKGROUND

Population ageing represents a significant global challenge, particularly pronounced in countries like India.

AIMS

This study aims to explore how factors such as socio-economic status, behaviour, and health influence healthy ageing across the Indian older population.

METHODS

In this study, we utilized the Longitudinal Ageing Study in India - wave 1 dataset for analysis purposes. Scores were generated for five dimensions of healthy aging, including physical, functional, mental, cognitive, and social aspects and these scores were treated as the target variables. Multivariate Regression Trees analysis was employed to identify the behavioural and socio-demographic factors associated with each dimension of healthy ageing.

RESULTS

Years of education emerge as crucial across all dimensions, positively impacting cognitive health and mitigating age-related decline in healthy ageing. Marital status, engagement in household activities, spiritual practices, and living arrangements impacts the scores of different aspects of healthy ageing. Gender disparities in healthy aging are noticeable in the 60-74 age group, with women generally having lower scores. Safety of the living environment is a crucial determinant of the mental health of the elderly across all age groups.These findings highlight the complex interplay of factors in healthy ageing outcomes.

CONCLUSION

Our study emphasizes the pivotal role of education in fostering healthy ageing in India. Factors such as environmental safety and social participation also influence well-being. Targeted interventions addressing education, gender equality, safety, and healthcare access are vital for enhancing the ageing experience and overall well-being of older adults.

Pre-COVID life expectancy, mortality, and burden of diseases for adults 70 years and older in Australia: a systematic analysis for the Global Burden of Disease 2019 Study

Background

The Australian population aged 70 and above is increasing and imposing new challenges for policy makers and providers to deliver accessible, appropriate and affordable health care. We examine pre-COVID patterns of health loss between 1990 and 2019 to inform policies and practices.

Methods

Using the standardised methodology framework and analytical strategies from GBD 2019 methodologies, we estimated mortality, causes of death, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life years (DALYs), life expectancy at age 70 and above (LE-70), and healthy life expectancy (HALE-70) in Australia comparing them globally and with high socio-demographic index (SDI) groups.

Findings

DALY rates have been improving steadily over the past 30 years among Australians aged 70 and above. Decreases in DALY rates were primarily attributed to a fall in YLLs attributable to cardiovascular diseases (60%) and chronic respiratory disorders (30.2%) and transport injuries (56.9%), while the non-fatal burden remained stable from 1990 to 2019. According to the DALY rates, the top five leading causes are ischemic heart disease, Alzheimer's disease, COPD, stroke, and falls, where falls exhibited the largest increase since 1990.

Interpretation

This study provides an in-depth report on the main causes of mortality and disability in Australia's population aged 70 and above. It sheds light on the shifts in burden over three decades, emphasising the need for the Australian health system to enhance its readiness in addressing the escalating demands of an ageing population. These findings establish pre-COVID baseline estimates for Australia's population aged 70 and above, informing healthcare preparedness.

Funding

Bill & Melinda Gates Foundation.

Determinants of Health Status and Life Satisfaction among Older South Koreans

South Korea is a rapidly aging society with the lowest fertility rates among the OECD economies. It is projected to become a super-aged society in 2025, with the share of individuals older than 65 reaching twenty percent. These developments make it important to analyze the determinants of health outcomes in older individuals. In this study, we identified the determinants of subjective and objective health outcomes among senior individuals in South Korea. We used self-rated health and life satisfaction scores as the two subjective health status indicators, while the number of chronic diseases was the objective one. We ran Tobit multivariate regressions of all three indicators on a set of factors related to the older citizens' physical, economic, and social characteristics. Active employment status and willingness to work in the future were positively related to self-rated health level but were not statistically related to life satisfaction, while income positively affected both subjective health status indicators. Age did not appear to affect satisfaction with life. Active leisure activities were positively related to both self-rated health and life satisfaction. In contrast, passive leisure, such as watching TV, was negatively related to both health status indicators while being associated with an increased number of chronic diseases. Our findings suggest that older South Koreans view employment primarily as a means of financial support rather than as an opportunity for active social engagement.

Association of socioeconomic position with sensory impairment among Chinese population: a nationally representative cohort and Mendelian randomization study

Aims

To investigate the association between socioeconomic position (SEP) and sensory impairments (SIs).

Methods

We used data from the China Health and Retirement Longitudinal Study (CHARLS) (2015). Logistic regressions estimated the odds ratio for associations of SEP with SIs. In addition, Mendelian randomization (MR) analysis was conducted to assess the causal relationship between them with the inverse variance weighting (IVW) estimator. MR-Egger, simple median, weighted median, maximum likelihood, and robust adjusted profile score were employed for sensitivity analyses.

Results

In the observational survey, we enrolled 19,690 individuals aged 45 and above. SEP was negatively associated with SIs. Adjusted odds of vision impairment were higher for illiterate (1.50; 95%CI: 1.19, 1.91), less than elementary school diploma (1.76; 95%CI: 1.39, 2.25), middle school diploma (1.53; 95%CI: 1.21, 1.93) and lower income (all p < 0.001). The odds of hearing impairment were significantly higher for people with less than a high school diploma than those with a college degree or higher diploma, for agricultural workers than non-agricultural workers, and for people in low-income families (p < 0.01). The MR analysis also showed that occupation was associated with HI (1.04, 95%CI: 1.01, 1.09, p < 0.05) using IVW.

Conclusion

We found that both observational and causal evidence supports the theory that SEP can result in SIs and that timely discovery, targeted management, and education can prevent SIs among middle-aged and older adults.

Worldwide cohort studies to support healthy ageing research: data availabilities and gaps

BACKGROUND

Population ageing is a transforming demographic force. To support evidence-based efforts for promoting healthy ageing, a summary of data availabilities and gaps to study ageing is needed.

METHOD

Through a multifaceted search strategy, we identified relevant cohort studies worldwide to studying ageing and provided a summary of available pertinent measurements. Following the World Health Organization's definition of healthy ageing, we extracted information on intrinsic capacity domains and sociodemographic, social, and environmental factors.

RESULTS

We identified 287 cohort studies. South America, the Middle East, and Africa had a limited number of cohort studies to study ageing compared to Europe, Oceania, Asia, and North America. Data availabilities of different measures varied substantially by location and study aim. Using the information collected, we developed a web-based Healthy Ageing Toolkit to facilitate healthy ageing research.

CONCLUSIONS

The comprehensive summary of data availability enables timely evidence to contribute to the United Nations Decades of Healthy Ageing goals of promoting healthy ageing for all. Highlighted gaps guide strategies for increased data collection in regions with limited cohort studies. Comprehensive data, encompassing intrinsic capacity and various sociodemographic, social, and environmental factors, is crucial for advancing our understanding of healthy ageing and its underlying pathways.

Profiles of well-being in French older adults and associations with successful aging and personality: findings from the SHARE project

Maintaining the well-being of the older adults is a primary concern in gerontology. This study determined different profiles of well-being (WB) and compared the profiles in terms of successful aging (SA), personality, and sociodemographic variables. The study sample consisted of 856 adults aged 65-98 years. WB was taken into account in an eudemonic and hedonic approach. SA was measured by assessing the three distinct components of Rowe and Kahn's model (Successful aging. Gerontol 37(4):433-440. 10.1093/geront/37.4.433, 1997), personality by the Big Five Inventory, and sociodemographic variables. Latent class analyses (LCA) determined the number of WB profiles, and ANOVAs and Chi2 tests to compare them. The LCA revealed three WB profiles: Profile 1 (9.35%, n = 80), Profile 2 (37.38%, n = 320), and Profile 3 (53.27%, n = 456) in which participants reported lower, intermediate, and higher WB scores. Our results confirm that a high level of WB (Profile 3) can be linked to the components of SA and socio-demographic characteristics (age, marital status, level of education, income). This raises questions about the injunctions concerning healthy aging that older people integrate. It's also interesting to note that the intermediate profile (profile 2) can be either close to the "lower WB" profile (Profile 1) in terms of openness, conscientiousness, and agreeableness or to the "higher WB" profile (Profile 3) in terms of extraversion. However the three profiles do not have the same level of neuroticism. These results also showed the importance of adapting the support offered to older people according to their health status and/or individual characteristics.

Social determinants of intrinsic capacity: A systematic review of observational studies

BACKGROUND

The World Health Organization defined healthy ageing as the maintenance of functional ability with ageing. Intrinsic capacity is a measurement of healthy ageing, and can be shaped by social determinants. However, an overall understanding of how multiple social determinants contribute to intrinsic capacity remains unclear. We aim to summarize observational studies investigating the relationships between social determinants and intrinsic capacity among community-dwelling adults.

METHODS

A systematic search was conducted through Medline, Embase, PsycInfo, Web of Science, and CINAHL until August 14, 2023.

RESULTS

After reviewing 813 articles, we included 21 studies from nine countries in Asia, Europe, and America. Seventeen studies used a cross-sectional design and the others were longitudinal studies. Social determinants related to intrinsic capacity can be classified into five domains, containing socioeconomic status (16, 76.2% of studies), lifestyles (14, 66.7%), psychosocial factors (9, 42.9%), material circumstances (4, 19.0%), and healthcare systems (1, 4.8%). Strong evidence supported that better intrinsic capacity was associated with higher education, higher wealth, more physical activities, no smoking, more social engagement, and being married or partnered. The relationships of intrinsic capacity with dietary patterns and alcohol drinking were contradictory across studies. Research on the associations of working status, housing environments, and healthcare accessibility with intrinsic capacity was insufficient to draw conclusions.

CONCLUSION

These findings highlight roles of socioeconomic status, lifestyles, and psychosocial factors in improving intrinsic capacity thus promoting healthy ageing. Future research is needed to investigate causal relationships between social determinants and intrinsic capacity, especially material circumstances and healthcare systems.

Living in poverty and accelerated biological aging: evidence from population-representative sample of U.S. adults

BACKGROUND

Biological aging reflects a decline in the functions and integrity of the human body that is closely related to chronological aging. A variety of biomarkers have been found to predict biological age. Biological age higher than chronological age (biological age acceleration) indicates an accelerated state of biological aging and a higher risk of premature morbidity and mortality. This study investigated how socioeconomic disadvantages influence biological aging.

METHODS

The data from the National Health and Nutrition Examination Survey (NHANES) IV, including 10 nationally representative cross-sectional surveys between 1999-2018, were utilized. The analytic sample consisted of N = 48,348 individuals (20-84 years). We used a total of 11 biomarkers for estimating the biological age. Our main outcome was biological age acceleration, indexed by PhenoAge acceleration (PAA) and Klemera-Doubal biological age acceleration (KDM-A). Poverty was measured as a ratio of family income to the poverty thresholds defined by the U.S. Census Bureau, adjusted annually for inflation and family size (5 categories). The PAA and KDM-A were regressed on poverty levels, age, their interaction, education, sex, race, and a data collection wave. Sample weights were used to make the estimates representative of the U.S. adult population.

RESULTS

The results showed that higher poverty was associated with accelerated biological aging (PAA: unstandardized coefficient B = 1.38 p <.001, KDM: B = 0.96, p = .026 when comparing the highest and the lowest poverty level categories), above and beyond other covariates. The association between PAA and KDM-A and age was U-shaped. Importantly, there was an interaction between poverty levels and age (p <.001), as the effect of poverty was most pronounced in middle-aged categories while it was modest in younger and elderly groups.

CONCLUSION

In a nationally representative US adult population, we found that higher poverty was positively associated with the acceleration of biological age, particularly among middle-aged persons.

Overadjustment bias in systematic reviews and meta-analyses of socio-economic inequalities in health: a meta-research scoping review

BACKGROUND

Overadjustment bias occurs when researchers adjust for an explanatory variable on the causal pathway from exposure to outcome, which leads to biased estimates of the causal effect of the exposure. This meta-research review aimed to examine how previous systematic reviews and meta-analyses of socio-economic inequalities in health have managed overadjustment bias.

METHODS

We searched Medline and Embase until 16 April 2021 for systematic reviews and meta-analyses of observational studies on associations between individual-level socio-economic position and health outcomes in any population. A set of criteria were developed to examine methodological approaches to overadjustment bias adopted by included reviews (rated Yes/No/Somewhat/Unclear).

RESULTS

Eighty-four reviews were eligible (47 systematic reviews, 37 meta-analyses). Regarding approaches to overadjustment, whereas 73% of the 84 reviews were rated as Yes for clearly defining exposures and outcomes, all other approaches were rated as Yes for <55% of reviews; for instance, 5% clearly defined confounders and mediators, 2% constructed causal diagrams and 35% reported adjusted variables for included studies. Whereas only 2% included overadjustment in risk of bias assessment, 54% included confounding. Of the 37 meta-analyses, 16% conducted sensitivity analyses related to overadjustment.

CONCLUSIONS

Our findings suggest that overadjustment bias has received insufficient consideration in systematic reviews and meta-analyses of socio-economic inequalities in health. This is a critical issue given that overadjustment bias is likely to result in biased estimates of health inequalities and accurate estimates are needed to inform public health interventions. There is a need to highlight overadjustment bias in review guidelines.

Enhancing understanding of healthy aging based on time-varying dependencies among multidimensional health, life satisfaction, and health behaviors of older adults aged 60 years and over

BACKGROUND

Healthy aging is a process of not only achieving good health but also increasing the life satisfaction of older adults aged 60 years and over, in which health behaviors play an important role. There is a lack of research on the time-varying dependencies between health, life satisfaction, and health behaviors, impeding a deeper understanding of healthy aging.

PURPOSE

To develop an integrated framework for modeling the interrelationships among the components of healthy aging between multiple time slices.

METHODS

Based on the Chinese Longitudinal Healthy Living Survey (CLHLS) data in the three waves of 2011/2012, 2014, and 2017/2018, Bayesian network and dynamic Bayesian network are jointly employed to study the relationships among the components of healthy aging within one time slice, as well as to explore the time-varying dependencies among the components between time slices.

RESULTS

The results of structure learning reveal the direction of effects between different dimensions of health, with mental health and social health affecting physical health and self-rated health affecting both physical and mental health. In addition, health behaviors are found to affect mental health and social health, while self-rated health can influence life satisfaction. The parameters learned from the data show the magnitude and direction of concurrent effects, one-period lagged effects and two-period lagged effects between the factors, which find that the time-varying dependencies vary but are generally positive, long-term, and accumulative over time. In addition, the results of autoregressive effects show the positive predictive effects of health and life satisfaction.

CONCLUSIONS

It confirms the influence pathway from health behaviors to multidimensional health to life satisfaction, and the time-varying dependencies among the components of healthy aging, which facilitates a deeper understanding of healthy aging. Combining the results of autoregressive effects and descriptive statistics, it further indicates that healthy aging is a comprehensive result arising from interactions of multiple factors. Policymakers should guide older adults aged 60 years and over to adopt healthier behaviors and ensure the long-term sustainability and continuity of policies.

Leaving no one behind: successful ageing at the intersection of ageism and ableism

BACKGROUND

The concept of 'successful ageing' has been a prominent focus within the field of gerontology for several decades. However, despite the widespread attention paid to this concept, its intersectional implications have not been fully explored yet. This paper aims to address this gap by analyzing the potential ageist and ableist biases in the discourse of successful ageing through an intersectional lens.

METHOD

A critical feminist perspective is taken to examine the sensitivity of the discourse of successful ageing to diversity in societies. The paper analyzes how ageist and ableist biases can manifest in the ways we conceptualize ageing, drawing on examples in the context of mental health.

RESULTS

We argue that the conventional approach to successful ageing is limited in its ability to account for the experiences of people who have faced intersectional discrimination throughout their lives. Drawing on examples in the context of mental health, we explore among others the link between depression and disabilities. Furthermore, we shed light on the negative impact of ageist and ableist attitudes concerning the diagnosis and treatment of dementia.

DISCUSSION

We demonstrate how diversity is often overlooked in discussions of ageing well, and how ageist and ableist biases can manifest in the ways we conceptualize ageing. We argue that focusing solely on the health status as a means of achieving success fails to adequately counter ageism for all people. We further emphasize the role of structural factors, such as ageist attitudes, in shaping the experience of ageing and exacerbating health inequalities.

CONCLUSION

Overall, our findings emphasize the need for a more nuanced and inclusive understanding of ageing and therefore an intersectional approach to conceptions of ageing well that recognizes and addresses the biases and limitations of current discourses. Thereby, this paper offers valuable insights into the complex intersections between age and disabilities from a bioethical perspective, highlighting the need for a more inclusive and intersectional approach to ageing.

Adverse childhood experiences from family and society contribute to increased risk of depressive symptoms and cognitive impairment: a cross-sectional study

Background

Family environments can shape children's personalities and social networks, rendering distinguishing adverse childhood experiences (ACEs) from family and society essential, but related evidence remains limited.

Aims

This cross-sectional study aimed to investigate the correlations between intrafamilial and social ACEs, their associations with depressive symptoms and cognitive impairment and the (education-moderated) mediating role of social ACEs.

Methods

Data for this cross-sectional study were from the China Health and Retirement Longitudinal Study. Nine intrafamilial (0, 1, 2, 3, and 4 or more) and three social (0, 1, and 2 or more) ACEs were identified. Depressive symptoms were assessed using the 10-item Center for Epidemiological Studies Depression Scale. Global cognition, including episodic memory and mental intactness, was calculated as z scores. Binary and ordered logistic regressions, generalised linear models with Gaussian family and identity link, and mediation analysis were used.

Results

13 435 participants aged 59.0 (51.0-66.0) were included. Compared with participants with no intrafamilial ACEs, those with 1, 2, 3, and 4 or more intrafamilial ACEs tended to develop more social ACEs, with odds ratios (ORs) of 1.55 (95% confidence interval (CI): 1.36 to 1.76), 2.36 (95% CI: 2.08 to 2.68), 3.46 (95% CI: 3.02 to 3.96) and 6.10 (95% CI: 5.30 to 7.02), respectively. Both intrafamilial and social ACEs were associated with depressive symptoms (OR >3 for four or more intrafamilial ACEs and two or more social ACEs) and global cognition (β=-0.26 for four or more intrafamilial ACEs and β=-0.29 for two or more social ACEs). Social ACEs mediated the associations of intrafamilial ACEs with depressive symptoms and global cognition by 12.3% and 13.1%, respectively. Furthermore, as education levels increased, the impact of intrafamilial ACEs on depressive symptoms was increasingly mediated through social ACEs, while the mediating role of social ACEs between intrafamilial ACEs and cognitive impairment gradually diminished.

Conclusions

Improving children's social environments and elevating general education can prevent later-life depressive symptoms and cognitive impairment attributed to ACEs in China.

Individual and environmental factors associated with successful aging among Korean older adults: Multilevel analysis of cross-sectional nationwide survey data

PURPOSE

The importance of environmental influences on successful aging has recently been emphasized. However, existing studies that investigated environmental factors related to successful aging in older adults did not apply multi-level analysis while simultaneously examining individual and environmental factors related to successful aging. Therefore, this study aimed to determine the level of successful aging in older adults and the individual and environmental factors related to successful aging.

MATERIALS AND METHODS

Data from a nationwide survey were used. The study comprised a cross-sectional sample of 73,942 community-dwelling adults aged ≥65 years with individual-level data drawn from the 2019 Korea Community Health Survey. Community-level data of 255 local administrative districts (cities or counties) were extracted from the Community Health Determinant Database from 2017 to 2019. These data were merged and used in multi-level logistic regression analyses.

RESULTS

Generally, 27.1% of the participants achieved successful aging. Individual factors including sex, age, marital status, education level, job, monthly household income, smoking, physical activity, and body mass index were significantly associated with successful aging. Four environmental factors, urban residential area, social network, satisfaction with living environment, and air quality, were positively associated with successful aging at the community level; among them, high satisfaction with living environment (OR = 6.06, 95% CI: 2.43-15.12) was the most strongly associated factor with successful aging.

CONCLUSIONS

The findings suggest that environmental factors are essential for successful aging among older adults in addition to individual factors. Therefore, multiple strategies considering individual and environmental factors are needed to improve successful aging.

Socio-economic status and trajectories of a novel multidimensional metric of Active and Healthy Ageing: the English Longitudinal Study of Ageing

Healthy ageing research largely has a unidimensional focus on physical health, negating the importance of psychosocial factors in the maintenance of a good quality-of-life. In this cohort study, we aimed to identify trajectories of a new multidimensional metric of Active and Healthy Ageing (AHA), including their associations with socio-economic variables. A latent AHA metric was created for 14,755 participants across eight waves of data (collected between 2004 and 2019) from the English Longitudinal Study of Ageing (ELSA), using Bayesian Multilevel Item Response Theory (MLIRT). Then, Growth Mixture Modelling (GMM) was employed to identify sub-groups of individuals with similar trajectories of AHA, and multinomial logistic regression examined associations of these trajectories with socio-economic variables: education, occupational class, and wealth. Three latent classes of AHA trajectories were suggested. Participants in higher quintiles of the wealth distribution had decreased odds of being in the groups with consistently moderate AHA scores (i.e., 'moderate-stable'), or the steepest deterioration (i.e., 'decliners'), compared to the 'high-stable' group. Education and occupational class were not consistently associated with AHA trajectories. Our findings reiterate the need for more holistic measures of AHA and prevention strategies targeted at limiting socio-economic disparities in older adults' quality-of-life.

Determinants of Healthy and Active Ageing in Korea

Based on a framework developed by the World Health Organization, we construct an individual-level percentage measure of healthy and active ageing employing the results of a unique survey of ten thousand elderly Korean respondents conducted in 2020 and relate its values to the senior respondent's physical, lifestyle, and socio-economic characteristics. We find that the median value of our healthy and active ageing index is approximately 40%, suggesting significant room for improvement. An important role in interpreting our empirical results is played by the apparent role of Korea's senior employment as a means of "making ends meet" rather than a way of improving the quality of one's ageing, suggesting an important direction for government policy development. Our results underscore the importance of promoting higher-quality employment opportunities for senior citizens as opposed to creating these opportunities per se. This appears especially important given the fast pace of Korea's ageing.

Healthy aging index and its link with relative education between individual and neighborhood: a population-based, cohort study

OBJECTIVES

There is increasing recognition of the importance of neighborhood socioeconomic status (SES) for establishing an age-friendly society. Despite the benefits of improved neighborhood SES, little is known about the link of relative education between individuals and neighborhoods with healthy aging. This study aims to construct a healthy aging index (HAI) accounting for indicators' interlinkages and to test the association of the HAI with relative education between neighborhoods and individuals.

METHODS

The study used data from the China Health and Retirement Longitudinal Study from 2011 to 2018, including middle-aged and older adults (≥ 45 years). The final sample comprised 11633 participants residing in 443 neighborhoods with 34123 observations. Based on 13 health indicators, a hybrid method integrating network analysis with TOPSIS was applied to construct a HAI accounting for health interlinkages. Weighted multilevel linear and ordered logistic models were used to estimate the effects of neighborhood education.

RESULTS

Among the 11633 participants (mean [SD] age, 58.20 [8.91] years; 6415 women [52.82%]), the mean (SD) HAI was 48.94 (7.55) at baseline, showing a downward trend with age. Approximately 10% of participants had a HAI trajectory characterized by a low starting point and fast decline. A one-year increase in neighborhood education was independently associated with a 0.37-point increase (95% CI, 0.23-0.52) in HAI. Regardless of individual education, each participant tended to gain benefits from a neighborhood with higher education. However, the effects of increased neighborhood education were weaker for individuals whose education was lower than the neighborhood average.

CONCLUSIONS

The HAI is an interaction system. Improving neighborhood education was beneficial to healthy aging, but individuals with lower education relative to the neighborhood average may experience poor person-environment fit and obtain fewer benefits from improved neighborhood education. Thus, in the process of improving neighborhood SES, individual-based interventions should be conducted for individuals whose education level is lower than the neighborhood average to achieve person-environment fit.

Development and Validation of a Multidimensional Population-Based Healthy Aging Scale: Results From the China Health and Retirement Longitudinal Study

Background

The World Health Organization proposed a multidimensional concept of healthy aging in 2015; there was limited evidence about how the concept was constructed and measured. The current study aims to develop a health aging scale (HAS) following the WHO framework and validate it using data from the China Health and Retirement Longitudinal Study (CHARLS).

Methods

A total of 13,233 adults aged ≥ 45 years old from the CHARLS included in current study. Based on the WHO framework, 37 self-reported indicators were used to determine healthy aging. Exploratory factor analysis and second-order and bi-factor modeling, as well as psychometric coefficients, were used to examine the structure of healthy aging. To assess concurrent validity of the HAS, regression analyses were used to examine the associations of HAS and its subscales with sociodemographic characteristics, health conditions, healthcare utilization and life satisfaction in Wave 1. The predictive validity of HAS and subscales was assessed by their associations with mortality in Wave 2 follow-up using Cox regressions.

Results

The general HAS and its five subscales were generated according to bi-factor modeling [CFI = 0.949; TLI = 0.942; SRMSR = 0.030; and RMSEA = 0.033 (95% CI, 0.032–0.034)] and psychometric coefficients (ω = 0.903; ωH = 0.692; ECV = 0.459). The general HAS presented solid evidence of concurrent validity with various sociodemographic characteristics, health conditions, healthcare utilization and life satisfaction; and predictive validity with mortality.

Conclusions

The population-based multidimensional healthy aging scale and its subscales can be used to monitor the trajectories of general healthy aging and its subdomains to support the development of healthy aging policies and interventions.

Associação entre fatores psicossociais e funcionais e desempenho de idosos em linguagem e fluência verbal

RESUMO Objetivo: identificar fatores psicossociais e funcionais associados ao desempenho de idosos em linguagem e fluência verbal. Métodos: estudo realizado com 149 idosos cadastrados no serviço de atenção primária à saúde de uma cidade do interior de São Paulo. Foram utilizados um questionário de caracterização sociodemográfica, Exame Cognitivo de Addenbrooke - Revisado (domínios de fluência verbal e de linguagem), Escala de Depressão Geriátrica, Escala de Estresse Percebido, Medical Outcomes Study, WHOQOL-OLD e Escala de Atividades Instrumentais da Vida Diária. Os participantes foram divididos em tercis de acordo com o desempenho em linguagem e fluência verbal: T1 = melhor desempenho, T2 = desempenho mediano e T3 = pior desempenho. Foram comparados os grupos T1 e T3 e realizada uma regressão binária para analisar os fatores associados ao melhor desempenho em linguagem e fluência verbal. Resultados: as variáveis associadas ao melhor desempenho de linguagem comparando T1 e T3 foram: maior escolaridade, maior renda e melhor funcionalidade. Para a melhor fluência verbal, os fatores associados foram: maior escolaridade e melhor funcionalidade. Conclusão: a escolaridade e a funcionalidade mostraram-se importantes fatores associados ao bom desempenho da linguagem e da fluência verbal, enquanto a renda mostrou-se associada apenas ao bom desempenho de linguagem.

Association between psychosocial and functional factors and language and verbal fluency performance in older adults

ABSTRACT Purpose: to identify psychosocial and functional factors associated with language and verbal fluency performance in older adults. Methods: a study conducted with 149 older adults registered in a primary health care service in a city in inland São Paulo. Instruments such as a sociodemographic questionnaire, the Addenbrooke Cognitive Examination-Revised (verbal fluency and language domains), Geriatric Depression Scale, Perceived Stress Scale, Medical Outcomes Study, WHOQOL-OLD, and Instrumental Activities of Daily Living Scale, were used. Participants were divided into tertiles, according to their language and verbal fluency performance: T1 = best performance, T2 = median performance, and T3 = worst performance. Groups T1 and T3 were compared, and a binary regression was conducted to analyze the factors associated with the best language and verbal fluency performance. Results: higher educational attainment, higher income, and better functioning were the factors associated with the best language performance comparing T1 and T3, while higher educational attainment and better functioning were associated with the best verbal fluency. Conclusion: educational attainment and functioning proved to be important factors associated with good language and verbal fluency performance, while income was associated only with good language performance.

Successful ageing among a national community-dwelling sample of older adults in India in 2017-2018

This study aimed to determine the prevalence and correlates of successful ageing in older community-dwelling adults in India. The cross-sectional sample included 21,343 individuals (≥ 65 years) from the Longitudinal Ageing Study in India (LASI) Wave 1 in 2017-2018. Successful ageing was assessed utilizing a multidimensional concept, including five components: (1) absence of major illness, (2) free of disability, (3) no major depressive disorder, (4) social engagement and (5) life satisfaction. Overall, 27.2% had successful ageing, including 83.3% had no major diseases, 51.0% free from disability, 91.8% had no major depressive disorder, 73.6% were socially engaged and 74.6% had high life satisfaction. In the adjusted logistic regression analysis, male sex (Adjusted Odds Ratio-AOR 1.40, 95% Confidence Interval-CI 1.21-1.26), married (AOR 1.48, 95% CI 1.22-1.79), having formal education (AOR 1.47, 95% CI 1.23-1.74), high subjective socioeconomic status (AOR 1.61, 95% CI 1.29-2.01), urban residence (AOR 1.42, 95% CI 1.19-1.70), Sikhs (AOR 1.76, 95% CI 1.38-2.24), high physical activity (AOR 1.65, 95% CI 1.38-1.97), and daily Yoga practice (AOR 1.34, 95% CI 1.11-1.61) increased the odds of successful ageing, while increasing age (AOR 0.96, 95% CI 0.94-0.79), poor childhood health (AOR: 0.47, 95% CI 0.29-0.75), and underweight (AOR 0.70, 95% CI 0.61-0.81) decreased the odds of successful ageing. Almost one in three older adults in India were successfully ageing. Factors associated with successful ageing included, male sex, married, having formal education, high subjective socioeconomic status, urban residence, Sikhs, physical activity, Yoga practice, younger age, good childhood health, and not having underweight.

Ethnic and Gender Disparities in Healthy Ageing among People 50 Years and Older in South Africa

OBJECTIVE

this study aimed to determine the prevalence and correlates of healthy ageing in older adults living in the community in South Africa.

METHODS

the cross-sectional sample consisted of 3734 individuals (≥50 years) from the cross-sectional South African National Health and Nutrition Survey (SANHANES-1) in 2011-2012. Healthy ageing was assessed using a multidimensional concept, which includes five components: (1) absence of major illness, (2) absence of disability, (3) good mental health, (4) social engagement and (5) well-being or good health.

RESULTS

in general, 36.6% had a healthy ageing, including 73.3% had no major diseases, 87.1% were free of disability, 62.3% had good mental health, 73.0% were socially engaged and 64.0% had a high well-being. In the adjusted logistic regression analysis, male sex (Adjusted Odds Ratio-AOR: 1.33, 95% confidence interval-CI: 1.03-1.72), white population group (AOR: 3.46, 95% CI: 2.29-5.22) and coloured population group (AOR: 1.82, 95% CI: 1.34-2.47), were positively associated with healthy ageing, while increasing age (AOR: 0.96, 95% CI: 0.94-0.97), daily tobacco use (AOR: 0.56, 95% CI: 0.42-0.74), perceived underweight (AOR: 0.48, 95% CI: 0.34-0.66) and perceived overweight (AOR: 0.53, 95% CI: 0.34-0.81) were negatively associated with associated with healthy ageing.

CONCLUSION

almost two in five older adults in South Africa were successfully ageing. Factors associated with healthy ageing included, younger age, male sex, population group (Whites, Coloureds), not daily tobacco users, not having underweight and overweight.

Body structural and cellular aging of women with low socioeconomic status in Hungary: A pilot study

OBJECTIVES

The health status of an individual is determined not only by their genetic background but also by their physical environment, social environment and access and use of the health care system. The Roma are one of the largest ethnic minority groups in Hungary. The majority of the Roma population live in poor conditions in segregated settlements in Hungary, with most experiencing higher exposure to environmental health hazards. The main aim of this study was to examine the biological health and aging status of Roma women living in low socioeconomic conditions in Hungary.

METHODS

Low SES Roma (n: 20) and high SES non-Roma women (n: 30) aged between 35 and 65 years were enrolled to the present analysis. Body mass components were estimated by body impedance analysis, bone structure was estimated by quantitative ultrasound technique. Cellular aging was assessed by X chromosome loss estimation. Data on health status, lifestyle and socioeconomic factors were collected by questionnaires.

RESULTS

The results revealed that low SES women are prone to be more obese, have a higher amount of abdominal body fat, and have worse bone structure than the national reference values. A positive relationship was found between aging and the rate of X chromosome loss was detected only in women with low SES. Waist to hip ratio, existence of cardiovascular diseases and the number of gravidities were predictors of the rate of X chromosome loss in women.

CONCLUSIONS

The results suggested that age-adjusted rate of X chromosome loss could be related to the socioeconomic status.