Tracing the origins of successful aging: The role of childhood conditions and social inequality in explaining later life health

Neighborhood racial income inequality and cognitive health

INTRODUCTION

Neighborhood socioeconomic status (SES) has been linked to dementia, but the distribution of SES within a neighborhood may also matter.

METHODS

Data from 460 (47% Black, 46% White) older adults from the Michigan Cognitive Aging Project were linked to census tract-level data from the National Neighborhood Data Archive (NaNDA). Neighborhood SES included two composites reflecting disadvantage and affluence. Neighborhood racial income inequality was the ratio of median incomes for White versus Black residents. Generalized estimating equations examined associations between neighborhood factors and cognitive domains.

RESULTS

Neighborhood racial income inequality was uniquely associated with worse cognitive health, and these associations did not differ by participant race. Neighborhood disadvantage was only associated with worse cognitive health among Black participants.

DISCUSSION

Both the level and racial distribution of SES within a neighborhood may be relevant for dementia risk. Racial differences in the level and impact of neighborhood SES contribute to dementia inequalities.

HIGHLIGHTS

Black participants lived in neighborhoods with lower socioeconomic status (SES) than White participants, on average. Neighborhood SES and racial income inequality were associated with worse cognition. Effects of neighborhood racial income inequality did not differ across racial groups. Effects of neighborhood SES were only evident among Black participants.

The embodiment of parental death in early life through accelerated epigenetic aging: Implications for understanding how parental death before 18 shapes age-related health risk among older adults

Parental death in early life has been linked to various adverse health outcomes in older adulthood. This study extends prior research to evaluate how parental death in early life is tied to accelerated epigenetic aging, a potentially important biological mechanism from which social and environmental exposures impact age-related health. We used data from the 2016 Venous Blood Study (VBS), a component of the Health and Retirement Study (HRS), to examine the association between parental death in early life and accelerated epigenetic aging as measured by three widely used epigenetic clocks (PCPhenoAge, PCGrimAge, and DunedinPACE). We also assessed whether some of the association is explained by differences in educational attainment, depressive symptoms, and smoking behavior. Methods included a series of linear regression models and formal mediation analysis. Findings indicated that parental death in early life is associated with accelerated epigenetic aging for PCPhenoAge and DunedinPACE. The inclusion of educational attainment, depressive symptoms, and smoking behavior attenuated this association, with formal mediation analysis providing additional support for these observations. Parental death in early life may be one of the most difficult experiences an individual may face. The elevated biological risk associated with parental death in early life may operate through immediate changes but also through more downstream risk factors. This study highlights how early life adversity can set in motion biological changes that have lifelong consequences.

Can countries shape the association between cumulative adversity and old-age health?

Introduction

The present study examined the relationships of Lifetime Cumulative Adversity (LCA) and country inequalities, as well as the interactions between them, with the self-rated health (SRH) in old age.

Methods

Using data from the Survey of Health, Aging and Retirement in Europe (SHARE), the study regressed self-rated health on Lifetime Cumulative Adversity and country-level inequality indices across European countries in two points in time. The analysis also considered adversity-inequality interactions, controlling for confounders. The sample was comprised of 28,789 adults, aged 50 to 80, from 25 European countries and Israel.

Results

The findings pointed out that LCA is negatively associated with SRH, but democracy and welfare regimes modify the ill effects of LCA on health. These effects are reduced as the LCA level increases. The effects remained significant over two measurement time-points over three years, showing that life-course trajectories may be shaped by individual accumulated risk exposure to stress, along with inequalities at the society level.

Discussion

The study provides constructive and important guidance for decreasing the harmful effect of lifetime adversity in old age, by the modification of the country's welfare policies.

The Role of Childhood Circumstances on Social Conditions and Health of Middle-Aged and Older Adults: Ardakan Cohort Study on Aging (ACSA)

Some studies suggest that childhood can affect some later outcomes. This cross-sectional study of the first phase of the Ardakan Cohort Study on Aging (ACSA) on 5,197 individuals examined the effects of childhood socioeconomic and health on aging well. Childhood socioeconomic status (SES) was measured using parents' education and self-expressed family's financial status. Quality of Life (SF-12), Satisfaction with Life Scale (SWLS), WHO well-being scale, and self-reported health questionnaire were used. All data, including childhood experiences, was collected at a single time point. Poor childhood health was associated with lower well-being, life satisfaction, and mental quality of life (OR: .53, p = .032, OR: 0.49, p = .019, and β: -3.51, p = .008, respectively). The family's financial status during childhood was associated with the mental and physical quality of life, satisfaction, well-being, and health (all p < .05). Fathers and mothers who had some level of education increased the odds of being healthy by 1.20 and 1.49 times, respectively. Childhood circumstances affect older adults' health and social conditions. Policies to improve childhood health and SES should be prioritized.

Aging in Place and 'The Little Things': Prioritizing Mobile Health and Social Care in Rural Communities

Older adults are more frequently wanting to age in place. Governments are seeking cost-effective and efficient methods of supporting aging populations. Older adults who want to stay in their homes for as long as possible encounter multiple barriers, including struggling to maintain their homes, inadequate levels of social and healthcare support, and the lack of financial capacity to pay for home support services. The Mobile Seniors' Wellness Network (MSWN), a multi-disciplinary and person-centered mobile health and social support intervention study was designed to investigate and support aging in place for older adults living in rural New Brunswick, Canada. Secondary analysis of case notes and exit interviews using content analysis revealed concerns with the lack of affordable and mobile care services for vulnerable rural older adults. Older adults revealed that their needs include "the little things" rather than grand gestures or sweeping policies to age in place such as assistance with grounds and home maintenance, in addition to relational and person-centered health and social care in the home. Reliance on private service delivery and volunteer organizations can increase the likelihood that older adults will experience a breakdown of social support networks tied together loosely by friends, family, and their communities. When services are unattainable aging in place becomes an unreachable goal.

Is Early-Life Enrichment Associated With Better Cognitive Function Among Older Adults? Examining Home and School Environments

Objectives: We examine whether early-life enrichment, involving varied and stimulating activities to enhance cognitive function during childhood and adolescence, is associated with cognitive function in later life and whether the benefits persist over time. Methods: Growth curve models were used to examine up to five waves of data from the Health and Retirement Study-a nationally representative survey of adults 50 years and older (N = 10,070). We constructed separate measures of early-life enrichment to distinguish sources of influence (i.e., enriched home environment and enriched school environment). Global cognitive function was assessed with a modified version of the Telephone Interview for Cognitive Status. Results: Greater enrichment in each environment was incrementally associated with better cognitive function at baseline, but enrichment was not associated with change in cognitive function over time. Discussion: Receiving enrichment from multiple environments during sensitive periods of cognitive development may be advantageous for cognitive functioning in later life.

Pathways from education and childhood parental death to successful aging: the role of social conditions and perceived income level

OBJECTIVES

Although the association between adverse childhood conditions and health in later life has been relatively well established, little is known about how and through which mechanism this association develops. Building on the developmental adaptation model (Martin & Martin, 2002), the present study investigates the effects of distal and proximal influences on successful aging (SA).

METHODS

A cross-sectional survey was conducted of 475 adults aged 50 and above (Mean age = 72.13, SD = 10.46). SA was measured based on Rowe and Kahn's successful aging criteria model (1997) and an SA operationalization based on a number of multidimensional biopsychosocial indicators, including no disease and disability, active engagement with life, high physical and cognitive functioning, psychological well-being, life satisfaction and a one-item subjective SA question.

RESULTS

Parental death had no direct effect on SA (β = .03, p = .629), whereas education had (β = .39, p < .001). Furthermore, perceived income level and social conditions were identified as two sequential mediators between both education and SA; and parental death and SA.

CONCLUSIONS

The findings suggest that both early life and current factors contribute to explaining SA in a variety of ways.

The roots of healthy aging: investigating the link between early-life and childhood experiences and later-life health

Whilst early-life conditions have been understood to impact upon the health of older adults, further exploration of the field is required. There is a lack of consensus on conceptualising these conditions, and interpretation of experiences are socially and culturally dependent.To advance this important topic we invite authors to submit their research to the Collection on 'The impact of early-life/childhood circumstances or conditions on the health of older adults'.

Testing a model of biopsychosocial successful aging based on socioemotional selectivity theory in the second half of life

OBJECTIVES

We first tested a successful aging model, which included biomedical and psychosocial indicators. Next, we tested the assumptions on the social network characteristics of the socioemotional selectivity theory in a model where the outcome variable is successful aging.

DESIGN

Cross-sectional study.

SETTING

The study was carried out in municipal centers and nursing homes.

PARTICIPANTS

A total of 478 adults (Mean age = 72.11, SD = 10.43) were enrolled.

MEASUREMENTS

Psychological Well-being Scale, Life Satisfaction Scale, Future Time Perspective, Katz Index of Independence in Activities of Daily Living Scale, Lawton Instrumental Activities of Daily Living Scale, and Mini-Mental State Examination Test were completed.

RESULTS

The structural equation modeling analyses indicated that higher social satisfaction mediated the association of the future time perspective with successful aging. Furthermore, there was another significant indirect sequential path from the future time perspective to successful aging. The path was first via the number of close social partners and second, social satisfaction.

CONCLUSIONS

The findings highlight the importance of social satisfaction in the process of successful aging and provide novel evidence that the socioemotional selectivity theory can be considered as a biopsychosocial model of successful aging in future studies.

Age, Individual Resources, and Perceived Expectations for Active Aging: General and Domain-Specific Effects

Exposure to expectations for active aging may be modulated by age and individual resources (socioeconomic status, social integration, and health) via multiple pathways. Using a cross-sectional, nationally representative sample of adults aged 17 to 94 (N = 2,007), we investigated the relations between age, individual resources, and perceived expectations for active aging (PEAA) in three domains (physical health, mental health, and social engagement). Across domains, young adults and individuals aged 70+ reported slightly lower PEAA than emerging adults did; no other age differences emerged. Multiple regression showed that a higher subjective socioeconomic status, better perceived general health, and partnership (in older adults) predicted higher PEAA (almost) across domains, whereas church attendance, employment status, and occupational prestige yielded domain- and age-specific effects, which were not always positive. We conclude that the effects of individual resources on PEAA are limited in general but vary depending on life domain and age.

Depression Earlier on in Life Predicts Frailty at 50 Years: Evidence from the 1958 British Birth Cohort Study

Frailty and depression in older ages have a bidirectional relationship, sharing some symptoms and characteristics. Most evidence for this has come from cross-sectional studies, or longitudinal studies with limited follow-up periods. We used data from the National Child Development Study (1958 Birth Cohort) to investigate the relationship between depression and early-onset frailty using a life course perspective. The primary outcome was frailty based on a 30-item inventory of physical health conditions, activities of daily living and cognitive function at 50 years. The main exposure was depression (based on a nine-item Malaise score ≥ 4) measured at 23, 33 and 42 years. We investigated this relationship using multiple logistic regression models adjusted for socio-demographic factors, early life circumstances and health behaviours. In fully adjusted models, when modelled separately, depression at each timepoint was associated with around twice the odds of frailty. An accumulated depression score showed increases in the odds of frailty with each unit increase (once: OR 1.92, 95%CI 1.65, 2.23; twice OR 2.33, 95%CI 1.85, 2.94; thrice: OR 2.95, 95%CI 2.11, 4.11). The public health significance of this finding is that it shows the potential to reduce the physical burden of disease later in life by paying attention to mental health at younger ages.

Distinct domains of childhood disadvantage and cognitive performance among older Brazilians: Evidence from ELSI-Brazil

Objective

To investigate the relationship between of distinct domains of childhood disadvantage and cognitive performance among older adults within the context of a middle-income country.

Methods

This study used baseline data (2015/2016) from the Brazilian Longitudinal Study of Aging (ELSI), a nationally representative cohort of 9412 adults aged 50 and over. Nine childhood exposure variables were grouped into three domains (family SES, childhood health, and cultural capital), for which scores were created. Survey-weighted Ordinary Least Squares (OLS) regressions estimated the association childhood disadvantage with cognitive performance as measured by immediate memory, late memory and semantic verbal fluency. Mediation analysis assessed whether adulthood socioeconomic status (SES) mediated this relationship of interest.

Results

Important disparities in cognitive performance were observed, particularly in terms of age, education, income, occupational status. Before controlling for adulthood SES in the multivariable analysis, all domains of childhood disadvantage were found to be associated with lower cognitive performance across all three measures. After inclusion of adulthood SES variables, the observed associations only remained for semantic verbal fluency. Formal mediation analysis indicated that adulthood SES mediates 47.9% (95% CI: 34.3%-78.6%) of the association between later-life verbal fluency and poor childhood health, and 49.9% (95% CI: 43.6%-57.8%) of the association between later-life verbal fluency and low childhood cultural capital.

Conclusions

We found that childhood disadvantage is associated with low performance in memory tests and semantic verbal fluency tests among older Brazilians. Adulthood SES fully mediated the association between all domains of childhood disadvantage and memory performance and only partially mediated its association with verbal fluency. Our findings support policy efforts to enhance early childhood development and improve adulthood SES, and guide additional research to better the mechanisms driving these relationships.

Early life factors associated with the experiences of pain in later life: evidence from a population based study in India

BACKGROUND

The influence of early life factors is becoming increasingly apparent as studies investigate how experiences, resources, and constraints in childhood affect health and well-being later in life. The present study contributes to this literature by examining the association between several early life factors and self-reported pain among older adults in India.

METHODS

Data come from the 2017-18 wave 1 of the Longitudinal Ageing Study of India (LASI). The sample size includes 28,050 older adults aged 60 and above (13,509 men and 14,541 women). Pain is a self-reported, dichotomous measure where participants responded to whether they were often troubled with pain and whether this experience interfered with their ability to carry out daily household chores. Early life factors, which are retrospective accounts of experiences, included the respondent's position in birth order, their health status, school absenteeism, being bedridden, family socioeconomic status (SES), and their parent's experience with chronic disease. Logistic regression analysis is employed to examine the unadjusted and adjusted average marginal effects (AME) of selected domains of early life factors associated with the probability of experiencing pain.

RESULTS

22.8% of men and 32.3% of women reported pain that interfered with daily activities. Pain was higher among men (AME: 0.01, confidence interval (CI): 0.01-0.03) and women (AME: 0.02, CI: 0.01-0.04) with third or fourth birth order compared to counterparts with first birth order. Both men (AME: -0.02, CI: -0.04-0.01) and women (AME: -0.07, CI: -0.09 - -0.04) having a fair childhood health status reported a lower probability of pain. The probability of pain was higher among both men (AME: 0.03, CI: 0.01-0.07) and women (AME: 0.07, CI: 0.03-0.13) who were bedridden due to sickness in their childhood. Similarly, the pain likelihood was higher among men who missed school for more than a month due to health problems (AME: 0.04, CI: -0.01-0.09). Men and women with poor financial condition in their childhood reported (AME: 0.04, CI: 0.01-0.07) a higher probability of experiencing pain relative to their peers who reported a more financially advantaged early life.

CONCLUSIONS

Findings of the present study add to the empirical literature on the association between early life factors and later life health and well-being. They also are pertinent to health care providers and practitioners working in pain management, as this knowledge better positions them to identify older adults most susceptible to pain. Moreover, findings of our study underscore that the interventions to ensure health and well-being in later life must start far earlier in the life course.

Tooth loss, body mass index and cognitive function among middle-aged and older adults in China: Does gender matter?

BACKGROUND

Previous studies have shown a longitudinal association between tooth loss and cognitive function. Body mass index (BMI) is an essential applicable indicator of health status screening. However, the underlying mechanism among these factors remains unclear. This study aimed to determine the mediating role of BMI in the tooth loss-cognition relationship by gender among Chinese middle-aged and older adults.

METHODS

This is a prospective and cohort study. We used three waves of follow-up data (2011, 2013, and 2015) from the China Health and Retirement Longitudinal Survey, including 10,013 participants aged 45 years or above. Cognitive function was evaluated by Telephone Interview of Cognitive Status, words recall, and figure drawing. The cross-lagged panel model was applied to test the hypothesized model.

RESULTS

Tooth loss is associated with higher BMI and lower level of cognitive function. We found significant total effects (B = -0.017, P = 0.008), direct effect (B = -0.015, P = 0.022) and indirect effects (B = -0.002, P = 0.010) of tooth loss on cognition mediated through BMI only among middle-aged and older men. For middle-aged and older women, the total effect (B = -0.010, P = 0.125) and direct effect (B = -0.007, P = 0.249) were no more significant.

CONCLUSIONS

The longitudinal association between tooth loss and cognition was primarily indirect through BMI among middle-aged Chinese males but not women. Public health authorities should remind middle-aged and older males with tooth loss and high BMI to participate in timely medical checkups for improving cognition.

Social insurance programs and later-life mortality: Evidence from new deal relief spending

A growing body of research explores the long-run effects of social programs and welfare spending. However, evidence linking welfare support in early life with longevity is limited. We add to this literature by evaluating the effect of in-utero and early-life exposure to the largest increases in welfare spending in the US history under the New Deal programs. Using Social Security Administration death records linked with the 1940-census and spending data for 115 major cities, we show that the spending is correlated with improvements in old-age longevity. A treatment-on-treated calculation focused on a period when spending rose by approximately 1900 percent finds that a 100 percent rise in municipal spending in the year of birth is associated with roughly 3.5 months higher longevity. We show that these effects are not driven by endogenous selection of births, selective fertility, endogenous migration, and sample selection caused by endogenous data linking. Additional analysis suggests that rises in education and socioeconomic status are likely channels of impact.

Refashioning the uneasy relationship between older people and geriatric medicine

A notable feature of most medical specialties is close joint working between patient advocacy groups and specialist societies in furthering improvements in policy and services. While growing old is not a disease, nor too is being a child, and the engagement of advocacy and international bodies such as UNICEF with paediatricians is well established and recognised. Yet almost eight decades after the founding of geriatric medicine, it is clear that this type of relationship does not hold for the advocacy bodies representing those we serve, as well as the wider constituency of older people. Geriatricians are an extraordinary resourceful and imaginative group, and a more effective promotion of our role as guardians of the longevity dividend is vital to a more positive and mutually beneficial relationship with older people and society. This will require a redirection of our focus to a more critical stance on our origins as a discipline, our relationship with ageing across the lifespan and with older people and a fuller engagement with the broader concepts of gerontology in training and research to develop a refreshed articulacy for, the opportunities arising from gerontologically attuned healthcare.

The body politics of successful ageing in the nexus of health, well-being and energy consumption practices

In this paper, we introduce the idea of the bio-socio-material body to think through the body politics that emerge within the nexus of health, well-being and domestic energy consumption as people age. Our work draws upon an ethnographic study with older Australians in regional New South Wales, Australia. We enrich social practice theory conceptualisations by foregrounding the body as a dynamic bio-socio-material entity that shapes and is shaped by practices. In doing so, we draw attention to the body politics of managing health, well-being and energy consumption while trying to age successfully. We identify that the bio-socio-material dimensions of the body play an important role in how health, well-being and energy practices are performed. Energy practices are bound up in understandings of health and well-being as an ongoing and contingent process. Here, the use of energy and appliances becomes integral to how people negotiate and work towards successful ageing. We found that embodied practices of health, well-being and energy consumption are linked to biological, emotional, affective, social and material concerns that create body politics. These include tensions and challenges relating to health and vitality, caring for the sick and the dying, maintaining good mental health, the affordances of buildings and appliances, energy affordability and billing anxiety, social connectedness, and pleasures and pains. We raise questions emerging from our research on the implications for successful ageing. We call for attention to how health, well-being and energy are imbricated and for policy and programmes that better support older people to navigate the nexus of health, well-being and energy consumption as they age.

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

BACKGROUND

The association between socioeconomic position (SEP) and health is well-established. However, the association between SEP and healthy ageing as a multidimensional construct is unclear.

METHODS

We conducted a systematic review of peer-reviewed cross-sectional and longitudinal studies on the associations between SEP and multidimensional healthy ageing measures. Studies were identified from a systematic search across major electronic databases from inception to February 2021.

RESULTS

Fourthy-five articles met inclusion criteria (26 cross-sectional and 19 longitudinal studies). There was no consistency in method of operationalizing healthy ageing across studies, domains included in the healthy ageing measures, or in the definition and number of levels of SEP indicators. Overall, regardless of heterogeneity between studies, a positive association between educational level (85.0 % of studies) and income/wealth (81.4 % of studies) and healthy ageing was evident. Regarding occupational position, evidence from 11 studies was inconclusive. The number of studies including home ownership, parenteral SEP, or composite SEP scores was insufficient to be able to draw a conclusion.

CONCLUSIONS

There is evidence that socioeconomic inequalities, as assessed by educational level and income/wealth, are associated with healthy ageing. These findings, and the broader evidence base on SEP and healthy ageing, highlight the importance of addressing inequality through integrated health and social policies and strategies.

Multigenerational Households During Childhood and Trajectories of Cognitive Functioning Among U.S. Older Adults

Objectives

Family structure in childhood influences early brain development and cognitive performance in adulthood. Much less is known about its long-term impact on later-life cognitive functioning. We extend the two-generation family structure approach to investigate the potential contribution of living with grandparents in multigenerational households to differences in cognitive functioning at older ages.

Methods

Data were drawn from 9 waves of the Health and Retirement Study (1998–2014) merged with newly collected childhood family history data. Five types of family structure were assessed: two-parent households, two-parent households with grandparents, single-parent households, single-parent households with grandparents, and grandparent-headed households. Growth curve models were used to estimate trajectories of cognitive functioning over time.

Results

Childhood family structure was significantly associated with level of cognitive functioning, but not to rate of cognitive decline. Relative to those from two-parent households, individuals who grew up in multigenerational households showed higher levels of cognitive functioning, including those living with a single parent and grandparents. Those who lived with a single parent alone were the most disadvantaged. The effects of these multigenerational households persisted net of childhood and adulthood socioeconomic status and health outcomes.

Discussion

Grandparent coresidence may cultivate a socially enriched home environment, providing resources and protection for early cognitive development that could persist throughout life. Multigenerational living arrangements are likely to increase as the contemporary population ages. More research needs to be done to understand the impact of these living arrangements on future generations’ brain health and cognitive aging.

The Long Arm of Conflict: How Timing Shapes the Impact of Childhood Exposure to War

This paper examines how the timing of childhood exposure to armed conflict influences both the magnitude of the impact it has on later-life health and the pathways through which those impacts manifest. Utilizing the Survey of Health and Retirement in Europe, we examine cohorts of children during World War II. We find that cohorts born during the war show the largest negative effects of exposure on health in later life. The pathways also vary the timing of exposure. Consistent with a latent critical period process, children born during the war experienced increased risk of poor health and illness in childhood, as well as adult cardiometabolic conditions and poor functional health. Conversely, cohorts born before the war experienced more indirect pathways consistent with cumulative disadvantage processes and institutional breakdown. These pathways include stunted socioeconomic attainment, increased risk behaviors, and poorer mental health. Overall, this study emphasizes that the timing of exposure is critical to understanding the long-term health effects of war.

The association between childhood conditions and heart disease among middle-aged and older population in China: a life course perspective

Background

Heart disease is a severe health problem among adult populations in China. The prevalence rates of heart disease increase with age. The pathogenic causes of heart disease are often related to conditions in early life. Using a nationally representative sample of adults aged 45 or older in China, we examined the association between childhood conditions and heart disease in later life from a life course perspective.

Methods

The data used in this study were derived from the life history module and 2015 wave of China Health and Retirement Longitudinal Study (CHARLS). Missingness were handled by multiple imputation, generating 20 complete datasets with a final sample of 19,800. Doctor-diagnosed heart disease was the main dependent variable. Respondents’ conditions in childhood, adulthood, and older age were the independent variables (e.g., socioeconomic status, health, and health resources). Random-effects logistic regression models were conducted to test the hypotheses.

Results

A total of 16.6% respondents reported being diagnosed with heart disease by doctors. Regarding childhood socioeconomic status, 8.2% of the respondents considered that they were (a lot) better off than their neighbors, and 31.1% considered that their health status in childhood was better than their peers. More than 90% of respondents did not have severe illnesses during their childhood, and around 80.3% had access to health resources nearby in childhood. Lower socioeconomic status and poorer health conditions in childhood were associated with a greater likelihood of reporting doctor-diagnosed heart diseases, even after controlling for conditions in adulthood and older age (socioeconomic status: odds ratio (OR) = 0.947; self-rated health: OR = 0.917; severe illnesses: OR = 1.196).

Conclusions

Along with chronic diseases (e.g., hypertension, diabetes, and dyslipidemia), unhealthy behaviors, overweight and obesity, poor childhood conditions should be considered as screening criteria to identify populations at risk of heart disease. Relevant preventive strategies and interventions should be developed from a life course perspective and conducted in communities by providing health education program among older population with low socioeconomic status, and encouraging early detection and treatment.

The Importance of Childhood for Adult Health and Development-Study Protocol of the Zurich Longitudinal Studies

Evidence is accumulating that individual and environmental factors in childhood and adolescence should be considered when investigating adult health and aging-related processes. The data required for this is gathered by comprehensive long-term longitudinal studies. This article describes the protocol of the Zurich Longitudinal Studies (ZLS), a set of three comprehensive cohort studies on child growth, health, and development that are currently expanding into adulthood. Between 1954 and 1961, 445 healthy infants were enrolled in the first ZLS cohort. Their physical, motor, cognitive, and social development and their environment were assessed comprehensively across childhood, adolescence, and into young adulthood. In the 1970s, two further cohorts were added to the ZLS and assessed with largely matched study protocols: Between 1974 and 1979, the second ZLS cohort included 265 infants (103 term-born and 162 preterm infants), and between 1970 and 2002, the third ZLS cohort included 327 children of participants of the first ZLS cohort. Since 2019, the participants of the three ZLS cohorts have been traced and invited to participate in a first wave of assessments in adulthood to investigate their current health and development. This article describes the ZLS study protocol and discusses opportunities, methodological and conceptual challenges, and limitations arising from a long-term longitudinal cohort recruited from a study about development in early life. In the future, the ZLS will provide data to investigate childhood antecedents of adult health outcomes and, ultimately, will help respond to the frequent call of scientists to shift the focus of aging research into the first decades of life and, thus, to take a lifespan perspective on aging.

Prenatal exposure to the German food crisis 1944-1948 and health after 65 years

Using data on 90% of the German population born 1930-1959, we investigate the long-term relationship between intra-uterine exposure to the German food crisis 1944-1948 and 16 doctor-diagnosed health conditions recorded in 2009 and 2015. Among the exposed, who are 60-70 years old in our data, we find elevated risks of being diagnosed with a wide range of conditions, including diabetes, depression, lung disease, and back pain. In terms of critical periods, malnutrition in the first trimester of pregnancy appears to have the strongest negative correlation with health at older ages.

The Effect of Material and Social Deprivation on Well-Being of Elderly in Europe

In this work, attention is paid to 2 explanatory factors of successful aging. The first is material deprivation. There is growing evidence that poverty is associated with the onset of physical and mental disorders and, broadly, with aspects such as life satisfaction and happiness. The second factor is social deprivation. Social exclusion affects health due to lack of emotional and concrete support; moreover, participation in social activities among older people is associated with greater longevity and a lower risk of disability. The study describes the effect of material and social deprivation on depression (measured through the EURO-D scale) and quality of life (through CASP-12 scale), for individuals aged 50 and older in 14 European countries. Data is derived from Wave 5 of the SHARE project. To estimate the effect of material and social deprivation on outcomes and to determine whether it is moderated by the country in which people live, we apply 2 multi-group path models, respectively, for people aged 65 or younger and for those aged 66 years or older. Findings indicate that higher material and social deprivation is associated with greater levels of stress and worse quality of life. The effect of social deprivation would be stronger than that of material deprivation, and this result seems to be valid in all countries considered, although their intensity varies significantly between them.

Social inequalities over the lifecourse and healthy ageing in Aotearoa/New Zealand: differences by Māori ethnicity and gender

Lifecourse approaches to healthy ageing recognise that health in older age is affected by long-term cumulative inequalities between socio-economic status (SES), gender and ethnicity groups, which begin in childhood. Combining longitudinal survey data with lifecourse history interviews from 729 older New Zealanders aged 61–81 (mean = 72, standard deviation = 4.5), we tested a lifecourse model of predictors of physical, mental and social health in older age. Latent growth curve and mediation analysis showed that the link between childhood SES and late-life health (over 10 years) was mediated by education, occupation and adult wealth. To account for the moderating effects of gender and ethnicity, we modelled the effects for sub-groups separately (225 non-Māori women, 158 Māori women, 219 non-Māori men and 127 Māori men). Childhood SES was an important predictor of later-life health, mediated by education and adult SES for all participants and for non-Māori men. However, there were significantly different pathways for Māori men and for women. Māori men and women and non-Māori women did not attain the same health benefits from higher childhood SES and education as non-Māori men. Findings point to the importance of considering the mediators of lifelong impacts on health in older age, and recognition of how membership of different socially structured groups produces different pathways to late-life health.

Determinants of Stunting at 6 Weeks in the Northern Cape Province, South Africa

The first 1,000 days from conception to 24 months is a critical period for healthy growth and development. In South Africa, stunting (weight-for-length below −2SD from the WHO reference mean) is a major public health issue with significant health consequences. We determined associations between demographic, health, and anthropometric indicators of mothers and their infants. A cross-sectional study was conducted in the Northern Cape. All mothers with 5- to 7-week-old babies visiting PHC facilities were invited to participate. A questionnaire was completed in a structured interview with each mother. Age and length of the baby at 6 weeks were used to determine stunting, while the weight and height of the mother were measured for body mass index (BMI). Eight hundred questionnaires were completed in 92 facilities. The median age of mothers was 26 years (IQR 20–30 years) and 44.9% were married. Only 40.1% had completed school or tertiary education and almost 40% relied on a government grant as the main source of income. Two-thirds (64.9%) had not planned the pregnancy and 17% were on antiretroviral therapy (ART). More than a quarter (26.1%) smoked cigarettes or used snuff during pregnancy, while 9.4% drank alcohol. At 6 weeks, 31% of boys and 14% of girls had a length-for-age below the WHO reference values, while 25.4% of mothers were classified as obese and 24.6% as overweight. More than 70% had a waist circumference above 80 cm. Significantly more mothers with stunted babies weighed less [−6 kg; −1 kg] and were shorter [−4 cm; −1 cm] than mothers with babies who were not stunted. Compared to babies who were not stunted, significantly more babies of mothers who lived in informal housing [−19.7%; −3.2%], relied on a grant [−19.7%; −3.2%], smoked/ snuffed [7.6%; 23.5%], and used alcohol during pregnancy [0.3%; 11.5%] were stunted. The following factors significantly increased the risk of having a stunted baby at 6 weeks: living in informal housing vs. formal housing (RR: 0.68, 95% CI [0.5; 0.9]); smoking or using snuff during pregnancy (RR: 1.74, 95% CI [1.3; 2.3]); using alcohol during pregnancy (RR: 1.5, 95% CI [1.1; 2.2]); both smoking and using alcohol during pregnancy (RR: 1.97, 95% CI [1.4; 2.9]). We confirmed the coexistence of under- and over-nutrition among mothers and their babies, possibly indicating that stunting in childhood may predispose to overweight and obesity in adulthood in a vicious cycle that affects generation after generation. Interventions aimed at poverty alleviation and encouraging healthy lifestyles with an emphasis on healthy eating, smoking cessation and abstaining from alcohol before pregnancy are urgently required.

Life-Course Circumstances and Frailty in Old Age Within Different European Welfare Regimes: A Longitudinal Study With SHARE

OBJECTIVES

This study aimed to assess whether cumulative disadvantage in childhood misfortune and adult-life socioeconomic conditions influence the risk of frailty in old age and whether welfare regimes influence these associations.

METHOD

Data from 23,358 participants aged 50 years and older included in the longitudinal SHARE survey were used. Frailty was operationalized according to Fried's phenotype as presenting either weakness, shrinking, exhaustion, slowness, or low activity. Confounder-adjusted mixed-effects logistic regression models were used to analyze associations of childhood misfortune and life-course socioeconomic conditions with frailty.

RESULTS

Childhood misfortune and poor adult-life socioeconomic conditions increased the odds of (pre-)frailty at older age. With aging, differences narrowed between categories of adverse childhood experiences (driven by Scandinavian welfare regime) and adverse childhood health experiences (driven by Eastern European welfare regime), but increased between categories of occupational position (driven by Bismarckian welfare regime).

DISCUSSION

These findings suggest that childhood misfortune is linked to frailty in old age. Such a disadvantaged start in life does not seem to be compensated by a person's life-course socioeconomic trajectory, though certain types of welfare regimes affected this relationship. Apart from main occupational position, our findings do not support the cumulative dis/advantage theory, but rather show narrowing differences.

Rethinking morbidity compression

Studies of morbidity compression routinely report the average number of years spent in an unhealthy state but do not report variation in age at morbidity onset. Variation was highlighted by Fries (1980) as crucial for identifying disease postponement. Using incidence of first hospitalization after age 60, as one working example, we estimate variation in morbidity onset over a 27-year period in Denmark. Annual estimates of first hospitalization and the population at risk for 1987 to 2014 were identified using population-based registers. Sex-specific life tables were constructed, and the average age, the threshold age, and the coefficient of variation in age at first hospitalization were calculated. On average, first admissions lasting two or more days shifted towards older ages between 1987 and 2014. The average age at hospitalization increased from 67.8 years (95% CI 67.7-67.9) to 69.5 years (95% CI 69.4-69.6) in men, and 69.1 (95% CI 69.1-69.2) to 70.5 years (95% CI 70.4-70.6) in women. Variation in age at first admission increased slightly as the coefficient of variation increased from 9.1 (95% CI 9.0-9.1) to 9.9% (95% CI 9.8-10.0) among men, and from 10.3% (95% CI 10.2-10.4) to 10.6% (95% CI 10.5-10.6) among women. Our results suggest populations are ageing with better health today than in the past, but experience increasing diversity in healthy ageing. Pensions, social care, and health services will have to adapt to increasingly heterogeneous ageing populations, a phenomenon that average measures of morbidity do not capture.

Association between childhood conditions and arthritis among middle-aged and older adults in China: the China Health and Retirement Longitudinal Study

This study examined the association between childhood conditions and arthritis among middle-aged and older adults in China. The data were derived from the 2015 wave and the life-history module of the China Health and Retirement Longitudinal Study. Face-to-face interviews were conducted with respondents age 45 and over across China. Multiple imputation was used to handle the missing data, generating a final analytic sample of 19,800. Doctor-diagnosed arthritis was the main outcome variable. Random-effects logistic regression models were used to test the proposed models. Approximately 8 per cent of the respondents had better family financial status in childhood than their neighbours. Close to 8 per cent had been hospitalised or encountered similar conditions (e.g. confined to bed or home) for at least one month in childhood. Around one-third reported better subjective health in childhood than their peers. The majority of the respondents (80%) reported that they had stable health resources, and that their mothers were illiterate during their childhood. Childhood family financial status, subjective health, mother's education, access to health care and medical catastrophic events were found to be significant factors associated with arthritis in later life, after controlling for adulthood and older-age conditions (family financial status: odds ratio (OR) = 0.885, 95 per cent confidence interval (95% CI) = 0.848–0.924; subjective health: OR = 0.924, 95% CI = 0.889–0.960; mother's education: OR = 0.863, 95% CI = 0.750–0.992; access to health care: OR = 0.729, 95% CI = 0.552–0.964; medical catastrophic events: OR = 1.266, 95% CI = 1.108–1.446). The study results highlight an important role that childhood conditions play in affecting the onset of arthritis in late life in China. Health-care providers may consider childhood conditions as a valuable screening criterion to identify risk populations, which could be used to guide health promotion and prevention programmes, and promote healthy ageing.

Childhood socioeconomic circumstances, social status, and health in older age: Are they related in China?

It is well known that in western countries, people with disadvantaged socioeconomic circumstances during childhood are at a significantly higher risk of ill health in older age. This study further questions whether in China, individuals' different childhood socioeconomic circumstances and social status continue to affect their life-long health. Furthermore, do later-life socioeconomic circumstances affect health so that childhood conditions no longer play a significant role? The influence of social mobility and accumulation was also tested. The analysis was based on the China Health and Retirement Longitudinal Study (CHARLS) 2013 and CHARLS life history survey. Health outcomes were measured based on self-reported health, disability for activities of daily life, depression symptoms, and cognitive impairment. In addition to measurements of childhood, the analysis included current socioeconomic circumstances, current health behaviors, and demographic characteristics. Using ordered logit or logit and Ordinary Least Square (OLS) regression models, the study shows the existence of the association between childhood conditions and later health in China. After adjusting for current socioeconomic circumstances, social status was no longer related to later health. However, childhood socioeconomic circumstances still significantly influenced health at a later age. Advantaged socioeconomic circumstances in the life course (high stability) provided the best protection for later health. However, moving downward-that is, experiencing childhood socioeconomic advantage but later-life socioeconomic disadvantage-was the most detrimental to later health. Overall, this study provides new evidence from China to support the notion that health in older age is related to dynamic processes structured by the social stratification system. Thus, this study emphasizes an integrated health policy based on the premise of maximizing health over the entire life course.

Association between early-life exposure to the Great Chinese Famine and poor physical function later in life: a cross-sectional study

OBJECTIVES

This study aimed to evaluate the association between early-life exposure to the Great Chinese Famine (1959-1961) and the prevalence of poor physical function in midlife.

DESIGN

A population-based historical prospective study was performed as part of a wider cross-sectional survey. Exposure to famine was defined by birthdate, and participants were divided into non-exposed group, fetal-exposed group and infant-exposed group.

SETTING AND PARTICIPANTS

A total of 3595 subjects were enrolled into the study from the China Health and Retirement Longitudinal Study (CHARLS) 2015 based on random selection of households that had at least one member aged 45 years old and older in 28 provinces of mainland China.

MAIN OUTCOME MEASURES

Physical function status was assessed by a six-item self-report on the Barthel scale which rated basic activities of daily living (BADL).

RESULTS

743 (20.7%) out of all participants were exposed to the Great Chinese Famine in their fetal periods, while 1550 (43.1%) participants were exposed at the age of an infant. The prevalence of poor physical function in the non-exposed group, fetal period-exposed group and infant period-exposed group were 12.3%, 15.5% and 17.0%, respectively. Among males, after stratification by gender and severity of famine, the prevalence of poor physical function in the fetal period was significantly higher (OR 2.40, 95% CI 1.18 to 4.89, p=0.015) than the non-exposed group in severely affected areas, even after adjusting for the number of chronic diseases, place of residence, smoking and alcohol drinking habits, marital status, educational level and body mass index. A similar connection between prenatal and early postnatal exposure to the Great Chinese Famine and the prevalence of poor physical function in midlife, however, was not observed from female adults.

CONCLUSIONS

Males who were exposed to the Great Chinese Famine (1959-1961) present considerably decreased physical function in their later life.

Binary and Nonbinary Measures of Successful Aging: Do They Yield Comparable Conclusions?

Recently, some researchers have employed nonbinary measures of successful aging. Little has been done to determine whether these newer measures yield similar findings compared to traditional binary measures. To test for differences, three measures of successful aging were constructed within five waves of the Americans' Changing Lives data set. A number of demographic, behavioral, and psychosocial predictors were used to predict each outcome, examining whether estimates of effect sizes and statistical significance were similar across measures. Although many effect sizes were similar, conclusions regarding statistical significance were inconsistent. For instance, the binary measure downplayed income gradients, the ordinal measure found more racial disparities, and the continuous measure was most likely to detect effects for stressful life events. These differences may be due to the statistical techniques used to handle each outcome. Results imply that uneven application of operationalization approaches may complicate replication efforts, suggesting a need for consistent measurement standards.

The Impact of Life Course Employment and Domestic Duties on the Well-Being of Retired Women and the Social Protection Systems That Frame This

Objectives: The article addresses whether specific combinations of employment and domestic duties over the life course are associated with variations in women's health at the time of retirement. It also explores the differences of this relationship in four European welfare states. Method: Women from three waves of SHARE (Survey of Health, Aging and Retirement in Europe) are grouped using sequence analysis. Using logistic regression models, group differences in later life depression and self-reported health are tested. Predicted probabilities are applied to analyze welfares' differences. Results: The findings confirm that a combination of employment and domestic duties across the life course has a positive association with later life health. Being outside the labor market is detrimental for women's health. Well-being across the life course is framed by the welfare context in which women live. Discussion: We suggest that further research is needed to explore the mechanisms linking work and care trajectories to poor health and enable appropriate interventions.

Health inequalities in old age: the relative contribution of material, behavioral and psychosocial factors in a German sample

Background

Whereas the association between education and health in later life is well described, investigations about the underlying mechanisms of these health inequalities are scarce. This study examines the relative contribution of material, behavioral and psychosocial factors to health inequalities in older Germans.

Methods

Data were drawn from the fifth wave of the Survey of Health, Ageing and Retirement in Europe (SHARE). The analytic sample included 3246 participants aged 60-85 years. We examined the independent and indirect contribution of material, behavioral and psychosocial factors to the association between education and self-rated health based on logistic regression models.

Results

Material factors were most important as they were additionally working through behavioral and psychosocial factors whereas the independent contribution of behavioral and psychosocial factors was much lower than suggested in the separate analyses of the three explanatory pathways.

Conclusions

Policy interventions that focus on the improvement of material living conditions might reduce health inequalities in old age. In studies on the underlying mechanisms of health inequalities, material, behavioral and psychosocial factors should be modeled as inter-related predictors as the separate analysis does not reveal their actual contribution so that the relevance of single explanatory pathways might be overestimated.

Partnership trajectories and cardiovascular health in late life of older adults in England and Germany

Objectives

Previous studies have shown marital status differences in incidence and prevalence of cardiovascular disease and cardiovascular mortality. This study examines the consequences of partnership on biomarkers related to cardiovascular health of older men and women in Germany and England (C-reactive protein, HbA1c, systolic and diastolic blood pressure; and total cholesterol).

Methods

Data used is from older adults (60 +) from the German Survey of Health and Retirement Europe SHARE (n=955) and the English Longitudinal Study of Ageing ELSA (n=9707). Life course partnership is measured using the timing (age at first partnership), quantum (number of partnerships) and partnership trajectory. OLS for C-reactive protein, logistic regressions for systolic and diastolic blood pressure, and multinomial logistic regressions for cholesterol are used to investigate the associations between life course partnership characteristics and biomarkers, accounting for early age socioeconomic and health conditions.

Results

Timing of first partnership is associated with poor cardiovascular health in England, number of partnership transitions with poor health in Germany, and partnership trajectories are associated with cardiovascular health both in Germany and England. Men in trajectories with multiple marriages have higher CRP, and are more likely to have elevated systolic and diastolic BP. Trajectories containing single marital disruption for men and women are no longer associated with poor health after accounting for selection effects of childhood conditions. Respondents in widowed partnership trajectories have poorer cardiovascular health compared to those in intact committed relationships, whereas cohabitation trajectories do not differ in the associations with biomarkers from those in intact marriage.

Conclusion

The results offer better understanding of the pathways through which family events and processes are linked to health and support the hypothesis that adversity related to partnerships over the life course accumulates and contributes to worse cardiovascular health in later life measured by objective health measures.

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This study investigates the longitudinal accumulated effects of partnership on cardiovascular health using haemostatic and inflammatory biomarkers in later-life, C-reactive protein, HbA1c, systolic and diastolic blood pressure; and total cholesterol.

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Based on life course theory of cumulative disadvantage, the study finds support that the benefits and risks of marital status accumulate over the life-course. The effects are visible on biomarkers of older adults in both Germany and England in models that account for conditions in early life, health behaviors in adult life and sociodemographic factors.

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Data used is from older adults (60 +) form the German Survey of Health and Retirement Europe SHARE (n=955) and the English Longitudinal Study of Ageing ELSA (n=9707). Life course partnership is measured using the timing (age at first partnership), quantum (number of partnerships) and partnership sequence type.

A grounded theory of successful aging among select incarcerated older Filipino women

BACKGROUND

Across the literature, impairment and disability among the older people have been associated with a decline in meeting their special needs. Failure in meeting such needs may cause deterioration of function and threaten successful aging. Accordingly, successful aging studies were carried out among males, in health care institutions, and in communities. In spite of these, the process by which successful aging is experienced by incarcerated older women remains to be a blank spot in research.

AIM

This study purports to describe the process by which incarcerated older Filipino women experience successful aging.

METHODS

Strauss and Corbin's grounded theory design was employed. Semistructured interviews were conducted among 15 purposively selected incarcerated older Filipino from a Philippine penal institution exclusive for women. Further, data gathered was reduced to field text and was analyzed through open, axial and selective coding. Finally, truthfulness and trustworthiness of the findings were established through member checking.

FINDINGS

The study generated "The Road to Success Model". Interestingly, five phases relative to successful aging emerged, namely: Struggling, Remotivating, Reforming, Reintegrating and Sustaining. These phases describe how select incarcerated older Filipino women undergo transformation towards successful aging. Similar to a road, each phase is considered a station where one must pass through in order to get to the destination.

CONCLUSION

Findings of the study serve as an impetus for structural and procedural changes in prison, with a view to providing an environment conducive to successful aging and appropriate recognition to the older prisoner's efforts to achieve successful aging.

Aging in Precarious Circumstances: Do Positive Views on Aging Make a Difference?

Purpose of the study

Precariousness, defined as low income combined with lack of security for retirement, can influence the way people grow old and result in health inequalities in old age.

Design and methods

A sequential mixed methods approach was used to identify differences in behavioral (physical activity), social (social network), and psychological resources (positive views on aging) that middle-aged individuals from both precarious and financially secure backgrounds use in preparation for positive aging and keep high levels of health and well-being. It was investigated whether positive views on aging can compensate the detrimental association of a lack of resources with health and well-being in midlife. Data from the German Aging Survey (N = 1,992 in the secure group, N = 240 in the precarious group) were analyzed to understand the relationship between resources on the one hand and health and well-being on the other, as well as to compare the strategies of individuals with precarious and financially secure backgrounds. Semistructured interviews with middle-aged individuals (N = 20) from these two categories were analyzed in order to further explain the quantitative findings.

Results

Precarious individuals are indeed disadvantaged in terms of behavioral, social, and psychological resources as well as in health and well-being. However, having a positive view on aging can compensate for insufficient resources. Qualitative findings showed differences in strategies for resource management and perceptions of positive aging.

Implications

Secondary analysis of quantitative and qualitative data reflects the importance of positive views on aging as a resource for a healthy old age despite aging in precarious circumstances.

Long-term Health Consequences of Adverse Labor Market Conditions at Time of Leaving Education: Evidence from West German Panel Data

Using longitudinal survey data from the Socio-Economic Panel Study ( N = 3,003 respondents with 22,165 individual-year observations) and exploiting temporal and regional variation in state-level unemployment rates in West Germany, we explore differences in trajectories of individuals' self-rated health over a period of up to 23 years after leaving education under different regional labor market conditions. We find evidence for immediate positive effects of contextual unemployment when leaving education on individuals' health. We find no evidence for generally accelerated or decelerated health deterioration when leaving education in high-unemployment contexts. We find, however, that individual unemployment experience when leaving education is associated with worse health and with more accelerated health deterioration in high-unemployment contexts. The cumulative experience of unemployment after leaving education does not mediate the influence of early labor market experiences for long-term health outcomes. In addition, our analyses indicate no gender differences in these results.

The Effect of Childhood Health Status on Adult Health in China

Childhood health in China was poor in the 1950s and 1960s because of limited nutrition. In the last three decades, China has distinguished itself through its tremendous economic growth and improvements in health and nutrition. However, prior to such growth, access to good nutrition was more variable, with potentially important implications, not only for childhood health, but also for adult health, because of its long-term effects lasting into adulthood. To shed light on these issues, this study examined the long-run association between childhood health and adult health outcomes among a middle-aged Chinese population and addresses the endogeneity of childhood health. A nationwide database from the 2011 China Health and Retirement Longitudinal Study (CHARLS) was employed. Three adult health outcomes variables were used: self-reported health status, cognition, and physical function. The local variation in grain production in the subjects’ fetal period and the first 24 months following birth was employed as an instrument for childhood health in order to correct for its endogeneity. Childhood health recalled by the respondents was positively and significantly associated with their adult health outcomes in terms of self-reported health status, cognition, and physical function in single-equation estimates that did not correct for the endogeneity of childhood health. A good childhood health status increased the probabilities of good adult health, good adult cognitive function, and good adult physical function by 16% (95% CI: 13–18%), 13% (95% CI: 10–15%), and 14% (95% CI: 12–17%), respectively. After correcting for endogeneity, the estimated effects of good childhood health were consistent but stronger. We also studied the male and female populations separately, finding that the positive effects of childhood health on adult health were larger for males. In China, childhood health significantly affects adult health. This suggests that early interventions to promote childhood health will have long-term benefits in China and that health-care policies should consider their long-term impacts over the life cycle in addition to their effects on specific age groups.

The Effects of Life Events and Socioeconomic Position in Childhood and Adulthood on Successful Aging

Objectives

Building on social stress theory, this study has 2 aims. First, we aim to estimate the effects of stressful life events in childhood and adulthood on Successful Aging (SA). Second, we examine how unequal exposure to such life events between individuals with different socioeconomic position (SEP) contributes to socioeconomic inequalities in SA.

Method

We used 16-year longitudinal data from 2,185 respondents aged 55-85 years in 1992 in the Dutch nationally representative Longitudinal Aging Study Amsterdam. Measurement of SA was based on earlier work, in which we integrated trajectories in 9 indicators of functioning into an index of SA. Using path analysis, we investigated direct and indirect effects of parental and adulthood SEP as well as of self-reported childhood and adulthood life events on SA.

Results

Almost all included life events had negative direct effects on SA. Parental SEP had no direct effect on SA, whereas adulthood SEP had. Higher Parental SEP increased the likelihood of parental problems and parental death in childhood, resulting in negative indirect effects on SA. Higher adulthood SEP had both positive and negative indirect effects on SA, through increasing the likelihood of divorce and unemployment, but decreasing the likelihood of occupational disability.

Discussion

SEP and particular stressful life events are largely, but not entirely independent predictors of SA. We found that high and low SEP may increase exposure to particular events that negatively affect SA. Findings suggest that low (childhood) SEP and stressful life events are interrelated factors that may limit individual opportunities to age successfully.

Healthy Aging After Age 65: A Life-Span Health Production Function Approach

This article examines the determinants of healthy aging using Grossman’s framework of a health production function. Healthy aging, sometimes described as successful aging, is produced using a variety of inputs, determined in early life, young adulthood, midlife, and later life. A healthy aging production function is estimated using nationally representative data from the 2010 and 2012 Health and Retirement Study on 7,355 noninstitutionalized seniors. Using a simultaneous equation mediation model, we quantify how childhood factors contribute to healthy aging, both directly and indirectly through their effects on mediating adult outcomes. We find that favorable childhood conditions significantly improve healthy aging scores, both directly and indirectly, mediated through education, income, and wealth. We also find that good health habits have positive effects on healthy aging that are larger in magnitude than the effects of childhood factors. Our findings suggest that exercising, maintaining proper weight, and not smoking are likely to translate into healthier aging.

Aging and Hearing Health: The Life-course Approach

Sensory abilities decline with age. More than 5% of the world's population, approximately 360 million people, have disabling hearing loss. In adults, disabling hearing loss is defined by thresholds greater than 40 dBHL in the better hearing ear.Hearing disability is an important issue in geriatric medicine because it is associated with numerous health issues, including accelerated cognitive decline, depression, increased risk of dementia, poorer balance, falls, hospitalizations, and early mortality. There are also social implications, such as reduced communication function, social isolation, loss of autonomy, impaired driving ability, and financial decline. Furthermore, the onset of hearing loss is gradual and subtle, first affecting the detection of high-pitched sounds and with difficulty understanding speech in noisy but not in quiet environments. Consequently, delays in recognizing and seeking help for hearing difficulties are common. Age-related hearing loss has no known cure, and technologies (hearing aids, cochlear implants, and assistive devices) improve thresholds but do not restore hearing to normal. Therefore, health care for persons with hearing loss and people within their communication circles requires education and counseling (e.g., increasing knowledge, changing attitudes, and reducing stigma), behavior change (e.g., adapting communication strategies), and environmental modifications (e.g., reducing noise). In this article, we consider the causes, consequences, and magnitude of hearing loss from a life-course perspective. We examine the concept of "hearing health," how to achieve it, and implications for policy and practice.