Psychological and cognitive determinants of mortality: Evidence from a nationally representative sample followed over thirty-five years

Patient-reported predictors of postdischarge mortality after cardiac hospitalization

BACKGROUND

Adults hospitalized for cardiovascular events are at high risk for postdischarge mortality. Screening of psychosocial risk is prioritized by the Joint Commission. We tested whether key patient-reported psychosocial and behavioral measures could predict posthospitalization mortality in a cohort of adults hospitalized for a cardiovascular event.

METHODS

We conducted a prospective cohort study to test the prognostic utility of validated patient-reported measures, including health literacy, social support, health behaviors and disease management, and socioeconomic status. Cox survival analyses of mortality were conducted over a median of 3.5 years.

RESULTS

Among 2977 adults hospitalized for either acute coronary syndrome or acute decompensated heart failure, the mean age was 53 years, and 60% were male. After adjusting for demographic, clinical, and other psychosocial factors, mortality risk was greatest among patients who reported being unemployed (hazard ratio [HR]: 1.99, 95% confidence interval [CI]): 1.30-3.06), retired (HR: 2.14, 95% CI: 1.60-2.87), or unable to work due to disability (HR: 2.36, 95% CI: 1.73-3.21), as compared to those who were employed. Patient-reported perceived health competence (PHCS-2) and exercise frequency were also associated with mortality risk after adjusting for all other variables (HR: 0.86, 95% CI: 0.73-1.00 per four-point increase in PHCS-2; HR: 0.86, 95% CI: 0.77-0.96 per 3-day increase in exercise frequency, respectively).

CONCLUSIONS

Patient-reported measures of employment status, perceived health competence, and exercise frequency independently predict mortality after a cardiac hospitalization. Incorporating these brief, valid measures into hospital-based screening may help with prognostication and targeting patients for resources during post-discharge transitions of care.

Patient-reported predictors of post-discharge mortality after cardiac hospitalization

Background

Adults hospitalized for cardiovascular events are at high risk for post-discharge mortality. Hospital-based screening of health-related psychosocial risk factors is now prioritized by the Joint Commission and the National Quality Forum to achieve equitable, high-quality care. We tested our hypothesis that key patient-reported psychosocial and behavioral measures could predict post-hospitalization mortality in a cohort of adults hospitalized for a cardiovascular event.

Methods

This was a prospective cohort of adults hospitalized at Vanderbilt University Medical Center. Validated patient-reported measures of health literacy, social support, disease self-management, and socioeconomic status were used as predictors of interest. Cox survival analyses of mortality were conducted over a median 3.5-year follow-up (range: 1.25 - 5.5 years).

Results

Among 2,977 adults, 1,874 (63%) were hospitalized for acute coronary syndrome and 1,103 (37%) were hospitalized for acute decompensated heart failure; 60% were male; and the mean age was 53 years. After adjusting for demographic, clinical, and other psychosocial factors, mortality risk was greatest among patients who reported being unable to work due to disability (Hazard Ratio (HR) 2.36, 95% Confidence Interval (CI): 1.73-3.21), who were retired (HR 2.14, 95% CI 1.60-2.87), and who reported unemployment (HR 1.99, 95% CI 1.30-3.06) as compared to those who were employed. Patient-reported measures of disease self-management, perceived health competence and exercise frequency, were also associated with mortality risk after full covariate adjustment (HR 0.86, 95% CI 0.73-1.00 per four-point increase), (HR 0.86, 95% CI 0.77-0.96 per three-day change), respectively.

Conclusions

Patient-reported measures of employment status independently predict post-discharge mortality after a cardiac hospitalization. Measure of disease self-management also have prognostic modest utility. Hospital-based screening of psychosocial risk is increasingly prioritized in legislative policy. Incorporating brief, valid measures of employment status and disease self-management factors may help target patients for psychosocial, financial, and rehabilitative resources during post-discharge transitions of care.

The destabilization and destandardization of social roles across the adult life course: Considering aggregate social role instability and its variability from a historical-developmental perspective

Existing research focused on social role destabilization (historical increases in role instability) and destandardization (historical increases in variability of role instability) has primarily focused on discrete social roles during discrete periods of development. Building on this work, we applied a macro approach to elucidate the extent to which historical trends toward destabilization and destandardization are occurring at the aggregate among a key set of social roles (union formation, education, residential independence, and employment) and across the whole of adulthood. Applying a historical-developmental approach, we also document how historical trends toward destabilization and destandardization vary by age. We used 3 historical, longitudinal data sets: the Monitoring the Future study (N = 69,464; 55.4% women; 75.5% white), the Panel Study of Income Dynamics (N = 45,001; 51.4% women; 54.3% white), and The Health and Retirement Study (N = 30,913; 53.6% women; 75.6% white) that collectively cover the entire adult life course and over a century of U.S. birth cohorts. We found that aggregate destabilization and destandardization have occurred across the entirety of adulthood, although trends appear more pronounced at either end of the adult life course and the specific roles driving both trends vary across the adult life course. Findings were robust for educational attainment, and destabilization and destandardization were more pronounced among women. Findings highlight the importance of considering social role changes at the aggregate and singularly, and the need to evaluate social role changes in any 1 period of adulthood in conjunction with those occurring in other periods of adulthood. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Midlife Work Limitations are Associated with Lower Odds of Survival and Healthy Aging

OBJECTIVES

Health conditions that limit work are associated with myriad socioeconomic disadvantages and around half of Americans could face a work limitation at some point in their working career. Our study examines the relationship between midlife work limitations and two aging outcomes: longevity and healthy aging.

METHODS

Using longitudinal data from the Panel Study of Income Dynamics and restricted mortality data, multivariate logistic regressions estimate the odds of desirable aging outcomes around age 65 for individuals with various midlife work limitation histories in samples of around 2,000 individuals.

RESULTS

Midlife work limitations are consistently linked with a lower likelihood of desirable aging outcomes. Temporary limitations are associated with 59% and 69% lower survival and healthy aging odds, respectively. Chronic limitations are associated with approximately 80% lower survival odds and 90% lower healthy aging odds at age 65.

DISCUSSION

Even temporary work limitations can be highly disadvantageous for aging outcomes, emphasizing the need to understand different work limitation histories. Future research should identify underlying mechanisms linking midlife work limitations and less desirable aging outcomes.

Psychological well-being and mortality: longitudinal findings from Lithuanian middle-aged and older adults study

BACKGROUND

The study aimed to examine whether after confounding by possible socio-demographic and other risk factors, psychological well-being is independently associated with reduced all-cause and cardiovascular mortality.

METHODS

Initial data were collected within the framework of the international project HAPIEE in 2006-2008. A random sample of 7115 individuals aged 45-72 years was screened. Deaths were evaluated by death register of Kaunas city (Lithuania) in a follow-up study till 2016. Psychological well-being was evaluated by a CASP-12 questionnaire. Socio-demographic, lifestyle, biologic factors and depressive symptoms were evaluated.

RESULTS

Age-adjusted survival curves revealed that psychological well-being predicts longevity in men and women (p < 0.001). After adjustment for many possible confounders psychological well-being was independently associated with all-cause mortality in men (HR 0.77; 95% CI 0.62-0.94) and women (HR 0.73; 95% CI 0.56-0.96). However, psychological well-being association with cardiovascular mortality attained statistical significance only in the women's group (HR 0.53; 95% CI 0.33-0.87), but not in men (HR 0.98; 95% CI 0.72-1.33).

CONCLUSIONS

Psychological well-being is an important predictor of longevity, controlling well-recognized risk factors such as age, education, cardiovascular diseases, social status, marital status, lifestyle and biological factors and depressive symptoms. Positive psychological well-being should be taken into account when screening older people to prevent negative health outcomes.

Uses of Panel Study of Income Dynamics Data in Research on Aging

The Panel Study of Income Dynamics (PSID) has, over its 50-year history, proven to be a useful source of data for research on virtually all of the major topics in the area of social gerontology. This usefulness reflects three of the leading features of the PSID: its longitudinality, its content, and its tracking rules, which permit users to develop family-based and generationally-linked measures. This paper summarizes key areas of survey content, including both routinely-collected data and several one-time or occasional supplements to the routine items. The paper also illustrates how these data elements have been used, providing examples of published papers in several areas of social gerontology. Finally, the paper points out some methodological issues associated with the PSID design; these methodological issues arise, in varying degrees, in longitudinal studies other than the PSID, and should be acknowledged by both the producers and consumers of longitudinal-data research.