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Fröberg A, Sacco L, Suorsa K, Leskinen T, Hettiarachchi P, Svartengren M, Stenholm S, Westerlund H. Changes in Accelerometer-Measured Physical Activity and Sedentary Time Across Retirement Transition as a Predictor of Self-Rated Health. J Phys Act Health 2024; 21:778-786. [PMID: 38702051 DOI: 10.1123/jpah.2023-0558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 02/20/2024] [Accepted: 04/01/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Retirement transition has been shown to associate with changes in physical activity (PA) and self-rated health (SRH), but their interrelationship is less studied. The aim was to investigate changes in accelerometer-measured total PA, moderate to vigorous PA (MVPA), and sedentary time across retirement transition as a predictor of SRH. METHODS Data from the Swedish Retirement Study and the Finnish Retirement and Aging study were harmonized and pooled. Data from 3 waves (about 12 mo apart) were included: 1 preretirement (wave 1) and 2 postretirement follow-ups (wave 2-3). A totally of 245 participants (27% men) were included. Thigh-worn accelerometers were used to collect data for PA variables (wave 1-2), and SRH was obtained from the questionnaire (wave 1-3). RESULTS Between wave 1 and 2, total PA decreased with 11 (CI, -22 to -1) minutes per day, MVPA was stable (0 [CI, -3 to 3] min), and sedentary time decreased nonsignificantly with 9 (CI, -20 to 1) minutes. SRH changed between all 3 waves (all P < .001). At preretirement, 10 more minutes of MVPA was associated with greater odds of better SRH when adjusting for accelerometer wear-time, cohort, sex, age, and occupational status (odds ratio: 1.11 [95% CI, 1.02-1.22]). This association was no longer statistically significant when additionally adjusting for marital status, body mass index, and smoking. No significant associations were observed between changes in the PA variables during retirement transition and SRH at postretirement follow-ups. CONCLUSIONS This study showed a cross-sectional association between MVPA and greater odds of reporting better SRH before retirement. No longitudinal associations were observed between changes in the PA variables from before to after retirement and later changes in SRH.
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Affiliation(s)
- Andreas Fröberg
- Department of Food and Nutrition, and Sport Science, University of Gothenburg, Gothenburg, Sweden
| | - Lawrence Sacco
- Stress Research Institute, Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Kristin Suorsa
- Department of Public Health, University of Turku, and Turku University Hospital, Turku, Finland
- Center for Population Health Research, University of Turku, and Turku University Hospital, Turku, Finland
| | - Tuija Leskinen
- Department of Public Health, University of Turku, and Turku University Hospital, Turku, Finland
- Center for Population Health Research, University of Turku, and Turku University Hospital, Turku, Finland
| | | | - Magnus Svartengren
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
- Department of Occupational and Environmental Medicine, Uppsala University Hospital, Uppsala, Sweden
| | - Sari Stenholm
- Department of Public Health, University of Turku, and Turku University Hospital, Turku, Finland
- Center for Population Health Research, University of Turku, and Turku University Hospital, Turku, Finland
| | - Hugo Westerlund
- Stress Research Institute, Department of Psychology, Stockholm University, Stockholm, Sweden
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Lüdecke D, von dem Knesebeck O. Worsened self-rated health in the course of the COVID-19 pandemic among older adults in Europe. Eur J Public Health 2023; 33:1148-1154. [PMID: 37568252 PMCID: PMC10710346 DOI: 10.1093/eurpub/ckad143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Governments across Europe deployed non-pharmaceutical interventions to mitigate the spread of coronavirus disease 2019 (COVID-19), which not only showed clear benefits but also had negative consequences on peoples' health. Health inequalities increased, disproportionally affecting people with higher age or lower education. This study analyzed associations between social factors and worsened self-rated health of elderly people in the course of the COVID-19 pandemic, taking different stringencies of government mandates as well as infection rates into account. METHODS Data stem from the European SHARE survey. The main outcome was a binary indicator of worsened self-rated health. Analyses included data from two waves (2020 and 2021) during the pandemic (N = 48 356 participants, N = 96 712 observations). Predictors were age, sex, education and living together with a partner, and two macro indicators that reflected the stringency of government response mandates and COVID-19 infection rates. Data were analyzed using logistic mixed-effects regression models. RESULTS Older age [odds ratio (OR) 1.73, confidence interval (CI) 1.65-1.81] and female sex (OR 1.26, CI 1.20-1.32) were positively associated and higher education (OR 0.74, CI 0.70-0.79) was negatively associated with worsened self-rated health. Not living together with a partner showed higher odds of worsened self-rated health (OR 1.30, CI 1.24-1.36). Inequalities increased from 2020 to 2021. Associations between worsened self-rated health and government response mandates or infection rates were inconsistent. CONCLUSION Self-rated health worsened in the course of the pandemic and health disparities increased. Possible future pandemics require targeted interventions to minimize adverse health outcomes, in particular among old, potentially isolated, and deprived people.
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Affiliation(s)
- Daniel Lüdecke
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Olaf von dem Knesebeck
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Whitmore C, Markle-Reid M, McAiney C, Fisher K, Ploeg J. How do individual, social, environmental, and resilience factors shape self-reported health among community-dwelling older adults: a qualitative case study. BMC Geriatr 2023; 23:8. [PMID: 36609212 PMCID: PMC9816521 DOI: 10.1186/s12877-023-03726-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 01/02/2023] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND While older adults are living longer, they often face health challenges, including living with multiple chronic conditions. How older adults respond and adapt to the challenges of multimorbidity to maintain health and wellness is of increasing research interest. Self-reported health, emerging as an important measure of health status, has broad clinical and research applications, and has been described as a predictor of future morbidity and mortality. However, there is limited understanding of how individual, social, and environmental factors, including those related to multimorbidity resilience, influence self-reported health among community-dwelling older adults (≥ 65 years). METHODS Informed by the Lifecourse Model of Multimorbidity Resilience, this explanatory case study research explored older adults' perceptions of how these factors influence self-reported health. Data were generated through semi-structured telephone interviews with community-dwelling older adults. RESULTS Fifteen older adults participated in this study. Four key themes, specific to how these older adults describe individual, social, environmental, and multimorbidity resilience factors as shaping their self-reported health, were identified: 1) health is a responsibility - "What I have to do"; 2) health is doing what you want to do despite health-related limitations - "I do what I want to do"; 3) the application and activation of personal strengths - "The way you think", and; 4) through comparison and learning from others - "Looking around at other people". These themes, while distinct, were found to be highly interconnected with recurring concepts such as independence, control, and psychological health and well-being, demonstrating the nuance and complexity of self-reported health. CONCLUSIONS Findings from this study advance understanding of the factors that influence assessments of health among community-dwelling older adults. Self-reported health remains a highly predictive measure of future morbidity and mortality in this population, however, there is a need for future research to contribute additional understanding in order to shape policy and practice.
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Affiliation(s)
- Carly Whitmore
- grid.25073.330000 0004 1936 8227School of Nursing, McMaster University, 1280 Main Street W., Hamilton, ON L8S 4K1 Canada
| | - Maureen Markle-Reid
- grid.25073.330000 0004 1936 8227School of Nursing, McMaster University, 1280 Main Street W., Hamilton, ON L8S 4K1 Canada
| | - Carrie McAiney
- grid.498777.2School of Public Health Sciences, University of Waterloo & Schlegel-University of Waterloo, Research Institute for Aging, 200 University Ave W., Waterloo, ON N2L 3G1 Canada
| | - Kathryn Fisher
- grid.25073.330000 0004 1936 8227School of Nursing, McMaster University, 1280 Main Street W., Hamilton, ON L8S 4K1 Canada
| | - Jenny Ploeg
- grid.25073.330000 0004 1936 8227School of Nursing, McMaster University, 1280 Main Street W., Hamilton, ON L8S 4K1 Canada
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Newsom JT, McQueen A, Rook KS, Krause N, Denning EC. A Change for the Worse: Negative Social Exchanges are Associated with an Accelerated Decline in Self-Rated Health Over Time. J Aging Health 2022; 34:984-995. [PMID: 35475380 DOI: 10.1177/08982643221083407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Age-associated accelerated declines in physical health vary across individuals, and researchers have suggested that individual differences in decline may vary as a function of stressors. The relation of one such stressor, negative social exchanges, to accelerated declines in self-rated health is investigated. Method: Participants are from a 2-year, 5-wave, national, longitudinal study of social relationships among older adults. Growth curve analyses are used to examine the relation of negative and positive social exchanges to accelerated changes in self-rated health, controlling for age, sex, race/ethnicity, education, and depressive symptoms. Results: Individuals reporting more frequent negative social exchanges showed significantly accelerated declines in physical health. Positive social exchanges were not related to linear or accelerated declines in self-rated health over time. DISCUSSION The association between negative social exchanges and accelerated deterioration in self-rated health provides general support for hypotheses that interpersonal stressors play an important role age-related physical health decline.
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Affiliation(s)
| | - Ann McQueen
- 6690Oregon Department of Human Services, Salem, USA
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Whitmore C, Markle-Reid M, McAiney C, Ploeg J, Griffith LE, Phillips SP, Wister A, Fisher K. Self-reported health and the well-being paradox among community-dwelling older adults: a cross-sectional study using baseline data from the Canadian Longitudinal Study on Aging (CLSA). BMC Geriatr 2022; 22:112. [PMID: 35144559 PMCID: PMC8832840 DOI: 10.1186/s12877-022-02807-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 02/02/2022] [Indexed: 11/30/2022] Open
Abstract
Background Self-reported health is a widely used epidemiologic measure, however, the factors that predict self-reported health among community-dwelling older adults (≥65 years), especially those with multimorbidity (≥2 chronic conditions), are poorly understood. Further, it is not known why some older adults self-report their health positively despite the presence of high levels of multimorbidity, a phenomenon known as the well-being paradox. The objectives of this study were to: 1) examine the factors that moderate or mediate the relationship between multimorbidity and self-reported health; 2) identify the factors that predict high self-reported health; and 3) determine whether these same factors predict high self-reported health among those with high levels of multimorbidity to better understand the well-being paradox. Methods A cross-sectional analysis of baseline data from the Canadian Longitudinal Study on Aging was completed (n = 21,503). Bivariate stratified analyses were used to explore whether each factor moderated or mediated the relationship between multimorbidity and self-reported health. Logistic regression was used to determine the factors that predict high self-reported health in the general population of community-dwelling older adults and those displaying the well-being paradox. Results None of the factors explored in this study moderated or mediated the relationship between multimorbidity and self-reported health, yet all were independently associated with self-reported health. The ‘top five’ factors predicting high self-reported health in the general older adult population were: lower level of multimorbidity (odds ratio [OR] 0.75, 95% confidence interval [CI] 0.74-0.76), female sex (OR 0.62, CI 0.57-0.68), higher Life Space Index score (OR 1.01, CI 1.01-1.01), higher functional resilience (OR 1.16, CI 1.14-1.19), and higher psychological resilience (OR 1.26, CI 1.23-1.29). These same ‘top five’ factors predicted high self-reported health among the subset of this population with the well-being paradox. Conclusions The factors that predict high self-reported health in the general population of older adults are the same for the subset of this population with the well-being paradox. A number of these factors are potentially modifiable and can be the target of future interventions to improve the self-reported health of this population. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-02807-z.
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Affiliation(s)
- Carly Whitmore
- School of Nursing, McMaster University, 1280 Main Street W, Hamilton, Ontario, L8S 4K1, Canada.
| | - Maureen Markle-Reid
- School of Nursing, McMaster University, 1280 Main Street W, Hamilton, Ontario, L8S 4K1, Canada
| | - Carrie McAiney
- School of Public Health Sciences, University of Waterloo & Schlegel-University of Waterloo Research Institute for Aging, 200 University Ave W, Waterloo, Ontario, N2L 3G1, Canada
| | - Jenny Ploeg
- School of Nursing, McMaster University, 1280 Main Street W, Hamilton, Ontario, L8S 4K1, Canada
| | - Lauren E Griffith
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street W, Hamilton, Ontario, L8S 4K1, Canada
| | - Susan P Phillips
- School of Medicine, Queen's University, 220 Bagot St, Kingston, Ontario, K7L 5E9, Canada
| | - Andrew Wister
- Department of Gerontology, Simon Fraser University, 515 W Hastings St, Vancouver, British Columbia, V6B 5K3, Canada
| | - Kathryn Fisher
- School of Nursing, McMaster University, 1280 Main Street W, Hamilton, Ontario, L8S 4K1, Canada
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Schneider A, Riedlinger D, Pigorsch M, Holzinger F, Deutschbein J, Keil T, Möckel M, Schenk L. Self-reported health and life satisfaction in older emergency department patients: sociodemographic, disease-related and care-specific associated factors. BMC Public Health 2021; 21:1440. [PMID: 34289829 PMCID: PMC8296655 DOI: 10.1186/s12889-021-11439-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 06/30/2021] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND Self-reported health (SRH) and life satisfaction (LS) are patient-reported outcomes (PROs) that independently predict mortality and morbidity in older adults. Emergency department (ED) visits due to serious health problems or accidents might pose critical life events for patients. This study aimed (a) to characterize older patients' SRH and LS during the distinct event of an ED stay, and (b) to analyze concomitant associations of PROs with ED patients' sociodemographic, disease-specific and care-related variables. METHODS Study personnel recruited mostly older ED patients from three disease groups during a two-year period (2017-2019) in eight EDs in central Berlin, Germany, in the context of the health services research network EMANet. Cross-sectional data from the baseline patient survey and associated secondary data from hospital information systems were analyzed. Multilevel linear regression models with random intercept were applied to assess concomitant associations with SRH (scale: 0 (worst) to 100 (best)) and LS (scale: 0 (not at all satisfied) to 10 (completely satisfied)) as outcomes, including sensitivity analyses. RESULTS The final sample comprised N = 1435 participants. Mean age was 65.18 (SD: 16.72) and 50.9% were male. Mean ratings of SRH were 50.10 (SD: 23.62) while mean LS scores amounted to 7.15 (SD: 2.50). Better SRH and higher LS were found in patients with cardiac symptoms (SRH: β = 4.35, p = .036; LS: β = 0.53, p = .006). Worse SRH and lower LS were associated with being in need of nursing care (SRH: β = - 7.52, p < .001; LS: β = - 0.59, p = .003) and being unemployed (SRH: β = - 8.54, p = .002; LS: β = - 1.27, p < .001). Sex, age, number of close social contacts, and hospital stays in the previous 6 months were additionally related to the outcomes. Sensitivity analyses largely supported results of the main sample. CONCLUSIONS SRH and LS were associated with different sociodemographic and disease-related variables in older ED patients. Nursing care dependency and unemployment emerged as significant factors relating to both outcomes. Being able to identify especially vulnerable patients in the ED setting might facilitate patient-centered care and prevent negative health outcomes. However, further longitudinal research needs to analyze trajectories in both outcomes and suitable intervention possibilities in the ED setting. TRIAL REGISTRATION EMANet sub-studies were registered separately: German Clinical Trials Register (EMAAge: DRKS00014273, registration date: May 16, 2018; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00014273; EMACROSS: DRKS00011930, registration date: April 25, 2017; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00011930); ClinicalTrials.gov (EMASPOT: NCT03188861, registration date: June 16, 2017; https://clinicaltrials.gov/ct2/show/NCT03188861?term=NCT03188861&draw=2&rank=1).
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Affiliation(s)
- Anna Schneider
- Charité - Universitätsmedizin Berlin, corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Sociology and Rehabilitation Science, Berlin, Germany.
| | - Dorothee Riedlinger
- Charité - Universitätsmedizin Berlin, corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Emergency Medicine, Campus Virchow-Klinikum and Campus Charité Mitte, Berlin, Germany
| | - Mareen Pigorsch
- Charité - Universitätsmedizin Berlin, corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Biometry and Clinical Epidemiology, Berlin, Germany
| | - Felix Holzinger
- Charité - Universitätsmedizin Berlin, corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of General Practice, Berlin, Germany
| | - Johannes Deutschbein
- Charité - Universitätsmedizin Berlin, corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Sociology and Rehabilitation Science, Berlin, Germany
| | - Thomas Keil
- Charité - Universitätsmedizin Berlin, corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Social Medicine, Epidemiology and Health Economics, Berlin, Germany.,University of Wuerzburg, Institute of Clinical Epidemiology and Biometry, Wuerzburg, Germany.,State Institute of Health, Bavarian Health and Food Safety Authority, Bad Kissingen, Germany
| | - Martin Möckel
- Charité - Universitätsmedizin Berlin, corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Emergency Medicine, Campus Virchow-Klinikum and Campus Charité Mitte, Berlin, Germany
| | - Liane Schenk
- Charité - Universitätsmedizin Berlin, corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Sociology and Rehabilitation Science, Berlin, Germany
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