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Atala-Acevedo C, McGrath R, Capurro D, Glenister K, Bourke L, Morgan M, Simmons D, Mariño R. Identifying Frailty in Older Adults in Rural Victoria, Australia: A Secondary Analysis of Population Health Data. J Aging Health 2024; 36:170-181. [PMID: 37260112 DOI: 10.1177/08982643231180045] [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] [Indexed: 06/02/2023]
Abstract
Objectives: To determine the prevalence of frailty among community-dwelling older adults in regional Victoria, Australia. Methods: Frailty status of 376 participants from the Crossroads II cross-sectional study was assessed by selected markers of frailty. The selected variables were psychometrically tested. Associations between frailty and socio-demographic, environmental and health factors were analysed using chi-square, ANOVA and binary logistic regression (BLR). Results: Estimated prevalence of frailty was 39.4%. BLR indicated that frailty decreased with higher educational attainment, (OR = .23; 95% CI: .10-.51) increased for divorced/separated participants (OR = 2.68; 95% CI: 1.29-5.56) and when having three (OR = 3.27; 95% CI: 1.07-9.98), four (OR = 7.20; 95% CI: 2.22-23.31) or five or more chronic conditions (OR = 9.18; 95% CI: 2.83-29.72). Discussion: Frailty in this Australian regional community-dwelling sample was higher than other studies conducted in urban areas of Australia. Present results highlight the importance of exploring the multidimensionality of the frailty construct to have a better understanding which factors are associated with the development of this syndrome.
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Affiliation(s)
- Claudia Atala-Acevedo
- Faculty of Dentistry, Universidad de La Frontera, Temuco, Chile
- Melbourne Dental School, The University of Melbourne, Melbourne, VIC Australia
| | - Roisin McGrath
- Melbourne Dental School, The University of Melbourne, Melbourne, VIC Australia
| | - Daniel Capurro
- School of Computing and Information Systems, Centre for the Digital Transformation of Health, The University of Melbourne, Melbourne, VIC Australia
| | - Kristen Glenister
- Department of Rural Health, The University of Melbourne, Melbourne, VIC Australia
| | - Lisa Bourke
- Department of Rural Health, The University of Melbourne, Melbourne, VIC Australia
| | - Mike Morgan
- Melbourne Dental School, The University of Melbourne, Melbourne, VIC Australia
| | - David Simmons
- Department of Rural Health, The University of Melbourne, Melbourne, VIC Australia
- Macarthur Clinical School, Western Sydney University, Sydney, Australia
| | - Rodrigo Mariño
- Melbourne Dental School, The University of Melbourne, Melbourne, VIC Australia
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2
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Kalu ME, Bello-Haas VD, Griffin M, Boamah S, Harris J, Zaide M, Rayner D, Khattab N, Abrahim S. A Scoping Review of Personal, Financial, and Environmental Determinants of Mobility Among Older Adults. Arch Phys Med Rehabil 2023; 104:2147-2168. [PMID: 37119957 DOI: 10.1016/j.apmr.2023.04.007] [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: 03/27/2022] [Revised: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 05/01/2023]
Abstract
OBJECTIVE To synthesize available evidence of factors comprising the personal, financial, and environmental mobility determinants and their association with older adults' self-reported and performance-based mobility outcomes. DATA SOURCES PubMed, EMBASE, PsychINFO, Web of Science, AgeLine, Sociological Abstract, Allied and Complementary Medicine Database, and Cumulative Index to Nursing and Allied Health Literature databases search for articles published from January 2000 to December 2021. STUDY SECTION Using predefined inclusion and exclusion criteria, multiple reviewers independently screened 27,293 retrieved citations from databases, of which 422 articles underwent full-text screening, and 300 articles were extracted. DATA EXTRACTION The 300 articles' information, including study design, sample characteristics including sample size, mean age and sex, factors within each determinant, and their associations with mobility outcomes, were extracted. DATA SYNTHESIS Because of the heterogeneity of the reported associations, we followed Barnett et al's study protocol and reported associations between factors and mobility outcomes by analyses rather than by article to account for multiple associations generated in 1 article. Qualitative data were synthesized using content analysis. A total of 300 articles were included with 269 quantitative, 22 qualitative, and 9 mixed-method articles representing personal (n=80), and financial (n=1), environmental (n=98), more than 1 factor (n=121). The 278 quantitative and mixed-method articles reported 1270 analyses; 596 (46.9%) were positively and 220 (17.3%) were negatively associated with mobility outcomes among older adults. Personal (65.2%), financial (64.6%), and environmental factors (62.9%) were associated with mobility outcomes, mainly in the expected direction with few exceptions in environmental factors. CONCLUSIONS Gaps exist in understanding the effect of some environmental factors (eg, number and type of street connections) and the role of gender on older adults' walking outcomes. We have provided a comprehensive list of factors with each determinant, allowing the creation of core outcome set for a specific context, population, or other forms of mobility, for example, driving.
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Affiliation(s)
- Michael E Kalu
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Canada.
| | - Vanina Dal Bello-Haas
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Meridith Griffin
- Department of Health, Aging & Society, Faculty of Social Science, McMaster University, Hamilton, Canada
| | - Sheila Boamah
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Jocelyn Harris
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Mashal Zaide
- Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Daniel Rayner
- Department of Health Science, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Nura Khattab
- Department of Kinesiology, Faculty of Sciences, McMaster University, Hamilton, Canada
| | - Salma Abrahim
- Department of Kinesiology, Faculty of Sciences, McMaster University, Hamilton, Canada
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3
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Newman AB, Visser M, Kritchevsky SB, Simonsick E, Cawthon PM, Harris TB. The Health, Aging, and Body Composition (Health ABC) Study-Ground-Breaking Science for 25 Years and Counting. J Gerontol A Biol Sci Med Sci 2023; 78:2024-2034. [PMID: 37431156 PMCID: PMC10613019 DOI: 10.1093/gerona/glad167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND The Health, Aging, and Body Composition Study is a longitudinal cohort study that started just over 25 years ago. This ground-breaking study tested specific hypotheses about the importance of weight, body composition, and weight-related health conditions for incident functional limitation in older adults. METHODS Narrative review with analysis of ancillary studies, career awards, publications, and citations. RESULTS Key findings of the study demonstrated the importance of body composition as a whole, both fat and lean mass, in the disablement pathway. The quality of the muscle in terms of its strength and its composition was found to be a critical feature in defining sarcopenia. Dietary patterns and especially protein intake, social factors, and cognition were found to be critical elements for functional limitation and disability. The study is highly cited and its assessments have been widely adopted in both observational studies and clinical trials. Its impact continues as a platform for collaboration and career development. CONCLUSIONS The Health ABC provides a knowledge base for the prevention of disability and promotion of mobility in older adults.
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Affiliation(s)
- Anne B Newman
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Marjolein Visser
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Stephen B Kritchevsky
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Eleanor Simonsick
- National Institute on Aging, Translational Gerontology Branch Biomedical Research Center, Baltimore, Maryland, USA
| | - Peggy M Cawthon
- Research Institute, California Pacific Medical Center, University of California, San Francisco, California, USA
| | - Tamara B Harris
- Laboratory of Epidemiology and Population Sciences, Intramural Research Program NIA, NIH, Bethesda, Maryland, USA
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4
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Wang F, Marsack-Topolewski CN, DiZazzo-Miller R, Samuel PS. Health of aging families: Comparing compound and noncompound caregivers. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2022; 65:290-304. [PMID: 34402756 DOI: 10.1080/01634372.2021.1963024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 06/13/2023]
Abstract
Providing care to a family member with disabilities takes a toll on the health of the caregiver and the family. Among aging caregivers, compound caregiving (i.e., caring for two or more family members) has become an increasingly common scenario. However, few research studies have focused on compound caregivers. Extant literature describes individual-level outcomes, with sparse knowledge on family-level outcomes. The family quality of life framework was used in this study to examine differences in the individual and family health of aging compound and noncompound caregivers. Web-based cross-sectional data collected from 112 aging caregivers (age 50 and older) were analyzed using chi-square and independent sample t-tests to examine differences between caregivers. Compound caregivers had poorer perceptions of personal health than noncompound caregivers. In terms of family health, although all caregivers shared similar perceptions on the importance, opportunities, initiative, and stability, compound caregivers had lower attainment and satisfaction than noncompound caregivers. Multivariate regression analyses indicated that compound caregiving was associated with poorer family health. Personal health was positively associated with family health. Study findings have practice implications for identifying caregivers' multiple responsibilities. It is necessary to develop individual and family level programs focused on health promotion and caregiver training.
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Affiliation(s)
- Fei Wang
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, United States
| | - Christina N Marsack-Topolewski
- Associate Professor College of Health and Human Services, Eastern Michigan University, School of Social Work, MI-Developmental Disabilities Institute Affiliated Research Associate, United States
| | - Rosanne DiZazzo-Miller
- Associate Professor Department of Health Care Sciences, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, United States
| | - Preethy S Samuel
- Associate Professor Department of Health Care Sciences, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, United States
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5
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Hamiduzzaman M, De-Bellis A, Abigail W, Fletcher A. Critical social framework on the determinants of primary healthcare access and utilisation. Fam Med Community Health 2021; 9:fmch-2021-001031. [PMID: 34799432 PMCID: PMC8606761 DOI: 10.1136/fmch-2021-001031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
This paper aims to contextualise ‘healthcare access and utilisation’ within its wider social circumstances, including structural factors that shape primary healthcare for marginalised groups. Mainstream theories often neglect complexities among the broader social, institutional and cultural milieus that shape primary healthcare utilisation in reality. A blended critical social framework is presented to highlight the recognition and emancipatory intents surrounding person, family, healthcare practice and society. Using the theoretical contributions of Habermas and Honneth, the framework focuses on power relationships, misrecognition/recognition strategies, as well as disempowerment/empowerment dynamics. To enable causal and structural analysis, we draw on the depth ontology of critical realism. The framework is then applied to the case of rural elderly women’s primary healthcare use in Bangladesh. Drawing on the literature, this article illustrates how a blended critical social perspective reveals the overlapping and complex determinants that affect primary healthcare utilisation, before concluding with the importance of situating healthcare access in sociocultural structures.
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Affiliation(s)
- Mohammad Hamiduzzaman
- College of Health, Medicine & Wellbeing, The University of Newcastle, Taree, New South Wales, Australia
| | - Anita De-Bellis
- College of Nursing and Health Sciences, Flinders University of South Australia, Adelaide, South Australia, Australia
| | - Wendy Abigail
- College of Nursing and Health Sciences, Flinders University of South Australia, Adelaide, South Australia, Australia
| | - Amber Fletcher
- Department of Sociology & Social Studies, University of Regina, Regina, Saskatchewan, Canada
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6
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Okoye SM, Szanton SL, Perrin NA, Nkimbeng M, Schrack JA, Han HR, Nyhuis C, Wanigatunga S, Spira AP. Objectively measured sleep and physical function: Associations in low-income older adults with disabilities. Sleep Health 2021; 7:735-741. [PMID: 34602384 DOI: 10.1016/j.sleh.2021.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 08/19/2021] [Accepted: 09/01/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Late-life sleep health has been tied to physical function, but little is known about these associations among socially disadvantaged populations. DESIGN We determined cross-sectional associations of sleep with physical function in low-income, predominantly Black older adults with disabilities. PARTICIPANTS One hundred thirty-six older adults (mean age 76.0 years, 83.8% women, 82.4% Black). MEASUREMENTS Primary predictors were actigraphic total sleep time (TST), wake after sleep onset (WASO), and subjective sleep complaints. Outcomes were objective physical performance (Short Physical Performance Battery (SPPB)) and participant-reported difficulties in basic and instrumental activities of daily living (ADLs and IADLs). RESULTS In regression models adjusted for potential confounders, both longer TST and greater WASO were associated with lower SPPB scores and increased IADL difficulty. Participants with a mean TST in the longest (>7.5 hours) vs. intermediate (6.3-7.5 hours) tertile had 27% higher odds of additional IADL difficulty (incident rate ratio = 1.27, 95% confidence interval [CI] 1.03, 1.58). Each additional 10 minutes of WASO was associated with 0.13 point lower SPPB scores (B = -0.13, 95% CI -0.25, -0.01) and increased IADL difficulty (B = 0.02, 95% CI 0.0003, 0.04). Sex moderated the associations of WASO with IADL and ADL difficulties: associations were stronger for males. Subjective sleep complaints were not statistically significantly associated with function. CONCLUSIONS Among disabled, low-income, mostly Black older adults, objective measures of long sleep and greater WASO are associated with poorer physical function. Effect sizes for the associations were modest; however, findings may have important implications given the significant consequences of decreased function on quality of life and caregiving demands.
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Affiliation(s)
- Safiyyah M Okoye
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; Johns Hopkins Center on Aging and Health, Baltimore, Maryland, USA.
| | - Sarah L Szanton
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; Johns Hopkins Center on Aging and Health, Baltimore, Maryland, USA
| | - Nancy A Perrin
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Manka Nkimbeng
- University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Jennifer A Schrack
- Johns Hopkins Center on Aging and Health, Baltimore, Maryland, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Hae-Ra Han
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Casandra Nyhuis
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sarah Wanigatunga
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Adam P Spira
- Johns Hopkins Center on Aging and Health, Baltimore, Maryland, USA; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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7
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Wang F, Qin W, Yu J. Neighborhood Social Cohesion and Mobility Limitations Among Community-dwelling Older Americans: The Mediating Roles of Depressive Symptoms and Mastery. Int J Aging Hum Dev 2021; 94:290-311. [PMID: 34409865 DOI: 10.1177/00914150211037657] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Neighborhood environment plays an important role in late-life health; yet, the social aspect of neighborhood environment and its impact on mobility limitations have rarely been examined. This nonexperimental, cross-sectional study examines the relationship between neighborhood social cohesion and mobility limitations and the potential mediators (i.e., depressive symptoms, mastery) of this relationship. A total of 8,317 Americans aged 65 years and older were selected from the Health and Retirement Study. Using ordinary least squares regressions, this study shows that neighborhood social cohesion was negatively associated with mobility limitations (B = -0.04, p < .01). A Sobel test of mediation indicated that this relationship was significantly mediated by depressive symptoms (z = -9.10, p < .001) and mastery (z = -8.86, p < .001). Findings suggest that neighborhood cohesion can reduce mobility limitations through mitigating depressive symptoms and increasing mastery. Future research should disentangle the temporal ordering of the mediators.
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Affiliation(s)
- Fei Wang
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, 114588Case Western Reserve University, Cleveland, OH, USA
| | - Weidi Qin
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, 114588Case Western Reserve University, Cleveland, OH, USA
| | - Jiao Yu
- Department of Sociology, College of Arts and Sciences, 142585Case Western Reserve University, Cleveland, OH, USA
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8
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Nicolson PJA, Sanchez-Santos MT, Bruce J, Kirtley S, Ward L, Williamson E, Lamb SE. Risk Factors for Mobility Decline in Community-Dwelling Older Adults: A Systematic Literature Review. J Aging Phys Act 2021; 29:1053-1066. [PMID: 34348224 DOI: 10.1123/japa.2020-0482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/17/2021] [Accepted: 01/18/2021] [Indexed: 11/18/2022]
Abstract
Mobility is essential to maintaining independence for older adults. This systematic review aimed to summarize evidence about self-reported risk factors for self-reported mobility decline; and to provide an overview of published prognostic models for self-reported mobility decline among community-dwelling older adults. Databases were searched from inception to June 2, 2020. Studies were screened by two independent reviewers who extracted data and assessed study quality. Sixty-one studies (45,187 participants) were included, providing information on 107 risk factors. High-quality evidence and moderate/large effect sizes for the association with mobility decline were found for older age beyond 75 years, the presence of widespread pain, and mobility modifications. Moderate-high quality evidence and small effect sizes were found for a further 21 factors. Three model development studies demonstrated acceptable model performance, limited by high risk of bias. These findings should be considered in intervention development, and in developing a prediction instrument for practical application.
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9
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Kyrönlahti SM, Stenholm S, Raitanen J, Neupane S, Koskinen S, Tiainen K. Educational Differences in Decline in Maximum Gait Speed in Older Adults Over an 11-Year Follow-up. J Gerontol A Biol Sci Med Sci 2020; 76:703-709. [DOI: 10.1093/gerona/glaa196] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
This study examined educational differences in decline in maximum gait speed over an 11-year follow-up in the general Finnish population aged 55 years and older and assessed the contribution of lifestyle factors, body mass index, physical workload, and chronic conditions on the association.
Method
Data from the nationally representative Health 2000 Survey and its 11-year follow-up were used. Participants aged 55 years and older with maximum gait speed measured at both time points were included (n = 1128). Information on education, age, sex, lifestyle factors, body mass index, physical workload, and chronic conditions was collected at baseline. General linear model was used to examine differences in decline in maximum gait speed between education groups. Mediation analyses using the product method was conducted to partition the total effect of education on decline in maximum gait speed into direct effect and indirect effect acting through mediators.
Results
Decline in maximum gait speed was greater in low and intermediate education groups in comparison to the high education group (0.24 m/s [95% confidence interval 0.21–0.26], 0.24 m/s [0.21–0.28], 0.10 m/s [0.07–0.14], respectively]. The most important mediators were higher body mass index and lifetime exposure to physical workload among the less educated, accounting for 10% and 11% of the total effect, respectively.
Conclusions
Education-based disparities in objectively measured mobility increase with age as lower education is associated with greater decline in gait speed. Higher body mass index and physical workload among less educated contributed most to the educational disparities in age-related decline in maximum gait speed.
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Affiliation(s)
- Saila M Kyrönlahti
- Faculty of Social Sciences, Unit of Health Sciences, Tampere University, Finland
| | - Sari Stenholm
- Department of Public Health, University of Turku and Turku University Hospital, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Finland
| | - Jani Raitanen
- Faculty of Social Sciences, Unit of Health Sciences, Tampere University, Finland
- UKK Institute for Health Promotion Research, Tampere, Finland
| | - Subas Neupane
- Faculty of Social Sciences, Unit of Health Sciences, Tampere University, Finland
| | - Seppo Koskinen
- Department of Public Health Solutions, National Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Kristina Tiainen
- Faculty of Social Sciences, Unit of Health Sciences, Tampere University, Finland
- Gerontology Research Center, Tampere University, Finland
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10
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Masters MC, Perez J, Tassiopoulos K, Andrade A, Ellis R, Yang J, Brown TT, Palella FJ, Erlandson KM. Gait Speed Decline Is Associated with Hemoglobin A1C, Neurocognitive Impairment, and Black Race in Persons with HIV. AIDS Res Hum Retroviruses 2019; 35:1065-1073. [PMID: 31468979 DOI: 10.1089/aid.2019.0101] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Gait speed declines at a faster rate in persons with HIV (PWH) than in the general population but the risk factors associated with this decline are not well understood. In the AIDS Clinical Trials Group (ACTG) A5322 (HAILO, HIV Infection, Aging, and Immune Function Long-term Observational Study), an observational cohort study of PWH ≥40 years of age, those who developed slow gait during the first 3 years of follow-up were compared with persons who maintained normal speed. Associations with demographic and clinical covariates were assessed using multivariable logistic regression. Of 929 participants, 81% were men, 31% Black, and 20% Hispanic. Median age was 51 years [interquartile range (IQR) = 46-56]. At study entry, 92% had plasma HIV RNA <50 copies/mL with median CD4 count 631 cells/mm3 (IQR = 458-840). At study entry, 7% of participants had slow gait, 16% had neurocognitive impairment (NCI), and 12% had diabetes. Over 3 years, 87% maintained normal gait speed, 3% maintained a slow gait, 6% developed a slow gait, and 4% improved from slow to normal gait speed. In multivariable models, hemoglobin A1C (HbA1C) percentage, per one unit increase [odds ratio (OR) = 1.36; 95% confidence interval (CI) = 1.03-1.81; p = .033], NCI (OR = 3.47; 95% CI = 1.57-7.69 p = .002), and black versus white race (OR = 2.45; 95% CI = 1.08-5.59; p = .032) at entry were significantly associated with development of slow gait compared with those maintaining normal gait speed. The association between baseline HbA1C and development of slow gait speed highlights an intervenable target to prevent progression of physical function limitations.
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Affiliation(s)
- Mary Clare Masters
- Division of Infectious Diseases, Northwestern University, Chicago, Illinois
| | - Jeremiah Perez
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Katherine Tassiopoulos
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | | | - Ronald Ellis
- Department of Neurosciences, University of California, San Diego, California
| | - Jingyan Yang
- Mailman School of Public Health, Columbia University, New York, New York
| | - Todd T. Brown
- Division of Endocrinology, Diabetes, & Metabolism, Johns Hopkins University, Baltimore, Maryland
| | - Frank J. Palella
- Division of Infectious Diseases, Northwestern University, Chicago, Illinois
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11
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Marini F, Gordon-Murer C, Sera M, Tanha T, Licudo F, Zenzeri J, Hughes CM. Age-related Declines in Sensorimotor Proficiency are Specific to the Tested Motor Skill Component. IEEE Int Conf Rehabil Robot 2019; 2019:654-659. [PMID: 31374705 DOI: 10.1109/icorr.2019.8779560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This study utilized a 3-degree of freedom robotic device (Wristbot) to examine wrist proprioception and eye-hand coordination in a cross-sectional sample of sixty-three young adults (19-29 years), 20 older young adults (30-49), and 17 older adults (50 years and older). Results indicated differences in the emergence of age-related declines in sensorimotor functioning depending on the tested motor skill component. While young adults exhibited smaller matching error and lower variability compared to older young adults and older adults on the proprioception task, we observed lower times-on-target and higher Linearity indices for participants older than 50 years of age compared to both young adults and older young adults. The present results provide necessary quantitative information on sensorimotor function in adulthood, and have implications for the early diagnosis and effective management of sensorimotor dysfunction in clinical settings using a commercially available robotic device.
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12
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Brigola AG, Alexandre TDS, Inouye K, Yassuda MS, Pavarini SCI, Mioshi E. Limited formal education is strongly associated with lower cognitive status, functional disability and frailty status in older adults. Dement Neuropsychol 2019; 13:216-224. [PMID: 31285797 PMCID: PMC6601310 DOI: 10.1590/1980-57642018dn13-020011] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Limited formal education is still common in ageing populations. Although limited
formal education seems to be independently and negatively associated with
cognition, functional abilities and frailty in ageing, no studies have examined
whether the gradient of limited formal education has an impact on health in
later life.
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Affiliation(s)
| | | | - Keika Inouye
- Department of Gerontology, Federal University of São Carlos, SP, Brazil
| | - Monica Sanches Yassuda
- Gerontology, School of Arts, Sciences and Humanities, University of São Paulo, SP, Brazil
| | - Sofia Cristina Iost Pavarini
- Nursing Post Graduate Program, Federal University of São Carlos, SP, Brazil.,Department of Gerontology, Federal University of São Carlos, SP, Brazil
| | - Eneida Mioshi
- School of Health Sciences, University of East Anglia, Norwich, UK
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13
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Harsha N, Ziq L, Giacaman R. Disability among Palestinian elderly in the occupied Palestinian territory (oPt): prevalence and associated factors. BMC Public Health 2019; 19:432. [PMID: 31023288 PMCID: PMC6482486 DOI: 10.1186/s12889-019-6758-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 04/08/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Disability poses an important challenge to countries all over the world since it affects more than 15% of the global population. The disability prevalence is higher in developing countries compared to developed ones. Disability has negative consequences on health, wellbeing, and quality of life. The goal of this study is to assess the prevalence of disability and to determine some of its associated factors among Palestinian elderly in the occupied Palestinian territory (oPt), a country marked by a chronic lack of political, economic, and social stability which affect various aspects of the population's life. METHODS We used data from the Palestinian Central Bureau of Statistics (PCBS) disability survey conducted in 2011 using a nationally representative sample of the Palestinians living in the West Bank (WB) and Gaza Strip (GS). Data were collected using a standardized questionnaire developed and adopted by the World Health Organization (WHO) and the Washington Group (WG) for Disability Statistics, adapted to satisfy the Palestinian context. RESULTS Overall, 31.2% of the Palestinian elderly 60 years and above reported one or more type of disability. Binary logistic regression with disability as the dependent variable showed that older people [OR = 2.88, 95% CI: 2.31-3.60], women [OR = 1.65, 95% CI: 1.33-2.04], illiterate people [OR = 2.37, 95% CI: 1.83-3.06], people reporting small family sizes with 1 to 2 members [OR = 1.69, 95% CI: 1.34-2.14], people who reported that they were not working at the time of the survey [OR = 4.59, 95% CI: 3.13-6.73], and Palestinian refugees [OR = 1.22, 95% CI: 1.04-1.42] were more likely to have a disability. However, residents of the Centre of WB were less likely to have disability compared to residents of the GS [OR = 0.46, 95% CI: 0.37-0.58]. CONCLUSIONS The study found a high prevalence of disability among Palestinian elderly, as has been reported by the majority of studies performed in developing countries. However, results indicate that demographic and socioeconomic differences among the disabled should be taken into special consideration in setting policies and practices to improve the health and wellbeing of the disabled.
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Affiliation(s)
- Nouh Harsha
- Faculty of Public Health, University of Debrecen, Debrecen, Hungary
- Institute of Community and Public Health, Birzeit University- ICPH/BZU, Birzeit, Occupied Palestinian Territory
| | - Luay Ziq
- MPH, ICPH/BZU, UNRWA, Ramallah, West Bank, Occupied Palestinian Territory
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14
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Palazzo C, Yokota RTC, Tafforeau J, Ravaud JF, Cambois E, Poiraudeau S, Van Oyen H, Nusselder WJ. Contribution of chronic diseases to educational disparity in disability in France: results from the cross-sectional "disability-health" survey. ACTA ACUST UNITED AC 2019; 77:2. [PMID: 30651987 PMCID: PMC6330417 DOI: 10.1186/s13690-018-0326-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 12/10/2018] [Indexed: 11/10/2022]
Abstract
Background This study aimed 1) to assess whether the contribution of chronic conditions to disability varies according to the educational attainment, 2) to disentangle the contributions of the prevalence and of the disabling impact of chronic conditions to educational disparities. Methods Data of the 2008–09 Disability Health Survey were examined (N = 23,348). The disability indicator was the Global Activity Limitation Indicator (GALI). The attribution method based on an additive hazard model was used to estimate educational differences in disabling impacts and in the contributions of diseases to disability. Counterfactual analyses were used to disentangle the contribution of differences in disease prevalence vs. disabling impact. Results In men, the main contributors to educational difference in disability prevalence were arthritis (contribution to disability prevalence: 5.7% (95% CI 5.4–6.0) for low-educated vs. 3.3% (3.0–3.9) for high-educated men), spine disorders (back/neck pain, deformity) (3.8% (3.6–4.0) vs. 1.9% (1.8–2.1)), chronic obstructive pulmonary diseases (2.4% (2.3–2.6) vs. 0.6% (0.5–0.7)) and ischemic heart /peripheral artery diseases (4.1% (3.9–4.3) vs. 2.4% (2.2–3.0)). In women, arthritis (9.5% (9.1–9.9) vs. 4.5%, (4.1–5.2)), spine disorders (4.5% (4.3–4.7) vs. 2.1% 1.9–2.3) and psychiatric diseases (3.1% (3.0–3.3) vs. 1.1% (1.0–1.3)) contributed most to education gap in disability. The educational differences were equally explained by differences in the disease prevalence and in their disabling impact. Conclusions Public health policies aiming to reduce existing socioeconomic disparities in disability should focus on musculoskeletal, pulmonary, psychiatric and ischemic heart diseases, reducing their prevalence as well as their disabling impact in lower socioeconomic groups. Electronic supplementary material The online version of this article (10.1186/s13690-018-0326-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Clémence Palazzo
- 1Department of Public Health, Erasmus MC, Rotterdam, Netherlands.,Epidemiology and Public Health, Sciensano, Rue Juliette Wytsmanstraat 14, 1050 Brussels, Belgium
| | - Renata T C Yokota
- Epidemiology and Public Health, Sciensano, Rue Juliette Wytsmanstraat 14, 1050 Brussels, Belgium.,3Department of Sociology, Interface Demography, Vrije Universiteit Brussel, Brussels, Belgium
| | - Jean Tafforeau
- Epidemiology and Public Health, Sciensano, Rue Juliette Wytsmanstraat 14, 1050 Brussels, Belgium
| | - Jean-François Ravaud
- 4INSERM, CNRS, EHESS, Université Paris Descartes, IFRH, CERMES3, Villejuif, France
| | | | - Serge Poiraudeau
- INSERM, Université Sorbonne Paris Cité, Université Paris Descartes, IFRH, Centre of Research in Epidemiology and Statistics, ECaMO Team, Paris, France
| | - Herman Van Oyen
- Epidemiology and Public Health, Sciensano, Rue Juliette Wytsmanstraat 14, 1050 Brussels, Belgium.,7Department of Public Health, Ghent University, Ghent, Belgium
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15
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Yang L, Konttinen H, Martikainen P, Silventoinen K. Socioeconomic Status and Physical Functioning: A Longitudinal Study of Older Chinese People. J Gerontol B Psychol Sci Soc Sci 2018; 73:1315-1329. [PMID: 28329825 DOI: 10.1093/geronb/gbx010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Indexed: 01/20/2023] Open
Abstract
Objectives We aimed to assess the longitudinal associations of socioeconomic status and physical functioning using a large population-based survey data in China. Method We used four waves of the Chinese Longitudinal Healthy Longevity Survey (2002-2011). Physical functioning was assessed by activities of daily living (ADL) and instrumental activities of daily living (IADL) measures. Socioeconomic status was assessed using educational attainment, occupational status, household income, financial resources, and access to health services. Latent growth curve model combined with selection model was utilized. Results High education was not associated with the baseline level or the rate of change in ADL score but predicted better baseline IADL functioning. High income was related to better IADL functioning but had no effect on the rate of change in IADL. Inadequate financial resources and unavailability of health services were mainly associated with poorer ADL and IADL functioning at baseline. White-collar occupation was unrelated to the trajectory of physical functioning. Discussion This study provides no support either for the cumulative disadvantage or age-as-leveler theory. Improving financial status and accessibility of health care services, especially in lower social classes, may help to improve the overall level of physical functioning of the older adults.
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Affiliation(s)
- Lei Yang
- Population Research Unit, University of Helsinki, Finland
| | - Hanna Konttinen
- Social Psychology, Department of Social Research, University of Helsinki, Finland
| | - Pekka Martikainen
- Population Research Unit, University of Helsinki, Finland.,Centre for Health Equity Studies (CHESS), Stockholm University and Karolinska Institutet, Sweden.,Max Planck Institute for Demographic Research, Rostock, Germany
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16
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Owusu C, Schluchter M, Koroukian SM, Schmitz KH, Berger NA. Black-white disparity in physical performance among older women with newly diagnosed non-metastatic breast cancer: Exploring the role of inflammation and physical activity. J Geriatr Oncol 2018; 9:613-619. [PMID: 29699938 DOI: 10.1016/j.jgo.2018.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 03/14/2018] [Accepted: 04/10/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To examine racial differences in physical performance among older women with newly diagnosed non-metastatic breast cancer and identify clinical, behavioral and biological factors that might contribute to such disparities. METHODS This is a cross-sectional study of women aged ≥65 years with newly diagnosed stage I-III breast cancer recruited from ambulatory oncology clinics at an academic center, between September 2010 and August 2015. Participants completed a Comprehensive Geriatric Assessment and laboratory testing for biomarkers of inflammation [interleukin-6 (IL6)] prior to receiving systemic treatment for cancer. The primary outcome was poor physical performance, defined as scoring ≤7 on the Short Physical Performance Battery, Yes or No. Logistic regression analyses were undertaken. RESULTS Among 135 women with mean age of 74.8 years (SD = 6.9), 31% were African-American (AA), and 33% had poor physical performance. Controlling for age, education, comorbidities and geriatric syndromes, participants with poor physical performance were more likely to be AA [versus (vs.) Non-Hispanic Whites (NHW)], odds ratio (OR) = 3.10, 95% confidence interval (CI) = 1.18-8.15. Controlling further for physical activity (PA) attenuated the racial disparity in physical performance (OR = 2.50, CI = 0.91-6.84). Lastly, controlling for IL6 further diminished the racial disparity in physical performance (OR = 1.93, CI = 0.67-5.56). In adjusted models, PA and IL6 explained 29% and 38%, respectively, of the racial disparity in poor physical performance. CONCLUSION Among older women with newly diagnosed non-metastatic breast cancer, poor physical performance was prevalent and AA were disproportionately affected. Less engagement in physical activity and subclinical inflammation partly contributed to this disparity.
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Affiliation(s)
- Cynthia Owusu
- Division of Hematology/Oncology, Department of Medicine, Case Western Reserve University School of Medicine, United States; Case Comprehensive Cancer Center, Cleveland, Ohio, United States.
| | - Mark Schluchter
- Case Comprehensive Cancer Center, Cleveland, Ohio, United States; Department of Epidemiology and Biostatistics, Case Western Reserve University School of Medicine, United States
| | - Siran M Koroukian
- Case Comprehensive Cancer Center, Cleveland, Ohio, United States; Department of Epidemiology and Biostatistics, Case Western Reserve University School of Medicine, United States
| | | | - Nathan A Berger
- Division of Hematology/Oncology, Department of Medicine, Case Western Reserve University School of Medicine, United States; Case Comprehensive Cancer Center, Cleveland, Ohio, United States
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17
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Chudyk AM, McKay HA, Winters M, Sims-Gould J, Ashe MC. Neighborhood walkability, physical activity, and walking for transportation: A cross-sectional study of older adults living on low income. BMC Geriatr 2017; 17:82. [PMID: 28395672 PMCID: PMC5385598 DOI: 10.1186/s12877-017-0469-5] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 03/22/2017] [Indexed: 11/10/2022] Open
Abstract
Background Walking, and in particular, outdoor walking, is the most common form of physical activity for older adults. To date, no study investigated the association between the neighborhood built environment and physical activity habits of older adults of low SES. Thus, our overarching aim was to examine the association between the neighborhood built environment and the spectrum of physical activity and walking for transportation in older adults of low socioeconomic status. Methods Cross-sectional data were from the Walk the Talk Study, collected in 2012. Participants (n = 161, mean age = 74 years) were in receipt of a rental subsidy for low income individuals and resided in neighbourhoods across Metro Vancouver, Canada. We used the Street Smart Walk Score to objectively characterize the built environment main effect (walkability), accelerometry for objective physical activity, and the Community Healthy Activities Model Program for Seniors (CHAMPS) questionnaire to measure walking for transportation. We used regression analyses to examine associations of objectively measured physical activity [total volume, light intensity and moderate intensity physical activity (MVPA)] and self-reported walking for transportation (any, frequency, duration) with walkability. We adjusted analyses for person- and environment-level factors associated with older adult physical activity. Results Neighbourhood walkability was not associated with physical activity volume or intensity and self-reported walking for transportation, with one exception. Each 10-point increase in Street Smart Walk Score was associated with a 45% greater odds of any walking for transportation (compared with none; OR = 1.45, 95% confidence interval = 1.18, 1.78). Sociodemographic, physical function and attitudinal factors were significant predictors of physical activity across our models. Conclusions The lack of associations between most of the explored outcomes may be due to the complexity of the relation between the person and environment. Given that this is the first study to explore these associations specifically in older adults living on low income, this study should be replicated in other settings.
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Affiliation(s)
- Anna M Chudyk
- Centre for Hip Health and Mobility, 7th floor-2635 Laurel Street, Vancouver, BC, V5Z 1M9, Canada. .,Department of Family Practice, University of British Columbia, 3rd Floor - 5950 University Boulevard, Vancouver, BC, V6T 1Z3, Canada.
| | - Heather A McKay
- Centre for Hip Health and Mobility, 7th floor-2635 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.,Department of Family Practice, University of British Columbia, 3rd Floor - 5950 University Boulevard, Vancouver, BC, V6T 1Z3, Canada
| | - Meghan Winters
- Centre for Hip Health and Mobility, 7th floor-2635 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.,Faculty of Health Sciences, Simon Fraser University, 11522 - 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Joanie Sims-Gould
- Centre for Hip Health and Mobility, 7th floor-2635 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.,Department of Family Practice, University of British Columbia, 3rd Floor - 5950 University Boulevard, Vancouver, BC, V6T 1Z3, Canada
| | - Maureen C Ashe
- Centre for Hip Health and Mobility, 7th floor-2635 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.,Department of Family Practice, University of British Columbia, 3rd Floor - 5950 University Boulevard, Vancouver, BC, V6T 1Z3, Canada
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Abstract
We provide an in-depth description of the mobility (capacity and enacted function, i.e., physical activity and travel behaviour) of community-dwelling older adults of low socioeconomic status. Participants [n = 161, mean age (range) = 74 (65-96) years] completed interviewer-administered questionnaires and objective measures of mobility. Our findings did not generally indicate that older adults of low socioeconomic status have a reduced capacity to be mobile. Participants presented with positive profiles across physical, psychosocial, and social environment domains that influence the capacity to be mobile. They also made a high proportion of trips by foot, although these did not together serve to meet physical activity guidelines for most. We challenge future researchers to focus on innovative strategies to recruit this difficult-to-access population, to consider the influence of socioeconomic status across the lifespan, and the role of behaviour-driven agency when investigating the association between the person, environment, and older adult mobility.
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19
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van Zon SK, Bültmann U, Reijneveld SA, de Leon CFM. Functional health decline before and after retirement: A longitudinal analysis of the Health and Retirement Study. Soc Sci Med 2016; 170:26-34. [DOI: 10.1016/j.socscimed.2016.10.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 09/02/2016] [Accepted: 10/03/2016] [Indexed: 10/20/2022]
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20
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Thorpe RJ, Gamaldo AA, Salas RE, Gamaldo CE, Whitfield KE. Relationship between Physical Function and Sleep Quality in African Americans. J Clin Sleep Med 2016; 12:1323-1329. [PMID: 27448426 DOI: 10.5664/jcsm.6180] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 06/20/2016] [Indexed: 01/24/2023]
Abstract
STUDY OBJECTIVES There is a growing body of research examining the relationship between sleep and functional outcomes. However, little is known about sleep and physical functioning in older African Americans. METHODS Data for this project included 450 community-dwelling older African Americans (71.4 ± 9.2 years of age) who participated in the Baltimore Study of Black Aging. Overall sleep pattern and quality was measured by the Pittsburgh Sleep Quality Index (PSQI). Physical functioning was measured by the number of activities of daily living that each participant reported difficulty (ADL; e.g. eating, dressing, and bathing). Negative binomial regression models were conducted to estimate the association between sleep quality and physical functioning. RESULTS Seventy-two percent of the participants reported poor sleep quality. African Americans who reported poor sleep quality had a greater likelihood of an increase in the number of difficulties in ADLs that they reported even after accounting for demographic characteristics and health conditions. The relationship between sleep quality and physical functioning did not vary by gender. CONCLUSIONS Sleep may be an important factor to consider when seeking to improve physical functioning among community-dwelling older African Americans.
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Affiliation(s)
- Roland J Thorpe
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | - Rachel E Salas
- Johns Hopkins University, School of Medicine, Baltimore, MD
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21
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Medina González P. Actitud de Marcha según Nivel Socioeconómico en Adultos Mayores Autovalentes. PSICOLOGIA: TEORIA E PESQUISA 2015. [DOI: 10.1590/0102-37722015042626501507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMEN La marcha es fundamental para la funcionalidad de adultos mayores (AM), además su expresión actitudinal se relaciona con diferentes estados emocionales, los cuales son condicionados por el nivel socioeconómico (NSE). El propósito de esta investigación fue evaluar el comportamiento de atributos actitudinales de marcha según el NSE en AM autovalentes. Participaron este estudio 71 AM autovalentes de la comunidad de Talca-Chile, categorizados según el NSE a los cuales se les aplicó el instrumento denominado análisis de forma y esfuerzo de la marcha previo caracterización de confiabilidad. Los resultados indican que el estilo de marcha no es diferente según el NSE en AM autovalentes; sin embargo, los perfiles cualificados presentan variaciones en los anclajes las que son dependientes del género.
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22
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Schrack JA, Althoff KN, Jacobson LP, Erlandson KM, Jamieson BD, Koletar SL, Phair J, Ferrucci L, Brown TT, Margolick JB. Accelerated Longitudinal Gait Speed Decline in HIV-Infected Older Men. J Acquir Immune Defic Syndr 2015; 70:370-6. [PMID: 26102450 PMCID: PMC4624470 DOI: 10.1097/qai.0000000000000731] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Gait speed predicts functional decline, disability, and death and is considered a biomarker of biological aging. Changes in gait speed in persons aging with HIV may provide an important method of gauging health and longevity in an under assessed population. The objective of this study was to evaluate and quantify the rate of gait speed decline in HIV-infected (HIV⁺) men compared with HIV-uninfected (HIV⁻) men. METHODS The study was nested in the Multicenter AIDS Cohort Study. The primary outcome was usual gait speed in meters per second measured between 2007 and 2013. Differences in the rate of gait speed decline and the incidence of clinically slow gait (<1.0 m/s) were assessed using multivariate linear regression models and Cox proportional hazards models, respectively. RESULTS A total of 2025 men (973 HIV⁺ and 1052 HIV⁻) aged 40 years and older contributed 21,187 person-visits (9955 HIV⁺ and 11,232 HIV⁻) to the analysis. Average gait speeds at the age 50 years were 1.24 and 1.19 m/s in HIV⁻ and HIV⁺ men, respectively (P < 0.001). In fully adjusted models, gait speed decline averaged 0.009 m/s per year after age 50 years (P < 0.001); this decline was 0.025 m/s per year greater in HIV⁺ men (P < 0.001). Moreover, HIV⁺ men had a 57% greater risk of developing clinically slow gait (adjusted hazard ratio = 1.57, 95% confidence interval: 1.27 to 1.91). CONCLUSIONS These findings indicate a faster rate of functional decline in HIV-infected men, suggesting greater risks of disability and death with advancing age.
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Affiliation(s)
- Jennifer A Schrack
- *Department of Epidemiology, Johns Hopkins Bloomberg, School of Public Health, Baltimore, Maryland; †Department of Medicine, University of Colorado School of Medicine, Denver Colorado; ‡Department of Medicine, Hemtaology/Oncology, David Geffen School of Medicine at UCLA, Los Angeles, California; §Division of Infectious Disease, Department of Internal Medicine, Ohio State University, Columbus, Ohio; ‖Translational Gerontology Branch, Intramural Research Program, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; ¶Division of Endocrineology and Metabolism, Internal Medicine, National Institute on Aging, National Institutes of Health, Baltimore, Maryland; and #Department of Molecular Microbiology and Immunology, Johns Hopkins School of Medicine, Baltimore, Maryland
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23
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Enroth L, Raitanen J, Hervonen A, Lehtimäki T, Jylhävä J, Hurme M, Jylhä M. Cardiometabolic and Inflammatory Biomarkers as Mediators Between Educational Attainment and Functioning at the Age of 90 Years. J Gerontol A Biol Sci Med Sci 2015; 71:412-9. [PMID: 26328604 DOI: 10.1093/gerona/glv105] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 06/12/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Low socioeconomic status is associated both with poorer functioning and elevated levels of inflammatory and cardiometabolic biomarkers; however, knowledge of such relations for the oldest old is limited. Our aim was to study whether education is associated with cardiometabolic (cholesterol levels, body mass index, and leptin) and inflammatory (C-reactive protein, interleukin-6, interleukin-1Ra) biomarkers for the 90-year-olds who participated in the Vitality 90+ study. In addition, we investigated whether these biomarkers explain educational inequalities in functioning. METHODS All persons in Tampere, Finland, who were born in 1909 or 1910, were invited to participate, irrespective of their health status or dwelling place. The sample consisted of 262 participants who went through the home interview and blood tests. The socioeconomic status indicator used was the highest education, and physical functioning was assessed using the Barthel index. The association of education with individual and combined biomarker scores, and with functioning, was analyzed cross-sectionally applying generalized linear models. RESULTS The low- and mid-level-educated participants had greater odds of belonging to the high risk group in cardiometabolic biomarkers than did the high-educated. Differences were statistically significant in three individual biomarkers (high-density lipoprotein-cholesterol, leptin, and body mass index) and in a cardiometabolic score. There were no educational differences in inflammatory biomarkers. When all biomarkers were combined, they mediated educational differences in functioning on an average of 23%. After controlling for smoking, alcohol use and diseases, biomarkers mediated part of the differences between the mid-level- and high-educated. CONCLUSIONS High education was associated with better cardiometabolic biomarkers and functioning among the 90-year-olds. In part, educational inequalities in functioning were explained by cardiometabolic biomarkers.
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Affiliation(s)
- Linda Enroth
- School of Health Sciences and Gerontology Research Center, University of Tampere, Finland.
| | - Jani Raitanen
- School of Health Sciences and Gerontology Research Center, University of Tampere, Finland. UKK Institute for Health Promotion Research, Tampere, Finland
| | - Antti Hervonen
- School of Health Sciences and Gerontology Research Center, University of Tampere, Finland
| | - Terho Lehtimäki
- Department of Clinical Chemistry, School of Medicine, University of Tampere, Finland. Department of Clinical Chemistry, Fimlab Laboratories, Tampere, Finland
| | - Juulia Jylhävä
- Gerontology Research Center, University of Tampere, Finland. Department of Microbiology and Immunology, School of Medicine, University of Tampere, Finland
| | - Mikko Hurme
- Gerontology Research Center, University of Tampere, Finland. Department of Microbiology and Immunology, School of Medicine, University of Tampere, Finland. Department of Microbiology, Fimlab Laboratories, Tampere, Finland
| | - Marja Jylhä
- School of Health Sciences and Gerontology Research Center, University of Tampere, Finland. Institute for Advanced Social Research, University of Tampere, Finland
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Arcaya MC, Arcaya AL, Subramanian SV. Inequalities in health: definitions, concepts, and theories. Glob Health Action 2015; 8:27106. [PMID: 26112142 PMCID: PMC4481045 DOI: 10.3402/gha.v8.27106] [Citation(s) in RCA: 288] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 02/23/2015] [Accepted: 04/03/2015] [Indexed: 11/14/2022] Open
Abstract
Individuals from different backgrounds, social groups, and countries enjoy different levels of health. This article defines and distinguishes between unavoidable health inequalities and unjust and preventable health inequities. We describe the dimensions along which health inequalities are commonly examined, including across the global population, between countries or states, and within geographies, by socially relevant groupings such as race/ethnicity, gender, education, caste, income, occupation, and more. Different theories attempt to explain group-level differences in health, including psychosocial, material deprivation, health behavior, environmental, and selection explanations. Concepts of relative versus absolute; dose-response versus threshold; composition versus context; place versus space; the life course perspective on health; causal pathways to health; conditional health effects; and group-level versus individual differences are vital in understanding health inequalities. We close by reflecting on what conditions make health inequalities unjust, and to consider the merits of policies that prioritize the elimination of health disparities versus those that focus on raising the overall standard of health in a population.
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Affiliation(s)
- Mariana C Arcaya
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, University in Boston, MA, USA
| | - Alyssa L Arcaya
- Region 2, United States Environmental Protection Agency, New York, NY, USA
| | - S V Subramanian
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, University in Boston, MA, USA;
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25
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Thorpe RJ, McCleary R, Smolen JR, Whitfield KE, Simonsick EM, LaVeist T. Racial disparities in disability among older adults: finding from the exploring health disparities in integrated communities study. J Aging Health 2015; 26:1261-79. [PMID: 25502241 DOI: 10.1177/0898264314534892] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Persistent and consistently observed racial disparities in physical functioning likely stem from racial differences in social resources and environmental conditions. METHOD We examined the association between race and reported difficulty performing instrumental activities of daily living (IADL) in 347 African American (45.5%) and Whites aged 50 or above in the Exploring Health Disparities in Integrated Communities-Southwest Baltimore, Maryland Study (EHDIC-SWB). RESULTS Contrary to previous studies, African Americans had lower rates of disability (women: 25.6% vs. 44.6%, p = .006; men: 15.7% vs. 32.9%; p = .017) than Whites. After adjusting for sociodemographics, health behaviors, and comorbidities, African American women (odds ratio [OR] = 0.32, 95% confidence interval [CI] = [0.14, 0.70]) and African American men (OR = 0.34, 95% CI = [0.13, 0.90]) retained their functional advantage compared with White women and men, respectively. CONCLUSION These findings within an integrated, low-income urban sample support efforts to ameliorate health disparities by focusing on the social context in which people live.
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Affiliation(s)
- Roland J Thorpe
- Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA Center on Biobehavorial Health Disparities Research, Duke University, Durham, NC, USA
| | - Rachael McCleary
- Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jenny R Smolen
- Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Keith E Whitfield
- Center on Biobehavorial Health Disparities Research, Duke University, Durham, NC, USA
| | - Eleanor M Simonsick
- Johns Hopkins School of Medicine, Baltimore, MD, USA National Institute on Aging, Baltimore, MD, USA
| | - Thomas LaVeist
- Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Chudyk AM, Winters M, Moniruzzaman M, Ashe MC, Gould JS, McKay H. Destinations matter: The association between where older adults live and their travel behavior. JOURNAL OF TRANSPORT & HEALTH 2015; 2:50-57. [PMID: 27104147 PMCID: PMC4835227 DOI: 10.1016/j.jth.2014.09.008] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
The positive effect of physical activity in the prevention and treatment of many chronic diseases and age-related disabilities, such as mobility-disability, are widely accepted. Mobility is broadly defined as the ability of individuals to move themselves within community environments. These two concepts -physical activity and mobility - are closely linked and together contribute to older adults living healthy, independent lives. Neighborhood destinations may encourage mobility, as older adults typically leave their homes to travel to specific destinations. Thus, neighborhoods with a high prevalence of destinations may provide older adults an attractive opportunity to walk, instead of drive, and thereby obtain incidental physical activity. We know surprisingly little about the specific types of destinations older adults deem relevant and even less about destinations that support the mobility of older adults with low income. Accessible neighborhood destinations may be especially important to older adults with low income as they are more likely to walk as a primary travel mode. Conversely, this population may also be at increased risk of functional impairments that negatively affect their ability to walk. As a means to fill this information gap we aimed to better understand the mobility habits of older adults with low income. Thus, our specific objectives were to: (1) describe the types of destinations older adults with low income most commonly travel to in one week; and (2) determine the association between the prevalence of neighborhood destinations and the number of transportation walking trips these individuals make (average per day). We conducted a cross-sectional study of community-dwelling older adults with low income residing within Metro Vancouver, Canada. We assessed participant travel behavior (frequency, purpose, mode, destination) using seven-day travel diaries and measured the prevalence of neighborhood destinations using the Street Smart Walk Score. We also assessed participants' sociodemographic characteristics and mobility (physical function, car access, confidence walking). We used a negative binomial model to determine the association between Street Smart Walk Score and number of transportation walking trips (average per day). Our sample was comprised of 150 participants (median age 74 years; 51 men) from who we acquired at least one day of travel diary data (range = 1-7 days). Participants made three trips per day (2, 5; median P25, P75) and travelled to six different destination types per week (5, 9; median P25, P75). Destinations most relevant to older adults were grocery stores, malls, and restaurants/cafés. Each 10-point increase in Street Smart Walk Score was associated with a 20% increase in the number of transportation walking trips (average per day, incidence rate ratio = 1.20, 95% CI = 1.12, 1.29). Our findings provide preliminary evidence regarding destinations that may be most relevant to older adults. They also suggest that the prevalence of these neighborhood destinations may encourage walking. As we approach a new era of healthy city benchmarks, our findings guide policy makers and developers to retrofit and develop communities that support the mobility, health, and independence of older adults.
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Affiliation(s)
- Anna M Chudyk
- Centre for Hip Health and Mobility and Department of Medicine, University of British Columbia, 2635 Laurel Street, Vancouver, BC, Canada V5Z 1M9
| | - Meghan Winters
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada V5A 1S6
| | - Md Moniruzzaman
- Business School, The University of Western Australia, 35 Stirling Highway, Crawley, WA, Australia
| | - Maureen C Ashe
- Centre for Hip Health and Mobility and Department of Family Practice, University of British Columbia, 2635 Laurel Street, Vancouver, BC, Canada V5Z 1M9
| | - Joanie Sims Gould
- Centre for Hip Health and Mobility and Department of Family Practice, University of British Columbia, 2635 Laurel Street, Vancouver, BC, Canada V5Z 1M9
| | - Heather McKay
- Centre for Hip Health and Mobility and Department of Family Practice, University of British Columbia, 2635 Laurel Street, Vancouver, BC, Canada V5Z 1M9
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Hoogendijk EO, van Hout HP, Heymans MW, van der Horst HE, Frijters DH, Broese van Groenou MI, Deeg DJ, Huisman M. Explaining the association between educational level and frailty in older adults: results from a 13-year longitudinal study in the Netherlands. Ann Epidemiol 2014; 24:538-44.e2. [DOI: 10.1016/j.annepidem.2014.05.002] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 04/17/2014] [Accepted: 05/06/2014] [Indexed: 10/25/2022]
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Klijs B, Nusselder WJ, Looman CW, Mackenbach JP. Educational disparities in the burden of disability: contributions of disease prevalence and disabling impact. Am J Public Health 2014; 104:e141-8. [PMID: 24922134 DOI: 10.2105/ajph.2014.301924] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES We assessed the contributions of the prevalence and disabling impact of specific diseases to educational disparities in the prevalence of disability. METHODS We examined a large representative survey of the Dutch population, the Dutch Permanent Survey of Living Conditions (2001-2007; n = 24 883; ages 40-97 years). We attributed the prevalence of disability to chronic diseases by using their empirical associations and assuming independent competing causes of disability. We estimated contributions of prevalence and the disabling impact of diseases to disparities in disability using counterfactuals. RESULTS We found that the prevalence of disability in individuals with only an elementary education was 19 to 20 percentage points higher than that in individuals with tertiary education. Sixty-five percent of this difference could be attributed to specific chronic diseases, but more so to their disabling impact (49%-51%) than to their prevalence (20%-29%). Back pain, neck or arm conditions, and peripheral vascular disease contributed most to the disparity in men, and arthritis, back pain, and chronic nonspecific lung disease contributed most to the disparity in women. CONCLUSIONS Educational disparities in the burden of disability were primarily caused by high disabling impacts of chronic diseases among low educated groups. Tackling disparities might require more effective treatment or rehabilitation of disability in lower socioeconomic groups.
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Affiliation(s)
- Bart Klijs
- At the time of the study, Bart Klijs, Wilma J. Nusselder, Caspar W. Looman, and Johan P. Mackenbach were with the Department of Public Health, Erasmus MC, University Medical Center Rotterdam, The Netherlands. Bart Klijs was also with the Department of Epidemiology, University of Groningen, University Medical Center Groningen, The Netherlands
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Christensen U, Krølner R, Nilsson CJ, Lyngbye PW, Hougaard CØ, Nygaard E, Thielen K, Holstein BE, Avlund K, Lund R. Addressing social inequality in aging by the Danish occupational social class measurement. J Aging Health 2014; 26:106-27. [PMID: 24584263 DOI: 10.1177/0898264314522894] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To present the Danish Occupational Social Class (DOSC) measurement as a measure of socioeconomic position (SEP) applicable in a late midlife population, and to analyze associations of this measure with three aging-related outcomes in midlife, adjusting for education. METHOD Systematic coding procedures of the DOSC measurement were applied to 7,084 participants from the Copenhagen Aging and Midlife Biobank (CAMB) survey. We examined the association of this measure of SEP with chronic conditions, self-rated health, and mobility in logistic regression analyses, adjusting for school education in the final analysis. RESULTS The measure of SEP showed a strong social gradient along the social classes in terms of prevalence of chronic conditions, poor self-rated health, and mobility limitations. Adjusting for school education attenuated the association only to a minor degree. DISCUSSION The DOSC measure was associated with aging-related outcomes in a midlife Danish population, and is, thus, well suited for future epidemiological research on social inequalities in health and aging.
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Pirkle CM, de Albuquerque Sousa ACP, Alvarado B, Zunzunegui MV. Early maternal age at first birth is associated with chronic diseases and poor physical performance in older age: cross-sectional analysis from the International Mobility in Aging Study. BMC Public Health 2014; 14:293. [PMID: 24684705 PMCID: PMC3977880 DOI: 10.1186/1471-2458-14-293] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 03/28/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Early maternal age at first birth and elevated parity may have long-term consequences for the health of women as they age. Both are known risk factors for obstetrical complications with lifelong associated morbidities. They may also be related to diabetes and cardiovascular disease development. METHODS We examine the relationship between early maternal age at first birth, defined as ≤18 years of age, multiparity (>2 births), and poor physical performance (Short Physical Performance Battery≤8) in community samples of women between 65 and 74 years of age from Canada, Albania, Colombia, and Brazil (N=1040). Data were collected in 2012 to provide a baseline assessment for a longitudinal cohort called the International Mobility in Aging Study. We used logistic regression and general linear models to analyse the data. RESULTS Early maternal age at first birth is significantly associated with diabetes, chronic lung disease, high blood pressure, and poor physical performance in women at older ages. Parity was not independently associated with chronic conditions and physical performance in older age. After adjustment for study site, age, education, childhood economic adversity and lifetime births, women who gave birth at a young age had 1.75 (95% CI: 1.17-2.64) the odds of poor SPPB compared to women who gave birth>18 years of age. Adjustment for chronic diseases attenuated the association between early first birth and physical performance. Results were weaker in Colombia and Brazil, than Canada and Albania. CONCLUSIONS This study provides evidence that adolescent childbirth may increase the risk of developing chronic diseases and physical limitations in older age. Results likely reflect both the biological and social consequences of early childbearing and if the observed relationship is causal, it reinforces the importance of providing contraception and sex education to young women, as the consequences of early pregnancy may be life-long.
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Affiliation(s)
- Catherine M Pirkle
- Department of Population Health and Environment, Research Center CHUQ, Laval University, 2875, Boulevard Laurier, Édifice Delta II; Bureau 600, 6e étage, Québec, QC G1V 2M2, Canada.
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Nilsson CJ, Siersma V, Mänty M, Avlund K, Vass M, Lund R. Mobility decline in old age: the combined effect of mobility-related fatigue and socioeconomic position. J Epidemiol Community Health 2014; 68:510-5. [DOI: 10.1136/jech-2013-203060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Mendes de Leon CF, Rajan KB. Psychosocial influences in onset and progression of late life disability. J Gerontol B Psychol Sci Soc Sci 2014; 69:287-302. [PMID: 24389123 DOI: 10.1093/geronb/gbt130] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES Disability in older age has been related to several psychosocial characteristics, including social networks, social engagement, and depression. However, the exact role of these characteristics in the disablement process remains uncertain. METHOD Data come from a population-based study of black and white adults aged ≥65 years (N = 5,306), with up to 9 yearly data on the primary outcome measure, activities of daily living (ADL) disability. We use a two-part regression model to simultaneously test the association between each psychosocial characteristic and both onset and progression of ADL disability, while controlling for demographic variables, education, and mode of interview in the first model and health status variables in the second model. RESULTS Social networks were negatively associated with onset of ADL disability but not associated with progression. The association became non-significant after adjustment for health status. Social engagement was negatively associated with both onset and progression of disability, even after adjustment for health status. Depression was significantly associated with onset of disability after adjustment for health status but not with progression of disability. DISCUSSION The results suggest a differential role for psychosocial characteristics in the disablement process, with generally stronger associations for transitions to onset of ADL disability than progression of ADL disability.
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Affiliation(s)
- Carlos F Mendes de Leon
- Correspondence should be addressed to Carlos F. Mendes de Leon, Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109. E-mail:
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Thorpe RJ, Koster A, Bosma H, Harris TB, Simonsick EM, van Eijk JTM, Kempen GIJM, Newman AB, Satterfield S, Rubin SM, Kritchevsky SB. Racial differences in mortality in older adults: factors beyond socioeconomic status. Ann Behav Med 2013; 43:29-38. [PMID: 22180315 DOI: 10.1007/s12160-011-9335-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Little is known about the simultaneous effect of socioeconomic status (SES), psychosocial, and health-related factors on race differences in mortality in older adults. PURPOSE This study examined the association between race and mortality and the role of SES, health insurance, psychosocial factors, behavioral factors, and health-related factors in explaining these differences. METHODS Data consisted of 2,938 adults participating in the Health, Aging and Body Composition study. Mortality was assessed over 8 years. RESULTS SES differences accounted for 60% of the racial differences in all-cause mortality; behavioral factors and self-rated health further reduced the disparity. The racial differences in coronary heart disease mortality were completely explained by SES. Health insurance and behavioral factors accounted for some, but not all, of the race differences in cancer mortality. CONCLUSIONS Race-related risk factors for mortality may differ by the underlying cause of mortality.
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Affiliation(s)
- Roland J Thorpe
- Hopkins Center for Health Disparities Solutions, Department of Health Policy and Management, The Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, USA.
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Groffen DAI, Koster A, Bosma H, van den Akker M, Aspelund T, Siggeirsdóttir K, Kempen GIJM, van Eijk JTM, Eiriksdottir G, Jónsson PV, Launer LJ, Gudnason V, Harris TB. Socioeconomic factors from midlife predict mobility limitation and depressed mood three decades later; findings from the AGES-Reykjavik Study. BMC Public Health 2013; 13:101. [PMID: 23379351 PMCID: PMC3599346 DOI: 10.1186/1471-2458-13-101] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Accepted: 01/30/2013] [Indexed: 11/10/2022] Open
Abstract
Background Taking into account our rapidly ageing population, older people are of particular interest in studying health inequalities. Most studies of older persons only include measures of current socioeconomic status (SES) and do not take into account data from earlier stages of life. In addition, only classic SES measures are used, while alternative measures, such as car ownership and house ownership, might equally well predict health. The present study aims to examine the effect of midlife socioeconomic factors on mobility limitation and depressed mood three decades later. Methods Data were from 4,809 men and women aged 33–65 years who participated in the Reykjavik Study (1967–1992) and who were re-examined in old age in the Age, Gene/Environment Susceptibility (AGES) -Reykjavik Study (2002–2006). Results Education and occupation predicted mobility limitation and depressed mood. Independently, home and car ownership and the availability of housing features predicted mobility limitation. Shortages of food in childhood and lack of a car in midlife predicted depressed mood. Conclusion Socioeconomic factors from midlife and from childhood affect mobility limitation and depressed mood in old age. Prevention of health problems in old age should begin as early as midlife.
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Affiliation(s)
- Daniëlle A I Groffen
- Department of Social Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands.
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Aiken ARA, Angel JL, Miles TP. Pregnancy as a risk factor for ambulatory limitation in later life. Am J Public Health 2012; 102:2330-5. [PMID: 23078483 PMCID: PMC3519336 DOI: 10.2105/ajph.2012.300791] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2012] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We investigated the relationship between the number of times a woman has been pregnant and walking difficulty in later life. METHODS With data from the Hispanic Established Populations for Epidemiologic Studies of the Elderly, a representative population-based cohort of Mexican Americans aged 65 years and older residing in 5 Southwestern states, we measured walking difficulty using 2 items from the performance-oriented mobility assessments: the timed walk and seated chair rise. RESULTS We observed significantly higher rates of ambulatory limitation among women with 6 or more pregnancies than among women with 4 or fewer pregnancies: 44.9% and 27.0%, respectively, were unable to perform or performed poorly in the seated chair rise and timed walk. Ordinal logistic regression models show that gravidity predicts level of performance in both mobility tasks and that higher gravidity is associated with worse performance, even after adjustment for both age and chronic disease. CONCLUSIONS Gravidity is a risk factor for ambulatory limitation in old age. A life course approach to reproduction in public health research and practice is warranted.
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Affiliation(s)
- Abigail R A Aiken
- Lyndon B. Johnson School of Public Affairs and the Population Research Center, University of Texas, Austin, TX 78713-8925, USA
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To what extent do biomarkers account for the large social disparities in health in Moscow? Soc Sci Med 2012; 77:164-72. [PMID: 23228966 DOI: 10.1016/j.socscimed.2012.11.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Revised: 11/09/2012] [Accepted: 11/19/2012] [Indexed: 11/23/2022]
Abstract
The Russian population continues to face political and economic challenges, has experienced poor general health and high mortality for decades, and has exhibited widening health disparities. The physiological factors underlying links between health and socioeconomic position in the Russian population are therefore an important topic to investigate. We used data from a population-based survey of Moscow residents aged 55 and older (n = 1495), fielded between December 2006 and June 2009, to address two questions. First, are social disparities evident across different clusters of biomarkers? Second, does biological risk mediate the link between socioeconomic status and health? Health outcomes included subscales for general health, physical function, and bodily pain. Socioeconomic status was represented by education and an index of material resources. Biological risk was measured by 20 biomarkers including cardiovascular, inflammatory, and neuroendocrine markers as well as heart rate parameters from 24-h ECG monitoring. For both sexes, the age-adjusted educational disparity in standard cardiovascular risk factors was substantial (men: standardized β = -0.16, 95% CI = -0.23 to -0.09; women: β = -0.25, CI = -0.32 to -0.18). Education differences in inflammation were also evident in both men (β = -0.17, CI = -0.25 to -0.09) and women (β = -0.09, CI = -0.17 to -0.01). Heart rate parameters differed by education only in men (β = -0.10, CI = -0.18 to -0.02). The associations between material resources and biological risk scores were generally weaker than those for education. Social disparities in neuroendocrine markers were negligible for men and women. In terms of mediating effects, biological risk accounted for more of the education gap in general health and physical function (19-36%) than in bodily pain (12-18%). Inclusion of inflammatory markers and heart rate parameters-which were important predictors of health outcomes-may explain how we accounted for more of the social disparities than previous studies.
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Zunzunegui MV. [Evolution of disability and dependency. An international perspective]. GACETA SANITARIA 2011; 25 Suppl 2:12-20. [PMID: 22169442 DOI: 10.1016/j.gaceta.2011.07.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2011] [Revised: 07/24/2011] [Accepted: 07/25/2011] [Indexed: 11/26/2022]
Abstract
In societies with a high level of population aging, the ability to live autonomously is a major goal of public health. The present article examines recent population-based studies analyzing a possible reduction in the prevalence of disability and provides evidence on the unmet needs of dependent individuals.In the last few decades, disability and reduced mobility have decreased in elderly persons living in high-income countries, including Spain. This decrease is clear in persons aged less than 85 years old but the trends in persons older than 85 years are difficult to study due to the lack of information. These trends depend on greater education among the population, a reduction in social and gender inequalities and the adoption of healthy lifestyle habits. A reduction in dependency also depends on changes in the physical and social environment to encourage active aging. The health gains in the generation aged between 40 and 65 years do not seem high. The reductions in disability in the next 25 years will not be as great as those observed between 1990 and the present time, except for a possible reduction in disability in women due to a decrease in gender roles. Dependence on help from third persons will tend to decrease, except in dementia. Use of technical aids is increasing and will continue to do so.
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Affiliation(s)
- María Victoria Zunzunegui
- Département de Médecine Sociale et Préventive, Faculté de Médecine, Université de Montréal, Montréal, Canada.
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Rodríguez López S, Nilsson C, Lund R, Montero P, Fernández-Ballesteros R, Avlund K. Social inequality in dynamic balance performance in an early old age Spanish population: the role of health and lifestyle associated factors. Arch Gerontol Geriatr 2011; 54:e139-45. [PMID: 22142494 DOI: 10.1016/j.archger.2011.11.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Revised: 11/10/2011] [Accepted: 11/11/2011] [Indexed: 11/16/2022]
Abstract
This study investigates the association between socioeconomic status (SES) and dynamic balance performance and whether lifestyle factors explained any possible associations. A total of 448 nondisabled individuals, age-range 54-75 years and enrolled in the Active Aging Longitudinal Study of Spain in 2006, constituted the study population. Baseline data of this cross-sectional study were obtained by personal interviews and objective measures of balance performance. The present study shows an educational gradient in poor dynamic balance, where individuals with no formal education had higher risk of poor balance, also after adjustment for age, gender, obesity and physical activity. In addition, obesity and sedentary physical activity were related to poor dynamic balance. The findings suggest an independent effect of both SES and behavioral factors on poor balance performance in the older Spanish population.
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Affiliation(s)
- Santiago Rodríguez López
- Department of Biology, Universidad Autónoma de Madrid, C/Darwin s/n (Campus Universitario de Cantoblanco), 28049 Madrid, Spain.
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Social inequality in onset of mobility limitations in midlife: a longitudinal study in Denmark. Eur J Ageing 2011; 8:255-269. [PMID: 28798655 DOI: 10.1007/s10433-011-0204-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Abstract
The aim of this longitudinal study was to investigate if social inequality in onset of mobility limitations is present in early midlife, and to examine whether common determinants of disability account for social status differences in onset of mobility limitations in midlife. 3,586 40-and 50-year-old Danish men and women enrolled in The Danish Longitudinal Study on Work, Unemployment and Health constituted the study population. Data were collected by mailed questionnaires in 2000 and 2006. Limitations in running 100 m and in climbing two flights of stairs represented two aspects of mobility limitations. Occupational social class was applied as a measure of socioeconomic position. Among individuals reporting no limitations in 2000 social gradients in onset of mobility limitations emerged in 2006. Having a low social class at age 40 and 50 respectively was associated with higher onset of mobility limitations 6 years later, and this association was overall only partly explained by common determinants of disability: smoking, alcohol consumption, physical activity, body mass index, and chronic diseases. These results indicate that the development of mobility limitations might begin earlier in lower compared to higher social strata, and that social status differences in mobility limitations might emerge already in the forties.
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Thorpe RJ, Clay OJ, Szanton SL, Allaire JC, Whitfield KE. Correlates of mobility limitation in African Americans. J Gerontol A Biol Sci Med Sci 2011; 66:1258-63. [PMID: 21798864 DOI: 10.1093/gerona/glr122] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This study identified demographic and health-related characteristics that were related to mobility limitation in a sample of community-dwelling African Americans. METHODS The sample consisted of 602 community-dwelling African-American men and women ages 48-92 years at study inception. Participants who reported being limited "a lot" or "a little" in climbing one flight of stairs or walking several blocks were considered to have mobility limitation. Logistic regression was conducted to estimate the independent effect of each demographic and health-related characteristic on odds of mobility limitation. RESULTS African Americans who reported two or more medical conditions had higher odds of mobility limitation (women: odds ratio = 3.52; 95% confidence interval: 1.89-6.53 and men: odds ratio = 2.53; 95% confidence interval: 1.10-5.85) than those who reported one or fewer medical conditions. African Americans with major depressive symptoms had higher odds of mobility limitation (women: odds ratio = 2.98; 95% confidence interval: 1.55-5.71 and men: odds ratio = 3.19; 95% confidence interval: 1.33-7.65) than those without major depressive symptoms. CONCLUSIONS These results highlight the importance of creating interventions particularly focused on chronic disease prevention and management for African American men and women during midlife to attempt to delay the onset or impede the progression of mobility problems that will likely become exacerbated in late life and severely affect the quality of life.
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Affiliation(s)
- Roland J Thorpe
- Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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Thorpe RJ, Koster A, Kritchevsky SB, Newman AB, Harris T, Ayonayon HN, Perry S, Rooks RN, Simonsick EM. Race, socioeconomic resources, and late-life mobility and decline: findings from the Health, Aging, and Body Composition study. J Gerontol A Biol Sci Med Sci 2011; 66:1114-23. [PMID: 21743093 DOI: 10.1093/gerona/glr102] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND This study examines the relationship between race and mobility over 5 years in initially well-functioning older adults and evaluates how a broad set of socioeconomic status indicators affect this relationship. METHODS Data were from 2,969 black and white participants aged 70-79 from the Health, Aging, and Body Composition study. Mobility parameters included self-reported capacity to walk a quarter mile and climb 10 steps and usual gait speed. Incident mobility limitation was defined as reported difficulty walking a quarter mile or climbing 10 steps at two consecutive semiannual assessments. Gait speed decline was defined as a 4% reduction in speed per year. RESULTS At baseline, even though all participants were free of mobility limitation, blacks had slower walking speed than their white counterparts, which was not explained by poverty, education, reading level, or income adequacy. After 5 years, accounting for age, site, and baseline mobility, blacks were more likely to develop mobility limitation than whites. Adjusting for prevalent conditions at baseline eliminated this difference in women; controlling for education eliminated this difference in men. No differences in gait speed decline were identified. CONCLUSIONS Higher rates of mobility loss observed in older blacks relative to older whites appear to be a function of both poorer initial mobility status and existing health conditions particularly for women. Education may also play a role especially for men.
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Affiliation(s)
- Roland J Thorpe
- Hopkins Center for Health Disparities Solutions, Department of Health Policy and Management, The Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway Ste. 441, Baltimore, MD 21205, USA.
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Gregory PC, Szanton SL, Xue QL, Tian J, Thorpe RJ, Fried LP. Education predicts incidence of preclinical mobility disability in initially high-functioning older women. The Women's Health and Aging Study II. J Gerontol A Biol Sci Med Sci 2011; 66:577-81. [PMID: 21382883 DOI: 10.1093/gerona/glr023] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND To examine the impact of educational attainment on the incidence of preclinical mobility disability (PCD). METHODS The Women's Health and Aging II Study is a prospective observational cohort study of 436 initially high-functioning community-dwelling women aged 70-79 years at baseline in Baltimore, Maryland. We measured the association of highest attained education level with preclinical mobility disability (PCD) over an 11-year period. PCD is defined as self-reported modification in any of four tasks without reporting difficulty in those tasks. The tasks were walking ½ mile, climbing up steps, doing heavy housework, and getting in/out of bed or chair. RESULTS Participants with less than 9 years of education were more likely to acquire incident PCD (hazard ratio: 3.1, 95% confidence interval = 1.2-7.7) than their counterparts with more education after adjusting for income, marital status, number of diseases, and high self-efficacy. CONCLUSIONS Lower education level is an independent predictor of incident preclinical mobility disability. This association has important implications for primary and secondary prevention and can be easily assessed in clinical encounters.
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Goldman N, Turra CM, Rosero-Bixby L, Weir D, Crimmins E. Do biological measures mediate the relationship between education and health: A comparative study. Soc Sci Med 2011; 72:307-15. [PMID: 21159415 PMCID: PMC3039215 DOI: 10.1016/j.socscimed.2010.11.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2010] [Revised: 09/23/2010] [Accepted: 11/02/2010] [Indexed: 11/28/2022]
Abstract
Despite a myriad of studies examining the relationship between socioeconomic status and health outcomes, few have assessed the extent to which biological markers of chronic disease account for social disparities in health. Studies that have examined this issue have generally been based on surveys in wealthy countries that include a small set of clinical markers of cardiovascular disease. The availability of recent data from nationally representative surveys of older adults in Costa Rica and Taiwan that collected a rich set of biomarkers comparable to those in a recent US survey permits us to explore these associations across diverse populations. Similar regression models were estimated on three data sets - the Social Environment and Biomarkers of Aging Study in Taiwan, the Costa Rican Study on Longevity and Healthy Aging, and the Health and Retirement Study in the USA - in order to assess (1) the strength of the associations between educational attainment and a broad range of biomarkers; and (2) the extent to which these biomarkers account for the relationships between education and two measures of health status (self-rated health, functional limitations) in older populations. The estimates suggest non-systematic and weak associations between education and high risk biomarker values in Taiwan and Costa Rica, in contrast to generally negative and significant associations in the US, especially among women. The results also reveal negligible or modest contributions of the biomarkers to educational disparities in the health outcomes. The findings are generally consistent with previous research suggesting stronger associations between socioeconomic status and health in wealthy countries than in middle-income countries and may reflect higher levels of social stratification in the US. With access to an increasing number of longitudinal biosocial surveys, researchers may be better able to distinguish true variations in the relationship between socioeconomic status and health across different settings from methodological differences.
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Affiliation(s)
- Noreen Goldman
- Office of Population Research, Princeton University, 243 Wallace Hall, Princeton, NJ 08544, USA.
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Mobility disability in midlife: A longitudinal study of the role of anticipated instrumental support and social class. Arch Gerontol Geriatr 2010; 51:152-8. [DOI: 10.1016/j.archger.2009.09.043] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2009] [Revised: 09/11/2009] [Accepted: 09/14/2009] [Indexed: 11/22/2022]
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Nilsson CJ, Avlund K, Lund R. Social Inequality in Onset of Mobility Disability Among Older Danes: The Mediation Effect of Social Relations. J Aging Health 2010; 22:522-41. [DOI: 10.1177/0898264309359684] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: This article investigates social inequality in onset of mobility disability and in measures of social relations and whether social relations mediated the effect of socioeconomic status on mobility. Method: A total of 2,825 nondisabled older men and women, enrolled in the Danish Intervention Study on Preventive Home Visits, constituted the study population. Data were obtained by mailed questionnaires in 1998-1999 and 2001-2002 and by merging analyses to registers at Statistics Denmark. Results: There was a social gradient in onset of mobility disability, with odds ratio of 1.11 (1.07-1.15) per step down the deciles of financial assets and in cohabitation status, social participation, and network diversity. Social relations did not mediate the effect of financial assets on onset of mobility disability. Discussion: The negative effects of low financial assets and poor social relations on mobility appear to be independent. More longitudinal studies on possible mediators of the social gradient in mobility among older people are needed.
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Affiliation(s)
| | | | - Rikke Lund
- University of Copenhagen, Copenhagen, Denmark
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Ford K, Sowers M, Seeman TE, Greendale GA, Sternfeld B, Everson-Rose SA. Cognitive functioning is related to physical functioning in a longitudinal study of women at midlife. Gerontology 2009; 56:250-8. [PMID: 19828933 DOI: 10.1159/000247132] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2008] [Accepted: 04/20/2009] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Studies have reported declines with age in cognitive or physical functioning, but rarely identify whether these are parallel or linked events in the same study. Furthermore, most research in this area has focused on persons in late life rather than midlife. OBJECTIVE The objective of the study was to determine (1) if cognitive functioning was related to physical functioning and whether this relationship persisted after adjustment for age, menopause status, metabolic status, depression and socioeconomic resources, and (2) if changes in physical functioning were associated with changes in cognitive functioning over a 4-year follow-up period. METHODS Data were from the Study of Women's Health Across the Nation (SWAN), a multi-site, longitudinal study of women aged 46-56 years at follow-up examination 4. Three follow-up examinations (study years 04, 06 and 08) included measures of physical functioning perception (MOS SF-36) and cognitive functioning [Symbol Digit Modality Test (SDMT), Digit Span Backward Test (DSBT), and East Boston Memory Test (EBMT)] (n = 2,405). RESULTS Women with lower cognitive functioning scores also had lower perceived physical functioning scores. While adjustment for covariates attenuated the association between perceived physical functioning and both the SDMT and EBMT cognitive measures, these associations remained statistically significant. Additionally, the 4-year change in perceived physical functioning was significantly associated with the 4-year change in the EBMT. CONCLUSIONS At midlife, there were associated declines in cognitive and perceived physical functioning scores, commencing at midlife in women.
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Affiliation(s)
- Kathleen Ford
- Department of Epidemiology, University of Michigan, Ann Arbor, 48104, USA.
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Skalicka V, van Lenthe F, Bambra C, Krokstad S, Mackenbach J. Material, psychosocial, behavioural and biomedical factors in the explanation of relative socio-economic inequalities in mortality: evidence from the HUNT study. Int J Epidemiol 2009; 38:1272-84. [DOI: 10.1093/ije/dyp262] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Gitlin LN, Winter L, Dennis MP, Hauck WW. Variation in response to a home intervention to support daily function by age, race, sex, and education. J Gerontol A Biol Sci Med Sci 2008; 63:745-50. [PMID: 18693230 DOI: 10.1093/gerona/63.7.745] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Functional difficulty is associated with increased frailty and poor life quality, with the oldest old, women, African Americans, and less educated persons at greatest risk of disablement. This study examines whether these at-risk groups benefit differentially from an in-home intervention previously found to effectively reduce functional difficulties. METHODS Three hundred nineteen community-living, functionally vulnerable adults 70 years old or older were randomized to usual care or an intervention involving occupational and physical therapy home instruction in problem solving, device use, energy conservation, safety, fall recovery, balance, and muscle strengthening. Outcome measures at 6 and 12 months included difficulty level in ambulation, instrumental (IADLs) and activities of daily living (ADLs), self-efficacy, and fear of falling. RESULTS At 6 months, for ADLs, individuals > or =80 years (p =.022), women (p =.036), and less educated persons (p =.028) improved compared to their control group counterparts. For mobility, women (p =.048) and the oldest participants (p =.001) improved relative to their counterparts. For self-efficacy, women (p =.036) benefited more than men. For fear of falling, less educated persons improved more than their counterparts (p =.001). A similar pattern was found at 12 months. For IADLs, whites improved more than non-whites at 12 months. CONCLUSIONS Treatment benefits varied by specific participant characteristics, with individuals at greatest disability risk being most responsive to the intervention. Both white and minority participants benefited similarly except in IADL functioning. Future research should control for participant characteristics, identify underlying mechanisms for variation in treatment effects, and tailor treatment to patient characteristics and desired outcomes.
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Affiliation(s)
- Laura N Gitlin
- Jefferson Center for Applied Research on Aging and Health, Thomas Jefferson University, Philadelphia, PA 19107, USA.
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Rutledge DN, Jones K, Jones CJ. Predicting high physical function in people with fibromyalgia. J Nurs Scholarsh 2008; 39:319-24. [PMID: 18021131 DOI: 10.1111/j.1547-5069.2007.00187.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE The purpose of this study was to investigate predictors of high physical function in people with fibromyalgia (FM). DESIGN Cross-sectional descriptive, correlational study of 2,580 persons with FM who responded to an online survey during fall 2005. METHODS The survey indicated self-reported physical activity levels, functional abilities, symptoms, health care costs, employment status, work productivity, self management strategies. It had adequate validity and reliability. A significant binary logistic regression model of predictors of physical function (individual factors, symptoms, self management strategies) was validated using backwards logistic regression. FINDINGS Significant explanatory variables of high physical function were: men, greater education, younger age, lower intensity fatigue, spasticity, and balance problems, not using prescription pain medications, using aerobic or strength training exercise, and not using relaxation methods. CONCLUSIONS People with FM suffer from multiple symptoms and use many modalities to control symptoms to remain functional. Given knowledge of predictors of physical function in FM, health care providers might be able to develop strategies to promote better functioning. Prospective trials are needed to track the natural course of study variables, measuring their effect on function, and to test effects of interventions to maximize function.
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Younus M, Hartwick E, Siddiqi AA, Wilkins M, Davies HD, Rahbar M, Funk J, Saeed M. The role of neighborhood level socioeconomic characteristics in Salmonella infections in Michigan (1997-2007): assessment using geographic information system. Int J Health Geogr 2007; 6:56. [PMID: 18093323 PMCID: PMC2267442 DOI: 10.1186/1476-072x-6-56] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2007] [Accepted: 12/19/2007] [Indexed: 11/10/2022] Open
Abstract
Background: The majority of U.S. disease surveillance systems contain incomplete information regarding socioeconomic status (SES) indicators like household or family income and educational attainment in case reports, which reduces the usefulness of surveillance data for these parameters. We investigated the association between select SES attributes at the neighborhood level and Salmonella infections in the three most populated counties in Michigan using a geographic information system. Methods: We obtained data on income, education, and race from the 2000 U.S. Census, and the aggregate number of laboratory-confirmed cases of salmonellosis (1997–2006) at the block group level from the Michigan Department of Community Health. We used ArcGIS to visualize the distribution, and Poisson regression analysis to study associations between potential predictor variables and Salmonella infections. Results: Based on data from 3,419 block groups, our final multivariate model revealed that block groups with lower educational attainment were less commonly represented among cases than their counterparts with higher education levels (< high school degree vs. ≥ college degree: rate ratio (RR) = 0.79, 95% confidence interval (CI):0.63, 0.99; ≥ and high school degree, but no college degree vs. ≥ college degree: RR = 0.84, 95% CI: 0.76, 0.92). Levels of education also showed a dose-response relation with the outcome variable, i.e., decreasing years of education was associated with a decrease in Salmonella infections incidence at the block group level. Conclusion: Education plays a significant role in health-seeking behavior at the population level. It is conceivable that a reporting bias may exist due to a greater detection of Salmonella infections among high education block groups compared to low education block groups resulting from differential access to healthcare. In addition, individuals of higher education block groups who also have greater discretionary income may eat outside the home frequently and be more likely to own pets considered reservoirs of Salmonella, which increase the likelihood of contracting Salmonella infections compared to their counterparts with lower levels of education. Public health authorities should focus on improving the level of disease detection and reporting among communities with lower income and education and further evaluate the role of higher educational attainment in the predisposition for salmonellosis.
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Affiliation(s)
- Muhammad Younus
- Department of Epidemiology, Michigan State University, East Lansing, Michigan 48824, USA.
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