Heterogeneity in multidimensional health trajectories of late old years and socioeconomic stratification: a latent trajectory class analysis

Associations between patterns of social support and perinatal mental health among Chinese mother: the mediating role of social trust

This study aims to explore the correlation between different social support patterns and perinatal mental health, and the mediating role of social trust in this. A cross-sectional survey was conducted in Jiangsu, China, with a sample size of 1705 pregnant respondents. Latent class analysis (LCA) was utilized to identify various social support patterns, while a multiple regression model was employed to analyze the mediating effect of social trust on the relationship between social support patterns and perinatal mental health. The study found four distinct social support patterns among the respondents: primary relationship-centric support, overall weak support, primary-secondary relationship-balanced support, and overall strong support. In the relationship between social support patterns and perinatal mental health, social trust played both a partial and full mediating role. The findings indicate that a social support system that enhances maternal trust and promotes honest disclosure of symptoms can effectively promote perinatal mental health.

Trajectories of Intergenerational Emotional Closeness in Multi-Child Aging Families in China

Intergenerational emotional closeness (IEC) in multi-child families manifests not only in the overall parent-child relationship but also by the extent of its within-family differentiation. This study aimed to identify distinct trajectories of collective IEC in multi-child families and to examine its potential associated factors. The study used four waves of the China Family Panel Studies (2010-2018). Based on a sample of 3474 older adults (age >60), growth mixture modelling and logistic regression were conducted. Two latent trajectory patterns of IEC were identified: increasingly tight-knit (93%) and persistently collectively ambivalent (7%). Compared to the latter trajectory, older adults who had a married/cohabiting partner, had better health and received support from all children, were more likely to have increasingly tight-knit trajectories of IEC. The study tells a story more about emotional cohesion between Chinese older adults and multiple offspring over time. Aging families experiencing persistently collectively ambivalent IEC deserve more attention.

Patterns of physical and mental co-occurring developmental health among Chinese elderly: A multidimensional growth mixture model analysis

Background

This study focuses on the heterogeneity, interaction, and imbalance in the concurrent development of physical and mental health trajectories among Chinese elderly.

Methods

The data used in this study are from four waves of the China Health and Retirement Longitudinal Study (CHRLS) conducted between 2011 and 2018. A multidimensional growth mixture model (MGMM) was employed to analyze the patterns and characteristics of co-occurring physical and mental health development. Additionally, multinomial logistic regression analysis was conducted to systematically investigate the factors that predict the conjoint trajectories of physical and mental health.

Results

The study findings reveal the presence of four distinct latent classes of conjoint trajectories for physical and mental health. These classes are categorized as follows: 'physical and mental health deteriorating', 'physical disease increasing & low mental vulnerability maintaining', 'low physical & mental vulnerability maintaining', and 'high physical disease increased & mental health moderate-stable'. Furthermore, demographic characteristics, socioeconomic status, family-society relations, health behaviors, and institutional factors were found to significantly predict these latent classes.

Conclusion

The study emphasizes the diversity and complexity of physical and mental co-occurring developmental health issues in the elderly population in China. These findings have significant implications for the development of targeted intervention strategies that take into account the unique health changes experienced by older adults. Additionally, they can serve as evidence for the establishment of a comprehensive long-term care system.

Racial, ethnic, and socioeconomic disparities in trajectories of morbidity accumulation among older Americans

Introduction

Multimorbidity, the presence of multiple chronic health conditions, generally starts in middle and older age but there is considerable heterogeneity in the trajectory of morbidity accumulation. This study aimed to clarify the number of distinct trajectories and the potential associations between race/ethnicity and socioeconomic status and these trajectories.

Methods

Data from 13,699 respondents (age ≥51) in the Health and Retirement Study between 1998 and 2016 were analyzed with growth mixture models. Nine prevalent self-reported morbidities (arthritis, cancer, cognitive impairment, depressive symptoms, diabetes, heart disease, hypertension, lung disease, stroke) were summed for the morbidity count.

Results

Three trajectories of morbidity accumulation were identified: low [starting with few morbidities and accumulating them slowly (i.e., low intercept and low slope); 80% of sample], increasing (i.e., low intercept and high slope; 9%), and high (i.e., high intercept and low slope; 11%). Compared to non-Hispanic (NH) White adults in covariate-adjusted models, NH Black adults had disadvantages while Hispanic adults had advantages. Our results suggest a protective effect of education for NH Black adults (i.e., racial health disparities observed at low education were ameliorated and then eliminated at increasing levels of education) and a reverse pattern for Hispanic adults (i.e., increasing levels of education was found to dampen the advantages Hispanic adults had at low education). Compared with NH White adults, higher levels of wealth were protective for both NH Black adults (i.e., reducing or reversing racial health disparities observed at low wealth) and Hispanic adults (i.e., increasing the initial health advantages observed at low wealth).

Conclusion

These findings have implications for addressing health disparities through more precise targeting of public health interventions. This work highlights the imperative to address socioeconomic inequalities that interact with race/ethnicity in complex ways to erode health.

Early-Life Socioeconomic Disadvantage and Health in Late Middle-Age: Importance of Heterogeneous Income Trajectories

This paper aims to investigate heterogeneous income changes and whether the income trajectories moderate effects of early socioeconomic disadvantage on health in late middle age. The sample was restricted to 9,056 middle-aged adults from the Health and Retirement Study (1998-2010). Through a latent class growth analysis, six patterns of income changes were identified: constantly low, constantly moderate, constantly high & increasing, high to low, moderate to high, and high to moderate. The Constantly low group more frequently displayed depressive symptoms if exposed to early socioeconomic disadvantage and Constantly low income mobility. Individuals who experienced early socioeconomic disadvantage and a downward income mobility in middle age tended to have multiple chronic conditions while there was no moderating effect of income changes for mobility functional limitations. These findings suggest that not all health outcomes are programmed in early life: Disadvantage can be somewhat alleviated through stable and better later-life economic status.

Life Course Socioeconomic Status and Healthy Longevity in China

In 2020, China's population aged 60 or older exceeded 264 million, representing 25% of the global population in that age-group. Older adults in China experienced periods of dramatic political and social unrest in early life, as well as economic transformations leading to drastic improvements in living standards during adulthood and older age. However, the implications of life course socioeconomic status (SES) trajectories for healthy longevity in later life have not been systematically studied in China. We utilize data from the China Health and Retirement Longitudinal Study (CHARLS) to comprehensively investigate how early-life conditions and adult SES combine to influence healthy longevity in later life. We find that both childhood and adulthood SES are associated with late-life health. The largest disparities in life expectancy (LE) and disability-free LE are found between those with persistently low SES throughout life and those with consistently high SES. At age 45, the gap in total LE between the most advantaged and least advantaged groups is six years for men and five years for women. Despite China's major policy changes prioritizing equity in income and health care in recent decades, our findings suggest that dramatic health inequalities among older adults remain. Our findings extend the literature on the effect of socioeconomic patterns across the life course on gradients in later-life health and highlight continuing disparities in healthy longevity among older adults in China.

Longitudinal Patterns of Grandchild Care in South Korea

This study examined the longitudinal patterns of grandchild care to observe the influence of factors related to social participation, financial support to grandparents, demographic characteristics, and family structure on classifying the grandchild care. The rate of grandparent care for grandchildren was increasing, and the amount of time commitment for grandchild care was large in South Korea. Understanding how grandchild care unfolds over time and who is likely to provide ongoing grandchild care helps to advance the knowledge about grandparents providing grandchild care. The total sample consisted of 333 South Korean grandparents derived from the 3 waves of nationally representative data. This study utilized growth mixture modeling to identify latent classes of longitudinal patterns of grandchild care, and ran a multinomial logistic regression to examine the relationships between factors related to grandparents, adult children, and family structure and the identified latent classes. Grandchild care was classified into one of three categories: low-level decrease, high-level decrease, and low-to-high increase. Grandparents in the group of low-to-high increase were more likely to have higher financial dependence on adult children and have lower social participation than grandparents in other groups. Findings indicate that there are distinct subgroups among grandparents who care for their grandchildren. Additionally, those in the three classifications varied according to financial support received from adult children, social participation, and personal and family structure. Our findings inform policymakers to provide older adults a means to maintain their self-sufficiency. The community needs to provide programs and resources for working parents on behalf of grandchild care.

Multidimensional trajectories of multimorbidity, functional status, cognitive performance, and depressive symptoms among diverse groups of older adults

Background

Inter-relationships between multimorbidity and geriatric syndromes are poorly understood. This study assesses heterogeneity in joint trajectories of somatic disease, functional status, cognitive performance, and depressive symptomatology.

Methods

We analyzed 16 years of longitudinal data from the Health and Retirement Study (HRS, 1998-2016) for n = 11,565 older adults (≥65 years) in the United States. Group-based mixture modeling identified latent clusters of older adults following similar joint trajectories across domains.

Results

We identified four distinct multidimensional trajectory groups: (1) Minimal Impairment with Low Multimorbidity (32.7% of the sample; mean = 0.60 conditions at age 65, 2.1 conditions at age 90) had limited deterioration; (2) Minimal Impairment with High Multimorbidity (32.9%; mean = 2.3 conditions at age 65, 4.0 at age 90) had minimal deterioration; (3) Multidomain Impairment with Intermediate Multimorbidity (19.9%; mean = 1.3 conditions at age 65, 2.7 at age 90) had moderate depressive symptomatology and functional impariments with worsening cognitive performance; (4) Multidomain Impairment with High Multimorbidity (14.1%; mean = 3.3 conditions at age 65; 4.7 at age 90) had substantial functional limitation and high depressive symptomatology with worsening cognitive performance. Black and Hispanic race/ethnicity, lower wealth, lower education, male sex, and smoking history were significantly associated with membership in the two Multidomain Impairment classes.

Conclusions

There is substantial heterogeneity in combined trajectories of interrelated health domains in late life. Membership in the two most impaired classes was more likely for minoritized older adults.

Frailty differences across population characteristics associated with health inequality: a cross-sectional analysis of baseline data from the Canadian Longitudinal Study on Aging (CLSA)

OBJECTIVE

To evaluate the pattern of frailty across several of social stratifiers associated with health inequalities.

DESIGN, SETTING AND PARTICIPANTS

Cross-sectional baseline data on 51 338 community-living women and men aged 45-85 years from the population-based Canadian Longitudinal Study on Aging (collected from September 2011 to May 2015) were used in this study.

PRIMARY OUTCOMES AND MEASURES

A Frailty Index (FI) was constructed using self-reported chronic conditions, psychological function and cognitive status and physical functioning variables. Social stratifiers were chosen based on the Pan-Canadian Health Inequalities Reporting Initiative, reflecting key health inequalities in Canada. Unadjusted and adjusted FIs and domain-specific FIs (based on chronic conditions, physical function, psychological/cognitive deficits) were examined across population strata.

RESULTS

The overall mean FI was 0.13±0.08. It increased with age and was higher in women than men. Higher mean FIs were found among study participants with low income (0.20±0.10), who did not complete secondary education (0.17±0.09) or had low perceived social standing (0.18±0.10). Values did not differ by Canadian province of residence or urban/rural status. After simultaneously adjusting for population characteristics and other covariates, income explained the most heterogeneity in frailty, especially in younger age groups; similar patterns were found for men and women. The average frailty for people aged 45-54 in the lowest income group was greater than that for those aged 75-85 years. The heterogeneity in the FI among income groups was greatest for the psychological/cognitive domain.

CONCLUSIONS

Our results suggest that especially in the younger age groups, psychological/cognitive deficits are most highly associated with both overall frailty levels and the gradient in frailty associated with income. If this is predictive of later increases in the other two domains (and overall frailty), it raises the question whether targeting mental health factors earlier in life might be an effective approach to mitigating frailty.

The lasting imprint of childhood disadvantage: cumulative histories of exposure to childhood adversity and trajectories of psychological distress in adulthood

This study contributes to the literature on the long-term effects of childhood disadvantage on mental health by estimating the association between patterns of cumulative childhood adversity on trajectories of psychological distress in adulthood. There is little research that investigates how compositional variations in the accumulation of childhood adversity may initiate distinct processes of disadvantage and differentially shape trajectories of psychological distress across the adult life course. Using the Panel Study of Income Dynamics' Childhood Retrospective Circumstance Study and latent class analysis, we first identify distinct classes representing varied histories of exposure to childhood adversities using 25 indicators of adversity across multiple childhood domains. Next, the latent classes are included as predictors of trajectories of psychological distress in adulthood. The results demonstrate that patterns of experiences of childhood adversity are associated with higher levels of adult psychological distress that persists, and in some cases worsens, in adulthood, contributing to disparities in mental health across the life course.

Executive Function and BMI Trajectories Among Rural, Poor Youth at High Risk for Obesity

OBJECTIVE

The aim of this study was to identify longitudinal trajectories of conjoint development of executive function (EF) and obesity among a diverse sample of poor, rural youth and to evaluate individual differences in infant growth, parental BMI, and cumulative risk.

METHODS

Participants included 948 youth from the Family Life Project. Child anthropometrics were measured at 2 and 6 months and at 2, 3, 4, 5, 7, and 12 years. EF tasks were administered at 3, 4, and 5 years. Mothers reported youth birth weight, parental height and weight, and cumulative risk indicators.

RESULTS

Multidimensional growth mixture modeling identified three classes: "High EF - High Obesity Resilience"; "Low EF - Delayed-Onset Severe Obesity"; and "Low EF - Early-Onset Severe Obesity." Youth in the low-EF, early-onset class displayed higher birth weight and BMI at 6 months, whereas the low-EF, delayed-onset class had rapid weight gain during infancy, parents with class II obesity, and greater cumulative risk and was more likely to be Black and female.

CONCLUSIONS

Despite increased obesity risk among this sample, the majority of youth exhibited higher EF and some degree of obesity resilience. Youth with EF deficits displayed the greatest risk for severe obesity but had differing BMI trajectories and obesity risk profiles, which has implications for obesity intervention.

Depression, Alcoholics Anonymous Involvement, and Daily Drinking Among Patients with co-occurring Conditions: A Longitudinal Parallel Growth Mixture Model

BACKGROUND

Patients with cooccurring mental health and substance use disorders often find it difficult to sustain long-term recovery. One predictor of recovery may be how depression symptoms and Alcoholics Anonymous (AA) involvement influence alcohol consumption during and after inpatient psychiatric treatment. This study utilized a parallel growth mixture model to characterize the course of alcohol use, depression, and AA involvement in patients with cooccurring diagnoses.

METHODS

Participants were adults with cooccurring disorders (n = 406) receiving inpatient psychiatric care as part of a telephone monitoring clinical trial. Participants were assessed at intake, 3-, 9-, and 15-month follow-up.

RESULTS

A 3-class solution was the most parsimonious based upon fit indices and clinical relevance of the classes. The classes identified were high AA involvement with normative depression (27%), high stable depression with uneven AA involvement (11%), and low AA involvement with normative depression (62%). Both the low and high AA classes reduced their drinking across time and were drinking at less than half their baseline levels at all follow-ups. The high stable depression class reported an uneven pattern of AA involvement and drank at higher daily frequencies across the study timeline. Depression symptoms and alcohol use decreased substantially from intake to 3 months and then stabilized for 90% of patients with cooccurring disorders following inpatient psychiatric treatment.

CONCLUSIONS

These findings can inform future clinical interventions among patients with cooccurring mental health and substance use disorders. Specifically, patients with more severe symptoms of depression may benefit from increased AA involvement, whereas patients with less severe symptoms of depression may not.

Health profiles and socioeconomic characteristics of nonagenarians residing in Mugello, a rural area in Tuscany (Italy)

Background

Health, as defined by the WHO, is a multidimensional concept that includes different aspects. Interest in the health conditions of the oldest-old has increased as a consequence of the phenomenon of population aging. This study investigates whether (1) it is possible to identify health profiles among the oldest-old, taking into account physical, emotional and psychological information about health, and (2) there are demographic and socioeconomic differences among the health profiles.

Methods

Latent Class Analysis with covariates was applied to the Mugello Study data to identify health profiles among the 504 nonagenarians residing in the Mugello district (Tuscany, Italy) and to evaluate the association between socioeconomic characteristics and the health profiles resulting from the analysis.

Results

This study highlights four groups labeled according to the posterior probability of determining a certain health characteristic: “healthy”, “physically healthy with cognitive impairment”, “unhealthy”, and “severely unhealthy”. Some demographic and socioeconomic characteristics were found to be associated with the final groups: older nonagenarians are more likely to be in worse health conditions; men are in general healthier than women; more educated individuals are less likely to be in extremely poor health conditions, while the lowest-educated are more likely to be cognitively impaired; and office or intellectual workers are less likely to be in poor health conditions than are farmers.

Conclusions

Considering multiple dimensions of health to determine health profiles among the oldest-old could help to better evaluate their care needs according to their health status.

Highways to Ageing - Linking life course SEP to multivariate trajectories of health outcomes in older adults

OBJECTIVES

Ageing is a temporal, multi-faceted process subject to interacting factors. In this study, we used life course and multidimensional approaches to elucidate the association between socioeconomic forces across a lifetime and the developmental origins in health and disease of the Mexican elderly.

METHODS

Data stemmed from the Mexican Health and Ageing Study, constituting a sample of older adults (N= 5169, ≥50 years). With retrospective information on early, intermediary and contemporaneous socioeconomic indicators, life course typologies of socioeconomic position were identified using Latent Class Analysis. Based on prospective data of functional mobility, number of chronic conditions and self-rated health, multivariate trajectories of health outcomes were uncovered with Group Based Trajectory Model. Links between the extracted SEP and multivariate health latent constructs were explored with multinomial logistic regression.

RESULTS

Life course SEP classes were heterogeneous, yet a large proportion of subjects was characterized by persistent socioeconomic adversity throughout life. The health outcomes' patterns of co-evolution were diverse too, shedding light on the nature of their developmental links, while revealing variable synchronicity in their temporal decline. A graded association was observed between the life course SEP classes and ageing trajectories.

CONCLUSION

The results primarily backed the cumulative advantage/disadvantage life course framework, while finding some indication for age as a leveller hypothesis. Variability in patterns of dynamic co-action among the health outcomes depicts ageing as a naturally variable process of interconnected changes. Life course evidence for the ways socio-economic forces are differentially linked to distinct developmental profiles of ageing is provided.

Joint trajectories of cognition and gait speed in Mexican American and European American older adults: The San Antonio longitudinal study of aging

OBJECTIVES

Cognitive decline and gait speed slowing are independent predictors of disability and mortality. While both factors increase in prevalence with advancing age, little is known about their combined patterns of change. The study goal was to identify joint trajectories of cognition and gait speed within an aging bi-ethnic cohort of Mexican Americans and European Americans.

METHODS/DESIGN

Participants included 182 Mexican Americans and 188 European Americans, ages 65 to 74, who were followed over a mean of 9.5 years. Cognition was assessed with the mini-mental state examination and gait speed was examined with a timed 10-ft walk. Joint trajectory classes of cognition and gait speed were identified with latent growth mixture modeling. Odd-ratios assessed predictors for trajectory classes.

RESULTS

Three latent trajectory classes were identified: (a) relatively stable cognition and gait (termed stable cognition and gait class, 65.4%); (b) deteriorating cognition and gait (termed cognitive and physical vulnerability class, 22.2%); (c) stable cognition and deteriorating gait (termed physical vulnerability class, 12.4%). The odds of classification in the cognitive and physical vulnerability class vs stable cognition and gait class was associated with Mexican American ethnicity (OR = 3.771, P = .016), age (OR = 1.186, P = .017), income (OR = 0.828, P = .029), education (OR = 0.703, P < .001), and diabetes (OR = 4.547, P = .010). The odds of classification in the physical vulnerability class was associated with female sex (OR = 6.481, P = .004) and body mass index (OR = 1.118, P = .025).

CONCLUSIONS

The trajectories of cognition and gait speed were generally parallel, suggesting the two domains may act synergistically to shape important health outcomes. Socioeconomic disparities and Mexican American ethnicity independently conferred risk for accelerated decline.

Psychological characteristics and stress differentiate between high from low health trajectories in later life: a machine learning analysis

Objective: This study set out to empirically identify joint health trajectories in individuals of advanced age. Predictors of subgroup allocation were investigated to identify the impact of psychological characteristics, stress, and socio-demographic variables on more favorable aging trajectories.Method: The sample consisted of N = 334 older adults (M_AGE=68.31 years; SD = 9.71). Clustered health trajectories were identified using a longitudinal variant of k-means and were based on health and satisfaction with life. Random forests with conditional interference were computed to examine predictive capabilities. Key predictors included psychological resilience resources, exposure to childhood adversities, and chronic stress. Data was collected via a survey, at two different time points one year apart.Results: Two different clustered health trajectories were identified: A 'constant high health' (low number of health-related symptoms, 65.6%) and a 'maintaining low health' profile (high number of symptoms, 34.4%). Over the one-year study period, both symptom profiles remained stable. Random forest analyses showed chronic stress to be the most important predictor in the interaction with other risk and also buffering factors.Conclusion: This study provides empirical evidence for two stable health trajectories in later life over one year. These results highlight the importance of chronic stress, but also psychological resilience resources in predicting aging trajectories.

Aging Together in Enduring Couple Relationships: A Life Course Systems Perspective

This article introduces and demonstrates the use of an integrated life course systems perspective to advance the study of the aging processes of couples in enduring relationships. This objective is accomplished by bridging the life course and systems perspectives to conceptualize the couple as a functioning system and to locate couple dynamics within a longitudinal life course context in order to identify multilevel relational mechanisms that explain partners' aging outcomes in their broader socioeconomic and longitudinal context. Informed by this integrated theoretical perspective, testable hypotheses related to aging processes are derived, and analytical methodologies that can advance the research on couple aging processes are demonstrated. Identifying these relationship-health processes and contextual considerations provides insight into leverage points for the development and implementation of prevention and intervention efforts to facilitate positive aging outcomes. Directions for further theoretical and analytical advances in the area of couple aging are discussed.

Inequalities in Longitudinal Health Trajectories in Middle to Later Life: a Comparison of European Countries and Korea

BACKGROUND

This study compared inequalities in the longitudinal trajectory of health measured by latent growth curves (LGCs) in Korea and six other developed European countries.

METHODS

Unconditional and conditional LGCs were fitted, with standardized self-rated health (SRH) as the outcome variable. Two nationally-representative longitudinal datasets were used: the Survey of Health, Aging and Retirement in Europe (2007-2015; 2,761 Swedish, 2,546 Danish, 2,580 German, 2,860 French, 2,372 Spanish, and 2,924 Italian respondents) and the Korean Longitudinal Study of Aging (2006-2014; 8,465 Korean respondents).

RESULTS

The unconditional patterns of SRH trajectory were similar and unfavorable for women across the countries. Social factors such as education and income generally exerted a significant impact on health trends among older adults. Korea showed less favorable results for the disadvantaged than the advantaged as compared with Denmark, Germany, and France, which was consistent with theoretical expectations. In contrast, the relative SRH trajectory of the disadvantaged as against the advantaged was better as compared with Sweden and worse as compared with Spain/Italy, which was inconsistent with theories that would predict Korea's results were worse than Sweden and similar to Spain/Italy. Women had good SRH trajectory in Denmark and poorer SRH trajectory in Spain, Italy, and Korea, which were consistent. However, women in Sweden showed poorer and mixed outcome, which does not correspond to theoretical predictions.

CONCLUSION

These findings suggest that it is inconclusive whether Sweden and Denmark (with the most generous welfare arrangements) have better trajectories of health, and Spain, Italy, and Korea (with the least advanced state policies) have worse SRH paths among older adults. However, it can be inferred that Korean governmental policies may have produced a relatively worse context for the less-educated than the six European countries, as well as poorer settings for women than Denmark in terms of their initial SRH status.

Gradual Change, Homeostasis, and Punctuated Equilibrium: Reconsidering Patterns of Health in Later Life

Longitudinal methods aggregate individual health histories to produce inferences about aging populations, but to what extent do these summaries reflect the experiences of older adults? We describe the assumption of gradual change built into several influential statistical models and draw on widely used, nationally representative survey data to empirically compare the conclusions drawn from mixed-regression methods (growth curve models and latent class growth analysis) designed to capture trajectories with key descriptive statistics and methods (multistate life tables and sequence analysis) that depict discrete states and transitions. We show that individual-level data record stasis irregularly punctuated by relatively sudden change in health status or mortality. Although change is prevalent in the sample, for individuals it occurs rarely, at irregular times and intervals, and in a nonlinear and multidirectional fashion. We conclude by discussing the implications of this punctuated equilibrium pattern for understanding health changes in individuals and the dynamics of inequality in aging populations.

Patterns of Change in Employment Status and Their Association with Self-Rated Health, Perceived Daily Stress, and Sleep among Young Adults in South Korea

We identified distinct trajectories of temporal changes in employment status and investigated their association with self-rated health, perceived stress, and sleep. Data pertaining to 1228 respondents (age: 17–31 years) were extracted from the Korea Youth Panel (YP2007) survey (3rd–9th wave) datasets. Participants were either paid employees (permanent or precarious) or currently unemployed but seeking a job at baseline. Latent class growth analyses were employed to extract different classes based on the annual change in employment status (permanent/precarious/unemployed). Logistic regression analyses were performed using extracted classes as predictor variables and health-related variables at the final time-point as outcome variables. Five trajectories of employment status change were identified: stability sustained; gradually deteriorated; swiftly alleviated; gradually alleviated; instability sustained. Compared with the stability sustained group, the gradually deteriorated and gradually alleviated groups showed higher odds of perceived stress. The gradually deteriorated, instability sustained, and gradually alleviated groups showed significantly higher odds of shorter sleep than the stabilized group. We highlight the adverse health effects of prolonged unstable employment and the need for interventions to mitigate these effects.

Life Course Patterns of Concurrent Trajectories of BMI and Affective Symptoms of Rural Mothers: Socioeconomic Antecedents and Disease Outcomes in Later Life

OBJECTIVES

The current study, using prospective data over 25 years (1991-2015), concurrently investigates patterns of body mass index (BMI) and affective symptom trajectories in middle-aged mothers and the socioeconomic antecedents and disease outcomes of these patterns.

METHOD

Growth mixture modeling was used to identify latent classes of conjoint health risk trajectories (BMI, depressive symptoms, and anxiety symptoms) from 1991 to 2001. For each latent class, we identified mean trajectories of each health risk. Then, analyses were conducted identifying how these conjoint health risk classes were associated with respondents' socioeconomic background profiles in 1991 and subsequent chronic health problems in 2015.

RESULTS

Socioeconomic background profiles were significantly associated with initially high-risk trajectories. There was a statistically significant association between membership in certain classes of conjoint trajectories and physical health outcomes in later years. Consistent patterns of association with changes in different health outcomes including onset of diseases were observed when classes of conjoint risk trajectories are examined.

DISCUSSION

The identification of members of various conjoint risk trajectory groups provides a potentially useful prognostic tool for early preventive intervention efforts, treatment, and policy formation. Such interventions should promote and develop resiliency factors, thereby aiding in the redirection of middle-aged women's adverse risk trajectories.

Neighborhood predictors of bullying perpetration and victimization trajectories among South Korean adolescents

AIMS

This study examined latent trajectories of bullying perpetration and victimization, and identified neighborhood antecedents of these trajectories among South Korean adolescents.

METHODS

Nationally representative individual-level data from waves 2 to 6 (middle school to high school) of the Korean Children and Youth Panel Survey were merged with neighborhood-level data drawn from the Korean Census and the Korean Ministry of Education. Latent class growth analysis (N = 2,178) and logistic regression were conducted (N = 2,021).

RESULTS

Three unique trajectories of bullying experience-low-risk (80.8%), transient (13.3%), high-risk (5.9%)-were identified. Neighborhood factors (e.g., public assistance receipt, marital status, official bullying incidents, collective efficacy) predicted these distinct developmental paths.

CONCLUSION

Joint trajectories of perpetration and victimization can inform service or policy decisions as each developmental path may represent unique experiences for youth in need of specific resources for treatment or intervention. Neighborhood indicators are important predictors of developmental trajectories of bullying experience among adolescents.

Robust Respondents and Lost Limitations: The Implications of Nonrandom Missingness for the Estimation of Health Trajectories

OBJECTIVE

We offer a strategy for quantifying the impact of mortality and attrition on inferences from later-life health trajectory models.

METHOD

Using latent class growth analysis (LCGA), we identify functional limitation trajectory classes in the Health and Retirement Study. We compare results from complete case and full information maximum likelihood (FIML) analyses, and demonstrate a method for producing upper- and lower-bound estimates of the impact of attrition on results.

RESULTS

LCGA inferences vary substantially depending on the handling of missing data. For older adults who die during the follow-up period, the widely used FIML approach may underestimate functional limitations by up to 20%.

DISCUSSION

The most commonly used approaches to handling missing data likely underestimate the extent of poor health in aging populations. Although there is no single solution for nonrandom missingness, we show that bounding estimates can help analysts to better characterize patterns of health in later life.

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

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

Intergenerational relationships and the trajectory of depressive symptoms among older Chinese adults in rural migrant families

OBJECTIVES

This study examined the trajectory patterns of depressive symptoms of older rural Chinese adults in migrant families and the role of intergenerational relationships in predicting trajectory class memberships.

METHOD

Data were derived from the 2001, 2003, 2006, and 2009 waves of a longitudinal survey titled The Well-being of Older People in Anhui Province. The sample featured 486 respondents who had at least one migrant adult children at all four waves. Growth mixture modeling was used to investigate the trajectory classifications of depressive symptoms from 2001 to 2009 and antecedents in differentiating among class memberships.

RESULTS

The findings suggested a two-class model to interpret depressive symptom trajectory patterns: persistently high symptoms and low but increasing symptoms. Older adults who had better intergenerational relationships at baseline were more likely to have low but increasing depressive symptoms after controlling for other covariates.

DISCUSSION

The findings suggest that intergenerational relationships have long-term impacts on depressive symptom trajectory classes. Policy and intervention implications are discussed.

Lifetime Socioeconomic Status and Late-life Health Trajectories: Longitudinal Results From the Mexican Health and Aging Study

Objective

This article examines the association between childhood and adult socioeconomic status (SES) and late-life health trajectories for older adults in Mexico.

Method

Data are from the Mexican Health and Aging Study, a panel survey that began with a nationally representative sample of Mexican adults 50 years and older at baseline (2001), with follow-up in 2003 and 2012. We use a hierarchical repeated measures model to estimate the relationship between SES and depressive symptoms, functional limitations, and self-rated health, respectively. We tested both discrete measures of SES in childhood and adulthood, as well as a combined indicator of lifetime SES.

Results

Childhood SES was significantly associated with later-life health trajectories net of adulthood SES indicators. Adult SES was significantly associated with late-life health trajectories, with some differences by gender and outcome. There were significant SES disparities in health outcomes over the 11-year study period. However, there were no significant multiplicative interactions between SES and age, which would have indicated either diminishing or widening SES health disparities with age.

Discussion

Socioeconomic disparities in health appear to persist into old age in the Mexican context. Efforts to reduce late-life health disparities in Mexico should target socioeconomic and material conditions across the life course.

Stressful Work Trajectories and Depressive Symptoms in Middle-Aged Couples: Moderating Effect of Marital Warmth

OBJECTIVES

The present study investigated the decade-long actor and partner infleunces between husbands' and wives' trajectories of stressful work conditions (SWCs) and their depressive symptoms while also considering the moderation of these influences by spousal warmth.

METHODS

Participants were 330 middle-aged dual-earner couples from the Iowa Midlife Transitions Project. Husbands and wives reported on own SWCs and reported on parenter's warmth in the years of 1991, 1992, and 1994. Depressive symptoms for husbands and wives were measured by the SCL-90-R in 1994 and 2001. Structural equation models, growth curves, and longitudinal data were used to perform our analyses.

RESULTS

For husbands and wives, trajectories of SWCs over early middle years (1991-1994) contributed to depressive symptoms in 1994. Notably, for husbands and wives, the severity (level) of SWCs in 1991 had a persistent influence on depressive symptoms a decade later (2001). For husbands, under conditions of wives' low warmth, SWCs exerted a relatively strong influence on their depressive symptoms. However, under conditions of high warmth from wives, most of these influences were greatly diminished.

DISCUSSION

Results from the current study indicate that contextual life experiences can have a persistent health influences over the life course.

Heterogeneous Trajectories of Physical and Mental Health in Late Middle Age: Importance of Life-Course Socioeconomic Positions

Drawing on life course and cumulative disadvantage theory, this study examines heterogeneous trajectories of functional limitations and depressive symptoms among late middle-aged individuals. This study used prospective data from 6010 adults, 51 to 64 years old, collected over a 12-year-period from the Health and Retirement Study. Considering the empirical proposition that several physical and mental trajectories may exist, Latent Class Growth Modeling was used. Five heterogeneous patterns of joint trajectories (Relatively healthy, Moderately improving, Steadily deteriorating, Steeply deteriorating, and Persistently high comorbid) were identified. Early life adversity was related to an increasing risk of declines in physical and mental health. The Persistently high comorbid class was characterized by a concentration of disadvantages over the life course. The development of public health interventions could help reduce co-existing physical and mental health problems, especially during late middle-age.

Intraindividual Variability in Late-Life Functional Limitations Among White, Black, and Hispanic Older Adults

Consistent with the weathering hypothesis, many studies have captured racial/ethnic disparities in average functional health trajectories. The same mechanisms of social inequality that contribute to worse average health among minority adults may also contribute to greater fluctuations in their physical function at upper ages. Using panel data from the Health and Retirement Study, we examine patterns of intraindividual variability over time in trajectories of functional limitations for White, Black, and Hispanic older adults. Intraindividual variability increases with age for both Whites and Blacks and such increase is greater for Blacks. Hispanics have the greatest intraindividual variability but there is no age-based pattern. Socioeconomic status and comorbidity are associated with intraindividual variability for all race/ethnicity yet do not explain the age-based increase in intraindividual variability for Whites or Blacks. The findings suggest further nuances to the weathering hypothesis—social disadvantage can generate instability in physical function as minority adults age.

Age and Socioeconomic Gradients of Health of Indian Adults: An Assessment of Self-Reported and Biological Measures of Health

This paper describes overall socioeconomic gradients and the age patterns of socioeconomic gradients of health of Indian adults for multiple health indicators encompassing the multiple aspects of health. Cross-sectional data on 11,230 Indians aged 18 years and older from the WHO-SAGE India Wave 1, 2007 were analyzed. Multivariate logit models were estimated to examine effects of socioeconomic status (education and household wealth) and age on four health domains: self-rated health, self-reported functioning, chronic diseases, and biological health measures. Results show that socioeconomic status (SES) was negatively associated with prevalence of each health measure but with considerable heterogeneity across age groups. Results for hypertension and COPD were inconclusive. SES effects are significant while adjusting for background characteristics and health risk factors. The age patterns of SES gradient of health depict divergence with age, however, no conclusive age pattern emerged for biological markers. Overall, results in this paper dispelled the conclusion of negative SES-health association found in some previous Indian studies and reinforced the hypothesis of positive association of SES with health for Indian adults. Higher prevalence of negative health outcomes and SES disparities of health outcomes among older age-groups highlight need for inclusive and focused health care interventions for older adults across socioeconomic spectrum.

Aging With Disability for Midlife and Older Adults

This analysis brings “aging with disability” into middle and older ages. We study U.S. adults ages 51+ and ages 65+ with persistent disability (physical, household management, personal care; physical limitations, instrumental activities of daily living [IADLs], activities of daily living [ADLs]), using Health and Retirement Study data. Two complementary approaches are used to identify persons with persistent disability, one based directly on observed data and the other on latent classes. Both approaches show that persistent disability is more common for persons ages 65+ than ages 51+ and more common for physical limitations than IADLs and ADLs. People with persistent disability have social and health disadvantages compared to people with other longitudinal experiences. The analysis integrates two research avenues, aging with disability and disability trajectories. It gives empirical heft to government efforts to make aging with disability an age-free (all ages) rather than age-targeted (children and youths) perspective.

Intergenerational Relationships and Self-Rated Health Trajectories Among Older Adults in Rural China: Does Gender Matter?

The present study examined trajectory patterns of self-rated health (SRH) among older rural Chinese adults and gender differences in the relationship between intergenerational relationships and SRH trajectories. Using data from four waves of a longitudinal study on the well-being of older adults in Anhui province, a general growth mixture model was estimated to examine the SRH trajectory patterns and antecedents of SRH trajectory class memberships. A two-class model was selected to interpret the SRH trajectory patterns. The two classes were labeled remaining poor and good but declining. Intergenerational relationships were a significant antecedent of SRH trajectory class memberships among men but not women. Gender differences in the cumulative effects of intergenerational relationships on the health of older adults were identified in rural China. Policy implications regarding how to help rural families support their elderly members are discussed.

Empirical redefinition of comprehensive health and well-being in the older adults of the United States

The World Health Organization (WHO) defines health as a "state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." Despite general acceptance of this comprehensive definition, there has been little rigorous scientific attempt to use it to measure and assess population health. Instead, the dominant model of health is a disease-centered Medical Model (MM), which actively ignores many relevant domains. In contrast to the MM, we approach this issue through a Comprehensive Model (CM) of health consistent with the WHO definition, giving statistically equal consideration to multiple health domains, including medical, physical, psychological, functional, and sensory measures. We apply a data-driven latent class analysis (LCA) to model 54 specific health variables from the National Social Life, Health, and Aging Project (NSHAP), a nationally representative sample of US community-dwelling older adults. We first apply the LCA to the MM, identifying five health classes differentiated primarily by having diabetes and hypertension. The CM identifies a broader range of six health classes, including two "emergent" classes completely obscured by the MM. We find that specific medical diagnoses (cancer and hypertension) and health behaviors (smoking) are far less important than mental health (loneliness), sensory function (hearing), mobility, and bone fractures in defining vulnerable health classes. Although the MM places two-thirds of the US population into "robust health" classes, the CM reveals that one-half belong to less healthy classes, independently associated with higher mortality. This reconceptualization has important implications for medical care delivery, preventive health practices, and resource allocation.

Mid-life socioeconomic status, depressive symptomatology and general cognitive status among older adults: inter-relationships and temporal effects

Background

Few longitudinal studies have analyzed how socioeconomic status (SES) influences both depressive and cognitive development over an individual’s life course. This study investigates the change trajectories of both depressive symptomatology and general cognitive status, as well as their associations over time, focusing on the effects of mid-life SES.

Methods

Data were obtained from the Taiwan Longitudinal Study on Aging (1993–2007), a nationally representative cohort study of older adults in Taiwan. The short form of the Center of Epidemiological Studies-Depression (CES-D) scale that measures depressive symptomatology in two domains (negative affect and lack of positive affect) was used. General cognitive status was assessed using the brief Short Portable Mental Status Questionnaire scale. Assessments of the subjects’ mid-life SES included measurement of the participant’s education and occupation. Analyses were conducted by the parallel latent growth curve modeling.

Results

The participants’ initial levels of depressive symptomatology and general cognitive status were significantly and negatively correlated; furthermore, any changes in these two outcomes were also correlated over time. The initial assessment of general cognitive status significantly contributed to any advancement towards more severe depressive symptomatology over time, particularly when this occurred in a negative manner. Furthermore, a mid-life SES advantage resulted in a significant reduction in late-life depressive symptomatology and also produced a slower decline in general cognitive status during later life. In contrast, lower mid-life SES exacerbated depressive symptomatology during old age, both at the initial assessment and in terms of the change over time. In addition, female gender was significantly associated with lower general cognitive status and more severe depressive symptomatology in negative affect.

Conclusions

These findings suggest a complex and longitudinal association between depressive symptomatology and general cognitive status in later life and this complicated relationship seems to be affected by mid-life SES over time.

Sequential Patterns of Health Conditions and Financial Outcomes in Late Life: Evidence From the Health and Retirement Study

The cost and prevalence of chronic health conditions increase in late life and can negatively impact accumulated wealth. Based on the financial challenges midaged and older adults face, we sought to understand the evolution of distinctive sequences of chronic health conditions and how these sequences affect retirement savings. We used 10 waves of the Health and Retirement Study and tracked the health states and changes in wealth of 5,540 individuals. We identified five typical sequences of chronic health conditions, which are defined as follows: Multimorbidity, Comorbidity, Mild Disease, Late Event, and No Disease. Wealth accumulation differed across the five sequences. Multimorbidity and Comorbidity were the most costly sequences. Individuals with these health patterns, respectively, had $91,205 and $95,140, less net worth than respondents identified with No Disease. Our findings suggest policy makers consider sequential disease patterns when planning for the health-care needs and expenditures of older Americans.

Dimensions of self-rated health in older adults

OBJECTIVE

To analyze the association between negative self-rated health and indicators of health, wellbeing and sociodemographic variables in older adults.

METHODS

Cross-sectional study that used data from a population-based health survey with a probability cluster sample that was carried out in Campinas, SP, Southeastern Brazil,, in 2008 and 2009. The participants were older adults (≥ 60 years) and the dependent variable was self-rated health, categorized as: excellent, very good, good, bad and very bad. The adjusted prevalence ratios were estimated by means of Poisson multiple regression.

RESULTS

The highest prevalences of bad/very bad self-rated health were observed in the individuals who never attended school, in those with lower level of schooling, with monthly per capita family income lower than one minimum salary. Individuals who scored five or more in the physical health indicator also had bad self-rated health, as well as those who scored five or more in the Self-Reporting Questionnaire 20 and those who did not refer feeling happiness all the time.

CONCLUSIONS

The independent effects of material life conditions, physical and mental health and subjective wellbeing, observed in self-rated health, suggest that older adults can benefit by health policies supported by a global and integrative view of old age.

Marital Quality and Cognitive Limitations in Late Life

OBJECTIVES

Identifying factors associated with cognitive limitations among older adults has become a major public health objective. Given the importance of marital relationships for older adults' health, this study examines the association between marital quality and change in cognitive limitations in late life, directionality of the relationship between marital quality and cognitive limitations, and potential gender differences in these associations.

METHOD

Latent growth curve models were used to estimate the association of marital quality with change in cognitive limitations among older adults and the direction of the association between marital quality and cognitive limitations using 4 waves of the Americans' Changing Lives survey (N = 841).

RESULTS

Results indicate that more frequent negative (but not positive) marital experiences are associated with a slower increase in cognitive limitations over time, and the direction of this association does not operate in the reverse (i.e., cognitive limitations did not lead to change in marital quality over time). The association between negative marital experiences and cognitive limitations is similar for men and women.

DISCUSSION

The discussion highlights possible explanations for the apparent protective effect of negative marital experiences for older adults' cognitive health over time, regardless of gender.

Disability Trajectories at the End of Life: A "Countdown" Model

OBJECTIVES

Studies of late-life disablement typically address the role of advancing age as a factor in developing disability, and in some cases have pointed out the importance of time to death (TTD) in understanding changes in functioning. However, few studies have addressed both factors simultaneously, and none have dealt satisfactorily with the problem of missing data on TTD in panel studies.

METHODS

We fit latent-class trajectory models of disablement using data from the Health and Retirement Study. Among survivors (~20% of the sample), TTD is unknown, producing a missing-data problem. We use an auxiliary regression equation to impute TTD and employ multiple imputation techniques to obtain final parameter estimates and standard errors.

RESULTS

Our best-fitting model has 3 latent classes. In all 3 classes, the probability of having a disability increases with nearness to death; however, in only 2 of the 3 classes is age associated with disability. We find gender, race, and educational differences in class-membership probabilities.

DISCUSSION

The model reveals a complex pattern of age- and time-dependent heterogeneity in late-life disablement. The techniques developed here could be applied to other phenomena known to depend on TTD, such as cognitive change, weight loss, and health care spending.

Socioeconomic stratification and multidimensional health trajectories: evidence of convergence in later old age

OBJECTIVES

This research sought to examine socioeconomic stratification in the joint trajectories of physical, emotional, and cognitive functioning among older Americans and how it differs by age groups.

METHODS

We used data from a nationally representative sample of 9,237 Americans age 65 or older from the Health and Retirement Study, who were observed biennially from 1998 to 2010. Joint trajectories of physical, emotional, and cognitive functioning were characterized using a group-based mixture model. We then applied multinomial logistic regression analysis to evaluate their linkages with socioeconomic status and how the linkages differ by age groups.

RESULTS

We identified four distinct patterns of joint changes in physical, emotional, and cognitive functioning over time. Accounting for 29.3%, 23.5%, 24.5%, and 22.6% of the older Americans, respectively, these trajectory patterns characterized groups of individuals experiencing minimal to severe levels of impairment and deterioration. Lower education, income, and net worth were associated with trajectories featuring greater impairment or more rapid deterioration in these functional dimensions. Disparities based on education, however, attenuated in later old age, whereas health benefits associated with higher income and higher net worth persisted into advanced age.

DISCUSSION

Distinct patterns of joint trajectories of physical, emotional, and cognitive functioning exist in old age. There were significant socioeconomic differences in the joint trajectories, with education-based inequality in health converging in later old age. Further research identifying strategies to alleviate the disproportionate burden of poor multidimensional health trajectories in lower socioeconomic groups is important.

Life-course socio-economic disadvantage and late-life cognitive functioning in Taiwan: results from a national cohort study

BACKGROUND

Declines in late-life cognitive functioning differ greatly between socio-economic status (SES) groups, but little is known about whether these effects are related to child and adult SES versus SES effects that accumulate over the individual's life course.

METHODS

An 18-year longitudinal national sample of older adults from Taiwan (n=2944) was used to estimate the effect of socio-economic disadvantage over the individual's life course on cognitive functioning during late life. Cognitive functioning was assessed using the brief Short Portable Mental Status Questionnaire scale. Life-course socio-economic disadvantage, as accrued during childhood and adulthood, included measures of paternal education and occupation and participant's education and occupation.

RESULTS

Multivariate analyses using various mixed-effects models showed that the effects of childhood SES could be largely explained by adult SES and that disadvantageous SES in adulthood further exacerbated declines in late-life cognitive functioning (β=-0.02; p<0.001), even controlling for aging, practice and other covariates. Possible factors that are associated with life-course socio-economic disadvantage and late-life cognitive decline included household income and perception of economic strain.

CONCLUSIONS

The results suggest a critical role for life-course socio-economic disadvantage in late-life cognitive decline and that this may be manifested via the inequitable distribution of socio-economic resources over the individual's life course.

Health status profiles in community-dwelling elderly using self-reported health indicators: a latent class analysis

PURPOSE

Latent class analysis (LCA), a statistical method for identifying latent classes within a population using multiple indicators, has been used to study the heterogeneity of health among the elderly. We aim to identify health status profiles of older adults using LCA and examine the socio-demographic characteristics associated with each profile.

METHODS

A community health survey of residents ≥60 years was conducted in Marine Parade, Singapore. We performed LCA on seven health indicators (number of chronic conditions, activities of daily living (ADL) dependency, pain, depression, cognition, social isolation, and frequency of socialising) to identify distinct classes of health status profiles. Multivariable logistic regression was conducted to examine the socio-demographic characteristics associated with each profile.

RESULTS

Of the 2,444 elderly interviewed, we identified two health status profiles: "Health at risk" (n = 465, 19.0 %), and "Relatively healthy" (n = 1,979, 81.0 %). The "Health at risk" profile was characterised by high probabilities of 3+ chronic conditions (λ = 0.63), at least one basic/instrumental ADL dependency (λ = 0.56), moderate/extreme pain (λ = 0.55), cognitive impairment (λ = 0.29), depressive symptoms (λ = 0.29), social isolation (λ = 0.27), and infrequent socialisation (λ = 0.61). Individuals who were older (65-74, 75-84, and 85+ years), females, of non-Chinese ethnicity (Indian, Malay, and Others), had primary and lower education, and were unemployed/not employed were more likely to be "Health at risk".

CONCLUSION

Using LCA, we identified two distinct health status profiles which accounted for the heterogeneity of the elderly population. Selected socio-demographic characteristics were associated with different profiles and provide implications for the structuring of future public health interventions targeting the older population.

The effects of mid-life socioeconomic disadvantage and perceived social support on trajectories of subsequent depressive symptoms among older Taiwanese women

Background

Scant research has taken a life-course perspective to explore the longitudinal impact of socioeconomic disadvantage and perceived social support on the psychological well-being of older women. We sought to explore whether socioeconomic disadvantage and perceived social support in mid-life are associated with subsequent depressive symptomatology among older Taiwanese women.

Methods

This study was based on data from the Taiwan Longitudinal Study on Aging conducted on a nationally representative sample (n = 1,073) of women aged 50 and above with a 12-year follow up. Mid-life socioeconomic disadvantage was assessed by socioeconomic status (SES) (i.e., educational attainment, major lifetime occupation in adulthood, and employment status) and economic strain. Perceived social support included three dimensions: listening, caring, and sick care. We used the short form of the Center of Epidemiological Studies-Depression (CES-D) scale that measures depressive symptomatology within two domains (negative affect and lack of positive affect). Growth curve models were employed to predict the relationships between mid-life socioeconomic disadvantage, perceived social support, and subsequent depressive trajectories, controlling for aging effects.

Results

Multivariate analyses demonstrated older women in a socioeconomic disadvantaged position are more likely to report higher initial levels of depressive symptoms in both domains; lack of formal education did not exacerbate depressive symptoms in the lack of positive affect domain over time. In addition, mid-life perceived positive social support in caring and sick care was associated with lower initial levels of depressive symptoms in both domains.

Conclusions

Our results suggest independent effects of mid-life socioeconomic disadvantage and perceived social support on subsequent depressive symptomatology among older Taiwanese women.

Heterogeneity in healthy aging

For a surprisingly large segment of the older population, chronological age is not a relevant marker for understanding, measuring, or experiencing healthy aging. Using the 2003 Medical Expenditure Panel Survey and the 2004 Health and Retirement Study to examine the proportion of Americans exhibiting five markers of health and the variation in health-related quality of life across each of eight age groups, we find that a significant proportion of older Americans is healthy within every age group beginning at age 51, including among those aged 85+. For example, 48% of those aged 51-54 and 28% of those aged 85+ have excellent or very good self-reported health status; similarly, 89% of those aged 51-54 and 56% of those aged 85+ report no health-based limitations in work or housework. Also, health-related quality of life ranges widely within every age group, yet there is only a comparatively small variation in median quality of life across age groups, suggesting that older Americans today may be experiencing substantially different age-health trajectories than their predecessors. Patterns are similar for medical expenditures. Several policy implications are explored.