Health across generations: findings from the Australian Longitudinal Study on Women's Health

Late life changes in mental health: a longitudinal study of 9683 women

OBJECTIVES

To identify latent subgroups of women in late life who are alike in terms of their mental health trajectories.

METHOD

Longitudinal data are for 9683 participants in the 1921-1926 cohort of the Australian Longitudinal Study on Women's Health, who completed at least two surveys between 1999 (aged 73-78 years) and 2008 (aged 82-87 years). Mental health was measured using the five-item mental health inventory (MHI-5). Latent profile analysis uncovered patterns of change in MHI-5 scores.

RESULTS

Three patterns of change were identified for women who were still alive in 2008 (n = 7061), and three similar patterns for deceased women (n = 2622): (1) 'poor mental health' representing women with low MHI-5 scores, (2) 'good mental health' and (3) 'excellent' mental health, where scores remained very high. Deceased women had lower mental health scores for each class. Remote areas of residence, higher education, single marital status, higher Body Mass Index (BMI) and falls were the covariates associated with mental health in the survivor group. For the deceased group, education, BMI and falls were significant. Arthritis, stroke, heart disease, bronchitis/emphysema, diabetes and osteoporosis were associated with worse mental health for both groups, while asthma increased these odds significantly for the survivor group only. Hypertension and cancer were not significant predictors of poor mental health.

CONCLUSION

The results show associations between chronic disease and level of mental health in older age, but no evidence of a large decline in mental health in the period prior to death.

Influence of age on pain intensity, functional impairment and health-related quality of life before and after surgery for lumbar degenerative disc disease

BACKGROUND

Demographic changes will lead to an increase of elderly people in our population and consecutively to a higher prevalence of patients suffering from degenerative disc disease (DDD). The goal of this study was to investigate age-related differences in pain intensity, subjective and objective functional impairment and health-related quality of life (HRQoL) in patients with lumbar DDD.

METHODS

In a prospective two-center study, back and leg pain intensity (visual analogue scale (VAS)), functional impairment (Oswestry Disability Index (ODI), Roland-Morris Disability Index (RMDI)) and HRQoL (EuroQol-5D (EQ-5D), Short-Form (SF12)) were collected for consecutive patients undergoing lumbar spine surgery. Objective functional impairment (OFI) was measured using the Timed Up and Go (TUG) test. Adjusted partial correlation was used to correlate age to each scale preoperatively, as well as to the postoperative improvement at six weeks.

RESULTS

A total of n=377 patients (161 females, 42.7%) with a mean age of 58.5 years (SD 15.7, range 18.0-93.7) were included. Unadjusted TUG test raw times naturally increased with age, whereas the age-effect on standardized OFI T-scores was close to zero in patients with a lumbar disc herniation (LDH; r=-0.0666, p=0.367) or lumbar spinal stenosis (LSS; r=-0.0134, p=0.879). There was a weak correlation between age and higher ODI (LDH: r=0.1289, p=0.089; LSS: r=0.1975; p=0.027), lower EQ-5D (LSS: r=-0.1824, p=0.042) and higher RMDI by trend (LSS: r=0.1679, p=0.061). The correlation between age and postoperative improvement was negative on the VAS for back pain (LDH: r=-0.3189, p=0.026), VAS for leg pain (LDH: r=-0.3656, p=0.009) and RMDI by trend (LSS: r=-0.2004, p=0.069), as well as positive on the EQ-5D index (r=0.2412, p=0.011), indicating that younger patients showed better improvement. Due to in-group heterogeneity, no age-effect could be calculated for patients scheduled for surgical fusion.

CONCLUSIONS

The influence of age on subjective and objective measures of pain, functional impairment and HRQoL is limited for patients with LDH and LSS, but suggests an age-dependent increase of functional disability. Younger patients generally showed greater postoperative improvement at six weeks than older patients.

Age Matters: Exploring Correlates of Self-Rated Health Across Four Generations of Australian Males

The importance of addressing health disparities experienced by boys and men reached tangible prominence in Australia with adoption of the 2010 National Male Health Policy and the establishment of a national longitudinal study on male health-Ten to Men. Ten to Men is based on a holistic model of health with a strong focus on social determinants and health and well-being over the life course. Given the life course focus, we set out to assess if health-related characteristics and the correlates of self-rated health differ across the life course among four sociologically defined generations of Australian males. While some differences in the correlates of good or excellent health were observed across generations, addressing obesity and depression appear to be important for improving the health of Australian males of all ages.

Lack of association between drought and mental health in a cohort of 45-61 year old rural Australian women

OBJECTIVE

To evaluate the impact of drought on the mental health of rural Australian women and those in vulnerable sub-populations: women who were more isolated, poorer and less educated; and women who had histories of chronic disease or poor mental health.

METHODS

Surveys were mailed in 1996, 1998, 2001, 2004 and 2008 to 6,664 women born between 1946 and1951 who were participating in the Australian Longitudinal Study on Women's Health. The surveys included the Mental Health Index of the Medical Outcomes Study Short-Form 36 (MHI). Drought was assessed by linking the latitude and longitude of women's place of residence at each survey to the Hutchinson Drought Index. Associations between MHI and drought were assessed using linear mixed-models.

RESULTS

While 31% of the women experienced drought in 1998 and 50% experienced drought in 2007; experience of droughts was less common in the other years. Although drought varied from survey year to survey year, mental health did not vary with drought conditions for rural women or vulnerable sub-populations.

CONCLUSIONS

These findings are contrary to the long-held assumption that droughts increase mental health problems in Australia.

IMPLICATIONS

While similar results may not be true for men, empirical evidence (rather than assumptions) is required on associations between drought and mental health.

Psychosocial risk factors for hypertension: an update of the literature

A growing body of research demonstrates that psychosocial factors play an important role in the development of hypertension. Previous reviews have identified several key factors (i.e., occupational stress) that contribute to the onset of hypertension; however, they are now outdated. In this review, we provide an updated synthesis of the literature from 2010 to April 2014. We identified 21 articles for inclusion in the review, of which there were six categories of psychosocial stressors: occupational stress, personality, mental health, housing instability, social support/isolation, and sleep quality. Sixteen of the studies reported an association between the psychosocial stressor and blood pressure. While several findings were consistent with previous literature, new findings regarding mediating and moderating factors underlying the psychosocial-hypertension association help to untangle inconsistencies reported in the literature. Moreover, sleep quality is a novel additional factor that should undergo further exploration. Areas for future research based on these findings are discussed.

Benefits gained, benefits lost: comparing baby boomers to other generations in a longitudinal cohort study of self-rated health

POLICY POINTS: Despite beliefs that baby boomers are healthier than previous generations, we found no evidence that the health of baby boomers is substantially different from that of the previous or succeeding cohorts. The effects of increased education, higher income, and lower smoking rates on improving self-rated health were nearly counterbalanced by the adverse effect of increasing body mass index (BMI). Assumptions that baby boomers will require less health care as they age because of better education, more prosperity, and less propensity to smoke may not be realized because of increases in obesity.

CONTEXT

Baby boomers are commonly believed to be healthier than the previous generation. Using self-rated health (SRH) as an indicator of health status, this study examines the effects of age, period, and birth cohort on the trajectory of health across 4 generations: World War II (born between 1935 and 1944), older baby boomers (born between 1945 and 1954), younger baby boomers (born between 1955 and 1964), and Generation X (born between 1965 and 1974).

METHODS

We analyzed Canada's longitudinal National Population Health Survey 1994-2010 (n = 8,570 at baseline), using multilevel growth models to estimate the age trajectory of SRH by cohort, accounting for period and incorporating the influence of changes in education, household income, smoking status, and body mass index (BMI) on SRH over time.

FINDINGS

SRH worsened with increasing age in all cohorts. Cohort differences in SRH were modest (p = 0.034), but there was a significant period effect (p = 0.002). We found marked cohort effects for increasing education, income, and BMI, and decreasing smoking from the youngest to the oldest cohorts, which were much reduced (education and smoking) or removed (income and BMI) once period was taken into account. At the population level, multivariable analysis showed the benefits of increasing education and income and declines in smoking on the trajectory of improving SRH were almost counterbalanced by the effects of increasing BMI (obesity).

CONCLUSIONS

We found no evidence to support the expectation that baby boomers will age more or less healthily than previous cohorts did. We also found that increasing BMI has likely undermined improvements in health that might have otherwise occurred, with possible implications for the need for health care. Period effects had a more profound effect than birth cohort effects. This suggests that interventions to improve health, such as reducing obesity, can be targeted to the entire, or a major portion of the, population and need not single out particular birth cohorts.