Long-term trajectories of peak expiratory flow rate in older men and women show linear decline mainly determined by baseline levels

BACKGROUND

Peak expiratory flow rate (PEFR) predicts mortality and other negative health outcomes. However, little evidence exists on how PEFR changes with ageing and how trajectories of change differ among older people.

AIMS

To identify trajectories of PEFR in older men and women, and to study characteristics associated with these trajectories.

METHODS

Data from the Longitudinal Aging Study Amsterdam were used, an ongoing cohort study in a representative sample of Dutch older men and women. PEFR was assessed using the Mini-Wright peak flow meter across a 13-year follow-up in 991 men and 1107 women. Trajectories were analyzed using Latent Class Growth Analysis.

RESULTS

Mean age was 72.5 (SD 8.4) in men and 72.4 (SD 8.4) in women. In men, three declining trajectories were identified, i.e. high, intermediate and low, with prevalences of 30%, 46% and 24%, respectively. In women, two declining trajectories were identified, i.e. high and low, with prevalences of 62 and 38%. All trajectories showed linear decline and differed mostly with regard to their intercept. Significant differences between trajectories with regard to baseline demographic, health and lifestyle characteristics were observed, e.g., men and women in the low PEFR trajectory were older, had more chronic diseases, and were more often smoker.

DISCUSSION AND CONCLUSIONS

Trajectories in both men and women differ mainly in baseline level of PEFR and not in rate of decline over time. Therefore, one PEFR measurement might be sufficient to give an indication of the trajectory that an older adult is likely to follow.

Changes in physical performance according to job demands across three cohorts of older workers in the Longitudinal Aging Study Amsterdam

This study set out to evaluate the association between job demands at baseline and physical performance over a six-year period across three cohorts of older Dutch workers examined 10 years apart. Data were drawn from three cohorts (1992-1999, 2002-2009 and 2012-2019) of the Longitudinal Aging Study Amsterdam. Individuals aged 55-65 years from each cohort who worked for pay were included (n = 274, n = 416, n = 618, respectively). Physical performance was measured using gait speed and chair stand performance. A population-based job exposure matrix was used to indicate levels of exposure probability of physical (use of force and repetitive movements) and psychosocial (cognitive demands and time pressure) job demands. We found that psychosocial job demands increased and physical demands decreased across the three cohorts. No between cohort differences were found for how job demands affected changes in physical performance over follow-up. For men, faster decline in gait speed was observed when comparing higher and lower use of force at baseline (β -0.012, 95% CI -0.021, -0.004). Greater use of force and repetitive movements were associated with faster decline in chair stand performance (β -0.012, 95% CI -0.020, -0.004 and β -0.009, 95% CI -0.017, -0.001, respectively). In women, no association of job demands on change in physical performance was observed. The study concluded that higher physical job demands were associated with stronger decline in physical performance across six years for men in all cohorts, while no associations were found among women.

Health trajectories across the work exit transition in the 1990s, 2000s, and 2010s: the role of working conditions and policy

PURPOSE

We examined health trajectories of Dutch older workers across their exit from the workforce in the 1990s, 2000s, and 2010s, testing the hypothesis that pre-post-exit health trajectories of workers with favourable and unfavourable working conditions increasingly diverged over time due to policy measures to extend working life.

METHODS

The Longitudinal Aging Study Amsterdam includes baseline samples in 1992/1993, 2002/2003 and 2012/2013 with two 3-year follow-up waves each. Selected respondents were aged 55 years and over who exited from a paid job within the first or second 3-year interval, up to and including the statutory retirement age (N = 522). Pre-post-exit trajectories were modelled using Generalized Estimating Equations with outcomes self-rated health and physical limitations and determinants physical demands, psychosocial demands, and psychosocial resources.

RESULTS

Average work exit age rose from 60.7 in the 1990s to 62.9 in the 2010s. On average, self-rated health decreased somewhat over successive periods and did not show pre-post-exit change; average physical limitations increased substantially both over successive periods and from pre- to post-exit. No support is found for our hypothesis. However, regardless of work exposures, we found sharp pre-post-exit increases in physical limitations in the 2010s.

CONCLUSION

Although these findings provide no support for our hypothesis of diverging health trajectories over time based on work exposure, they show that exiting at a higher age is linked to poorer pre- and post-exit health and to pre-post-exit increases in physical limitations, suggesting greater health care costs in the near future.

Employment trends at older ages: policy impact or secular change?

Observed increases in retirement age are generally attributed to policies to extend working lives (PEW). In a quasi-experimental design, we examine to what extent increases in employment of older workers can be attributed to secular changes in individual characteristics as opposed to PEW. We compare two countries: one with clear PEW (the Netherlands) and one without PEW (Norway). Data come from the Dutch Longitudinal Aging Study Amsterdam and the NORwegian Longitudinal study on Aging and Generations. From each study, two same-age (55-64 years) samples are selected, one recruited in 2002-03, and one recruited after five (Norway) and ten years (Netherlands). In pooled regression analysis, paid work is the outcome variable, and time of measurement, the main independent variable. Individual characteristics include age, sex, educational level, self-perceived health, functional limitations, sense of mastery, and work status of partner. Employment rose in both countries, faster in the Netherlands than in Norway. Of the rise in employment, individual characteristics explained less in the Netherlands than in Norway. Accounting for these, the interaction country*time was significant, indicating an extra rise in employment of 5.2 and 7.5% points for Dutch men and women, net of individual characteristics and unobserved factors that are assumed to be similar in both countries. The extra rise in the Netherlands represents 57% of the total rise for both sexes. Thus, secular change in individual characteristics explains part of the rise in employment in both countries. In the Netherlands, other factors such as PEW may additionally explain the rise in employment.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10433-021-00664-0.

Sex and gender differences in depressive symptoms in older workers: the role of working conditions

BACKGROUND

Female older workers generally leave the work force earlier than men. Depressive symptoms are a risk factor of early work exit and are more common in women. To extend working lives, pathways leading to these sex inequalities need to be identified. The aim of this study was to investigate the association of sex and gender with depressive symptoms in older workers, and the role of working conditions in this association.

METHODS

We used data from the Longitudinal Aging Study Amsterdam (2012-2013/2015-2016, n = 313). Our outcome was depressive symptoms, measured by the Center for Epidemiologic Studies Depression Scale. We included biological sex, a gender index ranging from masculine to feminine (consisting of six items measuring gender roles: working hours, income, occupation segregation, education, informal caregiving, time spent on household chores), and working conditions (physical demands, psychosocial demands, cognitive demands, autonomy, task variation, social support) in our models. We examined the differential vulnerability hypothesis, i.e., sex/gender moderates the association between working conditions and depressive symptoms, and the differential exposure hypothesis, i.e., working conditions mediate the association between sex/gender and depressive symptoms.

RESULTS

Female sex and feminine gender were both associated with more depressive symptoms. The differential vulnerability hypothesis was not supported by our results. We did find that femininity was negatively associated with autonomy and task variation. In turn, these working conditions were associated with fewer depressive symptoms. Thus, autonomy and task variation partially mediated the association between gender and depressive symptoms, supporting the differential exposure hypothesis. Mediation effects for sex inequalities were not significant.

CONCLUSIONS

Older female workers and older feminine workers have more depressive symptoms than their male/masculine counterparts. Autonomy and task variation appeared to be important in - partially - explaining gender differences in depressive symptoms rather than sex differences. By improving these conditions, gender inequality in mental health among older workers can be reduced, so that both genders have similar chances to reach the retirement age in good mental health.

Social position of older immigrants in the Netherlands: where do immigrants perceive themselves on the societal ladder?

Older Turkish and Moroccan immigrants are often ascribed a low social position based on their relatively unfavourable educational level, occupational status and income. Yet immigrants emigrated to improve their social position and came from contexts where determinants of social position might be based on different socio-cultural circumstances than those used in the country of settlement. In order to understand immigrants' own perception of their social position, we interviewed 23 60-68 year old immigrants from Turkish and Moroccan origin in the Netherlands. Using a ten rung ladder, participants were asked to position themselves in the societal hierarchy before migration, after settlement and currently. Most participants positioned themselves at a middle or high position on the societal ladder. Circumstances used for positioning were related to socioeconomic indicators, but also to social affirmation, family, social integration, physical, mental health, happiness and complying to religious prescriptions. When these circumstances were deemed favourable, participants tended to position themselves higher. Our findings also show that the circumstances that participants used for positioning themselves varied across the life course. These findings complement the picture of the often low objective low socioeconomic position of older immigrants and show that immigrants' perception of their subjective social position reflects a broader set of circumstances than just socioeconomic ones.

Predictors of resilience in older adults with lower limb osteoarthritis and persistent severe pain

BACKGROUND

Resilience refers to the process in which people function well despite adversity. Persistent severe pain may be considered an adversity in people with lower limb osteoarthritis (LLOA). The objectives of this study are: (1) to identify what proportion of older adults with LLOA and persistent severe pain show good functioning; and (2) to explore predictors of resilience.

METHODS

Data from the European Project on OSteoArthritis (EPOSA) were used involving standardized data from six European population-based cohort studies. LLOA is defined as clinical knee and/or hip osteoarthritis. Persistent severe pain is defined as the highest tertile of the pain subscale of the Western Ontario and McMaster Universities Osteoarthritis Index both at baseline and follow-up. Resilience is defined as good physical, mental or social functioning at follow-up despite having LLOA with persistent severe pain.

RESULTS

In total, 95 (14.9%) out of 638 individuals with LLOA had persistent severe pain. Among these, 10 (11.0%), 54 (57.4%) and 49 (53.8%) had good physical, mental and social functioning, respectively. Only 4 individuals (4.5%) were resilient in all three domains of functioning. Younger age, male sex, higher education, higher mastery, smoking and alcohol use, higher physical activity levels, absence of chronic diseases, and more contacts with friends predicted resilience in one or more domains of functioning.

CONCLUSIONS

Few people with LLOA and persistent severe pain showed good physical functioning and about half showed good mental or social functioning. Predictors of resilience differed between domains, and might provide new insights for treatment.

Enjoyment of Sexuality and Longevity in Late Midlife and Older Adults: The Longitudinal Ageing Study Amsterdam

Sexual well-being refers to the evaluation of one’s sexuality. We examined the association of enjoyment of sexuality with longevity and the moderating role of perceived importance of sexuality in this association. In the population-based Longitudinal Ageing Study Amsterdam, the survival of initially 55–84-year-olds was followed during 27 years. Complete data were available for 1042 participants (45.3%). Analyses were adjusted for health-related and psychosocial covariates. 60% of the participants experienced their sexuality as enjoyable and 44% as important. Enjoyment of sexuality was weakly, positively associated with longevity (B[CI] = 0.29[-0.004;0.58]). Perceived importance modified this association: only in those who perceived sexuality as important, the association between enjoyment and longevity was statistically significant (B[CI] = 0.78[0.29;1.27]). Positive affect, functional limitations, emotional loneliness, self-rated health, sense of mastery and alcohol consumption accounted for 35% of the latter association. Interventions may target older adults who perceive sexuality as important but not enjoyable.

Factors Associated With Functional Decline in Hand and Hip/Knee Osteoarthritis After One Year: Data From a Population-Based Study

OBJECTIVE

To investigate factors that together with hand or hip/knee osteoarthritis (OA) could contribute to functional decline over a year's time in elderly individuals.

METHODS

The data of 1,886 individuals between ages 65 and 85 years in a prospective, observational population-based study with 12-18 months of follow-up in the context of the European Project on Osteoarthritis were analyzed. The outcome measures were self-reported hand and hip/knee functional decline, evaluated using a minimum clinically important difference of 4 on the Australian/Canadian Hand OA Index and of 2 on the Western Ontario and McMaster Universities Osteoarthritis Index hip/knee physical function subscales, both normalized to 0-100. Using regression models adjusted for sex, age, country, and education level, the baseline factors considered were clinical hand or hip/knee OA, pain, analgesic/antiinflammatory medications, comorbidities, social isolation, income, walking time, grip strength, physical activity time, and medical/social care.

RESULTS

After a year, 453 participants were identified as having worse hand functionality and 1,389 as not worse. Hand OA, anxiety, walking time, and grip strength were risk factors for hand functional decline; pain was a confounder of the effect of hand OA. Analgesic/antiinflammatory medications mediated the combined effect of hip/knee OA plus pain on functional decline in the 554 individuals classified as having worse hip/knee functionality and the 1,291 persons who were not worse. Peripheral artery disease, obesity, and cognitive impairment were other baseline risk factors.

CONCLUSION

Study findings showed that together with emotional status and chronic physical and cognitive conditions, OA affects hand and hip/knee functional decline.

Trends in Frailty and Its Association With Mortality: Results From the Longitudinal Aging Study Amsterdam, 1995-2016

The aim of this study was to investigate trends in frailty and its relationship with mortality among older adults aged 64–84 years across a period of 21 years. We used data from 1995 to 2016 from the Longitudinal Aging Study Amsterdam. A total of 7,742 observations of 2,874 respondents in the same age range (64–84 years) across 6 measurement waves were included. Frailty was measured with a 32-item frailty index, with a cutpoint of ≥0.25 to indicate frailty. The outcome measure was 4-year mortality. Generalized estimating equation analyses showed that among older adults aged 64–84 years the 4-year mortality rate declined between 1995 and 2016, while the prevalence of frailty increased. Across all measurement waves, frailty was associated with 4-year mortality (odds ratio = 2.79, 95% confidence interval: 2.39, 3.26). There was no statistically significant interaction effect between frailty and time on 4-year mortality, indicating a stable association between frailty and mortality. In more recent generations of older adults, frailty prevalence rates were higher, while excess mortality rates of frailty remained the same. This is important information for health policy-makers and clinical practitioners, showing that continued efforts are needed to reduce frailty and its negative health consequences.

Capturing Subjective Age, Subjective Life Expectancy, and Their Links With Older Adults' Health: The Dutch Longitudinal Aging Study Amsterdam

Objectives: This study compares the associations of two subjective lifetime perspectives, subjective age (SA) and subjective life expectancy (SLE), with physical performance, self-rated health, and depressive symptoms. Methods: 64 91-year-old participants were selected from three waves of the Longitudinal Aging Study Amsterdam (2008/09, 2011/12, 2015/16; n = 1822 participants, n = 3500 observations) that included graphical and numerical measures of SA and SLE. We used generalized estimating equations to examine their associations with health. Results: Associations of SA/SLE with health were weaker for physical performance than for self-rated health and depressive symptoms. The associations of SA and SLE with physical performance were of similar magnitude but with self-rated health depended on the type of measure. Depressive symptoms, instead, showed a stronger association with SA than with SLE. Graphical measures showed weaker associations than numerical measures. Discussion: The way in which subjective lifetime perspectives and health are conceptualized and measured influences the strength of their associations.

The Linkage Between Aging, Migration, and Resilience: Resilience in the Life of Older Turkish and Moroccan Immigrants

OBJECTIVES

Older immigrants are affected by an accumulation of adversities related to migration and aging. This study investigates resilience in older immigrants by examining the resources they use to deal with these adversities in the course of their lives.

METHODS

Data from 23 life-story interviews with Turkish and Moroccan immigrants aged 60-69 years living in the Netherlands.

RESULTS

The circumstances under which individuals foster resilience coincide with four postmigration life stages: settling into the host society, maintaining settlement, restructuring life postretirement, and increasing dependency. Resources that promote resilience include education in the country of origin, dealing with language barriers, having two incomes, making life meaningful, strong social and community networks, and the ability to sustain a transnational lifestyle traveling back and forth to the country of origin. More resilient individuals invest in actively improving their life conditions and are good at accepting conditions that cannot be changed.

DISCUSSION

The study illustrates a link between conditions across life stages, migration, and resilience. Resilient immigrants are better able to accumulate financial and social and other resources across life stages, whereas less resilient immigrants lose access to resources in different life stages.

Predictors of Frailty and Vitality in Older Adults Aged 75 years and Over: Results from the Longitudinal Aging Study Amsterdam

INTRODUCTION

Frailty can be seen as a continuum, from fit to frail. While many recent studies have focused on frailty, much less attention has been paid to the other end of the continuum: the group of older adults that remain (relatively) vital. Moreover, there is a lack of studies on frailty and vitality that investigate predictors from multiple domains of functioning simultaneously. The aim of this study was to identify predictors of frailty as well as vitality among older adults aged 75 years and over.

METHODS

We used longitudinal data from 569 adults aged ≥75 years who participated in the Longitudinal Aging Study Amsterdam. Predictors from the sociodemographic, social, psychological, lifestyle, and physical domains of functioning were measured at T1 (2008-2009). We used the frailty index (FI) to identify frail (FI ≥ 0.25) and vital (FI ≤ 0.15) respondents at follow-up, 3 years later (T2: 2011-2012). We conducted logistic regression analyses with backward stepwise selection to develop and internally validate our prediction models.

RESULTS

The prevalence of frailty in our sample at follow-up was 49.4% and the prevalence of vitality was 18.3%. Predictors of frailty and vitality partly overlapped and included age, depressive symptoms, number of chronic diseases, and self-rated health. We also found predictors that did not overlap. Male sex, moderate alcohol use, more emotional support received, and no hearing problems, were predictors of vitality. Lower cognitive functioning, polypharmacy, and pain were predictors of frailty. The final model for vitality explained 42% of the variance and the final model for frailty explained 48%. Both models had a good discriminative value (area under ROC-curve [AUC] vitality: 0.88; AUC frailty: 0.85).

CONCLUSION

Among older adults aged 75 years and over, predictors of frailty only partially overlap with predictors of vitality. The readily accessible predictors in our models may help to identify older adults who are likely to be vital, or who are at risk of frailty.

Neighborhood Resources Associated With Active Travel in Older Adults-A Cohort Study in Six European Countries

OBJECTIVES

To study associations between perceived neighborhood resources and time spent by older adults in active travel.

METHODS

Respondents in six European countries, aged 65-85 years, reported on the perceived presence of neighborhood resources (parks, places to sit, public transportation, and facilities) with response options "a lot," "some," and "not at all." Daily active travel time (total minutes of transport-related walking and cycling) was self-reported at the baseline (n = 2,695) and 12-18 months later (n = 2,189).

RESULTS

Reporting a lot of any of the separate resources (range B's = 0.19-0.29) and some or a lot for all four resources (B = 0.22, 95% confidence interval [0.09, 0.35]) was associated with longer active travel time than reporting none or fewer resources. Associations remained over the follow-up, but the changes in travel time were similar, regardless of the neighborhood resources.

DISCUSSION

Perceiving multiple neighborhood resources may support older adults' active travel. Potential interventions, for example, the provision of new resources or increasing awareness of existing resources, require further study.

Work characteristics and health in older workers: Educational inequalities

To be able to extend working lives, maintaining good health in older workers is important. The aim of the present study was to identify which work characteristics are associated with physical and mental health outcomes in older workers in the Netherlands, and particularly whether there are educational differences in these associations. We used longitudinal tobit and ordered logistic regression analyses to examine the associations between physical demands, psychosocial demands, variation in tasks, autonomy, and job strain and self-rated health (SRH), functional limitations, and depressive symptoms. We included interaction terms between the work characteristics and education to examine effect modification by education. We found that high physical demands, low variation in tasks, low autonomy, and high job strain were associated with poorer physical and mental health. We found evidence for educational differences in the exposure to these work characteristics, as well as in the strengths of their associations with health, with lower educated workers being disadvantaged. The associations between physical demands (SRH: OR = 3.70 (95%CI:1.92;7.11); functional limitations: B = 1.27 (95%CI:.47;2.07)), autonomy (SRH: OR = .42(95%CI:.26;.69)), and job strain (active job; SRH: OR = .25 (95%CI:.09;.69); functional limitations: B = -1.51 (95%CI:-2.68;-.34), and health were strongest in the lower educated workers. In order to maintain good health in older workers and reduce health inequalities, it is recommended to implement workplace interventions to improve working conditions, especially among the lower educated workers.

Occupational Exposures Associated with Life Expectancy without and with Disability

Policies to extend working lives often do not take into account potentially important health inequalities arising from differences in occupational exposures. Little is known about which occupational exposures are associated with these inequalities. This study aims to examine differences in life expectancy without and with disability by occupational exposures. Longitudinal data (1992–2016) on disability and physical and psychosocial work demands and resources of 2513 (former) workers aged ≥55 years participating in the Longitudinal Aging Study Amsterdam were used. Gender specific life expectancies without and with disability by occupational exposures were calculated using multistate survival models. Women aged 55 years with high physical work demands had a lower life expectancy without disability than those with low exposure (1.02–1.57 years), whereas there was no difference for men. Men and women with high psychosocial work demands and resources had a longer life expectancy without disability than those with low exposure (1.19–2.14 years). Life expectancy with disability did not significantly differ across occupational exposures. Workers with higher psychosocial demands and resources and lower physical demands can expect to live more disability-free years. Information on occupational exposure helps to identify workers at risk for lower life expectancy, especially without disability, who may need specific support regarding their work environment.

Forecasting health prior to state pension age – projections for the Netherlands 2040

Objectives

In many Western societies, the state pension age is being raised to stimulate prolonged working. In the Netherlands, the raise of the state pension age is linked to the remaining life expectancy at age 65 with a factor of 2/3rd, and is expected to be 68 years in 2040. It is not yet well understood whether health of the 60+ permits this increase. In this study, health of Dutch adults aged 60 to 68 is forecasted up to 2040.

Methods

Data are from the Dutch Health Interview Survey (HIS) 1990-2017 (N≈280.000) and the Dutch Public Health Monitor (PHM) 2016 (N≈460.000). Health is operationalized using binomial scores of 1) self-rated health and 2) limitations in hearing, seeing or mobility. Categories are: good health (healthy on both items), moderate health (healthy on one item) and poor health (unhealthy on both items). First, based on the HIS, health status in 5-year age categories was modelled up to 2040 using logistic regression analysis in R. Second, the growth factor from 2016 to 2040 was applied to the health level from the PHM 2016.

Results

In 2016, 63% of men aged 60-65 had good health, 25% had moderate health and 12% had poor health. Among women, this distribution was 64%, 22% and 14%, respectively. In 2040, the health distribution among men aged 60-68 is estimated to be 63-71% in good health, 17-28% in moderate health and 9-12% in poor health. Among women this is estimated to be 64-69%, 17-24% and 12-14%, respectively.

Conclusions

Health of Dutch cohorts nearing the state pension age in the future is estimated to remain the same or improve up to 2040. This development in health is not an obstacle to raising the state pension age. However, due to the increasing state pension age and the baby boom generation reaching age 60+ in the coming years, the absolute number of people aged 60+ in poor and moderate health that participates in labor will increase. Policy aiming at sustainable employability will therefore become increasingly important.

Key messages

Health of Dutch cohorts nearing the state pension age is estimated to remain the same or improve in the future. The development in health is not an obstacle to raising the state pension age. Although health is estimated to remain the same or improve, the absolute number of people aged 60+ in poor and moderate health that participate in labor will increase due to an aging population.

Educational differences in macro-level determinants of early exit from paid work: a multilevel analysis of 14 European countries

The aim of this study was to identify macro-level determinants of early work exit and investigate whether the effects of these determinants differ across educational groups. We used data from the Survey on Health, Ageing and Retirement in Europe (SHARE) (2011–2013) and the English Longitudinal Study of Ageing (ELSA) (2010/2011–2012/2013) as well as macro-level data and included 10,584 participants in 14 European countries. We used logistic multilevel analyses to examine educational differences in macro-level determinants of early work exit. Macro-level determinants were: minimum unemployment replacement rates, expenditure on active labour market policies (aimed to help the unemployed find work) and passive labour market policies (unemployment and early retirement benefits), employment protection legislation (costs involved in dismissing individuals), unemployment rates, statutory pension age and implicit tax on continued work. We found low-educated workers to be more at risk of early work exit than higher educated workers. In low-educated men, higher unemployment replacement rates, higher expenditure on passive labour market policies, stricter employment protection legislation and a higher implicit tax on continued work were associated with a higher risk of early work exit, whereas no macro-level factors were associated with early work exit in highly educated men. In women, a higher expenditure on passive labour market policies and a higher implicit tax on continued work were determinants of early work exit, regardless of educational level. To conclude, low-educated men seem to be especially responsive to the effects of pull factors that make early retirement financially more attractive.

Trajectories of Big Five Personality Traits: A Coordinated Analysis of 16 Longitudinal Samples

This study assessed change in self-reported Big Five personality traits. We conducted a coordinated integrative data analysis using data from 16 longitudinal samples, comprising a total sample of over 60 000 participants. We coordinated models across multiple datasets and fit identical multi-level growth models to assess and compare the extent of trait change over time. Quadratic change was assessed in a subset of samples with four or more measurement occasions. Across studies, the linear trajectory models revealed declines in conscientiousness, extraversion, and openness. Non-linear models suggested late-life increases in neuroticism. Meta-analytic summaries indicated that the fixed effects of personality change are somewhat heterogeneous and that the variability in trait change is partially explained by sample age, country of origin, and personality measurement method. We also found mixed evidence for predictors of change, specifically for sex and baseline age. This study demonstrates the importance of coordinated conceptual replications for accelerating the accumulation of robust and reliable findings in the lifespan developmental psychological sciences.

Educational differences in the influence of health on early work exit among older workers

Objectives

Previous research has shown that poor physical and mental health are important risk factors for early work exit. We examined potential differences in this association in older workers (50+) across educational levels.

Methods

Coordinated analyses were carried out in longitudinal data sets from four European countries: the Netherlands (Longitudinal Aging Study Amsterdam), Denmark (Danish Longitudinal Study of Ageing), England (English Longitudinal Study of Ageing) and Germany (German Ageing Survey). The effect of poor self-rated health (SRH), functional limitations and depression on different types of early work exit (early retirement, economic inactivity, disability and unemployment) was examined using Cox regression analysis. We examined educational differences in these effects by testing interaction terms.

Results

Poor physical and mental health were more common among the lower educated. Poor SRH, functional limitations, and depression were all associated with a higher risk of early work exit. These health effects were strongest for the disability exit routes (poor SRH: HRs 5.77 to 8.14; functional limitations: HRs 6.65 to 10.42; depression: HRs 3.30 to 5.56). In the Netherlands (functional limitations) and England (functional limitations and SRH), effects were stronger in the lower educated.

Conclusions

The prevalence of health problems, that is, poor SRH, functional limitations and depression, was higher in the lower educated workers. All three health indicators increase the risk of early work exit. In some countries, health effects on early exit were stronger in the lower educated. Thus, lower educated older workers are an important target group for health policy and intervention.

Clinical osteoarthritis of the hip and knee and fall risk: The role of low physical functioning and pain medication

OBJECTIVE

Several studies have found an increased fall risk in persons with osteoarthritis (OA). However, most prospective studies did not use a clinical definition of OA. In addition, it is not clear which factors explain this risk. Our objectives were: (1) to confirm the prospective association between clinical OA of the hip and knee and falls; (2) to examine the modifying effect of sex; and (3) to examine whether low physical performance, low physical activity and use of pain medication are mediating these relationships.

METHODS

Baseline and 1-year follow-up data from the European Project on OSteoArthritis (EPOSA) were used involving pre-harmonized data from five European population-based cohort studies (ages 65-85, n = 2535). Clinical OA was defined according to American College of Rheumatology (ACR) criteria. Falls were assessed using self-report.

RESULTS

Over the follow-up period, 27.7% of the participants fell once or more (defined as faller), and 9.8% fell twice or more (recurrent faller). After adjustment for confounding, clinical knee OA was associated with the risk of becoming a recurrent faller (relative risk=1.55; 95% confidence interval: 1.10-2.18), but not with the risk of becoming a faller. No associations between clinical hip OA and (recurrent) falls were observed after adjustment for confounding. Use of opioids and analgesics mediated the associations between clinical OA and (recurrent) falls, while physical performance and physical activity did not.

CONCLUSION

Individuals with clinical knee OA were at increased risk for recurrent falls. This relationship was mediated by pain medication, particularly opioids. The fall risk needs to be considered when discussing the risk benefit ratio of prescribing these medications.

Association Between Osteoarthritis and Social Isolation: Data From the EPOSA Study

OBJECTIVE

To determine whether there is an association between osteoarthritis (OA) and incident social isolation using data from the European Project on OSteoArthritis (EPOSA) study.

DESIGN

Prospective, observational study with 12 to 18 months of follow-up.

SETTING

Community dwelling.

PARTICIPANTS

Older people living in six European countries.

MEASUREMENTS

Social isolation was assessed using the Lubben Social Network Scale and the Maastricht Social Participation Profile. Clinical OA of the hip, knee, and hand was assessed according to American College of Rheumatology criteria. Demographic characteristics, including age, sex, multijoint pain, and medical comorbidities, were assessed.

RESULTS

Of the 1967 individuals with complete baseline and follow-up data, 382 (19%) were socially isolated and 1585 were nonsocially isolated at baseline; of these individuals, 222 (13.9%) experienced social isolation during follow-up. Using logistic regression analyses, after adjustment for age, sex, and country, four factors were significantly associated with incident social isolation: clinical OA, cognitive impairment, depression, and worse walking time. Compared to those without OA at any site or with only hand OA, clinical OA of the hip and/or knee, combined or not with hand OA, led to a 1.47 times increased risk of social isolation (95% confidence interval = 1.03-2.09).

CONCLUSION

Clinical OA, present in one or two sites of the hip and knee, or in two or three sites of the hip, knee, and hand, increased the risk of social isolation, adjusting for cognitive impairment and depression and worse walking times. Clinicians should be aware that individuals with OA may be at greater risk of social isolation. J Am Geriatr Soc 68:87-95, 2019.

Trends across 20 years in multiple indicators of functioning among older adults in the Netherlands

BACKGROUND

Monitoring of trends in functioning of older adults provides indispensable information for health care policy. This study examined trends in multiple indicators of functioning among Dutch older adults across a period of 20 years.

METHODS

Data from the Longitudinal Aging Study Amsterdam were used. We included 10 870 observations of 3803 respondents aged 64-84 years across seven waves (1992-12) and 931 observations of 603 respondents aged 85-94 years across four waves (2001-12). At each wave, 8 indicators of functioning were measured: multimorbidity, severe functional limitations, depression, anxiety, cognitive impairment, physical inactivity, loneliness and social isolation. In addition, a sum score (range: 0-8) of these indicators was calculated, with a score of ≥5 indicating 'multiple problems.' Trends in functioning over time were assessed using Generalized Estimating Equation analyses.

RESULTS

In the 64-84-years-olds, the prevalence of multimorbidity increased over time [OR(year) = 1.06, 95% CI = 1.05-1.06], whereas the prevalence of the other indicators decreased [i.e. cognitive impairment, physical inactivity (in women) and loneliness (in women)] or remained stable [i.e. severe functional limitations, depression, anxiety, physical inactivity (in men), loneliness (in men) and social isolation]. In the 85-94-year-olds, the prevalence of severe functional limitations increased over time [OR(year) = 1.08, 95% CI = 1.02-1.13], whereas the prevalence of the other indicators remained stable. In both age groups, the prevalence of 'multiple problems' remained stable.

CONCLUSION

Unfavorable trends were observed in multimorbidity among 64-84-years-olds and in severe functional limitations among 85-94-year-olds. Favorable trends were found in cognitive impairment, physical inactivity (in women) and loneliness (in women) among 64-84-years-olds.

Educational inequalities in health after work exit: the role of work characteristics

Background

Educational inequalities in health have been widely reported. A low educational level is associated with more adverse working conditions. Working conditions, in turn, are associated with health and there is evidence that this association remains after work exit. Because many countries are raising the statutory retirement age, lower educated workers have to spend more years working under adverse conditions. Therefore, educational health inequalities may increase in the future. This study examined (1) whether there were educational differences over time in health after work exit and (2) whether work characteristics mediate these educational inequalities in health.

Methods

Data from five prospective cohort studies were used: The Netherlands (Longitudinal Aging Study Amsterdam), Denmark (Danish Longitudinal Study of Aging), England (English Longitudinal Study of Ageing), Germany (German Aging Study), and Finland (Finnish Longitudinal Study on Municipal Employees). In each dataset we used Generalized Estimating Equations to examine the relationship between education and self-rated health after work exit with a maximum follow-up of 15 years and possible mediation of work characteristics, including physical demands, psychosocial demands, autonomy, and variation in activities.

Results

The low educated reported significantly poorer health after work exit than the higher educated. Lower educated workers had a higher risk of high physical demands and a lower risk of high psychosocial demands, high variation in tasks, and high autonomy at work, compared to higher educated workers. These work characteristics were found to be mediators of the relationship between education and health after work exit, consistent across countries.

Conclusion

Educational inequalities in health are still present after work exit. If workers are to spend an extended part of their lives at work due to an increase in the statutory retirement age, these health inequalities may increase. Improving working conditions will likely reduce these inequalities in health.

Macro-level determinants of post-retirement health and health inequalities: A multilevel analysis of 18 European countries

Poor health after retirement may have an important economic and societal impact and may be affected by macro-level factors. Our aim was to examine whether macro-level factors are associated with health and educational differences in health in recent retirees. We used data covering 18 European countries from the Survey on Health, Ageing and Retirement in Europe (SHARE) and the English Longitudinal Study of Ageing (ELSA) on 8867 respondents who had been retired less than 5 years. We performed multi-level linear regression analyses to examine whether social expenditure in nine policy areas, minimum pension replacement rates, and unemployment replacement rates explained cross-country differences in post-retirement self-rated health (SRH) and educational inequalities in SRH. In both men and women, a higher total expenditure as well as higher expenditures on health, old age, housing, and 'other social policy areas' (non-categorical cash benefits to low-income households and other social services) were associated with better SRH. Cross-level interactions showed that in the presence of a higher old age expenditure, a higher unemployment expenditure, and a higher total expenditure, the absolute educational inequalities in post-retirement SRH were smaller than with lower expenditures in these areas, in both men and women. We found the same effect in women only for a higher expenditure on health as well as a higher minimum pension replacement rate. A higher expenditure on survivors pensions, a lower expenditure on family, and a higher unemployment replacement rate had this effect in men only. This study showed that social expenditure and replacement rates were associated with post-retirement health and health inequalities.

Time Trend in Persistent Cognitive Decline: Results From the Longitudinal Aging Study Amsterdam

Objective

To study time trends in the incidence of persistent cognitive decline (PCD), and whether an increase or decrease is explained by changes in well-known risk factors of dementia.

Method

Data from the Longitudinal Aging Study Amsterdam over a period of 20 years were used. Subsamples of 65-88 year-olds were selected at 7 waves, with numbers ranging from 1,800 to 1,165. Within-person change in cognitive functioning was used to determine PCD. In logistic generalized estimating equations (GEE), time (0, 3, 6, 9, 13, and 16 years) was the main predictor of 3-year PCD incidence. Explanatory variables were lagged one wave before incident PCD and included in separate models.

Results

PCD incidence was 2.5% at first, and 3.4% at last follow-up. GEE showed a positive time trend for PCD incidence [Exp(B)time = 1.042; p < .001]. None of the explanatory variables significantly changed the strength of the regression coefficient of linear time. Higher age, lower education, diabetes mellitus, smoking, lower body-mass index, and lower level of physical activity were associated with higher incidence of PCD.

Conclusion

An increase in PCD incidence over time was found. Although well-known risk factors were associated with incidence per se, they did not explain the increase in incidence of PCD.

Cohort Differences in Cognitive Aging in the Longitudinal Aging Study Amsterdam

Objectives

This study aims to examine cohort differences in cognitive performance and rates of change in episodic memory, processing speed, inductive reasoning, and general cognitive performance and to investigate whether these cohort effects may be accounted for by education attainment.

Method

The first cohort (N = 705) was born between 1920 and 1930, whereas the second cohort (N = 646) was born between 1931 and 1941. Both birth cohorts were aged 65 to 75 years at baseline and were followed up 3 and 6 years later. Data were analyzed using linear mixed models.

Results

The later born cohort had better general cognitive performance, inductive reasoning, and processing speed at baseline, but cohort differences in inductive reasoning and general cognitive performance disappeared after adjusting for education. The later born cohort showed steeper decline in processing speed. Memory decline was steeper in the earlier born cohort but only from Time 1 to Time 3 when the same memory test was administered. Education did not account for cohort differences in cognitive decline.

Discussion

The later born cohort showed better initial performance in certain cognitive abilities, but no better preservation of cognitive abilities overtime compared with the earlier born cohort. These findings carry implications for healthy cognitive aging.

Minimal clinically important decline in physical function over one year: EPOSA study

BACKGROUND

The Australian/Canadian hand Osteoarthritis Index (AUSCAN) and the Western Ontario and McMaster Universities knee and hip Osteoarthritis Index (WOMAC) are the most commonly used clinical tools to manage and monitor osteoarthritis (OA). Few studies have as yet reported longitudinal changes in the AUSCAN index regarding the hand. While there are published data regarding WOMAC assessments of the hip and the knee, the two sites have always evaluated separately. The current study therefore sought to determine the minimal clinically important difference (MCID) in decline in the AUSCAN hand and WOMAC hip/knee physical function scores over 1 year using anchor-based and distribution-based methods.

METHODS

The study analysed data collected by the European Project on Osteoarthritis, a prospective observational study investigating six adult cohorts with and without OA by evaluating changes in the AUSCAN and WOMAC physical function scores at baseline and 12-18 months later. Pain and stiffness scores, the performance-based grip strength and walking speed and health-related quality of life measures were used as the study's anchors. Receiver operating characteristic curves and distribution-based methods were used to estimate the MCID in the AUSCAN and WOMAC physical function scores; only the data of those participants who possessed paired (baseline and follow up-measures) AUSCAN and WOMAC scores were included in the analysis.

RESULTS

Out of the 1866 participants who were evaluated, 1842 had paired AUSCAN scores and 1845 had paired WOMAC scores. The changes in the AUSCAN physical function score correlated significantly with those in the AUSCAN pain score (r = 0.31). Anchor- and distribution-based approaches converged identifying 4 as the MCID for decline in the AUSCAN hand physical function. Changes in the WOMAC hip/knee physical function score were significantly correlated with changes in both the WOMAC pain score (r = 0.47) and the WOMAC stiffness score (r = 0.35). The different approaches converged identifying two as the MCID for decline in the WOMAC hip/knee physical function.

CONCLUSIONS

The most reliable MCID estimates of decline over 1 year in the AUSCAN hand and WOMAC hip/knee physical function scores were 4 and 2 points, respectively.

Do religious activities among young-old immigrants act as a buffer against the effect of a lack of resources on well-being?

OBJECTIVES

Despite a large body of sociological and psychological literature suggesting that religious activities may mitigate the effects of stress, few studies have investigated the beneficial effects of religious activities among immigrants. Immigrants in particular may stand to benefit from these activities because they often report a religious affiliation and often occupy disadvantaged positions. This study investigates whether private and public religious activities reduce the negative effects of a lack of physical, social, and socio-economic resources on wellbeing among Turkish and Moroccan young-old immigrants in the Netherlands.

METHOD

Using data from the Longitudinal Study Amsterdam, cluster analysis revealed three patterns of absence of resources: physically disadvantaged, multiple disadvantages, and relatively advantaged. Linear regression analysis assessed associations between patterns of resources, religious activities and wellbeing.

RESULTS

Persons who are physically disadvantaged or have multiple disadvantages have a lower level of wellbeing compared to persons who are relatively advantaged.  More engagement in private religious activities was associated with higher wellbeing. Among those with multiple disadvantages, however, more engagement in private religious activities was associated with lower wellbeing. Public religious activities were not associated with wellbeing in the disadvantaged group.

CONCLUSION

Private religious activities are positively related to wellbeing among Turkish and Moroccan immigrants. In situations where resources are lacking, however, the relation between private religious activities and wellbeing is negative. The study's results highlight the importance of context, disadvantage and type of religious activity for wellbeing.

Perceived constraints in late midlife: Cohort differences in the Longitudinal Aging Study Amsterdam (LASA)

Life span psychological and life course sociological perspectives have long acknowledged the role of historical and sociocultural contexts for individuals' functioning and development. Secular increases favoring older adults in later born cohorts are widely documented for fluid cognitive performance and well-being. However, less is known about secular trends in further key resources of psychosocial functioning, such as perceptions of constraints, and how these are driven by and associated with well-established and probably interrelated secular trends in several individual difference characteristics, including sociodemographic, religiosity, physical health, cognitive, and social variables. To examine these questions, we compared data from 2 independent local samples of the Longitudinal Aging Study Amsterdam (LASA) obtained 20 years apart, in 1992-1993 (n_1992-1993 = 795; age = 55-65 years) versus in 2012-2013 (n_2012-2013 = 819; age = 55-65 years). Results revealed that in late midlife, people today perceive fewer constraints than did same-aged peers 20 years ago. These secular trends remained after covarying for individual and cohort differences in physical health, performance-based measures of cognitive functioning (memory), quantitative and qualitative indicators of social support, and self-esteem. The effect size was in the moderate range (d = -.20). We conclude that secular trends such as perceptions of constraints in people's lives generalize to key psychosocial resources across adulthood and old age. We discuss potential underlying mechanisms and consider practical implications of our findings. (PsycINFO Database Record

Relative importance of four functional measures as predictors of 15-year mortality in the older Dutch population

BACKGROUND

Decreased physical function is known to raise mortality risk. Little is known about how different physical function measures compare in predicting mortality risk in older men and women. The objective of this study was to compare four, objective and self-reported, physical function measures in predicting 15-year mortality risk in older men and women.

METHODS

Data were used from the Longitudinal Aging Study Amsterdam (LASA), an ongoing cohort study in a population-based sample of the older Dutch population, sampled from municipal records. The 1995-96 cycle, including 727 men and 778 women aged 65-88 years, was considered as the baseline. Mortality was followed up through September 1, 2011. Physical function measures were: lower-body performance (chair stands test, walk test and tandem stand); handgrip strength (grip strength dynamometer); lung function (peak expiratory flow rate); functional limitations (self-report of difficulties in performing six activities of daily living). Cox proportional hazard models were used to determine the predictive value of each physical function measure for 15-year mortality risk, adjusted for demographic, lifestyle and health variables as potential confounders.

RESULTS

1031 participants (68.5%) had died. After adjustments for confounders, in models assessing single functional measures, peak flow was the strongest predictor of all-cause mortality in men (HR 1.76, CI 1.38-2.26, CI) and lower-body performance in women (HR 1.97,CI 1.40-2.76, CI). In a model including all four functional measures only peak flow was statistically significant in predicting mortality in both genders (men HR 1.54,CI 1.18-2.01 and women HR 1.45,CI 1.08-1.94). In women, lower-body performance (HR 1.66, CI 1.15-2.41) followed by grip strength (HR 1.38, CI 1.02-1.89), and in men, functional limitations (HR 1.43, CI 1.14-1.8) were the other significant predictors of all-cause mortality.

CONCLUSION

Both objective and self-reported measures of physical functioning predicted all-cause mortality in a representative sample of the older Dutch population to different extents in men and women. Peak flow contributed important unique predictive value for mortality in both men and women. In women, however, lower-body performance tests had better predictive ability. A second-best predictor in men was self-reported functional limitations. Peak flow, and possibly one of the other measures, may be used in clinical practice for assessment in the context of time constraints.

Diversity in Older Adults' Care Networks: The Added Value of Individual Beliefs and Social Network Proximity

Objectives

Policy reforms in long-term care require an increased share of informal caregivers in elderly care. This may be more feasible for older adults who (believe they) can organize the care themselves and have a local social network. This study describes care network types, how they vary in the share of informal caregivers, and examines associations with characteristics of community-dwelling older adults, including individual beliefs and network proximity.

Method

Latent class analyses were applied to a subsample of older care receivers (N = 491) from the Longitudinal Aging Study Amsterdam, in order to identify homogeneous subgroups of people with similar care networks. Multinomial regression analysis explored associations between network type and care receiver characteristics.

Results

Privately paid, coresidential, large informal, and publicly paid care network types were distinguished. Variation in informal care appeared mostly related to health, partner status, income, and proximity of children. Proximity of other potential informal caregivers did not affect the network type. Perceived control of care was highest in the privately paid network.

Discussion

The results suggest that local (non-)kin could be mobilized more often in coresidential networks. Increasing informal or alternative care in publicly paid networks is less likely, due to limited social and financial resources.

Predictors of Entering a Hearing Aid Evaluation Period: A Prospective Study in Older Hearing-Help Seekers

This study aimed to determine the predictors of entering a hearing aid evaluation period (HAEP) using a prospective design drawing on the health belief model and the transtheoretical model. In total, 377 older persons who presented with hearing problems to an Ear, Nose, and Throat specialist (n = 110) or a hearing aid dispenser (n = 267) filled in a baseline questionnaire. After 4 months, it was determined via a telephone interview whether or not participants had decided to enter a HAEP. Multivariable logistic regression analyses were applied to determine which baseline variables predicted HAEP status. A priori, candidate predictors were divided into ‘likely’ and ‘novel’ predictors based on the literature. The following variables turned out to be significant predictors: more expected hearing aid benefits, greater social pressure, and greater self-reported hearing disability. In addition, greater hearing loss severity and stigma were predictors in women but not in men. Of note, the predictive effect of self-reported hearing disability was modified by readiness such that with higher readiness, the positive predictive effect became stronger. None of the ‘novel’ predictors added significant predictive value. The results support the notion that predictors of hearing aid uptake are also predictive of entering a HAEP. This study shows that some of these predictors appear to be gender specific or are dependent on a person’s readiness for change. After assuring the external validity of the predictors, an important next step would be to develop prediction rules for use in clinical practice, so that older persons’ hearing help-seeking journey can be facilitated.

Within-person pain variability and physical activity in older adults with osteoarthritis from six European countries

BACKGROUND

This study examines the association of both pain severity and within-person pain variability with physical activity (PA) in older adults with osteoarthritis (OA).

METHODS

Data from the European Project on OSteoArthritis were used. At baseline, clinical classification criteria of the American College of Rheumatology were used to diagnose OA in older adults (65-85 years). At baseline and 12-18 months follow-up, frequency and duration of participation in the activities walking, cycling, gardening, light and heavy household tasks, and sports activities were assessed with the Longitudinal Aging Study Amsterdam Physical Activity Questionnaire. Physical activity was calculated in kcal/day, based on frequency, duration, body weight and the metabolic equivalent of each activity performed. At baseline and 12-18 months follow-up, pain severity was assessed using the pain subscales of the Western Ontario and McMaster Universities OA Index and the Australian/Canadian Hand OA Index. Within-person pain variability was assessed using two-week pain calendars that were completed at baseline, 6 months follow-up and 12-18 months follow-up.

RESULTS

Of all 669 participants, 70.0% were women. Sex-stratified multiple linear regression analyses showed that greater pain severity at baseline was cross-sectionally associated with less PA in women (Ratio = 0.95, 95% CI = 0.90-0.99), but not in men (Ratio = 0.99, 95% CI = 0.85-1.15). The longitudinal analyses showed a statistically significant inverse association between pain severity at baseline and PA at follow-up in women (Ratio = 0.94, 95% CI = 0.89-0.99), but not in men (Ratio = 1.00, 95% CI = 0.87-1.11). Greater pain variability over 12-18 months was associated with more PA at follow-up in men (Ratio = 1.18, 95% CI = 1.01-1.38), but not in women (Ratio = 0.94, 95% CI = 0.86-1.03).

CONCLUSIONS

Greater pain severity and less pain variability are associated with less PA in older adults with OA. These associations are different for men and women. The observed sex differences in the various associations should be studied in more detail and need replication in future research.

23-Year Trends in Life Expectancy in Good and Poor Physical and Cognitive Health at Age 65 Years in the Netherlands, 1993-2016

OBJECTIVES

To examine 23-year trends in both physically and cognitively healthy life expectancy from age 65 years in the Netherlands.

METHODS

We used 8 waves between 1993 and 2016 from the nationally representative Longitudinal Aging Study Amsterdam (12 948 observations). We calculated physically and cognitively healthy life expectancies by using the Sullivan life table method and tested prevalence trends over time by using generalized estimating equations.

RESULTS

Total life expectancy at age 65 years rose from 14.7 to 18.7 years (men) and from 19.2 to 21.4 years (women). Life expectancy in poor physical health increased nonlinearly from 1.8 to 2.9 years for men; for women it fluctuated around 5.7 years. Meanwhile, life expectancy in good cognitive health increased linearly from 11.0 to 15.7 years (men) and from 13.4 to 18.0 years (women). The proportion of people with poor physical and poor cognitive health combined did not increase, averaging 5.9% (men) and 8.7% (women).

CONCLUSIONS

This multiwave study shows that a negative trend in physically healthy life expectancy is accompanied by a positive trend in cognitively healthy life expectancy.

Working life expectancy in good and poor self-perceived health among Dutch workers aged 55–65 years with a chronic disease over the period 1992–2016

Objectives

Several governments have taken measures to encourage prolonged working. It is therefore likely that older adults with a chronic disease are required to work longer in poor self-perceived health (SPH) than before. This study examines to what extent working life expectancy (WLE) in good and poor SPH changed between 1992 and 2016 in workers with a chronic disease from age 55 years onwards.

Methods

Three cohorts (1992, 2002 and 2012) of workers with a chronic disease aged 55–65 years were selected from the Longitudinal Aging Study Amsterdam with a 3-year follow-up each (n=705). A three-state survival model was estimated, modelling transitions between states ‘working with good SPH’, ‘working with poor SPH’ and ‘exit from work’. WLEs were estimated using Multistate Modelling and Estimating Life Expectancies using Continuous Time in R.

Results

Of the workers with a chronic disease, total WLEs at age 55 years were 5.2, 5.7 and 6.8 years in cohorts 1992, 2002 and 2012, respectively. Workers initially having poor SPH, had total WLE of 4.7 years of which 2.4 years in poor SPH in cohort 1992. These workers had total WLE of 5.2 years of which 3.3 years in poor SPH in cohort 2002, and total WLE of 6.5 years of which 3.6 years in poor SPH in cohort 2012.

Conclusions

Workers with a chronic disease extended their working lives by approximately 18 months from 1992 to 2016. In the first decade, unhealthy WLE increased, whereas in the second decade, healthy WLE increased, among both workers in general and workers initially having poor SPH.

Tracking changes in frailty throughout later life: results from a 17-year longitudinal study in the Netherlands

Background

to better understand the development of frailty with ageing requires longitudinal studies over an extended time period.

Objective

to investigate changes in the degree of frailty during later life, and the extent to which changes are determined by socio-demographic characteristics.

Methods

six measurement waves of 1,659 Dutch older adults aged 65 years and over in the Longitudinal Aging Study Amsterdam (LASA) yielded 5,211 observations over 17 years. At each wave, the degree of frailty was measured with a 32-item frailty index (FI), employing the deficit accumulation approach. Socio-demographic characteristics included age, sex, educational level and partner status. Generalized Estimating Equation (GEE) analyses were performed to study longitudinal frailty trajectories.

Results

higher baseline FI scores were observed in older people, women, and those with lower education or without partner. The overall mean FI score at baseline was 0.17, and increased to 0.39 after 17 years. The average doubling time in the number of deficits was 12.6 years, and this was similar in those aged 65-74 years and those aged 75+. Partner status was associated with changes over time in FI score, whereas sex and educational level were not.

Conclusions

this longitudinal study showed that the degree of frailty increased with ageing, faster than the age-related increase previously observed in cross-sectional studies. Even so, the rate of deficit accumulation was relatively stable during later life.

Affective well-being in the last years of life: The role of health decline

Adding to recent evidence of terminal decline in affective well-being, this study examined the role of physical health in accounting for time-to-death-related changes in positive affect (PA) and negative affect (NA). We distinguished effects of preterminal health levels predicting levels ("preserved differentiation") and terminal changes ("differential preservation") and of terminal health declines predicting terminal changes ("terminal reactivity") of affective well-being in the terminal period of life. Data were used from the first cohort of the Longitudinal Aging Study Amsterdam, including 3-yearly measurements from 1992-1993 to 2011-2012 (N = 2310, age = 55-85 at baseline). Measures of PA and NA were derived from the Center for Epidemiologic Studies Depression Scale. Health measures included self-rated health, self-reported functional limitations, and gait speed. Exponential time-to-death-related trajectories in PA and NA were analyzed with mixed regression models. Results confirmed accelerated time-to-death-related decline of PA and increase of NA. Regarding health effects, the findings support terminal reactivity, in that the amount of end-of-life changes in affective well-being was closely linked to the concurrent terminal changes in health. Preterminal health levels did not predict the amount of terminal changes in affective well-being; however, reaching the final years of life with better levels of functional health appeared to promote longer maintenance of better levels of affective well-being and terminal declines more "compressed" to a shorter period prior to death. The findings point to needs to strengthen individuals' resources to compensate for health losses at the end of their life span. (PsycINFO Database Record

The physical, mental, and social impact of COPD in a population-based sample: results from the Longitudinal Aging Study Amsterdam

Chronic obstructive pulmonary disease (COPD) is associated with substantial health impact that may already become apparent in early disease. This study aims to examine the features of subjects with COPD in a Dutch population-based sample and compare their physical status, mental status, and social status to non-COPD subjects. This study made use of Longitudinal Aging Study Amsterdam (LASA) data. Demographics, clinical characteristics, self-reported diseases, post-bronchodilator spirometry, physical, mental, and social status were assessed. A number of 810 subjects (50.5% male, mean age 60.5 ± 2.9 years) were included. Subjects with COPD (n = 68, mean FEV₁ 67.6 [IQR 60.4–80.4] %.) had a slower walking speed than non-COPD subjects, p = 0.033. When compared to non-COPD subjects, COPD subjects gave a lower rating on their health (physical subscale of SF-12: 15 [IQR 16.0–19.0] vs. 18 [IQR 11.0–17.0] points) and life (EQ5D VAS: 75 [IQR 70.0–90.0] vs. 80 points [IQR 65.0–85.5]) surveys. COPD subjects also had a more impaired disease-specific health status (CAT: 9.5 ± 5.9 vs. 6.7 ± 5.2, respectively), were less likely to have a partner (69% vs. 84%, respectively) and received emotional support less often (24% vs. 36%, respectively) compared to non-COPD subjects (All comparisons p < 0.001). In a population-based sample, subjects with COPD had a reduced physical performance, a more impaired disease-specific health status and were more socially deprived compared to non-COPD subjects. These impairments need to be taken into consideration when setting up a management program for patients with mild COPD.

Patients with early-stage chronic lung disease need holistic support to limit the physical, mental and social impacts of the condition. There is more to chronic obstructive pulmonary disease (COPD) than persistent airflow limitation; systemic effects, including loss of muscle strength and higher risk of heart conditions, mental health and social problems can manifest from the early stages. Frits Franssen at CIRO, the Netherlands, and co-workers interviewed 810 participants aged 55–65 from the Longitudinal Aging Study Amsterdam to investigate the physical, mental and social status of COPD sufferers and compare them with healthy controls. Those with COPD were more likely to walk slower, tire easily and perceive themselves as having poor overall health. Socially, COPD patients were less likely to have long-term partners and felt the need for more emotional support than their healthy peers.

The association between singing and/or playing a musical instrument and cognitive functions in older adults

OBJECTIVES

Cognitive decline happens to everyone when aging, but to some more than others. Studies with children, adults, and professional musicians suggest that making music could be associated with better cognitive functioning. In older adults however, this association is less well investigated, which is therefore the aim of this study.

METHODS

In this cross-sectional study data from 1101 participants aged 64 and older from the Longitudinal Aging Study Amsterdam were used. Multivariable linear regression analyses were performed to test the association between making music and cognitive functioning and time spent making music and cognitive functioning. ANCOVA analyses were performed to differentiate between participants who made no music, only sang, only played an instrument or both sang and played an instrument in terms of cognitive functioning.

RESULTS

Making music was significantly positively associated with letter fluency, learning and attention/short-term memory. Time spent making music yielded no significant results. The ANCOVA analyses showed higher scores for participants who only played an instrument compared to participants who made no music on learning, working memory and processing speed. For processing speed the instrument only group also had a higher score than participants who only sang.

DISCUSSION

Making music at least once every two weeks and especially playing a musical instrument, is associated with better attention, episodic memory and executive functions. The results suggest that making music might be a potential protective factor for cognitive decline; however, to support this notion a longitudinal study design is needed.

Secular trends in the prevalence of major and subthreshold depression among 55-64-year olds over 20 years

BACKGROUND

Studying secular trends in the exposure to risk and protective factors of depression and whether these trends are associated with secular trends in the prevalence of depression is important to estimate future healthcare demands and to identify targets for prevention.

METHODS

Three birth cohorts of 55-64-year olds from the population-based Longitudinal Aging Study Amsterdam were examined using identical methods in 1992 (n = 944), 2002 (n = 964) and 2012 (n = 957). A two-stage screening design was used to identify subthreshold depression (SUBD) and major depressive disorder (MDD). Multinomial logistic regression analyses were used to identify secular trends in depression prevalence and to identify factors from the biopsychosocial domains of functioning that were associated with these trends.

RESULTS

Compared with 1992, MDD became more prevalent in 2002 (OR 1.90, 95% CI 1.10-3.28, p = 0.022) and 2012 (OR 1.80, 95% CI 1.03-3.14, p = 0.039). This was largely attributable to an increase in the prevalence of chronic diseases and functional limitations. Socioeconomic and psychosocial improvements, including an increase in labor market participation, social support and mastery, hampered MDD rates to rise more and were also associated with a 32% decline of SUBD-rates in 2012 as compared with 2002 (OR 0.68, 95% CI 0.48-0.96, p = 0.03).

CONCLUSIONS

Among late middle-aged adults, there is a substantial net increase of MDD, which is associated with deteriorating physical health. If morbidity and disability continue to increase, a further expansion of MDD rates may be expected. Improving socioeconomic and psychosocial conditions may benefit public health, as these factors were protective against a higher prevalence of both MDD and SUBD.

Do older individuals who are diagnosed with cancer have worse physical performance prior to diagnosis compared to matched controls? A longitudinal cohort study

Background

Impaired physical performance is highly prevalent in older cancer patients and is associated with cancer-related outcomes such as mortality and chemotherapy-related toxicity. Physical performance might already decline prior to the cancer diagnosis due to undiagnosed disease. This study aimed to assess whether the physical performance of community-dwelling individuals prior to cancer diagnosis is worse compared to matched controls who are not diagnosed with cancer.

Methods

The study sample was selected from the Longitudinal Aging Study Amsterdam, a longitudinal study on a nationally representative sample of the Dutch older population. Physical performance of initially cancer-free individuals aged 55–84 years who were diagnosed with cancer during 10 or 20 years of follow-up was compared to the physical performance of controls who were not diagnosed with cancer. For controls, the physical performance measurements of the cycle with a median age closest to the cancer group were used. The time interval between physical performance measurements and the report of cancer was 2 to 4 years. Groups were compared using logistic and linear regression analysis.

Results

The study sample included 1735 individuals with a median age of 68.7 [interquartile range 63.3–76.4] years. During follow-up, 414 (23.9%) individuals were diagnosed with cancer. Handgrip strength, gait speed, chair stand ability, chair stand test time and ability to put on and take off a cardigan did not differ between groups. Individuals prior to cancer diagnosis were more likely to complete the tandem balance test.

Conclusions

Physical performance of individuals 2 to 4 years prior to report of cancer diagnosis is not lower compared to controls. This suggests that physical performance may not be influenced by cancer before diagnosis.

Secular trends in excess mortality of late-life depression

BACKGROUND

Late-life depression is associated with premature mortality, however, little is known whether excess mortality rates of depression have changed over time. This study aims to identify and explain secular trends in excess mortality of major depressive disorder (MDD) and subthreshold depression (SUBD).

METHODS

Cohort-sequential-longitudinal study of 4084 community-dwelling older adults in the Netherlands based on data from the Longitudinal Aging Study Amsterdam (LASA). Six measurement cycles were included from 1992/93 until 2008/09, each linked to the overall 5-year mortality, covering a 16-year time span. MDD and SUBD were identified using a two-stage screening procedure with the Center for Epidemiological Studies Depression Scale and the Diagnostic Interview Schedule. Age and sex were covariates. Education, health and lifestyle factors, and use of antidepressants were included as putative explanatory factors. Generalized Estimating Equations was used to investigate the association between the interaction 'Depression × Time' and 5-year mortality, and to find explanatory factors for the trend.

RESULTS

A downward trend in excess mortality of MDD was found (OR = .92, 95%-CI:.85-.99, P = .04), adjusted for age and sex, which could not be explained by education, health and lifestyle factors, nor antidepressants use. Sex differences in the trend were not found (P = .77). No trend in excess mortality of SUBD was found (OR = 1.01, 95%-CI: .97-1.04, P = .65).

LIMITATIONS

The findings do not imply a similar trend for other countries.

CONCLUSIONS

The results indicate a favorable development in excess mortality of community-dwelling older adults with MDD, while those with SUBD do not show a clear trend in excess mortality.

Cohort profile: the Geoscience and Health Cohort Consortium (GECCO) in the Netherlands

PURPOSE

In the Netherlands, a great variety of objectively measured geo-data is available, but these data are scattered and measured at varying spatial and temporal scales. The centralisation of these geo-data and the linkage of these data to individual-level data from longitudinal cohort studies enable large-scale epidemiological research on the impact of the environment on public health in the Netherlands. In the Geoscience and Health Cohort Consortium (GECCO), six large-scale and ongoing cohort studies have been enriched with a variety of existing geo-data. Here, we introduce GECCO by describing: (1) the phenotypes of the involved cohort studies, (2) the collected geo-data and their sources, (3) the methodology that was used to link the collected geo-data to individual cohort studies, (4) the similarity of commonly used geo-data between our consortium and the nationwide situation in the Netherlands and (5) the distribution of geo-data within our consortium.

PARTICIPANTS

GECCO includes participants from six prospective cohort studies (eg, 44 657 respondents (18-100 years) in 2006) and it covers all municipalities in the Netherlands. Using postal code information of the participants, geo-data on the address-level, postal code-level as well as neighbourhood-level could be linked to individual-level cohort data.

FINDINGS TO DATE

The geo-data could be successfully linked to almost all respondents of all cohort studies, with successful data-linkage rates ranging from 97.1% to 100.0% between cohort studies. The results show variability in geo-data within and across cohorts. GECCO increases power of analyses, provides opportunities for cross-checking and replication, ensures sufficient geographical variation in environmental determinants and allows for nuanced analyses on specific subgroups.

FUTURE PLANS

GECCO offers unique opportunities for (longitudinal) studies on the complex relationships between the environment and health outcomes. For example, GECCO will be used for further research on environmental determinants of physical/psychosocial functioning and lifestyle behaviours.

A Healthy Lifestyle in Old Age and Prospective Change in Four Domains of Functioning

Objective: The aim of this article is to study the associations between healthy lifestyle in old age and decline in physical, psychological, cognitive, and social functioning. Method: A population-based sample of 3,107 Dutch men and women aged 55 and 85 years (1992/1993; Longitudinal Aging Study Amsterdam) was used with five 3-yeary follow-up examinations. Lifestyle score, based on smoking status, alcohol consumption, physical activity, and body mass index (BMI), ranged from 0 (unhealthy) to 4 (healthy). Outcomes included gait speed, depressive symptoms, cognitive status, and social contacts. Results: Persons with a healthy lifestyle had a 10.6% slower decline in gait speed (0.04 m/s, 95% confidence interval [CI] = [0.03, 0.05]), 10.8% slower increase in depressive symptoms (–1.07 [–1.70, –0.44]), a 1.8% slower decline in cognitive functioning (0.47 [0.23, 0.70]), and a 4.9% slower decline in social contacts (0.58 [0.01, 1.15]) compared with persons with no or one healthy lifestyle factor. Discussion: A healthy lifestyle benefits physical, psychological, cognitive, and social functioning up to very old age.