Search

Aging involves decline in a range of functional abilities and phenotypes, many of which are also associated with socioeconomic status (SES). Here we assessed whether lower SES is a determinant of the rate of decline over 8 y in six domains-physical capability, sensory function, physiological function, cognitive performance, emotional well-being, and social function-in a sample of 5,018 men and women aged 64.44 (SD 8.49) y on average at baseline. Wealth was used as the marker of SES, and all analyses controlled for age, gender, ethnicity, educational attainment, and long-term health conditions. Lower SES was associated with greater adverse changes in physical capability (grip strength, gait speed, and physical activity), sensory function (sight impairment), physiological function (plasma fibrinogen concentration and lung function), cognitive performance (memory, executive function, and processing speed), emotional well-being (enjoyment of life and depressive symptoms), and social function (organizational membership, number of close friends, volunteering, and cultural engagement). Effects were maintained when controlling statistically for other factors such as smoking, marital/partnership status, and self-rated health and were also present when analyses were limited to participants aged ≤75 y. We conclude that lower SES is related to accelerated aging across a broad range of functional abilities and phenotypes independently of the presence of health conditions and that social circumstances impinge on multiple aspects of aging., Competing Interests: The authors declare no competing interest., (Copyright © 2020 the Author(s). Published by PNAS.)

We examined whether the co-occurrence of four behavioural risk factors (alcohol consumption, smoking, physical inactivity and obesity) is associated with disability-free and chronic disease-free life expectancy similarly in two longitudinal studies of ageing in England and the United States. Data were from 17,351 individuals aged 50+ from the US Health and Retirement Study (HRS) and, 10,388 from the English Longitudinal Study of Ageing (ELSA), from 2002 to 2013. Disability-free life expectancy was estimated using repeat measures of limitations with instrumental activities and activities of daily living and, chronic disease-free life expectancy was based on chronic health conditions. Multistate life table models were used to estimate sex-specific health expectancy at the ages of 50, 60 and 70. In both countries and at all ages, there was a clear gradient towards shorter health expectancy with increasing number of behavioural risk factors. Compared to people with 2+ behavioural risk factors, in both countries, those with no behavioural risk factors could expect to live up to 11 years longer without disability and, up to 12 years longer without chronic conditions. Individual and co-occurring behavioural risk factors were strongly associated with shorter healthy life expectancy in both countries, attesting to the robustness of the contribution of lifestyle factors on health expectancy.

Background: UK state pension eligibility ages are linked to average life expectancy, which ignores wide socioeconomic disparities in both healthy and overall life expectancy., Objectives: Investigate whether there are occupational social class differences in the amount of time older adults live after they stop work, and how much of these differences are due to health., Methods: Participants were 76 485 members of the Office for National Statistics Longitudinal Study (LS), who were 50-75 years at the 2001 census and had stopped work by the 2011 census. Over 10 years of follow-up, we used censored linear regression to estimate mean differences in years between stopping work and death by occupational social class., Results: After adjustment for age, both social class and health were independent predictors of postwork duration (mean difference (95% CI): unskilled class vs professional: 2.7 years (2.4 to 3.1); not good vs good health: 2.4 years (1.9 to 2.9)), with LS members in the three manual classes experiencing ~1 additional year of postwork duration than professional workers (interaction p values all <0.001). Further adjustment for gender and educational qualifications was reduced but did not eliminate social class and postwork duration associations. We estimate the difference in postwork years between professional classes in good health and unskilled workers not in good health as 5.1 years for women (21.0 vs 26.1) and 5.5 years for men (19.5 vs 25.0)., Conclusions: Lower social class groups are negatively affected by uniform state pension ages, because they are more likely to stop work at younger ages due to health reasons., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Several studies have documented that older workers who live in areas with higher unemployment rates are more likely to leave work for health and non-health reasons. Due to tracking of area disadvantage over the life course, and because negative individual health and socioeconomic factors are more likely to develop in individuals from disadvantaged areas, we do not know at what specific ages, and through which specific pathways, area unemployment may be influencing retirement age. Using data from the MRC National Survey of Health and Development, we use structural equation modelling to investigate pathways linking local authority unemployment at three ages (4y, 26y and 53y) to age of retirement (right-censored). We explored five hypothesized pathways: (1) residential tracking, (2) health, (3) employment status, (4) occupational class, and (5) education. Initially, pathways between life course area unemployment, each pathway and retirement age were assessed individually. Mediation pathways were tested in the full model. Our results showed that area unemployment tracked across the life course. Higher area unemployment at ages 4 and 53 were independently associated with earlier retirement age [1% increase = mean -0.64 (95% CI: -1.12, -0.16) and -0.25 (95% CI: -0.43, -0.06) years]. Both were explained by adjustment for individual employment status at ages 26 and 53 years. Higher area unemployment at age 26 was associated with poorer health and lower likelihood of employment at aged 53; and these 2 individual pathways were identified as the key mediators between area unemployment and retirement age. In conclusion, these results suggest that interventions designed to create local employment opportunities for young adults should lead to extended working through improved employment and health at mid-life., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: Modifications in working conditions can accommodate changing needs of chronically ill persons. The self-employed may have more possibilities than employees to modify their working conditions. We investigate how working conditions change following diagnosis of chronic disease for employed and self-employed older persons., Methods: We used waves 2-7 from the English Longitudinal Study of Ageing (ELSA). We included 1389 participants aged 50-60 years who reported no chronic disease at baseline. Using fixed-effects linear regression analysis, we investigated how autonomy, physical and psychosocial job demands and working hours changed following diagnosis of chronic disease., Results: For employees, on diagnosis of chronic disease autonomy marginally decreased (-0.10, 95% CI -0.20 to 0.00) and physical job demands significantly increased (0.13, 95% CI 0.01 to 0.25), whereas for the self-employed autonomy did not significantly change and physical job demands decreased on diagnosis of chronic disease (-0.36, 95% CI -0.64 to -0.07), compared with prediagnosis levels. Psychosocial job demands did not change on diagnosis of chronic disease for employees or the self-employed. Working hours did not change for employees, but dropped for self-employed (although non-significantly) by about 2.8 hours on diagnosis of chronic disease (-2.78, 95% CI -6.03 to 0.48)., Conclusion: Improvements in working conditions after diagnosis of chronic disease were restricted to the self-employed. This could suggest that workplace adjustments are necessary after diagnosis of chronic disease, but that the self-employed are more likely to realise these. Policy seeking to extend working life should consider work(place) adjustments for chronically ill workers as a means to prevent early exit from work., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Background: Maintaining cognitive function is an important aspect of healthy ageing. In this study, we examined age trajectories of cognitive decline in a large nationally representative sample of older people in England. We explored the factors that influence such decline and whether these differed by gender., Methods: Latent growth curve modelling was used to explore age-specific changes, and influences on them, in an 8-year period in memory, executive function, processing speed and global cognitive function among 10 626 participants in the English Longitudinal Study of Ageing. We run gender-specific models with the following exposures: age, education, wealth, childhood socioeconomic status, cardiovascular disease, diabetes, physical function, body mass index, physical activity, alcohol, smoking, depression and dementia., Results: After adjustment, women had significantly less decline than men in memory (0.011, SE 0.006), executive function (0.012, SE 0.006) and global cognitive function (0.016, SE 0.004). Increasing age and dementia predicted faster rates of decline in all cognitive function domains. Depression and alcohol consumption predicted decline in some cognitive function domains in men only. Poor physical function, physical inactivity and smoking were associated with faster rates of decline in specific cognitive domains in both men and women. For example, relative to study members who were physically active, the sedentary experienced greater declines in memory (women -0.018, SE 0.009) and global cognitive function (men -0.015, SE 0.007 and women -0.016, SE 0.007)., Conclusions: The potential determinants of cognitive decline identified in this study, in particular modifiable risk factors, should be tested in the context of randomised controlled trials., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Objectives: Past studies have identified socioeconomic inequalities in the timing and route of labour market exit at older ages. However, few studies have compared these trends cross-nationally and existing evidence focuses on specific institutional outcomes (such as disability pension and sickness absence) in Nordic countries. We examined differences by education level and occupational grade in the risks of work exit and health-related work exit., Methods: Prospective longitudinal data were drawn from seven studies (n=99 164). Participants were in paid work at least once around age 50. Labour market exit was derived based on reductions in working hours, changes in self-reported employment status or from administrative records. Health-related exit was ascertained by receipt of health-related benefit or pension or from the reported reason for stopping work. Cox regression models were estimated for each study, adjusted for baseline self-rated health and birth cohort., Results: There were 50 003 work exits during follow-up, of which an average of 14% (range 2-32%) were health related. Low level education and low occupational grade were associated with increased risks of health-related exit in most studies. Low level education and occupational grade were also associated with an increased risk of any exit from work, although with less consistency across studies., Conclusions: Workers with low socioeconomic position have an increased risk of health-related exit from employment. Policies that extend working life may disadvantage such workers disproportionally, especially where institutional support for those exiting due to poor health is minimal., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Background: Socio-economic status from early life has been linked to cardiovascular disease risk, but the impact of life-course socio-economic trajectories, as well as the mechanisms underlying social inequalities in cardiovascular disease risk, is uncertain., Objectives: We assessed the role of behavioural, psychosocial and physiological (including inflammatory) factors in the association between life-course socio-economic status and cardiovascular disease mortality in older adults., Methods: Participants were 7846 individuals (44% women) from the English Longitudinal Study of Ageing, a representative study of individuals aged ≥ 50 years, established in 2002-03. Comprising four indicators of socio-economic status (father's social class, own education, occupational position and wealth), we computed an index of socio-economic trajectory and a lifetime cumulative socio-economic score. Behavioural (smoking, physical activity, alcohol consumption, body mass index) and psychosocial (social relations, loneliness) factors, physiological (blood pressure, total cholesterol, triglycerides) and inflammatory markers (C-reactive protein, fibrinogen), measured repeatedly over time, were potential explanatory variables. Cardiovascular disease mortality was ascertained by linkage of study members to a national mortality register. Mediation was calculated using the traditional 'change-in-estimate method' and alternative approaches such as counterfactual mediation modelling could not be applied in this context., Results: During the 8.4-year follow-up, 1301 study members died (438 from cardiovascular disease). A stable low-social-class trajectory was associated with around double the risk of cardiovascular disease mortality (hazard ratio; 95% confidence interval: 1.94, 1.37; 2.75) compared with a stable high social class across the life course. Individuals in the lowest relative to the highest life-course cumulative socio-economic status group were also more than twice as likely to die of cardiovascular disease (2.57, 1.81; 3.65). Behavioural factors and inflammatory markers contributed most to explaining this gradient, whereas the role of psychosocial and other physiological risk factors was modest., Conclusions: In a population-based cohort of older individuals living in England, we provide evidence that disadvantage across the life course is linked to cardiovascular mortality. That behavioural factors and inflammatory markers partially explain this gradient may provide insights into the potential for intervention., (© The Author 2017. Published by Oxford University Press on behalf of the International Epidemiological Association)

Objective: To examine the prospective relation between animal companionship and biomarkers of ageing in older people., Design: Analyses of data from the English Longitudinal Study of Ageing, an ongoing, open, prospective cohort study initiated in 2002-03., Setting: Nationally representative study from England., Participants: 8785 adults (55% women) with a mean age of 67 years (SD 9) at pet ownership assessment in 2010-11 (wave 5)., Main Outcome Measure: Established biomarkers of ageing in the domains of physical, immunological, and psychological function, as assessed in 2012-13 (wave 6)., Results: One third of study members reported pet ownership: 1619 (18%) owned a dog, 1077 (12%) a cat, and 274 (3%) another animal. After adjustment for a range of covariates, there was no evidence of a clear association of any type of pet ownership with walking speed, lung function, chair rise time, grip strength, leg raises, balance, three markers of systemic inflammation, memory, or depressive symptoms., Conclusion: In this population of older adults, the companionship of creatures great and small seems to essentially confer no relation with standard ageing phenotypes., Competing Interests: Ethical approval: Data collection for this study was approved by the London Multicentre Research Ethics Committee., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Objective Policy in many industrialized countries increasingly emphasizes extended working life. We examined associations between physical and cognitive capability in mid-adulthood and work in late adulthood. Methods Using self-reported physical limitations and performance-based physical and cognitive capability at age 53, assessed by trained nurses from the Medical Research Council (MRC) National Survey of Health and Development, we examined prospective associations with extended working (captured by age at and reason for retirement from main occupation, bridge employment in paid work after retirement from the main occupation, and voluntary work participation) up to age 68 among >2000 men and women. Results Number of reported physical limitations at age 53 was associated with higher likelihood of retiring for negative reasons and lower likelihood of participating in bridge employment, adjusted for occupational class, education, partner's employment, work disability at age 53, and gender. Better performance on physical and cognitive tests was associated with greater likelihood of participating in bridge or voluntary work. Cognitive capability in the top 10% compared with the middle 80% of the distribution was associated with an odds ratio of bridge employment of 1.71 [95% confidence interval (95% CI) 1.21-2.42]. Conclusions The possibility for an extending working life is less likely to be realized by those with poorer midlife physical or cognitive capability, independently of education, and social class. Interventions to promote capability, starting in mid-adulthood or earlier, could have long-term consequences for extending working.

Background: The relationship between the duration of depressive symptoms and mortality remains poorly understood., Aims: To examine whether the duration of depressive symptoms is associated with mortality risk., Method: Data (n= 9560) came from the English Longitudinal Study of Ageing (ELSA). We assessed depressive symptom duration as the sum of examinations with an eight-item Center for Epidemiologic Studies Depression Scale score of ⩾3; we ascertained mortality from linking our data to a national register., Results: Relative to those participants who never reported symptoms, the age- and gender-adjusted hazard ratios for elevated depressive symptoms over 1, 2, 3 and 4 examinations were 1.41 (95% CI 1.15-1.74), 1.80 (95% CI 1.44-2.26), 1.97 (95% CI 1.57-2.47) and 2.48 (95% CI 1.90-3.23), respectively (Pfor trend <0.001). This graded association can be explained largely by differences in physical activity, cognitive function, functional impairments and physical illness., Conclusions: In this cohort of older adults, the duration of depressive symptoms was associated with mortality in a dose-response manner., (© The Royal College of Psychiatrists 2016.)

Population ageing in Western countries has made delayed retirement and extended working life a policy priority in recent years. Retirement timing has been linked to individual factors such as health and wealth, but less is known about the role of the psychosocial work environment. This paper drew upon longitudinal data on 3462 workers aged 50-69 from five waves of the English Longitudinal Study of Ageing (ELSA). Regression models were used to assess the association of working conditions with preferred timing of retirement and actual work exit. Adjusting for a range of covariates, job demands (aspects of the job requiring sustained physical or psychological effort) were associated with preferences for earlier retirement (by 0.18 years; 95 % C.I. 0.06, 0.31). Decision authority was associated with preferences for later retirement (by 0.38 years; 95 % C.I. 0.23, 0.53) and reduced odds of work exit (OR = 0.93; 95 % C.I. 0.88, 0.97). Low recognition at work was associated with increased odds of work exit (OR = 1.23; 95 % C.I. 1.10, 1.43). There was little evidence of any interactive relationship between demands and resources. Efforts to extend working life should address issues relating to the immediate psychosocial work environment. Providing older workers with increased sense of control, and ensuring contributions are adequately recognised, may delay retirement intentions and the timing of labour market exit.

Objective: To compare blood pressure and the prevalence of hypertension in white Dutch and Dutch of Suriname-hindustani and Suriname-creole ethnic derivation with corresponding ethnic minority groups in England and to assess the quality of hypertension treatment in these groups., Design: Retrospective; comparison of cross-sectional studies., Method: Secondary analyses were performed on data from 3 population-based studies with 13,999 participants in total of European, African of South-Asian origin from England and the Netherlands., Results: English South-Asian men and women had lower blood pressure and lower prevalence of hypertension than people of South-Asian origin in the Netherlands (Suriname-hindustani), except for systolic blood pressure in men of Indian extraction in England. There was no difference in systolic blood pressure between groups of African origin in the Netherlands and England. Diastolic blood pressure levels, however, were lower in English men and women of African origin than in people of African origin in the Netherlands (Suriname-creole). White Dutch had higher systolic blood pressure levels, but lower diastolic blood pressure levels than white English men and women. There was no difference in the prevalence of hypertension between the white groups. In persons being treated for hypertension, a substantially lower percentage of the Suriname-hindustani and Suriname-creole persons in the Netherlands had well controlled blood pressure (lower than 140/90 mmHg) than their English equivalents, with the exception of English of Indian extraction., Conclusion: There were marked differences in blood pressure and prevalence of hypertension between comparable ethnic groups in England and the Netherlands. The relatively poor blood pressure control in Dutch ethnic minority groups partly explained the relatively high blood pressure levels in these groups.