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BackgroundPartnership break-up and living alone is associated with several negative health-related outcomes. Little is known about the association with physical functional ability in a life course perspective. The aim of this study is to investigate (1) the association between number of partnership break-ups and years living alone across 26 years of adult life respectively and objectively measured physical capability in midlife, (2) how the joint exposure of accumulated break-ups or years living alone respectively, and education relates to physical capability in midlife and (3) potential gender differences.MethodsLongitudinal study of 5001 Danes aged 48–62. Accumulated number of partnership break-ups and years living alone were retrieved from national registers. Handgrip strength (HGS) and number of chair rises (CR) were recorded as outcomes in multivariate linear regression analyses adjusted for sociodemographic factors, early major life events and personality.ResultsIncreasing number of years living alone was associated with poorer HGS and fewer CR. Concomitant exposure to short educational level and break-ups or long duration of time living alone respectively was associated with poorer physical capability compared with the groups with long educational level and no break-ups or few years lived alone.ConclusionAccumulated number of years living alone but not break-ups was associated with poorer physical functional ability. Joint exposure to a high number of years lived alone or break-ups respectively and having a short education was associated with the lowest levels of functional ability, which points towards an important target group for interventions. No gender differences were suggested.

Purpose We investigated schoolteachers' emotional reactions to COVID-19 and mental health during three phases of the COVID-19 pandemic. We further analyzed if teachers, who belonged to a COVID-19 risk group, had more emotional reactions and poorer mental health than "non-risk" groups. Methods We collected questionnaire data in May, June, and November-December 2020 and used data from 2665 teachers at public schools (871 individuals participated in all three surveys). Participants reported their fear of infection, fear of transmission of infection to their home or pupils, perceived burnout and stress, and worries about their ability to manage the working conditions. We included information about COVID-19 risk group status, gender, age, organization of teaching (physical presence or remote teaching), and the pupils' grade. We estimated prevalence ratios and took repeated measures into account. Results Emotional reactions and poor mental health increased significantly with 27-84% from May to November-December 2020. Teachers, who were particularly vulnerable to the adverse consequences of COVID-19, had the highest prevalence of fear of infection and poor mental health. Conclusion Teachers play a crucial role in a society's response to a pandemic. Yet, the dual role of teaching and virus control along with concerns regarding the health consequences of an infection may contribute to the observed increase in emotional reactions to COVID-19 and poor mental health.

To investigate the association between workplace COVID-19 (coronavirus disease 2019) risk management and eldercare workers' perception of their social environment at work.Cross-sectional questionnaire data from 952 participants were collected by the Danish labor union, FOA, and analyzed using multinomial logistic regression.Unclear guidelines, insecurity regarding organization of work, lack of attention to vulnerable employees, and lack of instruction in the use of personal protective equipment were associated with perceived negative changes in the social environment at work. Also, higher local incidence rates of SARS-CoV-2 infections were associated with a weaker sense of community (odds ratio, 1.18; 95% confidence interval, 1.04-1.36).These findings indicate that risk management is important not only for prevention of infection but also for individual and workplace resilience toward external demands and health threats.

Allostatic load is a model that is used to quantify the physiological damage from exposure to stressors. Stressful life events are chronic stressors that can lead to an elevated allostatic load through the physiological and behavioral stress responses. However, there is limited empirical studies that has tested the proposed behavioural pathway. Our study addresses this gap by examining the mediating role of combined modifiable lifestyle behaviors in the 12-years longitudinal association between stressful life events and allostatic load among participants from the Australian Diabetes, Obesity and Lifestyle (AusDiab) Study cohort. A latent profile analysis was performed to identify latent subgroups with distinct behavioral clusters based on five modifiable lifestyle behaviors (smoking, sedentary behavior, physical activity, alcohol consumption, and diet quality). We then used a sequential mediation model design with path analysis to test the mediating effect of these latent subgroups in the associations between stressful life events and three measures of allostatic load. Indirect effects were estimated using the product of coefficient approach and the statistical significance was determined by the 95% bias-corrected bootstrap confidence intervals with 1000 replications. We identified three latent subgroups: "least healthy lifestyle" (12%; n = 396), "moderately healthy lifestyle" (78.7%; n = 2599), and "most healthy lifestyle" (9.2%; n = 306). Exposure to stressful life events was not associated with the allocation of participants in latent subgroups. Compared to the "moderately healthy lifestyle" subgroups, we found that the "least healthy lifestyle" behavioral cluster was not associated with allostatic load. However, there was a significant inverse association between the "most healthy lifestyle" behavioral cluster and allostatic load. Overall, we did not find significant indirect effects between stressful life events and three measures of allostatic load via the "least healthy lifestyle" and the "most healthy lifestyle" groups. In summary, the combinations of modifiable lifestyle behaviors did not explain the association between stressful life events and allostatic load. More longitudinal studies are needed to replicate our study to confirm this finding.

OBJECTIVES: We explored teachers' emotional reactions to the COVID-19 pandemic, and the association between COVID-19 risk management and these emotional reactions. METHODS: We used cross-sectional data from 2665 teachers working at public schools. Participants responded to a questionnaire in May 2020. The analyses were adjusted for sex, age, cohabitation, and region. RESULTS: Knowledge about adequate test behavior and feeling secure regarding colleagues' actions to hinder spread of virus were associated with less frequent emotional reactions. Lack of access to personal protective equipment and exposure to infected pupils, parents or colleagues were associated with more frequent emotional reactions. CONCLUSION: Similar to other groups of frontline employees, teachers experience negative emotional reactions to the COVID-19 pandemic. Gaining knowledge about teachers' worries and fears during pandemics is an important first step enabling leaders and occupational health professionals to address these.

ObjectivesWe compared COVID-19 risk management, fear of infection and fear of transmission of infection among frontline employees working within eldercare, hospital/rehabilitation, psychiatry, childcare and ambulance service and explored if group differences in fear of infection and transmission could be explained by differences in risk management. We also investigated the association of risk management with fear of infection and fear of transmission of infection among eldercare personnel.MethodsWe used cross-sectional questionnaire data collected by the Danish labour union, FOA . Data were collected 5½ weeks after the first case of COVID-19 was registered in Denmark. Data for the first aim included 2623 participants. Data for the second aim included 1680 participants. All independent variables were mutually adjusted and also adjusted for sex, age, job title and region.ResultsFear of infection (49%) and fear of transmitting infection from work to the private sphere (68%) was most frequent in ambulance service. Fear of transmitting infection during work was most frequent in the eldercare (55%). Not all differences in fear of infection and transmission between the five areas of work were explained by differences in risk management. Among eldercare personnel, self-reported exposure to infection and lack of access to test was most consistently associated with fear of infection and fear of transmission, whereas lack of access to personal protective equipment was solely associated with fear of transmission.ConclusionWe have illustrated differences and similarities in COVID-19 risk management within five areas of work and provide new insights into factors associated with eldercare workers’ fear of infection and fear of transmission of infection.

Background Schoolteachers play a major role in the society's response to the COVID-19 pandemic. When schools are open teachers are responsible for hindering spread of SARS-CoV-2, while carrying out their core task of teaching. This double role as well as the risk of infection may affect mental health in this occupational group. Therefore, we investigated schoolteachers' emotional reactions to COVID-19 and mental health during three phases of the COVID-19 pandemic in Denmark. We further analyzed if teachers, who belonged to a COVID-19 risk group, had more emotional reactions and poorer mental health than “non-risk” groups. Methods We collected questionnaire data in May, June, and November-December 2020 and used data from 2665 teachers employed at public schools (871 individuals participated in all three surveys). Participants reported their fear of infection, fear of transmission of infection to their home or pupils, perceived burnout and stress, and worries about their ability to manage the working conditions. We also had information about COVID-19 risk group status, sex, age, organization of teaching (physical presence or remote teaching), and the pupils' grade. We estimated prevalence ratios and took repeated measures into account. Results Fear of infection and transmission of infection as well as burnout, stress, and worries increased statistically significantly with 27-84% from May to November-December 2020 (p < 0.05). We also found that teachers, who were particularly vulnerable to the adverse consequences of COVID-19, had the highest prevalence of fear of infection and poor mental health. Conclusions The dual role of teaching and virus control along with concerns regarding the health consequences of an infection may contribute to the observed increase in emotional reactions to COVID-19 and poor mental health from the beginning of the pandemic to the beginning of the second wave. Key messages The results raise attention to the working conditions, exposure to infection and mental health of teachers being in the frontline when schools were open during the COVID-19 pandemic. School teachers play a major role in pandemic control along with teaching obligations, which warrants allocation of resources, clear guidelines, and possibilities for protection from infection.

BACKGROUND: The concept of social foreground describes how adult offspring's socioeconomic resources may influence older adults' health and several studies have shown an association between socioeconomic position of adult offspring and the health of their older parents. However, little is known about the factors that generate these associations. We study 1) how adult offspring's social class is associated with physical function (PF) among older adults, 2) whether geographical closeness and contact frequency with offspring modify the association, and 3) whether intergenerational social mobility of offspring is associated with PF of older adults.METHOD: Data are obtained from the 2002 (n = 621) and 2011 (n = 931) waves of the Swedish Panel Study of Living Conditions of the Oldest Old. Multivariable linear regression models were employed and adjusted for own and partner's prior social class and offspring's age and gender.RESULTS: Compared to offspring with non-manual occupation, offsprings with manual occupation was associated with poorer PF in older adults (-0.14, CI95%:-0.28;0.00). In stratified analyses, offspring's social class was only associated with older adults' PF among those who lived geographically close. Contact frequency between the offspring and the older adults did not modify the associations. Older adults whose offspring experienced downward intergenerational social mobility were associated with the poorest PF.CONCLUSION: This study supports evidence of a relationship between social foreground and older adults' PF where geographical closeness and social mobility are important components.

The association between social relations and health outcomes is well described, but pathways are relatively poorly understood. Inflammation has been suggested as a potential physiological pathway, linking social relations to adverse health outcomes. However, previous studies have shown ambiguous results and have for the vast majority been based on studies small in sample size. The aim of the present study is to examine the association between comprehensive measures of structural and positive as well as negative functional aspects of social relations, across four relational domains—partner/spouse, children, other family and friends, and the level of systemic low-grade inflammation in a large population-based middle-aged cohort and to examine variation by gender and socioeconomic position in these associations. The study comprised of 5576 participants in the Copenhagen Aging and Midlife Biobank. The inflammatory biomarkers collected in late midlife included C-reactive protein, Interleukin-6, and TNF-alpha. Multiple linear regression models were implemented to explore associations between social relations and inflammatory measures controlling for gender, age, socioeconomic position, marital status, early major lifeevents and morbidity. Results show weak and ambiguous associations in all analyses. There were no strong indications of interaction with socioeconomic position. Concluding cautiously, men appear to be more vulnerable toward living alone and low contact frequency with family compared to women as regards high level of low-grade inflammation. In conclusion, this large-scale population-based study among middle-aged men and women showed no association between social relations and low-grade inflammation. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s10433-020-00561-y) contains supplementary material, which is available to authorized users.

Purpose: First, to investigate associations between mobility limitations and use of general practitioners and hospitalizations of acute care sensitive conditions, respectively. Second, to investigate whether these associations vary by socio-demographic factors. Methods: The study included 3574 females and males aged 75 or 80 years from the Danish Intervention Study on Preventive Home Visits. Fixed-effects logistic and poisson regression models were applied to study the relationship between mobility limitations (measured two-four times) and general practitioner consultations and hospitalizations with acute care sensitive conditions each subsequent year, respectively. Results: Each additional mobility limitation was associated with 15% higher odds of general practitioner home consultation (Odds ratio 1.15, 95% CI 1.07;1.23) and 4% increased incidence rate of general practitioner consultations among those with ≥ 1 consultation (Incidence rate ratio 1.04, 95% CI 1.03;1.04). There were no associations between mobility limitations and whether older adults had at least one general practitioner consultation nor acute care sensitive condition hospitalization. Test of interactions (p < 0.03) showed that more mobility limitations were associated with greater incidence rate of general practitioner consultations among males compared to females, married compared to unmarried, and older adults with high compared to low financial assets. Conclusions: Older adults with more mobility limitations had more often a general practitioner home consultation. Mobility limitations were not associated with whether older adults had at least one general practitioner consultation, but increased mobility limitations were associated with higher contact rate among those who had ≥ 1 consultation, especially among males and older adults who were married or had high financial assets.

With the ageing of the population and recent pressures on important welfare state arrangements, updated knowledge on the linkage between socioeconomic status and health in old age is pertinent for shedding light on emerging patterns of health inequalities in the Nordic countries. This study examined self-rated health (SRH), mobility and activities of daily living (ADL) according to level of education in the three oldest old age groups 75–84, 85–94, and 95+, in four Nordic countries. Altogether, 6132 individuals from Danish Longitudinal Study of Ageing, Norwegian Life Course, Ageing and Generation study, Swedish Panel Study of Living Conditions of the Oldest Old, the 5-Country Oldest Old (Sweden) and Vitality 90 + Study were analysed. First, associations of education level with SRH, mobility, and ADL were estimated for each individual study by means of age- and gender-adjusted logistic regression. Second, results from individual studies were synthesized in a meta-analysis. Older adults with higher education level were more likely to report good SRH, and they were more often independent in mobility and ADL than those with basic education when all age groups were combined. In mobility and ADL, differences between education groups remained stable across the age groups but for SRH, differences seemed to be weaker in older ages. With only a few exceptions, in all age groups, individuals with higher education had more favourable health and functioning than those with basic education. This study shows remarkable persistence of health and functioning inequalities in the Nordic countries throughout later life. © The Author(s) 2019 Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/)

ObjectivesFrailty is a major clinical geriatric syndrome associated with serious adverse events including functional disability, falls, hospitalisation, increased morbidity and mortality. The aim of this study was to study associations between a frailty phenotype and frailty characteristics well known from the literature.DesignRegistry-based cross-sectional study.SettingThe target population consists of inhabitants above the age of 50 living in the Danish municipalities of Lolland and Guldborgsund. Excluded are incapacitated people, inhabitants unable to understand Danish or English and inhabitants without a permanent residence.Participants7327 individuals aged 50+ years were included.Outcome measuresWe examined associations between the frailty measurement and factors known to be associated with frailty: sex, age, income insufficiency, education, comorbidity, self-assessed health, morbidity and mortality.Results7327 individuals aged 50+ years were included. Of these, 6.5% had ≥3 frailty components (frail), 46.7% had 1–2 components (prefrail) and 46.9% had none (non-frail). Those who were frail were older and more likely female than those who were non-frail or prefrail. There was a stepwise decrease in educational level, and in self-assessed health with increasing frailty status, and a stepwise increase in difficulty in making ends meet, number of hospital contacts and mortality with increasing frailty status, pConclusionsBased on these findings, we consider the Lolland-Falster Health Study frailty assessment a valid instrument demonstrating the same characteristics as other validated frailty measures concerning associations with sex, age, income insufficiency, education, comorbidity, self-assessed health, morbidity and mortality.Trial registration numberNCT02482896.

Objective: How are trajectories of mobility limitations (MLs) among older adults associated with mortality? Do social factors modify these associations? Method: Group-based trajectory modeling was used to identify four trajectories of MLs over a period of 4.5 years among 3,055 older Danes. Mortality analyses were conducted using additive hazard regression models. Results: Compared to older adults without MLs, older adults with high level of MLs who experienced further increase in MLs were associated with the most additional deaths followed by older adults with no MLs at baseline who later experienced limitations and older adults with a medium ML level at baseline who later experienced further increase in limitations. Men and 80-year olds experienced more additional deaths following adverse ML trajectories than women and 75-year olds. Discussion: Trajectories that led to higher ML levels were associated with most additional deaths especially among men and in the oldest age group.

Aims: Cross-country comparisons of mortality and longevity patterns of Nordic populations could contribute with novel insights into the compositional changes of these populations. We investigated three metrics of population ageing: the proportion of the population aged 75+ and 90+ years, the proportion of birth cohorts reaching 75 and 90 years, and life expectancy (LE) at age 75 and 90 years in Sweden, Norway, Iceland, Denmark and Finland, in the period 1990–2014. Methods: Demographic information was collected from national statistical databases and the Human Mortality Database. Results: All metrics on population ageing increased during the study period, but there were some cross-country variations. Finland experienced a notably steep increase in the proportion of 75+ and 90+ year olds compared to the other countries. Regarding the proportion reaching old ages, the Finnish lagged behind from the beginning, but females decreased this difference. The Danes were more similar to the other countries at the beginning, but did not experience the same increase over time. Gender-specific LE at age 75 and 90 years was similar overall in the five countries. Conclusions: Developments in cross-country variation suggest that survival until old age has become more similar for Finnish females and more different for Danish males and females compared with the other countries in recent decades. This provides perspectives on the potential to improve longevity in Denmark and Finland. Similarities in LE in old age suggest that expected mortality in old age has been more similar throughout the study period.

It is well established that socioeconomic position (SEP) and social relations impact physical function and mortality in old age. Due to differential vulnerability, few social relations may lead to greater decline in physical function and mortality among older people with low compared to high SEP. The aim was to investigate whether older people with few social relations experience greater decline in physical function and mortality when also subject to low financial assets? The study population included 4060 older people aged 75 or 80 years at baseline in 1998–1999. Social relations at baseline and physical function at baseline and after 1.5, 3.0 and 4.5 years were obtained from questionnaires. Financial assets at baseline and mortality during 10 years of follow-up were obtained from registers. Analyses of the associations between financial assets combined with social relations and decline in physical function and mortality, respectively, were conducted. Among males, but not females, low financial assets and few social relations were associated with the greatest decline in physical function. Yet, interaction only reached significance between financial assets and visits. Among males and females, low financial assets and few social relations were associated with the highest mortality. Interactions only reached significance between financial assets and visits for females and social activity for males. In conclusion, few social relations implied greater decline in physical function among older males and higher mortality among older males and females with low financial assets; however, the study only supports the presence of differential vulnerability for visits and social activity. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s10433-017-0437-0) contains supplementary material, which is available to authorized users.

Socioeconomic health inequality is a global phenomenon and the Nordic countries, known for their generous welfare systems, are no exceptions. However, less is known about the health inequalities in very old age. This study examines self-rated health (SRH), mobility and activities of daily living (ADL) according to level of education in three oldest old age groups 75–84, 85–94, and 95+, in four Nordic countries. Altogether, 6,204 individuals from the Danish Longitudinal Study of Ageing, the Vitality 90+ Study, the Norwegian study on life course, ageing and generation, the Swedish Panel Study of Living Conditions of the Oldest Old, and the Swedish part of the 5-Country Oldest Old Project, were included in the study. First, by means of age and gender adjusted logistic regression, we estimated the associations between low and high education and SRH, mobility, and ADL for each individual study. Second, results from five studies were synthesized in meta-analysis. We found that individuals with higher education were more likely to report good SRH, and they were more often independent in mobility and ADL than people with a basic education. Effects were significant for all age groups, except for SRH, where the effect of education was only statistically significant for the age group 75–84. The study shows the endurance of health inequalities to the last years of life. The Nordic societies, which attempts to support longevity, are not able to change the pattern in health inequalities well acknowledged among younger people.

Little is known about the association between negative aspects of close social relations and development of ischaemic heart disease (IHD). We aim to address if the experience of worries/demands and conflicts with close social relations are related to risk of first-time hospitalization with IHD and whether emotional support can buffer this effect.A total of 8550 randomly selected men and women aged 36-52 years free of earlier IHD hospitalization at baseline in 2000 were followed prospectively for first-time hospitalization with IHD (ICD10: I21-25) through 2010 in the Danish National Patient Registry. Cox regression analysis was used to analyse data and all analyses were adjusted for age, gender, social class, cohabitation, and depressive symptoms.Worries/demands from and conflicts with children were associated with IHD hospitalization in an exposure-dependent manner (p-trends 0.0001 and 0.03) with twice the risk among those most highly exposed, HRworries/demands = 2.05 (95% CI 0.91-4.54) and HRconflicts=1.90 (95% CI 1.00-3.61). 'Always' experiencing worries/demands from partner was also associated with a nearly twice the risk of IHD, whereas no association was found for conflicts with partner. High levels of worries/demands from or conflicts with family and friends were associated with a 40% higher risk of IHD.Negative aspects of close social relations are associated with higher risk of incident IHD hospitalization except for conflicts with partner. We found no clear evidence of a buffering effect of emotional support.

Introduction It is important to help older adults maintain a good physical function in old age in order to ensure quality of life, independent living and longevity. To tailor future preventive interventions and rehabilitation, it is necessary to identify how different trajectories of physical function are associated with mortality and whether certain groups of older adults are more vulnerable to negative consequences of adverse trajectories of physical function in old age. The aims of this study are to investigate how trajectories of physical function among older adults are associated with mortality and whether socio-demographic factors and social relations modify the associations. Methods Questionnaire data linked with register data on 2906 older Danish adults aged 75 and 80 years at baseline were included. Physical function was measured by the validated Mobility-help scale (0–6) four times over a 4.5-year period. Trajectories of physical function were based on the baseline measure of physical function and slopes of linear regression lines between the four measures of physical function over time. Four trajectories of physical function were identified by: (1) stable full physical function, (2) full physical function followed by a decrease, (3) stable low physical function and (4) low physical function followed by a decrease. Multivariable additive hazard regression models were used to estimate the association between the four trajectories of physical function and the following 5-year mortality. Results Compared to older adults with a stable full physical function, older adults with a low physical function followed by a decrease were associated with the highest number of additional deaths per 1000-person-years (py) (118.02, 95% CI: 67.40; 168.64). Hereafter older adults who had full physical function followed by a decrease (82.49, 95% CI: 65.22; 99.76) and finally older adults who had a stable low physical function (70.20, 95% CI: 35.33; 105.06). Wald test for global interaction showed significant interactions (P-value Conclusions Trajectories of physical function that included decline were associated with the greatest mortality. The magnitudes of the associations between adverse trajectories of physical function and mortality were greater for men than women and those aged 80 years than those aged 75 years at baseline.

Purpose to investigate if the increased risk of disability onset among older people who live alone could possibly be moderated by either high social participation or by being satisfied with the social relations. Design and methods logistic regression models were tested using two waves in a study population of 2,697 non-disabled older men and women from The Danish Longitudinal Study on Preventive Home Visits. Results living alone and low social participation were significant risk factors for later male disability onset. Not being satisfied with the social relations was significantly associated with onset of disability for both genders. Among men who lived alone low social participation was a significant predictor of disability onset [odds ratio, OR = 2.30 (1.00-5.29)]; for cohabiting men social participation was not associated with disability onset, [adjusted OR = 0.91 (0.49-1.71)]. Similar results were present concerning satisfaction with the social relations among men. There was no significant interaction for women. Conclusions the study suggests that men who live alone can possibly alleviate their risk of disability onset by being socially active and by having access to satisfactory social relations. Women do not seem to benefit as much from cohabitation as men, although women who live alone and who are not satisfied with their social relations also constitute a significant risk category.

Objectives: To investigate the effect of cohabitation status in older men and women on (a) onset of disability at 3- and 4.5-year follow-up and (b) changes in functional ability between 3- and 4.5-year follow-up, and to analyze whether this effect was mediated by social participation. Method: A total of 2,533 nondisabled older men and women enrolled in the Danish Intervention Study on Preventive Home Visits constituted the study population. Data were collected by mailed questionnaires in 1998-1999, 2000, 2001-2002, and 2003. Results: Living alone significantly increased the risk of onset of disability (T3 OR = 1.60[1.06-2.43], T4 OR = 1.74[1.22-2.47]) and the risk of sustained poor functional ability (OR = 2.35[1.44-3.84]) among men, but not among single-living women. Social participation mediated only a small part of the effect of cohabitation status on functional ability. Discussion: Our results underline the importance of cohabitation/marriage for maintaining a high functional ability among older men.

The Northern European countries are known for their similarities, but also differences in longevity. However, demographic differences between the oldest old are less explored. We investigated demographic changes and difference between the oldest old in five Northern European countries from 1990–2014. Demographic information was collected from national statistical databases and the Human Mortality Database. The gender-ratios for 85+ and 90+ year old decreased from 1990–2014 in most of the countries. The proportion of 85+ and 90+ year old, life expectancy at age 85- and 90-years, and the proportion reaching 85- and 90-years increased from 1990–2014 for both genders in all the countries. Yet, there were great differences in the pace of these increases and there were still great differences between the countries in 2014. In conclusion, demographic markers of the oldest old have become more similar in the Nordic European countries, however there still remains remarkable difference between the countries.

Having a larger social network has beneficial effects on health and survival in adults, but few studies have evaluated the role of network diversity, in addition to network size. We aim to determine whether social network diversity is associated with mortality, physical function, and disability in a population of older black and white adults. We used data from the Chicago Health and Aging Project, a longitudinal, population-based study of adults aged 65 years and older. We estimated hazard ratios (HRs) of mortality using Cox proportional hazards models (N=6,595), mean difference (b) in physical function using generalized estimating equations (N=4,304), odds ratios (ORs) of disability onset using logistic regression (N=5,318), and relative risk (RR) of disability progression using Poisson regression (N=5,318), associated with network diversity. Models were adjusted for age, gender, race, education, marital status, and health-related variables. In adjusted models, elderly with more diverse social networks had a lower risk of mortality (HR=0.76; 95% CI = 0.62–0.92) and higher physical function at baseline (b=0.85; p

Objectives To examine individual as well as joint associations of physical workload and leisure time physical activity with incident mobility limitations in initially well-functioning middle-aged workers. Methods This study is based on 6-year follow-up data of the Danish Longitudinal Study on Work, Unemployment and Health. Physical workload was reported at baseline and categorised as light, moderate or heavy. Baseline leisure time physical activity level was categorised as sedentary or active following the current recommendations on physical activity. Incidence of mobility limitations in climbing stairs and running among initially well-functioning workers (n=3202 and n=2821, respectively) was assessed during follow-up. Results Higher workload increased whereas active leisure time decreased the risk of developing mobility limitations. The incidence of limitations increased progressively with higher workload regardless of level of leisure time physical activity, although the risks tended to be higher among those with sedentary leisure time compared with their active counterparts. All in all, the risk for onset of mobility limitations was highest among those with heavy workload combined with sedentary leisure time and lowest among those with light workload combined with active leisure time. Conclusions Although leisure time physical activity prevents development of mobility decline, high workload seems to accelerate the progression of mobility limitations among both those with active and sedentary leisure time. Therefore, efforts should be made to recommend people to engage in physical activity regardless of their physical workload.

Few studies have examined the relationship between stressful social relations in private life and all-cause mortality.To evaluate the association between stressful social relations (with partner, children, other family, friends and neighbours, respectively) and all-cause mortality in a large population-based study of middle-aged men and women. Further, to investigate the possible modification of this association by labour force participation and gender.We used baseline data (2000) from The Danish Longitudinal Study on Work, Unemployment and Health, including 9875 men and women aged 36-52 years, linked to the Danish Cause of Death Registry for information on all-cause mortality until 31 December 2011. Associations between stressful social relations with partner, children, other family, friends and neighbours, respectively, and all-cause mortality were examined using Cox proportional hazards models adjusted for age, gender, cohabitation status, occupational social class, hospitalisation with chronic disorder 1980-baseline, depressive symptoms and perceived emotional support. Modification by gender and labour force participation was investigated by an additive hazards model.Frequent worries/demands from partner or children were associated with 50-100% increased mortality risk. Frequent conflicts with any type of social relation were associated with 2-3 times increased mortality risk. Interaction between labour force participation and worries/demands (462 additional cases per 100,000 person-years, p=0.05) and conflicts with partner (830 additional cases per 100,000 person-years, p0.01) was suggested. Being male and experiencing frequent worries/demands from partner produced 135 extra cases per 100,000 person-years, p=0.05 due to interaction.Stressful social relations are associated with increased mortality risk among middle-aged men and women for a variety of different social roles. Those outside the labour force and men seem especially vulnerable to exposure.

Objective: The objective of the present study is to analyze gender differences and social class gradients in physical functions; and to study whether the social class gradients in physical functions in midlife differed between men and women. Method: This study used traditionally used physical performance tests and we added several tests of vigorous physical functioning (trunk muscle strength and power and sagittal flexibility). We measured reaction time, one-legged balance, sagittal flexibility, jump height, chair rise ability, trunk muscle- and handgrip strength in 5,412 participants aged 50 to 60 years (68.5% men). Results: We found gender differences and social class gradients for all physical performance tests. We did not find an interaction between social class and gender, indicating that the social gradient in physical functions did not differ between men and women. Discussion: Including measures of vigorous physical functioning may add to the existing knowledge on development of functional limitation and poorer functional health later in life.

Objective: To present the Danish Occupational Social Class (DOSC) measurement as a measure of socioeconomic position (SEP) applicable in a late midlife population, and to analyze associations of this measure with three aging-related outcomes in midlife, adjusting for education. Method: Systematic coding procedures of the DOSC measurement were applied to 7,084 participants from the Copenhagen Aging and Midlife Biobank (CAMB) survey. We examined the association of this measure of SEP with chronic conditions, self-rated health, and mobility in logistic regression analyses, adjusting for school education in the final analysis. Results: The measure of SEP showed a strong social gradient along the social classes in terms of prevalence of chronic conditions, poor self-rated health, and mobility limitations. Adjusting for school education attenuated the association only to a minor degree. Discussion: The DOSC measure was associated with aging-related outcomes in a midlife Danish population, and is, thus, well suited for future epidemiological research on social inequalities in health and aging.

Mobility-related fatigue and low socioeconomic position predicts mobility limitations and disability in old age, but the interplay between these two factors is unknown. To evaluate whether mobility-related fatigue is a stronger risk factor for mobility limitations in certain socioeconomic groups, the aim of this study was to examine the combined effect of mobility-related fatigue and socioeconomic position on mobility limitations in a prospective study among older Danish men and women.Multivariate linear regression models with combined exposure variables using generalised estimating equations were performed using four waves of data on 2874 individuals without mobility limitations at baseline from The Danish Intervention Study on Preventive Home Visits.Low socioeconomic position and mobility-related fatigue are risk factors for mobility limitations in old age. The combined exposure to both factors additionally increased the risk, but there was no synergy effect between the two. Notably, fatigue predicted mobility decline at 3-year follow-up among those aged 80 years at baseline with a mean difference in number of mobility limitations from the joint reference category (high socioeconomic position and no fatigue) of -0.52, p0.0001 among those in high socioeconomic position and -0.96, p0.0001 among those in low socioeconomic position.Mobility-related fatigue is not a significantly stronger risk factor for subsequent mobility limitations among those with concomitant exposure to low socioeconomic position, compared with those with high socioeconomic position. Preventive strategies must focus on vulnerable groups of older people with low socioeconomic position as well as on individuals with fatigue.

Background Preventive home visits are offered to community dwelling older people in Denmark aimed at maintaining their functional ability for as long as possible, but only two thirds of older people accept the offer from the municipalities. The purpose of this study is to investigate 1) whether socioeconomic status was associated with acceptance of preventive home visits among older people and 2) whether municipality invitational procedures for the preventive home visits modified the association. Methods The study population included 1,023 community dwelling 80-year-old individuals from the Danish intervention study on preventive home visits. Information on preventive home visit acceptance rates was obtained from questionnaires. Socioeconomic status was measured by financial assets obtained from national registry data, and invitational procedures were identified through the municipalities. Logistic regression analyses were used, adjusted by gender. Results Older persons with high financial assets accepted preventive home visits more frequently than persons with low assets (adjusted OR = 1.5 (CI95%: 1.1-2.0)). However, the association was attenuated when adjusted by the invitational procedures. The odds ratio for accepting preventive home visits was larger among persons with low financial assets invited by a letter with a proposed date than among persons with high financial assets invited by other procedures, though these estimates had wide confidence intervals. Conclusion High socioeconomic status was associated with a higher acceptance rate of preventive home visits, but the association was attenuated by invitational procedures. The results indicate that the social inequality in acceptance of publicly offered preventive services might decrease if municipalities adopt more proactive invitational procedures.

The aim of this longitudinal study was to investigate if social inequality in onset of mobility limitations is present in early midlife, and to examine whether common determinants of disability account for social status differences in onset of mobility limitations in midlife. 3,586 40-and 50-year-old Danish men and women enrolled in The Danish Longitudinal Study on Work, Unemployment and Health constituted the study population. Data were collected by mailed questionnaires in 2000 and 2006. Limitations in running 100 m and in climbing two flights of stairs represented two aspects of mobility limitations. Occupational social class was applied as a measure of socioeconomic position. Among individuals reporting no limitations in 2000 social gradients in onset of mobility limitations emerged in 2006. Having a low social class at age 40 and 50 respectively was associated with higher onset of mobility limitations 6 years later, and this association was overall only partly explained by common determinants of disability: smoking, alcohol consumption, physical activity, body mass index, and chronic diseases. These results indicate that the development of mobility limitations might begin earlier in lower compared to higher social strata, and that social status differences in mobility limitations might emerge already in the forties.

Purpose to examine the combined effect of cohabitation status and social participation, respectively, and socioeconomic position on onset of mobility limitations in a prospective study among older Danes. Design and methods logistic regression analyses with combined exposure variables were performed in a study population of 2,839 older men and women from the Danish Intervention Study on Preventive Home Visits. Results among men low financial assets, living alone or having low social participation significantly increased the odds ratios (OR) for onset of mobility limitations. Among women only low financial assets and low social participation significantly increased the ORs for onset of mobility limitations. Analyses with combined exposure variables showed that simultaneous exposure to low financial assets and poor social relations significantly increased the ORs for onset of mobility limitations among both genders, yet the tendencies appeared stronger for males. In particular, men with simultaneous exposure to low financial assets and low social participation had increased odds ratios for onset of mobility limitations, OR = 5.36 (2.51-11.47), compared with the non-exposed. Conclusion the study suggests that future interventions to increase social participation might alleviate the negative effects on mobility experienced by older people in low socioeconomic position, perhaps especially among older males.

This study investigates the association between socioeconomic status (SES) and dynamic balance performance and whether lifestyle factors explained any possible associations. A total of 448 nondisabled individuals, age-range 54–75 years and enrolled in the Active Aging Longitudinal Study of Spain in 2006, constituted the study population. Baseline data of this cross-sectional study were obtained by personal interviews and objective measures of balance performance. The present study shows an educational gradient in poor dynamic balance, where individuals with no formal education had higher risk of poor balance, also after adjustment for age, gender, obesity and physical activity. In addition, obesity and sedentary physical activity were related to poor dynamic balance. The findings suggest an independent effect of both SES and behavioral factors on poor balance performance in the older Spanish population.

Objective: This article investigates social inequality in onset of mobility disability and in measures of social relations and whether social relations mediated the effect of socioeconomic status on mobility. Method: A total of 2,825 nondisabled older men and women, enrolled in the Danish Intervention Study on Preventive Home Visits, constituted the study population. Data were obtained by mailed questionnaires in 1998-1999 and 2001-2002 and by merging analyses to registers at Statistics Denmark. Results: There was a social gradient in onset of mobility disability, with odds ratio of 1.11 (1.07-1.15) per step down the deciles of financial assets and in cohabitation status, social participation, and network diversity. Social relations did not mediate the effect of financial assets on onset of mobility disability. Discussion: The negative effects of low financial assets and poor social relations on mobility appear to be independent. More longitudinal studies on possible mediators of the social gradient in mobility among older people are needed.