European Journal of Ageing最新文献

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.

Background: Frailty is a geriatric syndrome with repercussions on health, disability, and dependency.

Objectives: To assess health resource use and costs attributable to frailty in the aged population.

Methods: A population-based observational longitudinal study was performed, with follow-up from January 2018 to December 2019. Data were obtained retrospectively from computerized primary care and hospital medical records. The study population included all inhabitants aged ≥ 65 years ascribed to 3 primary care centres in Barcelona (Spain). Frailty status was established according to the Electronic Screening Index of Frailty. Health costs considered were hospitalizations, emergency visits, outpatient visits, day hospital sessions, and primary care visits. Cost analysis was performed from a public health financing perspective.

Results: For 9315 included subjects (age 75.4 years, 56% women), frailty prevalence was 12.3%. Mean (SD) healthcare cost in the study period was €1420.19 for robust subjects, €2845.51 for pre-frail subjects, €4200.05 for frail subjects, and €5610.73 for very frail subjects. Independently of age and sex, frailty implies an additional healthcare cost of €1171 per person and year, i.e., 2.25-fold greater for frail compared to non-frail.

Conclusions: Our findings underline the economic relevance of frailty in the aged population, with healthcare spending increasing as frailty increases.

How do personal networks evolve as individuals age? To what degree do social disadvantage and contextual factors matter for network dynamics in later life? This paper answers these two questions based on egocentric network data of older adults over a ten-year period. Specifically, I use longitudinal and nationally representative data on 1,168 older adults from the National Social Life, Health, and Aging Project. I use between-within models to separate the within- and between-individual effects of sociodemographic characteristics and contextual factors on three aspects of social connectedness in later life: network size, frequency of contact, and proportion of kin. Patterns of network change vary among people of different races and ethnicities as well as educational levels. Black and Hispanic respondents have a significantly smaller network size and a higher average frequency of contact with confidants. Moreover, Hispanic respondents have a higher proportion of kin in the network, compared to White respondents. Similarly, older adults with less education have a smaller network size, higher frequency of contact and higher proportion of kin in their confidant networks compared to those who attended college. Older adults who have better mental health are more likely to have a higher frequency of contact and higher proportion of kin. When an older adult starts to work for pay, their frequency of contact with confidants tends to increase. Older adults living in neighborhoods with stronger social ties are more likely to have a larger network size, higher frequency of contact, and lower proportion of kin in their confidant network. The above results show that disadvantaged backgrounds and contextual factors are associated with certain less favorable network characteristics, which helps to explain the concentration of social disadvantage on certain populations.

Ageing has been related to the onset of disability and dependency in older adults. There is a need to better understand the disability and dependency trajectories of older adults and their relationship with socio-demographic characteristics and institutional or cultural context. This study analyses the role of age, sex, education and self-perceived health in disability, dependency and death transitions, addressing the heterogeneity across European countries and inconsistencies when using different measures of disability. Multi-state models were adjusted to evaluate the role of risk and protective factors in the transitions to disability, dependency and death. Difficulties in performing activities of daily living (ADLs) assess disability and dependency states. Data were from the Survey of Health, Ageing and Retirement in Europe conducted in 2004-2013, considering individuals aged 65 and older at baseline from Austria, Belgium, Denmark, France, Germany, Italy, the Netherlands, Spain, Sweden and Switzerland. The results showed that transitions to disability and dependency varied with age, sex, education and self-perceived health. The probability of transition to disability and dependency states increases until the age of 70 for all countries. However, there was heterogeneity in the disability and dependency trajectories with ageing between men and women. In most countries, women live with difficulties and may need help for longer than men. Care policies should consider sex differences to decrease the burden of care of informal caregivers, particularly in countries where care systems are absent or partially developed and a high level of family obligations to care needs exist.

The aim of the present study was to investigate how frailty/pre-frailty in combination with subjective memory complaints predicts all-cause mortality in community dwelling cognitively unimpaired older adults. There were 1904 community-dwelling cognitively unimpaired persons aged 65 years or older who participated in the 2013 Taiwan National Health Interview Survey with a 5-year follow-up. Frailty was determined based on the fatigue, resistance, ambulation, illness, and loss of weight (FRAIL) scale. Two questions ("Do you have difficulties with your memory or attention?" and "Do you have difficulties with your memory only or attention only or both?") were used to screen for subjective memory complaints (SMC). In this study, 11.9% of participants had both frailty/pre-frailty and SMC. A total of 239 deaths were recorded after 9009.5 person-years of follow-up. After adjustment for other factors, compared with participants who were physically robust with no SMC, participants who reported either SMC alone (HR = 0.88, 95% CI = 0.60-1.27) or were frail/pre-frail alone (HR = 1.32, 95% CI = 0.90-1.92) had no significantly increased mortality risk. However, coexisting frailty/pre-frailty and SMC was associated with a significantly increased hazard ratio for mortality of 1.48 (95% CI = [1.02-2.16]). Our results highlight the high prevalence of co-occurring frailty/pre-frailty and SMC and that this co-occurrence is associated with an increased risk of mortality among cognitively unimpaired older adults.

We examine changes in the well-being of family caregivers during the early phase of the COVID-19 pandemic in Germany, using data from the German Socio-Economic Panel (SOEP) and the SOEP-CoV study. The COVID-19 pandemic posed an extraordinary challenge for family caregivers, as care recipients are a high-risk group requiring special protection, and professional care services were severely cut back. The specific situation of the COVID-19 pandemic allows us to re-examine the caregiver stress process model. Using first difference regression models, we analyse changes in general life satisfaction and depressive symptoms (PHQ-4 score) among family caregivers between 2019 and spring 2020, differentiating by care intensity and duration of the care episode. Caregivers show similar changes in well-being as non-caregivers: a simultaneous increase in depressive symptoms and life satisfaction between 2019 and 2020. However, our results reveal heterogeneity within the group of family caregivers as we find differences according to caregiving dynamics and intensity. Among the group of continuing caregivers, high-intensity caregivers experience a larger increase in life satisfaction, and low-intensity caregivers a smaller increase in life satisfaction, compared to non-caregivers. Our results therefore provide some support for the role enhancement hypothesis for continuing caregivers with high time commitment.

Civic engagement is one of the cornerstones of participatory democracy and fundamental to preventing old-age social exclusion. Even though civic engagement late-in-life has received considerable attention, there is a lacuna of research on older migrants' civic engagement. This study aims therefore to examine potential predictors of civic engagement in terms of formal volunteering and participation in political organisations among foreign-born and native-born older adults in Europe. Attention is hereby given to how socio-structural resources and social capital are associated with civic engagement, and whether these associations differ between foreign-born and native-born. Data from wave 7 of the Survey of Health, Ageing and Retirement in Europe [n = 74,150; 5710 of them are foreign-born] were used in multivariable logistic regression analyses. Results show that socio-structural and social capital variables are positively associated with volunteering and participation in political organisations, both in native-born and foreign-born older adults. The study also suggests that place of birth (in Europe vs. outside Europe) and age-upon-migration play a role in predicting civic engagement among foreign-born older adults, and are therefore features worth considering when studying older migrants' civic engagement.

While a large body of literature investigates the bidirectional relationship between retirement and health, few have analyzed the mechanism through which retirement affects health which will provide important policy instrument insights. Using three waves of National Social Life, Health, and Aging Project, we examine the mediating role of the social network in the relationship between retirement and health in USA. We address the endogeneity and reverse causality through panel instrumental fixed-effect methods. We apply both single and parallel mediation analyses to identify the potential mechanism by which social network characteristics mediate the impact of retirement on health. Findings reveal that retirement adversely affects physical and mental health outcomes, and a considerable portion of these effects are explained by social network changes post-retirement. Specifically, 58% of reduction in the probability of reporting good physical health and 4.5% of increment in chances of having depression symptoms post-retirement can be explained by shrinkage in the size of social network in retirees. Using parallel mediation identification to account for dependencies among social network features, we find that social network size induces 79.5% reduction in probability of reporting good physical health and 18.6% increase in probability of having depression in retirees as compared to non-retirees. Findings in this paper suggest that investing in social network of the elderly can buffer the adverse health effect of retirement and can be an effective policy target for promoting healthy aging.

Social exclusion (SE), or the separation of individuals and groups from mainstream society, is associated with poor health and wellbeing, yet a substantial number of older people are socially excluded. There is increasing agreement that SE is multidimensional, comprising among others social relations, material resources, and/or civic participation. However, measuring SE is still challenging as exclusion may occur in more than one dimension, whereas its sum does not reflect the content of SE. To account for these challenges, this study provides a typology of SE and describes how SE types differ from each other in terms of severity and risk factors. We concentrate on Balkan states, which are among the European countries with the highest prevalence of SE. Data come from the European Quality of Life Survey (N = 3030, age 50 +). Latent Class Analysis revealed four SE types: low SE risk (50%), material exclusion (23%), material and social exclusion (4%), and multidimensional exclusion (23%). A higher number of dimensions from which a person is excluded are associated with more severe outcomes. Multinomial regression further revealed that lower levels of education, lower subjective health, and lower social trust increase the risks of any SE type. Younger age, unemployment, and not having a partner are associated with specific SE types. This study is in line with the limited evidence that different types of SE exist. Policies designed to reduce SE should take account of the different SE types and specific associated risk factors in order to enhance the impact of interventions to reduce social exclusion.

The COVID-19 pandemic led to unprecedented levels of subjective unmet healthcare needs (SUN). This study investigates the association between SUN in 2020 and three health outcomes in 2021-mortality, cancer, and self-assessed health (SAH), among adults aged 50 years and older, using data from the regular administration of the Survey of Health, Ageing and Retirement in Europe and from the two special waves administered in 2020 and 2021 regarding COVID-19. Three types of SUN were surveyed: care foregone due to fear of contracting COVID-19, pre-scheduled care postponed, and inability to get medical appointments or treatments demanded. We resort on the relative risk and the logistic specification to investigate the association between SUN and health outcomes. To avoid simultaneity, 1-year lagged SUN variables are used. We found a negative association between SUN and mortality. This result differs from the (scarce) previous evidence, suggesting that health systems prioritised life-threatening conditions, in the pandemic context. In line with previous studies, we obtained a positive association between SUN and worse health, in the case of cancer, though it is statistically significant only for the global measure of SUN (any reason). The higher chances of reporting cancer among those exposed to SUN might mean delayed cancer diagnosis, confirming that healthcare foregone was truly needed for a timely diagnosis. The association between SUN and poor or fair SAH is positive but not statistically significant, for the period analysed.