Set for life? Socioeconomic conditions, occupational complexity, and later life health

Life expectancy has increased in the western parts of the world and more people reach old age. Some groups of people have benefitted more of the increase in life expectancy and have better health than others. Because of biological, psychological, behavioral, and social factors over the life course, adverse health accumulates in later life. Most societies are socially structured and people higher in the social structure tend to have better health. People’s position in the social hierarchy is commonly assessed by socioeconomic position (indicated by education, social class [occupation based], and income). Labor market stratification plays a central role in stratifying people in to socioeconomic positions. An important factor in the labor market stratification is the level of complexity of work. All these stratification principles could play a role in shaping the risk of adverse later life health. Identifying factors associated with later life health has become more important because of the growing number of people that reach old age. The overall aim of this thesis was to investigate the relationships between socioeconomic conditions, the complexity level of peoples’ work (measured as occupational complexity), and health in late life by studying 1) the association between complexity of work during midlife and later life health and 2) health inequalities in late life attributable to differences in socioeconomic position. All studies used individually linked data from the Swedish Level of Living Survey (LNU) and the Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD). Results from study I showed that higher occupational complexity in midlife decreased the odds of psychological distress 20 years later. Socioeconomic position partly accounted for the association between occupational complexity and psychological distress. Still, occupational complexity may play a role in shaping the risk of psychological distress in old age. Results from study II showed that the magnitude and direction of the effect sizes, for education, social class, and occupational complexity were similar in relation to later life health (psychological distress and physical functioning). Income was more strongly associated with late life health than the other indicators of socioeconomic position. The income-health association was also the only one that remained significant in the mutually adjusted models. Thus, if the primary objective to include socioeconomic position is to statistically adjust for socioeconomic position, income may be the preferable single indicator. However, if the primary objective of a study is to analyze socioeconomic health inequalities, and the underlying mechanisms that drive these inequalities, then the choice of how to measure socioeconomic position should be carefully considered. Results from study III initially showed that occupational complexity scores aggregated from across the working life and different trajectories of occupational complexity were associated with physical function (as indicated by mobility and ADL limitations) in late life. Adjusting for socioeconomic position diminished the association. This suggest that the association was confounded (or possibly mediated in the case of income) through socioeconomic position. Results from study IV showed that financial hardship in childhood increased the risk of psychological distress in late life (at mean age of 81 years). This was partly explained by a direct association from financial hardship in childhood to psychological distress in later life. In addition, chains of risks were found between financial hardship in childhood and psychological distress in later life. This means that financial hardship in childhood increased the risk of a) psychological distress in midlife, b) lower levels of education, c) unemployment in midlife, and d) financial hardship in midlife, which, in turn, increased the risk of psychological distress in later life. In summary, the results from this thesis showed that there are socioeconomic health inequalities in later life. Lower socioeconomic position in midlife and financial hardship in childhood increase the risk of adverse later life health. Moreover, higher occupational complexity in midlife was investigated, and showed, to play a role in shaping the risk of psychological distress in late life. In contrast, the results showed that occupational complexity is not associated with physical functioning. Occupational complexity play a role in determining socioeconomic position, however, it does not capture an aspect of general life chances that comes with higher socioeconomic position and is relevant for health, beyond that of education, social class, and income

social engagement in late life may attenuate the burden of depressive symptoms due to financial strain in childhood

Abstract Background : It remains poorly understood if childhood financial strain is associated with old-age depression and if active social life may mitigate this relationship. Aims : To investigate the association between childhood financial strain and depressive symptoms during aging; to examine whether late-life social engagement modifies this association. Method : 2884 dementia-free individuals (aged 60+) from the Swedish National study of Aging and Care-Kungsholmen were clinically examined over a 15-year follow-up. Presence of childhood financial strain was ascertained at baseline. Depressive symptoms were repeatedly assessed with the Montgomery–Asberg Depression Rating Scale. Social engagement comprised information on baseline social network and leisure activities. Linear, logistic and mixed-effect models estimated baseline and longitudinal associations accounting for sociodemographic, clinical, and lifestyle factors. Results : Childhood financial strain was independently associated with a higher baseline level of depressive symptoms (β = 0.37, 95%CI 0.10-0.65), but not with symptom change over time. Relative to those without financial strain and with active social engagement, depressive burden was increased in those without financial strain but with inactive social engagement (β = 0.43, 95%CI: 0.15-0.71), and in those with both financial strain and inactive engagement (β = 0.99; 95%CI: 0.59-1.40). Individuals with financial strain and active social engagement exhibited similar depressive burden as those without financial strain and with active social engagement. Limitations : Recall bias and reverse causality may affect study results, although sensitivity analyses suggest their limited effect. Conclusions : Early-life financial strain may be of lasting importance for old-age depressive symptoms. Active social engagement in late-life may mitigate this association

Cognitive reserve, cortisol, and Alzheimer\u27s disease biomarkers: A memory clinic study

INTRODUCTION Cognitive reserve might mitigate the risk of Alzheimer\u27s dementia among memory clinic patients. No study has examined the potential modifying role of stress on this relation. METHODS We examined cross-sectional associations of the cognitive reserve index (CRI; education, occupational complexity, physical and leisure activities, and social health) with cognitive performance and AD-related biomarkers among 113 memory clinic patients. The longitudinal association between CRI and cognition over a 3-year follow-up was assessed. We examined whether associations were influenced by perceived stress and five measures of diurnal salivary cortisol. RESULTS Higher CRI scores were associated with better cognition. Adjusting for cortisol measures reduced the beneficial association of CRI on cognition. A higher CRI score was associated with better working memory in individuals with higher (favorable) cortisol AM/PM ratio, but not among individuals with low cortisol AM/PM ratio. No association was found between CRI and AD-related biomarkers. DISCUSSION Physiological stress reduces the neurocognitive benefits of cognitive reserve among memory clinic patients. HIGHLIGHTS Physiological stress may reduce the neurocognitive benefits accrued from cognitively stimulating and enriching life experiences (cognitive reserve [CR]) in memory clinic patients.Cortisol awakening response modified the relation between CR and P-tau181, a marker of Alzheimer\u27s disease (AD).Effective stress management techniques for AD and related dementia prevention are warranted

Sleep disturbances and the speed of multimorbidity development in old age : results from a longitudinal population-based study

Sleep disturbances are prevalent among older adults and are associated with various individual diseases. The aim of this study was to investigate whether sleep disturbances are associated with the speed of multimorbidity development among older adults. Data were gathered from the Swedish National study of Aging and Care in Kungsholmen (SNAC-K), an ongoing population-based study of subjects aged 60+ (N = 3363). The study included a subsample (n = 1189) without multimorbidity at baseline (< 2 chronic diseases). Baseline sleep disturbances were derived from the Comprehensive Psychiatric Rating Scale and categorized as none, mild, and moderate-severe. The number of chronic conditions throughout the 9-year follow-up was obtained from clinical examinations. Linear mixed models were used to study the association between sleep disturbances and the speed of chronic disease accumulation, adjusting for sex, age, education, physical activity, smoking, alcohol consumption, depression, pain, and psychotropic drug use. We repeated the analyses including only cardiovascular, neuropsychiatric, or musculoskeletal diseases as the outcome. Moderate-severe sleep disturbances were associated with a higher speed of chronic disease accumulation (ß /year = 0.142, p = 0.008), regardless of potential confounders. Significant positive associations were also found between moderate-severe sleep disturbances and neuropsychiatric (ß /year = 0.041, p = 0.016) and musculoskeletal (ß /year = 0.038, p = 0.025) disease accumulation, but not with cardiovascular diseases. Results remained stable when participants with baseline dementia, cognitive impairment, or depression were excluded. The finding that sleep disturbances are associated with faster chronic disease accumulation points towards the importance of early detection and treatment of sleep disturbances as a possible strategy to reduce chronic multimorbidity among older adults. The online version contains supplementary material available at 10.1186/s12916-020-01846-w

Do cognitively stimulating activities affect the association between retirement timing and cognitive functioning in old age?

In response to the rising financial pressure on old-age pension systems in industrialised economies, many European countries plan to increase the eligibility age for retirement pensions. We used data from Sweden to examine whether (and if so, how) retirement after age 65 – the eligibility age for basic pension – compared to retiring earlier affects older adults’ (between ages 70 and 85) cognitive functioning. Using a propensity score matching (PSM) approach, we addressed the selection bias potentially introduced by non-random selection into either early or late retirement. We also examined average and heterogeneous treatment effects (HTEs). HTEs were evaluated for different levels of cognitive stimulation from occupational activities before retirement and from leisure activities after retirement. We drew from a rich longitudinal data-set linking two nationally representative Swedish surveys with a register data-set and found that, on average, individuals who retire after age 65 do not have a higher level of cognitive functioning than those who retire earlier. Similarly, we did not observe HTEs from occupational activities. With respect to leisure activities, we found no systematic effects on cognitive functioning among those working beyond age 65. We conclude that, in general, retirement age does not seem to affect cognitive functioning in old age. Yet, the rising retirement age may put substantial pressure on individuals who suffer from poor health at the end of their occupational career, potentially exacerbating social- and health-related inequalities among older people

Occupational complexity and cognition in the FINGER multidomain intervention trial

Introduction Lifetime exposure to occupational complexity is linked to late-life cognition, and may affect benefits of preventive interventions. Methods In the 2-year multidomain Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER), we investigated, through post hoc analyses (N = 1026), the association of occupational complexity with cognition. Occupational complexity with data, people, and substantive complexity were classified through the Dictionary of Occupational Titles. Results Higher levels of occupational complexity were associated with better baseline cognition. Measures of occupational complexity had no association with intervention effects on cognition, except for occupational complexity with data, which was associated with the degree of intervention-related gains for executive function. Discussion In older adults at increased risk for dementia, higher occupational complexity is associated with better cognition. The cognitive benefit of the FINGER intervention did not vary significantly among participants with different levels of occupational complexity. These exploratory findings require further testing in larger studies.Peer reviewe

It’s complex: exploring the associations between socioeconomic position, work complexity and psychological distress in old age. : A population based study with more than 20-years follow-up.

Self-reported psychological distress is quite common in the Swedish elderly population. Feelings of psychological distress may have devastating consequences. The overall aim of this study was to explore associations between socioeconomic position and work complexity during midlife with psychological distress in old age. Ordered logistic regression was used to investigate the associations between, (I) socioeconomic position during midlife and psychological distress in old age, (II) work complexity during midlife and psychological distress in old age, (III) the association between socioeconomic position and psychological distress independent of work complexity, and (IV) the association between work complexity and psychological distress independent of socioeconomic position. The results show that (I) higher socioeconomic position during midlife is associated with less psychological distress in old age (II) higher work complexity during midlife is associated with less psychological distress in old age, and that (III) higher work complexity is associated to less psychological distress independent of socioeconomic position, (IV) but the association between socioeconomic position and psychological distress diminishes adjusting for work complexity. The main conclusion from this study is that individuals with high socioeconomic position benefits from both their position in society and from their working conditions while individuals of lower socioeconomic position are more likely to also suffer the drawbacks of disadvantageous working conditions in relation to late life psychological distress

Internetenkäter, en väl fungerande datainsamlingsmetod?

Internet har förändrat samhället i grunden och har påverkat de flesta områden man kan tänka sig på något sätt. Ett av de påverkade områdena är samhällsvetenskaplig datainsamling. Med hjälp av internet och teknisk apparatur finns det idag fler valmöjligheter vid val av datainsamlingsmetod än någonsin tidigare. Studien undersöker hur internetenkäter fungerar som datainsamlingsmetod inom områdena bortfall, internt bortfall samt ur ett tids- och kostnadsperspektiv. Likt flera tidigare undersökningar av internetbaserade datainsamlingsmetoder jämförs resultaten från en internetenkät med resultaten från en pappersenkät för en population delad i två identiska grupper med en experimentell design. Populationerna som undersöks består av en ung elitgrupp, styrelseledamöter från Sveriges åtta riksdagspartiers ungdomsförbund. Elitpopulationen ger metodologiska fördelar genom att de antas ha större tekniska kunskaper samt större tillgång till internet jämfört med andra populationer vilket ger en unik möjlighet att testa avancerade frågeställningar. Avancerade frågeställningar representeras i denna studie av frågor om sociala nätverk. Studien resulterar i tre rekommendationer att tänka på då internetenkäter ska användas. (i) Det är viktigt att tänka på att målpopulationen har tillgång till och tillräckliga kunskaper om internet för att kunna besvara enkäten. (ii) Det ska vara möjligt att nå populationen via internet. (iii) Undersökningen bör inte vara beroende av avancerade och öppna frågeställningar

Different indicators of socioeconomic status and their relative importance as determinants of health in old age

Background: Socioeconomic status has been operationalised in a variety of ways, most commonly as education, social class, or income. In this study, we also use occupational complexity and a SES-index as alternative measures of socioeconomic status. Studies show that in analyses of health inequalities in the general population, the choice of indicators influence the magnitude of the observed inequalities. Less is known about the influence of indicator choice in studies of older adults. The aim of this study is twofold: i) to analyse the impact of the choice of socioeconomic status indicator on the observed health inequalities among older adults, ii) to explore whether different indicators of socioeconomic status are independently associated with health in old age. Methods: We combined data from two nationally representative Swedish surveys, providing more than 20 years of follow-up. Average marginal effects were estimated to compare the association between the five indicators of SES, and three late-life health outcomes: mobility limitations, limitations in activities of daily living (ADL), and psychological distress. Results: All socioeconomic status indicators were associated with late-life health; there were only minor differences in the effect sizes. Income was most strongly associated to all indicators of late-life health, the associations remained statistically significant when adjusting for the other indicators. In the fully adjusted models, education contributed to the model fits with 0-3% (depending on the outcome), social class with 0-1%, occupational complexity with 1-8%, and income with 3-18%. Conclusions: Our results indicate overlapping properties between socioeconomic status indicators in relation to late-life health. However, income is associated to late-life health independently of all other variables. Moreover, income did not perform substantially worse than the composite SES-index in capturing health variation. Thus, if the primary objective of including an indicator of socioeconomic status is to adjust the model for socioeconomic differences in late-life health rather than to analyse these inequalities per se, income may be the preferable indicator. If, on the other hand, the primary objective of a study is to analyse specific aspects of health inequalities, or the mechanisms that drive health inequalities, then the choice of indicator should be theoretically guided.