Trajectories of low back pain from midlife to retirement and functional ability at old age

BackgroundThis study aimed to identify trajectories of low back pain (LBP) over a 16-year follow-up from midlife to retirement and investigate their association with mobility limitations and disability in activities of daily living (ADL-disability) in later life.MethodsThe study population consisted of 6257 baseline (1981) respondents aged 44–58 years from Finnish Longitudinal study on Aging Municipal Employees. Repeated measurements of LBP were collected in 1985, 1992 and 1997. We studied persons who had data on LBP at baseline and in at least one of the follow-ups and had information on mobility limitations (n = 2305) and ADL-disability (n = 2359) at a 28-year follow-up in 2009. Latent class growth analysis was used to identify LBP trajectories. Odds ratios (ORs) with 95% confidence intervals (CIs) for the associations of LBP trajectory and later life mobility limitations and ADL-disability were estimated and adjusted for confounders.ResultsThree LBP trajectories with parallel shapes were identified: high-decreasing (19%), intermediate-stable (60%) and low (21%). After adjustment for confounders, high-decreasing trajectory had 3.2 times the odds (95% CI 2.1–4.9) of mobility limitations and 2.9 times the odds (95% CI 2.0–4.2) of ADL-disability as compared to low trajectory. The respective ORs for intermediate-stable trajectory were 1.6 (95% CI 1.2–2.1) and 1.7 (95% CI 1.3–2.3).ConclusionsAmong majority of respondents, LBP remained stable over the follow-up. The respondents belonging to intermediate-stable and high-decreasing trajectories of LBP had higher odds of mobility limitations and ADL-disability at old age. This highlights that LBP during midlife to retirement has far-reached consequences on functional ability at old age.</p

Educational Differences in Decline in Maximum Gait Speed in Older Adults over an 11-year Follow-up

Background: This study examined educational differences in decline in maximum gait speed over an 11-year follow-up in the general Finnish population aged ≥55 years, and assessed the contribution of lifestyle factors, body mass index, physical workload and chronic conditions on the association.Methods: Data from the nationally representative Health 2000 Survey and it's 11-year follow-up was used. Participants aged 55 years and older with maximum gait speed measured at both time-points were included (n=1128). Information on education, age, sex, lifestyle factors, body mass index, physical workload and chronic conditions was collected at baseline. General linear model was used to examine differences in decline in maximum gait speed between education groups. Mediation analyses using the product method was conducted to partition the total effect of education on decline in maximum gait speed into direct effect and indirect effect acting through mediators.Results: Decline in maximum gait speed was greater in low and intermediate education groups in comparison to the high education group [0.24 m/s, 95% confidence interval (0.21, 0.26), 0.24 m/s (0.21, 0.28), 0.10 m/s (0.07, 0.14), respectively]. The most important mediators were higher body mass index and lifetime exposure to physical workload among the less educated, accounting for 10% and 11% of the total effect, respectively.Conclusions: Education-based disparities in objectively measured mobility increase with age as lower education is associated with greater decline in gait speed. Higher body mass index and physical workload among less educated contributed most to the educational disparities in age-related decline in maximum gait speed.</p