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Comorbidity and functional trajectories from midlife to old age: the Health and Retirement Study.

ABSTRACT: The number of diseases and physical functioning difficulties tend to increase with age. The aim of this study was to examine the trajectories of physical functioning across age groups and whether the trajectories differ according to disease status in different population subgroups.Repeat data from a nationally representative population sample, the Health and Retirement Study, was used. Participants were 10,709 men and 13,477 women aged 60-107 years at baseline with biennial surveys from 1992 to 2010. Average length of follow-up was 10.3 years ranging from 0 to 18 years. Disease status and physical functioning was asked about at all study phases and 10 items were summed to obtain a physical functioning score (0-10).Age modified the relationship between number of chronic diseases and physical functioning with older participants having more physical functioning difficulties with increasing number of diseases. An average 70-year-old participant with no diseases had 0.89 (95% CI: 0.85-0.93) physical functioning difficulties, with one disease 1.72 (95% CI: 1.69-1.76) difficulties, with two diseases 2.57 (95% CI: 2.52-2.62) difficulties, and with three or more diseases 3.82 (95% CI: 3.76-3.88) difficulties. Of the individual diseases memory-related diseases, stroke, pulmonary diseases, and arthritis were associated with significantly higher physical functioning difficulties compared with other diseases.Comorbidity is associated with greater burden of physical functioning difficulties. Of the studied diseases, memory-related diseases, stroke, pulmonary diseases, and arthritis alone or in combination limit most physical functioning.

SUBMITTER: Stenholm S

PROVIDER: S-EPMC4336333 | biostudies-literature | 2015 Mar

REPOSITORIES: biostudies-literature

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Comorbidity and functional trajectories from midlife to old age: the Health and Retirement Study.

Stenholm Sari S Westerlund Hugo H Head Jenny J Hyde Martin M Kawachi Ichiro I Pentti Jaana J Kivimäki Mika M Vahtera Jussi J

The journals of gerontology. Series A, Biological sciences and medical sciences 20140724 3

<h4>Background</h4>The number of diseases and physical functioning difficulties tend to increase with age. The aim of this study was to examine the trajectories of physical functioning across age groups and whether the trajectories differ according to disease status in different population subgroups.<h4>Methods</h4>Repeat data from a nationally representative population sample, the Health and Retirement Study, was used. Participants were 10,709 men and 13,477 women aged 60-107 years at baseline ...[more]

PMID: 25060316

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Project description:BackgroundPrevious studies have examined physical risk factors in relation to functional health, but less work has focused on the protective role of psychological and social factors. We examined the individual and joint protective contribution of control beliefs, social support and physical exercise to changes in functional health, beyond the influence of health status and physical risk factors in middle-aged and older adults. Given that functional health typically declines throughout adulthood, it is important to identify modifiable factors that can be implemented to maintain functioning, improve quality of life, and reduce disability.Methodology/principal findingsWe conducted a national longitudinal study, Midlife in the United States (MIDUS), with assessments in 1995-1996 and 2004-2006, and 3,626 community-residing adults, aged 32 to 84, were included in the analyses. Functional health (Physical Functioning subscale of the SF-36) and protective factors were measured at both occasions. While controlling for socio-demographic, health status, and physical risk factors (large waist circumference, smoking, and alcohol or drug problems), a composite of the three protective variables (control beliefs, social support, and physical exercise) at Time 1 was significantly related to functional health change. The more of these factors at Time 1, the better the health maintenance over 10 years. Among middle-aged and older adults, declines in health were significantly reduced with an increased number of protective factors.Conclusion/significanceAge-related declines in health were reduced among those with more protective factors up to a decade earlier in life. Modifiable psychological, social, and physical protective factors, individually and in the aggregate, are associated with maintenance of functional health, beyond the damaging effects of physical risk factors. The results are encouraging for the prospect of developing interventions to promote functional health and for reducing public health expenditures for physical disability in later life.

Project description:BackgroundNo consensus has been reached on whether depression decreases or increases with age in later life. Majority of the evidence comes from Western societies, while little is known about this relationship and its rural-urban disparities in the Chinese context.MethodsThree waves of data from 15,501 Chinese adults aged 45-85 years from the China Health and Retirement Longitudinal Study, Chinese sister study of Health and Retirement Study, were used. Depression caseness was identified using the 10-item Center for Epidemiologic Studies Depression Scale (score ≥12). Urbanisation levels were determined by combining rural-urban residence and rural-urban Hukou (a household registration system). Odds ratios and predicted probabilities of depression caseness were estimated using generalised linear mixed models.ResultsFor both men and women and across all ages, the crude predicted probability of depression caseness was the highest in the rural group, followed by the semi-urban group, and the lowest in the urban group. The probability was stable over age among urban men (around 0.05), but it increased at an accelerated rate with age among semi-urban men (0.25 at age 85, 95% confidence interval [CI]: 0.13-0.44) and rural men (0.29 at age 85, 95% CI: 0.22-0.39). Among women the age pattern was similar between the urbanisation groups: the probability increased with age, reached a peak at ages 75-80 (urban women: 0.16, 95% CI: 0.13-0.20; semi-urban women: 0.28, 95% CI: 0.20-0.39; rural women: 0.41, 95% CI: 0.36-0.46), and decreased slightly afterwards. These differences were significantly attenuated when socio-demographic characteristics and physical disability, but not when behaviour-related factors, were controlled for.ConclusionThe age trajectories of later-life depression caseness varied by gender and urbanisation levels, and were not U-shaped as in many Western societies. The increasing depression caseness with age and the large rural disadvantage were substantially driven by socio-demographic characteristics and physical disability.

Project description:BackgroundAlthough multimorbidity is a risk factor for disability, the relationship between the accumulative patterns of multimorbidity and disability remains poorly understood. The objective of this study was to identify the latent groups of multimorbidity trajectories among mid to older age adults and to examine their associations with incident disability.MethodsWe included 5,548 participants aged ≥ 45 years who participated in the China Health and Retirement Longitudinal Study from 2011 to 2018 and had no multimorbidity (≥ 2 chronic conditions) at baseline. The group-based multi-trajectory modeling was used to identify distinct trajectory groups of multimorbidity based on the latent dimensions underlying 13 chronic conditions. The association between multimorbidity trajectories and incident disability was analyzed using the generalized estimating equation model adjusting for potential confounders.ResultsOf the 5,548 participants included in the current analysis, 2,407 (43.39%) developed multimorbidity during the follow-up. Among participants with new-onset multimorbidity, four trajectory groups were identified according to the combination of newly diagnosed diseases: "Cardiometabolic" (N = 821, 34.11%), "Digestive-arthritic" (N = 753, 31.28%), "Cardiometabolic/Brain" (N = 618, 25.68%), and "Respiratory" (N = 215, 8.93%). Compared to participants who did not develop multimorbidity, the risk of incident disability was most significantly increased in the "Cardiometabolic/Brain" trajectory group (OR = 2.05, 95% CI: 1.55-2.70), followed by the "Cardiometabolic" (OR = 1.96, 95% CI: 1.52 -2.53) and "Digestive-arthritic" (OR = 1.70, 95% CI: 1.31-2.20) trajectory groups.ConclusionsThe growing burden of multimorbidity, especially the comorbid of cardiometabolic and brain diseases, may be associated with a significantly increased risk of disability for mid to older age adults. These findings improve our understanding of multimorbidity patterns that affect the independence of living and inform the development of strategies for the primary prevention of disability.

Project description:ObjectivesTo examine cumulative associations between midlife health behaviors and walking speed and upper-limb strength in early old age.DesignProspective cohort study.SettingWhitehall II Study.ParticipantsIndividuals (mean age 49.1 ± 5.9 in 1991-93) with health behavior data for at least two of the three assessments (1991-93, 1997-99, 2002-04) and physical functioning measures in 2007-09 (mean age 65.9 ± 5.9) (N = 5,671).MeasurementsA trained nurse assessed walking speed and upper-limb strength. Unhealthy behaviors were defined as current or recent smoking, nonmoderate alcohol consumption (abstinence or heavy drinking), fruit and vegetable consumption less than twice per day, and physical inactivity (<1 h/wk of moderate and <1 h/wk of vigorous physical activity). For each unhealthy behavior, a cumulative score was calculated as the number of times a person reported the behavior over the three assessments divided by 3. The score ranged between 0 (never) and 1 (all three times).ResultsIn linear regression models adjusted for age, sex, education, marital status, and height, all unhealthy behaviors in 1991-93 were associated with slower walking speed in 2007-09, with differences ranging from 0.10 (nonmoderate alcohol consumption) to 0.25 (physical inactivity) of a standard deviation between participants with and without the unhealthy behavior (Pt-test <.001). For walking speed, the accumulation-of-risk model provided the best fit for unhealthy diet (β for a 1-point increment in the low fruit and vegetable consumption score = -0.29, 95% confidence interval (CI) = -0.36 to -0.22) and physical inactivity (β = -0.37, 95% CI = -0.45 to -0.29). For smoking and nonmoderate alcohol consumption, a cumulative effect was also observed, but partial F-tests did not suggest that it provided a better fit than models with behaviors in 1991-93, 1997-99, or 2002-04. All behavioral scores except smoking were associated with grip strength, but F-tests supported the accumulation-of-risk hypothesis only for physical inactivity.ConclusionThese findings highlight the importance of duration of unhealthy behaviors, particularly for diet and physical activity, when examining associations with physical functioning.

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Comorbidity and functional trajectories from midlife to old age: the Health and Retirement Study.

Publications

Comorbidity and functional trajectories from midlife to old age: the Health and Retirement Study.

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