The Life Skills of Older Americans: Association with Economic, Psychological, Social, and Health Outcomes.
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SUBMITTER: Steptoe A
PROVIDER: S-EPMC6033934 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundStudies on the association between frailty and health-related quality of life (HRQoL) are scarce and show contradictory results. This study aimed to evaluate the association between physical, psychological and social frailty and HRQoL among community-dwelling older people.MethodsA cross-sectional study was performed with baseline data collected in 2015 from the Urban Health Centers Europe (UHCE) project in five European countries, the United Kingdom, Greece, Croatia, The Netherlands and Spain. A total of 2325 participants were included in the baseline measurements of the Urban Health Centers Europe project; 2167 participants (mean age = 79.7; SD=5.6) were included in the analyses after excluding participants with missing data. The Tilburg Frailty Indicator measured overall frailty as well as physical, psychological and social frailty. The 12-Item Short-Form Health Survey was used to measured physical and mental HRQoL.ResultsRegarding physical HRQoL, a large difference (d=1.29) between physically and not physically frail participants was observed. Regarding mental HRQoL, a large difference (d=1.20) between psychologically and not psychologically frail participants was observed. In the full model with all three domains of frailty and the covariates to explain physical HRQoL, physical (P <0.001) and social frailty (P <0.001) remained significant. In the full model to explain mental HRQoL, all three domains of frailty remained significant (P <0.001).ConclusionPhysical frailty had the strongest association with physical HRQoL, and psychological frailty had the strongest association with mental HRQoL. The associations between social frailty and both physical and mental HRQoL remain significant when controlling for physical and psychological frailty.
| S-EPMC9186303 | biostudies-literature
Project description:BackgroundEmerging evidence suggests that structured and progressive exercise underpinned by a cognitive behavioural approach can improve functional outcomes in patients with neurogenic claudication (NC). However, evidence surrounding its economic benefits is lacking.ObjectivesTo estimate the economic costs, health-related quality of life outcomes and cost-effectiveness of a physical and psychological group intervention (BOOST programme) versus best practice advice (BPA) in older adults with NC.MethodsAn economic evaluation was conducted based on data from a pragmatic, multicentre, superiority, randomised controlled trial. The base-case economic evaluation took the form of an intention-to-treat analysis conducted from a UK National Health Service (NHS) and personal social services (PSS) perspective and separately from a societal perspective. Costs (£ 2018-2019 prices) were collected prospectively over a 12 month follow-up period. A bivariate regression of costs and quality-adjusted life-years (QALYs), with multiple imputation of missing data, was conducted to estimate the incremental cost per QALY gained and the incremental net monetary benefit (INMB) of the BOOST programme in comparison to BPA. Sensitivity and pre-specified subgroup analyses explored uncertainty and heterogeneity in cost-effectiveness estimates.ResultsParticipants (N = 435) were randomised to the BOOST programme (n = 292) or BPA (n = 143). Mean (standard error [SE]) NHS and PSS costs over 12 months were £1,974 (£118) in the BOOST arm versus £1,827 (£169) in the BPA arm (p = 0.474). Mean (SE) QALY estimates were 0.620 (0.009) versus 0.599 (0.006), respectively (p = 0.093). The probability that the BOOST programme is cost-effective ranged between 67 and 83% (NHS and PSS perspective) and 79-89% (societal perspective) at cost-effectiveness thresholds between £15,000 and £30,000 per QALY gained. INMBs ranged between £145 and £464 at similar cost-effectiveness thresholds. The cost-effectiveness results remained robust to sensitivity analyses.ConclusionsThe BOOST programme resulted in modest QALY gains over the 12 month follow-up period. Future studies with longer intervention and follow-up periods are needed to address uncertainty around the health-related quality of life impacts and cost-effectiveness of such programmes. Trial registration This study has been registered in the International Standard Randomised Controlled Trial Number registry, reference number ISRCTN12698674. Registered on 10 November 2015.
| S-EPMC9906820 | biostudies-literature
Project description:BackgroundThe economic selection hypothesis, which argues that the initial economic situation determines both subsequent health and economic conditions, has been drawn into the debate on causation-selection issues. This study aims to construct a path model with self-rated health and depression score of older adults as health outcomes to measure and compare the social causation forces of wealth accumulation, social selection forces of adulthood health, and economic selection forces of childhood economics, and to examine their gender disparities.MethodsData was obtained from a sample of 19613 older adults aged 45 years or above from the 2014 life history survey and the 2015 routine follow-up survey of the China Health and Retirement Longitudinal Study. Structural equation modeling analysis was conducted employing the full information maximum likelihood estimation method.ResultsThe presence of social causation, social selection, and economic selection were all statistically supported. In self-rated health, social selection forces held the dominant position, while social causation forces were comparable to economic selection forces. In depression score, social selection still exhibited stronger forces than economic selection, but social causation had forces close to social selection and greater than economic selection. The forces of the three hypotheses in self-rated health did not significantly change with gender, but social causation exerted mightier forces than economic selection within the male group, unlike the female group. The forces of economic selection in depression score were greater in females than males and no significant differences were observed among the forces of the three hypotheses in the female group.ConclusionsSocial causation, social selection, and economic selection operate simultaneously on the self-rated health and depression score of older adults. However, the force magnitudes of the three hypotheses and/or their rankings differ by health outcomes and gender.
| S-EPMC10500472 | biostudies-literature
Project description:Background and objectivesThe US housing market has experienced considerable fluctuations over the last decades. This study aimed to investigate the impacts of housing price dynamics on physical health, mental health, and health-related behaviors for older American outright owners, mortgaged owners, and renters.Research design and methodsWe drew longitudinal data from the 1992-2016 Health and Retirement Study and merged it to the 5-digit zip code-level Housing Price Index. The analytic sample comprised 34 182 persons and 174 759 person-year observations. We used a fixed-effects model to identify the health impacts of housing price dynamics separately for outright owners, mortgaged owners, and renters.ResultsA 100% increase in Housing Price Index was associated with a 2.81 and 3.50 percentage points (pp) increase in the probability of reporting excellent/very good/good health status for mortgage owners and renters, respectively. It was also related to a lower likelihood of obesity (1.82 pp) for outright owners and a lesser chance of obesity (2.85 pp) and smoking (3.03 pp) for renters. All of these relationships were statistically significant (p < .05). Renters also experienced significantly decreased depression scores (-0.24), measured by the Center for Epidemiologic Studies-Depression scale, associated with the same housing price changes.Discussion and implicationsHousing price dynamics have significant health impacts, and renters are more sensitive to fluctuations in the housing market. Our study rules out the wealth effect as the mechanism through which changes in housing prices affect older adults' health. Our findings may inform policies to promote older adults' health by investing in local area amenities and improving socioeconomic conditions.
| S-EPMC8152867 | biostudies-literature
Project description:Importance:Noncognitive life skills are patterns of behavior, thoughts, and feelings that complement cognitive ability in promoting positive economic and educational outcomes. These positive attributes have been associated with favorable social and health outcomes at older ages, but their combined association with survival is not known. Objectives:To evaluate the association of the combination of 5 noncognitive life skills with mortality, and to explore the role of sociodemographic, health, cognitive, and behavioral factors in explaining associations. Design, Setting, and Participants:This cohort study used data from wave 5 of the English Longitudinal Study of Ageing, conducted in 2010. Participants included adults 52 years and older. Associations of scores on 5 noncognitive life skills, including conscientiousness, perseverance, emotional stability, optimism, and control, with all-cause mortality were analyzed for a mean (SD) of 7.2 (1.3) years. Data analyses were completed in November 2019. Exposures:Response to wave 5 of the English Longitudinal Study of Ageing. Main Outcomes and Measures:Noncognitive life skills scores, including conscientiousness, perseverance, emotional stability, optimism, and control, were measured by questionnaire. The main outcome was all-cause mortality, and the associations with noncognitive life skills scores were analyzed using Cox proportional hazards regressions models to estimate hazard ratios per 1-SD increase in score. Results:A total of 7850 participants (mean [SD] age, 66.5 [9.0] years; 4333 [55.2%] women) were included. Combined life skill score was positively associated with survival, with a hazard ratio of 0.81 (95% CI, 0.72-0.90) per 1-SD increase in positive attributes after adjustment for age, sex, race/ethnicity, childhood socioeconomic status, educational attainment, baseline chronic disease, depressive symptoms, cognitive function, mobility impairment, social isolation, smoking, physical activity, alcohol intake, and fruit and vegetable consumption (P?<?.001). Excluding deaths during 24 months after baseline as a check for reverse causation showed the same pattern (adjusted hazard ratio, 0.79; 95% CI, 0.70-0.89; P?<?.001). Associations were maintained after each life skill was omitted in turn from the aggregate score, indicating that no single positive attribute accounted for the protective association. Conclusions and Relevance:These findings suggest that noncognitive life skills are associated with survival at older ages. Whether training and education programs could enhance these attributes and influence mortality risk is not known, but fostering and maintaining life skills may be important in later life.
| S-EPMC7225907 | biostudies-literature
Project description:The World Health Organization has defined collective violence as the instrumental use of violence by people who identify themselves as members of a group against other individuals and have political, economic, or social objectives. In Chile, the "Social Outbreak" was used to describe an episode of collective violence, which began on October 18, 2019, triggered by a multitude of socioeconomic and political factors, with protests and mobilizations in the country's large and small cities; in central, commercial, and residential areas, that lasted for several months, affecting a large part of the population. The objective of the present study was to associate the social outbreak in Chile with its biological, psychological, and social effects on people's health and quality of life, as well as its characteristics in terms of exposure, proximity, type, and frequency. This was a cross-sectional study with non-probabilistic national-level sampling, conducted from 28 November 2019, to 3 March 2020. The instrument had four sections. A total of 2651 participants answered the survey; 70.8% were female, and the mean age was 35.2. The main disturbances perceived were protests (70.9%), alarm sounds (68.1%), shooting sounds (59.0%), and tear gas bombs (56.9%). When quantifying the magnitude of these associations, people who had a medium exposure have a higher probability (OR: 1.99, CI: 1.58; 2.50) of suffering three or more biological effects than people that have a low exposure, while people with higher exposition have a 4.09 times higher probability (CI: 3.11; 5.38). A similar pattern was observed regarding psychological effects, although social effects were primarily experienced by those with high exposure. Social networks, TV, and radio were the most used media among people who perceived a greater effect. People who lived, worked, or shopped near the disturbance's areas show a higher proportion negative effect.
| S-EPMC10706229 | biostudies-literature
Project description:Life skills play a key role in promoting educational and occupational success in early life, but their relevance at older ages is uncertain. Here we measured five life skills-conscientiousness, emotional stability, determination, control, and optimism-in 8,119 men and women aged 52 and older (mean 66.7 y). We show that the number of skills is associated with wealth, income, subjective wellbeing, less depression, low social isolation and loneliness, more close relationships, better self-rated health, fewer chronic diseases and impaired activities of daily living, faster walking speed, and favorable objective biomarkers (concentration of high-density lipoprotein cholesterol, vitamin D and C-reactive protein, and less central obesity). Life skills also predicted sustained psychological wellbeing, less loneliness, and a lower incidence of new chronic disease and physical impairment over a 4-y period. These analyses took account of age, sex, parental socioeconomic background, education, and cognitive function. No single life skill was responsible for the associations we observed, nor were they driven by factors such as socioeconomic status or health. Despite the vicissitudes of later life, life skills impact a range of outcomes, and the maintenance of these attributes may benefit the older population.
| S-EPMC5410802 | biostudies-other
Project description:BackgroundSocial isolation is a serious public health issue affecting a significant number of older adults worldwide. However, associations between different dimensions of social isolation and functional health are unclear. We assessed the varied effects of social isolation on health among a nationwide sample of older adults from China.MethodsWe assessed social isolation among 5,419 people aged 65 and older who took part in both the 2011 and 2014 waves of the Chinese Longitudinal Healthy Longevity Survey. Social isolation includes objective social isolation (kinlessness and lack of social contacts) and subjective social isolation. Four functional health outcomes were examined: self-rated health (SRH), activities of daily living (ADLs), instrumental activities of daily living (IADLs), and cognitive function measured by the Mini-Mental State Examination (MMSE). We used multivariable regression analyses to examine the associations between social isolation and health outcomes.ResultsOlder people who never married or who had recently lost a spouse were more likely to report poor SRH (OR=2.44) and difficulty with IADLs (ORs=1.46) than those who were married and lived with a spouse. Older people who never gave birth were less likely to report cognitive impairment (OR=0.53) than those who had living children, while older people who had recently lost a child were more likely to report poor SRH than those who had living children (OR=1.32). Older people who had no children visiting were more likely to report difficulty with IADLs than those who had children visiting (OR=1.25). In terms of subjective social isolation, older people who felt lonely were more likely to report poor SRH, cognitive impairment, and difficulty with ADLs and IADLs (ORs=1.19, 1.27, 1.28 and 1.21, respectively), and older people who had no one to talk to were more likely to report poor SRH, cognitive decline, and difficulty with ADLs and IADLs (ORs=2.08, 5.32, 2.06 and 1.98, respectively).ConclusionsKinlessness, lack of social contacts and subjective social isolation may impact various dimensions of health in older people. Due to the varied health consequences of social isolation, targeted health interventions should be developed to address relevant situations of social isolation.
| S-EPMC8683828 | biostudies-literature
Project description:Federal and local government agencies were quick to issue orders for residents to shelter-in-place in response to the COVID-19 outbreak. This study utilized data collected from Unacast Inc., spanning observations of 3,142 counties across 50 states and the District of Columbia (N = 230,846) from March 8, 2020 to April 13, 2020 (n = 104,930) and from April 14, 2020 to May 24, 2020 (n = 131,912) in a 3-level multilevel model to examine the correlates of social distancing behavior, as measured by the relative reduction in (1) distance traveled and (2) non-essential visitations since baseline pre-COVID-19 times. Results showed that educational attainment and political partisanship were the most consistent correlates of social distancing. State-level indicators of culture appeared to have differentiated effects depending on whether the model outcomes were reduction in general mobility or to non-essential venues. State-level neuroticism was generally positively related to social distancing, but states marked by high neuroticism were slower to engage in such behaviors. Counties and states characterized as already engaging in preventive health measures (e.g., vaccination rates, preparedness for at-risk populations) enjoyed quicker engagement in social distancing. Specific implications of findings and future directions are discussed.
| S-EPMC8385125 | biostudies-literature
Project description:ObjectiveWorkers approaching retirement may be particularly vulnerable to economic downturns. This study assesses whether exposure to economic downturns around retirement age leads to poorer cognitive function in later life.MethodLongitudinal data for 13,577 individuals in the Health and Retirement Study were linked to unemployment rates in state of residence. Random- and fixed-effect models were used to examine whether downturns at 55-64 years of age were associated with cognitive functioning levels and decline at ≥65 years, measured by the Wechsler Adult Intelligence Scale-Revised.ResultsLonger exposure to downturns at 55-64 years of age was associated with lower levels of cognitive function at ≥65 years. Compared to individuals experiencing only up to 1 year in a downturn at 55-64 years of age, individuals experiencing two downturns at these ages had 0.09 point (95% Confidence Interval [CI, -0.17, -0.02]) lower cognitive functioning scores at ≥65 years (3 years: b = -0.17, 95%CI [-0.29, -0.06]; 4 years: b = -0.14, 95%CI [-0.25, -0.02]; ≥5 years: b = -0.22, 95%CI [-0.38, -0.06]). Downturns at 55-64 years of age were not associated with rates of cognitive decline.DiscussionExposure to downturns around retirement is associated with a long-lasting decline in cognitive function in later life. Policies mitigating the impact of downturns on older workers may help to maintain cognitive function in later life.
| S-EPMC6018975 | biostudies-literature