Life course approach to understanding inequalities in health in later life

2017 ◽  
pp. 69-76 ◽  
Author(s):  
Ruth Bell ◽  
Michael Marmot
Keyword(s):  
Life Course ◽  
Social Functioning ◽  
Later Life ◽  
Older Age ◽  
Cognitive Changes ◽  
Healthy Life ◽  
Inequalities In Health ◽  
Biological Ageing ◽  
Life Course Approach ◽  
The Life Course

A long and healthy life is universally valued. The starkest inequalities in later life are how many years of life remain at an older age such as 65 years, and how many years of life that remain free from disabilities that impede physical, cognitive, and social functioning to the extent that they limit the sense of valuing one’s life. In this chapter we apply the frame of social determinants of health, using the life course approach to understand inequalities in health in later life. Healthy ageing is patterned by degrees of social advantage. Biological ageing, as revealed by physical and cognitive changes, is slower in people in better socioeconomic circumstances. These inequalities in health in later life need to be understood in terms of current social, economic, environmental conditions of living, as well as previous experiences and living conditions across the life course that affect the biological processes of ageing.

A life course approach for understanding later life sustainability

2017 ◽  
pp. 103-110
Author(s):  
Holly Syddall ◽  
Avan Aihie Sayer
Keyword(s):  
Physical Activity ◽  
Risk Factors ◽  
Life Course ◽  
Grip Strength ◽  
Optimal Strategies ◽  
Later Life ◽  
Present Evidence ◽  
Considerable Evidence ◽  
Life Course Approach ◽  
The Life Course

This chapter describes a life course approach for understanding later life sustainability, focusing on grip strength as a marker of physical sustainability, and explaining how a life course approach recognizes that muscle strength in later life reflects not only rate of loss in later life, but also the peak attained earlier in life. We present evidence that risk factors operating throughout the life course have an impact on physical sustainability in later life with particular consideration of the effects of body size, socioeconomic position, physical activity, diet, and smoking. We have shown that low birth weight is associated with weaker grip strength across the life course and that there is considerable evidence for developmental influences on ageing skeletal muscle. Finally, a life course approach suggests opportunities for early intervention to promote later life physical sustainability; but optimal strategies and timings for intervention are yet to be identified.

scholarly journals AGING SEXUAL STEREOTYPES AND SEXUAL EXPRESSION IN MID- AND LATER LIFE: EXAMINING THE STEREOTYPE MATCHING EFFECT

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S888-S888
Author(s):  
Maggie Syme ◽  
Tracy Cohn
Keyword(s):  
Older Adults ◽  
Life Course ◽  
Online Survey ◽  
Later Life ◽  
Older Age ◽  
Sexual Stereotypes ◽  
Matching Effect ◽  
Convenience Sample ◽  
Sexual Stigma ◽  
The Life Course

Abstract Ageist sexual stereotypes are culturally embedded and may prohibit midlife and older adults from achieving sexual wellness when internalized over the life course (i.e., stereotype embodiment), which was examined in the current study. A cross sectional, convenience sample of 972 adults aged 50 and older was recruited online via a crowdsourcing platform. Participants completed an online survey assessing aging sexual stigma and their participation in a spectrum of sexual and intimate behaviors. Two hierarchical linear regressions examined study hypotheses predicting a) sexual and b) intimate behaviors among middle age and older adults, while accounting for several known covariates (e.g., education, relationship status, health). Results suggest that older age (β = -.24, p < .001), being a woman (β = -.29, p < .001), and higher levels of aging sexual stigma (β = -.30, p < 0.001) were associated with less sexual activity (F(19, 945) = 32.51, p < .001, R2 = 0.40). For intimate behaviors, older age (β = -0.14, p < .05) and higher levels of aging sexual stigma (β = -0.24, p < .001) were significantly associated with lower levels of intimate activity (F(19, 945) = 39.80, p < .001, R2 = 0.45). Contrary to expectations, neither gender nor age cohort moderated the effect of aging sexual stigma. Ageist sexual stereotypes appear to affect individual sexual health and wellness via internalized beliefs. Future studies should focus on the potential malleability of aging sexual stigma beliefs, and at what point(s) in the life course they are modifiable.

scholarly journals Life-Course Transitions to Precarious Housing in Older Age

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 596-596
Author(s):  
Helen Barrie ◽  
Debbie Faulkner ◽  
Laurence Lester
Keyword(s):  
Older People ◽  
Life Course ◽  
Home Ownership ◽  
Later Life ◽  
Older Age ◽  
Middle Income ◽  
Life Course Transitions ◽  
Health And Wellbeing ◽  
Household Dynamics ◽  
The Life Course

Abstract Home is central to health and wellbeing; yet the changing nature of work, household dynamics and especially housing markets, with scant policy attention and action around this, means low-middle income households are struggling in many countries. In Australia, while older people are considered to be at less risk because of higher levels of home ownership, there is a growing body of evidence about the living situations of older people who have not attained or retained home ownership over the life course and have limited wealth and savings moving into later life. This paper presents the findings of multivariate regression modelling using HILDA, a national longitudinal panel survey, to identify the profile(s) of older people at risk of homelessness in Australia. The data makes it clear a range of structural and individual factors across the life course are increasingly impacting on the ability to live a good life in older age.

Life course, exposure, and ageing populations

2020 ◽  
pp. 21-28
Author(s):  
Yoav Ben-Shlomo
Keyword(s):  
Life Course ◽  
Positive Impact ◽  
Case Fatality ◽  
Later Life ◽  
Ageing Population ◽  
Life Outcomes ◽  
Preventative Measures ◽  
Life Course Approach ◽  
The Life Course ◽  
Older Populations

The demographic changes experienced globally mean that the 21st century faces the challenge of caring for an ageing population. Without preventative measures, this will be further aggravated by the successes of medical technologies which continue to reduce case fatality and hence add to the multi-morbid nature of older populations. A life-course approach to ageing conceptualizes the different trajectories by which traits may decline before leading to clinical disease or disability. It highlights gaps in our current understanding of the drivers of such trajectories and periods where the timing of adverse exposures may have a disproportionate negative or positive impact on later life outcomes. This is illustrated with a wide variety of examples and applied to neurodegenerative disorders such as dementia. Future primary and secondary preventative measures must consider interventions across the whole of the life course.

A life course approach for understanding later life sustainability

2017 ◽  
pp. 103-110
Author(s):  
Richard Dodds ◽  
Holly Syddall ◽  
Avan Aihie Sayer
Keyword(s):  
Life Course ◽  
Grip Strength ◽  
Optimal Strategies ◽  
Later Life ◽  
Long Term Conditions ◽  
Present Evidence ◽  
Considerable Evidence ◽  
Life Course Approach ◽  
The Life Course

This chapter describes a life course approach for understanding later life sustainability, focusing on grip strength as a marker of physical sustainability, and explaining how a life course approach recognizes that muscle strength in later life reflects not only rate of loss in later life, but also the peak attained earlier in life. We present evidence that risk factors operating throughout the life course have an impact on physical sustainability in later life with particular consideration of the effects of body size, socioeconomic position, long-term conditions, physical activity, diet, and smoking. We have shown that low birth weight is associated with weaker grip strength across the life course and that there is considerable evidence for developmental influences on ageing skeletal muscle. Finally, a life course approach suggests opportunities for early intervention to promote later life physical sustainability; but optimal strategies and timings for intervention are yet to be identified.

Associations between life-course frailty and later-life heart size and function in the 1946 NSHD British birth cohort-an epidemiological study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C.C Topriceanu ◽  
J.C Moon ◽  
R Hardy ◽  
A.D Hughes ◽  
N Chaturvedi ◽  
...  
Keyword(s):  
Life Course ◽  
Birth Cohort ◽  
Frailty Index ◽  
Later Life ◽  
Left Ventricular ◽  
Step Change ◽  
Deficit Accumulation ◽  
Heart Size ◽  
And Function ◽  
The Life Course

Abstract Background Cardiovascular diseases are an important component of the multi-morbidity syndrome which is associated with negative health outcomes resulting in a major societal economic burden. An objective way to assess multi-morbidity is to calculate a frailty index based on medical deficit accumulation. Late-life frailty has been validated to predict mortality, but little is known about the association between life-course frailty and cardiovascular health in later-life. Purpose To study the association between life-course frailty and later-life heart size and function using data from the world's longest running birth cohort with continuous follow-up. Methods A 45-deficit frailty index (FI) was calculated at 4 age-intervals across the life-course (0 to 16 years old, 19 to 44 years old, 45 to 54 years old and 60 to 64 years old) in participants from the UK 1946 Medical Research Council (MRC) National Survey of Heath and Development (NSHD) birth cohort. The life-course frailty indices (FI0_16, FI19_44, FI45_54 and FI60_64) reflect the cumulative medical deficits at the corresponding age-intervals. They were used to derive FImean and FIsum reflecting overall-life frailty. The step change in deficit accumulation between age-intervals was also calculated (FI2-1, FI3-1, FI4-1, FI3-2, FI4-2, FI4-3). Echocardiographic data at 60–64 years provided: E/e' ratio, ejection fraction (EF), myocardial contraction fraction index (MCFi) and left ventricular mass index (LVmassi). Generalized linear mixed models with gamma distribution and log link assessed the association between FIs and echo parameters after adjustment for sex, socio-economic position and body mass index. Results 1.805 NSHD participants were included (834 male). Accumulation of a single deficit had a significant impact (p<0.0001 to p<0.049) on LVmassi and MCFi in all the life-course FIs and overall FIs. LVmassi increased by 0.89% to 1.42% for the life-course FIs and by 0.36%/1.82% for FIsum and FImean respectively. MCFi decreased by 0.62% to 1.02% for the life-course FIs and by 0.33%/ 1.04%. for FIsum and FImean respectively. One accumulated deficit translated into higher multiplicative odds (13.2 for FI60-64, 2.1 for FI4-1, 75.4 for FI4-2 and 78.5 for FI4-3) of elevated filling pressure (defined as E/e' ratio >13, p<0.0.005 to p<0.02).A unit increase in frailty decreased LV EF (%) by 11%/12% for FI45-54 and FI60-64 respectively, by 10% to 12% for FI2-1, FI3-1, FI4-1 and FI4-2, and 4%/15% for FIsum and FImean respectively (p<0.0014 to p<0.044). Conclusion Frailty during the life-course, overall life-frailty and the step change in deficit accumulation is associated with later-life cardiac dysfunction. Frailty strain appears to have its greatest impact on pathological myocardial hypertrophy (high LVmassi and low MCFi) potentially paving the way to later-life systolic or diastolic dysfunction in susceptible individuals. Funding Acknowledgement Type of funding source: None

scholarly journals Body size throughout the life-course and incident benign prostatic hyperplasia-related outcomes and nocturia

BMC Urology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Saira Khan ◽  
K. Y. Wolin ◽  
R. Pakpahan ◽  
R. L. Grubb ◽  
G. A. Colditz ◽  
...  
Keyword(s):  
Body Size ◽  
Benign Prostatic Hyperplasia ◽  
Life Course ◽  
Early Life ◽  
Prostate Volume ◽  
Late Life ◽  
Later Life ◽  
Normal Weight ◽  
Prostatic Hyperplasia ◽  
The Life Course

Abstract Background Existing evidence suggests that there is an association between body size and prevalent Benign Prostatic Hyperplasia (BPH)-related outcomes and nocturia. However, there is limited evidence on the association between body size throughout the life-course and incident BPH-related outcomes. Methods Our study population consisted of men without histories of prostate cancer, BPH-related outcomes, or nocturia in the intervention arm of the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO) (n = 4710). Associations for body size in early- (age 20), mid- (age 50) and late-life (age ≥ 55, mean age 60.7 years) and weight change with incident BPH-related outcomes (including self-reported nocturia and physician diagnosis of BPH, digital rectal examination-estimated prostate volume ≥ 30 cc, and prostate-specific antigen [PSA] concentration > 1.4 ng/mL) were examined using Poisson regression with robust variance estimation. Results Men who were obese in late-life were 25% more likely to report nocturia (Relative Risk (RR): 1.25, 95% Confidence Interval (CI): 1.11–1.40; p-trendfor continuous BMI < 0.0001) and men who were either overweight or obese in late-life were more likely to report a prostate volume ≥ 30 cc (RRoverweight: 1.13, 95% CI 1.07–1.21; RRobese: 1.10, 95% CI 1.02–1.19; p-trendfor continuous BMI = 0.017) as compared to normal weight men. Obesity at ages 20 and 50 was similarly associated with both nocturia and prostate volume ≥ 30 cc. Considering trajectories of body size, men who were normal weight at age 20 and became overweight or obese by later-life had increased risks of nocturia (RRnormal to overweight: 1.09, 95% CI 0.98–1.22; RRnormal to obese: 1.28, 95% CI 1.10–1.47) and a prostate volume ≥ 30 cc (RRnormal to overweight: 1.12, 95% CI 1.05–1.20). Too few men were obese early in life to examine the independent effect of early-life body size. Later-life body size modified the association between physical activity and nocturia. Conclusions We found that later-life body size, independent of early-life body size, was associated with adverse BPH outcomes, suggesting that interventions to reduce body size even late in life can potentially reduce the burden of BPH-related outcomes and nocturia.

scholarly journals A Life Course Approach to Inequality: Examining Racial/Ethnic Differences in the Relationship between Early Life Socioeconomic Conditions and Health in Later Life Among Men

2015 ◽  
Vol 25 (3) ◽  
pp. 313 ◽  
Author(s):  
Taylor W. Hargrove, MA ◽  
Tyson H. Brown, PhD
Keyword(s):  
Life Course ◽  
Mexican American ◽  
White Men ◽  
Later Life ◽  
Adult Health ◽  
Socioeconomic Conditions ◽  
Growth Curve Models ◽  
Life Course Approach ◽  
Race Ethnicity ◽  
Racial Ethnic

<br clear="all" /><p> </p><p> <strong>Objective: </strong>Previous research has docu­mented a relationship between childhood socioeconomic conditions and adult health, but less is known about racial/ethnic dif­ferences in this relationship, particularly among men. This study utilizes a life course approach to investigate racial/ethnic differ­ences in the relationships among early and later life socioeconomic circumstances and health in adulthood among men.</p><p><strong>Design: </strong>Panel data from the Health and Retirement Study and growth curve models are used to examine group differences in the relationships among childhood and adult socioeconomic factors and age-tra­jectories of self-rated health among White, Black and Mexican American men aged 51-77 years (<em>N</em>=4147).</p><p><strong>Results: </strong>Multiple measures of childhood socioeconomic status (SES) predict health in adulthood for White men, while significant­ly fewer measures of childhood SES predict health for Black and Mexican American men. Moreover, the health consequences of childhood SES diminish with age for Black and Mexican American men. The child­hood SES-adult health relationship is largely explained by measures of adult SES for White men.</p><p><strong>Conclusion: </strong>The life course pathways link­ing childhood SES and adult health differ by race/ethnicity among men. Similar to argu­ments that the universality of the adult SES-health relationship should not be assumed, results from our study suggest that scholars should not assume that the significance and nature of the association between child­hood SES and health in adulthood is similar across race/ethnicity among men.<em> Ethn Dis.</em>2015;25(3):313-320.</p>

Sex in an ideology of love

2017 ◽  
Author(s):  
Torbjörn Bildtgård ◽  
Peter Öberg
Keyword(s):  
Older People ◽  
Life Course ◽  
Case Studies ◽  
Intimate Relationships ◽  
Later Life ◽  
Sexual Intimacy ◽  
Sexual Norms ◽  
Gerontological Research ◽  
The Life Course ◽  
Loving Relationship

Until recently the sex life of older people was more or less invisible in family and gerontological research. This chapter contributes to breaking this silence by focusing on the role and meaning of sex in intimate relationships in later life. Based on biographical case studies, the chapter investigates how sexual norms have changed over the life course of contemporary cohorts of older people and how they have experienced this change. The chapter considers sexual intimacy as part of new intimate relationships established late in life and questions the persistent assumption that older people who date are primarily looking for companionate relationships. It is shown that older people’s ideas about sex are deeply embedded in an ideology of love, where sex tends to be viewed as a natural part of a loving relationship, while sex outside of a loving relationship – also in a loveless marriage – is frowned on.

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