scholarly journals Robust Respondents and Lost Limitations: The Implications of Nonrandom Missingness for the Estimation of Health Trajectories

2017 ◽  
Vol 31 (4) ◽  
pp. 685-708 ◽  
Author(s):  
Heide Jackson ◽  
Michal Engelman ◽  
Karen Bandeen-Roche
Keyword(s):  
Missing Data ◽  
Latent Class ◽  
Functional Limitations ◽  
Functional Limitation ◽  
Later Life ◽  
Full Information Maximum Likelihood ◽  
Health Trajectories ◽  
Aging Populations ◽  
The Impact

Objective: We offer a strategy for quantifying the impact of mortality and attrition on inferences from later-life health trajectory models. Method: Using latent class growth analysis (LCGA), we identify functional limitation trajectory classes in the Health and Retirement Study. We compare results from complete case and full information maximum likelihood (FIML) analyses, and demonstrate a method for producing upper- and lower-bound estimates of the impact of attrition on results. Results: LCGA inferences vary substantially depending on the handling of missing data. For older adults who die during the follow-up period, the widely used FIML approach may underestimate functional limitations by up to 20%. Discussion: The most commonly used approaches to handling missing data likely underestimate the extent of poor health in aging populations. Although there is no single solution for nonrandom missingness, we show that bounding estimates can help analysts to better characterize patterns of health in later life.

scholarly journals Increased development of radiographic hip osteoarthritis in individuals with high bone mass: a prospective cohort study

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
April Hartley ◽  
Sarah A. Hardcastle ◽  
Monika Frysz ◽  
Jon Parkinson ◽  
Lavinia Paternoster ◽  
...  
Keyword(s):  
Bone Mass ◽  
Functional Limitations ◽  
Functional Limitation ◽  
Hip Osteoarthritis ◽  
Joint Space ◽  
Mineral Density ◽  
High Bone Mass ◽  
High Bone ◽  
Subchondral Sclerosis

Abstract Background Individuals with high bone mass (HBM) have a greater odds of prevalent radiographic hip osteoarthritis (OA), reflecting an association with bone-forming OA sub-phenotypes (e.g. osteophytosis, subchondral sclerosis). As the role of bone mineral density (BMD) in hip OA progression is unclear, we aimed to determine if individuals with HBM have increased incidence and/or progression of bone-forming OA sub-phenotypes. Methods We analysed an adult cohort with and without HBM (L1 and/or total hip BMD Z-score > + 3.2) with pelvic radiographs collected at baseline and 8-year follow-up. Sub-phenotypes were graded using the OARSI atlas. Superior/inferior acetabular/femoral osteophyte and medial/superior joint space narrowing (JSN) grades were summed and Δosteophyte and ΔJSN derived. Pain and functional limitations were quantified using the WOMAC questionnaire. Associations between HBM status and change in OA sub-phenotypes were determined using multivariable linear/logistic regression, adjusting for age, sex, height, total body fat mass, follow-up time and baseline sub-phenotype grade. Generalised estimating equations accounted for individual-level clustering. Results Of 136 individuals, 62% had HBM at baseline, 72% were female and mean (SD) age was 59 (10) years. HBM was positively associated with both Δosteophytes and ΔJSN (adjusted mean grade differences between individuals with and without HBM βosteophyte = 0.30 [0.01, 0.58], p = 0.019 and βJSN = 0.10 [0.01, 0.18], p = 0.019). Incident subchondral sclerosis was rare. HBM individuals had higher WOMAC hip functional limitation scores (β = 8.3 [0.7, 15.98], p = 0.032). Conclusions HBM is associated with the worsening of hip osteophytes and JSN over an average of 8 years, as well as increased hip pain and functional limitation.

scholarly journals The impact of meningitis on the motor function of adult survivors in Harare, Zimbabwe

1999 ◽  
Vol 55 (1) ◽  
pp. 6-10
Author(s):  
Jennifer Jelsma ◽  
Helen Lilley ◽  
Helen Smith ◽  
Jens Mielke ◽  
James Hakim ◽  
...  
Keyword(s):  
Functional Disability ◽  
Functional Limitation ◽  
Adult Survivors ◽  
Stepwise Logistic Regression ◽  
Motor Impairments ◽  
Forward Stepwise ◽  
The One ◽  
A Prospective Study ◽  
The Impact

Objective: The study aimed to document the spectrum of motor impairments and the degree of functional limitation of those who survived adult meningitis and to identify which factors were associated with a poor functional outcome and mortality.Methods: A prospective study was undertaken in the central hospitals in Harare, Zimbabwe. Twenty six adult patients who had survived meningitis were interviewed between one and five months post-admission. Seventeen of these were examined in the clinic for signs of impairment. Nine did not attend the follow-up session and were interviewed at home. The Barthel Activities of Daily Living Index (BI) was administered to all twenty six subjects.Results: Twenty subjects were HIV sero-positive. Eight subjects died in the time period between the one month interview and the final follow-up five months later. The majority of the seventeen examined in the clinic, demonstrated sensory and motor disturbances. Seven of the twenty six subjects scored eighteen or less on the BI. Forward stepwise logistic regression revealed that a low BI was the only variable which significantly predicted mortality (p.<0.01). The odds of a patient with a low BI dying were 63 times the odds of a patient dying who had a normal BI.Discussion and Conclusions: Survivors of meningitis in this study displayed a diversity of impairments and disabilities. Rehabilitation intervention is recommended to provide functional reeducation and support for those with a low BI and to mitigate against the effects of the impairments. A measure of functional disability should be included in the examination of these clients as functional impairment appears to be a predictor of mortality.

Ten-Year Course of Cosmic Transcendence in Older Adults in the Netherlands

2016 ◽  
Vol 84 (1) ◽  
pp. 44-65 ◽  
Author(s):  
Arjan W. Braam ◽  
Henrike Galenkamp ◽  
Peter Derkx ◽  
Marja J. Aartsen ◽  
Dorly J. H. Deeg
Keyword(s):  
Cognitive Ability ◽  
Latent Class ◽  
Later Life ◽  
Roman Catholic ◽  
Longitudinal Aging Study Amsterdam ◽  
Aging Study ◽  
Longitudinal Aging Study ◽  
Cosmic Transcendence ◽  
Sense Of Mastery

Objectives Gerotranscendence is defined as a transition from a materialistic and rationalistic perspective to a more cosmic and transcendent view of life accompanying the aging process. Would gerotranscendence levels still increase in later life? The current prospective study investigates 10-year trajectories of cosmic transcendence (a core dimension of gerotranscendence). Methods Four interview cycles of the Longitudinal Aging Study Amsterdam with 3-year intervals from 1995 to 2006 provide data on cosmic transcendence, demographics (ages 57–85), religiousness, health, sense of mastery, and humor coping. Data are available for 2,257 respondents and 1,533 respondents in multivariate models. Results Latent Class Growth Analysis shows three course trajectories of cosmic transcendence: stable high, intermediate with a decrease, and stable low. Higher levels are predicted by age, importance of prayer, Roman Catholic affiliation, a low sense of mastery, higher cognitive ability, and humor coping. Similar results were obtained for the respondents who died during the study ( N = 378). Discussion Although levels of cosmic transcendence do not show much change during 10 years of follow-up, the oldest respondents nonetheless attain the highest cosmic transcendence levels. An inclination toward relativism and contemplation may facilitate cosmic transcendence. However, lower cognitive ability probably impairs the development toward cosmic transcendence.

scholarly journals Deaths, Disparities, and Cumulative (Dis)Advantage: How Social Inequities Produce an Impairment Paradox in Later Life

2021 ◽  
Author(s):  
Heide Jackson ◽  
Michal Engelman
Keyword(s):  
Black Women ◽  
Multinomial Logistic Regression ◽  
Functional Limitations ◽  
Later Life ◽  
Functional Health ◽  
Race And Gender ◽  
Nationally Representative ◽  
And Gender ◽  
Gender Groups ◽  
The Impact

Abstract Background Research on health across the life course consistently documents widening racial and socioeconomic disparities from childhood through adulthood, followed by stabilization or convergence in later life. This pattern appears to contradict expectations set by cumulative (dis)advantage (CAD) theory. Informed by the punctuated equilibrium perspective, we examine the relationship between midlife health and subsequent health change and mortality and consider the impact of earlier socioeconomic exposures on observed disparities. Methods Using the Health and Retirement Study, we characterize the functional impairment histories of a nationally-representative sample of 8,464 older adults between 1994-2016. We employ non-parametric and discrete outcome multinomial logistic regression to examine the competing risks of mortality, health change, and attrition. Results Exposures to disadvantages are associated with poorer functional health in midlife and mortality. However, a higher number of functional limitations in midlife is negatively associated with the accumulation of subsequent limitations for white men and women and for Black women. The impact of educational attainment, occupation, wealth, and marriage on later life health differs across race and gender groups. Conclusions Observed stability or convergence in later-life functional health disparities is not a departure from the dynamics posited by CAD, but rather a result of the differential impact of racial and socioeconomic inequities on mortality and health at older ages. Higher exposure to disadvantages and a lower protective impact of advantageous exposures lead to higher mortality among Black Americans, a pattern which masks persistent health inequities later in life.

scholarly journals Effectiveness of a Multifactorial Intervention in the First 1000 Days of Life to Prevent Obesity and Overweight in Childhood: Study Protocol

2020 ◽  
Vol 17 (7) ◽  
pp. 2239
Author(s):  
Mercedes Díaz-Rodríguez ◽  
Celia Pérez-Muñoz ◽  
José Manuel Lendínez-de la Cruz ◽  
Martina Fernández-Gutiérrez ◽  
Pilar Bas-Sarmiento ◽  
...  
Keyword(s):  
Controlled Trial ◽  
Later Life ◽  
Randomized Controlled ◽  
Early Programming ◽  
Obesity And Overweight ◽  
Data Collection Sheet ◽  
Ethical Approval ◽  
The Impact ◽  
Global Health Problem

(1) Background: Obesity is a global health problem, and its prevention must be a priority goal of public health, especially considering the seriousness of the problem among children. It is known that fetal and early postnatal environments may favor the appearance of obesity in later life. In recent years, the impact of the programs to prevent obesity in childhood has been scarce. The aim of this research is to evaluate the effectiveness of an intervention based on the concept of early programming. (2) Methods: Non-randomized controlled trial design. Inclusion criteria are: two-year-old infants whose gestational period begins in the 14 months following the start of the intervention, and whose mothers have made the complete follow-up of their pregnancy in the same clinical unit of the study. The intervention will be developed over all the known factors that affect early programming, during pregnancy up to 2 years of life. Data will be collected through a data collection sheet by the paediatricians. A unibivariate and multivariate analysis of the data will be carried out. (3) Ethics and dissemination: The trial does not involve any risk to participants and their offspring. Signed informed consent is obtained from all participants. Ethical approval has been obtained. (4) Results: It is expected that this study will provide evidence on the importance of the prevention of obesity from the critical period of the first 1000 days of life, being able to establish this as a standard intervention in primary care.

Empowering Native Adolescents: Responsibility for Their Health Behaviors

2021 ◽  
Vol 45 (1) ◽  
pp. 3-16
Author(s):  
Rachel A. Chambers ◽  
Dane Hautala ◽  
Anne Kenney ◽  
Summer Rosenstock ◽  
Marissa Begay ◽  
...  
Keyword(s):  
Native American ◽  
Prevention Program ◽  
Diabetes Prevention ◽  
Latent Class ◽  
Diabetes Prevention Program ◽  
Transition Analysis ◽  
Home Based ◽  
The Impact ◽  
Diabetes And Obesity

Objectives: In this study, we assess the impact of a home-based diabetes prevention program, Together on Diabetes (TOD), on adolescent responsibility-taking for tasks related to diabetes risk. Methods: Participants were Native American youth ages 10-19 with or at risk of type 2 diabetes who participated in a 12-session, 6-month diabetes prevention program with an adult caretaker. Assessments completed at baseline, 6-month, and 12-month follow-up include demographics and the Diabetes and Obesity Task Sharing (DOTS) Questionnaire. We used latent class analysis (LCA) at baseline to examine heterogeneity in DOTS responses. We identified 3 classes (adolescent, shared, caretaker). We used latent transition analysis to examine stability and change in latent status at baseline, 6- and 12-month follow-up. Results: At baseline, the mean age of participants was 13.6 years and 55.9% were boys. From baseline to 6-month follow-up, the adolescent class was most stable, whereas the shared and caretaker classes were less stable. For participants who transition from the adolescent class, most transition to shared class compared to caretaker class. Conclusions: TOD helps to empower Native American adolescents to take responsibility for their health and engage with their caregivers in these decisions.

scholarly journals FUNCTIONAL LIMITATION IN LATER LIFE: THE IMPACT OF SIPS, SOCIALIZATION, AND SADNESS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S565-S565
Author(s):  
Rosanna Scott ◽  
Chelsea Wiener ◽  
Daniel Paulson
Keyword(s):  
Depressive Symptoms ◽  
Social Interaction ◽  
Alcohol Use ◽  
Health Outcomes ◽  
Selection Bias ◽  
Functional Limitation ◽  
Later Life ◽  
Demographic Variables ◽  
Moderate Drinking ◽  
The Impact

Abstract Recent studies posit discrepant impacts of alcohol use on health outcomes. Potential reasons for contrasting results include: (1) selection bias involved in classifying individuals as “abstainers” or “drinkers,” (2) unexamined demographic variables associated with alcohol use, and (3) unaddressed mechanisms of action. Given new studies identifying socialization as a mediator between alcohol use and health outcomes, this study examines social interaction and depressive symptoms, respectively, as serial mediators in the relationship between moderate alcohol use and functional limitation, while employing methods to reduce selection bias. HRS data from 2012 and 2014 were utilized (n=1,902); heavy drinkers, adults younger than 65, and respondents with inconsistent alcohol use from 2008 to 2014 were excluded. Hypotheses were evaluated using a longitudinal serial mediation model with bias-corrected bootstrapping. Results indicated that, in the context of demographic variables, medical burden, and previous functional limitation, the beneficial relationship between moderate alcohol use and future functional limitation is only present when considering social interaction and depressive symptoms as mediators, both individually and serially (variance accounted for=39.4%). There was no direct effect of moderate alcohol use on functional limitation outside the context of these mediators. Data indicate that previously suggested relationships between moderate drinking and reduced functional limitation are better explained through increased social interaction and subsequent reduced depressive symptoms. Results identify social interaction as an accessible treatment target to prevent/reduce depressive symptoms and functional limitation in later-life, and support increased assessment of IADLs in adults experiencing depressive symptoms to facilitate early treatment/prevention of functional limitation.

scholarly journals What Are the Key Workplace Influences on Pathways of Work Ability? A Six-Year Follow Up

2019 ◽  
Vol 16 (13) ◽  
pp. 2363 ◽  
Author(s):  
Jodi Oakman ◽  
Subas Neupane ◽  
K.C. Prakash ◽  
Clas-Håkan Nygård
Keyword(s):  
Musculoskeletal Pain ◽  
Working Conditions ◽  
Work Ability ◽  
Latent Class ◽  
Good Work ◽  
Physical Strain ◽  
Effective Prevention ◽  
Multisite Pain ◽  
The Impact

Objective: To study the trajectories of work ability and investigate the impact of multisite pain and working conditions on pathways of work ability over a six-year period. Methods: The longitudinal study was conducted with Finnish food industry workers (n = 866) with data collected every 2 years from 2003–2009. Questions covered musculoskeletal pain, physical and psychosocial working conditions (physical strain, repetitive movements, awkward postures; mental strain, team support, leadership, possibility to influence) and work ability. Latent class growth analysis and logistic regression were used to analyse the impact of multisite pain and working conditions on work ability trajectories (pathways). Results: Three trajectories of work ability emerged: decreasing (5%), increasing (5%), and good (90%). In the former two trajectories, the mean score of work ability changed from good to poor and poor to good during follow-up, while in the latter, individuals maintained good work ability during the follow-up. In the multivariable adjusted model, number of pain sites was significantly associated with higher odds of belonging to the trajectory of poor work ability (Odds ratio (OR) 4 pain sites 2.96, 1.25–7.03). Conclusions: A substantial number of employees maintained good work ability across the follow up. However, for employees with poor work ability, multisite musculoskeletal pain has an important influence, with effective prevention strategies required to reduce its prevalence.

scholarly journals The Impacts Of Socio-Economic Challenge On Long-Term Physical and Mental Health In Retirement Age

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 1057-1058
Author(s):  
Ilan Kwon ◽  
Sojung Park ◽  
BoRin Kim ◽  
ByeongJu Ryu
Keyword(s):  
Mental Health ◽  
Latent Class Analysis ◽  
Latent Class ◽  
Later Life ◽  
The United States ◽  
Class Analysis ◽  
Physical And Mental Health ◽  
Term Care ◽  
The Impact

Abstract Despite consistent evidence on the negative effect of social and economic challenges on health, little is known about the pattern of economic difficulties people experience and the impact of those challenging patterns on long-term health in later life. This study used the national data, Mid Life in the United States (MIDUS 3 in 2013-2014), to identify the different patterns of socio-economic challenges that older Americans (50-64 ages old) experienced during the Recession in 2008 and to examine the impact of past challenging experiences on physical and mental health in their later life. Socio-economic challenges included twenty-six items such as losing or moving a job, missing rent, selling or losing a home, bankruptcy, having debts, and cutting spending. We conducted the latent class analysis and regression while controlling other social determinant factors (e.g., education, employment status, poverty, etc.). The latent class analysis result found five patterns during the Recession: people who experienced various difficulties during the Recession, who moved their jobs, who experienced financial difficulties, who bought a home with decreased debts, and who experienced no difficulty. Compared to people with no challenging experience, those who needed to move their jobs but could make debt off during the Recession reported physically healthier, but not mentally healthier in later life. Interestingly, among this group, women reported more long-term physical health problems than men. The findings suggest the close connection between physical and mental health and the importance of long-term care for mental health among older adults in recovering from socio-economic challenges.

Precarious Work in Midlife: Long-Term Implications for the Health and Mortality of Women and Men

2021 ◽  
pp. 002214652110550
Author(s):  
Rachel Donnelly
Keyword(s):  
Mortality Risk ◽  
Job Insecurity ◽  
Functional Limitations ◽  
Later Life ◽  
Health Consequences ◽  
Precarious Work ◽  
Health Trajectories ◽  
Aging Adults ◽  
Health And Mortality

Although prior research documents adverse health consequences of precarious work, we know less about how chronic exposure to precarious work in midlife shapes health trajectories among aging adults. The present study uses longitudinal data from the Health and Retirement Study to consider how histories of precarious work in later midlife (ages 50–65) shape trajectories of health and mortality risk after age 65. Results show that greater exposure to unemployment, job insecurity, and insufficient work hours in midlife predicts more chronic conditions and functional limitations after age 65. Characteristics of precarious work also predict increased mortality risk in later life. Findings indicate few gender differences in linkages between precarious work and health; however, women are more likely than men to experience job insecurity throughout midlife. Because precarious work is unlikely to abate, results suggest the need to reduce the health consequences of working in precarious jobs.

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