Charlotte Juul Nilsson

Can the higher risk of disability onset among older people who live alone be alleviated by strong social relations? A longitudinal study of non-disabled men and women

PURPOSE to investigate if the increased risk of disability onset among older people who live alone could possibly be moderated by either high social participation or by being satisfied with the social relations. DESIGN AND METHODS logistic regression models were tested using two waves in a study population of 2,697 non-disabled older men and women from The Danish Longitudinal Study on Preventive Home Visits. RESULTS living alone and low social participation were significant risk factors for later male disability onset. Not being satisfied with the social relations was significantly associated with onset of disability for both genders. Among men who lived alone low social participation was a significant predictor of disability onset [odds ratio, OR = 2.30 (1.00-5.29)]; for cohabiting men social participation was not associated with disability onset, [adjusted OR = 0.91 (0.49-1.71)]. Similar results were present concerning satisfaction with the social relations among men. There was no significant interaction for women. CONCLUSIONS the study suggests that men who live alone can possibly alleviate their risk of disability onset by being socially active and by having access to satisfactory social relations. Women do not seem to benefit as much from cohabitation as men, although women who live alone and who are not satisfied with their social relations also constitute a significant risk category.

Addressing Social Inequality in Aging by the Danish Occupational Social Class Measurement

Objective: To present the Danish Occupational Social Class (DOSC) measurement as a measure of socioeconomic position (SEP) applicable in a late midlife population, and to analyze associations of this measure with three aging-related outcomes in midlife, adjusting for education. Method: Systematic coding procedures of the DOSC measurement were applied to 7,084 participants from the Copenhagen Aging and Midlife Biobank (CAMB) survey. We examined the association of this measure of SEP with chronic conditions, self-rated health, and mobility in logistic regression analyses, adjusting for school education in the final analysis. Results: The measure of SEP showed a strong social gradient along the social classes in terms of prevalence of chronic conditions, poor self-rated health, and mobility limitations. Adjusting for school education attenuated the association only to a minor degree. Discussion: The DOSC measure was associated with aging-related outcomes in a midlife Danish population, and is, thus, well suited for future epidemiological research on social inequalities in health and aging.

Onset of mobility limitations in old age: the combined effect of socioeconomic position and social relations

PURPOSE to examine the combined effect of cohabitation status and social participation, respectively, and socioeconomic position on onset of mobility limitations in a prospective study among older Danes. DESIGN AND METHODS logistic regression analyses with combined exposure variables were performed in a study population of 2,839 older men and women from the Danish Intervention Study on Preventive Home Visits. RESULTS among men low financial assets, living alone or having low social participation significantly increased the odds ratios (OR) for onset of mobility limitations. Among women only low financial assets and low social participation significantly increased the ORs for onset of mobility limitations. Analyses with combined exposure variables showed that simultaneous exposure to low financial assets and poor social relations significantly increased the ORs for onset of mobility limitations among both genders, yet the tendencies appeared stronger for males. In particular, men with simultaneous exposure to low financial assets and low social participation had increased odds ratios for onset of mobility limitations, OR = 5.36 (2.51-11.47), compared with the non-exposed. CONCLUSION the study suggests that future interventions to increase social participation might alleviate the negative effects on mobility experienced by older people in low socioeconomic position, perhaps especially among older males.

Social Inequality in Onset of Mobility Disability Among Older Danes: The Mediation Effect of Social Relations

Objective: This article investigates social inequality in onset of mobility disability and in measures of social relations and whether social relations mediated the effect of socioeconomic status on mobility. Method: A total of 2,825 nondisabled older men and women, enrolled in the Danish Intervention Study on Preventive Home Visits, constituted the study population. Data were obtained by mailed questionnaires in 1998-1999 and 2001-2002 and by merging analyses to registers at Statistics Denmark. Results: There was a social gradient in onset of mobility disability, with odds ratio of 1.11 (1.07-1.15) per step down the deciles of financial assets and in cohabitation status, social participation, and network diversity. Social relations did not mediate the effect of financial assets on onset of mobility disability. Discussion: The negative effects of low financial assets and poor social relations on mobility appear to be independent. More longitudinal studies on possible mediators of the social gradient in mobility among older people are needed.

Social Class Differences in Physical Functions in Middle-Aged Men and Women:

Objective: The objective of the present study is to analyze gender differences and social class gradients in physical functions; and to study whether the social class gradients in physical functions in midlife differed between men and women. Method: This study used traditionally used physical performance tests and we added several tests of vigorous physical functioning (trunk muscle strength and power and sagittal flexibility). We measured reaction time, one-legged balance, sagittal flexibility, jump height, chair rise ability, trunk muscle- and handgrip strength in 5,412 participants aged 50 to 60 years (68.5% men). Results: We found gender differences and social class gradients for all physical performance tests. We did not find an interaction between social class and gender, indicating that the social gradient in physical functions did not differ between men and women. Discussion: Including measures of vigorous physical functioning may add to the existing knowledge on development of functional limitation and poorer functional health later in life.

Cohabitation status and onset of disability among older Danes: is social participation a possible mediator?

Objectives: To investigate the effect of cohabitation status in older men and women on (a) onset of disability at 3- and 4.5-year follow-up and (b) changes in functional ability between 3- and 4.5-year follow-up, and to analyze whether this effect was mediated by social participation. Method: A total of 2,533 nondisabled older men and women enrolled in the Danish Intervention Study on Preventive Home Visits constituted the study population. Data were collected by mailed questionnaires in 1998-1999, 2000, 2001-2002, and 2003. Results: Living alone significantly increased the risk of onset of disability (T3 OR = 1.60[1.06-2.43], T4 OR = 1.74[1.22-2.47]) and the risk of sustained poor functional ability (OR = 2.35[1.44-3.84]) among men, but not among single-living women. Social participation mediated only a small part of the effect of cohabitation status on functional ability. Discussion: Our results underline the importance of cohabitation/marriage for maintaining a high functional ability among older men.

Stressful social relations and mortality: a prospective cohort study

Background Few studies have examined the relationship between stressful social relations in private life and all-cause mortality. Objective To evaluate the association between stressful social relations (with partner, children, other family, friends and neighbours, respectively) and all-cause mortality in a large population-based study of middle-aged men and women. Further, to investigate the possible modification of this association by labour force participation and gender. Methods We used baseline data (2000) from The Danish Longitudinal Study on Work, Unemployment and Health, including 9875 men and women aged 36–52 years, linked to the Danish Cause of Death Registry for information on all-cause mortality until 31 December 2011. Associations between stressful social relations with partner, children, other family, friends and neighbours, respectively, and all-cause mortality were examined using Cox proportional hazards models adjusted for age, gender, cohabitation status, occupational social class, hospitalisation with chronic disorder 1980–baseline, depressive symptoms and perceived emotional support. Modification by gender and labour force participation was investigated by an additive hazards model. Results Frequent worries/demands from partner or children were associated with 50–100% increased mortality risk. Frequent conflicts with any type of social relation were associated with 2–3 times increased mortality risk. Interaction between labour force participation and worries/demands (462 additional cases per 100 000 person-years, p=0.05) and conflicts with partner (830 additional cases per 100 000 person-years, p<0.01) was suggested. Being male and experiencing frequent worries/demands from partner produced 135 extra cases per 100 000 person-years, p=0.05 due to interaction. Conclusions Stressful social relations are associated with increased mortality risk among middle-aged men and women for a variety of different social roles. Those outside the labour force and men seem especially vulnerable to exposure.

Social inequality in dynamic balance performance in an early old age Spanish population: The role of health and lifestyle associated factors

This study investigates the association between socioeconomic status (SES) and dynamic balance performance and whether lifestyle factors explained any possible associations. A total of 448 nondisabled individuals, age-range 54-75 years and enrolled in the Active Aging Longitudinal Study of Spain in 2006, constituted the study population. Baseline data of this cross-sectional study were obtained by personal interviews and objective measures of balance performance. The present study shows an educational gradient in poor dynamic balance, where individuals with no formal education had higher risk of poor balance, also after adjustment for age, gender, obesity and physical activity. In addition, obesity and sedentary physical activity were related to poor dynamic balance. The findings suggest an independent effect of both SES and behavioral factors on poor balance performance in the older Spanish population.

Negative aspects of close social relations and 10-year incident ischaemic heart disease hospitalization among middle-aged Danes

Background: Little is known about the association between negative aspects of close social relations and development of ischaemic heart disease (IHD). We aim to address if the experience of worries/demands and conflicts with close social relations are related to risk of first-time hospitalization with IHD and whether emotional support can buffer this effect. Methods: A total of 8550 randomly selected men and women aged 36–52 years free of earlier IHD hospitalization at baseline in 2000 were followed prospectively for first-time hospitalization with IHD (ICD10: I21–25) through 2010 in the Danish National Patient Registry. Cox regression analysis was used to analyse data and all analyses were adjusted for age, gender, social class, cohabitation, and depressive symptoms. Results: Worries/demands from and conflicts with children were associated with IHD hospitalization in an exposure-dependent manner (p-trends 0.0001 and 0.03) with twice the risk among those most highly exposed, HRworries/demands = 2.05 (95% CI 0.91–4.54) and HRconflicts=1.90 (95% CI 1.00–3.61). ‘Always’ experiencing worries/demands from partner was also associated with a nearly twice the risk of IHD, whereas no association was found for conflicts with partner. High levels of worries/demands from or conflicts with family and friends were associated with a 40% higher risk of IHD. Conclusions: Negative aspects of close social relations are associated with higher risk of incident IHD hospitalization except for conflicts with partner. We found no clear evidence of a buffering effect of emotional support.

Psychosocial factors at work and the development of mobility limitations among adults in Denmark

Aim: Psychosocial factors in the working environment have been shown to be associated with mobility limitations, but this has not yet been confirmed in a Danish population. We aimed to examine how psychosocial factors at work are related to developing mobility limitations in Denmark. Methods: This study is based on data from 2952 middle-aged men and women without mobility limitations in 2000. Results: We found increased risk of incident mobility limitations during 6-year follow up among men who often perceived high work pace (OR 5.45, 95% CI 1.21–24.52) vs. never, who only sometimes or/never perceived the work to be meaningful (OR 6.54, 95% CI 1.55–27.55) vs. always, and who sometimes perceived high emotional demands at work (OR 7.85, 95% CI 1.78–34.65) vs. never. Among women, lower risk of incident mobility limitations was observed among those who in 2000 perceived high work pace sometimes (OR 0.46, 95% CI 0.24–0.87) or often (OR 0.43, 95% CI 0.22–0.85) vs. never in 2000. Also, women who always or often experienced high emotional demands had an increased risk. Conclusions: The most important finding was that high work pace was strongly associated with increased risk of mobility limitations among men, but associated with lower risk of mobility limitations among women. This knowledge may be used to better target interventions among men and women in midlife from physical deterioration later in life.