Linda B. Hassing

What matters for life satisfaction in the oldest-old?

The purpose of this study was to examine factors associated with life satisfaction in the oldest-old within a spectrum of psychosocial and health related variables. Scores on the life satisfaction index (LSI-Z) were related to scales and questions regarding, demographics, depression, locus of control, cognitive function, functional capacity (instrumental and personal activities of daily living), self-rated overall health and medically based health, and social network. The sample consisted of 315 participants, aged 80–98 years; (M = 83 years, 66% women). Regression analyses indicated that social network quality, self-rated overall health, sense of being in control of ones life, and depressive symptoms were significantly associated with life satisfaction. There was no gender difference in overall life satisfaction. However, there were different patterns of variables associated with life satisfaction in men and women. Self-rated overall health and depressive symptoms were related to life satisfaction in women, whereas widowhood was significantly associated with lower life satisfaction among men. The results emphasize the need to analyse associates of life satisfaction within a broader context of psychosocial variables and separately for men and women.

Type 2 diabetes mellitus contributes to cognitive decline in old age: A longitudinal population-based study

We examined change in neuropsychological test performance related to type 2 diabetes mellitus across a 6-year interval. A population-based sample of 274 elderly participants (36 with diabetes and 238 without diabetes) was examined at four occasions at a 2-year interval. The participants were 80-93 years of age (M = 82.8 years) and without dementia at baseline. The test battery included tests of speed, visuospatial ability, short-term memory, semantic memory, episodic memory, and the Mini Mental Status Examination. Several models, taking into account diabetes and demographic data, were analyzed using SAS Proc Mixed multilevel modeling. At baseline, there were no significant differences in the neuropsychological tests related to diabetes. The longitudinal analyses, however, showed that diabetes was a significant predictor of decline for many of the tests. These findings points to the conclusion that type 2 diabetes is associated with accelerated cognitive decline in old age that may result in dementia.

State provision down, offspring's up : the reverse substitution of old-age care in Sweden

Substitution among the providers of old-age care has usually meant a process whereby the state ‘takes over’ what families used to do, but during the 1980s and 1990s, both home help and institutional care were cut back substantially in Sweden as elsewhere. Comparable, nationally representative surveys in Sweden of the provision of care for older people living in the community enable analysis of the effects of these cutbacks on the sources and patterns of care. It emerges that increased inputs from families match the decline of public services, that is, a ‘reverse’ substitution has recently been taking place. Local studies, of older people who have been followed over time as the provision of home help has changed, support these conclusions. Of the increased informal care, most has been provided by daughters, but sons have also contributed. A problematic aspect of these shifting patterns of care is that an increasing number of family carers with increasingly heavy care commitments are now without formal or informal support, whereas in the recent past many could expect their responsibilities to be shared with the state. The evidence from this study also calls into question common metaphors and assumptions about the assumed interdependence between informal care and public services for older people, and challenges the so-called substitution thesis.

Overweight in midlife and risk of dementia: a 40-year follow-up study

Objective:This study examines whether overweight in midlife increases dementia risk later in life.Methods:In 1963 body mass index was assessed in 1152 participants of The Swedish Twin Registry, at the age of 45–65 years. These participants were later screened for dementia in a prospective study with up to 40 years follow-up. A total of 312 participants were diagnosed with dementia.Results:Logistic regression analyses adjusted for demographic factors, smoking and alcohol habits, indicated that men and women categorized as overweight in their midlife had an elevated risk of dementia (OR=1.59; 95% CI: 1.21–2.07, P=0.002), Alzheimers disease (OR=1.71; 95% CI: 1.24–2.35, P=0.003), and vascular dementia (OR=1.55; 95% CI: 0.98–2.47, P=0.059). Further adjustments for diabetes and vascular diseases did not substantially affect the associations, except for vascular dementia (OR=1.36; 95% CI: 0.82–2.56, P=0.116), reflecting the significance of diabetes and vascular diseases in the etiology of vascular dementia. There was no significant interaction between overweight and APOE ɛ4 status, indicating that having both risk factors does not have a multiplicative effect with regard to dementia risk.Conclusions:This study gives further support to the notion that overweight in midlife increases later risk of dementia. The risk is increased for both Alzheimers disease and vascular dementia, and follows the same pattern for men and women.

Further evidence on the effects of vitamin B12 and folate levels on episodic memory functioning: a population-based study of healthy very old adults

BACKGROUND The relationship between vitamin status and cognitive functioning has been addressed in several recent studies with inconclusive results. The purpose of this study was to examine separate and combined effects of serum vitamin B12 and folic acid on episodic memory functioning in very old age. METHODS Four study groups were selected from a population-based sample of healthy very old adults (90-101 years of age): normal B12/normal folic acid, low B12/normal folic acid, normal B12/low folic acid, and low B12/low folic acid. Cutoff levels were set at 180 pmol/L for vitamin B12 and at 13 nmol/L for folic acid. Subjects completed two episodic recall tasks (objects and words) and two episodic recognition tasks (faces and words). RESULTS Neither vitamin affected recognition or primary memory. Most interesting, although B12 was unrelated to recall performance, subjects with low folic acid levels showed impairment in both word recall and object recall. CONCLUSIONS These results replicate and extend previous findings that folic acid may be more critical than B12 to memory functioning in late life. The selective effects of folic acid on episodic recall were discussed in terms of encoding and retrieval mechanisms, as well as in relation to brain protein synthesis.

Type 2 Diabetes as a Risk Factor for Dementia in Women Compared With Men: A Pooled Analysis of 2.3 Million People Comprising More Than 100,000 Cases of Dementia

OBJECTIVE Type 2 diabetes confers a greater excess risk of cardiovascular disease in women than in men. Diabetes is also a risk factor for dementia, but whether the association is similar in women and men remains unknown. We performed a meta-analysis of unpublished data to estimate the sex-specific relationship between women and men with diabetes with incident dementia. RESEARCH DESIGN AND METHODS A systematic search identified studies published prior to November 2014 that had reported on the prospective association between diabetes and dementia. Study authors contributed unpublished sex-specific relative risks (RRs) and 95% CIs on the association between diabetes and all dementia and its subtypes. Sex-specific RRs and the women-to-men ratio of RRs (RRRs) were pooled using random-effects meta-analyses. RESULTS Study-level data from 14 studies, 2,310,330 individuals, and 102,174 dementia case patients were included. In multiple-adjusted analyses, diabetes was associated with a 60% increased risk of any dementia in both sexes (women: pooled RR 1.62 [95% CI 1.45–1.80]; men: pooled RR 1.58 [95% CI 1.38–1.81]). The diabetes-associated RRs for vascular dementia were 2.34 (95% CI 1.86–2.94) in women and 1.73 (95% CI 1.61–1.85) in men, and for nonvascular dementia, the RRs were 1.53 (95% CI 1.35–1.73) in women and 1.49 (95% CI 1.31–1.69) in men. Overall, women with diabetes had a 19% greater risk for the development of vascular dementia than men (multiple-adjusted RRR 1.19 [95% CI 1.08–1.30]; P < 0.001). CONCLUSIONS Individuals with type 2 diabetes are at ∼60% greater risk for the development of dementia compared with those without diabetes. For vascular dementia, but not for nonvascular dementia, the additional risk is greater in women.

Being Overweight in Midlife Is Associated With Lower Cognitive Ability and Steeper Cognitive Decline in Late Life

BACKGROUND Although an increasing body of evidence links being overweight in midlife with an increased risk for dementia in late life, no studies have examined the association between being overweight in midlife and cognitive ability in late life. Our aim was to examine the association between being overweight in midlife as measured by body mass index (BMI) and cognitive ability assessed over time. METHODS Participants in the Swedish Adoption/Twin Study Aging were derived from a population-based sample. The participants completed baseline surveys in 1963 or 1973 (mean age 41.6 years, range 25-63 years). The surveys included questions about height, weight, diseases, and lifestyle factors. Beginning in 1986, the same individuals were assessed on neuropsychological tests every 3 years (except in 1995) until 2002. During the study period, 781 individuals who were 50 years and older (60% women) had at least one complete neuropsychological assessment. A composite score of general cognitive ability was derived from the cognitive test battery for each measurement occasion. RESULTS Latent growth curve models adjusted for twinness showed that persons with higher midlife BMI scores had significantly lower general cognitive ability and significantly steeper longitudinal decline than their thinner counterparts. The association did not change substantially when persons who developed dementia during the study period were excluded from the analysis. CONCLUSIONS Higher midlife BMI scores precede lower general cognitive ability and steeper cognitive decline in both men and women. The association does not seem to be mediated by an increased risk for dementia.

What Matters, and What Matters Most, for Change in Life Satisfaction in the Oldest-Old? A Study Over 6 Years Among Individuals 80+

Objectives: The study investigates whether markers of life satisfaction identified in a cross-sectional study–quality of social network, self-rated health, depressive symptoms, locus of control and widowhood, in addition to financial satisfaction and the personality traits of extraversion and neuroticism–predict change in life satisfaction (LSI-Z) across four measurement occasions during a 6-year period in individuals aged 80+. Method: Data were drawn from the Swedish OCTO-Twin-study of individuals aged 80 and older. Results: Growth curve analysis showed a relatively consistent significant linear decline in life satisfaction, but certain markers predicted change in life satisfaction. The loss of spouse, in particular in men, and higher levels of depressive symptoms were related to lower levels of life satisfaction over time. Conclusion: The results from the study question the notion of a life-long stability of life satisfaction.

Agreement between self-reported and measured height, weight and body mass index in old age—a longitudinal study with 20 years of follow-up

BACKGROUND self-reported body mass index (BMI) based on self-reported height and weight is a widely used measure of adiposity in epidemiological research. Knowledge about the accuracy of these measures in late life is scarce. OBJECTIVE the study aimed to evaluate the accuracy and changes in accuracy of self-reported height, weight and BMI calculated from self-reported height and weight in late life. DESIGN a longitudinal population-based study with five times of follow-up was conducted. PARTICIPANTS seven hundred seventy-four community-living men and women, aged 40-88 at baseline (mean age 63.9), included in The Swedish Adoption/Twin Study of Aging. METHODS participants self-reported their height and weight in a questionnaire, and height and weight were measured by experienced research nurses at an in-person testing five times during a 20-year period. BMI was calculated as weight (kilogramme)/height (metre)(2). RESULTS latent growth curve modelling showed an increase in the mean difference between self-reported and measured values over time for height (0.038 cm/year) and BMI (0.016 kg/m(2)/year), but not for weight. CONCLUSIONS there is a very small increase in the mean difference between self-reported and measured BMI with ageing, which probably would not affect the results when self-reported BMI is used as a continuous variable in longitudinal studies.

Body Mass Index, Change in Body Mass Index, and Survival in Old and Very Old Persons

To examine how body mass index (BMI) and change in BMI are associated with mortality in old (70–79) and very old (≥80) individuals.