Linda Enroth

Do Socioeconomic Health Differences Persist in Nonagenarians

OBJECTIVES Social inequality in health is well documented in younger adults and the younger old adults, but data from the very old adults are scarce. We used a representative population sample to investigate socioeconomic differences in health and functioning among nonagenarian men and women. METHOD Data came from the Vitality 90+ Study. All individuals aged 90 and older in the city of Tampere, Finland, were included, irrespective of health or dwelling place. Data were collected from 1,283 participants whose age range ran from 90 to 107 years. Education and former main occupation were used as indicators of socioeconomic status, and health was measured as functional ability, comorbidity, and self-rated health. Data were analyzed in a cross-sectional design using cross tabulation, ordered regression model with marginal effects, and binary logistic regression model. RESULTS Manual workers had poorer functional ability and health than upper nonmanuals and similarly the low- educated suffered more from health issues than the high-educated. Most analyses showed a graded association between the lower socioeconomic status and a poorer health outcome. On each level of the socioeconomic hierarchy, men had better functional status than women. DISCUSSION We found socioeconomic differences in functional ability, comorbidity, and self-rated health in nonagenarians. Our findings suggest that social disparity in health and functioning exists in very old age.

Trends of Functioning and Health in Nonagenarians: The Vitality 90+ Study

Mortality in the very old is rapidly declining in many countries, but development and change in health and functioning in this age group is poorly understood. In the Vitality 90+ Study, we investigated functional status, multimorbidity, and self-rated health (SRH) in nonagenarians in 2001, 2003, 2007, and 2010 in one geographic area of Finland. At each time, all inhabitants aged 90 years and older were included, and the response rate was high. We found minor improvement over time in independence in performing activities of daily living (ADL), no change in mobility or chronic conditions, and declining SRH. During the study period, both survival until the age of 90 years and the life expectancy at the age of 90 years clearly increased. Longer lives in very old age are likely to include both healthy and disabled years, and the number of those in need of help will grow. Studies of the oldest old are challenging because of poor health, cognitive problems, and a high rate of institutionalization; but more information on their health trends is urgently needed.

Is socioeconomic status a predictor of mortality in nonagenarians? The vitality 90+ study

BACKGROUND socioeconomic inequalities in mortality are well-known in middle-aged and younger old adults, but the situation of the oldest old is less clear. The aim of this study was to investigate socioeconomic inequalities for all-cause, cardiovascular and dementia mortality among the people aged 90 or older. METHODS the data source was a mailed survey in the Vitality 90+ study (n = 1,276) in 2010. The whole cohort of people 90 years or over irrespective of health status or dwelling place in a geographical area was invited to participate. The participation rate was 79%. Socioeconomic status was measured by occupation and education, and health status by functioning and comorbidity. All-cause and cause-specific mortality was followed for 3 years. The Cox regression, with hazard ratios (HR) and 95% confidence intervals (CI), was applied. RESULTS the all-cause and dementia mortality differed by occupational class. Upper non-manuals had lower all-cause mortality than lower non-manuals (HR: 1.61; 95% CI: 1.11-2.32), skilled manual workers (HR: 1.56 95% CI: 1.09-2.25), unskilled manual workers (HR: 1.88; 95% CI: 1.20-2.94), housewives (HR: 1.77 95% CI: 1.15-2.71) and those with unknown occupation (HR: 2.33; 95% CI: 1.41-3.85). Inequalities in all-cause mortality were largely explained by the differences in functioning. The situation was similar according to education, but inequalities were not statistically significant. Socioeconomic differences in cardiovascular mortality were not significant. CONCLUSIONS socioeconomic inequalities persist in mortality for 90+-year-olds, but their magnitude varies depending on the cause of death and the indicator of socioeconomic status. Mainly, mortality differences are explained by differences in functional status.

Do Successful Agers Live Longer? The Vitality 90+ Study

Objective: To discover whether successful aging, understood as a multidimensional concept, predicts further survival in very old people. Method: The population sample consisted of 1,370 persons aged 90 or over in the Vitality 90+ study. Four alternative models of successful aging were constructed, each of them consisting of physical, psychological, and social dimensions. Mortality was followed up after 4 and 7 years. Results: Three out of four models significantly predicted survival at both follow-ups for the whole group. Separately, “success” in the physical, psychological, and social components was also associated with higher survival. The associations were stronger in women than in men. Discussion: Successful aging, measured using physical, psychological, and social dimensions, predicts the length of future life in nonagenarians.

Cardiometabolic and Inflammatory Biomarkers as Mediators Between Educational Attainment and Functioning at the Age of 90 Years

BACKGROUND Low socioeconomic status is associated both with poorer functioning and elevated levels of inflammatory and cardiometabolic biomarkers; however, knowledge of such relations for the oldest old is limited. Our aim was to study whether education is associated with cardiometabolic (cholesterol levels, body mass index, and leptin) and inflammatory (C-reactive protein, interleukin-6, interleukin-1Ra) biomarkers for the 90-year-olds who participated in the Vitality 90+ study. In addition, we investigated whether these biomarkers explain educational inequalities in functioning. METHODS All persons in Tampere, Finland, who were born in 1909 or 1910, were invited to participate, irrespective of their health status or dwelling place. The sample consisted of 262 participants who went through the home interview and blood tests. The socioeconomic status indicator used was the highest education, and physical functioning was assessed using the Barthel index. The association of education with individual and combined biomarker scores, and with functioning, was analyzed cross-sectionally applying generalized linear models. RESULTS The low- and mid-level-educated participants had greater odds of belonging to the high risk group in cardiometabolic biomarkers than did the high-educated. Differences were statistically significant in three individual biomarkers (high-density lipoprotein-cholesterol, leptin, and body mass index) and in a cardiometabolic score. There were no educational differences in inflammatory biomarkers. When all biomarkers were combined, they mediated educational differences in functioning on an average of 23%. After controlling for smoking, alcohol use and diseases, biomarkers mediated part of the differences between the mid-level- and high-educated. CONCLUSIONS High education was associated with better cardiometabolic biomarkers and functioning among the 90-year-olds. In part, educational inequalities in functioning were explained by cardiometabolic biomarkers.

Successful Aging as a Predictor of Long-Term Care Among Oldest Old: The Vitality 90+ Study

Aim: The aim of the study was to investigate whether successful aging (SA) predicts entering long-term care (LTC) among nonagenarians. Methods: Data originated from the linkage of the Vitality 90+ Study surveys with register data from Finnish Population Register and Care Registers. Altogether 1,966 community-dwelling individuals were followed for 2 years and 1,354 individuals for 5 years. Four models of SA were constructed by varying combinations of physical, psychological, and social components. Competing risk regression analysis was used. Findings: The incidence rate for entering LTC was lower for successful agers. Three models of SA presented a significantly decreased risk for entering LTC in the whole group and in women. The impact of SA was attenuated when living alone, needing help, and the year of participation were adjusted for, but was still significant for Model 3. Conclusion: Nonagenarians who meet the multidimensional criteria of SA are less likely to enter LTC than those aging less successfully.

Ageing populations in the Nordic countries: Mortality and longevity from 1990 to 2014

Aims: Cross-country comparisons of mortality and longevity patterns of Nordic populations could contribute with novel insights into the compositional changes of these populations. We investigated three metrics of population ageing: the proportion of the population aged 75+ and 90+ years, the proportion of birth cohorts reaching 75 and 90 years, and life expectancy (LE) at age 75 and 90 years in Sweden, Norway, Iceland, Denmark and Finland, in the period 1990–2014. Methods: Demographic information was collected from national statistical databases and the Human Mortality Database. Results: All metrics on population ageing increased during the study period, but there were some cross-country variations. Finland experienced a notably steep increase in the proportion of 75+ and 90+ year olds compared to the other countries. Regarding the proportion reaching old ages, the Finnish lagged behind from the beginning, but females decreased this difference. The Danes were more similar to the other countries at the beginning, but did not experience the same increase over time. Gender-specific LE at age 75 and 90 years was similar overall in the five countries. Conclusions: Developments in cross-country variation suggest that survival until old age has become more similar for Finnish females and more different for Danish males and females compared with the other countries in recent decades. This provides perspectives on the potential to improve longevity in Denmark and Finland. Similarities in LE in old age suggest that expected mortality in old age has been more similar throughout the study period.

Pitkäaikaissairaudet ja monisairastavuus hyvin vanhoilla sekä niiden yhteys toimintakykyyn ja itse arvioituun terveyteen-Tervaskannot 90+ -tutkimus

Tutkimuksessa selvitettiin pitkaaikaissairauksien ja monisairastavuuden esiintyvyytta 90-vuotiailla ja sita vanhemmilla tamperelaisilla. Erityisena mielenkiinnon kohteena oli sairastavuuden yhteys huonoon itse arvioituun terveyteen ja toimintakykyyn seka avun tarpeeseen paivittaisissa toiminnoissa ja liikkumisessa. Tutkimuksessa kaytettiin Tervaskannot 90+ -tutkimuksen vuoden 2014 postikyselyaineistoa, johon vastasi 1637 henkiloa ja vastausprosentti oli 80. Tutkimuksen mukaan miehista 77 prosenttia ja naisista 82 prosenttia sairasti vahintaan kahta pitkaaikaissairautta. Etenkin muistisairautta ja masennusta sairastavat henkilot arvioivat terveytensa ja toimintakykynsa huonoksi, ja heilla avun tarve liikkumisessa ja paivittaisissa toiminnoissa oli lisaantynyt. Naisilla useampi yksittainen sairaus oli yhteydessa huonoon itse arvioituun terveyteen ja toimintakykyyn kuin miehilla. Monisairaat henkilot arvioivat terveytensa ja toimintakykynsa heikommaksi ja tarvitsivat enemman apua liikkumisessa ja paivittaisissa toiminnoissa kuin ne henkilot, joilla oli vain yksi sairaus. Hyvin vanhojen sairastavuutta ja monisairastavuutta tulisi selvittaa lisaa, jotta terveydenhuollossa ja yha enemman kotona tapahtuvassa hoidossa voitaisiin nykyista paremmin huomioida monisairaiden henkiloiden tarpeet. Chronic conditions and multimorbidity - associations with functioning and self-rated health among nonagenarians: The Vitality 90+ Study The aim of this study was to examine the prevalence of chronic conditions and multimorbidity and their association with self-rated health, self-rated functioning, activities of daily living (ADL) and mobility in individuals aged 90 years and older. The study population consisted of 1637 nonagenarians who answered the mailed survey in the Vitality 90+ Study in 2014. Results showed that almost all of the nonagenarians had a chronic condition and the majority suffered from multimorbidity. Those who had memory disorder or depression had poor self-rated health and functioning and were more often disabled in ADL and mobility. In addition, multimorbidity was associated with poor health indicated by all four health outcomes. More research on morbidity is needed in this age group to meet the needs of nonagenarians with multimorbidity.