Riitta-Liisa Heikkinen

The association of socio-economic factors with physical and mental capacity in elderly men and women

The association of socio-economic factors with functional capacity has received less research attention than their association with diseases and mortality. However, functional capacity is an important measure of health and independence in the elderly. This study explores the associations of socio-economic factors with physical and mental capacity as measured in laboratory tests and on the basis of self-report. The data were drawn from the Evergreen project, comprising all persons aged 75 (N=388) and 80 (N=291) in Jyväskylä, central Finland. Women with a higher level of education showed better functional capacity on all indicators, among men higher education was only associated with better vital capacity and cognitive capacity. Better perceived financial situation was associated with better functional capacity in both men and women. The association between socio-economic factors and functional capacity remained even when the number of chronic diseases was controlled for. The results lend support to the assumption that socio-economic factors are associated with physical and mental capacity in elderly people.

Depressive symptoms in late life : Results from a study in three Nordic urban localities.

The prevalence and correlates of depressive symptoms among 75-year-olds were examined in three Nordic urban localities: Gothenburg, Sweden (n=446), Jyväskylä, Finland (n=382) and Glostrup, Denmark (n=541). Depressive symptomatology was assessed with the Center for Epidemiologic Studies Depression Scale (CES-D). Prevalence figures for depressiveness seemed to be somewhat higher in Jyväskylä than in the two other localities. Women had more depressive symptoms than men in all three areas. The lowest mean score was recorded for Danish men and the highest level of symptoms in Finnish women. The associations discovered in this Nordic comparative study between demographic characteristics and depressive symptoms are very similar to the findings of earlier studies: male sex, being married, a high level of education, and a good financial situation seemed to afford ‘protection’ against depressiveness. Morbidity and poor self-rated health showed a clear correlation with frequent depressive symptoms, as did loneliness variables describing the quality or the lack of human relations.

Factors related to carrying out everyday activities among elderly people aged 80

The study was based on an epidemiological model in which performing activities of daily living (ADL) was the dependent variable. Variation in performing was explained by physical and mental health, and by physical performance. The population consisted of all 80-year-old residents (N=291) of the city of Jyväskylä in central Finland; 90% of them agreed to take part in the interviews at home, while 72% took part in the laboratory examinations to determine health status and functional capacity. Difficulties in at least some PADL (Physical Activities of Daily Living) tasks were reported by 86.5% of the men, and 87.2% of the women; none said they could perform all IADL (Instrumental Activities of Daily Living) tasks without difficulty. Physical performance (grip strength and stair mounting test in men, and stair mounting test, balance, and upper extremity function test in women) and visual acuity showed a significant association with ADL performance both in men and in women. In addition, depressive symptoms in women, and cognitive capacity in men were associated with both PADL and IADL, and ADL performance, respectively. In the search for pathways to reduced ADL performance, it is important to look not only at chronic diseases but also at the aging processes as well as the disabilities caused by inactivity. Tests of cognitive capacity, psychological well-being and physical performance provide valuable information on the factors that underlie the aged individual’s reduced functional capacity. (Aging Clin. Exp. Res. 6: 433-443, 1994)

Does Social Activity Decrease Risk for Institutionalization and Mortality in Older People

OBJECTIVES Social inactivity predicts adverse health events, but less is known about how different dimensions of social activity are related to health. The aim of this study was to investigate collective (e.g., cultural and organizational activities) and productive (e.g., helping others) social activity as predictors of risk for mortality and institutionalization in old age. METHOD A total of 1,181 community-living people aged 65-84 years at baseline were interviewed face to face as part of the Evergreen project, in Jyväskylä, Finland in 1988. Time to institutionalization and mortality were analyzed in separate models for proportional hazard regression on mortality and competing risks analysis on institutionalization and mortality. RESULTS At follow-up, approximately 17 years later, 22% of persons were institutionalized and 71% had died. When sociodemographics, health, functioning, and intensity of physical activity were controlled for, collective social activity reduced risk for mortality and initially for institutionalization although this latter effect diminished over time. DISCUSSION Collective social activity may be associated with a reduced risk for mortality and institutionalization in older people. Further studies on the mechanisms underlying the association between social activity and health are needed.

Ageing in an autobiographical context

A cohort study was carried out in 1990 in Jyväskylä, central Finland among 80-year-old residents as part of the Evergreen project. A total of 262 people born in 1910 were interviewed. In addition to epidemiological data, tape-recorded narrative stories focusing on the ageing experience were collected from a subsample of 20 people (10 men and 10 women). A five-year follow-up was carried out with the same cohort in 1995. Out of the 20 people in the original subsample, 17 (8 women and 9 men) were still alive to describe their ageing experience at 85. The analysis proceeded along the hermeneutic circle in the form of dialogue, first with the elderly narrators and then with the tape-recorded material. Unlike five years previously, most of the narrators said they had now crossed the line into old age. These findings are considered in light of the concepts of ageing, bodiliness and temporality.

Mental well-being: A 16-year follow-up among older residents in Jyväskylä

This study investigated changes in perceived depression, anxiety and loneliness during a 16-year follow-up among elderly Jyväskylä residents born in 1914-1923. A further concern was with how perceived atmosphere in the formative environment was reflected in depression, anxiety and loneliness in old age. The first phase of the study took place in 1988 when interviews were conducted with 635 persons (241 men and 394 women). Depression and anxiety were assessed using the Finnish modified version of Becks 13-item depression scale (RBDI), which was completed fully by 74% of the interviewees. Loneliness was assessed with a single four category item. In the second phase of the study in 1996, interviews were conducted with 410 persons, of whom 94% filled the RBDI questionnaire. In the third phase in 2004, the number of interviewees was 220 and the response rate 82%. There were no significant changes in the number of people with depressive symptomatology and anxiety, except in 1996 when the proportion of men with mild and moderate depression almost doubled. The number of men and women who felt lonely increased significantly during the 16-year follow-up. People who said they were lonely also had more depression and anxiety than others. People who had grown up in warm and safe environment were the most balanced mentally. The presence or absence of warmth and safety in the formative environment is reflected in mental well-being even at a very old age.

The Structure and Stability of Perceived Togetherness in Elderly People during a 5-Year Follow-Up

The objective of this study was to study the structure andstability of perceived togetherness using cross-sectional and longitudinal confirmatory factor analysis models. Togetherness was measured with the self-administered Social Provision Scale (SPS). The sample consisted of 111 persons interviewed in connection with the Evergreen project’s 5-year follow-up at ages 80 and 85. One and two-factormodels were specified separately at two different pointsof measurement. The stability of the factor models’ structure and the level of latent factors was studied using longitudinal factor analysis models. The two-factor model fit the data better than the one-factor model. Perceived togetherness was differentiated into factors of emotional and social togetherness. The structure of perceived togetherness remainedunchanged during the 5-year follow-up. In terms of means, the latent factors showed a statistically highly significant decline in time (i.e. perceived togetherness decreased with increasing age).

Cohort differences in health, functioning and physical activity in the young-old Finnish population

Background and aims: A mixed picture emerges from the international literature about secular and cohort changes in the health and functioning of older adults. We conducted a repeated population-based cross-sectional study to determine trends in health, functioning and physical activity in the young-old Finnish population. Methods: Representative samples of community-dwelling people aged 65–69 years in 1988 (n=362), 1996 (n=320) and 2004 (n=292) were compared in socio-economic status, self-rated health, chronic diseases, memory problems, ability to carry out instrumental activities of daily living, physical activity, and five-year mortality. Results: Significant improvement in all the investigated modalities, except that of chronic diseases, was observed in the newer cohorts. In logistic regression analysis, after controlling for socio-economic status and gender, cohort effects remained significant for memory problems, IADL difficulties and physical activity. Cox regression analyses showed significant improvement in survival when later cohorts were compared with the earlier ones. Conclusions: This study provides evidence of improving levels of socio-economic status, self-rated health, functioning, physical activity, and lower risk of mortality in the newer cohorts of the Finnish young-old, but this was not accompanied by a parallel diminution in chronic diseases.

Social relations in older adults: Secular trends and longitudinal changes over a 16-year follow-up

Drawing on population studies in Finland, we investigated secular trends and longitudinal changes in social relations. The cohort comparison data comprised on 974 persons aged 65-69 years from three cohorts born between 1919 and 1939 and interviewed in 1988, 1996 and 2004. Longitudinal analyses were conducted for 635 persons aged 65-74 years over a 16-year follow-up at three measurement points. Social relations were studied on the basis of frequency seeing ones offspring, perceptions of the sufficiency of these contacts, and by asking whom the participants considered as their closest person and how often and in how many tasks they helped someone. The cohort comparisons showed that the frequency of seeing ones offspring had decreased in the most recent cohort and that the number of contacts was considered more inadequate. Longitudinal analyses showed that although the proportion of children as the closest persons increased, meetings with them became fewer. Helping others was more common in the last cohort, but in the longitudinal analyses it decreased with age. Finnish people at retirement help others more than before, but they do not meet their offspring as often as they would like. Measures are needed for action to promote intergenerational exchange in older adults on both individual and societal level.

Experienced health in older women with rheumatoid arthritis.

ABSTRACT This study explored how older women with chronic illness and disability experience their own health. Data were collected in in-depth interviews with ten older women with rheumatoid arthritis. Data analysis and interpretation was carried out within a phenomenological-hermeneutic frame of understanding, which revealed five major themes: health as coping with everyday life, health as freedom, health as absence of inconvenience, health as togetherness and health as mental well-being. For older people with chronic illness and disability, good health found expression in general well-being. It was perceived as a state of equilibrium that the respondents sought to maintain through their own active choices.