Health effects of involuntary job loss among older workers: findings from the health and retirement survey

OBJECTIVES: To estimate the health consequences of involuntary job loss among older workers in the United States. METHODS: Using longitudinal data from the 1992 and 1994 waves of the Health and Retirement Survey, multivariate regression models were estimated to assess the impact of involuntary job loss on both physical functioning and mental health. Our analysis sample included 209 workers who experienced involuntary job loss between survey dates and a comparison group of 2,907 continuously employed workers. RESULTS: The effects of late-life involuntary job loss on both follow-up physical functioning and mental health were negative and statistically significant (p < .05), even after baseline health status and sociodemographic factors were controlled for. Among displaced workers, reemployment was positively associated with both follow-up physical functioning and mental health, whereas the duration of joblessness was not significantly associated with either outcome. DISCUSSION: The findings provide evidence of a causal relationship between job loss and morbidity among older workers. This relationship is reflected in both poorer physical functioning and mental health for workers who experience involuntary job loss. In addition to the economic consequences of worker displacement, there may be important health consequences of job loss, especially among older workers.     

The persistence of depressive symptoms in older workers who experience involuntary job loss: results from the health and retirement survey

OBJECTIVES: The purpose of this study was to investigate the association between involuntary job loss among workers nearing retirement and long-term changes in depressive symptoms. METHODS: Analyzing data from the first four waves (1992-1998) of the Health and Retirement Survey, we used longitudinal multiple regression in order to assess whether involuntary job loss between Wave 1 and Wave 2 was associated with depressive symptoms at Wave 3 and Wave 4. The study sample included 231 workers who had experienced job loss in the Wave 1-Wave 2 interval and a comparison group of 3,324 nondisplaced individuals. We analyzed the effect of job loss on depressive symptoms both in the full study sample and in subsamples determined by wealth. RESULTS: Among individuals with below median net worth, Wave 1-Wave 2 involuntary job loss was associated with increased depressive symptoms at Wave 3 and Wave 4. We found no effect of involuntary job loss for high net worth individuals at the later survey waves. DISCUSSION: Our findings identify older workers with limited wealth as an important group for which the potential effect of involuntary job separation in the years preceding retirement is ongoing (enduring) adverse mental health.     

Impact of husbands' involuntary job loss on wives' mental health,among older adults

OBJECTIVES: This study estimates the consequences of older husbands' involuntary job loss for their wives' mental health. METHODS: Using longitudinal data from the 1992, 1994, and 1996 waves of the Health and Retirement Study, multivariate regression models were estimated to measure the impact of older husbands' involuntary job loss on wives' mental health. We created two longitudinal data sets of two waves each to use in our analysis. The first data set, or period, combined Waves 1 and 2 of the Health and Retirement Study and described the 1992-1994 experience of spouse pairs in our sample. It included the wives of 55 husbands who experienced involuntary job loss between these survey dates and a comparison group of wives of 730 continuously employed husbands. The second data set described the 1994-1996 experience of couples. In particular, it included the wives of an additional 38 husbands who were displaced from their jobs between Waves 2 and 3, and a comparison group of wives of 425 husbands who were continuously employed from 1994 to 1996. RESULTS: Husbands' involuntary job loss did not have a statistically significant effect on wives' mental health. We found no evidence that changes in husbands' depressive symptoms modified the effect of his job loss on wives' mental health. In the first period only, the effect of husbands' job loss on wives' mental health was more pronounced for wives who were more financially satisfied at baseline. DISCUSSION: There is limited evidence among this cohort that husbands' job loss increases wives' subsequent depressive symptoms. However, the effect of husbands' job loss on wives' mental health appears to be magnified when wives report being financially satisfied pre-job loss. This suggests that, for subgroups of older couples, mental health services specifically targeted at displaced men should also be made available to wives.     

The impact of multimorbidity on grip strength in adults age 50 and older: Data from the health and retirement survey (HRS)

BackgroundMultimorbidity, the presence of two or more chronic diseases, is a public health concern. The measurement of grip strength has been proposed as a measure of overall body strength and is reliable and easy to measure. The purpose of this study was to investigate the relationship between the number of chronic diseases and common co-occurring chronic diseases with grip strength.MethodsA cross-sectional analysis was conducted of 5877 respondents (2744 = male, 3103 = female) from the 2008 Health and Retirement Study (HRS) who completed grip strength measurements (kg).ResultsAs the number of chronic diseases increased, an incremental decrease in grip strength occurred and became more pronounced with ≥3 chronic diseases present (b = 3.1, 95% CI = 2.3–3.9, p < 0.001). No statistically significant relationship was identified between specific chronic diseases (except for stroke) and grip strength.ConclusionMultimorbidity has a statistically significant negative relationship on grip strength. Grip strength should be considered as a physical performance measure to incorporate into the care of patients with multimorbidity.     

The effect of involuntary job loss on smoking intensity and relapse

AIMS: To assess the impact of involuntary job loss due to plant closure or layoff on relapse to smoking and smoking intensity among older workers. DESIGN, PARTICIPANTS, SAMPLE: Data come from the Health and Retirement Study, a nationally representative survey of older Americans aged 51-61 in 1991 followed every 2 years beginning in 1992. The 3052 participants who were working at the initial wave and had any history of smoking comprise the main sample. METHODS: Primary outcomes are smoking relapse at wave 2 (1994) among baseline former smokers, and smoking quantity at wave 2 among baseline current smokers. As reported at the wave 2 follow-up, 6.8% of the sample experienced an involuntary job loss between waves 1 and 2. FINDINGS: Older workers have over two times greater odds of relapse subsequent to involuntary job loss than those who did not. Further, those who were current smokers prior to displacement that did not obtain new employment were found to be smoking more cigarettes, on average, post-job loss. CONCLUSIONS: The stress of job loss, along with other significant changes associated with leaving one's job, which would tend to increase cigarette consumption, must outweigh the financial hardship which would tend to reduce consumption. This highlights job loss as an important health risk factor for older smokers.     

Excess alcohol consumption and health outcomes: a 6-year follow-up of men over age 50 from the health and retirement study

Aims This study examined the association of problem drinking history and alcohol consumption with the onset of several health conditions and death over a 6‐year follow‐up period. Setting We analyzed two waves of longitudinal data on men over 50 who participated in the Health and Retirement Study, a nationally representative sample of people aged 51–61 and their spouses living in the United States in 1992. Measurements Five types of health outcomes—mortality, general health, functional status, cognitive status, and mental health—were examined. Drinking categories were based on average drinks per day (0, <1, 1–2, 3–4, 5+), with 5 + defined as ‘very heavy drinking’. Problem drinking history was identified as 2+ affirmative responses to the CAGE questionnaire. We controlled for smoking and other factors at baseline. Findings Over the 6‐year follow‐up period, very heavy drinking at baseline quadrupled the risk of developing functional impairments (OR: 4.21 95% CI: 1.67, 10.61). A problem drinking history increased the onset of depression (OR: 1.67 95% CI: 1.02, 2.74), psychiatric problems (OR: 2.15 95% CI: 1.47, 3.13) and memory problems (OR: 1.71 95% CI: 1.14, 2.56). Heavy drinking among mature adults was not associated with increased incidence of other adverse health events (i.e. angina, cancer, congestive heart failure, diabetes, myocardial infraction, lung disease or stroke). Conclusion Very heavy drinking and a problem drinking history greatly increased rates of onset of functional impairments, psychiatric problems and memory loss in late middle age for men who had not experienced these impairments at their initial interview.     

Effects on alcohol consumption of announcing revised UK low-risk drinking guidelines: findings from a monthly cross-sectional survey

BackgroundHealth authorities publish alcohol consumption guidelines for low-risk drinking in most high-income countries but the effects of these guidelines on alcohol consumption are unclear. In January, 2016, the UK's Chief Medical Officers announced revised guidelines recommending that men and women should not regularly drink more than 14 units per week, a reduction to the previous guideline for men of 3–4 units per day. We aimed to evaluate the effect of announcing the revised guidelines on alcohol consumption.MethodsData were collected from March, 2014, to October, 2017, using the Alcohol Toolkit Survey, a monthly repeat cross-sectional survey of approximately 1800 adults (older than 16 years) resident in England. The survey uses a hybrid between random location sampling and quota sampling designed to generate a nationally representative sample, which selects random areas in England (about 300 households) from strata defined by area-level geographical and sociodemographic profiles. Participants provided verbal informed consent. The University College London ethics committee granted ethical approval for the Alcohol Toolkit Study and The University of Sheffield for the evaluation of the UK lower-risk drinking guidelines. The primary outcome is participants’ Alcohol Use Disorders Identification Test for Consumption (AUDIT-C) scores. Effects were estimated using segmented regression. Secondary analyses test for alternative breakpoints in the long-term trend and pulse effects. All analyses were preregistered in the ISRCTN registry, number ISRCTN15189062.FindingsAt baseline, 70·4% of the sample were drinkers and the mean AUDIT-C score was 2·8. The main analysis showed no significant step-change in AUDIT-C scores immediately following announcement of the guideline (β=0·001 [95% CI –0·079 to 0·099]; p=0·82) and the trend changed significantly such that scores increased by 0·005 each month (β=0·008 [0·001–0·015]; p=0·015). This finding was not robust as secondary analyses of alternative breakpoints suggested the change in behaviour began in June, before the new guidelines were announced. Secondary analyses also suggest that AUDIT-C scores reduced temporarily for 3 months (a pulse effect) after the announcement (β=–0·126 [–0·218 to –0·034]; p=0·007).InterpretationAnnouncing new UK drinking guidelines with no large-scale organised promotion did not lead to a substantial or sustained reduction in drinking or a downturn in long-term alcohol consumption behaviour. Well designed promotional campaigns might improve the effect of drinking guidelines on alcohol consumption. This study is limited by potential seasonal confounding—January is typically a light-drinking month, whereas December is a heavy-drinking month. We control for seasonal trends but this approach might be inadequate if seasonality varies substantially between years as our time series is relatively short.FundingNational Institute for Health Research Public Health Research Programme, School for Public Health Research, Cancer Research UK.     

Polypharmacy prevalence among older adults based on the survey of health,ageing and retirement in Europe

Polypharmacy, a common condition among the elderly, is associated with adverse outcomes, including increased healthcare costs, due to higher mortality, falls and hospitalizations rates, adverse drug reactions, drug–drug reactions and medication nonadherence. This study aims to evaluate the prevalence and factors related to polypharmacy in older adults across 17 European countries, plus Israel.In this cross-sectional analysis, we used data from participants aged 65 or more years from Wave 6 of the Survey of Health, Ageing, and Retirement in Europe (SHARE) database. Polypharmacy was defined as the concurrent use of five or more medications. Age, gender, education, physical inactivity, number of limitations with activities of daily living, network satisfaction, quality of life, depression, number of chronic diseases and difficulty taking medication variables were found to be associated with polypharmacy.Our results showed a prevalence of polypharmacy ranging from 26.3 to 39.9%. Switzerland, Croatia and Slovenia were the countries with the lowest prevalence, whereas Portugal, Israel and the Czech Republic were the countries where the prevalence of polypharmacy was the highest. Age, gender, number of limitations with activities of daily living, number of chronic diseases, quality of life, depression, physical inactivity, network satisfaction, difficulty in taking medications, years of education and shortage of money were significant variables associated with polypharmacy.Polypharmacy is a highly prevalent condition in the elderly population. Identification of variables associated with polypharmacy, such as those identified in this study, is important to identify and monitor elderly groups, which are most vulnerable to polypharmacy.     

Effects of bereavement/loss and pre-event status on subsequent physical health in older adults

Males and females aged fifty-five and older were interviewed before and after three types of bereavement/loss: attachment bereavement (child, spouse, parent), nonattachment bereavement (sibling, grandchild, close friend), and other losses (nonbereavements). Five measures of health were used. Before pre-event health was accounted for on self-report measures of health status and medical conditions, pre-event measures of environmental factors and impact measures of bereavement/loss events had significant but modest effects on post-event health. However, after pre-event health was taken into account, the effects of bereavement and other losses were pale in comparison. Bereavement/loss events were not related to subsequent deaths, health events, or the use of medical services. Environmental factors were modestly predictive of nonattachment bereavements and other losses. An unexpected finding was that other losses had stronger effects on health than bereavements. Trend analysis over eighteen months showed a modest decline in health status immediately after a loss event, followed by an improvement in health. In general, this older adult sample handled bereavements and other losses with minimal morbidity and mortality.     

Associations of back and leg pain with health status and functional capacity of older adults: findings from the retirement community back pain study

OBJECTIVE: Low back pain (LBP) is the most frequently reported musculoskeletal problem in older adults, but its impact on health status is not well understood. Our objective was to determine whether LBP and concurrent leg pain are associated with health-related quality of life (HRQOL) and function in a cohort of older adults, and to examine care-seeking behaviors related to LBP. METHODS: This was a population-based, cross-sectional survey study of 522 community-dwelling men and women (67.4%) ages >/=62 living in 4 retirement communities in Maryland and northern Virginia. LBP status in the past year was categorized as no pain in the low back or leg, LBP only, and LBP with leg pain. HRQOL and function were measured with the Medical Outcomes Study Short Form 36 (SF-36). RESULTS: A total of 26.8% of the sample reported LBP only and 21.3% reported LBP plus leg pain. Participants with LBP and LBP plus leg pain had lower scores in all SF-36 domains, reflecting worse HRQOL (P < 0.0001). LBP and LBP plus leg pain were associated with 2-fold greater odds of falling and increased difficulty lifting grocery bags, walking several blocks, and bathing. LBP plus leg pain was associated with difficulty in social interactions (odds ratio 10.63, 95% confidence interval 3.57-31.60). Less than half sought care for LBP and those who did had poorer health status and greater pain burden. CONCLUSION: LBP is common among older adults and strongly associated with reduced HRQOL and function. These findings argue strongly for both identifying cases of LBP by health care practitioners and pursuing effective treatments for LBP given the potential consequences.     

Self-reported alcohol consumption and falls in older adults: cross-sectional and longitudinal analyses of the cardiovascular health study

OBJECTIVES: To assess the cross-sectional and longitudinal associations between alcohol consumption and risk of falls in older adults. DESIGN: Cross-sectional and longitudinal analyses. SETTING: Four U.S. communities. PARTICIPANTS: A total of 5,841 older adults enrolled in the Cardiovascular Health Study, an ongoing, population-based, prospective cohort study, participated. MEASUREMENTS: Self-reported alcohol consumption at baseline, self-reported frequent falls at baseline, and the 4-year risk of falls of participants who denied frequent falls at baseline. RESULTS: Cross-sectional analysis indicated an apparent inverse association between alcohol consumption and risk of frequent falls (adjusted odds ratio in consumers of 14 or more drinks per week=0.41; 95% confidence interval (CI)=0.14-1.17; P for trend=.06), but longitudinal analysis indicated a similar 4-year risk of falls in abstainers and light to moderate drinkers but a 25% higher risk in consumers of 14 or more drinks per week (95% CI=3-52%; P for trend=.07). Similar results were found in analyses stratified by age, sex, race, and physical activity. CONCLUSION: Consumption of 14 or more drinks per week is associated with an increased risk of subsequent falls in older adults. Cross-sectional studies may fail to identify this risk of heavier drinking, perhaps because older adults at risk for falls decrease their alcohol use over time or because heavier drinkers at risk for falls tend not to enroll in cohort studies. However, because this study relied upon annual reporting of falls, further prospective studies should be conducted to confirm these findings.     

Nutrition and respiratory health in adults: findings from the health survey for Scotland.

There is a growing body of evidence to support the hypothesised links between consumption of antioxidant rich foods and the occurrence of obstructive airway disease. The main research question was to examine the relationships between two types of dietary exposure and two indicators of respiratory morbidity in Scottish adults. The relationships between dietary consumption of fruit, vegetables and fish, and plasma levels of vitamins A, C, E and beta-carotene, and pulmonary function (forced expiratory volume in one second (FEV1)) and symptoms (phlegm production and shortness of breath with wheezing), were examined in a random population sample of adults. A dose/response relationship was found between fruit consumption and pulmonary function. In comparison with eating fruit rarely or never, eating fruit at least once per day, 1-6 times per week, and 1-3 times per month were associated with differences of 132, 100 and 63 mL in FEV1, after adjustment for known confounders and dietary intake of vegetables and fish (n=6186). An SD score change in plasma vitamin C was associated with a 49 mL difference in FEV1 (n=930). Fruit and vitamin E were associated with a reduced prevalence of phlegm production for 3 months or more per year. The most beneficial combination of dietary components may be found in natural foodstuffs, particularly fresh fruit.     

Pet ownership and health in older adults: findings from a survey of 2,551 community-based Australians aged 60-64

BACKGROUND: It is commonly assumed that owning a pet provides older residents in the community with health benefits including improved physical health and psychological well-being. It has also been reported that pet owners are lower on neuroticism and higher on extraversion compared with those without pets. However, findings of research on this topic have been mixed with a number of researchers reporting that, for older people, there is little or no health benefit associated with pet ownership. OBJECTIVE: To identify health benefits associated with pet ownership and pet caring responsibilities in a large sample of older community-based residents. METHODS: Using survey information provided by 2,551 individuals aged between 60 and 64 years, we compared the sociodemographic attributes, mental and physical health measures, and personality traits of pet owners and non-owners. For 78.8% of these participants, we were also able to compare the health services used, based on information obtained from the national insurer on the number of general practitioner (GP) visits they made over a 12-month period. RESULTS: Compared with non-owners, those with pets reported more depressive symptoms while female pet owners who were married also had poorer physical health. We found that caring for a pet was associated with negative health outcomes including more symptoms of depression, poorer physical health and higher rates of use of pain relief medication. No relationship was found between pet ownership and use of GP services. When we examined the personality traits of pet owners and carers, we found that men who cared for pets had higher extraversion scores. Our principal and unexpected finding, however, was that pet owners and carers reported higher levels of psychoticism as measured by the Revised Eysenck Personality Questionnaire. CONCLUSIONS: We conclude that pet ownership confers no health benefits for this age group. Instead, those with pets have poorer mental and physical health and use more pain relief medication. Further, our study suggests that those with pets are less conforming to social norms as indicated by their higher levels of psychoticism.