The relation between age of retirement and frailty in later life? A cross-sectional study in Flemish older adults

BackgroundPolicymakers in several European countries, concerned about the sustainability of their pension system, have raised the statutory retirement age. While several studies investigated the effect of retirement on health, the relationship between retirement and frailty is neglected. Notwithstanding, frailty is associated with adverse outcomes.ObjectiveThe aim of this study was to examine the relationship between age of retirement and frailty in later life.MethodsData of the Belgian Ageing Studies, a cross-sectional research project was used. The present study includes N=12659 participants (>60y) in 83 Flemish municipalities. To address reverse causality, only participants not retired because of health-related reasons were included. The Comprehensive Frailty Assessment Instrument, a multidimensional frailty scale with four domains (physical, psychological, social and environmental) was used to operationalize frailty. Univariate general linear regression analyses (GLM) were performed for scores on the total frailty scale and the four subdomains separately. The analysis was done for men and women separately, since both groups have different labor trajectories.ResultsThe present study found a negative association between age of retirement and physical frailty for both men and women in later life, and total frailty for men, although the differences were small. No evidence was found for a relation between age of retirement and the other subdomains of frailty.ConclusionsThe results suggest that age of retirement is not a clinically relevant predictor for frailty in later life. Differences within and between subpopulations (e.g., profession) can shed a new light on this relation.     

Economic stress of people 50 + in European countries in the Covid-19 pandemic–do country policies matter?

The Covid-19 pandemic caused lockdown of economies, which in turn led to the worsening of the economic situation of many households. During the first wave of the Covid-19 pandemic governments undertook various measures to support economies and societies, including jobs protection along with financial support provision to people who suffered financial loss during the economic crisis. We analyse the economic situation of older Europeans, depending on their socio-economic status as well as country of residence characteristics, including economic and labour market changes during the first phase of the pandemic, the strictness of government policies but also the country development level using the Human Development Index. We use the results of the Survey of Health, Ageing, and Retirement in Europe (SHARE), including the SHARE Corona Telephone Survey, which was conducted during the first wave of the Covid-19 pandemic. Our results indicate that individual characteristics have a higher impact on individual economic stress, compared to country characteristics. However, country’s response to the consequences of the Covid-19 pandemic, but also the overall level of development influences the economic situation and ability to cope with the economic risks people aged 50 and over face. People in more developed countries have smaller difficulties in making ends meet, while the economic crisis and more stringent policies reduce chances to receive financial support and increase economic risks.     

Univariable associations between a history of incarceration and HIV and HCV prevalence among people who inject drugs across 17 countries in Europe 2006 to 2020 – is the precautionary principle applicable?

BackgroundPeople who inject drugs (PWID) are frequently incarcerated, which is associated with multiple negative health outcomes.AimWe aimed to estimate the associations between a history of incarceration and prevalence of HIV and HCV infection among PWID in Europe.MethodsAggregate data from PWID recruited in drug services (excluding prison services) or elsewhere in the community were reported by 17 of 30 countries (16 per virus) collaborating in a European drug monitoring system (2006–2020; n = 52,368 HIV+/−; n = 47,268 HCV+/−). Country-specific odds ratios (OR) and prevalence ratios (PR) were calculated from country totals of HIV and HCV antibody status and self-reported life-time incarceration history, and pooled using meta-analyses. Country-specific and overall population attributable risk (PAR) were estimated using pooled PR.ResultsUnivariable HIV OR ranged between 0.73 and 6.37 (median: 2.1; pooled OR: 1.92; 95% CI: 1.52–2.42). Pooled PR was 1.66 (95% CI 1.38–1.98), giving a PAR of 25.8% (95% CI 16.7–34.0). Univariable anti-HCV OR ranged between 1.06 and 5.04 (median: 2.70; pooled OR: 2.51; 95% CI: 2.17–2.91). Pooled PR was 1.42 (95% CI: 1.28–1.58) and PAR 16.7% (95% CI: 11.8–21.7). Subgroup analyses showed differences in the OR for HCV by geographical region, with lower estimates in southern Europe.ConclusionIn univariable analysis, a history of incarceration was associated with positive HIV and HCV serostatus among PWID in Europe. Applying the precautionary principle would suggest finding alternatives to incarceration of PWID and strengthening health and social services in prison and after release (‘throughcare’).     

Size at birth,gestational age and cortisol secretion in adult life: foetal programming of both hyper‐ and hypocortisolism?

OBJECTIVE: Recent studies have suggested that lifelong programming of the hypothalamic-pituitary-adrenal (HPA) axis in utero is an important mechanism in explaining the link between small size at birth and adult cardiovascular disease. However, direct evidence from human birth cohorts has so far been contradictory. We set out to study reasons for this discrepancy by examining the relationship between adult HPA axis function and birthweight and body proportions at birth in a group of elderly subjects with detailed birth records. DESIGN: Birth cohort study. SUBJECTS: Four hundred and twenty-one men and women (mean age 69.5 years, range 65.1-75.8 years) born at term in Helsinki, Finland, during 1924-33, with body size and gestational age at birth recorded. MEASUREMENTS: Fasting serum cortisol and cortisol-binding globulin concentrations. The concentration of free cortisol was estimated by their ratio. RESULTS: There was no significant correlation between fasting cortisol concentrations and birthweight in either men or women. However, there was a weak inverse association between fasting cortisol and length at birth in women but not in men. There was also a significant positive association between cortisol and ponderal index in both genders. We found that the association between foetal growth on fasting total and free cortisol concentrations differed in subjects born at different gestational ages. In subjects born before 39 weeks of gestation, both total and free cortisol showed inverse correlations with birthweight (P = 0.02 and P = 0.09, respectively) and length at birth (P = 0.001 and P = 0.02), whereas in subjects born after 40 weeks of gestation there were positive correlations with birthweight (P = 0.06 and P = 0.002) and ponderal index at birth (P = 0.003 and P = 0.003). The interactions between birthweight and gestational age were statistically significant (P = 0.01 for total and P = 0.003 for free cortisol). CONCLUSIONS: These data suggest that the relationship between size at birth and cortisol concentrations in adult life is different in subjects born at different gestational ages: both hyper- and hypocortisolism may arise as a consequence of foetal programming of the hypothalamic-pituitary-adrenal axis during intrauterine life.     

Factor VIII: the protein,cloning its gene,synthetic factor and now – 35 years later – gene therapy; what happened in between?

The foundation of haemophilia A therapy in the last 35 years has been critically dependent on isolation of the Factor VIII (FVIII) protein and discovery of the cDNA sequence of the FVIII gene, published in 1984. Identification of the FVIII sequence resulted in a new era of recombinant concentrates and led to significant improvements in safety, set against the tragedy of widespread HIV and hepatitis infections in haemophilia patients from contaminated plasma-based products. We chronicle the scientific methods and race leading up to the publication of the FVIII DNA sequence and the legacy that follows through to revolutionary gene therapy treatment in clinical trials today.     

Is there really a ‘J‐shaped’ curve in the association between alcohol consumption and symptoms of depression and anxiety? Findings from the Mater‐University Study of Pregnancy and its outcomes*

AIMS: To determine the nature of the association between alcohol consumption and symptoms of anxiety and depression in women. DESIGN: Prospective cohort study of women (n = 4527) who received antenatal care at a major public hospital (Mater Misericordiae Hospital) in South Brisbane between 1981 and 1984 and who have follow-up data on alcohol use, depressive and anxiety symptoms over a 14-year period. FINDINGS: At the 5-year follow-up there was a 'J-shaped' association between alcohol consumption and both symptoms of depression and of anxiety. However, at the baseline assessment and the 14-year follow-up alcohol consumption was linearly and positively associated with depressive symptoms with increasing prevalence of symptoms with greater consumption. At the 5-year follow-up the prevalence of depressive and anxiety symptoms among those who were abstainers at both baseline and 5-year follow-up was similar to that among those who had been previous drinkers and then become abstainers (P = 0.67). Similarly, the prevalence of these symptoms was the same at the 14-year follow-up comparing those who had been abstainers at baseline, 5-year and 14-year follow-up to those who had previously consumed alcohol but were then abstainers. CONCLUSIONS: The nature of the association between alcohol consumption and symptoms of depression and anxiety may vary across their life course in women. Previous drinkers who become abstainers do not appear to be at any higher risk of symptoms of depression or anxiety compared to those who always abstained, suggesting that increased symptoms in abstainers at age 30 is not due to 'sick quitters'. The association of high alcohol consumption with symptoms of depression and anxiety may be confounded by low income and smoking.     

“What do you expect? You're just getting older”: A comparison of perceived osteoarthritis‐related and aging‐related health experiences in middle‐ and older‐age adults

Objective

To compare the health experiences of middle‐ and older‐age adults with moderate osteoarthritis (OA) symptoms with experiences of individuals with no chronic health conditions. Similarities and differences in health changes, the meaning of these changes, and their impact were examined.

Methods

Sixteen focus groups (10 OA, 6 control) were conducted with 53 women and 37 men (age 39–88 years). OA participants were recruited from practitioners' offices and The Arthritis Society, Ontario Division. Additional OA participants and controls were recruited from community centers and newspaper advertisements. All participants were asked about changes in health, the impact of these changes, and self‐management strategies. Participants also completed standardized measures including demographic information; the Short Form 36; Western Ontario and McMaster Universities Osteoarthritis Index; and Disabilities of the Arm, Shoulder and Hand questionnaire.

Results

Differences in the depth, breadth, and meaning of symptoms such as pain, stiffness, and fatigue were reported with little overlap between OA and control groups. OA was often seen as part of a normal aging process requiring acceptance, not treatment. However, younger OA participants reported more distress and frustration managing the disease. OA participants reported an impact of their health on work, leisure, social activities, and relationships that was described as upsetting compared with controls.

Conclusion

This study illuminates personal and social factors associated with OA by comparing health experiences of individuals with OA and controls. It highlights directions for future research that can improve our understanding of the needs of individuals with OA and can help link individuals' health status to the broader framework of their lives.

     

Housewife or working mum—each to her own? The relevance of societal factors in the association between social roles and alcohol use among mothers in 16 industrialized countries

Aims To investigate whether differences in gender–income equity at country level explain national differences in the links between alcohol use, and the combination of motherhood and paid labour. Design Cross‐sectional data in 16 established market economies participating in the Gender, Alcohol and Culture: An International Study (GenACIS) study. Setting Population surveys. Participants A total of 12 454 mothers (aged 25–49 years). Measurements Alcohol use was assessed as the quantity per drinking day. Paid labour, having a partner, gender–income ratio at country level and the interaction between individual and country characteristics were regressed on alcohol consumed per drinking day using multi‐level modelling. Findings Mothers with a partner who were in paid labour reported consuming more alcohol on drinking days than partnered housewives. In countries with high gender–income equity, mothers with a partner who were in paid labour drank less alcohol per occasion, while alcohol use was higher among working partnered mothers living in countries with lower income equity. Conclusion In countries which facilitate working mothers, daily alcohol use decreases as female social roles increase; in contrast, in countries where there are fewer incentives for mothers to remain in work, the protective effect of being a working mother (with partner) on alcohol use is weaker. These data suggest that a country's investment in measures to improve the compatibility of motherhood and paid labour may reduce women's alcohol use.     

IRS1, KCNJ11, PPARγ2 and HNF‐1α: do amino acid polymorphisms in these candidate genes support a shared aetiology between type 1 and type 2 diabetes?

AIMS: Type 1 diabetes mellitus (T1DM) is a chronic disorder primarily triggered by environmental and immunological factors in genetically susceptible individuals. Despite the fact that there are indications of common aetiological features of T1DM and type 2 diabetes (T2DM), variation in genes involved in insulin secretion and insulin signalling has to a large extent been ignored as potential modifiers in the pathogenesis of T1DM. Recent studies suggest, however, that proven T2DM susceptibility gene variants may be involved in the pathogenesis of T1DM. The objective of this study was to estimate the impact of four selected amino acid polymorphisms -IRS-1 Gly972Arg, Kir6.2 Glu23Lys, HNF-1alpha Ala98Val and PPARgamma2 Pro12Ala in a Danish population of T1DM families. METHODS: All variants were genotyped in 490 simplex- and multiplex-T1DM families applying polymerase chain reaction-restriction fragment length polymorphism, and results were evaluated by means of a transmission disequilibrium test (TDT) analysis. RESULTS: TDT analysis revealed that the Arg972 IRS-1, the Lys23 Kir6.2 and the Val98 HNF-1alpha variants were transmitted from heterozygous parents to affected probands at frequencies of 49.1%, 47.0% and 54.1%, respectively (p > 0.05 for all). This was similar to the rate of transmission to unaffected siblings. The transmission rate of the Ala12 PPARgamma2 variant to affected probands was 46.5% (p > 0.05) which differed significantly from the transmission to unaffected offspring (p = 0.024). A combined analysis of the present and published pertinent data of 1691 transmissions showed a significantly decreased transmission of the PPARgamma2 Ala12 allele to affected probands (p = 0.0045). CONCLUSIONS: The Pro12Ala variant of PPARgamma2 is associated with T1DM, the minor Ala allele conferring a reduced risk. This same finding has been reported in patients with T2DM.     

Does the label “fibromyalgia” alter health status,function, and health service utilization? A prospective,within‐group comparison in a community cohort of adults with chronic widespread pain

Objective

To determine if assigning the label of fibromyalgia (FM) to individuals with chronic widespread pain has a significant effect on long‐term health status, function, and health service utilization.

Methods

In the London Fibromyalgia Epidemiology Study, 100 individuals with FM were identified by screening 3,395 non‐institutionalized adults. Only 28 of the 100 had been previously diagnosed with FM; for 72, the diagnostic label was new. All 28 with prediagnosed FM were female compared with 58 of the 72 newly diagnosed cases. In a prospective, within‐group comparison, we compared previously non‐labeled FM cases at study entry (prelabeling) and at 18 and 36 months followup (postlabeling) with respect to general health status, fibromyalgia‐related symptoms, and all items from the Fibromyalgia Impact Questionnaire (FIQ) (including total FIQ score, and several measures of health service utilization) to see if health status, function, and health services utilization had changed, using paired t‐tests. We also compared percentage reporting work disability at baseline and 18 months using Pearson's χ².

Results

Fifty‐six (78%) of the original 72 newly diagnosed FM cases were available for reassessment at 18 months, and 43 (60%) at 36 months. Although physical functioning decreased slightly over time, there also was a statistically significant improvement in satisfaction with health, and newly diagnosed FM cases reported fewer symptoms and major symptoms over the long term. No other differences in clinical status or health service use occurred over time.

Conclusion

The FM label does not have a meaningful adverse affect on clinical outcome over the long term. Further research is necessary to document the short‐ and long‐term effect of labeling in the chronic pain patient.