Neighborhoods and disability in later life

This paper uses the US Health and Retirement Study to explore linkages between neighborhood conditions and stages of the disablement process among adults aged 55 years and older in the United States. We consider multiple dimensions of the neighborhood including the built environment as well as social and economic conditions. In doing so, we use factor analysis to reduce indicators into eight neighborhood scales, which we incorporate into two-level logistic regression models along with controls for individual-level factors. We find evidence that economic conditions and the built environment, but not social conditions, matter. Neighborhood economic advantage is associated with a reduced risk of lower body limitations for both men and women. We also find for men that neighborhood economic disadvantage is linked to increased chances of reporting personal care limitations, particularly for those aged 55-64 years, and that high connectivity of the built environment is associated with reduced risk of limitations in instrumental activities. Our findings highlight the distinctive benefits of neighborhood economic advantage early in the disablement process. In addition, findings underscore the need for attention in the design and evaluation of disability-prevention efforts to the benefits that accrue from more physically connected communities and to the potential harm that may arise in later life from living in economically disadvantaged areas.     

Neighborhoods and obesity

This review critically summarizes the literature on neighborhood determinants of obesity and proposes a conceptual framework to guide future inquiry. Thirty-seven studies met all inclusion criteria and revealed that the influence of neighborhood-level factors appears mixed. Neighborhood-level measures of economic resources were associated with obesity in 15 studies, while the associations between neighborhood income inequality and racial composition with obesity were mixed. Availability of healthy versus unhealthy food was inconsistently related to obesity, while neighborhood features that discourage physical activity were consistently associated with increased body mass index. Theoretical explanations for neighborhood-obesity effects and recommendations for strengthening the literature are presented.     

Leptin intake during lactation prevents obesity and affects food intake and food preferences in later life

Breast milk is practically the only food ingested during the first months of life in fully breastfed infants and it is assumed to match the infant's nutritional needs. Epidemiological data suggest that breastfeeding compared with infant formula feeding confers protection against several chronic diseases later on in life and, particularly, against obesity and related medical complications. However, causality has not been related to any specific compound of breast milk. Recent data in our laboratory have identified leptin as the specific compound that is responsible for some of these beneficial effects of breastfeeding. The hormone leptin was identified as a key candidate because it is present in breast milk, but is not present in infant formula, and when ingested during the suckling period can be absorbed by the immature stomach exerting biological effects. Evidence of the beneficial effects of breast milk leptin was obtained from human studies, showing that milk-borne maternal leptin appeared to give moderate protection to infants from excess weight gain. Direct cause-effect evidence was obtained in rats, where oral leptin supplementation during the suckling period resulted in a decrease in food intake, affected food preferences in favour of carbohydrates versus fat, and protected against overweight in adulthood, with an improvement of related parameters such as leptin and insulin sensitivity. These findings open a new area of research on the use of leptin in the design of more appropriate infant formula, which is significant considering the increasing incidence of obesity and its associated medical complications.     

Stamina in later life

Patterns of aging raise a number of important questions concerning the paths to successful adaptation. What gives some older individuals their staying power in the face of misfortune? What causes others to function less effectively when stressed, to resist change? Clearly, the margin of safety, the degree of elasticity and resilience varies across individuals in the later years. This study focuses on event histories and current behavior of 62 elderly men and women (Phase I) and reports by their confidants (N = 62; Phase II). A central proposition, that stamina in later life depends, in part, on the appraisal of previous events involving loss is investigated using a model that incorporates aspects of earlier life, cognitive appraisal and clinically judged dimensions of stamina in old age. Multivariate (particularly path analytic) techniques are used to test the links between variable foci. Results suggest that antecedents of stamina involve the interaction of social resources and cognitive orientations. Specifically, stamina in later life is contingent, for the most part, on a triumphant, positive outlook during periods of adversity. Elderly so oriented are also those with robust health histories and marked educational accomplishments. Conversely, persons who view situations involving loss as threatening, overwhelming and potentially defeating experience no such outcome; low levels of stamina mark their later years. Interestingly, quality childhood ties matter for stamina in old age only by increasing the likelihood of perceptions of a supportive environment during hard times. The findings corroborate the general pattern of research documenting the importance of cognitive orientations in adaptive processes.     

Self-neglect in later life

Although considerable attention has been given to the abuse and neglect of older people by others, little attention has been given to self-neglect in later life. This paper reviews the research literature on self-neglect which comes primarily from the medical profession. It is argued that evidence that gross self-neglect constitutes a specific psychiatric syndrome (commonly referred to as Diogenes syndrome) is scant. Given current moves to make legal provision for the protection of ‘vulnerable’ older people, more rigorous research into self-neglect is required.     

Housing and health in later life

The goal of this paper is to compile recent data on the housing and health in old age, with special emphasis on geropsychological and gerontological studies. The authors first introduce their understanding of both housing and health. Second, theoretical models that are important to understand better the relation between housing- and health-related outcomes are incorporated into an analytic scheme. Third, data on objective and subjective aspects of housing in old age in relation to health-related outcomes are presented. Among the objective functional housing aspects are health-relevant micro-environmental indicators like housing hazards and amenities, retrofitting and assistive devices, as well as meso- and macro-environmental indicators like housing type, neighborhood conditions, or urban-rural differences. Relocation is a classic field in environmental gerontology in which drastic environmental change has been linked to health outcomes. Among subjective housing aspects are residential satisfaction, housing-related control beliefs, and meaning of home. Direct health-related outcomes, such as physical and mental diseases and functional limitations, as well as indirect health-related outcomes like satisfaction or well-being receive attention. We conclude with a discussion addressing the environment and health dynamics of aging in the future.     

Early life conditions and cognitive functioning in later life

Early life conditions are related to cognitive development and abilities in childhood and cognitive function in adulthood. However, the association between early life conditions and cognitive change in old age is unknown. The authors examined the relation between socioeconomic position (SEP) and cognitive milieu in childhood and change in cognitive function in a population-based sample of 4,398 community-dwelling adults (62.1% female; 61.7% Black) aged 65 years or older from Chicago, Illinois. Baseline data were collected in 1993-1997. Change in cognitive function was assessed by means of a global cognitive index derived from measures of memory, perceptual speed, and overall cognitive function administered at three in-home assessments between 1993 and 2003, with an average of 5.3 years of follow-up. After results were controlled for age, sex, race, and education, interactions of time with childhood SEP (beta = -0.003, t = -1.0, p = 0.32) and childhood cognitive milieu (beta = -0.0008, t = -0.5, p = 0.62) were nonsignificant, indicating that early life conditions were not related to cognitive change. SEP (beta = 0.034, t = 2.4, p = 0.01) and cognitive milieu (beta = 0.017, t = 2.2, p = 0.03) were associated with absolute level of cognitive function, with better performance being related to higher SEP and a better cognitive milieu. A better SEP and a more stimulating cognitive milieu in childhood have small but significant effects on absolute level of cognitive function; however, they do not seem to protect against cognitive decline in old age.     

Sexual activity and risk-taking in later life

The primary study objective was to identify the prevalence of sexual activity and sexual risk-taking behaviour among a sample of older community-based adults. Secondary objectives included gathering data about past experiences of consultations regarding sexual health issues with general practitioners (GPs) and at genitourinary medicine (GUM) clinics, and exploring participants' STI and HIV/AIDS-related information needs. Individuals over the age of 50 were identified from four electoral wards within Sheffield, UK by means of a postal screen based on the electoral register. Respondents self completed a short postal questionnaire. Three hundred and nineteen individuals aged over 50 years selected at random from the general population responded. Approximately 80% of respondents were currently sexually active and 7% engaged in behaviours that may place them at risk of contracting a sexually transmitted infection (STI). Risk takers were typically male, aged between 50 and 60 years and married. Being male was also related to reporting current or past sexual health concerns. In total, of 75 respondents reporting such concerns, two thirds had discussed these concerns with their GP or attended a GUM clinic. Levels of satisfaction with such consultations were generally high, but declined with increasing age. Overall, most participants felt they had not received very much information about STIs and HIV, and about one quarter reported that they would like to receive more information on these topics. These data have implications for all health and social care professionals who work with older people and indicate a potential need for education to help professionals meet the sexual health needs of their older patients/clients. Further implications for sexual health promotion and the need for additional research in this field are also discussed.     

Early nutrition and leptin concentrations in later life

BACKGROUND: Formula feeding or overweight in infancy may increase the later risk of obesity, but the mechanisms involved are uncertain. Because obesity is associated with high leptin concentrations relative to fat mass, programming of leptin concentrations may be one mechanism by which early nutrition influences later obesity. OBJECTIVE: We tested the hypothesis that high nutrient intake or formula feeding in infancy programs greater leptin concentrations relative to fat mass in later life. DESIGN: Serum leptin concentrations were measured by radioimmunoassay in 197 adolescents aged 13-16 y who were born preterm and randomly assigned at birth to receive either a nutrient-enriched preterm formula or banked donated breast milk (trial 1) or a preterm formula or a standard formula (trial 2). Fat mass was estimated with the use of bioelectrical impedance analysis. RESULTS: After combining the results of trials 1 and 2 as planned, the ratio of leptin to fat mass was significantly greater in the children who received the preterm formula (geometric : 0.84 microg x L(-1) x kg(-1)) than in those who received standard formula or banked breast milk (0.62 microg x L(-1) x kg(-1); mean difference: 30.8%; 95% CI for difference: 8.4%, 53.2%; P = 0.007). The difference between the diet groups remained significant after adjustment for age, sex, Tanner stage, social class, and fat mass. Human milk intake was significantly associated with lower leptin concentrations relative to fat mass in adolescence (P = 0.023), independent of potential confounding factors. CONCLUSION: Programming of relative leptin concentrations by early diet may be one mechanism that links early nutrition with later obesity.     

Estrogen use and blood pressure in later life

Use of oral estrogens did not alter the blood pressure (BP) or BP lability of women aged 52--87. The effect was similar in normotensives and women who were hypertensive before starting estrogen. Compared with nonusers of estrogen, users had lower systolic pressures, but did not differ in diastolic blood pressure, lability, frequency of doctor visits or BP determination, obesity, smoking or use of alcohol or psychotropic medication. The data neither confirm a previously reported association between estrogen use and hypertension nor do they suggest pre-selection of users for hypertension or labile BP.     

Adolescent mothers and their children in later life

The popular belief that early childbearing almost certainly leads to school dropout, subsequent unwanted births and economic dependence is greatly oversimplified, if not seriously distorted: A longitudinal study of over 300 primarily urban black women who gave birth as adolescents in the middle to late 1960s shows that a substantial majority completed high school, found regular employment and, even if they had at some point been on welfare, eventually managed to escape dependence on public assistance. Relatively few ended up with large families; most had fewer births than they had wanted or expected at the time they first became pregnant. The study also found that the pathways to success were surprisingly diverse. Although young women who gave birth at an early age were disadvantaged when compared with their peers who bore children later, huge variability existed. Teenage childbearing lowered the women's likelihood of economic success and increased their likelihood of having a large family. However, the women who had more economically secure and better-educated parents were more likely to succeed--perhaps as a result of receiving a greater amount of direct aid and having other family resources available. In addition, differences in educational motivation and performance were especially important factors. Young mothers who had been doing well in school and who had had high educational aspirations at the time of their first birth were much more likely than others to be successful later. Additional births at young ages also constrained the mothers' ability to attend school and accrue job experience. Women who had more children in the five years after their first birth did less well in school, had lower aspirations and came from more disadvantaged families than did women who curtailed their fertility. However, even when such factors were controlled for, subsequent fertility lowered the chances of economic success in later life. Changes in the mothers' life courses affected some aspect of their children's behavior at all ages, but there was no simple or recurring pattern of influence. For example, a mother's welfare receipt was associated with behavior problems in her child during the preschool years, but not later on. In contrast, the mother's marital status was not related to behavior problems during the preschool period but was clearly related to such problems during the child's adolescence.     

Housing in early life and later mortality.

STUDY OBJECTIVES--The aim was to examine the influence of domestic crowding and household amenities in early life on later mortality from all causes and specifically from stomach cancer, chronic obstructive pulmonary disease, and rheumatic heart disease. DESIGN--This was a retrospective cohort study of people whose houses had been surveyed in 1936 and whose household size was known from the 1939 census. Subjects were followed through the National Health Service Central Register from 1951 to 1989. SETTING--The housing survey had been carried out in the midland town of Chesterfield. SUBJECTS--Subjects comprised 8138 men and women born after 1900. RESULTS--A total of 2929 deaths were observed during the follow up period. All causes mortality in the full cohort was not consistently related to any of the housing variables examined, but among subjects who were still children at the time of the housing survey, death rates were higher in those whose houses were crowded or lacked a hot water tap. No associations could be shown between stomach cancer and domestic crowding or food storage facilities; chronic obstructive pulmonary disease and domestic crowding or use of gas for cooking; or rheumatic heart disease and domestic crowding. There were few deaths from these causes, however, in subjects who were children at the time of housing survey. CONCLUSIONS--The findings suggest that the housing of young adults in Chesterfield during the 1930s had little effect on their later mortality. Further follow up of the cohort is needed before firm conclusions can be drawn about the influence of housing at younger ages.     

Geographical life-space and subjective wellbeing in later life

Geographical life-space is an important factor to consider when studying subjective wellbeing of older adults. The purpose of this article is twofold: to provide an in-depth understanding of 1) the geographical life-spaces in which the lives of older adults take place and 2) the relation between life-space and experienced levels of subjective wellbeing. Seventy-six older adults (aged 65 and older) participated in our qualitative study. We applied a qualitative research approach, through combining indepth-interviews with visual life-space diagrams. Our findings show that most older adults continue to experience a high level of subjective wellbeing, regardless of the extent of their life-space. We conclude that the possibility to fulfill one's needs, even in a restricted life-space, is more conducive to maintaining subjective wellbeing than the extent of life-space itself.     

History of socioeconomic disadvantage and allostatic load in later life

There is a growing interest in understanding how the experience of socioeconomic status (SES) adversity across the life course may accumulate to negatively affect the functioning of biological regulatory systems important to functioning and health in later adulthood. The goal of the present analyses was to examine whether greater life course SES adversity experience would be associated with higher scores on a multi-system allostatic load (AL) index of physiological function in adulthood. Data for these analyses are from 1008 participants (92.2% White) from the Biomarker Substudy of the Study of Midlife in the US (MIDUS). Multiple indicators of SES adversity in childhood (parent educational attainment, welfare status, financial situation) and two points in adulthood (educational attainment, household income, difficulty paying bills, availability of money to meet basic needs, current financial situation) were used to construct SES adversity measures for each life course phase. An AL score was constructed using information on 24 biomarkers from 7 different physiological systems (sympathetic and parasympathetic nervous systems, hypothalamic-pituitary-adrenal axis, cardiovascular, lipid metabolism, glucose metabolism, inflammatory immune activity). Analyses indicate higher AL as a function of greater SES adversity at each phase of, and cumulatively across, the life course. Associations were only moderately attenuated when accounting for a wide array of health status, behavioral and psychosocial factors. Findings suggest that SES adversity experience may cumulate across the life course to have a negative impact on multiple biological systems in adulthood. An important aim of future research is the replication of current findings in this predominantly White sample in more ethnically diverse populations.     

The growing years and prevention of osteoporosis in later life

Ca is the major mineral in bone, and 99% of the Ca in the body resides in the skeleton. Skeletal mass is a determinant of risk of fracture in childhood as well as adulthood. Over 40% of adult peak bone mass is acquired during adolescence. This period is when lifestyle choices, including ensuring adequate dietary Ca, regular weight-bearing exercise and avoiding hormonal insufficiency, are especially important. Current Ca intakes for adolescent females are woefully inadequate.