Health trajectories after age 60: the role of individual behaviors and the social context

Abstract

Background: This study aimed to detect health trajectories after age 60, and to explore to what extent individual and social factors may contribute to healthier aging.

Methods: Twelve-year health trajectories were identified in subjects from the Swedish National Study on Aging and Care in Kungsholmen (N=3108), integrating five indicators of disease, physical and cognitive function, and disability through nominal response models. Growth mixture models were applied to explore health trajectories in terms of rate and pattern of change. Baseline information about health-related behaviors and the social context was collected through standardized questionnaires. The strength of the associations was estimated using logistic regression, and their impact through population attributable fractions (PAF).

Results: Three trajectories were identified grouping 78%, 18%, and 4% of people with respectively increasing rates of health decline. Compared to the best trajectory, subjects in the middle and worst trajectories became functionally dependent 12.0 (95% CI: 11.4-12.6) and 12.1 (95% CI: 11.5-12.7) years earlier, respectively. Insufficient physical activity (OR: 3.38, 95% CI: 2.58-4.42), financial strain (OR: 2.76, 95% CI: 1.77-4.30), <12 years education (OR: 1.53, 95% CI: 1.14-2.04), low social connections (OR: 1.45, 95% CI: 1.09-1.94), low social participation (OR: 1.39, 95% CI: 1.06-1.83) and a body mass index ≥25 (OR: 1.34, 95% CI: 1.03-1.75) were associated with belonging to the middle/worst trajectories. The highest PAFs were observed for insufficient physical activity (27.1%), low education (19.3%) and low social participation (15.9%); a total PAF of 66.1% was obtained.

Conclusions: Addressing the social determinants of health in its broadest sense, complementarily considering life-long factors belonging to the socioeconomic, psychosocial, and behavioral dimensions, should be central to any strategy aimed at fostering health in older age.

Keywords: cohort studies; health behaviors; healthy aging; social determinants of health.

Figure 1

Individual (dotted) and average (solid) HAT-score trajectories for the general population (A) and stratified by baseline age (B) and sex (C). The x-axis in all graphs reflects the age structure of SNAC-K, whereby participants belong to any of the following 11 age cohorts (aged 60, 66, 72, 78, 81, 84, 87, 90, 93, 96 and 99+) both at baseline and at follow-ups. The shading in the background of the graphs reflects the clinical interpretation of HAT scores, as described in Table 1.