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  • 1. Baumann, I.
    et al.
    Sif Eyjólfsdóttir, H.
    Fritzell, J.
    Lennartsson, C.
    Darin-Mattsson, A.
    Nilsen, Charlotta
    Kåreholt, Ingemar
    Jönköping University, Hälsohögskolan, HHJ, Institutet för gerontologi. Jönköping University, Hälsohögskolan, HHJ. ARN-J (Aging Research Network - Jönköping).
    Andel, R.
    Dratva, J.
    Agahi, N.
    Retirement age and cognitive functioning in old age: the role of stimulating occupational activities2018Konferansepaper (Fagfellevurdert)
  • 2. Darin-Mattsson, A.
    et al.
    Fors, S.
    Nilsen, Charlotta
    Fritzell, J.
    Andel, R.
    Kåreholt, Ingemar
    Jönköping University, Hälsohögskolan, HHJ, Institutet för gerontologi. Jönköping University, Hälsohögskolan, HHJ. ARN-J (Aging Research Network - Jönköping).
    Occupational complexity in relation to late life physical functioning in Sweden2018Konferansepaper (Fagfellevurdert)
  • 3.
    Ekezie, Promise E.
    et al.
    Jönköping University, Hälsohögskolan, HHJ, Institutet för gerontologi.
    Eriksson, Ulrika
    Jönköping University, Hälsohögskolan, HHJ, Institutet för gerontologi.
    Shaw, Benjamin A.
    Division of Community Health Sciences, University of Illinois Chicago School of Public Health, Chicago, IL, USA.
    Agahi, Neda
    Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
    Nilsen, Charlotta
    Jönköping University, Hälsohögskolan, HHJ, Institutet för gerontologi. Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Stress Research Institute, Stockholm University, Stockholm, Sweden.
    Is the mental health of older adults receiving care from their children related to their children's dual burden of caregiving and work stress?: A linked lives perspective2023Inngår i: Aging & Mental Health, ISSN 1360-7863, E-ISSN 1364-6915, Vol. 27, nr 9, s. 1796-1802Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives

    Mental health problems are a major concern in the older population in Sweden, as is the growing number of older adults aging alone in their homes and in need of informal care. Using a linked lives perspective, this study explored if older parents' mental health is related to their children's dual burden of informal caregiving and job strain.

    Methods

    Data from a nationally representative Swedish survey, SWEOLD, were used. Mental health problems in older age (mean age 88) were measured with self-reported 'mild' or 'severe' anxiety and depressive symptoms. A primary caregiving adult child was linked to each older parent, and this child's occupation was matched with a job exposure matrix to assess job strain. Logistic regression analyses were conducted with an analytic sample of 334.

    Results

    After adjusting for covariates, caregiving children's lower job control and greater job strain were each associated with mental health problems in their older parents (OR 2.52, p = 0.008 and OR 2.56, p = 0.044, respectively). No association was found between caregiving children's job demands and their older parents' mental health (OR 1.08, p = 0.799).

    Conclusion

    In line with the linked lives perspective, results highlight that the work-life balance of informal caregiving adult children may play a role in their older parent's mental health.

  • 4.
    Finkel, Deborah
    et al.
    Jönköping University, Hälsohögskolan, HHJ, Institutet för gerontologi. Center for Economic and Social Research, University of Southern California.
    Nilsen, Charlotta
    Jönköping University, Hälsohögskolan, HHJ, Institutet för gerontologi.
    Sindi, Shireen
    Division of Clinical Geriatrics, Center for Alzheimer's Research, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet.
    Kåreholt, Ingemar
    Jönköping University, Hälsohögskolan, HHJ, Institutet för gerontologi. Jönköping University, Hälsohögskolan, HHJ. Studies on Integrated Health and Welfare (SIHW).
    Impact of childhood and adult socioeconomic position on change in functional aging2024Inngår i: Health Psychology, ISSN 0278-6133, E-ISSN 1930-7810Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES: To examine life-course models by investigating the roles of childhood and adult socioeconomic position (SEP) in longitudinal changes in a functional aging index.

    METHOD: Up to eight waves of testing, covering 25 years, were available from the Swedish Adoption/Twin Study of Aging: N = 654, intake age = 50-82. A two-slope latent growth curve model was applied to the data, and the impact of including childhood and adult SEP as covariates of the intercept (at age 70) and slopes (before and after age 70) was tested.

    RESULTS: Both childhood and adult SEP contributed to the best-fitting model. Childhood SEP was significantly associated with intercept and Slope 1 (before age 70) of the latent growth curve model (p < .05). Association of adult SEP with Slope 2 (after age 70) trended toward significance (p < .10). There was a significant interaction effect of childhood and adult SEP on the intercept (p < .05). As a result, intercept at age 70 was highest and change after age 70 was fastest for those whose SEP decreased from childhood to adulthood.

    CONCLUSIONS: Both childhood and adult SEP impact change in functional abilities with age, supporting both critical period and social mobility models. The social environment is modifiable by policies at local, national, and international levels, and these policies need to recognize that early social disadvantage can have long-lasting health impacts. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

  • 5.
    Finkel, Deborah
    et al.
    Jönköping University, Hälsohögskolan, HHJ, Institutet för gerontologi. Jönköping University, Hälsohögskolan, HHJ. ARN-J (Aging Research Network - Jönköping). Indiana Univ Southeast, New Albany, IN 47150 USA..
    Nilsen, Charlotta
    Jönköping University, Hälsohögskolan, HHJ, Institutet för gerontologi.
    Sindi, Shireen
    Karolinska Inst, Solna, Stockholms Lan, Sweden..
    Kåreholt, Ingemar
    Jönköping University, Hälsohögskolan, HHJ, Institutet för gerontologi. Jönköping University, Hälsohögskolan, HHJ. ARN-J (Aging Research Network - Jönköping).
    Impact of Objective and Subjective Sep on Aging Trajectories of Functional Capacity2022Inngår i: Innovation in Aging, E-ISSN 2399-5300, Vol. 6, nr Supplement 1, s. 220-220Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Long-term stress is associated with adverse health outcomes in aging. It is important to identify not only factors that influence functioning in late adulthood, such as accumulated stress, but also the timing of such factors. The aim of the current analysis was to examine how socioeconomic stressors throughout the life course are associated with aging in functional capacity. Data were available from 740 adults ranging in age from 40 to 83 at intake (mean = 62.4, SD = 8.2) who participated in up to 8 waves of data collection (mean = 3.9, SD = 2.4). A Functional Aging Index (FAI) was created by combining measures of sensory, pulmonary, gait, and grip functioning. Both childhood and adulthood measures of objective socioeconomic position (SEP) and perceived SEP (financial strain) were available. Latent growth curve models (corrected for twinness) were used to estimate the trajectory of change in FAI over age and the impact of child and adult SEP measures on the trajectories. Results indicated that both childhood and adult objective SEP independently influenced rates of change in FAI in adulthood: higher SEP was associated with higher mean functioning and slower rates of decline. In combination, model fitting indicated that if SEP is above the median in adulthood, then childhood SEP has no impact on FAI trajectories; however, if SEP is below the median in adulthood, then childhood SEP can play a role. In addition, results indicated possible long-term effects of childhood financial strain on rates of change in FAI in adulthood.

  • 6.
    Kåreholt, Ingemar
    et al.
    Jönköping University, Hälsohögskolan, HHJ, Institutet för gerontologi.
    Andel, R.
    Darin-Mattsson, A.
    Nilsen, Charlotta
    The Influence of Psychosocial Working Conditions on Late-Life Physical Functioning2018Konferansepaper (Fagfellevurdert)
  • 7.
    Kåreholt, Ingemar
    et al.
    Jönköping University, Hälsohögskolan, HHJ, Institutet för gerontologi. Jönköping University, Hälsohögskolan, HHJ. ARN-J (Aging Research Network - Jönköping).
    Andel, Ross
    Univ S Florida, Tampa, FL USA.
    Darin-Mattsson, Alexander
    Aging Res Ctr, Solna, Sweden.
    Nilsen, Charlotta
    Aging Res Ctr, Solna, Sweden.
    The Influence of Psychosocial Working Conditions on Late-Life Physical Functioning2018Inngår i: International Journal of Behavioral Medicine, ISSN 1070-5503, E-ISSN 1532-7558, Vol. 25, s. S154-S154Artikkel i tidsskrift (Fagfellevurdert)
  • 8.
    Kåreholt, Ingemar
    et al.
    Jönköping University, Hälsohögskolan, HHJ, Institutet för gerontologi. Jönköping University, Hälsohögskolan, HHJ. ARN-J (Aging Research Network - Jönköping).
    Darin Mattsson, A.
    Nilsen, Charlotta
    Are work related stress, work complexity, and socioeconomic position more than 20 years earlier associated to mobility after retirement age2014Konferansepaper (Fagfellevurdert)
  • 9.
    Kåreholt, Ingemar
    et al.
    Jönköping University, Hälsohögskolan, HHJ, Institutet för gerontologi. Karolinska institutet, Stockholm, Sweden.
    Darin Mattsson, Alexander
    Nilsen, Charlotta
    Are socioeconomic position, work stress, and work complexity associated to mobility after retirement?2014Inngår i: International Journal of behavioral medicine: Abstracts from the ICBM 2014 Meeting, Springer, 2014, Vol. 21, s. 154-154Konferansepaper (Fagfellevurdert)
  • 10.
    Kåreholt, Ingemar
    et al.
    Jönköping University, Hälsohögskolan, HHJ, Institutet för gerontologi. Jönköping University, Hälsohögskolan, HHJ. ARN-J (Aging Research Network - Jönköping).
    Fors, S.
    Nilsen, Charlotta
    Fritzell, J.
    Andel, R.
    Darin-Mattsson, A.
    Occupational complexity in relation to late life physical functioning in Sweden2019Konferansepaper (Fagfellevurdert)
  • 11.
    Kåreholt, Ingemar
    et al.
    Jönköping University, Hälsohögskolan, HHJ, Institutet för gerontologi. Jönköping University, Hälsohögskolan, HHJ. ARN-J (Aging Research Network - Jönköping).
    Mehmedi, Liberta
    Jönköping University, Hälsohögskolan, HHJ. ARN-J (Aging Research Network - Jönköping).
    Nilsen, Charlotta
    Jönköping University, Hälsohögskolan, HHJ, Institutet för gerontologi. Jönköping University, Hälsohögskolan, HHJ. ARN-J (Aging Research Network - Jönköping).
    Lung Function In Old Age And Physical Activity From Midlife To Old Age: Longitudinal Study With 24-30 Years' Follow-Up2021Inngår i: Innovation in Aging, E-ISSN 2399-5300, Vol. 5, nr Supplement 1, s. 455-455Artikkel i tidsskrift (Fagfellevurdert)
  • 12.
    Kåreholt, Ingemar
    et al.
    Jönköping University, Hälsohögskolan, HHJ, Institutet för gerontologi. Jönköping University, Hälsohögskolan, HHJ. ARN-J (Aging Research Network - Jönköping).
    Nilsen, Charlotta
    Jönköping University, Hälsohögskolan, HHJ, Institutet för gerontologi.
    Agerholm, Janne
    Karolinska Inst, Stockholm, Stockholms Län, Sweden.
    Kelfve, Susanne
    Linkoping Univ, Linköping, Östergötlands Län, Sweden.
    Wastesson, Jonas
    Karolinska Inst, Stockholm, Stockholms Län, Sweden.
    Nabe-Nielsen, Kirsten
    Univ Copenhagen, Copenhagen, Hovedstaden, Denmark..
    Meinow, Bettina
    Stockholm Gerontol Res Ctr, Stockholm, Stockholms Län, Sweden.
    History of Job Strain And Risk of Late-Life Dependency: A Nationwide Swedish Registerbased Study2022Inngår i: Innovation in Aging, E-ISSN 2399-5300, Vol. 6, nr Supplement 1, s. 502-503Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    There is substantial evidence that work plays a significant role in post-retirement health. Yet little is known about its role in when late-life dependency may occur. We examined associations between job strain and the risk of entering late-life dependency. Individually linked nationwide Swedish registers were used to identify people 70+ alive in January 2014, and who did not experience the outcome (late-life dependency) during two months prior to the start of the follow-up. Late-life dependency was operationalized as use of long-term care. Information about job strain was obtained via a job exposure matrice and matched with job titles. Cox regression models with age as time-scale (adjusted for living situation, educational attainment, country of birth, and sex) were conducted to estimate hazard ratios (HR) for entering late-life dependency during the 24 months of follow-up (n=993,595). Having an initial high starting point of job strain followed by an increasing trajectory throughout working life implied a 23% higher risk of entering late-life dependency at a younger age, compared with the reference group (low starting point with a decreasing trajectory). High initial starting point followed by a stable trajectory implied a 12% higher risk of entering late-life dependency at a younger age. High initial starting point followed by a decreasing trajectory implied a 10% risk reduction, and a low starting point with a stable trajectory implied a 22% risk reduction, of entering late-life dependency at a younger age. Reducing stressful jobs across working life may contribute to postponing late-life dependency.

  • 13.
    Kåreholt, Ingemar
    et al.
    Jönköping University, Hälsohögskolan, HHJ, Institutet för gerontologi. Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
    Nilsen, Charlotta
    Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
    Darin-Mattsson, Alexander
    Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
    Andel, Ross
    School of Aging Studies, University of South Florida, Tampa, Florida, USA ; International Clinical Research Center, St. Anne’s University Hospital, Brno, Czech Republic.
    Are socioeconomic position and working conditions before retirement age related to physical function 20 years later after retirement?2015Inngår i: Differences, Inequalities and Sociological Imagination: ESA 2015 12th conference of the European Sociological Association: Abstract book, European Sociological Association (ESA). I nstitute of Sociology of the Czech Academy of Scienc es (IS CAS) , 2015, s. 107-107Konferansepaper (Fagfellevurdert)
    Abstract [en]

    INTRODUCTION: Socioeconomic position and working situation are two factors associated to health inequalities and to each other.AIM: To study how socioeconomic position and working conditions 20+ years earlier associates to physical functioning after retirement age.DATA: Swedish nationally representative samples, from 1968, 1981, and 1991 were re-interviewed 1992, 2002, and 2011 (76+) with 20-24 years follow-up time (women, n=431; men, n=450).METHOD: Ordered logistic regressions, censored normal regression, and ordinary OLS regressions will be used.VARIABLES: Physical function: Self-reported mobility, objective tests of lung function and general physical function.Socioeconomic position: Education, income, cash margin, social class based on occupation, and an index based on all measures.Psychosocial working conditions: job control, psychological demands, high strain (low control+high demands) and work complexity regarding data (information), people, and substantive (general) complexity.Controls: age, sex, follow-up year, mobility at baseline, and hours worked.RESULTS: Job control, work complexity with data and people and all measures of SEP, were significantly associated to the three measures of physical function. Controlling for working conditions, the only significant associations was between general physical function and cash margin and the socioeconomic index respectively. When controlling for socioeconomic position, job control was significantly associated to less limitations in mobility and general physical functioning, substantive complexity and complexity with data were associated to less mobility limitations.CONCLUSIONS: Both socioeconomic position, work related stress, and work complexity were associated to physical function in old age, but only partly independent of each other. The strongest single factor is job control.

  • 14.
    Kåreholt, Ingemar
    et al.
    Jönköping University, Hälsohögskolan, HHJ, Institutet för gerontologi. Jönköping University, Hälsohögskolan, HHJ. Studies on Integrated Health and Welfare (SIHW). Jönköping University, School of Health and Welfare , Jönköping, Jonkopings Lan , Sweden.
    Nilsen, Charlotta
    Jönköping University, Hälsohögskolan, HHJ, Institutet för gerontologi. Jönköping University, Hälsohögskolan, HHJ. Studies on Integrated Health and Welfare (SIHW).
    Finkel, Deborah
    Jönköping University, Hälsohögskolan, HHJ, Institutet för gerontologi.
    Sindi, Shireen
    Karolinska Institutet, Solna, Stockholms Län, Sweden.
    Mid-life financial stress and cognitive and physical problems in older age: The role of potentially modifying factors2023Inngår i: Innovation in Aging, E-ISSN 2399-5300, Vol. 7, nr Supplement 1, s. 377-377Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [en]

    Financial stress is an important source of chronic stress and has been associated with cognitive and physical impairments. This study investigates whether midlife financial stress is associated with the combination of cognitive and physical impairment, the role of potentially modifiable factors, and sex differences.

    Methods: The Cardiovascular Risk Factors, Aging, and Dementia population-based cohort study from Finland was used (n=1497) (baseline collected 1972-1987, mean age 50 years). There were two late-life re-examinations (mean total follow-up 25 years). Midlife financial stress was measured using two questions on financial situation. Cognitive impairment was based on six cognitive domains. Physical impairment was self-reported. Potential modifying factors investigated were smoking, alcohol, physical activity, cohabiting/not, non-manual work, and sleep disturbances. Sex differences were investigated. We used path analyses with full information maximum likelihood estimation.

    Results: Among women and men, midlife financial stress associated with cognitive impairment, physical impairment and their combination. Smoking and sleep disturbances mediated associations between financial stress, physical impairment, and combined impairments. Among men: manual/non-manual work mediated the association to cognitive impairments; cohabitation mediated to cognitive impairment; financial stress was associated with cognitive impairment only among smokers and stress had a stronger association to physical and combined impairments among non-drinkers. Among women, sleep seems to have role in the association between financial stress and cognitive impairment.

    Conclusions: Midlife financial stress associates with late-life impairments, and lifestyle/sociodemographic factors may modify these associations. Sex differences were observed. Interventions promoting healthier lifestyle and psychosocial factors may buffer against the deleterious role of financial stress.

  • 15.
    Malm, Johannes
    et al.
    Jönköping University, Hälsohögskolan, HHJ, Institutet för gerontologi. Jönköping University, Hälsohögskolan, HHJ. Studies on Integrated Health and Welfare (SIHW).
    Bielsten, Therese
    Jönköping University, Hälsohögskolan, HHJ, Institutet för gerontologi. Jönköping University, Hälsohögskolan, HHJ. Studies on Integrated Health and Welfare (SIHW).
    Odzakovic, Elzana
    Jönköping University, Hälsohögskolan, HHJ, Avdelningen för omvårdnad. Jönköping University, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, Hälsohögskolan, HHJ, Institutet för gerontologi.
    Finkel, Deborah
    Jönköping University, Hälsohögskolan, HHJ, Institutet för gerontologi.
    Nilsen, Charlotta
    Jönköping University, Hälsohögskolan, HHJ, Institutet för gerontologi. Jönköping University, Hälsohögskolan, HHJ. Studies on Integrated Health and Welfare (SIHW).
    Kåreholt, Ingemar
    Jönköping University, Hälsohögskolan, HHJ, Institutet för gerontologi. Jönköping University, Hälsohögskolan, HHJ. Studies on Integrated Health and Welfare (SIHW). Jönköping University, School of Health and Welfare , Jönköping, Jonkopings Lan , Sweden.
    Co-production to tailor a digital tool for monitoring symptoms of dementia in nursing home care in Sweden2023Inngår i: Innovation in Aging, E-ISSN 2399-5300, Vol. 7, nr Supplement 1, s. 743-743Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [en]

    Symptoms of dementia change over time, resulting in complex situations that can negatively impact the person with dementia, as well as their relatives, and create challenges for staff members. Behavioral and Psychological Symptoms of Dementia (BPSD), such as delusions, hallucinations, agitation, depression, anxiety, apathy, irritability, aberrant motor behavior, and sleep disturbances, occur in approximately 90% of older people with dementia. The purpose of the study was to identify potential barriers and facilitators prior to introducing a web-based digital tool, the Daily-BPSD. Daily-BPSD is going to be used by staff members for daily registrations of severity levels of BPSD for persons with dementia in nursing home care in Sweden. Qualitative data collection was conducted in co-production with previous users of a similar digital tool in disability care (n = 11) and future users in dementia care (n = 32). The participants were assistant nurses, care managers, nurses, occupational therapists, and relatives. The responses highlight the importance of an accessible and time-effective registration procedure, a manageable number of variables and registrations occasions per day, and ensuring that the same information does not need to be documented in different systems. The findings will be used to tailor Daily-BPSD and adequately prepare staff members for large-scale data collection in the next step of the research project. Daily-BPSD could provide an extended foundation of knowledge of the person with BPSD, which could be used to provide more person-centered and appropriate care.

  • 16.
    Mehmedi, Liberta
    et al.
    Jönköping University, Hälsohögskolan, HHJ, Institutet för gerontologi. Jönköping University, Hälsohögskolan, HHJ. ARN-J (Aging Research Network - Jönköping).
    Nilsen, Charlotta
    Jönköping University, Hälsohögskolan, HHJ, Institutet för gerontologi. Aging research center, Karolinska institutet och Stockholms universitet; Stressforskningsinstitutet, Stockholms universitet.
    Kåreholt, Ingemar
    Jönköping University, Hälsohögskolan, HHJ, Institutet för gerontologi. Jönköping University, Hälsohögskolan, HHJ. ARN-J (Aging Research Network - Jönköping). Aging research center, Karolinska institutet och Stockholms universitet.
    Lungfunktion i hög ålder och dess samband med fysisk aktivitet från medelålder upp till hög ålder: En longitudinell studie med 24–30 års uppföljningstid2021Inngår i: Äldre i Centrum Vetenskapligt supplement, ISSN 2003-9050, Vol. 1, nr 1, s. 15-26Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [sv]

    Studien undersöker sambandet mellan lungfunktion i hög ålder och fysisk aktivitet från medel­ålder till hög ålder, samt sambandet mellan fysisk aktivitet i medelålder och i hög ålder. Vi använder data från Levnadsnivåundersökningen, LNU, och Undersökningen om äldre personers levnadsvillkor, SWEOLD. Deltagarna intervjuades i medelålder (genomsnitt 53 år), sen medelålder (genomsnitt 61 år) och hög ålder (genomsnitt 81 år), med en uppföljningstid på 24–30 år från medel­ålder till hög ålder.

    Mer fysisk aktivitet i sen medelålder har ett samband med bättre lungfunktion i hög ålder. Sambandet består men blir mindre starkt när fysisk aktivitet i hög ålder inkluderas i analysmodellen. Det finns ett starkt samband mellan fysisk aktivitet i hög ålder och bättre lungfunktion i hög ålder. Fysisk aktivitet i sen medelålder har ett positivt samband med fysisk aktivitet i hög ålder.

    Vår studie visar vikten av fysisk aktivitet även högt upp i åldrarna för att bibehålla god lungfunktion. Insatser som främjar fysisk aktivitet är av särskild vikt för att främja ett fortsatt hälsosamt åldrande, även för de allra äldsta.

  • 17.
    Nilsen, Charlotta
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Do psychosocial working conditions contribute to healthy and active aging? studies of mortality, late-life health, and leisure2017Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    The growing demographic challenge posed by an aging population makes finding predictors of health in old age increasingly important. This thesis investigated long-term associations between midlife psychosocial working conditions and late-life health and leisure and examined whether sense of coherence in midlife modified the association between psychosocial working conditions and all-cause mortality. The studies were based on individually linked data from the Swedish Cause of Death Register and two Swedish longitudinal surveys, the Level of Living Survey (LNU) and the Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD).

    The results of Study I and Study II suggest that self-reported adverse psychosocial working conditions in late midlife, especially low job control, high strain, or passive jobs, were associated with complex health problems and limitations in physical functioning 20-24 years later. However, women and men seemed to be vulnerable to different self-reported psychosocial working conditions. High job strain (high psychological demands and low control) was more negative for women than men. Passive jobs (low psychological demands and low control) were negative for men but not for women.

    The results of Study III suggest that a weak sense of coherence magnified the association between occupation-based (measured with a job exposure matrix) high job strain in midlife and mortality in women and men and self-reported passive jobs in midlife and mortality in men.

    The results of Study IV suggest that occupation-based active jobs (high psychological demands and high control) in midlife were associated with physical, social, and intellectual/cultural activity 23 years later in women and men.

    In summary, the results underscore the importance of psychosocial working conditions in midlife for health, physical functioning, and leisure activity after retirement²and thus for healthy and active aging. It is therefore important to reduce stress at work but at the same time induce intellectual stimulation and personal growth. Moreover, it is important to find ways to strengthen sense of coherence in midlife to buffer the negative influence of adverse psychosocial working conditions on health. Investing in healthy workplaces and strengthening sense of coherence to improve the health of workers may reduce societal costs during working age. It may also lower the cost of health and social care by improving the health of the older population. Hence, it would be a double-win investment for society.

  • 18. Nilsen, Charlotta
    The role of midlife psychosocial work environment in aging and health2015Konferansepaper (Fagfellevurdert)
  • 19. Nilsen, Charlotta
    et al.
    Agahi, N.
    Kåreholt, Ingemar
    Jönköping University, Hälsohögskolan, HHJ, Institutet för gerontologi. Jönköping University, Hälsohögskolan, HHJ. ARN-J (Aging Research Network - Jönköping).
    Work stressors in late midlife and physical functioning in old age2016Konferansepaper (Annet vitenskapelig)
  • 20. Nilsen, Charlotta
    et al.
    Agahi, N.
    Kåreholt, Ingemar
    Jönköping University, Hälsohögskolan, HHJ, Institutet för gerontologi. Jönköping University, Hälsohögskolan, HHJ. ARN-J (Aging Research Network - Jönköping).
    Work stressors in late midlife and physical functioning in old age2016Konferansepaper (Annet vitenskapelig)
  • 21.
    Nilsen, Charlotta
    et al.
    Aging Research Center (KI/SU).
    Agahi, N.
    Aging Research Center (KI/SU).
    Shaw, B. A.
    University at Albany, Albany, New York.
    Aging In Place: Can Leisure Participation Enhance Survival?2017Inngår i: Innovation in Aging, E-ISSN 2399-5300, Vol. 1, nr Suppl. 1, s. 761-762Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    People living alone are a growing vulnerable population. We aim to see what kind of activities in old age (76+) may enhance survival for people living alone, and determine if these activities have different associations with survival in people not living alone, and whether these associations differ based on socioeconomic position and gender. The Swedish nationally representative SWEOLD study, 2011 and the Swedish cause of death register were used to conduct Cox regression analyses (n = 742). Incident mortality: 35.6%. In our preliminary results, participation in any activities in old age was related to reduced mortality compared to no participation. However, different types of activities seemed beneficial depending on living situation. Interacting with relatives and friends was protective among people living alone, while having hobbies and solving crosswords was protective among those not living alone. Socioeconomic position did not explain these associations. Most results were similar in women and men.

  • 22.
    Nilsen, Charlotta
    et al.
    Aging Research Center, Karolinska Institutet, Stockholm University, Stockholm, Sweden.
    Agahi, N.
    Aging Research Center, Karolinska Institutet, Stockholm University, Stockholm, Sweden.
    Shaw, B. A.
    Center for Social and Demographic Analysis, School of Public Health, University at Albany, State University of New York, Albany, NY, United States.
    Does the association between leisure activities and survival in old age differ by living arrangement?2018Inngår i: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 72, nr 1, s. 1-6Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Government policies to promote ageing in place have led to a growing frail population living at home in advanced old age, many of whom live alone. Living alone in old age is associated with adverse health outcomes, but we know little about whether it moderates the health impact of other risk and protective factors. Engagement in leisure activities is considered critical to successful ageing. We investigated whether the association between different types of leisure activities and survival in non-institutionalised older adults (aged 76 and above) differs by living arrangement and gender.

    Methods: We used the Swedish Panel Study of Living Conditions of the Oldest Old study from 2011 and the Swedish Cause of Death Register (until 30 June 2014) to conduct Cox regression analyses (n=669). Incident mortality was 30.2% during the follow-up period.

    Results: Overall level of leisure activity was not significantly associated with survival in either living arrangement, but some specific leisure activities, and associations, were different across gender and living arrangement. More specifically, certain social activities (participation in organisations and having relatives visit) were associated with longer survival, but only in men living alone. In women, most results were statistically non-significant, with the exception of solving crosswords being associated with longer survival in women living with someone.

    Conclusion: In order to facilitate engagement with life, interventions focusing on leisure activities in the oldest age groups should take gender and living arrangement into consideration when determining the type of activity most needed. 

  • 23.
    Nilsen, Charlotta
    et al.
    Karolinska Institutet and Stockholm University, Sweden.
    Agahi, Neda
    Karolinska Institutet and Stockholm University, Sweden.
    Kåreholt, Ingemar
    Jönköping University, Hälsohögskolan, HHJ, Institutet för gerontologi. Karolinska Institutet and Stockholm University, Sweden.
    Midlife work-related stress and late life physical functioning: a 20-year prospective cohort study2015Inngår i: 'Life Courses in Cross-­National Comparison: Similarities and Differences': Abstract book, 2015, s. 14-Konferansepaper (Annet vitenskapelig)
  • 24.
    Nilsen, Charlotta
    et al.
    Aging Research Center, Stockholm, Sweden.
    Agahi, Neda
    Aging Research Center, Stockholm, Sweden.
    Kåreholt, Ingemar
    Jönköping University, Hälsohögskolan, HHJ, Institutet för gerontologi. Jönköping University, Hälsohögskolan, HHJ. ARN-J (Aging Research Network - Jönköping). Aging Research Center, Stockholm, Sweden.
    Work Stressors in Late Midlife and Physical Functioning in Old Age2017Inngår i: Journal of Aging and Health, ISSN 0898-2643, E-ISSN 1552-6887, Vol. 29, nr 5, s. 893-911Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: The aim of this study was to explore the relationship between work stressors in late midlife and physical functioning in old age.

    METHOD: Two linked nationally representative Swedish surveys were used: the 1991 Level of Living Survey (age 57-65) and the 2011 Swedish Panel Study of Living Conditions of the Oldest Old. Work stressors were measured with the job demand-control model and physical functioning in old age with physical performance tests, lung function tests, and self-reported mobility. Ordered logistic and linear regressions were performed (n = 166-214).

    RESULTS: High demands, low control, and high strain (i.e., high demands combined with low control) were associated with limited physical functioning in women. Low control and passive jobs were associated with limited physical functioning in men.

    DISCUSSION: Work stressors in late midlife are important predictors of physical functioning in older adults. However, women and men seem to be vulnerable to different work stressors.

  • 25. Nilsen, Charlotta
    et al.
    Agahi, Neda
    von Saenger, Isabelle
    Österman, Jenny
    Hedberg Rundgren, Åsa
    Lennartsson, Carin
    Hur mår stockholmarna efter 65? Beskrivning av hälsa och levnadsvanor 2002-20182019Rapport (Annet vitenskapelig)
    Abstract [sv]

    Personer som är äldre än 65 år utgör en ökande andel av befolkningen totalt sett isåväl Sverige som i Stockholms län. Anledningen till den demografiska förändringenberor delvispå att vi lever allt längre och att det genomsnittliga antalet år som en personlever i hög ålder har ökat över tid. Livet efter 65 år utgör idag omkring en tredjedel aven vuxen persons liv.

    Rapporten, som bygger på data från folkhälsoenkäterna i Stockholms län, syftar tillatt beskriva befolkningens hälsotillstånd, hur hälsan och levnadsvanor fördelar sigmellan olika grupper bland personer 65 år och äldre i Stockholms län 2018, samtutvecklingen av dessa faktorer över tid (2002–2018).Undersökningen 2002, 2006 och2018 har dock ett ålderstak på 84 år, vilket begränsar möjligheten att beskrivahälsoläget och levnadsvanor för de allra äldsta (85 år och äldre) dessa år. Beskrivningen av hälsoläget och levnadsvanor för de allra äldsta fokuserar därför på åren2010 och 2014. 

  • 26.
    Nilsen, Charlotta
    et al.
    Jönköping University, Hälsohögskolan, HHJ, Institutet för gerontologi. Jönköping University, Hälsohögskolan, HHJ. ARN-J (Aging Research Network - Jönköping). Stress Research Institute, Stockholm University, Sweden; Aging Research Center, Karolinska Institutet/Stockholm University, Sweden.
    Agerholm, Janne
    Aging Research Center, Karolinska Institutet/Stockholm University, Sweden; Department of Global Public Health, Division of Social Medicine, Karolinska Institutet, Sweden.
    Kelfve, Susanne
    Aging Research Center, Karolinska Institutet/Stockholm University, Sweden; Department of Culture and Society, Division Ageing and Social Change & Division of Social Work, Linköping University, Sweden.
    Wastesson, Jonas W.
    Aging Research Center, Karolinska Institutet/Stockholm University, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden.
    Kåreholt, Ingemar
    Jönköping University, Hälsohögskolan, HHJ, Institutet för gerontologi. Jönköping University, Hälsohögskolan, HHJ. ARN-J (Aging Research Network - Jönköping). Aging Research Center, Karolinska Institutet/Stockholm University, Sweden.
    Nabe-Nielsen, Kirsten
    The National Research Center for the Working Environment, Denmark; Department of Public Health, Section of Social Medicine, University of Copenhagen, Denmark.
    Meinow, Bettina
    Aging Research Center, Karolinska Institutet/Stockholm University, Sweden; Stockholm Gerontology Research Center, Sweden.
    History of working conditions and the risk of old-age dependency: a nationwide Swedish register-based study2023Inngår i: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aims: There is substantial evidence that previous working conditions influence post-retirement health, yet little is known about previous working conditions' association with old-age dependency. We examined job strain, hazardous and physical demands across working life, in relation to the risk of entering old-age dependency of care.

    Methods: Individually linked nationwide Swedish registers were used to identify people aged 70+ who were not receiving long-term care (residential care or homecare) at baseline (January 2014). Register information on job titles between the years 1970 and 2010 was linked with a job exposure matrix of working conditions. Random effects growth curve models were used to calculate intra-individual trajectories of working conditions. Cox regression models with age as the timescale (adjusted for living situation, educational attainment, country of birth, and sex) were conducted to estimate hazard ratios for entering old-age dependency during the 24 months of follow-up (n = 931,819).

    Results: Having initial adverse working conditions followed by an accumulation throughout working life encompassed the highest risk of entering old-age dependency across the categories (job strain: HR 1.23, 95% CI 1.19-1.27; physical demands: HR 1.36, 95% CI 1.31-1.40, and hazardous work: HR 1.35, 95% CI 1.30-1.40). Initially high physical demands or hazardous work followed by a stable trajectory, or initially low-level physical demand or hazardous work followed by an accumulation throughout working life also encompassed a higher risk of dependency.

    Conclusions: A history of adverse working conditions increased the risk of old-age dependency. Reducing the accumulation of adverse working conditions across the working life may contribute to postponing old-age dependency.

  • 27. Nilsen, Charlotta
    et al.
    Andel, R.
    Agahi, N.
    Fritzell, J.
    Kåreholt, Ingemar
    Jönköping University, Hälsohögskolan, HHJ, Institutet för gerontologi. Jönköping University, Hälsohögskolan, HHJ. ARN-J (Aging Research Network - Jönköping).
    Active Aging: the influence of active jobs in midlife: Charlotta Nilsen2017Inngår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, nr Suppl. 3Artikkel i tidsskrift (Fagfellevurdert)
  • 28. Nilsen, Charlotta
    et al.
    Andel, R.
    Darin-Mattsson, A.
    Kåreholt, Ingemar
    Jönköping University, Hälsohögskolan, HHJ, Institutet för gerontologi. Jönköping University, Hälsohögskolan, HHJ. ARN-J (Aging Research Network - Jönköping).
    The influence of psychosocial working conditions on late-life mobility in Sweden2018Konferansepaper (Fagfellevurdert)
  • 29. Nilsen, Charlotta
    et al.
    Andel, R.
    Darin-Mattsson, A.
    Kåreholt, Ingemar
    Jönköping University, Hälsohögskolan, HHJ, Institutet för gerontologi. Jönköping University, Hälsohögskolan, HHJ. ARN-J (Aging Research Network - Jönköping).
    Trajectories of psychosocial working conditions as predictors of later life physical function2019Konferansepaper (Fagfellevurdert)
  • 30. Nilsen, Charlotta
    et al.
    Andel, R.
    Fors, S.
    Meinow, B.
    Darin Mattsson, A.
    Kåreholt, Ingemar
    Jönköping University, Hälsohögskolan, HHJ, Institutet för gerontologi. Jönköping University, Hälsohögskolan, HHJ. ARN-J (Aging Research Network - Jönköping).
    Work stressors in late midlife and physical functioning in old age2014Konferansepaper (Annet vitenskapelig)
  • 31.
    Nilsen, Charlotta
    et al.
    Aging Research Center, Karolinska Institutet/Stockholm University, Sweden.
    Andel, Ross
    School of Aging Studies, University of South Florida, United States.
    Agahi, Neda
    Aging Research Center, Karolinska Institutet/Stockholm University, Sweden.
    Fritzell, Johan
    Aging Research Center, Karolinska Institutet/Stockholm University, Sweden.
    Kåreholt, Ingemar
    Jönköping University, Hälsohögskolan, HHJ, Institutet för gerontologi. Jönköping University, Hälsohögskolan, HHJ. ARN-J (Aging Research Network - Jönköping). Aging Research Center, Karolinska Institutet/Stockholm University, Sweden.
    Association between psychosocial working conditions in mid-life and leisure activity in old age2021Inngår i: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 49, nr 2, s. 168-175Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aims:

    Leisure activity helps people engage with life, and it promotes health and well-being as we age. This study investigated whether individuals with active jobs (high psychological demands, high control) in mid-life were more active during leisure time in old age compared with those with less active jobs.

    Methods:

    Two individually linked Swedish surveys were used (N=776) with 23 years of follow-up. Data were analysed with logistic regression.

    Results:

    Having an active job in mid-life was associated with greater engagement in intellectual/cultural, social and physical activity in old age, even when leisure activity in mid-life was taken into account.

    Conclusions:

    The results suggest that active jobs in mid-life may be replaced by active leisure during retirement. Active job conditions may promote engagement in society in old age, which in turn may have positive health consequences. 

  • 32.
    Nilsen, Charlotta
    et al.
    Aging Research Center (ARC), Karolinska Institutet/Stockholm University, Sweden.
    Andel, Ross
    School of Aging Studies, University of South Florida, Tampa, Florida, USA.
    Darin-Mattsson, Alexander
    Aging Research Center (ARC), Karolinska Institutet/Stockholm University, Sweden.
    Kåreholt, Ingemar
    Jönköping University, Hälsohögskolan, HHJ, Institutet för gerontologi. Jönköping University, Hälsohögskolan, HHJ. ARN-J (Aging Research Network - Jönköping). Aging Research Center (ARC), Karolinska Institutet/Stockholm University, Sweden.
    Psychosocial working conditions across working life may predict late-life physical function: a follow-up cohort study2019Inngår i: BMC Public Health, E-ISSN 1471-2458, Vol. 19, nr 1, artikkel-id 1125Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Increasing life expectancy has made understanding the mechanisms underlying late-life health and function more important. We set out to investigate whether trajectories of change in psychosocial working conditions are associated with late-life physical function.

    METHODS: Two Swedish surveys, linked at the individual level, were used (n = 803). A psychosocial job exposure matrix was used to measure psychosocial working conditions during people's first occupation, as well as their occupation every five years thereafter until baseline in 1991. Physical function was measured in 2014. Random effects growth curve models were used to calculate intraindividual trajectories of working conditions. Predictors of physical function were assessed with ordered logistic regression.

    RESULTS: A more active job at baseline was associated with increased odds of late-life physical function (OR 1.15, CI 1.01-1.32). Higher baseline job strain was associated with decreased odds of late-life physical function (OR 0.75, CI 0.59-0.96). A high initial level followed by an upward trajectory of job strain throughout working life was associated with decreased odds of late-life physical function (OR 0.32, CI 0.17-0.58).

    CONCLUSIONS: Promoting a healthier workplace by reducing chronic stress and inducing intellectual stimulation, control, and personal growth may contribute to better late-life physical function.

  • 33.
    Nilsen, Charlotta
    et al.
    Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
    Andel, Ross
    School of Aging Studies, University of South Florida, Tampa, FL, USA.
    Fors, Stefan
    Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
    Meinow, Bettina
    Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
    Darin Mattsson, Alexander
    Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
    Kåreholt, Ingemar
    Jönköping University, Hälsohögskolan, HHJ, Institutet för gerontologi.
    Associations between work-related stress in late midlife, educational attainment, and serious health problems in old age: a longitudinal study with over 20 years of follow-up2014Inngår i: BMC Public Health, E-ISSN 1471-2458, Vol. 14, nr 878, s. 1-12Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND:

    People spend a considerable amount of time at work over the course of their lives, which makes the workplace important to health and aging. However, little is known about the potential long-term effects of work-related stress on late-life health. This study aims to examine work-related stress in late midlife and educational attainment in relation to serious health problems in old age.

    METHODS:

    Data from nationally representative Swedish surveys were used in the analyses (n = 1,502). Follow-up time was 20-24 years. Logistic regressions were used to examine work-related stress (self-reported job demands, job control, and job strain) in relation to serious health problems measured as none, serious problems in one health domain, and serious problems in two or three health domains (complex health problems).

    RESULTS:

    While not all results were statistically significant, high job demands were associated with higher odds of serious health problems among women but lower odds of serious health problems among men. Job control was negatively associated with serious health problems. The strongest association in this study was between high job strain and complex health problems. After adjustment for educational attainment some of the associations became statistically nonsignificant. However, high job demands, remained related to lower odds of serious problems in one health domain among men, and low job control remained associated with higher odds of complex health problems among men. High job demands were associated with lower odds of complex health problems among men with low education, but not among men with high education, or among women regardless of level of education.

    CONCLUSIONS:

    The results underscore the importance of work-related stress for long-term health. Modification to work environment to reduce work stress (e.g., providing opportunities for self-direction/monitoring levels of psychological job demands) may serve as a springboard for the development of preventive strategies to improve public health both before and after retirement.

    Fulltekst (pdf)
    fulltext
  • 34.
    Nilsen, Charlotta
    et al.
    Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden .
    Andel, Ross
    School of Aging Studies, University of South Florida, Tampa, USA.
    Fritzell, Johan
    Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
    Kåreholt, Ingemar
    Jönköping University, Hälsohögskolan, HHJ. ARN-J (Aging Research Network - Jönköping). Jönköping University, Hälsohögskolan, HHJ, Institutet för gerontologi. Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
    Work-related stress in midlife and all-cause mortality: can sense of coherence modify this association?2016Inngår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 26, nr 6, s. 1055-1061Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Survival reflects the accumulation of multiple influences experienced over the life course. Given the amount of time usually spent at work, the influence of work may be particularly important. We examined the association between work-related stress in midlife and subsequent mortality, investigating whether sense of coherence modified the association.

    METHODS: Self-reported work-related stress was assessed in 1393 Swedish workers aged 42-65 who participated in the nationally representative Level of Living Survey in 1991. An established psychosocial job exposure matrix was applied to measure occupation-based stress. Sense of coherence was measured as meaningfulness, manageability and comprehensibility. Mortality data were collected from the Swedish National Cause of Death Register. Data were analyzed with hazard regression with Gompertz distributed baseline intensity.

    RESULTS: After adjustment for socioeconomic position, occupation-based high job strain was associated with higher mortality in the presence of a weak sense of coherence (HR, 3.15; 1.62-6.13), a result that was stronger in women (HR, 4.48; 1.64-12.26) than in men (HR, 2.90; 1.12-7.49). Self-reported passive jobs were associated with higher mortality in the presence of a weak sense of coherence in men (HR, 2.76; 1.16-6.59). The link between work stress and mortality was not significant in the presence of a strong sense of coherence, indicating that a strong sense of coherence buffered the negative effects of work-related stress on mortality.

    CONCLUSIONS: Modifications to work environments that reduce work-related stress may contribute to better health and longer lives, especially in combination with promoting a sense of coherence among workers.

  • 35.
    Nilsen, Charlotta
    et al.
    Jönköping University, Hälsohögskolan, HHJ, Institutet för gerontologi. Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Stress Research Institute, Stockholm University, Stockholm, Sweden.
    Celeste, Roger K.
    Department of Preventive and Social Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
    Lennartsson, Carin
    Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Swedish Institute for Social Research, Stockholm University, Stockholm, Sweden.
    McKee, Kevin J.
    School of Health and Welfare, Dalarna University, Falun, Sweden.
    Dahlberg, Lena
    Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden; School of Health and Welfare, Dalarna University, Falun, Sweden.
    Long-term risk factors for old-age social exclusion in Sweden: a 30-year longitudinal study2022Inngår i: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 103, artikkel-id 104760Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose of the research: Social exclusion threatens quality of life in older age. However, there is a lack of research on social exclusion from life-course and gender perspectives. We investigated early-and midlife risk factors for old-age social exclusion among women and men.

    Materials and methods: Two individually linked studies of Swedish nationally representative samples provided longitudinal data over a 30-year period on 1,819 people at baseline. Indicators of economic exclusion, leisure/ social exclusion, and civic exclusion were assessed at early late life (M=70 years) and late life (M=81). Educational attainment, non-employment, psychological health problems and mobility problems were measured as risk factors at midlife (M=54) and late midlife (M=61). Path analysis derived a model of old-age social exclusion.

    Results: Exclusion on a domain in early late life led to exclusion on the same domain in late life, except for the economic domain. Leisure/social exclusion in early late life also led to civic exclusion in late life. Midlife risk factors influenced late-life exclusion almost exclusively through early late-life exclusion. While model fit could not be significantly improved by allowing coefficients to vary freely by gender, there was a stronger effect of non -employment on exclusion in women and a stronger effect of psychological health problems on exclusion in men.

    Conclusions: This study confirms that old-age exclusion is persistent and dynamic, and influenced by risk factors experienced earlier in life. A holistic approach with integrated efforts across different policy areas is needed to efficiently reduce old-age social exclusion.

  • 36. Nilsen, Charlotta
    et al.
    Darin Mattsson, Alexander
    Fors, Stefan
    Kåreholt, Ingemar
    Jönköping University, Hälsohögskolan, HHJ. Åldrande - livsvillkor och hälsa. Jönköping University, Hälsohögskolan, HHJ, Institutet för gerontologi.
    Work-related stress, midlife socioeconomic position, complex and severe health problems in old age2013Konferansepaper (Fagfellevurdert)
  • 37. Nilsen, Charlotta
    et al.
    Darin-Mattsson, A.
    Andel, R.
    Kåreholt, Ingemar
    Jönköping University, Hälsohögskolan, HHJ, Institutet för gerontologi. Jönköping University, Hälsohögskolan, HHJ. ARN-J (Aging Research Network - Jönköping).
    The Influence of Psychosocial Working Conditions on Late-Life Physical Functioning2018Konferansepaper (Fagfellevurdert)
  • 38.
    Nilsen, Charlotta
    et al.
    Jönköping University, Hälsohögskolan, HHJ, Institutet för gerontologi.
    Darin-Mattsson, A.
    Aging Research Center (ARC), Karolinska Institutet/Stockholm University, Stockholm, Sweden.
    Hyde, M.
    Centre for Innovative Ageing, Swansea University, Swansea, United Kingdom.
    Wastesson, J. W.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Life-course trajectories of working conditions and successful ageing2021Inngår i: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, artikkel-id 14034948211013279Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aims: As populations are ageing worldwide, it is important to identify strategies to promote successful ageing. We investigate how working conditions throughout working life are associated with successful ageing in later life. Methods: Data from two nationally representative longitudinal Swedish surveys were linked (n=674). In 1991, respondents were asked about their first occupation, occupations at ages 25, 30, 35, 40, 45 and 50 years and their last recorded occupation. Occupations were matched with job exposure matrices to measure working conditions at each of these time points. Random effects growth curve models were used to calculate intra-individual trajectories of working conditions. Successful ageing, operationalised using an index including social and leisure activity, cognitive and physical function and the absence of diseases, was measured at follow-up in 2014 (age 70 years and older). Multivariable ordered logistic regressions were used to assess the association between trajectories of working conditions and successful ageing. Results: Intellectually stimulating work; that is, substantive complexity, in the beginning of one’s career followed by an accumulation of more intellectually stimulating work throughout working life was associated with higher levels of successful ageing. In contrast, a history of stressful, hazardous or physically demanding work was associated with lower levels of successful ageing. Conclusions: Promoting a healthy workplace, by supporting intellectually stimulating work and reducing physically demanding and stressful jobs, may contribute to successful ageing after retirement. In particular, it appears that interventions early in one’s employment career could have positive, long-term effects.

  • 39.
    Nilsen, Charlotta
    et al.
    Aging Research Center, Stockholm University, Karolinska Institute, Stockholm, Sweden.
    Darin-Mattsson, A.
    Aging Research Center, Stockholm University, Karolinska Institute, Stockholm, Sweden.
    Kåreholt, Ingemar
    Jönköping University, Hälsohögskolan, HHJ, Institutet för gerontologi. Jönköping University, Hälsohögskolan, HHJ. ARN-J (Aging Research Network - Jönköping). Aging Research Center, Stockholm University, Karolinska Institute, Stockholm, Sweden.
    Andel, R.
    International Clinical Research Center, University of South Florida, Tampa, United States.
    The influence of psychosocial working conditions on late-life physical functioning2018Inngår i: Revue d'épidémiologie et de santé publique, ISSN 0398-7620, E-ISSN 1773-0627, Vol. 66, nr Suppl. 5, s. S279-S279Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background

    In older adults, increasing age correlates with declining physical functioning. The growing demographic challenge posed by an aging population makes finding predictors of physical functioning in old age increasingly important. Work dominates much of our adult lives, which makes it likely that the workplace is important to health and aging. Stressful working conditions have been associated with limitations in physical functioning in old age. Active jobs (high psychological demands, high control) are considered to increase learning, which may reduce the perception of situations as stressful and instead be viewed as challenges and opportunities for personal growth. This will, in turn, lead to feelings of self-efficacy that may encourage an active leisure-time, such as physical activity. We investigated the long-term association between active jobs and mobility in old age.

    Method

    Two individually linked Swedish surveys were used (n=775). A psychosocial job-exposure matrix was used to measure active jobs four times in midlife (age 40–65). Mobility was measured in 2014 as the self-reported ability to stand without support, walk up and down stairs, walk 100 meters fairly briskly, rise from a chair with arms crossed across the chest, and ability to balance indoors, summarized in a 5-item index (0–5). Data were analyzed with ordered logistic regressions.

    Results

    Having an active job was associated with significantly better mobility in old age compared to people in non-active jobs. However, the accumulated score of active jobs over working life were not more strongly associated with mobility in old age than the score of active job in 1991, which may indicate that the conditions of a person's most recent job mattered the most.

    Conclusions

    Active job conditions in midlife are important predictors of mobility in old age. Promoting active job conditions may be used to improve midlife interventions aimed at preventing physical deterioration later in life.

  • 40. Nilsen, Charlotta
    et al.
    Darin-Mattsson, A.
    Kåreholt, Ingemar
    Karolinska Institute, Stockholm, Sweden.
    Andel, R.
    The Influence of Psychosocial Working Conditions on Late-Life Physical Functioning2018Konferansepaper (Fagfellevurdert)
  • 41.
    Nilsen, Charlotta
    et al.
    Stockholm University, Sweden.
    Fritzell, Johan
    Stockholm University, Sweden.
    Kåreholt, Ingemar
    Jönköping University, Hälsohögskolan, HHJ, Institutet för gerontologi.
    Andel, Ross
    University of South Florida, USA.
    Work-related stress in midlife and all-cause mortality: the role of sense of coherence2015Inngår i: 'Life Courses in Cross-­National Comparison: Similarities and Differences: Abstract book, 2015, s. 125-Konferansepaper (Fagfellevurdert)
  • 42. Nilsen, Charlotta
    et al.
    Hyde, M.
    Darin-Mattsson, A.
    Wastesson, J.
    Psychosocial working conditions as predictors of successful aging2019Konferansepaper (Fagfellevurdert)
  • 43.
    Nilsen, Charlotta
    et al.
    Aging Research Center (KI/SU).
    Lamura, G.
    INRCA - National Institute of Health and Science on Ageing, Ancona, Marche, Italy.
    Harper, S. H.
    The Oxford Institute of Population Ageing, Oxford, United Kingdom.
    Inequalities In Active Aging: A European Perspective2017Inngår i: Innovation in Aging, E-ISSN 2399-5300, Vol. 1, nr Suppl. 1, s. 761-762Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The concept of active ageing has become central to the European policy discourse in recent years. Aiming to optimize opportunities for health, participation and socioeconomic security, active ageing policies suggest that one way that disadvantages in health and living conditions in old age can be mitigated is by fostering older people’s own contributions to the labour market and to society. Crucially, however, the ability to contribute depends on socio-demographic and socioeconomic factors, and the access to resources that these afford. For instance, for women these resources are frequently less readily available, due to their reproductive roles over the life course, and their higher likelihood to become widowed and live alone in older age. To date, research on active ageing has paid little attention to these factors and how they influence the degree to which it is possible to ‘actively’ age for older women and men, and for different socio-economic groups of older people.

    This symposium aims to highlight inequalities in the experiences of active ageing from a comprehensive European perspective, as well as focussing in-depth on three countries representing three distinct welfare regimes in Europe: Germany, England and Sweden. The three single-country case studies showcase how inequalities in workability, pension literacy and living situation influence participation in the labour market and in society. In addition, an alternative policy framework is suggested, going beyond aggregated measures of ‘active ageing’ by acknowledging the role of socio-demographic and socioeconomic inequalities across the life course.

  • 44.
    Nilsen, Charlotta
    et al.
    Jönköping University, Hälsohögskolan, HHJ, Institutet för gerontologi. Aging Research Center (ARC), Karolinska Institutet/Stockholm University, Sweden; Stress Research Institute, Stockholm University, Sweden .
    Nelson, Monica E.
    School of Aging Studies, University of South Florida, USA.
    Andel, Ross
    School of Aging Studies, University of South Florida, USA .
    Crowe, Michael
    Department of Psychology, University of Alabama at Birmingham, USA.
    Finkel, Deborah
    Jönköping University, Hälsohögskolan, HHJ, Institutet för gerontologi. Jönköping University, Hälsohögskolan, HHJ. ARN-J (Aging Research Network - Jönköping). Department of Psychology, Indiana University Southeast, USA.
    Pedersen, Nancy L.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden; Department of Psychology, University of Southern California, USA.
    Job Strain and Trajectories of Cognitive Change Before and After Retirement2021Inngår i: The journals of gerontology. Series B, Psychological sciences and social sciences, ISSN 1079-5014, E-ISSN 1758-5368, Vol. 76, nr 7, s. 1313-1322, artikkel-id gbab033Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES: We examined associations between job strain and trajectories of change in cognitive functioning (general cognitive ability plus verbal, spatial, memory, and speed domains) before and after retirement.

    METHOD: Data on indicators of job strain, retirement age, and cognitive factors were available from 307 members of the Swedish Adoption/Twin Study of Aging (SATSA). Participants were followed for up to 27 years (mean=15.4, SD=8.5).

    RESULTS: In growth curve analyses controlling for age, sex, education, depressive symptoms, cardiovascular health, and twinness, greater job strain was associated with worse memory (Estimate=-1.22, p=.007), speed (Estimate=-1.11, p=.012), spatial ability (Estimate=-0.96, p=.043), and general cognitive ability (Estimate=-1.33, p=.002) at retirement. Greater job strain was also associated with less improvement in general cognitive ability before retirement and a somewhat slower decline after retirement. The sex-stratified analyses showed that the smaller gains of general cognitive ability before retirement (Estimate=-1.09, p=.005) were only observed in women. Domain-specific analyses revealed that greater job strain was associated with less improvement in spatial (Estimate=-1.35, p=.010) and verbal (Estimate=-0.64, p=.047) ability before retirement in women, and a slower decline in memory after retirement in women (Estimate=0.85, p=.008) and men (Estimate=1.12, p=.013). Neither pre-retirement nor post-retirement speed was affected by job strain.

    DISCUSSION: Greater job strain may have a negative influence on overall cognitive functioning prior to and at retirement, while interrupting exposure to job strain (post-retirement) may slow the rate of cognitive aging. Reducing level of stress at work should be seen as a potential target for intervention to improve cognitive aging outcomes.

  • 45.
    Pandey, Nikita
    et al.
    Aging Research Center (ARC), Karolinska Institutet, Stockholm University, Stockholm, Sweden.
    Darin-Mattsson, Alexander
    Aging Research Center (ARC), Karolinska Institutet, Stockholm University, Stockholm, Sweden.
    Nilsen, Charlotta
    Aging Research Center (ARC), Karolinska Institutet, Stockholm University, Stockholm, Sweden.
    Working conditions mediate the association between social class and physical function in older age in Sweden: A prospective cohort study2020Inngår i: BMC Public Health, E-ISSN 1471-2458, Vol. 20, nr 1, artikkel-id 1360Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Global demographics are changing as societies all over the world are aging. This puts focus on maintaining functional ability and independence into older age. Individuals from lower social classes are at greater risk of developing limitations in physical function later in life. In this study, we investigated the mediating role of working conditions in the association between occupation-based social class and physical function measured as self-reported mobility limitations and objectively measured physical impairment in older age.

    Methods: Two Swedish surveys, linked at the individual level, were used (n = 676-814 depending on the outcome). Follow-up time was 20-24 years. Multiple logistic regression analyses were performed with adjustments for age, sex, level of education, mobility, and health problems at baseline. This was followed by analyses of the size of the mediating effect of working conditions.

    Results: Working conditions seem to mediate 35-74% of the association between social class and physical impairment in older age. The pattern of mediation was primarily driven by passive jobs, i.e., low psychological demands and low control, among blue-collar workers. Working conditions did not mediate the association between social class and self-reported mobility limitations in older age.

    Conclusions: The results of this study indicate that working conditions are important in combating the social gradient in healthy aging, contributing to the evidence regarding the magnitude of impact exerted by both the physical and psychosocial work environment separately and in conjunction. 

  • 46.
    Parker, Vanessa
    et al.
    Karolinska Institutet.
    Andel, Ross
    University of South Florida.
    Nilsen, Charlotta
    Karolinska Institutet.
    Kåreholt, Ingemar
    Jönköping University, Hälsohögskolan, HHJ. Åldrande - livsvillkor och hälsa. Jönköping University, Hälsohögskolan, HHJ, Institutet för gerontologi. Karolinska Institutet.
    The Association Between Mid-Life Socioeconomic Position and Health After Retirement—Exploring the Role of Working Conditions2013Inngår i: Journal of Aging and Health, ISSN 0898-2643, E-ISSN 1552-6887, Vol. 25, nr 5, s. 863-881Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To explore the role of working conditions in the association between socioeconomic position and health after retirement age using over 20 years follow-up.

    Method: Two Swedish nationally representative Level of Living Surveys (total N = 1,131) were used. Ordered logistic regression was used to assess the association between socioeconomic position and health (self-rated health, psychological distress, musculoskeletal pain, circulatory problems, physical and cognitive impairment). The role of physical and psychological working conditions was also assessed.

    Results: Lower socioeconomic position was associated with more adverse physical, but not psychological, working conditions. Physical working conditions partially explained the differences in physical impairment and musculoskeletal pain in old age attributed to socioeconomic position, but not differences in self-rated health, circulatory problems, psychological distress, and cognitive impairment. Socioeconomic position was a stronger correlate of health than psychological working conditions alone.

    Discussion: Improving physical working conditions may be important for reducing the influence of socioeconomic position on health after retirement.

  • 47.
    Piiroinen, Ilkka
    et al.
    Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Finland.
    Tuomainen, Tomi-Pekka
    Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Finland.
    Tolmunen, Tommi
    Department of Adolescent Psychiatry, Kuopio University Hospital, Institute of Clinical Medicine / Psychiatry, University of Eastern Finland, Finland.
    Kauhanen, Jussi
    Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Finland.
    Kurl, Sudhir
    Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Finland.
    Nilsen, Charlotta
    Jönköping University, Hälsohögskolan, HHJ, Institutet för gerontologi. Stress Research Institute, Stockholm University, Sweden; Aging Research Center (ARC), Karolinska Institutet/Stockholm University, Sweden.
    Suominen, Sakari
    University of Turku, Turku, Finland; University of Skövde, Skövde, Sweden.
    Välimäki, Tarja
    Department of Nursing Science, University of Eastern Finland, Finland.
    Voutilainen, Ari
    Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Finland.
    Long-term changes in sense of coherence and mortality among middle-aged men: A population -based follow-up study2022Inngår i: Advances in Life Course Research, E-ISSN 1040-2608, Vol. 53, artikkel-id 100494Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Sense of coherence (SOC) scale measures one’s orientation to life. SOC is the core construct in Antonovsky's salutogenic model of health. It has been shown that weak SOC correlates with poor perceived health, low quality of life, and increased mortality. Some studies have indicated that SOC is not stable across life, but there are no previous studies on how a change of SOC is reflected in mortality. However, there is some evidence that a change in perceived quality of life is associated with mortality. The study explores the association between the change in SOC and mortality using longitudinal data from a cohort of middle-aged Finnish men recruited between 1986 and 1989. Approximately 11 years after the baseline examinations, between 1998 and 2001, 854 men returned the SOC questionnaire a second time. The baseline SOC was adjusted for the regression to the mean phenomenon between the two measurements. The hazard ratios of the SOC difference scores were adjusted for initial SOC age and 12 somatic risk factors of mortality (alcohol consumption, blood pressure, body mass index, cholesterol concentration, physical activity, education, smoking, marital status, employment status, history of cancer, history of cardiovascular disease and diabetes). SOC was not stable among middle-aged Finnish men and a decline in SOC was associated with an increased hazard of all-cause mortality. In the fully adjusted model, a decrease of one standard deviation (SD) of the SOC mean difference increased the mortality hazard by about 35 %, two SDs decrease about 70 %, and 2.5 SDs about 100 %. Strengthening SOC showed a limited association with decreasing mortality hazards in the age-adjusted model. Policies, strategies, or plans, supporting SOC in the middle-age may help to decrease mortality and increase quality of life in later years.

  • 48.
    Piiroinen, Ilkka
    et al.
    Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Finland.
    Tuomainen, Tomi-Pekka
    Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Finland.
    Tolmunen, Tommi
    Kuopio University Hospital, Kuopio, Finland.
    Kauhanen, Jussi
    Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Finland.
    Kurl, Sudhir
    Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Finland.
    Nilsen, Charlotta
    Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
    Suominen, Sakari
    University of Turku, Turku, Finland.
    Välimäki, Tarja
    Department of Nursing Science, University of Eastern Finland, Kuopio, Finland.
    Voutilainen, Ari
    Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Finland.
    Sense of Coherence and Mortality: A Systematic Review and Meta-Analysis2020Inngår i: Psychosomatic Medicine, ISSN 0033-3174, E-ISSN 1534-7796, Vol. 82, nr 6, s. 561-567Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    Objective

    The aim of the study was to investigate the association between sense of coherence (SOC) and all-cause mortality in the general adult population.

    Methods

    We conducted a systematic review and meta-analysis of prospective cohort studies. We searched eight electronic bibliographic databases for eligible studies. A random effects model and the restricted maximum likelihood method were used to calculate the pooled effect size.

    Results

    Eight studies were eligible for the meta-analysis. The studies included 48,138 participants, of whom 5307 died during a median follow-up of 14.1 years (range, 8-29.5 years). Their age ranged from 20 to 80 years, and 53% of them were men. In the meta-analysis model of crude values, the risk of all-cause mortality for individuals with a weak SOC (lowest tertile) was 1.30 (95% confidence interval [CI] = 1.09-1.55, p =.003, I2 = 78.84%) compared with individuals with a strong SOC (highest tertile). In the model adjusted for age, the risk remained almost the same (risk ratio = 1.26, 95% CI = 1.15-1.38, p <.001, I2 = 69.59%). In the model adjusted for several other risk factors for mortality, the risk was still 1.17 (95% CI = 1.07-1.27, p <.001, I2 = 57.85%).

    Conclusions

    This meta-analysis shows that a weak SOC is associated with an increased risk of all-cause mortality in the general adult population. Future studies are needed to further develop assessment tools for SOC with good psychometric properties and to determine the disease processes that mediate the association of SOC with mortality. 

  • 49.
    Shaw, Benjamin A.
    et al.
    University at Albany (State University of New York), Rensselaer, NY, United States.
    Dahlberg, Lena
    Karolinska Institutet and Stockholm University, Stockholm, Sweden.
    Nilsen, Charlotta
    Karolinska Institutet and Stockholm University, Stockholm, Sweden.
    Agahi, Neda
    Karolinska Institutet and Stockholm University, Stockholm, Sweden.
    Trends in the Mortality Risk of Living Alone during Old Age in Sweden, 1992–20112020Inngår i: Journal of Aging and Health, ISSN 0898-2643, E-ISSN 1552-6887, Vol. 32, nr 10, s. 1399-1408Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives: This study investigates the association between living alone and mortality over a recent 19-year period (1992–2011).

    Method: Data from a repeated cross-sectional, nationally representative (Sweden) study of adults ages 77 and older are analyzed in relation to 3-year mortality.

    Results: Findings suggest that the mortality risk associated with living alone during old age increased between 1992 and 2011 (p =.076). A small increase in the mean age of those living alone is partly responsible for the strengthening over time of this association. Throughout this time period, older adults living alone consistently reported poorer mobility and psychological health, less financial security, fewer social contacts, and more loneliness than older adults living with others.

    Discussion: Older adults living alone are more vulnerable than those living with others, and their mortality risk has increased. They may have unique service needs that should be considered in policies aiming to support aging in place.

  • 50.
    Sindi, Shireen
    et al.
    Aging Research Center, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet and Stockholm University, Stockholm, Sweden.
    Hagman, Göran
    Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet Center for Alzheimer Research, Stockholm, Sweden.
    Håkansson, Krister
    Aging Research Center, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet and Stockholm University, Stockholm, Sweden.
    Kulmala, Jenni
    Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland.
    Nilsen, Charlotta
    Aging Research Center, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet and Stockholm University, Stockholm, Sweden.
    Kåreholt, Ingemar
    Jönköping University, Hälsohögskolan, HHJ, Institutet för gerontologi. Jönköping University, Hälsohögskolan, HHJ. ARN-J (Aging Research Network - Jönköping). Aging Research Center, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet and Stockholm University, Stockholm, Sweden.
    Soininen, Hilkka
    NeuroCenter, Department of Neurology, Kuopio University Hospital, Kuopio, Finland.
    Solomon, Alina
    Aging Research Center, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet and Stockholm University, Stockholm, Sweden.
    Kivipelto, Miia
    Aging Research Center, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet and Stockholm University, Stockholm, Sweden.
    Midlife work-related stress increases dementia risk in later life: The CAIDE 30-year study2017Inngår i: The journals of gerontology. Series B, Psychological sciences and social sciences, ISSN 1079-5014, E-ISSN 1758-5368, Vol. 72, nr 6, s. 1044-1053Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To investigate the associations between midlife work-related stress and mild cognitive impairment (MCI), dementia, and Alzheimer's disease later in life, in a large representative population.

    METHOD: Cardiovascular Risk Factors, Aging and Dementia (CAIDE) study participants were randomly selected from independent population-based surveys (mean age 50 years). A random sample of 2,000 individuals was invited for two reexaminations including cognitive tests (at mean age 71 and mean age 78), and 1,511 subjects participated in at least one reexamination (mean follow-up 28.5 years). Work-related stress was measured using two questions on work demands that were administered in midlife. Analyses adjusted for important confounders.

    RESULTS: Higher levels of midlife work-related stress were associated with higher risk of MCI (odds ratio [OR], 1.38; 95% confidence interval [CI], 1.08-1.76), dementia (OR, 1.53; CI, 1.13-2.07), and Alzheimer's disease (OR, 1.55; CI, 1.19-2.36) at the first follow-up among the CAIDE participants. Results remained significant after adjusting for several possible confounders. Work-related stress was not associated with MCI and dementia during the extended follow-up.

    DISCUSSION: Midlife work-related stress increases the risk for MCI, dementia, and Alzheimer's disease in later life. The association was not seen after the extended follow-up possibly reflecting selective survival/participation, heterogeneity in dementia among the oldest old, and a critical time window for the effects of midlife stress.

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