Purpose: In Sweden, in the wake of deinstitutionalization, in 1995 the responsibility for support regarding accommodation, employment, and an active everyday life for persons with severe mental illness (SMI) became a matter for the municipality’s social services. The overall aim of this study was to investigate whether there are differences in functioning and needs among older adults (65+) with severe mental illness (SMI) when divided into Psychosis and Non‑Psychosis groups.

Materials and methods: Data was collected from 5 surveys, and data from national registers. A group of older adults with SMI, with a history of long-term stays in mental hospitals, was identified and divided into two groups: Psychosis diagnosis (N = 222) and Non-Psychotic diagnosis (N = 253).

Results: The level of functioning was significantly lower in the Psychosis group, but at the same time, long periods of institutionalization, regardless of diagnosis category, also contributed to lower functioning scores. Diagnostic group did not explain differences in the proportion of unsatisfied needs; however, the length of institutionalization did.

Conclusions: Although there were diagnostic group differences in functioning, there were no diagnostic group differences in unmet needs, suggesting that social services were responding to individuals’ actual level of functioning. In line with the studies by Barton and by Goffman, it can be argued that the long periods of institutionalization were the most decisive factors influencing functional levels.

BACKGROUND: Leisure activity is associated with a wide range of physical and mental health outcomes. Nonetheless, the causal basis for these associations is uncertain and we do not fully understand why some individuals are active while others are sedentary.

METHODS: We investigated genetic and environmental contributions to individual differences in frequencies of social, physical, and intellectual leisure activities and their relationship to depressive symptoms, using data from the Interplay of Genes and Environment across Multiple Studies consortium. The sample consisted of 31 596 like-sex twins (44.1% monozygotic, 31.4% women, age range 32-99 years) representing 11 studies from Sweden, Denmark, United States, and Australia.

RESULTS: Results indicated moderate contributions of genetic factors to social (a2 = 0.26, 95% CI = 0.16; 0.35), physical (a2 = 0.39, CI = 0.28; 0.51), and intellectual (a2 = 0.47, CI = 0.33; 0.61) activities. The contribution of shared environmental factors (c2) was trivial, ranging from -0.03 to 0.02, while estimates of nonshared environmental factors (e2) were consistently substantial, ranging from 0.52 to 0.68. There was no evidence that estimates varied by age and limited evidence that they varied by sex and country. Co-twin control analyses revealed a significant negative within-pair association of depressive symptoms with each activity domain.

CONCLUSIONS: Although genetic factors contribute importantly to mid-to-late-life activity levels, associations of leisure activity levels with depressive symptoms remained significant when controlling for (unmeasured) genetic and shared environmental confounding. These findings are consistent with, albeit not proof of, a causal effect of leisure activities on depressive symptoms.

OBJECTIVES: Birth weight is a widely used indicator of prenatal experiences in models of the developmental origins of cognitive ability across the lifespan. This study aimed to examine the association between birth weight and cognitive ability using a community sample of twins followed prospectively from infancy to midlife. We leveraged the twin study design to identify phenotypic and biometric associations between the two constructs.

METHODS: The sample consisted of 1,501 participants (387 dizygotic pairs, 360 monozygotic pairs, and 7 singletons; 53.1% female; 91.1% White) from the Louisville Twin Study. We modeled the change in the strength of the association between birth weight and cognitive ability using exponential decay functions.

RESULTS: The magnitude of the association between birth weight and cognitive ability declined exponentially from infancy (β = .59, p < .05) to midlife (β = .27, p < .05). The lower asymptote of the exponential decay function was reached at about age 2.5 years of age, after which the association between birth weight and cognitive ability stabilized and remained constant up to midlife. A 1-kilogram increase in birth weight was associated with an 8.85-point increase in cognitive scores at 3 months and a 4.05-point advantage after about 2.5 years. Biometric regression models revealed that shared environmental factors accounted for the decline in the association between birth weight and cognitive ability. A small, positive within-pair association persisted into midlife.

DISCUSSION: These findings suggest that prenatal experiences may have lasting effects on cognitive development across the lifespan, supporting developmental origin models of cognitive ability.

BACKGROUND: Obesity and aging share biological processes, but their relationship remains unclear, especially in late life. Understanding how body mass index (BMI) and biological aging influence each other can guide strategies to reduce age- and obesity-related health risks. We examined the bidirectional, longitudinal association between changes in BMI and biological aging, measured by frailty index (FI) and functional aging index (FAI), across late life.

METHODS: This longitudinal cohort study used data from the Swedish Twin Registry substudies, GENDER, OCTO-Twin and SATSA, collected via in-person assessments from 1986 to 2014 at 2- to 4-year intervals. We analysed 6216-6512 evaluations from 1902 to 1976 Swedish twins. Dual change score models were applied to assess the bidirectional, longitudinal association between BMI and FI or FAI from ages 60.0-91.9. FI measured physiological aging, while FAI assessed functional aging through a composite score of functional abilities.

RESULTS: At first measurement, mean age was 74 ± 8, and 41% were males. BMI-FI relationship was bidirectional (p value ≤ 0.001): Higher BMI predicted a greater increase in FI over time (coupling effect [γ] = 0.86, 95% confidence interval [CI] = 0.65-1.06, p value ≤ 0.001), and higher FI predicted steeper decline in BMI (γ = -0.04, 95% CI = -0.05 to -0.03, p value ≤ 0.001). When including coupling from FI, BMI showed a nonlinear trajectory with a mean intercept of 26.32 kg/m² (95% CI = 25.76-26.88), declining more rapidly after age 75. When including BMI coupling, FI increased from a mean intercept of 7.91% (95% CI = 6.41-9.42), with steeper growth from ages 60-75. BMI-FAI relationship was unidirectional (p value ≤ 0.001): Higher FAI predicted a steeper BMI decline (γ = -0.02, 95% CI = -0.02 to -0.01, p value ≤ 0.001). By including FAI coupling, BMI had a mean intercept of 26.10 kg/m² (95% CI = 25.47-26.74), declining rapidly after age 75. FAI increased exponentially from a mean intercept of 36.49 (95% CI = 34.54-38.43).

CONCLUSIONS: Higher BMI predicted a steeper increase in FI, substantiating the hypothesis that obesity accelerates biological aging. Higher biological aging, measured as FI and FAI, drove a steeper BMI decline in late life, signalling that late-life weight loss may result from accelerated aging. Higher BMI may accelerate aspects of the aging process, and the aging process, in turn, accelerates late-life BMI decline, necessitating an integrated approach to manage both obesity and unintentional weight loss among older adults.

Changes in daily function and cognition are two of the primary indicators of the aging process. However, how these twodomains decline with respect to each other remains unclear.Recent work has suggested accelerated declines in fine motorfunction in instrumental activities of daily living (IADLs) precedethe onset of dementia in older adults. However, whether earlychanges in IADLs contribute to subsequent changes in cognitionremains unclear. Random intercept cross lag panel models(RI-CLPM) allow us to examine the temporal dynamics of therelationships between two variables that change over time andtest hypotheses about direction of influence. This study appliedage-based RI-CLPM to longitudinal changes in performance ona timed fine motor IADL test (which included five subtests, e.g.,putting coins into a slot) and changes in the Mini-Mental StatusExam (MMSE). Up to 20 years of follow-up were available for1,462 participants (aged 62-88 years at baseline) from three longitudinal Swedish datasets of older adults (OCTO-Twin,GENDER, SATSA). Model comparisons indicated a unidirectional relationship when participants were in their 60s and 70s:IADL time contributed to subsequent MMSE scores, but MMSEscores did not contribute to subsequent IADL time. For participants in their 80s, the relationship was bi-directional: both variables contributed to subsequent performance on the othervariable. These data not only give insights into the temporaldynamics of decline in IADLs and cognition, but also provideproof-of-concept that tests involving motor performance, particularly when evaluated in ecologically-valid contexts, can beused for monitoring progression towards dementia.

Background

Clarifying risk factors for Alzheimer's disease (AD) in midlife permits intervening earlier in the lifespan and delaying conversion to AD. Understanding the relationship between blood-based AD biomarkers and memory functioning during middle age may help clarify whether elevated levels correspond to poor memory performance in later life. Blood-based biomarkers, including amyloid-β42/amyloid-β40 and ptau181, are associated with AD diagnosis, but studies investigating the correlates of these biomarker levels in middle age are scarce (Li et al., 2022; Karikari et al., 2020).

Method

Blood-based AD biomarkers and episodic memory scores from the California Verbal Learning Test- 3rd Edition (CVLT-3) were collected from 154 midlife twins (78 complete families) as part of the Louisville Twin Study. Pearson correlations and mixed effects regression analysis were used to estimate between-family and within-family associations between AD biomarkers and four CVLT-3 subtests (immediate word recall, short-delay free recall, long-delay free recall, and recognition).

Result

Correlations of amyloid-β42/amyloid-β40 and the CVLT3 subtests ranged from -.02 to .04 while correlations with ptau181 ranged from -.09 to -.04. Although no correlations were statistically significant, the pattern of associations between episodic memory and ptau181 at least suggested a reliable negative association. Neither between-family nor within-family correlations were observed.

Conclusion

Although AD biomarker levels have been found to correlate with memory functioning in older adult samples, we did not observe these same effects in middle adulthood. Thus, the current results suggest that individual differences in blood-based AD biomarkers may not have predictive utility for observed memory functioning in middle adulthood.

OBJECTIVES: Socioeconomic status impacts emotional health outcomes, but a lifecourse approach is necessary to understand the timing of these effects. The current analyses examined the impact of financial strain in childhood and adulthood on longitudinal changes in three measures of emotional health: depressive symptoms, loneliness, and anxiety.

METHOD: Data were from 1596 adults from the Swedish Twin Registry, aged 45 to 98 at intake (mean = 72.6) who participated in up to 9 waves over 25 years. Measures of financial strain (FS) included questions about how well finances met family needs. Latent growth curve models (LGCM) were used to estimate the impact of childhood and adult FS on changes in emotional health.

RESULTS: Results indicated that both childhood and adult FS independently influenced trajectories of emotional health in mid to late adulthood. For all 3 emotional health variables, both childhood and adult FS were associated with the LGCM intercept and childhood FS was associated with linear change with age. Interaction effects of childhood and adult FS were found for the LGCM intercept for loneliness, only.

CONCLUSION: Results corroborate the accumulation of risk models, with effects of both childhood and adult FS on emotional health, and possible social mobility effects for loneliness.

Temporal aspects of falls are not well characterized in people with Parkinson’s disease (PD), particularly those later in life. The purpose of the current study is to characterize the timing (across day and year) of falls in people with probable PD compared to non-PD peers. Swedish registries were used to identify 441 people (mean age, 83.7 years, range = [59.0–100.0]) with one or more prospectively registered falls over the course of approximately 2.5 years. Of these participants, 40 were prescribed drugs of the class N04 “Anti-Parkinson Drugs”. Of these 40, 30 were prescribed dopamine or dopamine derivatives, suggesting presence of PD, and 10 were prescribed “other PD-related medications”. Given the unclear nature of these 10 participants, they were excluded from all analyses. Chi-squared tests and Generalized Estimating Equations were used to assess the time of day and year of falls in people with probable PD (n = 30) and non-PD (n = 401) accounting for covariates (age, gender, number of prescription medications). There was a statistically-significant effect of PD-group on fall time of day (accounting for gender, age, & number of prescription medications), such that Swedish residents with probable PD fell less often in the evening than the day (p = 0.015, OR = 0.61). Across the whole sample, female participants fell less frequently at night than the day (p = 0.032, OR = 0.73). People with probable PD fell more frequently in the spring months than other seasons (×2 = 32.1, p < 0.001). The finding that people with probable PD exhibit more falls during the day than night is consistent with previous work and extends knowledge to show a similar result in older, more frail people with PD. Characterizing the temporal nature of falls in people with PD can provide additional context to other fall circumstances, thus improving our ability to treat and predict falls in this group.

PURPOSE OF THE RESEARCH: Stress has a clear impact on health and function. Yet, little is known about how different stressors (factors that cause stress) in various contexts throughout the life course impact cognitive and physical aging. The study aimed to investigate if different types of stressors predicted cognitive and physical impairment in late life. The role of social support and internal locus of control was also investigated.

MATERIAL AND METHODS: Two individually linked studies of Swedish nationally representative samples provided longitudinal data over 21 years, including retrospective childhood data (n = 1086). Indicators of work and financial stressors were assessed at late midlife (M=62 years) and financial stressors at early late life (M=70). Social support and internal locus of control were assessed at the mean ages of 62 and 70 years. Physical and cognitive impairment were assessed at late life (M=83). Path analyses were conducted with maximum likelihood estimation and adjusted for smoking, age, sex, educational attainment, and follow-up period.

RESULTS: Work stressors were associated with physical and cognitive impairment directly. Work stressors were also associated with financial stressors, which, in turn, were associated with physical impairment. Childhood conflicts were associated with less social support, and less social support was associated with worse cognitive aging. Internal locus of control was not associated with cognitive and physical impairment.

CONCLUSIONS: This study confirms that stressors earlier in life predict cognitive and physical aging, but that different types of stressors have different paths to impact impairment in late life.

Objectives: Understanding the timing of service access for persons with young-onset dementia is essential for developing adequate support. This study aims to describe the formal support available for persons with young-onset dementia in Sweden and identify factors influencing its provision over time.

Method: A prospective cohort study was carried out using data from the Swedish Dementia Registry (SveDem), focusing on persons diagnosed with young-onset dementia between January 2009 and April 2022 (n = 2592). Descriptive statistics provided a comprehensive overview of the population, and Cox Regressions were used to analyse factors associated with the time to receive support services post-diagnosis.

Results: Living with another adult and higher MMSE scores were significantly associated with later access to home help services (p < 0.001) and care facilities (p < 0.001). Higher MMSE scores (p < 0.001), older age (p = 0.023), living with another adult (p = 0.010) and diagnosis at primary care centres (p = 0.016) were also associated with later access to day-care services. No significant associations were found between age, sex, medications, care setting, living arrangement, or MMSE score or with the time to access counselling services.

Conclusion: The timing of access to support services for persons with young-onset dementia varies significantly, particularly for those living with another adult. These patterns may reflect a hidden caregiver burden.