Employment Trajectories Across the Life Course and Oral Health Among Older Persons in a Developing Country.

A significant research gap on socioeconomic determinants of oral health among older persons is that socioeconomic indicators, like employment status, have essentially been problematized and measured using a cross-sectional approach. Based on a life course approach, and using data from a population-representative, face-to-face and longitudinal-retrospective survey focused on older people in Chile (N = 802), we reconstructed representative types of individual employment trajectories and measured their association with different oral health indicators in old age. Our results show that employment trajectories characterized by continuous, formal, full-time employment have a protective effect for multiple oral health indicators among older people. Our study demonstrates the need for public policies on oral health in old age to incorporate a life course approach and to consider the negative impact of constantly working in informal employment or being out of the labor market permanently, particularly in countries like Chile where temporary and informal employment has risen steadily.

Simultaneous employment and depressive symptom trajectories around retirement age in Chile.

Objectives: Over the last decade, an increasing number of empirical studies have examined long-term patterns of depression among adults around retirement age and identified employment status as a crucial determinant. However, most research has examined associations between cross-sectional measures of employment and prospective depression patterns, overlooking the changing nature of employment statuses, particularly close to retirement age. Furthermore, most knowledge in this field comes from studies conducted in developed countries in Western Europe and North America. To address these gaps, this study examined simultaneous trajectories in the employment and depressive symptom domains among two age groups of Chileans before and after the standard retirement age. Method: Using population-representative data and longitudinal statistical methods, we identified different trajectory types among two age groups (one aged 56-65 and another aged 66-75, at baseline) and characterized them according to social and health characteristics.Results: We found that trajectories defined by permanent employment were accompanied by lower depressive symptoms than trajectories indicating either retirement or inactivity. However, trajectories combining employment and the absence of depressive symptoms were primarily followed by individuals with advantaged health and social statuses at the baseline. Conclusion: Public policies aimed at promoting the mental health of older adults through their labor market integration risk forcing individuals who have accumulated social and health disadvantages across the life course to work longer.

Extending the Analysis of Functional Ability Trajectories to Unexplored National Contexts: The Case of Chile.

OBJECTIVES: Despite the enormous advances in the field, most evidence about functional ability trajectories in old age comes from studies conducted in developed and high-income countries. This research aims to build on these previous advances to examine functional ability trajectories in Chile. METHOD: Drawing on a robust, publicly available 15-year panel data set (2004-2018), and using sequence analysis, we examine functional ability trajectories types among 4 age groups (people aged 46-50, 51-55, 56-60, and 61-64 at baseline). Then, we analyze trajectories' dynamics looking at intraindividual health-declining and health-recovery transitions between functional ability statuses, within each trajectory type. Finally, we assess how multiple baseline individual characteristics predict the likelihood of following a functional ability trajectory type, using multinomial regression models. RESULTS: Across all age groups, an important fraction (between 26% and 50%) reports stable healthy trajectories, and between 10% and 20% follow equivocal-declining trajectories (i.e., exhibiting both health-declining and health-recovery intraindividual transitions), suggesting that age might not be the main source of heterogeneity in functional ability trajectories. Overall, women, lower educated people, nonworking individuals, and people with a higher burden of chronic conditions at baseline are more prevalent among health-declining trajectory types; however, these results are not constant across the age groups analyzed. DISCUSSION: This nationally focused study reinforces the feasibility and usefulness of an in-depth analysis of functional ability trajectories in old age. The study findings can be crucial to define different prevention strategies according to the functional ability path that an individual might follow, especially in countries like Chile that currently navigate the challenges of population aging.

Trajectories of family and employment stress associated with cerebrovascular accidents.

OBJECTIVES: Reconstruct types of simultaneous stress trajectories in the family and employment domain at different stages of life and estimate their association with cerebrovascular accident (CVA) in old age. METHODS: We used a retrospective, face-to-face, representative survey of people aged 65 to 75 years in the city of Santiago, Chile, (n = 802). We performed a multichannel sequence analysis to reconstruct family and employment stress trajectory types at various life stages and then used logistic regression models to estimate the association of these trajectory types with CVA in old age, controlled for traditional cardiovascular risk factors. RESULTS: Four representative types of family and employment stress trajectories were identified: (1) Absence of family and employment stress, (2) Absence of family stress, persistent employment stress, (3) Absence of family stress, out of the labor market, and (4) Persistent family stress, absence of employment stress. The 61.7% of the sample followed trajectories marked by the permanent presence of family and/or employment stress. Likewise, 18.3% had a trajectory characterized by prolonged absence from the labor market. Individuals with persistent family or employment stress trajectories, as well as those with extended periods of inactivity, are more at risk of developing CVA. CONCLUSIONS: Stress is a risk factor for cardiovascular disease experienced by many people at different stages and domains of life on a prolonged basis. Consequently, prevention systems for this type of chronic diseases should emphasize the highly harmful effects of daily and cumulatively stressful life experiences. This could mitigate the multiple health and financial consequences associated with CVA.

Lifetime socioeconomic determinants of health trajectories among older adults.

Drawing on life course theory and research, we explored how socioeconomic circumstances during childhood and adulthood shape self-reported health trajectories among older Mexican adults. We used data from the Mexican Health and Aging Study panel survey (2001-2015) and used sequence analysis to estimate types of self-reported health trajectories in older adulthood. We then explored the association between those health trajectories and socioeconomic determinants at different life stages, including education, occupation, employment, economic status, parental education, and adverse living conditions and illnesses during childhood. Our contributions are threefold. First, we identified four types of health trajectories for men and eight for women, representing a more nuanced longitudinal health status profile than previously shown. Second, we found that childhood and adult socioeconomic circumstances influence self-reported health trajectories at older age. Third, our results suggest there is no simple monotonic relationship between life course circumstances and self-reported health trajectories.

Association between Lifetime Tobacco Use and Alcohol Consumption Trajectories and Cardiovascular and Chronic Respiratory Diseases among Older People.

Background: We identify representative types of simultaneous tobacco use and alcohol consumption trajectories across the life course and estimate their association with cardiovascular and chronic respiratory diseases (CVDs and CRDs) among older people in Chile. Methods: We used data from a population-representative, face-to-face and longitudinal-retrospective survey focused on people aged 65-75 (N = 802). To reconstruct trajectory types, we employed weighted multichannel sequence analysis. Then, we estimated their associations with CVDs and CRDs through weighted logistic regression models. Results: Long-term exposure to tobacco use and alcohol consumption across life are associated with the highest CVD and CRD risks. Long-term nonsmokers and nondrinkers do not necessarily show the lowest CVDs and CRDs risks if these patterns are accompanied by health risk factors such as obesity or social disadvantages such as lower educational levels. Additionally, trajectories showing regular consumption in one domain but only in specific periods of life, whether early or late, while maintaining little or no consumption across life in the other domain, lead to lower CVDs or CRDs risks than trajectories indicating permanent consumption in both domains. Conclusions: A policy approach that considers CVDs and CRDs as conditions that strongly depend on previous individual experiences in diverse life domains can contribute to the improved design and evaluation of preventive strategies of tobacco use and alcohol consumption across the life course.

Lifetime employment, tobacco use, and alcohol consumption trajectories and cardiovascular diseases in old age.

Despite the great advances of life course epidemiology studies during the last decade in understanding the general health effects of employment trajectories, research has yet to evaluate the effects of employment trajectories along with other major risk factors, such as tobacco and alcohol consumption, on cardiovascular diseases (CVDs)-the main cause of deaths worldwide. This is highly relevant, since health advantages in one domain (e.g., being a permanent formal full-time worker) may offset health disadvantages in other domains (e.g., being a regular smoker or alcohol consumer); conversely, disadvantages in both domains may interact, leading to even greater health risks. Considering these knowledge gaps, this research has two main objectives: (1) to reconstruct simultaneous employment, tobacco use, and alcohol consumption trajectories over the life course (from birth to old age) and (2) to measure the association between these trajectories and CVD in old age. Drawing on a rich and comprehensive life history dataset and using multichannel sequence and regression analyses, we analyzed a cohort of individuals aged 65-75 in Chile, a Latin American country with high social inequalities and scarce research on this matter. Our study shows that following a trajectory of formal employment together with no tobacco and alcohol use reduces CVD risk by 36 percentage points relative to a similar employment trajectory but with regular tobacco and alcohol use. Even with an employment trajectory characterized by constant informal employment or permanent inactivity, a life course free of regular tobacco and alcohol use shows protective effects against CVD. This study stresses the importance of health policies that consider CVD as a condition that strongly depends on individual experiences in multiple life domains and across different life stages.

Retirement Trajectories in Countries with Flexible Retirement Policies but Different Welfare Regimes.

We examine how both the welfare regime and health affect retirement trajectories in countries with flexible retirement policies using longitudinal methods and harmonized panel data from two social-democratic (Sweden and Denmark) and two liberal welfare regimes (Chile and the United States). An early retirement trajectory, which represents retirement in the early 60s, is the most frequent in all countries, although it is less prevalent in liberal than in social-democratic regimes. Adverse health conditions are more frequent among early retirees in liberal but not in social-democratic regimes. Overall, we do not find evidence for an inciting effect of flexible retirement policies on working life extension. However, welfare regimes substantially affect late-life labor force participation.

It Is Not Just Mortality: A Call From Chile for Comprehensive COVID-19 Policy Responses Among Older People.

OBJECTIVE: Provide a synthesis of the COVID-19 policies targeting older people in Chile, stressing their short- and long-term challenges. METHOD: Critical analysis of the current legal and policy measures, based on national-level data and international experiences. RESULTS: Although several policies have been enacted to protect older people from COVID-19, these measures could have important unintended negative consequences in this group's mental and physical health, as well as financial aspects. DISCUSSION: A wider perspective is needed to include a broader definition of health-considering financial scarcity, access to health services, mental health issues, and long-term care-in the policy responses to COVID-19 targeted to older people in Chile.

Trajectories of family and employment stress associated with cerebrovascular accidents / Trayectorias de estrés familiar y laboral y su asociación con accidentes cerebrovasculares

ABSTRACT OBJECTIVES: Reconstruct types of simultaneous stress trajectories in the family and employment domain at different stages of life and estimate their association with cerebrovascular accident (CVA) in old age. METHODS: We used a retrospective, face-to-face, representative survey of people aged 65 to 75 years in the city of Santiago, Chile, (n = 802). We performed a multichannel sequence analysis to reconstruct family and employment stress trajectory types at various life stages and then used logistic regression models to estimate the association of these trajectory types with CVA in old age, controlled for traditional cardiovascular risk factors. RESULTS: Four representative types of family and employment stress trajectories were identified: (1) Absence of family and employment stress, (2) Absence of family stress, persistent employment stress, (3) Absence of family stress, out of the labor market, and (4) Persistent family stress, absence of employment stress. The 61.7% of the sample followed trajectories marked by the permanent presence of family and/or employment stress. Likewise, 18.3% had a trajectory characterized by prolonged absence from the labor market. Individuals with persistent family or employment stress trajectories, as well as those with extended periods of inactivity, are more at risk of developing CVA. CONCLUSIONS: Stress is a risk factor for cardiovascular disease experienced by many people at different stages and domains of life on a prolonged basis. Consequently, prevention systems for this type of chronic diseases should emphasize the highly harmful effects of daily and cumulatively stressful life experiences. This could mitigate the multiple health and financial consequences associated with CVA.

RESUMEN OBJETIVOS: Reconstruir tipos de trayectorias de estrés simultáneo en el dominio familiar y laboral en diferentes etapas de la vida y estimar su asociación con accidentes cerebrovasculares (ACV) en la vejez. MÉTODOS: Se utilizó una encuesta retrospectiva, cara a cara, y representativa de personas de 65 a 75 años en la ciudad de Santiago de Chile (n = 802). Se empleó un análisis de secuencias multicanal para reconstruir tipos de trayectorias de estrés familiar y laboral en diversas etapas de la vida y luego se utilizaron modelos de regresión logística para estimar la asociación de estos tipos de trayectoria con ACV en la vejez, controlado por factores tradicionales de riesgo cardiovascular. RESULTADOS: Se identificaron cuatro tipos representativos de trayectorias de estrés familiar y laboral: (1) Ausencia de estrés familiar y laboral, (2) Ausencia de estrés familiar, estrés laboral persistente, (3) Ausencia de estrés familiar, fuera de mercado laboral, y (4) Estrés familiar persistente, ausencia de estrés laboral. El 61,7% de la muestra siguió trayectorias marcadas por la presencia permanente de estrés familiar y/o laboral. Asimismo, el 18,3% tuvo una trayectoria caracterizada por la ausencia prolongada del mercado del trabajo. Las personas con trayectorias de estrés familiar o laboral persistente, así como aquellas con períodos extensos de inactividad, tienen más riesgo de desarrollar ACV. CONCLUSIONES: El estrés es un factor de riesgo de enfermedades cardiovasculares que experimenta de manera prolongada muchas personas en distintas etapas y dominios de la vida. En consecuencia, los sistemas de prevención de este tipo de enfermedades crónicas deben enfatizar los efectos altamente nocivos de enfrentar cotidiana y acumulativamente experiencias de vida estresantes. Esto a su vez podría mitigar las múltiples consecuencias sanitarias y financieras asociadas al ACV.

Aging in Different Welfare Contexts: A Comparative Perspective on Later-Life Employment and Health.

OBJECTIVE: We adopt a cross-national comparative perspective to assess the labor market experiences of older adults in the years leading up to and beyond the full pension age (FPA) and their association with health in diverse welfare state contexts. METHOD: We work with a harmonized pooled-country data set of 12 nations to model individuals' employment trajectories during the 10 years surrounding gender- and country-specific FPAs over the same chronological period (2004 to 2014/2015) using sequence analysis. We then analyze these trajectories' relationships with self-rated health and chronic conditions across different welfare state contexts. RESULTS: We find five types of later-life employment trajectories: early retirement, conventional retirement, predominantly part-time, not in the labor market, and partial retirement. Among other findings, our analyses indicate that early retirement is associated with positive health outcomes in social-democratic and corporatist countries but not in liberal and liberal-corporatist countries. For people in the not in the labor market trajectory, poor self-rated health is more frequent in liberal and southern, and less frequent in corporatist countries. DISCUSSION: The research findings illustrate the importance of both generous public benefits in old age and later-life employment trajectories for older individuals' health.

Advantages and disadvantages across the life course and health status in old age among women in Chile.

OBJECTIVES: Based on a life course perspective, we assessed the association between three types of social advantages and disadvantages accumulated across different life stages, with the number of self-reported chronic conditions among women aged 60 + in Chile, a Latin-American country with almost no reports on this matter. METHODS: We used a population-representative longitudinal survey (Chile's Social Protection Survey) with information about childhood conditions, economic mobility across life, educational attainment, late adulthood labor-force trajectories, and later-life health, of 2627 women aged 60+. We then used sequence and Poisson regression analyses to assess the effect of life course (dis)advantages over the number of chronic conditions in old age. RESULTS: Growing up in a poor household and experiencing downward economic mobility (especially among those with a non-poor childhood) increases the predicted number of chronic conditions in old age. By contrast, having a continuous and formal labor-force trajectory in late adulthood and higher educational attainment is associated with fewer chronic conditions later in life. CONCLUSIONS: Policy measures that seek to foster health prevention and health care among older women should consider how multiple exposures to social advantages/disadvantages during earlier stages of the life course could affect health in late life.

Private Pension Systems Built on Precarious Foundations: A Cohort Study of Labor-Force Trajectories in Chile.

The success of private pension systems to provide old-age security is mainly a function of continuous individual pension contributions linked to formal employment. Using a rich longitudinal dataset from Chile and employing sequence analysis, this study examines the pension contribution histories and formal employment pathways of a cohort of individuals who began their working lives simultaneously to the introduction of the Chilean private pension system in the early 1980s, which pioneered private-oriented pension reforms worldwide. Results show that more than half of the individuals from this cohort developed labor-force trajectories inconsistent with continuous pension contributions and formal employment, which particularly affects women and lower educated people. We conclude that policy and decision makers focused on aging topics should be aware of the increasing diversity and precariousness of labor-force trajectories when evaluating the performance and sustainability of both private and public pension regimes.

From Snapshots to Movies: The Association Between Retirement Sequences and Aging Trajectories in Limitations to Perform Activities of Daily Living.

OBJECTIVE: This study analyzes the dynamic association between retirement sequences and activities of daily living (ADLs) trajectories between ages 60 and 70. METHOD: Retirement sequences previously established for 7,880 older Americans from the Health and Retirement Study were used in hierarchical linear and propensity score full matching models, analyzing their association with ADL trajectories. RESULTS: Sequences of partial retirement from full- or part-time jobs showed higher baseline and slower decline in ADL than sequences characterized by early labor force disengagement. DISCUSSION: The conventional model in which people completely retire from a full-time job at normative ages and the widely promoted new conventional model of late retirement are both associated with better functioning than early labor force disengagement. But unconventional models, where older adults keep partially engaged with the labor force are also significantly associated with better functioning. These findings call attention to more research on potential avenues to simultaneously promote productive engagement and health later in life.

Retirement Sequences of Older Americans: Moderately Destandardized and Highly Stratified Across Gender, Class, and Race.

Purpose of the Study: A destandardization of labor-force patterns revolving around retirement has been observed in recent literature. It is unclear, however, to which degree and of which kind. This study looked at sequences rather than individual statuses or transitions and argued that differentiating older Americans' retirement sequences by type, order, and timing and considering gender, class, and race differences yields a less destandardized picture. Design and Methods: Sequence analysis was employed to analyze panel data from the Health and Retirement Study (HRS) for 7,881 individuals observed 6 consecutive times between ages 60-61 and 70-71. Results: As expected, types of retirement sequences were identified that cannot be subsumed under the conventional model of complete retirement from full-time employment around age 65. However, these retirement sequences were not entirely destandardized, as some irreversibility and age-grading persisted. Further, the degree of destandardization varied along gender, class, and race. Unconventional sequences were archetypal for middle-level educated individuals and Blacks. Also, sequences for women and individuals with lower education showed more unemployment and part-time jobs, and less age-grading. Implications: A sequence-analytic approach that models group differences uncovers misjudgments about the degree of destandardization of retirement sequences. When a continuous process is represented as individual transitions, the overall pattern of retirement sequences gets lost and appears destandardized. These patterns get further complicated by differences in social structures by gender, class, and race in ways that seem to reproduce advantages that men, more highly educated individuals, and Whites enjoy in numerous areas over the life course.

How voluntary is the active ageing life? A life-course study on the determinants of extending careers.

In Switzerland, as in many other European states, there is an increasing emphasis in public policy on promoting later retirement from the labour market. But this accelerating drive in Swiss policy-making to extend occupational activity does not mean that every worker is currently likely to retire late, nor does it imply that all those who do retire late do so voluntarily. This article uses a life-course approach, first to study the determinants of late retirement, and secondly to analyse whether the decision to postpone retirement is made voluntarily or involuntarily. Both objectives are addressed on the basis of data from the Swiss survey Vivre/Leben/Vivere. The results of logistic regression modelling indicate that, whereas self-employed and more highly educated individuals are more likely to retire late, people with access to private pension funds and workers who have benefited from periods of economic growth have a lower tendency to retire late. Regarding voluntariness, those who are more likely to opt for voluntary late retirement tend to be Swiss citizens, more highly educated, and also benefited from periods of economic expansion, while the self-employed, men and widowed individuals leaving the labour market late tend to do so involuntarily. In conclusion, the article discusses the absence of a social inequality debate in the design of active ageing policies.