A life course perspective on the associations between lifestyle and mental health in older age
Mental health is an important component of the general health status and wellbeing, affecting willpower and agency, the ability to function in daily life, and overall life satisfaction. Mental health problems occur more frequently in younger years (adolescence) and again in old age (WHO 2017; Laidra 2016).
There are various reasons for increased mental health issues later in life. The life course approach offers the most comprehensive framework, linking a person’s life events to age-specific changes and temporal and social dimensions (Elder et al. 2003). Ageing or getting older is not necessarily a depressing process in and of itself. According to the life course approach, the health of individuals is affected by their life experiences. The accumulation of negative, unfavourable or what are perceived as unusual conditions or events can lead to poorer health.
There are various life course mechanisms that affect health (Pearlin et al. 2005). First, the ways in which people assume social roles and achieve status throughout life may be different depending on their family background and childhood home conditions, as well as the neighbourhood they inhabit or grew up in. These past factors can affect health by limiting access to necessary information and resources. The accumulation of constant or repeated difficulties in key areas of life such as family or work can also have a negative impact on health. Persisting economic vulnerability or repeated threats to identity may affect health. Early traumatic experiences are another aspect that may lead to chronic stress and tension. Secondary stressors resulting from trauma and the increased likelihood of their post-traumatic occurrence may affect mental health in later life, mostly indirectly. Deviations from social norms in the timing and sequence of important life events may also create tensions by impacting access to certain opportunities in life (e.g. education or the labour market). Disruptions to the regular course of life, such as breakups, job loss or unexpected caregiving responsibilities, can have a greater impact on those who lack the necessary resources to cope with new situations.
Therefore, in addition to preventive measures that stress the role of individual responsibility and personal choice, social and economic adjustments on a national and community level also play an important role in improving health.
This article provides an overview of the association between lifestyle and mental health in people aged 65 and older by examining changes and differences in mental health in old age through lifestyle factors. For this, we will be relying on data from the SHARE (Survey on Health, Ageing and Retirement in Europe) longitudinal survey. This survey collects data on individual ageing, health and exiting the labour market in European countries.
Approaching health from a life course perspective makes it possible to evaluate and understand how experiences from various stages of life as well as different historical periods impact life in later years. Many stressful early life experiences or events can affect health later in life.
Relevant stressors that occur during sensitive or critical life periods can affect biological stress regulation mechanisms, the functioning of the nervous system or the expression of genetic predispositions as a stress reaction (WHO 2014). Lifestyle may also change in different periods of life in response to the surrounding social environment and the needs and opportunities of the individual. The aspects of lifestyle we will consider more closely are diet, physical activity, sleep patterns, smoking and alcohol consumption, as previous research has identified these as key factors for mental health.
Changes in diet can be viewed from a life course perspective. First, certain food-related attitudes and strategies develop at an early age and remain fairly stable throughout life (Devine 2005). Second, food choices and eating behaviours can change as a result of pivotal life events – for example, when people are suddenly faced with the need to take better care of their own health or that of loved ones, to improve self-efficacy through dietary choices, or to redefine themselves through food. Third, food choice is closely connected with the meaning attributed to and the norms associated with food, which may differ or change with social positioning, for example, reflecting social class, ethnic group, gender or generation. These links can manifest themselves in dietary habits, the role of food quality, access to different nutrients, and the availability of free time to prepare meals. Eating habits can also change across generations. For example, people born in the early 20th century grew up in an environment with fewer or different dietary guidelines than later generations. If the habits typical of a generation are sufficiently widespread or long-lasting, they can be reflected in population-level health indicators.
Physical activity can be understood as either a (health) behaviour or a habit: the former emphasises its cognitive, emotional and operational component, while the latter is an automatic and often subconscious activity (Hirvensalo and Lintunen 2011). From a life course perspective, it has been found that physical activity in childhood and adolescence predicts physical activity in adulthood, although many other factors influence adult physical activity in addition to childhood conditions. This association may function through motivation and the accumulation of experience. However, the relationship between physical activity in childhood and old age is already weaker, probably due to the long intervals that separate these life periods. Nevertheless, patterns of physical activity adopted early on in life can also influence physical activity in later life – for example, through the early acquisition of skills. A change in physical activity is also more likely when assuming new social roles (Hirvensalo and Lintunen 2011). Retirement has been associated with a decrease in physical activity, linked with, for example, the end of daily commuting. On the other hand, former sedentary workers have been found to become more physically active in this life stage.
While sleep provides relief from the problems of everyday life, the quality of sleep can similarly vary among people with different backgrounds and coping strategies. In general, sleep disorders are more common in people with a poorer socioeconomic situation. The reasons include structural disadvantages, related psychological stress, lifestyle
factors, and less knowledge about better sleep hygiene (van de Straat et al. 2020). In general, middle-aged and older women experience more sleep disorders than men of the same age. While men’s sleep disorders are only associated with their current socioeconomic status, women’s sleep disorders are associated with both their current socioeconomic conditions and those of their childhood. Therefore, growing up in poorer socioeconomic conditions affects the quality of sleep in older women, even if their socioeconomic situation improves later in life (van de Straat et al. 2020). Here, we should not forget that changes in sleep patterns and poor quality of sleep are also frequent symptoms of mental health problems.
Smoking and alcohol use are reflections of stress- or tension-responsive behaviour that can harm one’s health when done excessively, leading to addiction and mental health problems. In the older population, the abuse of tobacco and alcohol has generally been more common among men, with a greater effect on their morbidity and mortality. Because in Estonia, the life expectancy of men is significantly shorter than that of women, this effect on health outcomes may not be reflected in surveys, as respondents generally include healthier people and those who have survived longer.
Our analysis is based on data from the 2013 Estonian SHARE survey, which asked the respondents detailed questions about their childhood conditions, enabling us to consider various life course conditions. The data consists of answers given by people aged 65 and older who were interviewed in 2011 and again in 2013. We analysed the changes that had taken place in the respondents’ mental health in that period. The final Estonian sample included 2,026 individuals aged 65 and older (684 men and 1,342 women).
We mainly looked at the EURO-D depressiveness scale, which has been internationally developed, allows for comparisons and has been validated for the middle-aged and older population (Guerra et al. 2015). SThis scale measures the presence of 12 symptoms (including low mood, pessimism, suicidal thoughts, guilt, sleep disturbance, loss of interest, irritability, change in appetite, fatigue, poor concentration, lack of enjoyment and tearfulness) during the previous four weeks; the individual scores are summed to form a composite score, with higher values indicating depressiveness (score value over 3). The self-reported results do not indicate medically diagnosed depression, which means that the prevalence of self-reported depressiveness is significantly higher than the prevalence of depression. Nonetheless, the scale helps to estimate the number of people in need of some form of mental health (first) aid. Within this article, it is therefore more accurate to speak of ‘depressiveness’ or ‘depressive symptoms’.
In general, the average number of depressive symptoms among people aged 65 or older was relatively high in Estonia compared to the other countries surveyed. In 2011, the prevalence of depressiveness in Estonian respondents was 40% (46% in women, 29% in men). By 2013 it had somewhat decreased, settling at 38% (43% in women and 28% in men).
Although women had more depressive symptoms than men in both Estonia and other countries, men had a worse position than women in a European comparison (Figure 2.4.1). Estonian men had an average of 2.5 depressive symptoms. This was one of the highest scores in 2013 and was matched only by men in Italy, France and Slovenia. However, Estonian women had an average of 3.4 symptoms (crossing the threshold indicating depressiveness), slightly less than women in Spain and Italy and on par with French women.
library(ggplot2) library(tidyr) library(scales) #faili sisselugemine ja andmete formaadi korrigeerimine J241=read.csv2("PT2-T2.4-J2.4.1.csv",header=TRUE, encoding ="UTF-8") J241$Keskmine=as.numeric(J241$Keskmine) J241$Usaldusintervallid=as.numeric(J241$Usaldusintervallid) J241$Usaldusintervallid.1=as.numeric(J241$Usaldusintervallid.1) J241$Country=as.factor(J241$Country) J241$Country=factor(J241$Country,levels=rev(levels(J241$Country))) #joonis ggplot(J241,aes(x=Country,y=Keskmine,col=Sugu))+ geom_point(cex=3)+ geom_errorbar(aes(x=Country,ymin=Usaldusintervallid,ymax=Usaldusintervallid.1),width=0.1,linewidth=0.9)+ theme_minimal()+ coord_flip()+ scale_y_continuous(limits=c(1,5))+ scale_color_manual(values=c("#6666cc","#FF3600"))+ theme(text = element_text(color="#668080"),axis.text=element_text(color="#668080",face=c(1,1,1,1,1,1,1,1,1,2,1,1)),legend.title=element_blank())+ ylab("Average depressiveness (EURO-D)")
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The average number of depressive symptoms increased with age in all the countries surveyed. For men aged 85 years and older, there were no significant differences between countries in the number of symptoms. While Estonian women crossed the threshold indicating depressiveness, or reached the average level of three symptoms, in their mid-60s, Estonian men arrived at the same level only in their 80s (Figure 2.4.2).