‘Fateful Life Events’ affect ageing and mortality risk

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Working overtime health risk and work exhaustion symbol as business people running away from falling clock objects as a corporate stress metaphor with 3D illustration elements.A sudden substantial financial loss in middle-age or older people, is associated with an up to 50% higher risk of death, found a US study.

The Northwestern Medicine and University of Michigan study found that when people lose 75% or more of their total wealth during a two-year period, they are 50% more likely to die in the next 20 years, the study found.

“We found losing your life-savings has a profound effect on person’s long-term health,” said lead author Lindsay Pool, a research assistant professor of preventive medicine at Northwestern University Feinberg School of Medicine. “It’s a very pervasive issue. It wasn’t just a few individuals but more than 25% of Americans had a wealth shock over the 20 years of the study.”

Though the rate of savings loss spiked during the Great Recession, middle- and older-age Americans consistently lost savings across the 20-year period, regardless of the larger economic climate. The study is the first to look at the long-term effects of a large financial loss.

“Our findings offer new evidence for a potentially important social determinant of health that so far has not been recognised: sudden loss of wealth in late middle or older age,” said senior author Carlos Mendes de Leon, professor of epidemiology and global public health at University of Michigan’s School of Public Health.

The study also examined a group of low-income people who didn’t have any wealth accumulated and who are considered socially vulnerable in terms of their health. Their increased risk of mortality over 20 years was 67%.

“The most surprising finding was that having wealth and losing it is almost as bad for your life expectancy as never having wealth,” Pool said.

The likely cause of the increased death risk may be twofold. “These people suffer a mental health toll because of the financial loss as well as pulling back from medical care because they can’t afford it,” Pool said.

The new study builds on prior research in the wake of the Great Recession from 2007 to the early 2010s. Those studies examined short-term health effects such as depression, blood pressure and other markers of stress that changed as peoples’ financial circumstances took a nosedive.

The study was based on data from the Health and Retirement Study from the National Institute on Aging (NIA). Started in 1992, the longitudinal study follows a representative group of US adults 50 years and older every two years. More than 8,000 participants were included in the Northwestern study.

“This shows clinicians need to have an awareness of their patients’ financial circumstances,” Pool said. “It’s something they need to ask about to understand if their patients may be at an increased health risk.”

Next, Pool and colleagues will investigate the mechanisms that lead to higher mortality after a big financial loss. “Why are people dying, and can we intervene at some point in a way that might reverse the course of that increased risk?” she said.

Abstract
Importance: A sudden loss of wealth—a negative wealth shock—may lead to a significant mental health toll and also leave fewer monetary resources for health-related expenses. With limited years remaining to regain lost wealth in older age, the health consequences of these negative wealth shocks may be long-lasting.
Objective: To determine whether a negative wealth shock was associated with all-cause mortality during 20 years of follow-up.
Design, Setting, and Participants: The Health and Retirement Study, a nationally representative prospective cohort study of US adults aged 51 through 61 years at study entry. The study population included 8714 adults, first assessed for a negative wealth shock in 1994 and followed biennially through 2014 (the most recent year of available data).
Exposures: Experiencing a negative wealth shock, defined as a loss of 75% or more of total net worth over a 2-year period, or asset poverty, defined as 0 or negative total net worth at study entry.
Main Outcomes and Measures: Mortality data were collected from the National Death Index and postmortem interviews with family members. Marginal structural survival methods were used to account for the potential bias due to changes in health status that may both trigger negative wealth shocks and act as the mechanism through which negative wealth shocks lead to increased mortality.
Results: There were 8714 participants in the study sample (mean [SD] age at study entry, 55 [3.2] years; 53% women), 2430 experienced a negative wealth shock during follow-up, 749 had asset poverty at baseline, and 5535 had continuously positive wealth without shock. A total of 2823 deaths occurred during 80 683 person-years of follow-up. There were 30.6 vs 64.9 deaths per 1000 person-years for those with continuously positive wealth vs negative wealth shock (adjusted hazard ratio [HR], 1.50; 95% CI, 1.36-1.67). There were 73.4 deaths per 1000 person-years for those with asset poverty at baseline (adjusted HR, 1.67; 95% CI, 1.44-1.94; compared with continuously positive wealth).
Conclusions and Relevance: Among US adults aged 51 years and older, loss of wealth over 2 years was associated with an increased risk of all-cause mortality. Further research is needed to better understand the possible mechanisms for this association and determine whether there is potential value for targeted interventions.

Authors
Lindsay R Pool; Sarah A Burgard; Belinda L Needham; Michael R Elliott; Kenneth M Langa; Carlos F Mendes de Leon

Another study found that ‘fateful life events’ (FLEs), suchs as conflict, a death in the family, financial hardship and serious medical crises are all associated with accelerated physical ageing in the brain. In a study, researchers at the University of California San Diego School of Medicine found that such negative fateful life events – or FLEs – appear to also specifically accelerate ageing in the brain.

The study, led by senior author Dr William S Kremen, professor of psychiatry and co-director of the Centre for Behaviour Genetics of Aging at UC San Diego School of Medicine, found that major adverse events in life, such as divorce, separation, miscarriage or death of a family member or friend, can measurably accelerate aging in the brains of older men, even when controlling for such factors as cardiovascular risk, alcohol consumption, ethnicity and socioeconomic status, which are all associated with aging risk.

Specifically, they found that on average, one FLE was associated with an increase in predicted brain age difference (PBAD) of 0.37 years. In other words, a single adverse event caused the brain to appear physiologically older by approximately one-third of a year than the person’s chronological age, based upon magnetic resonance imaging (MRI).

The researchers studied 359 men, ages 57 to 66 years old, participating in the Vietnam Era Twin Study of Aging (VETSA). Researchers asked participants to tally a list of life-changing events over the past two years, which were compared to a similar measure collected five years previously when they joined VETSA. The summaries encapsulated stressful midlife events that had occurred in the first two and last two years of the past seven years. All participants underwent MRI exams and further physical and psychological assessments within one month of completing the most recent self-reports.

The MRIs assessed physiological aspects of the brain, such as volume and cortical thickness – a measure of the cerebral cortex or outer layer of the brain linked to consciousness, memory, attention, thought and other key elements of cognition. These neuroanatomical measurements were then analysed using advanced software to predict brain age.

“Having more midlife FLEs, particularly relating to divorce/separation or a family death, was associated with advanced predicted brain aging,” said Dr Sean Hatton, a post-doctoral scholar at UC San Diego School of Medicine and the study’s first author.
Hatton said exposure to chronic stress has long been associated with biological weathering and premature aging, linked, for example, to oxidative and mitochondrial damage in cells, impaired immune system response and genomic changes. The study’s authors said their findings provide a possible link between molecular aging and brain structure changes in response to major stressful life events.

They do note that the study was a snapshot of a narrow demographic: older, predominantly white, males. It is not known whether females or other ethnicities would show similar findings.

The authors said additional, broader studies involving greater and more diverse numbers of participants were needed to further validate their findings. But they suggest that using tools to predict brain age could be clinically useful in helping patients understand their brain health relative to their age and in clinical trials where it might improve study design and recruitment.

Abstract
Negative fateful life events (FLEs) such as interpersonal conflict, death in the family, financial hardship, and serious medical emergencies can act as allostatic stressors that accelerate biological aging. However, the relationship between FLEs and neuroanatomical aging is not well understood. We examined 359 men (mean age 62 years) participating in the Vietnam Era twin study of aging (VETSA) to determine whether negative midlife FLEs are associated with advanced brain aging after controlling for physical, psychological, and lifestyle factors. At two different time points, participants were assessed for negative FLEs, health and well-being, general cognitive ability, socioeconomic status, depression, and ethnicity. Participants underwent a magnetic resonance imaging examination, and T1-weighted images were processed with FreeSurfer. Subsequent neuroanatomical measurements were entered into the Brain-Age Regression Analysis and Computation Utility software (BARACUS) to predict brain age. Having more midlife FLEs, particularly relating to interpersonal relationships, was associated with advanced predicted brain aging (i.e., higher predicted brain age relative to chronological age). This association remained after controlling for the significant covariates of alcohol consumption, cardiovascular risk, adult socioeconomic status, and ethnicity.

Authors
Sean N Hatton, Carol E Franz, Jeremy A Elman, Matthew S Panizzon, Donald J Hagler, Christine Fennema-Notestine, Lisa T Eyler, Linda K McEvoy, Michael J Lyons, Anders M Dale, William S Kremen

Northwestern University material
JAMA abstract
University of California – San Diego material
Neurobiology of Ageing abstract


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