The Average Health of Baby Boomers Compared to Previous Generations
Practise infant boomers feel healthier than earlier cohorts after retirement age? The Lausanne cohort Lc65+ written report
Abstract
Objective Despite the pop belief that baby boomers are ageing in better wellness than previous generations, express scientific evidence is available since babe boomers have turned retirement age simply recently. This study aimed to compare self-reported health status at ages 65–70 years amidst three cohorts of older people born before, during and at the cease (baby boomers) of the 2d World War.
Design Repeated cross-sectional population-based study.
Setting Community in a region of French-speaking Switzerland.
Participants Community-abode older adults who enrolled in the Lausanne accomplice 65+ study at ages 65–70 years in 2004 (n=1561), 2009 (n=1489) or 2014 (due north=1678).
Outcomes Number of cocky-reported chronic atmospheric condition (from a listing of 11) and chronic symptoms (from a list of 11); depressive symptoms; self-rated health (very good, good, average, poor or very poor); fright of disease (not afraid at all, barely afraid, a bit afraid, quite afraid or very afraid); self-perception of ageing; disability in bones and instrumental activities of daily living.
Results There was no significant departure betwixt cohorts in the number of self-reported chronic conditions and chronic symptoms equally well as the presence of difficulty in bones activities of daily living, depressive symptoms, fright of disease and negative self-perception of ageing. In women only, significant differences betwixt cohorts were observed in self-rated wellness (p=0.005) and disability in instrumental activities of daily living (p=0.003), but these associations did non remain significant in logistic regression models adjusted for sociodemographic characteristics and unhealthy behaviours.
Conclusions Despite important sociodemographic differences betwixt older baby boomers and earlier cohorts, virtually health indicators did not suggest whatsoever trend towards a compression of morbidity. Futurity studies comparing these iii cohorts at more than advanced age are required to farther investigate whether differences sally later in life.
- older people
- health status
- cohort outcome
- baby boom
- population characteristics
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- older people
- health status
- cohort effect
- baby boom
- population characteristics
Strengths and limitations of this study
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The repeated cross-sectional design allowed comparing at 5-year intervals three representative samples of community-dwelling older men and women of similar age, with identical instruments and information collection procedure.
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Comparisons between cohorts could be adapted for a substantial number of potential confounders.
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Comparisons betwixt cohorts may reflect a cohort effect, a period result or a combination of both effects.
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The baby nail cohort is representative of early on members of this generation.
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Accomplice differences may become more apparent at more than advanced ages.
Introduction
Life expectancy has risen past 3 months per twelvemonth over the by century in economically developed countries.1 This remarkable gain in longevity was driven past reductions in mortality at different ages over time. Until the 1920s, medical advances aimed at curing infectious diseases mainly benefited survival in infants and children.2 From the second one-half of the 20th century, bloodshed reduction at older ages gradually became the main contributor to the increase in life expectancy. Equally a event of the epidemiological transition, the proportion of the population anile 65 years and over in Switzerland about doubled from 9.half dozen% in 1950 to 18.0% in 2015.3 This increase will go on until 2030 as babe boomers (defined in this report as those born between 1944 and the mid-1960s) are turning 65. This demographic shift represents a major challenge to wellness systems worldwide and raises a key question whether new cohorts of older people volition be and feel healthier than those who preceded them.4
Given the favourable context in which baby boomers grew up, the media frequently convey the idea that this generation will age more healthily than their earlier counterparts.v The infant boom generation distinguishes itself from earlier generations because of its large size and its singled-out socioeconomic characteristics such every bit lower rates of marriage, a higher proportion of women in the workforce, as well every bit increased racial and ethnic diversity.6 The prosperous period post-obit the 2d World War had noticeable social and economic impacts that improved baby boomers' admission to education and wellness resources. Despite these advantages, the literature addressing the baby blast generation's health in machismo provides contradictory observations. According to some studies, baby boomers rated their health more favourably than their predecessors,vii 8 whereas others did not study a meaning difference9–eleven or even institute worse results in baby boomers.12–15 Nevertheless, every bit early on babe boomers began retiring in 2011, all aforementioned studies could non yet address wellness trends after historic period 65. Advances in medical care for health weather condition that affect most individuals only at an older age may notwithstanding favour baby boomers compared with previous cohorts.10
This study aimed to investigate differences in the health condition reported past community-domicile older people enrolled in the Lausanne cohort 65+ (Lc65+) population-based report in 2004, 2009 and 2014, who were born, respectively, before, during and at the cease of the Second World War. Amend self-reported health indicators were expected for baby boomers compared with their predecessors born 5 and 10 years earlier, respectively.
Methods
Written report design and population
The Lc65+ is a population-based study initiated in 2004 to investigate the manifestation and development of frailty afterwards 65 years. The Lc65+ study enrolment program was described in detail previously.16 As illustrated in figure 1, in 2004, 2009 and 2014, three samples were randomly selected from the community-habitation population in Lausanne (the capital of Canton Vaud, Switzerland) born, respectively, before (1934–1938, n=3236), during (1939–1943, due north=3293) and at the end (1944–1948, due north=3796) of the Second World War. Place of residence (Lausanne) and year of nativity were the only eligibility criteria. Participants living in an establishment or unable to respond by themselves due to avant-garde dementia were excluded. Accounting for eligibility and exclusion criteria, the number of mailed enrolment questionnaires in 2004, 2009 and 2014 was, respectively, 3053, 3179 and 3655. Due to non-responses, refusals and further exclusions, the number of valid enrolment questionnaires was 1564 (51.ii%) in 2004, 1489 (46.ix%) in 2009 and 1678 (46.0%) in 2014. For the present analysis, three participants in 2004 were excluded a posteriori due to cognitive inability. Compared with non-participants, participants did not differ in age or sexual practice (online supplementary tables one–3). Previous analyses of data from the first moving ridge besides indicated that participants' socioeconomic characteristics (nationality, marital status, place of birth, living arrangement, professional person activeness—data non shown) closely reflected the Lausanne full general population in the same age category.16
Supplementary file 1
Patient and public interest
Participants in the Lc65+ accomplice or the public were non involved in the design, recruitment or conduct of the study. However, a lay publication chosen 'Lettre de la Cohorte' informs annually participants in the Lc65+ written report and their primary care physician near selected summary results from the study, health-related communication and data on the following research steps. In addition, a total of 1100 participants in the Lc65+ cohort equally well as 300 wellness actors and professionals took office in the briefing 'meliorate agreement age-related frailty' held in Lausanne on 5 November 2013.
Measures
The complete list of baseline assessments of the Lc65+ report has been described previously.16 The present study focused on data collected through the enrolment questionnaire.
Chronic conditions
To assess chronic conditions, participants were asked whether they were e'er diagnosed by a doctor with any of 11 common health weather condition: hypertension, coronary middle affliction, other heart diseases, stroke, diabetes mellitus, chronic respiratory disease, osteoporosis, arthritis, cancer, gastrointestinal ulcer and Parkinson's illness. The number of chronic conditions was categorised as '0', '1' or '≥2'.
Chronic symptoms
Respondents were asked whether or not they were disturbed past any of 11 chronic symptoms for at least 6 months: joint pain, back pain, breast hurting (on exertion), dyspnoea, persistent cough, swollen legs, mental harm (ie, memory gaps, difficulty concentrating or difficulty making decisions in daily life), dizziness or vertigo, skin problems (eg, eczema, psoriasis), stomach or intestine problems (including diarrhoea and constipation) and urinary incontinence.
This list was adapted from the Survey of Wellness, Ageing and Retirement in Europe (SHARE).17 The number of chronic symptoms was categorised as '0', '1' or '≥2'.
Depressive symptoms
The presence of depressive symptoms was defined as a positive response to whatsoever of the two following questions of the Primary Care Evaluation of Mental Disorders Procedure: 'During the past calendar month, take you frequently been bothered by: (1) feeling downwards, depressed or hopeless?; (2) little interest or pleasure in doing things?' These two questions had a sensitivity of 96% and a specificity of 57% in diagnosing low as compared with a standardised interview.eighteen
Self-rated health
Self-rated health was reported every bit 'very adept', 'good', 'average', 'poor' or 'very poor'. Considering of low frequencies in the two poorest response choices, they were complanate into 'poor/very poor'. A single question is a valuable indicator of how individuals perceive their overall health status, and a stiff predictor of morbidity and bloodshed.19 twenty
Fear of disease
Fear of illness or worsening health was cocky-rated as 'not afraid at all', 'barely afraid', 'a bit agape', 'quite afraid' or 'very agape'. Considering of low frequencies in the two poorest response choices, they were collapsed into 'quite agape/very afraid'.
Self-perception of ageing
The Attitudes Toward Own Aging Subscale of the Philadelphia Geriatric Centre Morale Scale21 includes five items: (ane) 'Things keep getting worse as I get older'; (2) 'I take as much pep every bit I did last yr'; (3) 'As you lot become older, you are less useful'; (4) 'I am as happy now every bit I was when I was younger' and (v) 'Every bit I get older, things are (better, worse or the same) as I thought they would be'. For the last item, a pilot study indicated that respondents oftentimes referred to their economic state of affairs. In social club to focus answers on wellness, the terms 'concerning wellness' were added to this detail. Respondents were asked whether they agreed (scored 0) or disagreed (scored 1) with the first four items. According to the methodology used past Levy et al,22 the last detail was dichotomised equally 'better' (scored 0) versus 'the same' or 'worse' (scored 1). Afterward reversing the scores of the first and the third items, the sum of the five scores was dichotomised as positive (total score 0–ii) versus negative (total score 3–v) self-perception of ageing.
Difficulty with activities of daily living
Basic activities of daily living (BADLs) were divers equally dressing, bathing, eating, getting in/out of bed or an armchair and using the toilet.23 Instrumental activities of daily living (IADLs) were defined as shopping and routine tasks at home. Participants were asked whether they had had difficulty in performing BADLs and IADLs over the last 4 weeks. Response choices were 'no difficulty', 'difficulty with one or several activities but no help' or 'received aid with one or several activities'.
Covariates
Respondents' date of birth and sex were obtained from the population part at the stage of sample selection (meet section 'Study design and population'). Additional sociodemographic data was gathered by means of the enrolment questionnaire that provided data well-nigh country of birth ('Switzerland'; 'other country'), citizenship ('Swiss'; 'other'; 'Swiss plus another'), marital status ('single'; 'married'; 'separated/divorced'; 'widowed'), ever having children, living arrangement ('alone'; 'with others') and highest level of instruction accomplished ('bones compulsory'; 'apprenticeship'; 'baccalaureate/professional degree'; 'university/high school'). Age was calculated from the appointment of nascence and the date of receipt of the enrolment questionnaire.
Unhealthy behaviours included hazardous drinking, smoking, low physical action and obesity. Chancy drinking was assessed using the Alcohol Utilise Disorders Identification Test, Consumption, which provides a score ranging from 0 to 20. Women and men who scored ≥4 and ≥5 points, respectively, were classified as hazardous drinkers.24 Smoking was defined as current smoking. Cocky-reported physical activeness was divers equally low if the three post-obit criteria were met: (ane) <20 min of sport activity once a week; (2) <thirty min of walking three times a week and (3) abstention of climbing stairs or carrying light loads in daily activities.16 Body mass index (BMI) was calculated from self-reported peak and weight. Obesity was defined as a BMI ≥thirty kg/m2.
Statistical analyses
A Kruskal-Wallis test was performed to determine if historic period differed significantly betwixt cohorts. Proportions were compared using Pearson χtwo tests. Facing the jitney nature of the χ2 exam, adjusted residuals were calculated for each prison cell from the contingency table and those higher or lower than ±1.96 were identified.25 To adjust for multiple mail service hoc comparisons, the difference betwixt observed and expected frequencies for a given cell was divers every bit statistically significant if adapted residuals were greater or lower than ±2.39 for a contingency tabular array of three cells, ±ii.64 for 6 cells, ±2.77 for ix cells, ±ii.87 for 12 cells and ±2.94 for 15 cells, respectively.
Binary and ordinal logistic regression models were constructed to examine trends in health status across cohorts, adjusting for age and sexual practice, and additionally for sociodemographic characteristics and unhealthy behaviours. For ordinal dependent variables, the proportional odds assumption posits that ORs are constant for every possible cut-offs on the dependent variable, which was tested using the Brant test. When the assumption was violated, a secondary assay was performed where the proportional odds assumption was relaxed for the independent variables identified by the Brant exam.26 Models constructed without interaction term between sex and accomplice fitted the data better than those that included the interaction, based on Akaike data benchmark and Bayesian data benchmark. Furthermore, none of the interaction terms was significant in any of the models. Therefore, only main furnishings were included.
Analyses were conducted using Stata Five.fourteen.0 software (StataCorp). Significance was prepare at p<0.05, with Bonferroni adjustment for multiple testing.
Results
Sociodemographic characteristics of the cohorts
Table one displays and compares sexual activity-specific sociodemographic characteristics of prewar, war and baby boom cohorts. Significant differences between cohorts were observed in marital status (p<0.001) and instruction (p<0.001) among women, and in citizenship (p=0.002), marital status (p=0.004), living arrangement (p=0.002) and education (p<0.001) among men. Inspection of adjusted residuals indicated an increase beyond cohorts in the level of education, a trend in marital status towards fewer marriages, more separations or divorces and less widowhood (women but), an increase in the proportion of men living alone and an increment in the proportion of Swiss male participants with dual nationality. Unhealthy behaviours (chancy drinking, currently smoking, depression physical activity and obesity) did not differ significantly betwixt cohorts.
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Table one
Characteristics of community-domicile older women and men from iii cohorts of the Lausanne cohort 65+ study
Health condition of the cohorts
The sex-specific unadjusted health status of respondents from prewar, war and baby boom cohorts is detailed in table 2. In men, no significant difference between cohorts was observed in any health outcome measures. In women from the prewar accomplice, self-rated health indicated a lower than expected proportion of 'very adept' answers (observed: 13.6%; expected: 16.8%; p=0.005). Difficulty in IADL as well differed beyond cohorts (p=0.003), with higher than expected proportion of 'no difficulty' answers (observed: 88.7%; expected: 85.6%) and lower than expected proportion of 'difficulty only no help' answers (observed: v.6%; expected: eight.7%) in women from the war cohort.
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Table 2
Cocky-reported wellness condition amid community-abode older women and men from three cohorts of the Lausanne cohort 65+ report
Logistic regression models
Tabular array 3 shows the results of binary and ordinal logistic regression models. Self-rated wellness was better in both baby boomers (OR=0.81; p=0.001) and the war cohort (OR=0.81; p=0.002) equally compared with the prewar accomplice. These associations were no more pregnant at the Bonferroni-adjusted significance level (p<0.006) when adjusting for sociodemographic characteristics and unhealthy behaviours (baby boomers: OR=0.84; p=0.019, war cohort: OR=0.83; p=0.017). In that location was no significant cohort effect on the number of chronic weather and chronic symptoms, the presence of depressive symptoms, fear of illness, self-perception of ageing and difficulty in BADL and IADL. According to the Brant examination, the proportional odds assumption was not violated when the dependent variable was self-rated health (partially adjusted model: p=0.278; fully adjusted model: p=0.458). Equally the proportional odds assumption was violated for the fear of illness variable (p<0.001 for partially and fully adjusted models), a secondary analysis allowing odds ratios of independent variables identified by the Brant test to vary for each cutting-off on fright of illness was performed. Results did not show any meaning accomplice consequence.
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Table 3
Logistic regression models for trends in health condition among customs-dwelling house older women and men from three cohorts of the Lausanne cohort 65+ study
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Discussion
Main findings
The present study sought to compare self-reported health condition at ages 65–lxx years in baby boomers and peers from cohorts born 5 years and x years before. Results from this study seriously challenge the widely held belief that babe boomers are ageing in ameliorate health. Although babe boomers rated their health more favourably on boilerplate than their counterparts born before the Second World War, their ratings were comparable to those of the war accomplice. Furthermore, trends in chronic atmospheric condition, chronic symptoms, depressive symptoms, fear of disease, self-perception of ageing and difficulty in activities of daily living did non provide show that would back up a compression of morbidity (ie, a reduced amount of fourth dimension spent in poor health at the end of life through postponement of morbidity27). These findings are of utmost importance for wellness systems planning. Given the challenges posed by population ageing and babe boomers retirement, overly optimistic projections may place a tremendous burden on societies by 2030.
Sociodemographic characteristics and health condition of the cohorts
Sociodemographic characteristics observed in the nowadays sample are consequent with previous studies indicating amend access to education and a shift in marital status in infant boomers compared with previous generations.6 The deviation between prewar and baby boom cohorts was most evident among women, every bit the proportion with bones compulsory education was almost halved and the proportion with academy/high school caste more than doubled. Although higher educational attainment is strongly associated with a favourable health status,28 this written report emphasises that this link might exist balanced past other factors. Among these factors, marital status deserves special attention, as it seems to play an important role. Indeed, according to the Health and Retirement Study, female baby boomers aged 51–lx years in 2006 had higher divorce rates than their peers in 1992, and being married was associated with lower affliction risk and fewer functional limitations.29 Similarly, from 1980 to 2009 Lin et al reported an increasing proportion of unmarried adults aged 45–63 years, and identified them equally a vulnerable subgroup in terms of economic disadvantage, poor health and loneliness.30 In the present study, the coexistence of health-promoting and health-impairing sociodemographic trends across cohorts likely explains results that showed just slight differences afterward aligning for sociodemographic characteristics.
A meaning contribution of the current study is likewise to show that the proportion of women reporting 'no difficulty' in IADL was highest in the war cohort rather than in baby boomers. Although this result may seem counterintuitive, it is in line with those of a recent study on the association betwixt prenatal exposure to the Second World War and health at the ages of l–70 years.31 Using data from the SHARE, the authors reported no substantial negative effect of war exposure, and fifty-fifty a meliorate health among exposed women. Further analyses suggested that this was due to selective mortality at young ages and to selective fertility (ie, healthier individuals were more likely to give birth during the state of war). In the present report, some other caption may exist that 7 in 10 participants were built-in in Switzerland whose economy and society were afflicted by the war only whose neutral status protected against farthermost circumstances such equally armed services hostilities and persecutions.
Strengths and limitations of the study
A clear forcefulness of this written report is the repeated cross-sectional pattern that allowed comparing at five-year intervals three representative samples of community-dwelling older men and women of similar age, with identical instruments and information collection procedure, likewise as to adjusting for a number of potential confounders. Nonetheless, several limitations should be mentioned. Get-go, the sociocultural, economical and technological context may have been unlike in 2004, 2009 and 2014. Comparisons between samples may hence reflect a cohort outcome (ie, being part of the prewar, war or baby boom sample), a period effect (existence assessed in 2004, 2009 or 2014) or a combination of both furnishings. Statistical techniques such equally age-period-cohort modelling accept been developed for decades, but there is still substantial controversy around their ability to overpass the exact linear dependency of age, period and cohort (accomplice=flow−age).32 Furthermore, whether retired babe boomers experience healthier than before cohorts at the same age depends on the cumulative effect of period and accomplice, which limits the usefulness of distinguishing their specific furnishings. 2nd, the baby boom cohort is representative of early members of this generation. The next decades volition show if late baby boomers will have a better health condition than early infant boomers. Furthermore, larger intervals between cohorts may uncover differences that the present study could not capture with five-year intervals. Nevertheless, these intervals were sufficient to notice several differences betwixt cohorts in sociodemographic characteristics. Third, although the cohorts compared in the present study were older than baby boom cohorts in any previous study, age-related losses may still exist insufficient to translate into cohort differences that may become apparent only at more than advanced ages. Finally, no normative health data were available to verify if external validity in terms of age, sex and socioeconomic characteristics can exist generalised to health outcomes.
Decision
Opposite to popular belief, the present written report does not provide evidence for a better self-reported health at ages 65–70 years in babe boomers than in before cohorts. Despite a slight trend in reporting better self-rated health, other data signal that babe boomers exercise not feel healthier than previous cohorts did in terms of chronic atmospheric condition, chronic symptoms, depressive symptoms, fearfulness of affliction, cocky-perception of ageing and difficulty in activities of daily living. Nevertheless, information technology is still possible that protective factors, to which infant boomers were especially exposed, such as prevention of at-adventure behaviours and technological advances, will promote their health at an older age. Future studies will also show whether belatedly baby boomers will feel healthier than early baby boomers at retirement age.
Acknowledgments
The authors thank Alain Pécoud, Peter Vollenweider and Gérard Waeber for their support to the Lc65+ study and their advice.
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