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Psychosocial working conditions, trajectories of disability, and the mediating role of cognitive decline and chronic diseases: A population-based cohort study
Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).ORCID iD: 0000-0003-0523-663X
Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).ORCID iD: 0000-0001-6140-2968
Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Karolinska Institutet, Sweden.
Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).ORCID iD: 0000-0001-7209-741X
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Number of Authors: 82019 (English)In: PLoS Medicine, ISSN 1549-1277, E-ISSN 1549-1676, Vol. 16, no 9, article id e1002899Article in journal (Refereed) Published
Abstract [en]

Background Unfavorable psychosocial working conditions have been associated with cognitive decline and chronic diseases, both of which may subsequently accelerate functional dependence. This study aimed to investigate the association between job demand-control-support combinations and trajectories of disability in later life and to further explore the role of cognitive decline and the co-occurrence of chronic diseases in mediating this association. Methods and findings In this cohort study, 2,937 community dwellers aged 60+ years (mean age 73 +/- 10.6; 62.9% female) residing in the Kungsholmen District of Stockholm, Sweden, participated in the baseline survey (2001-2004) and were followed up to 12 years. Lifelong occupational history was obtained through a standardized interview; job demands, job control, and social support at work in the longest-held occupation were graded with a psychosocial job-exposure matrix. Job control, demands, and social support were dichotomized using the median values from the matrix, respectively, to further generate demand-control-support combinations. Disability was measured by summing the number of impaired basic and instrumental activities of daily living. Global cognitive function was assessed by Mini-Mental State Examination. Chronic conditions were ascertained by clinical examinations, medical history, and patient clinical records; the total number of chronic diseases was summed. Data were analyzed using linear mixed-effects models and mediation analysis. Age, sex, education, alcohol consumption, smoking, leisure activity engagement, early-life socioeconomic status, occupational characteristic and physical demands, and baseline cognitive function and number of chronic diseases were adjusted for in the analyses. Compared with active jobs (high control/high demands; n = 1,807), high strain (low control/high demands; n = 328), low strain (high control/low demands; n = 495), and passive jobs (low control/low demands; n = 307) were all associated with a faster rate of disability progression (beta = 0.07, 95% CI 0.02-0.13, p = 0.01; beta = 0.10, 95% CI 0.06-0.15, p < 0.001; beta = 0.11, 95% CI 0.05-0.18, p < 0.001). The association between high strain and disability progression was only shown in people with low social support at work (beta = 0.13, 95% CI 0.07-0.19, p < 0.001), but not in those with high social support (beta = 0.004, 95% CI -0.09 to 0.10, p = 0.93). Moreover, we estimated that the association between demand-control status and disability trajectories was mediated 38.5% by cognitive decline and 18.4% by accumulation of chronic diseases during the follow-up period. The limitations of this study include unmeasured confounding, self-reported work experience, and the reliance on a psychosocial job-exposure matrix that does not consider variabilities in individuals' perception on working conditions or job characteristics within occupations. Conclusions Our findings suggest that negative psychosocial working conditions during working life may accelerate disability progression in later life. Notably, social support at work may buffer the detrimental effect of high strain on disability progression. Cognitive decline and chronic-disease accumulation, and especially the former, partially mediate the association of psychosocial working conditions with trajectories of disability. Further studies are required to explore more mechanisms that underlie the association between psychosocial working conditions and disability trajectories. Author summaryWhy was this study done? Work is one of the activities that take up a considerable amount of time in our adult lives, thus potentially making it an important determinant of health, even in later life. Inability to independently carry out daily tasks (defined as disability) can affect older people's quality of life and pose a burden on caregivers and societies. A better understanding of the pathway between midlife working conditions and late-life disability may help the development of preventive strategies. What did the researchers do and find? We studied the association of psychosocial working conditions with the rate of disability progression over 12 years in a cohort of 2,937 individuals aged 60 years and older. We found that unfavorable psychosocial working conditions, including high-strain, low-strain, and passive jobs, were related to a faster rate of disability progression. The association of high-strain jobs with accelerated disability accumulation was only present among people with low social support at work. The decrement in cognitive function and increase in chronic-disease burden, and especially the former, partially explained the relationship between unfavorable working conditions and disability progression in later life. What do these findings mean? Unfavorable psychosocial working conditions during working life are related to the progression of disability in later life. Public health authorities, employers, and employees should all be aware of that. Social support at work is especially important in a high-strain work environment given its capacity to attenuate the impact of high-strain jobs on disability accumulation. Monitoring cognitive function and medical conditions of people with unfavorable working conditions is endorsed by the role of both dimensions, and especially of cognitive dysfunction, in accelerating disability progression in older age.

Place, publisher, year, edition, pages
2019. Vol. 16, no 9, article id e1002899
National Category
Gerontology, specialising in Medical and Health Sciences Occupational Health and Environmental Health
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URN: urn:nbn:se:su:diva-175743DOI: 10.1371/journal.pmed.1002899ISI: 000489902400021PubMedID: 31525191OAI: oai:DiVA.org:su-175743DiVA, id: diva2:1369215
Available from: 2019-11-11 Created: 2019-11-11 Last updated: 2019-12-12Bibliographically approved

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