Psychosocial working conditions, trajectories of disability, and the mediating role of cognitive decline and chronic diseases: A population-based cohort study.
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...
| Publicado en: | PLoS Medicine Vol. 16; no. 9; pp. 1 - 17 |
|---|---|
| Autores principales: | , , , , , , , |
| Formato: | research Journal Article |
| Publicado: |
Public Library of Science
9/16/2019
|
| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=138643917&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 138643917 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 15491277 UIH jtl: PLoS Medicine issn: 15491277 maglogo: N pubinfo: dt: 9/16/2019 vid: 16 iid: 9 pid: 16707 pub: Public Library of Science place: San Francisco, California artinfo: ui: 138643917 138643917 NLM31525191 138643917 10.1371/journal.pmed.1002899 NLM31525191 138643917 ppf: 1 ppct: 16 formats: tig: atl: Psychosocial working conditions, trajectories of disability, and the mediating role of cognitive decline and chronic diseases: A population-based cohort study. aug: au: Pan, Kuan-Yu Xu, Weili Mangialasche, Francesca Wang, Rui Dekhtyar, Serhiy Calderón-Larrañaga, Amaia Fratiglioni, Laura Wang, Hui-Xin affil: Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden sug: subj: Disability Evaluation Occupational Health Job Description Work Environment Psychosocial Factors Support, Psychosocial Chronic Disease Psychosocial Factors Cognition Risk Factors Aged Female Risk Assessment Male Work Capacity Evaluation Prospective Studies Middle Age Aged, 80 and Over Human Time Factors Sweden Validation Studies Comparative Studies Evaluation Research Multicenter Studies Aged: 65+ years Middle Aged: 45-64 years Aged, 80 & over Female Male ab: 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 (β = 0.07, 95% CI 0.02-0.13, p = 0.01; β = 0.10, 95% CI 0.06-0.15, p < 0.001; β = 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 (β = 0.13, 95% CI 0.07-0.19, p < 0.001), but not in those with high social support (β = 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. pubtype: Academic Journal doctype: research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
|---|