Life-course socioeconomic status and its impact on functional health of Portuguese older adults

BACKGROUND: Functional health is arguably one of the most important health indicators for older adults, because it assesses physical, cognitive, and social functions in combination. However, life-course circumstances may impact this multidimensional construct. The aim of the present study was to assess the relationship between life-course socioeconomic status (SES) and different dimensions of functional health in older adults. METHODS: Data on 821 Portuguese adults aged 50 and over in 2013-2015 were analyzed. Life-course SES was computed using participants’ paternal occupation (non-manual (nm); manual (m)) and own occupation (nm; m), resulting in four patterns: stable high (nm+nm), upward (m+nm), downward (nm+m), stable low (m+m). Functional health included physical and mental functioning, cognitive function, handgrip strength, and walking speed. Linear (beta coefficients) and logistic regressions (odds ratios) were used to estimate the association between life-course SES and functional health. RESULTS: Overall, those who accumulated social disadvantage during life-course presented worse functional health than those with stable high SES (stable low - SF-36 physical functioning: β=−9.75; 95%CI: -14.34;-5.15; SF-36 mental health: β=−7.33; 95%CI: -11.55;-3.11; handgrip strength: β=−1.60; 95%CI: -2.86;-0.35; walking time, highest tertile: OR = 5.28; 95%CI: 3.07;9.09). Those with an upward SES were not statistically different from those in the stable high SES for most of the health outcomes however, those with an upward SES trajectory tended to have higher odds of cognitive impairment (OR = 1.75; 95%CI: 0.96;3.19). A downward SES trajectory increased the odds of slower walking speed (OR = 4.62; 95%CI: 1.78;11.95). CONCLUSIONS: A disadvantaged life-course SES impacts older adults’ physical and mental functioning. For some outcomes, this was attenuated by a favourable adulthood SES but those with a stable low SES consistently presented worse functional health. KEY MESSAGES: • Overall, stable high SES leads to better functional health, but for mental health functioning, handgrip strength and walking speed, it is possible to overcome the initial social disadvantage. • These results reinforce that even though health disparities may start early in life, they are mutable and capable of changing through the improvement of socioeconomic conditions.