Midlife financial stress and cognitive and physical impairments in older age: The role of potentially modifying factors
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Connects with: @aslund2014 @kahn2006 @park2017 @sturgeon2016 @wickrama2021
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kareholt2025 - p. 2
Yet, it is unclear whether self-reported midlife financial stress is longitudinally associated with the co-existence between cognitive and physical impairment among older adults, and whether sex differences are present in these associations. The goal of this study was to investigate whether financial stress is associated with late-life cognitive and physical impairments, and their combination, and whether lifestyle factors (such as smoking, alcohol consumption, or physical activity) or psycho-sociodemographic factors (such as cohabitant status, manual work, or sleep disturbances) modify these associations. We additionally aimed to examine potential sex differences in these associations.
kareholt2025 - p. 2
Data were derived from The Cardiovascular Risk Factors, Aging and Dementia (CAIDE) study. Midlife (baseline) examinations were conducted within the North Karelia Project and the FINMONICA (later FINRISK) population-based studies (Finland). Participants performed baseline assessments during one of the following years: 1972, 1977, 1982, or 1987 (Borodulin et al., 2018; Puska, 2010). At baseline, participation rates ranged from 82% to 90%. The follow-up study (CAIDE) included older adults aged 65–79 by the end of 1997.
kareholt2025 - p. 3
829
kareholt2025 - p. 4
Financial situation in midlife (baseline) was measured using the following two questions with 5-point likert scales. Each question was initially analyzed separately: (1) Satisfaction with financial situation at midlife: The question asked: ‘How satisfied are you with your financial situation?’. Response options were: 1 = Very satisfied, 2 = Satisfied, 3 = Somewhat satisfied, 4 = Dissatisfied, 5 = Very dissatisfied. (2) Change in financial situation at midlife: The question asked: ‘Is your financial situation now better or worse than before?’. Response options were: 1 = Much better, 2 = A little bit better, 3 = Same as before, 4 = A little bit worse, 5 = Much worse. The final measure was constructed as an index based on the mean of the two variables and subtracting one to obtain a centered variable.
kareholt2025 - p. 4
Physical function at follow-up was based on Activities of Daily Living (ADL) and mobility. ADL is based on two questions: Washing without help; Dressing without help. Response options to each of these questions were: 1 = not able to, 2 = able to, but with difficulties, 3 = able to without any difficulties. Mobility was based on four questions: Climbing stairs without help; Walk about half a kilometer without help; Run about a hundred meters; Run over half a kilometer. Response options to each of these questions were: 1 = not able to, 2 = able to, but with difficulties, 3 = able to without any difficulties. Mobility and ADL were computed into two separate mean indices. From these two indices a new combined mean index was created.
kareholt2025 - p. 4
Cognitive function was based on five measures on cognitive functioning: episodic memory, pegboard, stroop32, verbal fluency, and the letter-digit substitution test, as described previously (Sindi et al., 2017) and below.
kareholt2025 - p. 4
(1) episodic memory measured with an immediate word recall test (10-word list); (2) executive functioning measured through the Stroop test (time difference between the task of naming the color of the ink used to write the name of a different color, and task of naming colors of dots); (3) verbal fluency measured through category fluency test (number of correct animal names generated in 60 s); (4) psychomotor speed measured by the letter digit substitution test; (5) manual dexterity measured through the bimanual Purdue Pegboard test
kareholt2025 - p. 4
Finally, an outcome variable showing the combined presence of physical impairment and worse cognitive functioning was created. A multiplicative variable was created by multiplying the indexes on physical impairments with the index on worse cognitive function (both having zero as lowest value).
kareholt2025 - p. 5
This study aimed to assess the role of potential modifying variables in the associations between financial stress and physical impairment, worse cognitive functioning and the combination of physical impairment and worse cognitive functioning (referred to as ‘combined impairments’).
kareholt2025 - p. 7
Direct effect from financial stress (regardless of smoking) 0.14 <0.001
kareholt2025 - p. 7
0.09 0.002
kareholt2025 - p. 7
Indirect effect from financial stress, mediation through smoking 0.01 0.013
kareholt2025 - p. 7
Direct effect 0.13 <0.001
kareholt2025 - p. 7
Indirect effect 0.01 0.030
kareholt2025 - p. 7
Total effect 0.14 <0.001
kareholt2025 - p. 7
Non-drinkers4 0.27 <0.001