Women Often Face Physical Decline in Midlife Leading to Later Life Issues


Factors associated with a physical decline include greater BMI, less educational attainment, current smoking, osteoarthritis, clinically significant depressive symptoms, and cardiovascular disease.

Daniel H. Solomon, MD, MPH

Daniel H. Solomon, MD, MPH

A better understanding of physical decline in the midlife for women could yield better targeted interventions to prevent later life decline.

A team, led by Daniel H. Solomon, MD, MPH, Division of Rheumatology, Brigham and Women’s Hospital, Harvard Medical School, examined the factors associated with clinically important 10-year declines in the physical component summary score (PCS) of the Short Form 36 (SF-36), in women in the midlife.

Starting Decline

Women in their midlives can often develop chronic conditions and declines in physical health and function. However, there is a need to identify the factors linked to declines in physical health and function among women to better allow for targeted interventions for at-risk sub-groups.

Recent research shows declines in health and function that are common in later life often begin in midlife.

The SF-36 is a widely used patient-reported outcome measure.

In the longitudinal cohort study, the investigators collected data from geographically dispersed sites in the US. Each participant was part of the Study of Women’s Health Across the Nation (SWAN), which is a racially and ethnically diverse cohort of women enrolled at or immediately before the menopause transition.

Each participant was followed up to 21 years between 1996-2016 with annual visits.

The investigators sought main outcomes of a clinically important decline of at least 8 points on the PCS, based on the 10-year difference in scores between the ages of 55-65 years.

Examining the Data

The team identified 3302 women in the SWAN cohort, 1091 of which were included in the final analysis. The median age of this cohort was 54.8 years.

The investigators found women at age 55 had a median body mass index of 27.0 and a median baseline PCS of 53.1. in addition, 9.9% (n = 108) of the participants were current smokers and 86.3% (n = 938) had at least 1 comorbidity.

In the 10-year period between 55-65, the median change in PCS was -1.02 points, while 18.9% (n = 206) of women experiencing declines of 8 points or more.

Using multivariable models, the investigators identified a number of factors associated with clinically important decline.

These factors included higher baseline PCS (OR, 1.08; 95% CI, 1.06-1.11), greater BMI (OR, 1.06; 95% CI, 1.03-1.09), less educational attainment (OR, 1.87; 95% CI, 1.32-2.65), current smoking (OR, 1.93; 95% CI, 1.14-3.26), osteoarthritis (OR, 1.46; 95% CI, 1.01-2.09), clinically significant depressive symptoms (OR, 2.03; 95% CI, 1.34-3.09), and cardiovascular disease (OR, 2.06; 95% CI, 1.26-3.36).

“In this cohort study, clinically important declines in women’s physical health and function were relatively common between ages 55 and 65 years,” the authors wrote. “Several variables associated with these declines were identified as potentially useful components in a clinical score identifying women at increased risk of physical health and functional declines.”

The study, “Factors Associated With 10-Year Declines in Physical Health and Function Among Women During Midlife,” was published online in JAMA Network Open.

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