Association of midlife value priorities with health-related quality of life, frailty and mortality among older men: a 26-year follow-up of the Helsinki Businessmen Study (HBS)
Personal values influence behavior and decision making, but their long-term associations with health-related quality of life (HRQoL), frailty, and mortality are less clear. We studied these associations from midlife to old age in a 26-year follow-up of the Helsinki Businessmen Study (HBS) cohort.
In 1974, 1320 clinically healthy men (born 1919–1934) reported in a 12-item questionnaire their personal values. In 2000, a mailed questionnaire, including assessment of HRQoL with RAND-36 (SF-36) instrument, was sent to survivors, and 1025 men responded. In 2000, the presence of phenotypic frailty was assessed using modified Fried criteria including indicators of shrinking, physical weakness, exhaustion, and physical inactivity. Mortality through December 31, 2000 was verified from national registries.
Using a factor analysis, the data of the 12-item questionnaire of personal values were loaded in 3 factors: valuing health (“Health”), enjoyable and varying life (“Enjoyment”), and comfort and work-oriented life (“Work-life-balance”). Adjusted for age, we found a significant positive association between valuing “Health” in midlife and RAND-36 domains of Physical functioning (p = .032) and Vitality (p = .005) in old age. “Health” also predicted less frailty (p = .008), and “Enjoyment” was associated with higher mortality (p = .017).
Value priorities of men assessed in midlife had long-term associations with HRQoL and frailty in old age, and they may also predict mortality.
KeywordsPersonal values RAND-36 Functional aging Prevention Disability
Compliance with ethical standards
Conflict of interest
The authors have no conflict of interest to report.
All procedures performed in this study were in accordance with the ethical standards of the institutional research committee (Ethical approval by the Ethical committee of the Department of Medicine, Helsinki University Central Hospital) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 2.Schwartz, S. H. (1992). Universals in the content and structure of values: Theoretical advances and empirical tests in 20 countries. In M. P. Zanna (Ed.), Advances in experimental social psychology (pp. 1–65). San Diego, CA: Academic Press.Google Scholar
- 3.Rokeach, M. (1973). The nature of human values. New York: Free Press.Google Scholar
- 12.Dobewall, H., Tark, R., & Aavik, T. (2017). Health as a value and its association with health-related quality of life, mental health, physical health, and subjective well-being. Applied Research in Quality of Life, 1–14.Google Scholar
- 14.Rodriquez-Manas, L., Féart, C., Mann, G., Vina, J., Chatterji, S., et al. (2012). Searching for an operational definition on frailty: A Delphi method based consensus statement. The frailty operative definition – Consensus conference project. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 68(1), 62–67. https://doi.org/10.1093/gerona/gls119.CrossRefGoogle Scholar
- 15.Lafortune, L., Martin, S., Kelly, S., Kuhn, I., Remes, O., Cowan, A., & Brayne, C. (2016). Behavioural risk factors in mid-life associated with successful ageing, disability, dementia and frailty in later life: A rapid systematic review. PLoS ONE, 11(2), e0144405. https://doi.org/10.1371/journal.pone.0144405.CrossRefPubMedPubMedCentralGoogle Scholar
- 16.Strandberg, A. Y., Strandberg, T. E., Stenholm, S., Salomaa, V. V., Pitkälä, K., & Tilvis, R. S. (2014). Low midlife blood pressure, survival, comorbidity, and health-related quality of life in old age: The Helsinki Businessmen Study. Journal of Hypertension, 32(9), 1797–1804. https://doi.org/10.1097/HJH.0000000000000265.CrossRefPubMedGoogle Scholar
- 19.Strandberg, A. Y., Strandberg, T. E., Pitkälä, K., Salomaa, V. V., Tilvis, R. S., & Miettinen, T. A. (2008). The effect of smoking in midlife on health-related quality of life in old age: A 26-year prospective study. Archives of Internal Medicine, 168(18), 1968–1974. https://doi.org/10.1001/archinte.168.18.1968.CrossRefPubMedGoogle Scholar
- 21.Strandberg, A. Y., Strandberg, T. E., Salomaa, V. V., Pitkälä, K., Häppölä, O., & Miettinen, T. A. (2004). A follow-up study found that cardiovascular risk in middle age predicted mortality and quality of life in old age. Journal of Clinical Epidemiology, 57(4), 415–421. https://doi.org/10.1016/j.jclinepi.2003.09.013.CrossRefPubMedGoogle Scholar
- 23.Strandberg, T. E., Sirola, J., Pitkälä, K. H., Tilvis, R. S., Strandberg, A. Y., & Stenholm, S. (2012). Association of midlife obesity and cardiovascular risk with old age frailty: A 26-year follow-up of initially healthy men. International Journal of Obesity, 36(9), 1153–1157. https://doi.org/10.1038/ijo.2012.83.CrossRefPubMedGoogle Scholar
- 24.Sirola, J., Pitkala, K. H., Tilvis, R. S., Miettinen, T. A., & Strandberg, T. E. (2011). Definition of frailty in older men according to questionnaire data (RAND-36/SF-36): The Helsinki Business Study. The Journal of Nutrition, Health & Aging, 15(9), 783–787. https://doi.org/10.1007/s12603-011-0131-4.CrossRefGoogle Scholar
- 25.Huohvanainen, E., Strandberg, A., Stenholm, S., Pitkälä, K., Tilvis, R., & Strandberg, T. E. (2016). Association of self-rated health in midlife with mortality and old age frailty: A 26-year follow-up of initially healthy men. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 71(7), 923–928. https://doi.org/10.1093/gerona/glv311.CrossRefGoogle Scholar
- 27.Miettinen, T. A., Huttunen, J. K., Naukkarinen, V., Stranberg, T. E., Mattila, S., Kumlin, T., & Sarna, S. (1985). Multifactorial primary prevention of cardiovascular diseases in middle-aged men: Risk factor changes, incidence, and mortality. JAMA, 254(15), 2097–2102. https://doi.org/10.1001/jama.1985.03360150073027.CrossRefPubMedGoogle Scholar
- 29.Rosenberg, M. (1957). Occupations and values. Glecoe, IL: Free Press.Google Scholar
- 31.Aalto, A.-M., Aro, A. R., & Teperi, J. (1999). RAND-36 as a measure of health-related quality of life: Reliability, construct validity, and reference values in the Finnish general population. Helsinki: Stakes; Research Reports No.101.Google Scholar
- 33.Ware, J. E., & Kosinski, M. (2001). SF-36 physical and mental health summary scales: A manual for users of version 1 (2nd ed.). Lincoln, RI: Quality Metric Inc.Google Scholar
- 34.Dubuc, N., Haley, S. M., Ni, P., Kooyoomjian, J. T., & Jette, A. M. (2004). Function and disability in late life: Comparison of the Late-Life Function and Disability Instrument to the Short-Form-36 and the London Handicap Scale. Disability and Rehabilitation, 26(6), 362–370.CrossRefPubMedGoogle Scholar
- 35.Pine, G., & Innis, G. (1987). Cultural and individual work values. The Career Development Quarterly, 35, 279–287. https://doi.org/10.1002/j.2161-0045.1987.tb00926.x.CrossRefGoogle Scholar
- 37.Sagiv, L., Roccas, S., & Hazan, O. (2004). Value pathways to well-being: Healthy values, valued goal attainment, and environmental congruence. Positive Psychology in Practice, 68–85. https://doi.org/10.1002/9780470939338.ch5.
- 38.Sagiv, L., & Schwartz, S. H. (2000). Value priorities and subjective well-being: Direct relations and congruity effects. European Journal of Social Psychology, 30(2), 177–198. https://doi.org/10.1002/(SICI)1099-0992(200003/04)30:23.0.CO;2-Z.CrossRefGoogle Scholar