Course director

• Public health implications of an aging population, Karolinska Institutet 
• Theory of Science and Scientific Method, Jönköping University

Lecturer

• Public health implications of an aging population, Karolinska Institutet, doctoral level
• Theory of Science and Scientific Method, Jönköping University, advanced level

Research projects

2023-2025: SWEAH Alumni Interdisciplinary Network (SAIN) - An Early Career Researcher Network within Aging. Jönköping University. Institute of Gerontology, Jönköping University. PI: Charlotta Nilsen. Funded by the Kamprad Family Foundation.

2022-2025: Stress across the life course and associations to late-life cognitive and physical function: Which modifiable social and lifestyle factors affect the association? Institute of Gerontology, Jönköping University. PI: Ingemar Kåreholt. Funded by Riksbankens Jubileumsfond.

2020-2023: The emergence of a new conflict to work-life balance among older workers? The dual threat of “caregiver-burden” and challenging working conditions. Karolinska Institutet. PI: Charlotta Nilsen. Funded by the Swedish Research Council for Health, Working Life, and Welfare (Forte).

2020-2023: The fruits of labor: Investigating the influence of working conditions on the initiation and duration of the fourth age. Stress Research Institute, Stockholm University. PI: Charlotta Nilsen. Funded by the Swedish Research Council for Health, Working Life, and Welfare (Forte).

2020-2021: Pushed to the edge of society: Social exclusion among older women and men in Sweden. Karolinska Institutet. PI: Lena Dahlberg. Funded by the Swedish Research Council for Health, Working Life, and Welfare (Forte).

2018-2021: Psychosocial working conditions and late-life physical functioning: What role do gender, socioeconomic position, work-life balance, and coping play? Karolinska Institutet. PI: Ingemar Kåreholt. Funded by Marianne and Marcus Wallenberg Foundation.

 

A selection from Stockholm University publication database

• History of working conditions and the risk of old-age dependency: a nationwide Swedish register-based study

  2023. Charlotta Nilsen (et al.). Scandinavian Journal of Public Health

  Article

  Aims: There is substantial evidence that previous working conditions influence post-retirement health, yet little is known about previous working conditions' association with old-age dependency. We examined job strain, hazardous and physical demands across working life, in relation to the risk of entering old-age dependency of care. Methods: Individually linked nationwide Swedish registers were used to identify people aged 70+ who were not receiving long-term care (residential care or homecare) at baseline (January 2014). Register information on job titles between the years 1970 and 2010 was linked with a job exposure matrix of working conditions. Random effects growth curve models were used to calculate intra-individual trajectories of working conditions. Cox regression models with age as the timescale (adjusted for living situation, educational attainment, country of birth, and sex) were conducted to estimate hazard ratios for entering old-age dependency during the 24 months of follow-up (n = 931,819). Results: Having initial adverse working conditions followed by an accumulation throughout working life encompassed the highest risk of entering old-age dependency across the categories (job strain: HR 1.23, 95% CI 1.19-1.27; physical demands: HR 1.36, 95% CI 1.31-1.40, and hazardous work: HR 1.35, 95% CI 1.30-1.40). Initially high physical demands or hazardous work followed by a stable trajectory, or initially low-level physical demand or hazardous work followed by an accumulation throughout working life also encompassed a higher risk of dependency. Conclusions: A history of adverse working conditions increased the risk of old-age dependency. Reducing the accumulation of adverse working conditions across the working life may contribute to postponing old-age dependency.

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• Psychosocial working conditions and cognitive and physical impairment in older age

  2023. Shireen Sindi (et al.). Archives of gerontology and geriatrics (Print) 104

  Article

  Background: Psychosocial working conditions are associated with cognitive and physical impairments. The aim of this study was to investigate the associations between mid-late life psychosocial working conditions and the combination of physical and cognitive impairment among older adults, and the potential sex differences in these associations.

  Methods: Data were derived from two Swedish nationally representative surveys (n = 839; follow-up: 20-24 years). Multinomial and binary logistic regressions assessed the associations between work stressors (job demand-control model), and a combination of cognitive and physical impairment.

  Results: Low control jobs were significantly associated with higher odds of cognitive (OR: 1.41, CI: 1.15-1.72) and physical impairment (OR: 1.23, CI: 1.02-1.47), and cognitive and physical impairment combined (OR: 1.50, CI: 1.19-1.89). Passive jobs (low control, low demand) were associated with higher odds of cognitive impairment (OR: 1.57, CI: 1.12-2.20), and combined cognitive and physical impairment (OR: 1.59, CI: 1.07-2.36). Active jobs (high control, high demand) were associated with lower odds of cognitive impairment (OR: 0.48, CI: 0.29-0.80). Sex-stratified analyses showed stronger associations among men; passive jobs were associated with both cognitive (OR: 2.18, CI: 1.31-3.63) and physical impairment (OR: 1.78, CI: 1.13-2.81), while low strain jobs were associated with less physical impairment (OR: 0.55, CI: 0.33-0.89). No significant associations between work stressors and impairment were found for women.

  Conclusions: These results highlight the importance of psychosocial working conditions for late-life physical and cognitive impairment, especially among men. Jobs characterised by low control and low demands are associated with higher risk for impairments.

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• Is the mental health of older adults receiving care from their children related to their children's dual burden of caregiving and work stress? A linked lives perspective

  2022. Promise E. Ekezie (et al.). Aging & Mental Health 27 (9), 1796-1802

  Article

  Objectives: Mental health problems are a major concern in the older population in Sweden, as is the growing number of older adults aging alone in their homes and in need of informal care. Using a linked lives perspective, this study explored if older parents' mental health is related to their children's dual burden of informal caregiving and job strain.

  Methods: Data from a nationally representative Swedish survey, SWEOLD, were used. Mental health problems in older age (mean age 88) were measured with self-reported 'mild' or 'severe' anxiety and depressive symptoms. A primary caregiving adult child was linked to each older parent, and this child's occupation was matched with a job exposure matrix to assess job strain. Logistic regression analyses were conducted with an analytic sample of 334.

  Results: After adjusting for covariates, caregiving children's lower job control and greater job strain were each associated with mental health problems in their older parents (OR 2.52, p = 0.008 and OR 2.56, p = 0.044, respectively). No association was found between caregiving children's job demands and their older parents' mental health (OR 1.08, p = 0.799).

  Conclusion: In line with the linked lives perspective, results highlight that the work-life balance of informal caregiving adult children may play a role in their older parent's mental health.

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• Long-term changes in sense of coherence and mortality among middle-aged men: A population -based follow-up study

  2022. Ilkka Piiroinen (et al.). Advances in Life Course Research 53

  Article

  Sense of coherence (SOC) scale measures one’s orientation to life. SOC is the core construct in Antonovsky's salutogenic model of health. It has been shown that weak SOC correlates with poor perceived health, low quality of life, and increased mortality. Some studies have indicated that SOC is not stable across life, but there are no previous studies on how a change of SOC is reflected in mortality. However, there is some evidence that a change in perceived quality of life is associated with mortality. The study explores the association between the change in SOC and mortality using longitudinal data from a cohort of middle-aged Finnish men recruited between 1986 and 1989. Approximately 11 years after the baseline examinations, between 1998 and 2001, 854 men returned the SOC questionnaire a second time. The baseline SOC was adjusted for the regression to the mean phenomenon between the two measurements. The hazard ratios of the SOC difference scores were adjusted for initial SOC age and 12 somatic risk factors of mortality (alcohol consumption, blood pressure, body mass index, cholesterol concentration, physical activity, education, smoking, marital status, employment status, history of cancer, history of cardiovascular disease and diabetes). SOC was not stable among middle-aged Finnish men and a decline in SOC was associated with an increased hazard of all-cause mortality. In the fully adjusted model, a decrease of one standard deviation (SD) of the SOC mean difference increased the mortality hazard by about 35 %, two SDs decrease about 70 %, and 2.5 SDs about 100 %. Strengthening SOC showed a limited association with decreasing mortality hazards in the age-adjusted model. Policies, strategies, or plans, supporting SOC in the middle-age may help to decrease mortality and increase quality of life in later years.

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• Long-term risk factors for old-age social exclusion in Sweden: a 30-year longitudinal study

  2022. Charlotta Nilsen (et al.). Archives of gerontology and geriatrics (Print) 103

  Article

  Purpose of the research: Social exclusion threatens quality of life in older age. However, there is a lack of research on social exclusion from life-course and gender perspectives. We investigated early-and midlife risk factors for old-age social exclusion among women and men.

  Materials and methods: Two individually linked studies of Swedish nationally representative samples provided longitudinal data over a 30-year period on 1,819 people at baseline. Indicators of economic exclusion, leisure/ social exclusion, and civic exclusion were assessed at early late life (M=70 years) and late life (M=81). Educational attainment, non-employment, psychological health problems and mobility problems were measured as risk factors at midlife (M=54) and late midlife (M=61). Path analysis derived a model of old-age social exclusion.

  Results: Exclusion on a domain in early late life led to exclusion on the same domain in late life, except for the economic domain. Leisure/social exclusion in early late life also led to civic exclusion in late life. Midlife risk factors influenced late-life exclusion almost exclusively through early late-life exclusion. While model fit could not be significantly improved by allowing coefficients to vary freely by gender, there was a stronger effect of non -employment on exclusion in women and a stronger effect of psychological health problems on exclusion in men.

  Conclusions: This study confirms that old-age exclusion is persistent and dynamic, and influenced by risk factors experienced earlier in life. A holistic approach with integrated efforts across different policy areas is needed to efficiently reduce old-age social exclusion.

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• Life-course trajectories of working conditions and successful ageing

  2021. Charlotta Nilsen (et al.). Scandinavian Journal of Public Health

  Article

  Aims: As populations are ageing worldwide, it is important to identify strategies to promote successful ageing. We investigate how working conditions throughout working life are associated with successful ageing in later life. Methods: Data from two nationally representative longitudinal Swedish surveys were linked (n=674). In 1991, respondents were asked about their first occupation, occupations at ages 25, 30, 35, 40, 45 and 50 years and their last recorded occupation. Occupations were matched with job exposure matrices to measure working conditions at each of these time points. Random effects growth curve models were used to calculate intra-individual trajectories of working conditions. Successful ageing, operationalised using an index including social and leisure activity, cognitive and physical function and the absence of diseases, was measured at follow-up in 2014 (age 70 years and older). Multivariable ordered logistic regressions were used to assess the association between trajectories of working conditions and successful ageing. Results: Intellectually stimulating work; that is, substantive complexity, in the beginning of one's career followed by an accumulation of more intellectually stimulating work throughout working life was associated with higher levels of successful ageing. In contrast, a history of stressful, hazardous or physically demanding work was associated with lower levels of successful ageing. Conclusions: Promoting a healthy workplace, by supporting intellectually stimulating work and reducing physically demanding and stressful jobs, may contribute to successful ageing after retirement. In particular, it appears that interventions early in one's employment career could have positive, long-term effects.

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• Job Strain and Trajectories of Cognitive Change Before and After Retirement

  2021. Charlotta Nilsen (et al.). The journals of gerontology. Series B, Psychological sciences and social sciences 76 (7), 1313-1322

  Article

  Objectives: We examined associations between job strain and trajectories of change in cognitive functioning (general cognitive ability plus verbal, spatial, memory, and speed domains) before and after retirement.

  Methods: Data on indicators of job strain, retirement age, and cognitive factors were available from 307 members of the Swedish Adoption/Twin Study of Aging. Participants were followed up for up to 27 years (mean = 15.4, SD = 8.5).

  Results: In growth curve analyses controlling for age, sex, education, depressive symptoms, cardiovascular health, and twinness, greater job strain was associated with general cognitive ability (estimate = −1.33, p = .002), worse memory (estimate = −1.22, p = .007), speed (estimate = −1.11, p = .012), and spatial ability (estimate = −0.96, p = .043) at retirement. Greater job strain was also associated with less improvement in general cognitive ability before retirement and a somewhat slower decline after retirement. The sex-stratified analyses showed that the smaller gains of general cognitive ability before retirement (estimate = −1.09, p = .005) were only observed in women. Domain-specific analyses revealed that greater job strain was associated with less improvement in spatial (estimate = −1.35, p = .010) and verbal (estimate = −0.64, p = .047) ability before retirement in women and a slower decline in memory after retirement in women (estimate = 0.85, p = .008) and men (estimate = 1.12, p = .013). Neither preretirement nor postretirement speed was affected significantly by job strain.

  Discussion: Greater job strain may have a negative influence on overall cognitive functioning prior to and at retirement, while interrupting exposure to job strain (postretirement) may slow the rate of cognitive aging. Reducing the level of stress at work should be seen as a potential target for intervention to improve cognitive aging outcomes.

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• Sense of Coherence and Mortality

  2020. Ilkka Piiroinen (et al.). Psychosomatic Medicine 82 (6), 561-567

  Article

  Objective: The aim of the study was to investigate the association between sense of coherence (SOC) and all-cause mortality in the general adult population.

  Methods: We conducted a systematic review and meta-analysis of prospective cohort studies. We searched eight electronic bibliographic databases for eligible studies. A random effects model and the restricted maximum likelihood method were used to calculate the pooled effect size.

  Results: Eight studies were eligible for the meta-analysis. The studies included 48,138 participants, of whom 5307 died during a median follow-up of 14.1 years (range, 8-29.5 years). Their age ranged from 20 to 80 years, and 53% of them were men. In the meta-analysis model of crude values, the risk of all-cause mortality for individuals with a weak SOC (lowest tertile) was 1.30 (95% confidence interval [CI] = 1.09-1.55, p = .003, I-2 = 78.84%) compared with individuals with a strong SOC (highest tertile). In the model adjusted for age, the risk remained almost the same (risk ratio = 1.26, 95% CI = 1.15-1.38, p < .001, I-2 = 69.59%). In the model adjusted for several other risk factors for mortality, the risk was still 1.17 (95% CI = 1.07-1.27, p < .001, I-2 = 57.85%).

  Conclusions: This meta-analysis shows that a weak SOC is associated with an increased risk of all-cause mortality in the general adult population. Future studies are needed to further develop assessment tools for SOC with good psychometric properties and to determine the disease processes that mediate the association of SOC with mortality.

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• Working conditions mediate the association between social class and physical function in older age in Sweden

  2020. Nikita Pandey, Alexander Darin-Mattsson, Charlotta Nilsen. BMC Public Health 20 (1)

  Article

  Background: Global demographics are changing as societies all over the world are aging. This puts focus on maintaining functional ability and independence into older age. Individuals from lower social classes are at greater risk of developing limitations in physical function later in life. In this study, we investigated the mediating role of working conditions in the association between occupation-based social class and physical function measured as self-reported mobility limitations and objectively measured physical impairment in older age.

  Methods: Two Swedish surveys, linked at the individual level, were used (n=676-814 depending on the outcome). Follow-up time was 20-24years. Multiple logistic regression analyses were performed with adjustments for age, sex, level of education, mobility, and health problems at baseline. This was followed by analyses of the size of the mediating effect of working conditions.

  Results: Working conditions seem to mediate 35-74% of the association between social class and physical impairment in older age. The pattern of mediation was primarily driven by passive jobs, i.e., low psychological demands and low control, among blue-collar workers. Working conditions did not mediate the association between social class and self-reported mobility limitations in older age.

  Conclusions: The results of this study indicate that working conditions are important in combating the social gradient in healthy aging, contributing to the evidence regarding the magnitude of impact exerted by both the physical and psychosocial work environment separately and in conjunction.

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Show all publications by Charlotta Nilsen at Stockholm University